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NURS 6630 Week 9 Therapy for Patients With ADHD/ODD

NURS 6630 Week 9 Therapy for Patients With ADHD/ODD

NURS 6630 Week 9 Therapy for Patients With ADHD/ODD

ADHD is a disease common among children and often continues to adulthood. This chronic condition includes the combination of various persisting problems in a patient. Such problems include impulsive behavior, difficulty in sustaining attention, and always hyperactivity. Children diagnosed with ADHD would as well struggle with low self-esteem, poor performance in academics, and trouble relating with others (Enriquez-Geppert et al., 2019). The treatment of ADHD has taken various dimensions, with different drugs chosen for the treatment depending on the underlying conditions of a patient. While another patient may be treated using Wellbutrin XL or Ritalin chewable tablets, others may be treated using intuniv extended release 1mg orally. All these medications are approved to use in patients who have ADHD. Therefore, the purpose of this study is to assess and treat Katie, who has been diagnosed with ADHD.

Introduction to the Case

The case involves an 8-year-old Caucasian girl called Katie. The patient is presented for mental examination by her parents. Katie’s educator had earlier mentioned that she might have ADHD. The parents have also carried the Conner’s Teacher Rating Scale-Revised (CTRS-R) system completed and approved by her teacher. CTRSR is a professional method used to assess the learner’s attention in class. The result from the CTRSR shows that Katie is sometimes not attentive, easily confused, and troubled in remembering things told. Her reading, spelling, and arithmetic scores are below average. She struggles in completing assigned tasks, including homework. Sometimes she starts her homework but fails to complete it and rarely follows the assignment in the order provided by the instructor. The parents oppose the teacher’s assessment that Katie might have ADHD.

In the subjective assessment, Katie seems unconcerned about the issue and claims that school life is fine. She likes art and playing. She also claims that some subjects are boring and difficult to understand. She accepts that her mind sometimes wanders off issues she finds amusing. Again, she claims that she has perfect friends and family and has never been bullied at school. On the mental state assessment, she is oriented to date, occurrence, and location and has dressed appropriately for her age and temperature. Her voice is rational and simple and fails to make any noticeable mannerisms. She claims she has never had any auditory or sensory problems.

Decision #1

Initiate the treatment by giving Ritalin (methylphenidate) chewable tablets 10mg in the morning.

The selected decision

Based on the available choices, the first decision was Ritalin-10mg chewable tablets in the morning. Ritalin is one of the best medications for treating severe ADHD. Ritalin is a methylphenidate that stimulates the central nervous system (CNS), as highlighted by Caye et al. (2019). This drug is the first-line treatment for ADHD in children and adolescents.

What I was Hoping Achieve by Making this Decision

I hope that prescribing Ritalin 10mg chewable tablets would improve the patient’s condition and increase her concentration in class. The drug has been found to eb effective in improving the general attention and performance of students (Antshel & Russo, 2019). I would as well seek the consent of the parents before administering the medication.

Why the Other Two Decisions were Not Selected

The other two decisions were to use Wellbutrin XL and intuniv extended release 1mg orally. Wellbutrin is an antidepressant that is not commonly used to treat ADHD. The drug has immense side effects, such as suicidal ideation, which are risky for children who might not understand the best ways of dealing with such emotions (Antshel & Russo, 2019). On the other hand, Intuniv is not a stimulant primarily used to control oppositional habits among ADHD patients. Katie’s condition is described by lack of attention. However, this medication would not be effective in correcting her condition.

How Ethical Considerations May Impact the Treatment Plan

While my selected treatment plan focuses on improving Katie’s condition, it would trigger beneficence and nonmaleficence ethical principles. Choosing Ritalin over provided drugs would trigger these two ethical principles (Caye et al., 2019). Ritalin appears to provide the patient with more medicinal benefits with reduced side effects (harm) on the patient.

Decision #2

Switch to Ritalin LA 20 mg PO in the morning.

Reasons for Selecting this Decision

When the patient came for her second appointment after four weeks, her instructor reported that her problems were more intense in the morning. However, she would begin her episodes of fantasy in the afternoon. Her academic success improved, but her parents were worried about her abnormal heart rate, and her pulse rate was 130 BPM. In my second option, I will switch to Ritalin 20mg PO taken in the morning. The patient heat was strange because Ritalin chewable tablets 10 mg PO is an immediate-release form that can even induce tachycardia (Antshel & Russo, 2019).

