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ADHD

Open Posted By: ahmad8858 Date: 01/05/2021 High School Rewriting & Paraphrasing

 

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.
Category: Mathematics & Physics Subjects: Mathematics Deadline: 24 Hours Budget: $80 - $120 Pages: 2-3 Pages (Short Assignment)

Attachment 1

Running head: TREATING PATIENTS WITH ADHD 1

Treating Clients with ADHD

Tracie Grider

Walden University

October 27, 2019

NURS 6630

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TREATING ADHD 2

This week’s scenario is concerning an 8-year-old Caucasian female with symptoms of

possible Attention-Deficient Hyperactivity Disorder (ADHD) per her primary care provider.

ADHD is primarily a problem with sustained attention, concentration, and task persistence.

Statistics show that, in 2016, 9.4 percent of 2 to 17-year-olds in the United States had received a

diagnosis of ADHD at some time (CDC, 2019). ADHD has three forms: Inattentive,

Hyperactive/impulsive, and Combined.

This patient will be assessed for a medication regime which can decrease or control her

behavior issues related to her diagnosis of ADHD inattentive and engage the patient with some

counseling for additional support and techniques useful for this disorder.

Decision #1

 Which decision did you select? I chose to start Ritalin (methylphenidate) chewable

tablets 10mg orally in the am.

 Why did you select this decision? Support your response with evidence and

references to the Learning Resources. Stimulants are considered the first-line of

therapy for children with ADHD and appears to be more favorable in children than

amphetamine-type stimulants (Stahl, 2008). Methylphenidate is a stimulant which works

to enhance arousal in the prefrontal cortex and acts explicitly to boost norepinephrine and

dopamine neurotransmission in the prefrontal cortex (Sulkes, 2019). Common side

effects may include: sleep disturbances, appetite suppression, depression, sadness,

anxiety, headaches, stomachaches and elevated heart rate and blood pressure (Stahl,

2008).

 I didn’t choose to use Intuniv extended release because it is a non-simulant and used as

second-line or third-line therapy. It also has side effects such as bradycardia, sedation,

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TREATING ADHD 3

and hypotensive effects that need to be closely monitored (Stahl, 2008) Wellbutrin was

not chosen due to it also being a non-stimulant medication which has unwanted side

effects such as possible increase thoughts of suicide in young children (Stahl, 2008).

 What were you hoping to achieve by making this decision? Support your response

with evidence and references to the Learning Resources. To decrease the patient’s

inattentive behavior that disrupts her schoolwork by increasing her attention span.

 Explain any difference between what you expected to achieve with Decision #1 and

the results of the decision. Why were they different? I expected the patient to respond

by having better days at school and less behavior problems that don’t disrupt her in the

class. According to the results after four weeks, the parents state the teacher has seen

improvement in symptoms in the morning time but by afternoon the patient is losing

focus and not productive. The patient has also voiced she feels like her heart is racing and

upon assessing the pulse rate it was elevated to 130 beats per minute. Despite the side

effects of this medication the patient has shown some improvement in her attentiveness in

school but some adjustments will need to be made to increase positive therapeutic

response to the medication prescribed.

Decision #2

I selected to change to Ritalin LA 20mg orally daily in the morning.

Why did you select this decision? Support your response with evidence and

references to the Learning Resources.

 Due to the original dosage of medication only lasted for a short portion of the day, I opted

to switch a longer-acting stimulate medication such as Ritalin LA to hopefully have

coverage of symptoms from morning throughout most of the evening. The recommended

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TREATING ADHD 4

starting dose for Ritalin LA is 20 mg once daily. Increase dosage gradually, in increments

of 10 mg weekly. Ritalin LA produces a bi-modal plasma concentration-time that peaks

approximately 4 hours apart when administered orally to children diagnosed with ADHD

and healthy adults (Stahl,2008)

 What were you hoping to achieve by making this decision? Support your response

with evidence and references to the Learning Resources. I would like to continue her

response of a positive classroom performance while increasing that effect throughout the

entire day.

 Explain any difference between what you expected to achieve with Decision #2 and

the results of the decision. Why were they different? I expected the patient to return

with continued attentiveness in school and decrease in racing heart and pulse rate. The

patient returned to clinic in four weeks, and mom states the patient’s performance is

lasting throughout the day and her feelings of racing heartbeat have stopped. Upon

examination of the pulse rate it was 92. This shows the medication Ritalin LA has a

positive response for the patient which stopped her heart racing and is lasting throughout

the day.

Decision #3

I selected to continue the current dose of Ritalin LA and reevaluate in another 4 weeks.

Why did you select this decision? Support your response with evidence and references to

the Learning Resources.

The patient continues to show symptom improvement with the medication dosage and no

adverse effects, I will continue with the same dosage.

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TREATING ADHD 5

 What were you hoping to achieve by making this decision? Support your response

with evidence and references to the Learning Resources. I was hoping to maintain the

patients well controlled symptoms with minimum side effects. With the use of Ritalin LA some

immediate effects can be seen with first dosing however it can take several weeks to attain

maximum therapeutic benefit.

 Explain any difference between what you expected to achieve with Decision #3 and

the results of the decision. Why were they different? I expected continued therapeutic

response to the medication so the patient can remain in control of her ADHD and be a productive

person in her classroom and her social surroundings.

Ethical Considerations

 Some ethical decisions about treatment with Stimulant medication are the side effects and

potential abuse of the substance. Before treatment, assess for presence of cardiac disease,

monitor weight and height and complete blood cell and platelet counts. Other problems

that girls and women with ADHD may experience include: chronic stress, low self-

esteem, underachievement and depression this is why therapy should also be considered

with starting medication management for any mental illness.

Summary

The goal of treatment of ADHD is reduction of symptoms of inattentiveness, motor

hyperactivity, and/or impulsiveness. Continuation of treatment may be needed until all symptoms

are under control or improved with the least amount of side effects for the patient.

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TREATING ADHD 6

References

Centers for Disease Control and Prevention. 2019. Attention-Deficit/Hyperactivity Disorder.

Retrieved from: https://www.cdc.gov/ncbddd/adhd/guidelines.html

Sulkes, S. B. (2019). Attention-deficit/hyperactivity disorder (ADHD). Merck Manual

Professional Version. Retrieved from: https://www.merckmanuals.com/home/children-s-

health-issues/learning-and-developmental-disorders/attention-deficit-hyperactivity-

disorder-adhd

Stahl, S. M. (2008). Essential Psychopharmacology Online. Retrieved October 28, 2019 from

https://stahlonline-cambridge-org.ezp.waldenulibrary.org/prescribers_drug.jsf?

page=9781316618134c77.html.dosing&name=METHYLPHENIDATE

%20(D,L)&title=Dos

Stahl, S. M. (2008). Essential Psychopharmacology Online. Retrieved October 28, 2019 from

https://stahlonline-cambridge-org.ezp.waldenulibrary.org/prescribers_drug.jsf?

page=9781316618134c17.html.therapeutics&name=BUPROPION&title=Therapeutics

Stahl, S. M. (2008). Essential Psychopharmacology Online. Retrieved October 28, 2019 from

https://stahlonline-cambridge-org.ezp.waldenulibrary.org/prescribers_drug.jsf?

page=9781316618134c54.html.therapeutics&name=GUANFACINE&title=Therapeutics

This study source was downloaded by 100000795183161 from CourseHero.com on 04-30-2021 19:52:51 GMT -05:00

https://www.coursehero.com/file/51126345/wk9-assgn-TGrider-ADHD-decision-treedocx/

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