NURS 6630 Week 9 Assignment Assessing And Treating Patients With ADHD

NURS 6630 Week 9 Assignment Assessing And Treating Patients With ADHD

Assessing and Treating Patients with ADHD

 Introduction

Katie, an 8-year-old Caucasian girl, is brought into the facility by her parents for a mental evaluation. They say Katie’s teacher had suggested that she might have ADHD. The Conner’s Teacher Rating Scale-Revised (CTRS-R) system from the parents’ arrival. Hire our assignment writing services in case your assignment is devastating you. We offer assignment help with high professionalism.

According to (Conners et al., 1998), the CTSR is a method for evaluating and reporting on students’ classroom activity. According to the scale, Katie is easily confused, occasionally drowsy, and has trouble recalling what she has heard. Her spelling, reading, and math test results are all below average. According to the instructor, Katie frequently struggles to finish tasks, including homework, starts them but never finishes them, and rarely complies with instructions. The teacher’s claims that Katie has ADHD have drawn a strong response from Katie’s parents.

Katie claims that her school life is fine and that she does not understand the problem. She claims that some subjects are boring and difficult to learn, making it impossible for her to understand what is being taught. Her favorite subjects are art and play. She acknowledges that occasionally, her thoughts turn to amusing topics. She asserts that she adores her friends and that her family is perfect. She asserts that she was never harassed or mistreated at school. She has dressed appropriately for her age and the weather, according to the mental state assessment, and she is aware of the time, place, people, and events. She doesn’t make any noticeable movements or mannerisms and speaks in a straightforward, rational manner. Her affect is positive, she has a euthymic temperament, and she appears to be normally thinking. She asserts that she has never experienced any sensory or auditory issues.

Decision Point #1

Decision Made and Justification for Choosing It Over Alternatives

Ritalin-10 mg chewable tablets in the morning are Katie’s preferred medication, given the options. Methylphenidate, a CNS stimulant, is the ingredient in Ritalin. Especially in children and teenagers, methylphenidate is most frequently used as a first-line treatment for ADHD (Centre for Disease Control and Prevention, 2021).

Antidepressant Wellbutrin (bupropion) is not frequently prescribed for ADHD. It has risky side effects, especially for kids who don’t know how to handle these kinds of emotions, such as suicidal thoughts (Harmon, 2020). A non-stimulant medication called Intuniv is also used to treat ADHD patients’ oppositional behavior (Bernknopf, 2011). Katie’s ADHD is primarily characterized by her lack of attention, so this medication won’t work.

anticipated therapeutic results

Because Ritalin is a methylphenidate that activates the CNS without having any noticeable side effects, I hoped that by choosing it, I would be able to treat Katie’s inattentiveness.

Methylphenidate is prescribed as a first-line treatment, especially for children and teenagers, because it has been proven to be effective (Centre for Disease Control and Prevention, 2021).

Ethics-Related Matters

When choosing Ritalin over the other medications, I adhered to the ethical principles of nonmaleficence (do no harm) and beneficence. Ritalin seemed to offer the greatest medical benefit with the fewest side effects (harm).

Second Decision Point

Decision Made and Justification for Choosing It Over Alternatives

Four weeks later, Katie and her parents reported to the clinic, saying that Katie’s instructor noticed her problems were worse in the morning but that she would resume fantasizing in the afternoon. On the other hand, her academic performance has improved. Because Katie reported that her “heartfelt funny” and that a test revealed that her pulse rate was 130 BPM, her parents are still concerned. I made the decision to switch to Ritalin LA (20mg) at this point, which I would take every morning. Given that Katie was given an immediate-release form of Ritalin that could cause tachycardia, her heat “was strange.”

Ritalin at the same dosage for four weeks and then reassessing is not really the best course of action because it eliminates the afternoon attention lapse but doesn’t address the adverse effect of tachycardia. A healthy medication is one with minimal side effects and a protracted healing effect (Staudt et al., 2019). If Ritalin hadn’t been shown to work, albeit with a few minor side effects that could be managed with careful supervision, it would be a good idea to stop taking it and start taking Extra Release Adderall. Potential side effects are not sufficient to justify changing treatments.

anticipated therapeutic results

Ritalin LA seemed to be the best choice for this decision because it was expected to lessen the tachycardia while also addressing the afternoon lapses.

Ethics-Related Matters

The moral guidelines of beneficence and nonmaleficence (do no harm) were regarded at this time (Goldberg & Wagner, 2019). Katie’s Ritalin should be switched to an extended-release formulation in order to give her longer-lasting therapeutic effects (benefit) while still preventing the adverse effects of tachycardia (harm).

Third Decision Point

The Choice Made and the Justification for It

The client returns four weeks later with the news that her academic performance has improved and that she is experiencing fewer symptoms during the school year than she did previously. She also observes that the odd sensation in her heart has disappeared. She beat her heart 92 times per minute. At this point, I consented to continue the patient on the same medication and dosage (Ritalin LA20mg) and have her evaluated again in four weeks to assess her progress and rule out any medication side effects. This course of action was necessary because Katie’s condition had improved throughout the day, and the negative effects had disappeared.

Since her effects seem to be adequately managed by the current dose of 20 mg during the day, there is no need to increase her long-acting Ritalin dosage to 30 mg. Additionally, the least amount necessary should be used; increasing the amount exposes Katie to additional/other negative effects (Wolraich & Hagan, 2019). Although Katie’s electrocardiogram (EKG) should not be focused on her actual heart rhythm, her heartbeat is normal for her age. An EKG would be advised if there were any additional heart abnormality symptoms in addition to tachycardia.

anticipated therapeutic results

I wanted to keep Katie on the same medication so I could track her progress and response because the patients seemed to respond well to the long-acting Ritalin.