Why the Other Two Decisions were Not Selected

Proceeding with a similar dosage of Ritalin on the patient after the four-week assessment is not the correct option because it does not eliminate the afternoon lapse in her attention. Again, Ritalin does not resolve the tachycardia effect on the patient (Antshel & Russo, 2019). In her case, it would be better to switch to Ritalin LA 20mg PO taken in the morning if chewable tablets 10mg had been proven inactive after four weeks.

What I Was Hoping to Achieve by Making This Decision

I hoped changing to Ritalin LA 20mg PO in the morning would solve the drug’s side effects. The patient would record an increased concentration span throughout the day. I also hoped that the LA formulation would have no side effects and solve the tachycardia effect (Ghanaatgar et al., 2022).

How Ethical Considerations May Impact the Treatment Plan

In this case, one of the ethical concerns is nonmaleficence (do not harm) and beneficence because the patient already shows a positive response to the given drug. Again, shifting Katie to an extended-release form is another better choice for offering a long-term medicinal benefit to the patient (Ghanaatgar et al., 2022). Switching to Ritalin LA 20mg PO taken in the morning of Ritalin also aims to solve the patient’s tachycardia problem (reducing harm).

Decision #3

The decision at this point is to continue giving the patient Ritalin LA 20mg dosage in the morning.

Reasons for Selecting this Decision

The patient is back to the clinic after four weeks with the reports on her enhanced academic performance and improved symptoms. The patient also noted that the funny heart rate has also vanished. Her tests showed a heart rate of 92 beats per minute, improving. At this stage, I agreed to maintain Ritalin LA 20mg PO taken in the morning on the patient and re-evaluate her condition after another four weeks to determine her progress. The patient’s condition has changed daily, and the adverse effects have vanished (Caye et al., 2019). This shows that the choice of changing the medication on the patient was warranted.

Why the Other Two Decisions were Not Selected

Increasing the dosage of Ritalin LA to 30mg is not warranted at this stage because the effects of ADHD seem to disappear with the Ritalin LA 20mg dosage in the morning. Besides, it is recommended to use a lower dosage of Ritalin LA because raising the dosage could worsen the side effects (Zečević et al., 2019). The patient’s heartbeat is acceptable according to her age. However, other symptoms of abnormality other than tachycardia should prompt the parent to take Katie for an electrogram (EKG) focusing on her actual heart rhythm.

What I Expect to Achieve

The therapeutic decision to switch from Ritalin 10 mg chewable tables to Ritalin LA 20mg PO taken in the morning was reached because the patient was reacting positively to Ritalin LA. I aimed to keep the patient on the same medication and observe her change over four weeks. The ethical principles of beneficence and nonmaleficence came into play at this stage because of switching to Ritalin LA 20mg PO taken in the morning (Pakdaman et al., 2018). However, the patient showed an improved outcome with the Ritalin LA dosage.

How Ethical Considerations May Impact the Treatment Plan

Ethics demands that a healthcare professional select the best option that would not have the patient change their conditions for the better. In this case, beneficence and nonmaleficence have been taken into account by not allowing the parents of the patients to undertake an EKG without reason.

Conclusion

Katie is an 8-year-old Caucasian girl admitted to the mental facility by her parents after her teacher suspected that she had ADHD. The teacher assessment shows that Katie is not attentive, is quickly frustrated, and rarely follows orders from her instructor, as shown by the updated CTRS system. The patient claims that her mind wanders off to pleasant thinking. She had difficulty in learning and understanding subjects such as algebra. Her behavioral examination is regular in terms of her focus and discipline.

In my treatment plan, I took the first choice of 10 mg Ritalin in the morning, a chewable pill. The aim of using Ritalin was that it contains methylphenidate, which is one of the first-line medications for treating ADHD. Again, Ritalin is a stimulant that appears to be the most effective in treating common symptoms of limited attention. After four weeks, the patient reported notable treatment but her hallucinations would still appear in the afternoon. I switched to Ritalin LA 20mg PO taken in the morning to solve the noted side effect and improve her condition. The second assessment was positive because the patient had reduced symptoms of the infection. Therefore, the medication choice selected for the patient gave a desired positive outcome.

