NURS 6630 ASSESSING AND TREATING PATIENTS WITH ADHD ASSIGNMENT
NURS 6630 ASSESSING AND TREATING PATIENTS WITH ADHD ASSIGNMENT
Assessing and Treating Patients with ADHD
This paper develops treatment for Katie. Katie is an 8-year-old female who has been brought to the officer by her parents for review after being referred by their primary care provider. The primary care provider feels that Katie may have ADHD, hence the need for psychiatric review. The parents give PMHNP a copy of Conner’s Teacher Rating Scale-Revised completed by Katie’s teacher. The scoring by the teacher shows that Katie is inattentive, easily distracted, forgets things she already learned, poor in spelling, reading, and arithmetic. He attention span is also short, lacks interest in school, easily distracted, and starts things but never finishes them or follows through on instructions. Mental status examination performed revealed that Katie does not demonstrate any noteworthy mannerisms, tics, or gestures. She has euthymic mood, bright affect, and grossly intact concentration and attention. A diagnosis of attention deficit hyperactive disorder, predominantly inattentive presentation has been reached. The patient factors that will influence the decisions made in treating Katie include her age, presenting symptoms, learning ability,and her parents’ preferences for the existing interventions.
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Decision 1
Selected Decision
Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the morning
Why the Decision was Selected
Ritalin or methylphenidate was selected as the first treatment of choice for Katie because it is the recommended treatment for ADHD. The Food and Drug Administration (FDA) has approved methylphenidate for use in treating ADHD in adults and children aged above 6 years. The existing evidence supports its use since it increases the levels of dopamine and norepinephrine in the brain. The inhibition of the uptake of these neurotransmitters increases their concentration, hence, elevated mood, attention, and behavior. Ritalin also has enhanced efficacy against the primary symptoms of ADHD such as inattention, impulsiveness, and hyperactivity(Motaharifard et al., 2019). These benefits will improve Katie’s attention span, learning, and social skills in school and at home.
Why the Other Two Options were Not Selected
The decision to begin the client on Wellbutrin (bupropion) XL 150 mg orally daily was not chosen because it is an antidepressant that is used in patients that want to stop smoking. It is also an alternative drug and not first-line therapy for ADHD due to its safety concerns. The decision to start Katie on Intuniv extended release 1 mg orally bedtime was also not selected because of safety concerns. The side effects due to Intuniv such as hypotension and sedation may affect adherence level, hence, making methylphenidate a priority(Kweon & Kim, 2019).
What I was Hoping to Achieve
As noted above, Ritalin improves the concentration of dopamine and norepinephrine in the brain. The increase in these neurotransmitters improve learning, social skills, and manage symptoms of ADHD(Moran, 2023). Therefore, I anticipated reduction of ADHD symptoms and increased Katie’s learning ability.
Impact of Ethical Considerations
PMHNP should prioritize safety in treating ADHD in children. Children are increasingly at a risk of developing side and adverse effects to drugs because of their immature organs and immune systems. As a result, PMHNP must rely on FDA-recommended treatments and evidence-based data to make treatment decisions for ADHD. Such considerations will minimize the risk of harm while optimizing outcomes such as safety, quality, and efficiency(Butts & Rich, 2019).
Decision 2
Selected Decision
Change to Ritalin LA 20 mg orally daily in the morning.
Why the Decision was Selected
I selected the above decision because Katie returned to the clinic in four weeks with improved symptoms. Katie’s parents report that Katie’s teacher noted improved symptoms in the morning, which have led to her overall academic performance. However, she stares off into space and daydreams by the afternoon. Katie’s parents raised some concerns. They reported that her heart felt funny and current pulse rate is 130 beats per minute. This data shows that Ritalin had mild effect on ADHD symptoms. An appropriate decision would be prescribing Katie Ritalin LA 20 mg, which would produce long-lasting effect throughout the day. The side effect of Ritalin includes elevated pulse rate, which improves with time as the patient tolerates the dosage(Pertermann et al., 2019).
