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NURS 6630 Assignment Treating Patients With ADHD

NURS 6630 Assignment Treating Patients With ADHD

NURS 6630 Assignment Treating Patients With ADHD

Attention-deficit/hyperactivity disorder (ADHD) is a mental condition that is mostly common among children. The condition is associated with various behavioral symptoms including issues with maintaining good attention, excessive motor activities, and impulsiveness during the subsistence of the condition. The symptoms of ADHD in children include challenges in socializing with peers, poor grades in class, and excitability. The diagnosis of ADHD is challenging because it is problematic to determine the precise setting where the victims can demonstrate the symptoms. However, if some of the above mentioned symptoms endure for more than six months, it is can result in diagnosis of the conditioned and consequently pave way for an effective therapy (Ahmann et al., 2017). The aim of this paper is to delve into the management of ADHD on an 8-year-old Caucasian girl. In particular, a therapy will be developed based on pharmacokinetics and pharmacodynamics. Moreover, ethical considerations of the therapy will be examined.

Summary of the Case

The present case involves is about an 8-year old Caucasian female named Katie. She was brought to the clinic by her parents after receiving a referral from the primary care provider (PCP) after an evaluation by her teacher and a perception that she might be having ADHD. Parents wanted their daughter to be evaluated by a psychiatrist to affirm or rule out ADHD as reported by Katie’s teacher. In addition, the parents handed over a Corner’s Teacher Rating Scale-Revised form to the psychiatric-mental health nurse practitioner (PMHNP) which was filled by Katie’s teacher to report about the patient’s symptoms. According to the report, Katie is easily distracted, inattentive, forgetful in addition to having challenges with spelling, arithmetic, and reading. She also has a short attention span and mostly attends to activities that are of interest to her. According to the teacher, Katie is not interested in classwork, and that she gets easily distracted with non-academic things. She can also start activities and fails to finish them and rarely follows instructions required to accomplish schoolwork.  Katie’s parents, however, deny the teacher’s assertion about the condition of their daughter arguing that she could manifest psychotic symptoms that they have not yet seen in their child. In using the DMS-IV rating scale, Katie’s condition points to ADHD.  She has difficulty in paying attention and is also hyperactive when informed about her mental condition. Besides, Katie acts without thought especially when she affirms that she likes art and recess but finds other school subjects boring. She, therefore, misses the details as to why she has been enrolled in a school and is likely not to apply mental effort required in learning if not treated on time.

First Decision Point

Chosen Decision

Begin the patient on Ritalin 10 mg tablets PO in their chewable form in the mornings.

Reasons for the Selecting this Decision

Ritalin (methylphenidate) is approved by the FDA as the first line medication in the ADHD management. Ritalin is also ideal compared to other non-stimulant agents ion relation to the effect size. While effect size of Ritalin is 0.5, other non-stimulant agents such as Intuniv has effect size of 0.9. Mechanically, Ritalin operates by inhibiting the dopamine and neurotransmitters norepinephrine reuptake. In addition, the medication contains a concentration of a plasma bi-modial when administered to children orrally. Moreover, the medication contains plasma binding in low capacity and a bioavailability of 22±8%, which is an indication of a marked presystemic metabolism. The adverse effects of the medication in children is relatively low given that it has a rapid half-life of about 3.5 hours (Brown et al., 2018). Other medications such as Wellbutrin was not considered in this case because of minimal safety profile especially in children. It also has many side effects including seizures, making it unfit for children. Therefore, this drug was not used because it is considered as an alternative non-stimulant agent that is not FDA authorized.

Expected Results in this Decision

Ritalin has been demonstarted to generate the desired effects 2 weeks following adminstration. Therefore, the PMNHP anticipates that the girl would demonstrate high concentration, interpersonal relationships, and improved focus (Brown et al., 2018). The rationale for opting for lower dose daily is informed by a precautionary measure not to affect the girl by the medication.

