NURS 6630 The Management of Attention Deficit Hyperactivity Disorder (ADHD)
Walden University NURS 6630 The Management of Attention Deficit Hyperactivity Disorder (ADHD)-Step-By-Step Guide
This guide will demonstrate how to complete the Walden University NURS 6630 The Management of Attention Deficit Hyperactivity Disorder (ADHD) assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.
How to Research and Prepare for NURS 6630 The Management of Attention Deficit Hyperactivity Disorder (ADHD)
Whether one passes or fails an academic assignment such as the Walden University NURS 6630 The Management of Attention Deficit Hyperactivity Disorder (ADHD) depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.
After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.
How to Write the Introduction for NURS 6630 The Management of Attention Deficit Hyperactivity Disorder (ADHD)
The introduction for the Walden University NURS 6630 The Management of Attention Deficit Hyperactivity Disorder (ADHD) is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.
How to Write the Body for NURS 6630 The Management of Attention Deficit Hyperactivity Disorder (ADHD)
After the introduction, move into the main part of the NURS 6630 The Management of Attention Deficit Hyperactivity Disorder (ADHD) assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.
Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.
How to Write the Conclusion for NURS 6630 The Management of Attention Deficit Hyperactivity Disorder (ADHD)
After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.
How to Format the References List for NURS 6630 The Management of Attention Deficit Hyperactivity Disorder (ADHD)
The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.
Stuck? Let Us Help You
Completing assignments can sometimes be overwhelming, especially with the multitude of academic and personal responsibilities you may have. If you find yourself stuck or unsure at any point in the process, don’t hesitate to reach out for professional assistance. Our assignment writing services are designed to help you achieve your academic goals with ease.
Our team of experienced writers is well-versed in academic writing and familiar with the specific requirements of the NURS 6630 The Management of Attention Deficit Hyperactivity Disorder (ADHD) assignment. We can provide you with personalized support, ensuring your assignment is well-researched, properly formatted, and thoroughly edited. Get a feel of the quality we guarantee – ORDER NOW.
The management of attention deficit hyperactivity disorder (ADHD) in children is difficult due to a lack of evidence supporting the safety of several recommended drugs for this disorder. The case of an 8-year-old Caucasian female has been provided to further illustrate the management of ADHD. The patient exhibits ADHD symptoms as identified by her teacher, who completed the Conner’s Teacher Rating Scale-Revised. Her teacher claims that the patient is frequently forgetful and easily distracted, with a short attention span. The patient also has poor language, spelling, and arithmetic skills, which negatively impact her overall school performance. The teacher also stated that the patient has recently been failing to follow instructions, resulting in incomplete homework. Despite her parents’ denial that their daughter has ADHD, the patient reports that she is bored most of the time at school and has little interest in her schoolwork. She, on the other hand, denies any kind of bullying at school and has a positive home life experience. The patient was diagnosed with Attention deficit hyperactivity disorder, predominantly inattentive presentation, based on the findings of the conducted mental status examination and the Conner’s Teacher Rating Scale-Revised.
Several factors were considered when deciding on the specific pharmacological agent and dosage to prescribe in the patient’s condition management. Such factors include the patient’s young age, Caucasian race, ADHD diagnosis, and reported symptoms. The completed Conner’s Teacher Rating Scale-Revised can also assist in determining the severity of the patient’s condition, which is important in determining the dosage of the chosen drug. As such, the purpose of this discussion is to devise the most effective treatment plan for the 8-year-old patient’s ADHD management, with a rationale for each decision made.
Not only do children and adults have different presentations for ADHD, but males and females may also have vastly different clinical presentations. Different people may also respond to medication therapies differently. For example, some ADHD medications may cause children to experience stomach pain, while others can be highly addictive for adults. In your role, as a psychiatric nurse practitioner, you must perform careful assessments and weigh the risks and benefits of medication therapies for patients across the life span. For this Assignment, you consider how you might assess and treat patients presenting with ADHD.
To get ready for this Task:
Review the Learning Resources for this week, as well as the Medication Resources for this week.
Think about what kinds of psychopharmacological treatments you might suggest for evaluating and treating people with ADHD.
