Feb 23, 2024 NURS 6630 Assessing and Treating Patients With ADHD
A Sample Answer For the Assignment: NURS 6630 Assessing and Treating Patients With ADHD
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).
NURS 6630 Assessing and Treating Patients With ADHD
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).
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
The management of attention deficit hyperactivity disorder (ADHD) in children is difficult due to a lack of evidence supporting the safety of several recommended drugs for this disorder. The case of an 8-year-old Caucasian female has been provided to further illustrate the management of ADHD. The patient exhibits ADHD symptoms as identified by her teacher, who completed the Conner’s Teacher Rating Scale-Revised. Her teacher claims that the patient is frequently forgetful and easily distracted, with a short attention span.
The patient also has poor language, spelling, and arithmetic skills, which negatively impact her overall school performance. The teacher also stated that the patient has recently been failing to follow instructions, resulting in incomplete homework. Despite her parents’ denial that their daughter has ADHD, the patient reports that she is bored most of the time at school and has little interest in her schoolwork.
She, on the other hand, denies any kind of bullying at school and has a positive home life experience. The patient was diagnosed with Attention deficit hyperactivity disorder, predominantly inattentive presentation, based on the findings of the conducted mental status examination and the Conner’s Teacher Rating Scale-Revised.
Several factors were considered when deciding on the specific pharmacological agent and dosage to prescribe in the patient’s condition management. Such factors include the patient’s young age, Caucasian race, ADHD diagnosis, and reported symptoms. The completed Conner’s Teacher Rating Scale-Revised can also assist in determining the severity of the patient’s condition, which is important in determining the dosage of the chosen drug. As such, the purpose of this discussion is to devise the most effective treatment plan for the 8-year-old patient’s ADHD management, with a rationale for each decision made.
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 get ready for this Task:
Review the Learning Resources for this week, as well as the Medication Resources for this week.Think about what kinds of psychopharmacological treatments you might suggest for evaluating and treating people with ADHD.
The Task: Five pages
Check out the Case Study: A Young White Girl with ADHD.
You will be asked to decide on three different medications to give to this patient. Make sure to think about things that could affect the pharmacokinetic and pharmacodynamic processes of the patient.
At each decision point, you should think about all of your choices before making a choice and moving on. Before you make a choice, make sure you’ve looked into each option and thought carefully about the one you’ll choose. Make sure to look into each choice using the primary sources.
The beginning of the case (1 page)
Explain and sum up the case for this Assignment in a few words. When writing a prescription for this patient, make sure to list the specific patient factors that may affect your choice.
NURS 6630 Assessing and Treating Patients With ADHD
Choice No. 1 (1 page)
Which choice did you choose?Why did you choose this path? Be specific and back up your answer with resources that are clinically relevant and specific to the patient, such as the primary literature.Why didn’t you choose either of the other two choices in the exercise? Be specific and back up your answer with resources that are clinically relevant and specific to the patient, such as the primary literature.What did you want to happen when you made this choice? Use evidence and references to the Learning Resources to back up your answer (including the primary literature).Explain how your treatment plan and how you talk to patients may be affected by ethical issues. Give examples and be specific.
Choice No. 2 (1 page)
Why did you choose this path? Be specific and back up your answer with resources that are clinically relevant and specific to the patient, such as
Primary literature.
Why didn’t you choose either of the other two choices in the exercise? Be specific and back up your answer with resources that are clinically relevant and specific to the patient, such as the primary literature.What did you want to happen when you made this choice? Use evidence and references to the Learning Resources to back up your answer (including the primary literature).Explain how your treatment plan and how you talk to patients may be affected by ethical issues. Give examples and be specific.
Read Also: Assignment: Assessing and Treating Clients With ADHD NURS6630
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Choice No. 3 (1 page)
Why did you choose this path? Be specific and back up your answer with resources that are clinically relevant and specific to the patient, such as the primary literature.Why didn’t you choose either of the other two choices in the exercise? Be specific and back up your answer with resources that are clinically relevant and specific to the patient, such as the primary literature.What did you want to happen when you made this choice? Use evidence and references to the Learning Resources to back up your answer (including the primary literature).Explain how your treatment plan and how you talk to patients may be affected by ethical issues. Be specific and provide examples.
In the end (1 page)
Summarize the treatment options you chose for this patient and what you think should be done. Make sure to back up your recommendations and answer with resources that are relevant to the patient and clinically useful, such as the primary literature.
Note: Use at least five academic sources to back up your reasoning. You can use the course text to back up your reasoning, but it won’t count as one of the resources you need. You should use both first-hand and second-hand sources.
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.
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The management of attention deficit hyperactivity disorder (ADHD) among the pediatric population is quite challenging due to the limited amount of evidence supporting the safety of several recommended drugs for this disorder. To illustrate further the management of ADHD, the case of an 8-year-old Caucasian female has been provided.
The patient presents with symptoms of ADHD as suggested by her teacher who completed the Conner’s Teacher Rating Scale-Revised. Her teacher claims that the patient is forgetful most of the time, and easily distracted with a very short concentration time. The patient also displays poor language, spelling, and arithmetic skills, hurting her overall school performance. The teacher also reported that lately, the patient has been failing to follow instructions, leaving her homework incomplete.
Despite the patient’s parents refusing their daughter has ADHD, the patient reports that she gets bored most of the time at school with a lack of interest in school work. She however denies bullying of any kind at school with a good home life experience. With the findings of the conducted mental status examination and the Conner’s Teacher Rating Scale-Revised, the patient has been diagnosed with Attention deficit hyperactivity disorder, predominantly inattentive presentation.
Several factors were considered when deciding on the specific pharmacological agent and the rig
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