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NURS 6630 Week 9: Therapy for Patients With ADHD/ODD

NURS 6630 Week 9: Therapy for Patients With ADHD/ODD

NURS 6630 Week 9: Therapy for Patients With ADHD/ODD

Therapy for Patients With ADHD/ODD

Individuals with personality disorders often find it difficult to overcome the enduring patterns of thought and behavior that they have thus far experienced and functioned with in daily life. Even when patients are aware that personality-related issues are causing significant distress and functional impairment and are open to counseling, treatment can be challenging for both the patient and the therapist. For this Assignment, you examine specific personality disorders and consider therapeutic approaches you might use with clients.

Diego, a 9-year-old third grader, had always been an energetic child with a short attention span. For years, his mother attributed his behaviors to him being “all boy” and assumed it would improve as he grew older. Instead, daily tasks like chores and homework became increasingly overwhelming for Diego, resulting in disruptive behaviors at home and school. After being evaluated by his healthcare provider, Diego was diagnosed with and treated for attention deficit hyperactivity disorder (ADHD).

ADHD is a prevalent disorder for patients across the lifespan, as more than 6 million children (CDC, n.d.) have been diagnosed with the disorder. Further, consider that about 60% of children with ADHD in the United States become adults with ADHD (ADAA, n.d.). Like Diego, individuals of all ages find that symptoms of ADHD can make life challenging. However, when properly diagnosed and treated, patients often respond well to therapies and have positive health outcomes.

This week, as you study ADHD therapies, you examine the assessment and treatment of patients with ADHD. You also explore ethical and legal implications of these therapies. NURS 6630 Week 9: Therapy for Patients With ADHD/ODD

References:

Centers for Disease Control and Prevention. (n.d.). Data and statistics about ADHDhttps://www.cdc.gov/ncbddd/adhd/data.html

Anxiety and Depression Association of America. (n.d.). Adult ADHD (Attention Deficit Hyperactive Disorder). https://adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/adult-adhd

Learning Objectives

Students will:

  • Assess patient factors and history to develop personalized therapy plans for patients with ADHD
  • Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients requiring therapy for ADHD
  • Synthesize knowledge of providing care to patients presenting for ADHD
  • Analyze ethical and legal implications related to prescribing therapy for patients with ADHD
  • Identify concepts related to psychopharmacologic treatments and therapy for patients across the lifespan

Learning Resources

Required Readings

  • Prince, J. B., Wilens, T. E., Spencer, T. J., & Biederman, J. (2016). Stimulants and other medications for ADHD. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 99–112). Elsevier.
  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
  • Hodgkins, P., Shaw, M., McCarthy, S., & Sallee, F. R. (2012). The pharmacology and clinical outcomes of amphetamines to treat ADHD: Does composition matter? CNS Drugs, 26(3), 245–268. https://doi.org/10.2165/11599630-000000000-00000
  • Martin, L. (2020). A 5-question quiz on ADHD. Psychiatric Times. https://www.psychiatrictimes.com/view/5-question-quiz-adhd

Medication Resources

  • IBM Corporation. (2020). IBM Micromedex. https://www.micromedexsolutions.com/micromedex2/librarian/deeplinkaccess?source=deepLink&institution=SZMC%5ESZMC%5ET43537
  • Note: To access the following medications, use the IBM Micromedex resource. Type the name of each medication in the keyword search bar. Be sure to read all sections on the left navigation bar related to each medication’s result page, as this information will be helpful for your review in preparation for your Assignments. NURS 6630 Week 9: Therapy for Patients With ADHD/ODD
  • armodafinil
  • amphetamine (d)
  • amphetamine (d,l)
  • atomoxetine
  • bupropion
  • chlorpromazine
  • clonidine
  • guanfacine
  • haloperidol
  • lisdexamfetamine
  • methylphenidate (d)
  • methylphenidate (d,l)
  • modafinil
  • reboxetine

Required Media

Case Study: A Young Caucasian Girl with ADHD
Note: This case study will serve as the foundation for this week’s Assignment.