Why the Other Two Options were Not Selected
The decision to continue with the same dose of Ritalin and re-evaluate in 4 weeks was not selected because it would not have improved Katie’s symptoms. The desired therapeutic effect of Ritalin has not been achieved, hence, the need for dosage increase(Moran, 2023). The decision to discontinue Ritalin and begin Adderall XR 15 mg orally daily was not selected since there are no indications for discontinuing the therapy.
What I was Hoping to Achieve
I was hoping the patient’s pulse will be within the normal rate during the next visit because of her tolerability to treatment. I was also expecting the current dose will produce its effect throughout the day, hence, sustained learning, social functioning, and productivity by the patient(Pertermann et al., 2019).
Impact of Ethical Considerations
PMHNP should weigh the benefits and risks of the available treatments in the ongoing treatment of mental health problems. The decisions to titrate or taper down the treatments for different mental health problems largely depend on patient’s tolerance and symptom improvement. As a result, the PMHNP to titrate the dosage upwards with the intention of achieving sustained symptom improvement(Dyer et al., 2021). This is crucial in ensuring patient-centeredness and optimizing outcomes while minimizing the risk of harm.
Decision 3
Selected Decision
Maintain the current dose of Ritalin LA and re-evaluate in 4 weeks
Why the Decision was Selected
I selected the decision to maintain the current dose of Ritalin LA and reevaluate in 4 weeks because the client returned in four weeks with optimum symptom improvement and tolerability. Katie was returned to the clinic in four weeks with reports that her academic performance is still improved. The switch to the LA preparation is lasting Katie throughout the school day. The reports of heart feeling funny have also gone away with today’s pulse being 92. These findings demonstrate that LA preparation has been effective in managing ADHD symptoms(Pertermann et al., 2019). Katie is also tolerating the increased dosage, hence, no need for increasing the dosage further or changing the treatment.
Why the Other Two Options were Not Selected
The decision to increase Ritalin to 30 mg orally daily was not chosen because of safety concerns. Katie has demonstrated optimum symptom improvement and tolerance to LA 20 mg. increasing the dose further may lead to side and adverse effects of Ritalin(Pertermann et al., 2019). I did not select the decision to obtain EKG based on the current heart rate since the pulse rate is within the normal range.
What I was Hoping to Achieve
I made the above decision hoping to achieve sustained improvements in ADHD symptoms. I also aimed at ensuring continued improvement in Katie’s academic performance and tolerance towards the treatment(Pertermann et al., 2019).
Impact of Ethical Considerations
PMHNP should protect the patients’ right to autonomous care. Patients have the right to accept or decline specific interventions. They also have the right to information in the treatment of their mental health problems. Therefore, the PMHNP would respect Katie’s parent’s decisions should they reject the use of Ritalin in ADHD treatment. This consideration contributes to ethical care in nursing practice (Dyer et al., 2021).
Conclusion
Ritalin proved effective in improving ADHD symptoms that Katie was experiencing. The initial decision led to mild improvement in symptoms. This necessitated the need to increase the dosage and adopt a long-acting Ritalin preparation to last Katie throughout the day. This decision was effective, leading to the dosage being maintained in the third step of the treatment. Ritalin was selected as the drug of choice since the FDA has approved it for children aged above six years and adults. The other options given were not selected because of the safety concerns in the treatment process. For example, Wellbutrin was not selected because it is an alternative treatment for ADHD. The decision to use it for treating Katie would only have been considered if Ritalin had proven ineffective (Kweon & Kim, 2019). The decision to change the treatment in the second step was not selected because Ritalin had shown mild improvement in ADHD symptoms. Lastly, increasing Ritalin LA dosage to 30 mg was not selected because the patient was likely to develop side or adverse effects.