Differences between Anticipated and Real Results

The patient was presented back to the facility after two weeks. After assessment and data collection, the PMNHP realized that the girl did not demonstrate signs of being inattentive in school during morning hours. Consequently, the secondary data identified that the girl had improved in her academic performance. This is essentially in line with what the PMNHP expected. However, the improvements were shown to deterioriate during the afternoon hours due to the reduction in the therapeutic effect of the Ritalin. As a result, the girl starts wandering into space and daydreaming in the afternoon hours. The Tachycardia, which is a side-effect commonly associated with  Ritalin was also reported in patient.

How Ethical Considerations May Impact the Treatment Plan

There is need for ethical considerations in the treatment plan such as autonomy to help in engaging the patient and her family in the treatment process. Beneficence and nonmaleficence considerations are also necessary in ensuring that the identified plan results in the best care outcomes without the risk of harm to the patients (Slade, 2017). For example, the medication chosen in this case is effective in treating ADHD with least side effects that cannot cause harm to the girl.

Second Decision Point

Chosen Decision

Shift to 20 mg of Ritalin LA once daily in the morning.

Reason for Selecting this Decision

The ratiobnale of increasing the dosage is to help in managing the elevated hearts which emanated as a consequence of the initail decision. Increasing the Ritalin dosage is essential for long action, thus, making it have extended therapeutic effect on the patient, which can last for about 12 hours unlike the initial dosage which had half-life of 3.5 hours. Also, it is likely to be controlled and demonstrate reduced release nature, which is crucial in minimizing the peak plasma concentration of the medication, thus, dealing with the cardiovascular side effects that the patient experienced after the initial intervention (Ching et al., 2019).  There was no any drug compliance issues reported in patient and so, it is not neccesary to opt for other agents such as Adderal. In fact, Adderal is likely to result in increased heart beats as side effects similar to what was reported in the initial intervention.

Expected Results in this Decision

The expectation by the PMHP is that the girl would demonstrate controlled symptoms the whole day for the duration of four weeks that she would be on the long acting medication. She is also expected to have better concentration both in the morning and evening hours. The improved concentration should in turn help her to improve in her academic performance at school. Moreover, the PMNHP anticipates that the girl’s heart rate activities will be restored back to normal within the medication period (Konrad-Bindl et al., 2016).

Differences between Expected Results and Real Results

When the patient visited after four weeks, the assessment and data gathered through secondary sources indicated that her concentration at school improved after effecting the adjustments to the original therapy. As a result, their was outstanding improvement in her academic performances. Moreover, the patient’s heart rate stabilized as a result of using the Ritalin LA. This improvement in the patient outcomes is attributed to consistent compliance to the therapy as anticipated by the PMNHP.

How Ethical Considerations May Impact the Treatment Plan

Ethical principles of beneficence and nonmaleficence can possibly impact treatment plan by determining how the medication can help patient and the possible side effects of the treatment choice (Slade, 2017). For instance, in the present case, Ritalin was opted for due to its potential in ensuring beneficence and other medications such as Wellbutrin avoided due to their dire side effects that may cause harm to the patient.

Third Decision Point

Chosen Decision

The Ritalin dosage will be maintained. However, the girl will have to be re-evaluated after four weeks following the administration of medication.

Reason for Selecting this Decision

As shown above, the girl positively responded to the second dosage. The dosage proved effective in managing the symptoms and addressing the Tachycardia, which is an indication that it is necessary for the nurse to maintain this therapy.  The idea of increasing the dosage of Ritalin LA to 30 mg was ruled out on the ground that it is likely to lead to negative events as a result of increased plasma concentration which can lead to another incidences of reccurance of increased heart rate (Huss et al., 2017). The current heart rate of the girl is 92, which is in the ordinary heart rate range for children and young people between the ages 6-12. Imperatively, the impacts of extended use of  Ritalin in children have not been systematically assessed and established. As such, it is vital to conduct the re-assessment after four weeks.

