Feb 23, 2024 NURS 6630 Week 9 Therapy for Patients With ADHD/ODD
A Sample Answer For the Assignment: NURS 6630 Week 9 Therapy for Patients With ADHD/ODD
Attention Deficit Hyperactivity Disorder (ADHD) is one of the most prevalent disorders in child psychiatry with the prevalence increasing over the years. It is characterized by inattention, hyperactivity, and impulsivity. It has a male predilection with a male to female ratio of 2:1. The hyperactive and impulsive subtype is the most prevalent. The inattentive subtype occurs in 18.3% of the condition and mostly affects females (Magnus et al., 2020). ADHD is diagnosed before the age of 12 years. It affects an individual’s ability to form and maintain close social ties.
This week’s case study focuses on Katie an 8-year-old Caucasian female brought into the office by her parents following a referral. She is referred for a psychiatry assessment to determine if she has ADHD. From the Conner’s Teacher Rating Scale-Revised, Katie is inattentive, easily distracted, forgets things already learned, and poor in spelling, reading, and arithmetic. Of note is that she has a short attention span, lacks interest in school work, is easily distracted, starts things but never finishes them, seldom follows through on instructions, and fails to finish her school work. She has no open defiance or temper outbursts. In subjective history, her favorite subjects are art and recess. She finds other subjects hard and boring. She admits her mind wanders off from class most of the time. There is no history of abuse or bullying at school. She reports that her home life is fine and her parents are good to her.
The Mental State Exam is normal. She is appropriately developed for her age. She has a clear, coherent, and logical speech. She is oriented to time, place, person, and event. She has no mannerisms or tics. Her subjective mood is euthymic with a bright affect. She has no hallucinations, delusions, or abnormalities of thought. Attention and concentration are intact. Insight and judgment are age appropriate. Her diagnosis is ADHD, predominantly inattentive presentation. Decision-making in the prescription of ADHD medication is influenced by the patient’s gender, the subtype of ADHD displayed, level of academic impairment, age, and the parent’s socioeconomic status (Kamimura-Nishimura et al., 2019). These factors act together to influence the drug to be used, the dosage, and the duration of therapy. The purpose of this paper is to discuss the decision points on the treatment of this patient in regards to the choice of drug, the expectations post initiation of therapy, and the ethical considerations.
The patient is an 8-year-old Caucasian girl who was referred by a primary care physician and was brought in by her parents. The patient’s primary care provider assessed the patient after the teacher raised the possibility that she might have ADHD.”Corners Teacher Rating Scale -Revised” is presented by the parents. Katie exhibits inattentive, easily distracted, forgetful, poor spelling, poor reading, and poor arithmetic behaviors, per the teacher’s evaluations.
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Katie has a limited attention span, focuses on what interests her, and shows little enthusiasm for her homework. Katie is known for starting things but not finishing them and for not doing as she is told. Parents believe Katie would exhibit behavioral outbursts and be perpetually hyperactive if she had ADHD. Katie acknowledges having a restless mind in class and finding most courses to be dull. Katie rejects any claims of bullying at school.
She speaks clearly and coherently, and she is suitably matured. She is dressed appropriately for the place and the weather and is aware of place, time, and other person. She doesn’t exhibit any notable tics, gestures, or mannerisms. A euthymic mood is self-reported. No delusions, paranoia, or hallucinations. Can count from 100 by 2s and 5s and has mostly intact attention and concentration, insight and sound judgment, denying SI and HI. Intuniv ER 1mg at bedtime, bupropion XL 150mg PO daily, or 10mg chewable methylphenidate in the morning are the three options for Katie after her ADHD diagnosis.
Decision One: Begin Ritalin (methylphenidate) Chewable Tablets 10 Mg Orally in the Morning
The initial choice was to take 10mg of oral methylphenidate chewable tablets in the morning. The family reported that the patient does not look hyper at home and that the most of the attention problems arise in school, which was the impetus for the decision. Psychostimulants have a solid track record of short-term efficacy and have been shown to be both secure and reliable.
This prescription is beneficial because it can be used for a short, medium, or long period of time, providing the patient with coverage during school and other associated activities while letting the drug to wear off and not be in the system for a longer period of time during the day (Mühlberger et al . ,2020).