Discussion: Presentations of ADHD

Although ADHD is often associated with children, this disorder is diagnosed in clients across the lifespan. While many individuals are properly diagnosed and treated during childhood, some individuals who have ADHD only present with subsyndromal evidence of the disorder. These individuals are often undiagnosed until they reach adulthood and struggle to cope with competing demands of running a household, caring for children, and maintaining employment. For this Discussion, you consider how you might assess and treat individuals presenting with ADHD.

Learning Objectives
Students will:
  • Assess client factors and history to develop personalized therapy plans for clients with ADHD
  • Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring therapy for ADHD
  • Evaluate efficacy of treatment plans
  • Apply knowledge of providing care to adult and geriatric clients presenting for antidepressant therapy
Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

REQUIRED READINGS

Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.
Clancy, C.M., Change, S., Slutsky, J., & Fox, S. (2011). Attention deficit hyperactivity disorder: Effectiveness of treatment in at-risk preschoolers; long-term effectiveness in all ages; and variability in prevalence, diagnosis, and treatment. Table B. KQ2: Long-term(>1 year) effectiveness of interventions for ADHD in people 6 years and older.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

  • Chapter 12, “Attention Deficit Hyperactivity Disorder and Its Treatment”

Stahl, S. M., & Mignon, L. (2012). Stahl’s illustrated attention deficit hyperactivity disorder. New York, NY: Cambridge University Press.
To access the following chapter, click on the Illustrated Guides tab and then the ADHD tab.

  • Chapter 4, “ADHD Treatments”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.
Review the following medications:
For ADHD

  • armodafinil
  • amphetamine (d)
  • amphetamine (d,l)
  • atomoxetine
  • bupropion
  • chlorpromazine
  • clonidine
  • guanfacine
  • haloperidol
  • lisdexamfetamine
  • methylphenidate (d)
  • methylphenidate (d,l)
  • modafinil
  • reboxetine

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Note: Retrieved from Walden Library databases.

OPTIONAL RESOURCES

Hodgkins, P., Shaw, M., McCarthy, S., & Sallee, F. R. (2012). The pharmacology and clinical outcomes of amphetamines to treat ADHD: Does composition matter? CNS Drugs, 26(3), 245–268. doi:10.2165/11599630-000000000-00000

Psychiatric Times. (2016). A 5-question quiz on ADHD. Retrieved from http://www.psychiatrictimes.com/adhd/5-question-qu…

Assignment: Assessing and Treating Patients With ADHD

Not only do children and adults have different presentations for ADHD, but males and females may also have vastly different clinical presentations. Different people may also respond to medication therapies differently. For example, some ADHD medications may cause children to experience stomach pain, while others can be highly addictive for adults. In your role, as a psychiatric nurse practitioner, you must perform careful assessments and weigh the risks and benefits of medication therapies for patients across the life span. For this Assignment, you consider how you might assess and treat patients presenting with ADHD.

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To prepare for this Assignment:
  • Review this week’s Learning Resources, including the Medication Resources indicated for this week.
  • Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients with ADHD.

The Assignment: 5 pages

Examine Case Study: A Young Caucasian Girl with ADHD. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.

At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.

Introduction to the case (1 page)

  • Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

Decision #1 (1 page)

  • Which decision did you select?
  • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
  • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #2 (1 page)

  • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
  • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. NURS 6630 Week 9: Therapy for Patients With ADHD/ODD

Decision #3 (1 page)

  • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
  • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Conclusion (1 page)

  • Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.

By Day 7

Submission and Grading Information. NURS 6630 Week 9: Therapy for Patients With ADHD/ODD

To submit your completed Assignment for review and grading, do the following:

  • Please save your Assignment using the naming convention “WK9Assgn+last name+first initial.(extension)” as the name.
  • Click the Week 9 Assignment Rubric to review the Grading Criteria for the Assignment.
  • Click the Week 9 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
  • Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK9Assgn+last name+first initial.(extension)” and click Open.
  • If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
  • Click on the Submit button to complete your submission.
Grading Criteria
Check Your Assignment Draft for Authenticity
  • To check your Assignment draft for authenticity:
  • Submit your Week 9 Assignment draft and review the originality report.
Submit Your Assignment by Day 7 of Week 9

