NURS 6630 Assessing And Treating Patients With ADHD Essay

Case:
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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)NURS 6630 Assessing And Treating Patients With ADHD Essay

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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)NURS 6630 Assessing And Treating Patients With ADHD Essay

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.

Introduction

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopment disorder diagnosed based on observing the behavioral system. The condition is the most common among children and adolescent psychiatrists, with a prevalence rate of approximately 5% (Drechsler et al., 2020). The DSM-5 categorized ADHD into different subtypes depending on the defining symptoms: predominantly inattentive, predominantly hyperactive, combined presentation, and partial remission (Drechsler et al., 2020)NURS 6630 Assessing And Treating Patients With ADHD Essay. Both neurobiological and genetic factors are associated with the development of ADHD in children. The DSM-5 identified ADHD as a diagnosis for exclusion if the behavioural symptoms are associated with other mental illnesses such as anxiety disorder, personality disorder, substance abuse, or withdrawal. However, ADHD is comorbidity to other mental disorders. The condition is related to several underlying neurobiological pathways and genetic and heterogeneous neuropsychological aspects.

Clinical diagnosis for the condition involves a clinical interview with parents by exploring the problem, detailed development history including medical or psychiatric background, data on family functioning, relationships, and school history (Sayal et al., 2018). The mental state should also be examined, and a standard semistructured clinical interview containing the ADHD assessment is recommended. A further interview is conducted with the child to have a picture from the parent’s interview, including the patient’s problem, needs, and goals. ADHD is mostly comorbid with learning disorders, including reading, dyscalculia, and autism spectrum disorder (Sayal et al., 2018)NURS 6630 Assessing And Treating Patients With ADHD Essay. Further, it increases the risk of obesity, substance use disorder, and sleep disorder. Therefore, early diagnosis and treatment are essential for improving the patient’s quality of life. Treatment may involve either pharmacologic or non-pharmacologic approaches based on the severity of the condition and other patient factors.

Summary of the Case and the Patient Factors that may Affect treatment

The case study is about Katie; an 8-year-olf Caucasian female brought to the clinic by her parents. The parents were referred by their health provider after their daughter’s teacher noticed she might have Attention Deficit Hyperactivity Disorder (ADHD). The parents presented to the psychiatrist a form labelled “conner’s teacher rating scale revised that was filled out by Katie’s teacher to be shared with her provider. The scores show that Katie is distracted, pays attention only to things that interest her, forgets things she has learned easily, does not follow through with instructions, and is uninterested in school work. She is also poor in reading, spelling, and arithmetic. However, her parents are in denial that Katie has ADHD. The patient admits to being distracted during class but feels that life is fine at home. During her mental assessment, the patient is clear in speech, coherent, logical, and appropriately developed for her age. The self-reported mood is euthymic, and she illustrates mannerisms, gestures, and tics. Attention and concentration are grossly intact when told to count backwards from 100. The assessment reveals Katie has Attention deficit hyperactivity disorder.

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When prescribing medication, specific patient factors must be considered when establishing treatment decisions. The major factor to consider is age-specific needs. According to (Drechsler et al., 2020), a major distinction when recommending medication must be made between children below the age of five and those above that age. It is important to note that medication for ADHD is recommended when the symptoms are causing persistent, significant impairment in at least one life domain. In this case, Katie’s condition is affecting her school life. Thus medication can be integrated with education and information on the cause of ADHD and advice to parents and teachers on parenting strategies. Other patient factors include child and parent medical history, current medication, and pre-existing conditions. NURS 6630 Assessing And Treating Patients With ADHD Essay

Decision Point One; Ritalin (methylphenidate) chewable tablets 10mg orally

The first decision would be administering Ritalin (methylphenidate) chewable tablets 10mg orally in the morning. According to (Pakdaman et al., 2018), Ritalin has been identified as a first-line medication for ADHD among children and their lifespan. The drug can either be used short-term or long-term. The drug is effective as it increases dopamine and norepinephrine levels in the brain, which play a significant role in attention and thinking. Consequently, the child shows improved class performance and behaviour, thus improving the ADHD symptoms. Additionally, the medication has been proven to show immediate symptom reduction, safety and manageable side effects, which include reduced appetite and sleep disturbances.

Administering bupropion or intuniv extended release was not recommended because symptom reductions unfold after several weeks while that for Ritalin was immediate. Additionally, Wellbutrin is mainly recommended in treating ADHD in adults and thus might have adverse side effects on a child patient, including suicidal ideation. The intuniv extended releases were not also considered because it is recommended for children above 12 years and it may cause sedation that may impact the patient’s attention. NURS 6630 Assessing And Treating Patients With ADHD Essay

The goal of administering Ritalin as the first-line medication was to help improve the cognitive behavioural functioning of the patient. Therefore, after a few weeks of monitoring, the expectation may include improved attention, thinking, and memory. Therefore, the improved symptoms consequently improved Katie’s academic performance.