The Task: Five pages
Check out the Case Study: A Young White Girl with ADHD.
You will be asked to decide on three different medications to give to this patient. Make sure to think about things that could affect the pharmacokinetic and pharmacodynamic processes of the patient.
At each decision point, you should think about all of your choices before making a choice and moving on. Before you make a choice, make sure you’ve looked into each option and thought carefully about the one you’ll choose. Make sure to look into each choice using the primary sources.
The beginning of the case (1 page)
Explain and sum up the case for this Assignment in a few words. When writing a prescription for this patient, make sure to list the specific patient factors that may affect your choice.
Choice No. 1 (1 page)
Which choice did you choose?
Why did you choose this path? Be specific and back up your answer with resources that are clinically relevant and specific to the patient, such as the primary literature.
Why didn’t you choose either of the other two choices in the exercise? Be specific and back up your answer with resources that are clinically relevant and specific to the patient, such as the primary literature.
What did you want to happen when you made this choice? Use evidence and references to the Learning Resources to back up your answer (including the primary literature).
Explain how your treatment plan and how you talk to patients may be affected by ethical issues. Give examples and be specific.
Choice No. 2 (1 page)
Why did you choose this path? Be specific and back up your answer with resources that are clinically relevant and specific to the patient, such as
- primary literature.Why didn’t you choose either of the other two choices in the exercise? Be specific and back up your answer with resources that are clinically relevant and specific to the patient, such as the primary literature.
What did you want to happen when you made this choice? Use evidence and references to the Learning Resources to back up your answer (including the primary literature).
Explain how your treatment plan and how you talk to patients may be affected by ethical issues. Give examples and be specific.
Read Also: Assignment: Assessing and Treating Clients With ADHD NURS6630
Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: NURS 6630 The management of attention deficit hyperactivity disorder (ADHD)
Choice No. 3 (1 page)
Why did you choose this path? Be specific and back up your answer with resources that are clinically relevant and specific to the patient, such as the primary literature.
Why didn’t you choose either of the other two choices in the exercise? Be specific and back up your answer with resources that are clinically relevant and specific to the patient, such as the primary literature.
What did you want to happen when you made this choice? Use evidence and references to the Learning Resources to back up your answer (including the primary literature).
Explain how your treatment plan and how you talk to patients may be affected by ethical issues. Be specific and provide examples.
In the end (1 page)
Summarize the treatment options you chose for this patient and what you think should be done. Make sure to back up your recommendations and answer with resources that are relevant to the patient and clinically useful, such as the primary literature.
Note: Use at least five academic sources to back up your reasoning. You can use the course text to back up your reasoning, but it won’t count as one of the resources you need. You should use both first-hand and second-hand sources.
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
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:
Sample Answer for NURS 6630 The Management of Attention Deficit Hyperactivity Disorder (ADHD)
Attention Deficit Hyperactivity Disorder (ADHD) is one of the most prevalent disorders in child psychiatry with the prevalence increasing over the years. It is characterized by inattention, hyperactivity, and impulsivity. It has a male predilection with a male to female ratio of 2:1. The hyperactive and impulsive subtype is the most prevalent. The inattentive subtype occurs in 18.3% of the condition and mostly affects females (Magnus et al., 2020). ADHD is diagnosed before the age of 12 years. It affects an individual’s ability to form and maintain close social ties.