A Young Girl With ADHD Case Study

BACKGROUND

Katie is an 8 year old Caucasian female who is brought to your office today by her mother & father. They report that they were referred to you by their primary care provider after seeking her advice because Katie’s teacher suggested that she may have ADHD. Katie’s parents reported that their PCP felt that she should be evaluated by psychiatry to determine whether or not she has this condition. NURS 6630 Week 9: Therapy for Patients With ADHD/ODD

The parents give you a copy of a form titled “Conner’s Teacher Rating Scale-Revised”. This scale was filled out by Katie’s teacher and sent home to the parents so that they could share it with their family primary care provider. According to the scoring provided by her teacher, Katie is inattentive, easily distracted, forgets things she already learned, is poor in spelling, reading, and arithmetic. Her attention span is short, and she is noted to only pay attention to things she is interested in. The teacher opined that she lacks interest in school work and is easily distracted. Katie is also noted to start things but never finish them, and seldom follows through on instructions and fails to finish her school work.

Katie’s parents actively deny that Katie has ADHD. “She would be running around like a wild person if she had ADHD” reports her mother. “She is never defiant or has temper outburst” adds her father.

SUBJECTIVE

Katie reports that she doesn’t know what the “big deal” is. She states that school is “OK”- her favorite subjects are “art” and “recess.” She states that she finds her other subjects boring, and sometimes hard because she feels “lost”. She admits that her mind does wander during class to things that she thinks of as more fun. “Sometimes” Katie reports “I will just be thinking about nothing and the teacher will call my name and I don’t know what they were talking about.”

Katie reports that her home life is just fine. She reports that she loves her parents and that they are very good and kind to her. Denies any abuse, denies bullying at school. Offers no other concerns at this time.

MENTAL STATUS EXAM

The client is an 8 year old Caucasian female who appears appropriately developed for her age. Her speech is clear, coherent, and logical. She is appropriately oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Self-reported mood is euthymic. Affect is bright. Katie denies visual or auditory hallucinations, no delusional or paranoid thought processes readily appreciated. Attention and concentration are grossly intact based on Katie’s attending to the clinical interview and her ability to count backwards from 100 by serial 2’s and 5’s. Insight and judgment appear age appropriate. Katie denies any suicidal or homicidal ideation. NURS 6630 Week 9: Therapy for Patients With ADHD/ODD

Diagnosis: Attention deficit hyperactivity disorder, predominantly inattentive presentation

RESOURCES

Conners, C. K., Sitarenios, G., Parker, J. D. A., & Epstein, J. N. (1998). Revision and restandardization of the Conners’ Teacher Rating Scale (CTRS-R): Factors, structure, reliability, and criterion validity. Journal of Abnormal Child Psychology, 26, 279-291.

Decision Point One
Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING

RESULTS OF DECISION POINT ONE

  •  Client returns to clinic in four weeks
  •  Katie’s parents report that they spoke with Katie’s teacher who notices that her symptoms are much better in the morning, which has resulted in improvement in her overall academic performance. However, by the afternoon, Katie is “staring off into space” and “daydreaming” again
  •  Katie’s parents are very concerned, however, because Katie reported that her “heart felt funny.” You obtain a pulse rate and find that Katie’s heart is beating about 130 beats per minute
Decision Point Two
Change to Ritalin LA 20 mg orally daily in the MORNING

RESULTS OF DECISION POINT TWO

  •  Client returns to clinic in four weeks
  •  Katie’s academic performance is still improved, and the switch to the LA preparation is lasting Katie throughout the school day
  •  Katie’s reports of her heart feeling “funny” have gone away. Pulse was 92 during today’s office visit
Decision Point Three
Maintain current dose of Ritalin LA and reevaluate in 4 weeks
Guidance to Student

At this point, Katie’s symptoms are well controlled (her attention is sustained throughout the school day) and her side effects have gone away following change to a long-acting preparation. There is no indication at this point that the dose should be increased as it is always advisable to use the lowest effective dose of stimulant medication. Katie’s heart rate is appropriate for an 8 year old girl and an EKG would not be indicated based on her heart rate.

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