Expected Results in this Decision

The expectation is that the girl will consistently demonstrate improvements in concentration, which would in turn ensure better improvement in her academic performances. It is also expectation of the PMNHP that heart rate of the girl will return to the normal range for young children which is between 75-118. Regarding the side efefcts, it is the expectation of the PMNHP that no side effects will be manifested in patient again.

Differences between Expected Results and Real Results

The restraint of the symptom in the patient is anticipated to persist. As a result, the expectation is that the patient would improve in her concentration in class the entire day without any distractions. Moreover, it is expected that the heart rate will continue to be about 92 and no severe side effect wiil manifest. To achieve these expectations, the patient should strictly adhere to the medications to benefit from the long-term positive impacts.

How Ethical Considerations May Impact the Treatment Plan

Ethical considerations such as nonmaleficence and beneficence can potentially impact the treatment plan by ensuring that the identified medication fosters desired outcomes. The benefits of the medication should also offset the risk (Slade, 2017). Upholding these considerations can be demonstrated in efforts to reduce side effects of medication by reducing the dosage in case of side effect or opting for a drug with insignificant or no side effects.

Conclusion

ADHD as a mental condition that is assocaited with many dire consequences in young children. The disgnosis of the ADHD is chalenging due to several symptomatology similarities it has with other mental health conditions. However, stimulants such as Ritalin have proven valuable in managing this condition. The first decision entailed the use of ritalin 10 mg in  its chewable form to ensure compliance. The client’s parents and teachers repoerted improved symptomatology by the patient. Her concentration and attention to things improved significantly. However, the intervention also produced a side effect of increased heart beat rate, which is common in the drug in some cases (Brown et al., 2018). As such, I was compelled to ensure that the next decision would address the side effect. As such, I chose to use 20 mg of the same medication but in its longacting form. The longacting nature of the drug was effective in managing both the high heart rate side effect. In addition, the long acting capacity improved the therapeutic effect of the drug. The client was able to concentrate on activities throughout the day.

The improved therapeutic impact of the second choice meant that it was unnecessary to interfere with the therapy. As such, the Ritalin dosage and nature were maintained. However, I choose to recommend another assessment within 4 weeks to monitor the progress of the therapy. The other reason for conducting the assessment after four weeks is based in the fact that the effect of the long acting nature of the drug has not been established (Konrad-Bindl et al., 2016). As such, I chose the decision  deliberately for those reasons. Therefore, Ritalin is an effective drug in the management of the ADHD in the patient.

References

Ahmann, E., Saviet, M., & Tuttle, L. J. (2017). Interventions for ADHD in children and teens: A focus on ADHD coaching. Pediatric Nursing, 43(3), 121. https://search.proquest.com/openview/e957b43bd0b75aec19bee528ffece353/1?pq-origsite=gscholar&cbl=47659

Brown, K. A., Samuel, S., & Patel, D. R. (2018). Pharmacologic management of attention deficit hyperactivity disorder in children and adolescents: a review for practitioners. Translational pediatrics, 7(1), 36. doi: 10.21037/tp.2017.08.02

Ching, C., Eslick, G. D., & Poulton, A. S. (2019). Evaluation of methylphenidate safety and maximum-dose titration rationale in attention-deficit/hyperactivity disorder: a meta-analysis. JAMA pediatrics, 173(7), 630-639. doi:10.1001/jamapediatrics.2019.0905

Huss, M., Duhan, P., Gandhi, P., Chen, C. W., Spannhuth, C., & Kumar, V. (2017). Methylphenidate dose optimization for ADHD treatment: review of safety, efficacy, and clinical necessity. Neuropsychiatric disease and treatment. https://psycnet.apa.org/record/2017-30608-001

Konrad-Bindl, D. S., Gresser, U., & Richartz, B. M. (2016). Changes in behavior as side effects in methylphenidate treatment: review of the literature. Neuropsychiatric disease and treatment. https://psycnet.apa.org/record/2016-51190-001

Slade, M. (2017). Implementing shared decision making in routine mental health care. World psychiatry, 16(2), 146-153. https://doi.org/10.1002/wps.20412

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.