 

 

References

Antshel, K. M., & Russo, N. (2019). Autism spectrum disorders and ADHD: Overlapping phenomenology, diagnostic issues, and treatment considerations. Current Psychiatry Reports21(5), 1-11. https://doi.org/10.1007/s11920-019-1020-5

Caye, A., Swanson, J. M., Coghill, D., & Rohde, L. A. (2019). Treatment strategies for ADHD: an evidence-based guide to select optimal treatment. Molecular Psychiatry24(3), 390-408. https://doi.org/10.1038/s41380-018-0116-3

Enriquez-Geppert, S., Smit, D., Pimenta, M. G., & Arns, M. (2019). Neurofeedback as a treatment intervention in ADHD: Current evidence and practice. Current Psychiatry Reports21(6), 1-7. https://doi.org/10.1007/s11920-019-1021-4

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. https://doi.org/10.1108/NFS-12-2021-0388

Pakdaman, F., Irani, F., Tajikzadeh, F., & Jabalkandi, S. A. (2018). The efficacy of Ritalin in ADHD children under neurofeedback training. Neurological Sciences39(12), 2071-2078. https://doi.org/10.1007/s10072-018-3539-3

Zečević, D., Tešović, M., & Fatić, S. (2019). The Use of Neurofeedback in the Treatment of ADHD-Review of Papers. Speech And Language 2019, 227. http://www.iefpg.org.rs/Conference/2019/S&L2019_PROCEEDINGS.pdf#page=227

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.html
Anxiety and Depression Association of America. (n.d.). Adult ADHD (Attention Deficit Hyperactive Disorder). https://adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/adult-adhd

NURS 6630 Week 9 Therapy for Patients With ADHD/ODDLearning Objectives

Students 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
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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 ADHD
Note: This case study will serve as the foundation for this week’s Assignment.

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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 pages
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.
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 Information
To 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 Images
By Day 7
Complete the 20-question Quiz to gauge your understanding of this module’s content.
Submission Information
Submit 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 Images
In 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.
Content
Name: NURS_6630_Week9_Assignment_Rubric
• Grid View
• List View
Excellent

Point range: 90–100 Good

Point range: 80–89 Fair

Point range: 70–79 Poor

Point range: 0–69
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. 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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NURS 6630 Week 9 Therapy for Patients With ADHD/ODD
NURS 6630 Week 9 Therapy for Patients With ADHD/ODD

• 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 relevant resources that fully support the response.

The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients.

Examples provided fully support the decisions and responses provided. Points Range: 16 (16%) – 17 (17%)
The response accurately explains the decision selected.

The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected.

The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response.

The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response.

The response accurately explains how ethical considerations impact the treatment plan and communication with patients.

Examples provided support the decisions and responses provided. Points Range: 14 (14%) – 15 (15%)
The response inaccurately or vaguely explains the decision selected.

The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected.

The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response.

The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response.

The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients.

Examples provided may support the decisions and responses provided. Points Range: 0 (0%) – 13 (13%)
The response inaccurately and vaguely explains the decision selected.

The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing.

The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing.

The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing.

The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing.

Examples provided do not support the decisions and responses provided, or is missing.

NURS 6630 Week 9 Therapy for Patients With ADHD/ODDDecision #2 (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.
• 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 relevant resources that fully support the response.

The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients.

Examples provided fully support the decisions and responses provided. Points Range: 16 (16%) – 17 (17%)
The response accurately explains the decision selected.

The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected.

The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response.

The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response.

The response accurately explains how ethical considerations impact the treatment plan and communication with patients.

Examples provided support the decisions and responses provided. Points Range: 14 (14%) – 15 (15%)
The response inaccurately or vaguely explains the decision selected.

The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected.

The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response.

The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response.

The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients.

Examples provided may support the decisions and responses provided. Points Range: 0 (0%) – 13 (13%)
The response inaccurately and vaguely explains in detail the decision selected.

The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing.

The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing.

The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing.

The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing.

Examples provided do not support the decisions and responses provided, or is missing.

NURS 6630 Week 9 Therapy for Patients With ADHD/ODDDecision #3 (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.
• 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 relevant resources that fully support the response.

The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients.

Examples provided fully support the decisions and responses provided. Points Range: 16 (16%) – 17 (17%)
The response accurately explains the decision selected.

The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected.

The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response.

The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response.

The response accurately explains how ethical considerations impact the treatment plan and communication with patients.

Examples provided support the decisions and responses provided. Points Range: 14 (14%) – 15 (15%)
The response inaccurately or vaguely explains the decision selected.

The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected.

The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response.

The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response.

The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients.

Examples provided may support the decisions and responses provided. Points Range: 0 (0%) – 13 (13%)
The response inaccurately and vaguely explains in detail the decision selected.

The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing.

The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing.

The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing.

The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing.

Examples provided do not support the decisions and responses provided, or is missing.