Because bupropion XL is not regarded as a first-line therapy and can cause suicidal thoughts in children, it was a poor choice. Additionally, bupropion has a half-life of up to 21 days, so adverse effects might not manifest right away. Additionally, bupropion takes time to take effect. Her symptoms were noted at school, and Intuniv XL was not chosen because it is not regarded as a first-line treatment, has side effects like hypotension, bradycardia, and sedation, and takes time to take effect. The dosage is appropriate and is still a possibility. If the patient is not having any issues with sleeplessness or hyperactivity at home, the medication’s sedative effect may not be good (Huecker et al, 2017).
Decision Two: Change to Ritalin LA 20mg Orally Daily in the Morning
Results reveal that after four weeks, teachers are aware that the patient loses focus in the afternoon but that her symptoms are improved in the morning. The complaints of “feeling heart funny” and a heart rate of 130 beats per minute worry the parents. Continue and reevaluate in four weeks, switch to Ritalin 20mg taken orally in the morning, or stop Ritalin and start Adderall XR 15 PO are the alternatives on the table. Making the right choice with Ritalin LA 20mg PO in the morning was crucial. Ritalin affects cognition, motivation, and action by increasing the amount of dopamine produced in the striatum (Smith, 2017).
NURS 6630 Week 9 Therapy for Patients With ADHD/ODD
Due to the patient’s cardiac complaints while using Adderall and the fact that they were losing concentration in the middle of the day, altering the drug was a critical step in preventing future effects. Because the medication has a long half-life, it won’t lose its effectiveness in the middle of the day. Since Adderall was one of two options, it was not chosen.
There was a need to increase the amount because the first dose was ineffective and had negative side effects. The fact that Adderall increases dopamine, serotonin, and norepinephrine levels can increase heart rate or cause a fluttering sensation and should thus not be prolonged or increased (Wolraich et al., 2019).
Decision Three: Maintain Current Dose of Ritalin LA and Reevaluate in 4 Weeks
Academic performance increased and persisted as a result of this choice after four weeks, and her chest felt better with a heart rate of 92 beats per minutes during the clinic appointment. There are three options: stick with the existing course of treatment with a follow-up evaluation in four weeks, up the dosage of Ritalin LA to 30 mg PO, or get an EKG based on Katie’s heart rate. The decision is to stick with the existing course of treatment and reevaluate after 4 weeks.
This choice was taken because there are now no side effects or adverse events documented and the patient’s symptoms seem to be under control. Since the patient is feeling better and the higher dose could result in side effects or symptoms, it is not necessary to increase the medication to 30 mg PO. Since the patient’s heart rate is within normal ranges and they are not currently complaining of chest pain, heart palpitations, or tachycardia, an EKG is not required (Ghanaatgar et al., 2022).
Conclusion
Stimulant medication classes are one of the most well-known ways to treat ADHD, which is a frequent diagnosis and has many treatment options. Stimulants have a short half-life, are effective, and operate quickly. They have their drawbacks, yet they can be useful at work and at school without having sedative or suicidal effects. Children who use drugs that influence serotonin are more likely to have suicide thoughts. When giving a child medication, it’s crucial to keep an eye out for any side effects and changes (Rajeh et al, 2017).
Katie began to get better, but stimulants can make your heart race and make your chest flutter. Because Adderall affects serotonin, dopamine, and norepinephrine, it is more likely to result in those side effects. Therefore, switching the patient to a stimulant that only affects dopamine can lessen the symptoms. It’s also critical that the medication be long-lasting rather than short-lasting, which would wear off in the middle of the class (Harris & Green 2019)
References
Ghanaatgar, M., Taherzadeh, S., Ariyanfar, S., Jahromi, S. R., Martami, F., Gharaei, J. M., … & Shahrivar, Z. (2022). Probiotic supplement as an adjunctive therapy with Ritalin for treatment of attention-deficit hyperactivity disorder symptoms in children: A double- blind placebo-controlled randomized clinical trial. Nutrition & Food Science, 53(1), 19- 34. Doi: 10.1108/NFS-12-2021-0388/full/html
Harris, S., & Green, S. (2019). Role of Cortical Catecholamines in the Paradoxical Action of Psychostimulants. The FASEB Journal, 33(S1), lb90-lb90. Doi: 10.1038/s41598-022- 07029-2.