Consider how you may assess and treat patients who present with ADHD for this Assignment.
To get ready for this assignment, do the following:
• Go over this week’s Learning Resources, including the Medication Resources listed.
• Consider the psychopharmacologic treatments you might propose for the screening and treatment of ADHD patients.
The assignment is 5 pages long.
Examine Study of a Case: A young Caucasian girl suffering from ADHD. You will be required to make three decisions on the medication to be prescribed to this patient. Take into account any circumstances that may have an impact on the patient’s pharmacokinetic and pharmacodynamic processes.
At each decision point, consider all choices before making your choice and continuing on with the activity. Choose certain that you have thoroughly examined each alternative and that you have evaluated the decision that you will make. Make careful to conduct primary literature study on each option.
The Case’s Introduction (1 page)
• Explain and describe the case for this Assignment in a few sentences. When recommending medication for this patient, make sure to note any specific patient variables that may influence your decision.
NURS 6630 Assignment: Treating ADHD Patients
First decision (1 page)
• Which option did you choose?
• Why did you make this choice? Be detailed in your response and back it up with clinically relevant and patient-specific resources, such as original literature.
• Why didn’t you choose the other two possibilities presented in the exercise? Be detailed in your response and back it up with clinically relevant and patient-specific resources, such as original literature.
• What did you hope to accomplish by making this decision? Provide evidence and references to the Learning Resources to back up your response (including the primary literature).
• Describe how ethical issues may affect your treatment approach and patient communication. Provide specifics and instances.

NURS 6630 Assignment Treating Patients With ADHD
Decision No. 2 (1 page) • Why did you make this choice? Be detailed in your response and back it up with clinically relevant and patient-specific resources, such as original literature.
• Why didn’t you choose the other two possibilities presented in the exercise? Be detailed in your response and back it up with clinically relevant and patient-specific resources, such as original literature.
• What did you hope to accomplish by making this decision? Provide evidence and references to the Learning Resources to back up your response (including the primary literature).
• Describe how ethical issues may affect your treatment approach and patient communication. Provide specifics and instances.
Third decision (1 page)
• Why did you make this choice? Be detailed in your response and back it up with clinically relevant and patient-specific resources, such as original literature.
• Why didn’t you choose the other two options presented in the exercise? Be detailed in your response and back it up with clinically relevant and patient-specific resources, such as original literature.
• What did you hope to accomplish by making this decision? Provide evidence and references to the Learning Resources to back up your response (including the primary literature).
• Describe how ethical issues may affect your treatment approach and patient communication. Provide specifics and instances.
Conclusion (1 page)
• Provide a summary of your suggestions for the therapy options you chose for this patient. Make sure to substantiate your recommendations and back them up with clinically relevant and patient-specific resources, such as primary literature.
Please include at least five academic resources to back up your reasoning. While you may utilize the course content to support your reasoning, it will not count as a resource. You should use both primary and secondary literature.

Reminder: All papers submitted to the College of Nursing must have a title page, introduction, summary, and references. The Walden Writing Center Sample Paper (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632) is an example of those needed features. This formatting must be used for all papers submitted.

By Day 7

NURS 6630 Assignment Treating Patients With ADHD
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

Week 9: Therapy for Patients With ADHD/ODD
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 Assignment Treating Patients With ADHDLearning 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

NURS 6630 Assignment Treating Patients With ADHD
________________________________________

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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

Medication 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.

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.
Decision #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.
• 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.

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NURS 6630 Assignment Treating Patients With ADHD
NURS 6630 Assignment Treating Patients With ADHD

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.
Decision #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 Assignment Treating Patients With ADHDDecision #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.
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. 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