NURS 6630 Week 9 Therapy for Patients With ADHD/ODDConclusion (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. Points Range: 14 (14%) – 15 (15%)
The response accurately and clearly summarizes in detail the recommendations on the treatment options selected for this patient.

The response accurately and clearly explains a justification for the recommendations provided, including clinically relevant resources that fully support the recommendations provided. Points Range: 12 (12%) – 13 (13%)
The response accurately summarizes the recommendations on the treatment options selected for this patient.

The response accurately explains a justification for the recommendation provided, including clinically relevant resources that support the recommendations provided. Points Range: 11 (11%) – 11 (11%)
The response inaccurately or vaguely summarizes the recommendations on the treatment options selected for this patient.

The response inaccurately or vaguely explains a justification for the recommendations provided, including clinically relevant resources that inaccurately or vaguely support the recommendations provided. Points Range: 0 (0%) – 10 (10%)
The response inaccurately and vaguely summarizes the recommendations on the treatment options selected for this patient, or is missing.

The response inaccurately and vaguely explains a justification for the recommendations provided, including clinically relevant resources that do not support the recommendations provided, or is missing.
Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria. Points Range: 5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. Points Range: 4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive. Points Range: 3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.

Purpose, introduction, and conclusion of the assignment is vague or off topic. Points Range: 0 (0%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.

No purpose statement, introduction, or conclusion were provided.
Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation Points Range: 5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors. Points Range: 4 (4%) – 4 (4%)
Contains a few (1 or 2) grammar, spelling, and punctuation errors. Points Range: 3.5 (3.5%) – 3.5 (3.5%)
Contains several (3 or 4) grammar, spelling, and punctuation errors. Points Range: 0 (0%) – 3 (3%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list. Points Range: 5 (5%) – 5 (5%)
Uses correct APA format with no errors. Points Range: 4 (4%) – 4 (4%)
Contains a few (1 or 2) APA format errors. Points Range: 3.5 (3.5%) – 3.5 (3.5%)
Contains several (3 or 4) APA format errors. Points Range: 0 (0%) – 3 (3%)
Contains many (≥ 5) APA format errors.
Total Points: 100

Name: NURS_6630_Week9_Assignment_Rubric

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.

Decision 1

Chewable Methylphenidate tablets 10mg orally in the morning

Reason for Selection

Methylphenidate is considered the first-line drug therapy for childhood, adolescent, and adult ADHD (Cortese et al., 2021). The American Academy of Pediatrics recommends parent training in behavior management, and classroom training, along with medications. Methylphenidate is highly efficacious in the resolution of emotional dysregulation, and propensity to violent behavior and increases susceptibility to learning and rehabilitation of social skills (Asherson et al., 2019). The availability of methylphenidate also influences its wide use.

The few Randomized Control Studies done show that Bupropion is considered as effective as Methylphenidate in the treatment of ADHD. It also has fewer adverse symptoms compared to methylphenidate. For therapy, several trials agree that there is still a need for a further trial of the medication. Some serious adverse effects like paresthesia, agitation, and palpitations were marked in bupropion (Pozzi et al., 2020). For this reason, its suitability for treatment is reduced especially in children and adolescents.

In trials of Intuniv, there was significant symptomatology improvement in inattention, hyperactivity, and impulsivity. Intuniv is however associated with severe side effects such as polydipsia, hypotension, nasopharyngitis, and hypersomnolence (Iwanami et al., 2020). This limits its use despite having a decent efficacy.

Expectation

There is an expected beginning of the resolution of symptomatology within a few days of therapy. These changes include an enhanced concentration with a slightly increased concentration span, improved attention, reduced distractibility, and a reduction in antisocial behaviors like violence and breaking of school rules (Jaeschke et al., 2021). These changes must be supported by both classroom and parent training.

Ethical Considerations

The ethical considerations are hinged on the four principles of justice, do no harm, beneficence, and respect for autonomy. Considering the best treatment for the child’s condition is approved through research findings. The autonomy of children is an important factor. A child’s flexibility in preference is important in character development. A small room for guided autonomy is associated with better outcomes. For this reason, the parents act in the best interest of the child. Informed consent is key. Informed consent in children is proven to strengthen the morals and structure of the child by improving esteem and social interactions (Díaz-Pérez et al., 2020). Providing adequate information and education regarding the condition is n important tenet. Providing top-notch care in the best interest of the child through offering follow-up is vital.