https://doi.org/10.1542/peds.2019-2528
Huecker, M. R., Smiley, A., & Saadabadi, A. (2017). Bupropion. https://pubmed.ncbi.nlm.nih.gov/29262173/
Mühlberger, A., Jekel, K., Probst, T., Schecklmann, M., Conzelmann, A., Andreatta, M., … & Romanos, M. (2020). The influence of methylphenidate on hyperactivity and attention deficits in children with ADHD: a virtual classroom test. Journal of Attention Disorders, 24(2), 277-289. Doi: 10.1177/1087054716647480.
Rajeh, A. Amanullah, S., Shivakumar, K., & Cole, J. (2017). Interventions in ADHD: A comparative review of stimulant medications and behavioral therapies. Asian Journal of Psychiatry, 25, 131-135. Doi: 10.1016/j.ajp.2016.09.005.
Smith, M. (2017). Hyperactive around the world? The history of ADHD in global perspective. Social History of Medicine, 30(4), 767-787. Doi: 10.1093/shm/hkw127
Wolraich, M. L., Hagan, J. F., Allan, C., Chan, E., Davison, D., Earls, M., & Zurhellen, W. (2019). Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics, 144(4). Doi: 10.1542/peds.2019-2528
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.
References:
Centers for Disease Control and Prevention. (n.d.). Data and statistics about ADHD. https://www.cdc.gov/ncbddd/adhd/data.htmlAnxiety and Depression Association of America. (n.d.). Adult ADHD (Attention Deficit Hyperactive Disorder). https://adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/adult-adhdNURS 6630 Week 9 Therapy for Patients With ADHD/ODDLearning ObjectivesStudents 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 (click to expand/reduce)
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
NURS 6630 Week 9 Therapy for Patients With ADHD/ODDMedication Resources (click to expand/reduce)
U.S. Food & Drug Administration. (n.d.). Drugs@FDA: FDA-approved drugs. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm
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 (click to expand/reduce)
Case Study: A Young Caucasian Girl with ADHDNote: This case study will serve as the foundation for this week’s Assignment.
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.
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 pagesExamine 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 formatting.
By Day 7
Submit your Assignment.Submission and Grading InformationTo 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
To access your rubric:Week 9 Assignment Rubric
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
To participate in this Assignment:Week 9 Assignment
________________________________________Quiz: Assessing and Treating Patients With Psychopharmacology
Photo Credit: Getty ImagesBy Day 7Complete the 20-question Quiz to gauge your understanding of this module’s content.Submission InformationSubmit Your Quiz by Day 7
To submit your Quiz :Week 9 Quiz
________________________________________What’s Coming Up in Module 3?
Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty ImagesIn the next module, you will begin to apply your assessment and therapy skills in treating patients for disorders with behavioral components.Next Module
To go to the next module:Module 3
Rubric Detail
Select Grid View or List View to change the rubric’s layout.ContentName: NURS_6630_Week9_Assignment_Rubric• Grid View• List ViewExcellent
Point range: 90–100 Good
Point range: 80–89 Fair
Point range: 70–79 Poor
Point range: 0–69Introduction 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. Points Range: 9 (9%) – 10 (10%)The response accurately, clearly, and fully summarizes in detail the case for the Assignment.
The response accurately and clearly explains in detail the specific patient factors that impact decision making when prescribing medication for this patient. Points Range: 8 (8%) – 8 (8%)The response accurately summarizes the case for the Assignment.
The response accurately explains the specific patient factors that impact decision making with prescribing medication for this patient. Points Range: 7 (7%) – 7 (7%)The response inaccurately or vaguely summarizes the case for the Assignment.
The response inaccurately or vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient. Points Range: 0 (0%) – 6 (6%)The response inaccurately and vaguely summarizes the case for the Assignment, or is missing.
The response inaccurately and vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient.NURS 6630 Week 9 Therapy for Patients With ADHD/ODDDecision #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.
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• 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. Points Range: 18 (18%) – 20 (20%)The response accurately and clearly explains in detail the decision selected.
The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected.
The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response.
The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically rel
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