At this point, the ethical principles of beneficence and nonmaleficence were considered. With the current Ritalin LA dosage, Katie seemed to be functioning better; therefore, increasing it would be harmful because it would expose her to more side effects and wouldn’t offer her much more benefit than the current medication dosage.

Ethics-Related Matters

Additionally, beneficence and nonmaleficence are considered by refraining from performing an excessive EKG without a purpose. This prevents the family from accruing additional costs.

Conclusion

Finally, Katie, an eight-year-old girl, was brought to the facility by her parents for a mental examination after her teacher suspected she had ADHD. According to the instructor on an updated Conner Teacher’s Rating Scale, Katie is easily irritated, unfocused, reluctant to finish assignments, and rarely obeys instructions. Katie claims that because she sometimes loses focus on pleasant thoughts or somewhere in particular, she struggles with subjects like algebra because she is unable to comprehend what is being taught. She was able to carry on during the examination and count backward from 100 through serial 5s and serial 2s, indicating that her behavior during the examination was generally normal in terms of her concentration and discipline. The majority of Katie’s symptoms, which included being inattentive, led to her being diagnosed with ADHD.

I decided to start her on 10 mg of chewable Ritalin in the morning as my first course of action. T Finally, Katie, an eight-year-old girl, was brought to the facility by her parents for a mental examination after her teacher suspected she had ADHD. According to the instructor on an updated Conner Teacher’s Rating Scale, Katie is easily irritated, unfocused, reluctant to finish assignments, and rarely obeys instructions. Katie claims that because she sometimes loses focus on pleasant thoughts or somewhere in particular, she struggles with subjects like algebra because she is unable to comprehend what is being taught. She was able to carry on during the examination and count backward from 100 through serial 5s and serial 2s, indicating that her behavior during the examination was generally normal in terms of her concentration and discipline. The majority of Katie’s symptoms, which included being inattentive, led to her being diagnosed with ADHD.

I decided to start her on 10 mg of chewable Ritalin in the morning as my first course of action. Ritalin’s inclusion of methylphenidate, one of the first-line treatments for ADHD in children and teenagers, was cited as the justification (Wolraich & Hagan, 2019).

The most popular signs of inattention appeared to be best treated with Ritalin, a stimulant. The client reported that her symptoms and results had changed four weeks later but that she still experienced afternoon hallucinations. The alternative was to switch her Ritalin medication to a Long-Acting Ritalin (Ritalin LA), which would prolong the effects of the medication throughout the school day. She complained of a funny sensation in her heart despite having 130 beats per-minute heartbeat.

Ritalin’s abrupt release was what caused the tachycardia, so switching to Ritalin LA would typically eliminate this side effect. Ritalin’s inclusion of methylphenidate, one of the first-line treatments for ADHD in children and teenagers, was cited as the justification (Wolraich & Hagan, 2019). The most popular signs of inattention appeared to be best treated with Ritalin, a stimulant. The client reported that her symptoms and results had changed four weeks later but that she still experienced afternoon hallucinations.

The alternative was to switch her Ritalin medication to a Long-Acting Ritalin (Ritalin LA), which would prolong the effects of the medication throughout the school day. She complained of a funny sensation in her heart despite having 130 beats per minute heartbeat. Ritalin’s abrupt release was what caused the tachycardia, so switching to Ritalin LA would typically eliminate this side effect.

References

Barterian, J. A. (2019). Psychopharmacology: Special Considerations When Working with Young  Children. In School Psychopharmacology (pp. 159–177). Springer, Cham.

Bernknopf, A. (2011). Guanfacine (Intuniv) for attention-deficit/hyperactivity disorder. American Family Physician, 83(4), 468.

Centers for Disease Control and Prevention. (2021). Treatment Of ADHD.

https://www.cdc.gov/ncbddd/adhd/treatment.html> [Accessed 25 January 2021].

Goldberg, S. G., & Wagner, K. (2019). American Psychological Association Practice guidelines for psychopharmacology: Ethical practice considerations for psychologists involving psychotropic use with children and adolescents. Journal of Clinical Psychology, 75(3), 344–363.

Harmon, D. (2020). Effects of Bupropion (Wellbutrin) on Suicidal behavior, Risk-Taking behavior, and mood.

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.

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

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BACKGROUND

Katie is an 8-year-old Caucasian female who was 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.

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’s primary care provider. According to the scoring provided by her teacher, Katie is inattentive, easily distracted, forgets things she has already learned and 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 schoolwork and is easily distracted. Katie is also noted to start things but never finish them, 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 outbursts,” adds her father.

SUBJECTIVE

Katie reported that she didn’t know what the “big deal” was. 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 reported that her home life was 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 has dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. The self-reported mood is euthymic. The effect is bright. Katie denies visual or auditory hallucinations, and no delusional or paranoid thought processes are readily appreciated. Attention and concentration are grossly intact based on Katie’s attendance at the clinical interview and her ability to count backward from 100 by serial 2s and 5s. Insight and judgment appear age-appropriate. Katie denies any suicidal or homicidal ideation.

Diagnosis: Attention deficit hyperactivity disorder, predominantly inattentive presentation

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.