Decision 2

Change to Ritalin LA 20mg orally daily in the morning

Reason for Selection

The slow-release long-acting Ritalin is considered effective in controlling symptoms of inattention and hyperactivity (Karahmadi et al., 2020). The long-acting Ritalin has increased compliance with medication. Although the adverse effects of the long-acting and short-acting Ritalin are comparatively the same, Ritalin LA could be responsible for a reduction in side effects as it causes a maintained plasma concentration of the drug over time.

Arrhythmias and increased systolic blood pressure are common adverse effects of Ritalin (Liang et al., 2018). Continuation with the same dose of Ritalin could cause further development in other side effects of cardiovascular disease such as stroke which would be detrimental (Nauman et al., 2021). Adderall has a very high potential for abuse and dependence. In women, Adderall can cause infertility. Sudden stoppage of the drug also comes with severe withdrawal effects such as suicidal ideas, delusions, and psychosis. These side effects occur in both the short term and the long term.

Expectations

Due to a change to Ritalin LA, there is expected maintenance in improved concentration and consequently a good performance. Resolution of the daydreaming in the afternoon. There is also an expected decrease in the presenting side effects like high heart rate; there is an expected reduction in heart rate.

Ethical Considerations.

Informed consent to the change of drug is important with adequate education on the dosage. Autonomy of the child should be guided by the parents as at the same time the child is allowed to express their preference (Díaz-Pérez et al., 2020). Continuous counseling of the family on how best to handle and train the child. A cordial patient-doctor relationship is very vital for this particular case as it eases subsequent clinic visits for follow-up.

Decision 3

Maintain current dose of Ritalin LA and reevaluate in 4 weeks

Reason for Selection

At this point, the current dose is effective in perfectly controlling the symptoms and the side effects have vanished. It is advised that in drug usage, the lowest effective dose is indicated. Here heart rate of 92 beats per minute falls in the range appropriate for her age. For this reason, maintaining the current dosage is the most plausible option. Increasing Ritalin LA  to higher doses is not advisable firstly because the symptoms are well controlled without any adverse effects. Secondly higher doses are associated with increased side effects (Karahmadi et al., 2020). Obtaining an EKG based on her heart rate is futile. The heart rate of 92 beats per minute is normal for her age.

Expectations

The current dose of Ritalin in conjunction with the psychosocial treatments should be able to abate the symptoms. There should be a net effect of improved concentration and learning. The girl should be able to get better grades. There will be improved interest in school work and not easily distractible. There will be minimal side effects of the drug as it is set at the lowest effective dose.

Ethical Considerations

The mere fact of not doing any harm and providing recommended drug treatment at the minimal effective dose is not enough. Respectful handling of the patient in a child-friendly manner and her parents by the healthcare provider is an essential part of treatment as it builds patient confidentiality and trust (Díaz-Pérez et al., 2020). The success of long-term follow-up is also greatly dependent on this relationship. Sound patient education on the side effects and dosage of the drug is key.

Conclusion

ADHD is a common encounter in child psychiatry. It is mostly overdiagnosed even in patients who show a few symptoms but don’t meet the diagnostic criteria (Magnus et al., 2020).  It is characterized by reduced attention, hyperactivity, and impulsivity. These symptoms have to occur for no less than 6 months and the patient less than 12 years for a primary diagnosis to be made. Although ADHD is more common in boys, the inattention subtype is common in girls. This case study provides a perfect example of the inattention subtype. It involves an 8-years-old Caucasian girl who displays markedly reduced attention in class, easy distractibility, and poor academic performance but does not have violent properties. There is no demarcated precipitating factor for her condition. Methylphenidate is the first-line drug used in the management of ADHD in all age groups (Cortese et al., 2021). Methylphenidate is highly efficacious in the resolution of emotional dysregulation, and violent behavior and increases susceptibility to learning and rehabilitation of social skills (Asherson et al., 2019).

The availability of methylphenidate also influences its wide use. Studies show that Bupropion is as effective as Methylphenidate in the treatment of ADHD. For therapy, several trials agree that there is still a need for a further trial of the medication. Intuniv use is marred by adverse effects such as increased thirst, nasopharyngitis, and somnolence which makes its use unpopular  (Iwanami et al., 2020). Studies comparing the efficacies of Ritalin LA and the short-acting Ritalin show only a minimal difference in their profiles. The slow release of Ritalin reduces the dosing interval hence improving medication adherence. In the dissolution of symptoms, there is no major difference although clinically, Ritalin LA is associated with reduced side effects (Karahmadi et al., 2020). The principle of monotherapy and usage of the lowest effective dose is a key facet in the treatment of ADHD. The drug choice is influenced by the pharmacokinetic profile of the drug, availability, age of the patient, symptomatology, level of academic and social impairment, subtype of ADHD, gender, and the socio-economic status of the patient (Kamimura-Nishimura et al., 2019). Ethical considerations include informed consent, guided autonomy, providing the best treatment possible, formation of meaningful patient and healthcare provider relationships that improve treatment, and constant counseling and education of the patient concerning the different aspects of management.