Ethical considerations informed the decisions made in this case study. One of them is the promotion of safety, quality, and efficiency in the treatment process. The PMHNP utilized evidence-based data and practice guidelines in selecting Ritalin for Katie’s treatment. The use of evidence-based data and practice guidelines minimize the risk of harm in the patient’s treatment. The PMHNP also weighed the benefits and risks of the different treatments before deciding. The PMHNP was aware of the patient’s right to accepting or rejecting the prescribed treatments(Butts & Rich, 2019; Dyer et al., 2021). As a result, the decision by Katie’s parents to try other alternatives would have been considered in the case study.
References
Butts, J. B., & Rich, K. L. (2019). Nursing Ethics: Across the Curriculum and Into Practice. Jones & Bartlett Learning.
Dyer, A. R., Kohrt, B. A., &Candilis, P. J. (2021). Global Mental Health Ethics. Springer Nature.
Kweon, K., & Kim, H.-W. (2019). Effectiveness and Safety of Bupropion in Children and Adolescents with Depressive Disorders: A Retrospective Chart Review. Clinical Psychopharmacology and Neuroscience, 17(4), 537–541. https://doi.org/10.9758/cpn.2019.17.4.537
Moran, L. V. (2023). Long-term safety of methylphenidate in children with ADHD. The Lancet Psychiatry, 10(5), 306–307. https://doi.org/10.1016/S2215-0366(23)00092-5
Motaharifard, M. S., Effatpanah, M., karimi, M., Akhondzadeh, S., Rahimi, H., Yasrebi, S. A., &Nejatbakhsh, F. (2019). Effect of sweet almond syrup versus methylphenidate in children with ADHD: A randomized triple-blind clinical trial. Complementary Therapies in Clinical Practice, 36, 170–175. https://doi.org/10.1016/j.ctcp.2019.07.008
Pertermann, M., Bluschke, A., Roessner, V., & Beste, C. (2019). The Modulation of Neural Noise Underlies the Effectiveness of Methylphenidate Treatment in Attention-Deficit/Hyperactivity Disorder. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 4(8), 743–750. https://doi.org/10.1016/j.bpsc.2019.03.011
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Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
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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 disordersLinks to an external site. (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 DrugsLinks to an external site., 26(3), 245–268. https://doi.org/10.2165/11599630-000000000-00000
Martin, L. (2020). A 5-question quiz on ADHD. Psychiatric TimesLinks to an external site.. https://www.psychiatrictimes.com/view/5-question-quiz-adhd
Medication Resources
U.S. Food & Drug Administration. (n.d.). Drugs@FDA: FDA-approved drugsLinks to an external site.. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm
Links to an external site.
Note: To access the following medications, use the Drugs@FDA resource. Type the name of each medication in the keyword search bar. Select the hyperlink related to the medication name you searched. Review the supplements provided and select the package label resource file associated with the medication you searched. If a label is not available, you may need to conduct a general search outside of this resource provided. Be sure to review the label information for each medication as this information will be helpful for your review in preparation for your Assignments.
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 ADHDLinks to an external site.
Note: This case study will serve as the foundation for this week’s Assignment.
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.
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.
Reminder : The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formattingLinks to an external site..
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Rubric
NURS_6630_Week9_Assignment_Rubric
| Criteria | Ratings | Pts | ||||
|---|---|---|---|---|---|---|
| This criterion is linked to a Learning OutcomeIntroduction 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. |
|
10 pts | ||||
| This criterion is linked to a Learning OutcomeDecision #1 (1–2 pages)• 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. |
|
20 pts | ||||
| This criterion is linked to a Learning OutcomeDecision #2 (1–2 pages)• 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. |
|
20 pts | ||||
| This criterion is linked to a Learning OutcomeDecision #3 (1–2 pages)• 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. |
|
20 pts | ||||
| This criterion is linked to a Learning OutcomeConclusion (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. |
|
15 pts | ||||
| This criterion is linked to a Learning OutcomeWritten Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria. |
|
5 pts | ||||
| This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation |
|
5 pts | ||||
| This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list. |
|
5 pts | ||||
| Total Points: 100 | ||||||
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NURS 6630 ASSESSING AND TREATING PATIENTS WITH ADHD ASSIGNMENT
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