It is important to consider that the patient is a child, and several considerations may affect the treatment plan. Informed consent is a principle that may affect treatment. It is important to communicate to the patient how the medication works and the possible side effects for them to give their output and decide regarding their daughter’s treatment plan.

Decision Point Two; Administer Ritalin LA 20mg once per day in the morning

The initial dosage was Ritalin 10mg chewable tablets orally. Monitoring the treatment response is important in establishing whether to discontinue or continue the treatment plan. Factors to consider include medication efficacy in reducing the symptoms, safety and side effects. It is necessary to continue with medication as long as it remains clinically necessary and effective (Brown et al., 2018)NURS 6630 Assessing And Treating Patients With ADHD Essay. In this case, the efficacy of the initial dosage was for a short while. Thus increasing the dosage to Ritalin LA 20mg daily in the morning will help prolong the therapeutic effect on the patient. This decision was made after Katie’s teacher reported that her attention shifted by the afternoon, which shows its efficacy until the afternoon. Thus increasing the dosage will help increase the duration of the therapeutic efficacy.

The decision to maintain the dosage for at least four weeks was not considered, as the effectiveness of the dosage would be limited. The results would be the same, and during the afternoon, the patient would start experiencing ADHD symptoms. The choice of administering Adderall was also not considered, as the medication is associated with a risk for cardiovascular complications (Brown et al., 2018)NURS 6630 Assessing And Treating Patients With ADHD Essay.

The expected outcome of the increased dosage to 20mg daily in the morning was to gain full concentration and attention throughout the day, thus improving Katie’s overall academic performance.

The ethical consideration PMHNP is obligated to ensure no harm to their patients. Thus, it is important to communicate to Katie’s parents why it was important to increase the dosage, the possible side effects, and how the symptoms can be managed.

Decision point three; Maintain Ritalin 20mg orally and re-evaluate in 4-weeks

The decision chosen is to maintain the current Ritalin 20 mg daily in the morning and re-evaluate its efficacy after four weeks. The first dosage effectively reduced the symptoms but for a limited time frame. Increasing the dosage would have helped improve the therapeutic efficacy throughout the rest of the day. Additionally, the patient did not experience severe side effects and thus, maintaining the dosage was recommended. The decision to increase the dosage to 30mg daily in the morning was not selected because the current dosage effectively reduced the ADHD symptoms in the patient. In addition, increasing the dosage could have increased the risk of adverse side effects, including suicidal thoughts and tachycardia (Verghese & Abdijadid, 2022) NURS 6630 Assessing And Treating Patients With ADHD Essay.

By maintaining the medication at 20mg daily in the morning, I was hoping to reduce the symptoms of ADHD and finally re-emission significantly. Therefore, the impact of the intervention was to improve cognitive functioning and increase performance in school. The ethical consideration of non-maleficence would have affected the patient’s treatment plan. Thus any decision that would have increased the risk of adverse side effects could have been avoided.

In summary, the case study aimed to study children’s assessment and treatment of ADHD. In establishing the most effective medication for the patient in the case study. The first decision was to administer Ritalin 10mg daily in the morning. The drug works by increasing the dopamine and norepinephrine in the brain, consequently reducing the symptoms by improving attentive and attention levels, thus improving the cognitive behaviour of the patient. The second decision was based on the fact that the first dosage was safe and effective but limited to the duration of its efficacy. Thus increasing the dosage was relevant in increasing the therapeutic effect throughout the day. Lastly, since the increased dosage was effective, maintaining the dosage was the most appropriate, as increasing the dosage would increase the risk of suicidal ideation. NURS 6630 Assessing And Treating Patients With ADHD Essay

References

Brown, K. A., Samuel, S., & Patel, D. R. (2018). Pharmacologic management of attention deficit hyperactivity disorder in children and adolescents: A review for Practitioners. Translational Pediatrics, 7(1), 36–47. https://doi.org/10.21037/tp.2017.08.02

Drechsler, R., Brem, S., Brandeis, D., Grünblatt, E., Berger, G., & Walitza, S. (2020). ADHD: Current concepts and treatments in children and adolescents. Neuropediatrics, 51(05), 315–335. https://doi.org/10.1055/s-0040-1701658

Pakdaman, F., Irani, F., Tajikzadeh, F., & Jabalkandi, S. A. (2018). The efficacy of Ritalin in ADHD children under neurofeedback training. Neurological Sciences, 39(12), 2071–2078. https://doi.org/10.1007/s10072-018-3539-3

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Sayal, K., Prasad, V., Daley, D., Ford, T., & Coghill, D. (2018). ADHD in children and young people: Prevalence, care pathways, and service provision. The Lancet Psychiatry, 5(2), 175–186. https://doi.org/10.1016/s2215-0366(17)30167-0

Verghese C, Abdijadid S. Methylphenidate. [Updated 2022 Jan 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482451/ NURS 6630 Assessing And Treating Patients With ADHD Essay