 

References

Asherson, P., Johansson, L., Holland, R., Fahy, T., Forester, A., Howitt, S., Lawrie, S., Strang, J., Young, S., Landau, S., & Thomson, L. (2019). Randomised controlled trial of the short-term effects of OROS-methylphenidate on ADHD symptoms and behavioural outcomes in young male prisoners with attention-deficit/hyperactivity disorder (CIAO-II). Trials, 20(1). https://doi.org/10.1186/s13063-019-3705-9

Cortese, S., Newcorn, J. H., & Coghill, D. (2021). A Practical, Evidence-informed Approach to Managing Stimulant-Refractory Attention Deficit Hyperactivity Disorder (ADHD). CNS Drugs, 35(10), 1035–1051. https://doi.org/10.1007/s40263-021-00848-3

Díaz-Pérez, A., Navarro Quiroz, E., & Aparicio Marenco, D. E. (2020). Moral structuring of children during the process of obtaining informed consent in clinical and research settings. BMC Medical Ethics, 21(1). https://doi.org/10.1186/s12910-020-00540-z

Iwanami, A., Saito, K., Fujiwara, M., Okutsu, D., & Ichikawa, H. (2020). Efficacy and Safety of Guanfacine Extended-Release in the Treatment of Attention-Deficit/Hyperactivity Disorder in Adults. The Journal of Clinical Psychiatry, 81(3). https://doi.org/10.4088/jcp.19m12979

Jaeschke, R. R., Sujkowska, E., & Sowa-Kućma, M. (2021). Methylphenidate for attention-deficit/hyperactivity disorder in adults: a narrative review. Psychopharmacology, 238(10), 2667–2691. https://doi.org/10.1007/s00213-021-05946-0

Kamimura-Nishimura, K. I., Epstein, J. N., Froehlich, T. E., Peugh, J., Brinkman, W. B., Baum, R., Gardner, W., Langberg, J. M., Lichtenstein, P., Chen, D., & Kelleher, K. J. (2019). Factors Associated with Attention Deficit Hyperactivity Disorder Medication Use in Community Care Settings. The Journal of Pediatrics, 213, 155-162.e1. https://doi.org/10.1016/j.jpeds.2019.06.025

Karahmadi, M., Saadatmand, S., & Tarahi, M. J. (2020). Investigation of Efficacy of Short-Acting Methylphenidate (Ritalin) and Long-Acting (Matoride) on Symptoms of Attention Deficit Hyperactivity Disorder in Children Aged 6–18 Years: A Single-Blind, Randomized Clinical Trial. Advanced Biomedical Research, 9. https://doi.org/10.4103/abr.abr_9_20

Liang, E. F., Lim, S. Z., Tam, W. W., Ho, C. S., Zhang, M. W., McIntyre, R. S., & Ho, R. C. (2018). The Effect of Methylphenidate and Atomoxetine on Heart Rate and Systolic Blood Pressure in Young People and Adults with Attention-Deficit Hyperactivity Disorder (ADHD): Systematic Review, Meta-Analysis, and Meta-Regression. International Journal of Environmental Research and Public Health, 15(8), 1789. https://doi.org/10.3390/ijerph15081789

Magnus, W., Nazir, S., Anilkumar, A. C., & Shaban, K. (2020). Attention Deficit Hyperactivity Disorder (ADHD). PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK441838/

Nauman, M., Hahn, C., Nketiah, E., Ahmad, S., & Karmali, R. (2021). Adderall induced dilated cardiomyopathy in an adult male with ADHD. Journal of the American College of Cardiology, 77(18), 2325. https://doi.org/10.1016/s0735-1097(21)03680-9

Pozzi, M., Bertella, S., Gatti, E., Peeters, G. G. A. M., Carnovale, C., Zambrano, S., & Nobile, M. (2020). Emerging drugs for the treatment of attention-deficit hyperactivity disorder (ADHD). Expert Opinion on Emerging Drugs, 25(4), 1–13. https://doi.org/10.1080/14728214.2020.1820481