This week’s case study focuses on Katie an 8-year-old Caucasian female brought into the office by her parents following a referral. She is referred for a psychiatry assessment to determine if she has ADHD. From the Conner’s Teacher Rating Scale-Revised, Katie is inattentive, easily distracted, forgets things already learned, and poor in spelling, reading, and arithmetic. Of note is that she has a short attention span, lacks interest in school work, is easily distracted, starts things but never finishes them, seldom follows through on instructions, and fails to finish her school work. She has no open defiance or temper outbursts. In subjective history, her favorite subjects are art and recess. She finds other subjects hard and boring. She admits her mind wanders off from class most of the time. There is no history of abuse or bullying at school. She reports that her home life is fine and her parents are good to her. The Mental State Exam is normal. She is appropriately developed for her age. She has a clear, coherent, and logical speech. She is oriented to time, place, person, and event. She has no mannerisms or tics. Her subjective mood is euthymic with a bright affect. She has no hallucinations, delusions, or abnormalities of thought. Attention and concentration are intact. Insight and judgment are age appropriate. Her diagnosis is ADHD, predominantly inattentive presentation. Decision-making in the prescription of ADHD medication is influenced by the patient’s gender, the subtype of ADHD displayed, level of academic impairment, age, and the parent’s socioeconomic status (Kamimura-Nishimura et al., 2019). These factors act together to influence the drug to be used, the dosage, and the duration of therapy. The purpose of this paper is to discuss the decision points on the treatment of this patient in regards to the choice of drug, the expectations post initiation of therapy, and the ethical considerations.
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.
Also Read:
NURS 6630 Assignment Assessing and Treating Patients With ADHD
NURS 6630 Psycopharmacologic Approaches to Treatment
NURS 6630 Psychopharmacological Approach to Treat Psychopathology Assessment
NURS 6630 Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction
NURS 6630 Case 13: 8-Year-Old Girl Who Was Naughty
NURS 6630 Case 11: The Figment of a Man Who Looked Upon a Lady
NURS 6630 Case 14: Scatter-Brained Mother Whose Daughter Has ADHD, Like Mother, Like Daughter
NURS 6630 Case 21: Hindsight is Always 202/20, or Attention Deficit Hyperactivity Disorder
NURS 6630 Antidepressants for Pediatric Patients
NURS 6630 Assessing and Treating Clients With Dementia Patients
NURS 6630 Discussion Chemical Neurotransmission
NURS 6630 Discussion Psychiatric Mental Health Nurse Practitioner
NURS 6630 Dementia and Its Treatment
NURS 6630 Therapy for Patients With Dementia and Comorbid States
NURS 6630 Week 7 Therapy for Patients With Schizophrenia
NURS 6630 Posttraumatic Stress Disorder Treatment
NURS 6630 Week 2 Neurotransmitters and Receptor Theory
NURS 6630 Week 1 Introduction to Neuroanatomy
NURS 6630 Assignment Psychiatric Nurse Practitioner
NURS 6630 Assignment Treating Pediatric Patients With Mood Disorders
NURS 6630 Assessing and Treating Patients With challenging Disorders
NURS 6630 Discussion Psychiatric Mental Health
NURS 6630 Discussion The Impact of Ethnicity on Antidepressant Therapy
NURS 6630 treatment of Insomnia
NURS 6630 Post-Traumatic Stress Disorder (PTSD)
NURS 6630 characteristic of generalized anxiety disorder
NURS 6630 Case Study 53-year-old Puerto Rican Female with Comorbid Addiction
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
Sample Answer 2 for NURS 6630 The Management of Attention Deficit Hyperactivity Disorder (ADHD)
Attention deficit hyperactive disorder (ADHD) is a mental health condition characterized by inattention and hyperactivity commonly diagnosed in childhood. The impact of ADHD affects children’s schoolwork and daily social living. The purpose of this paper is to describe the assessment and treatment plan and reflect on a case of ADHD.
Assessment
The common differential diagnosis for ADHD include:
- Anxiety disorders
- Depression
- Learning disorders
Patients experiencing the above conditions have symptoms that may mimic ADHD (Drechsler et al., 2020). Poor concentration, easy distractibility, and memory loss are commonly seen in anxiety and depressed patients. In addition, he has significant weight loss due to loss of appetite commonly seen in depressed patients.Lastly, just like in ADHD, patients with learning disorders and some anxiety disorders, such as panic disorders, may experience learning difficulties.
My primary diagnosis for the patient is ADHD. According to DSM-V, hyperactive symptoms of ADHD include fidgeting, restlessness, inability to play quietly, excessive talking, motor agitation, inappropriate intrusion, and impatience (Cabral et al., 2020). On the other hand, inattention symptoms include inattention to details, making careless mistakes, not listening when spoken to, not following instructions, and being unable to complete or organize a task. In addition, they avoid tasks that require concentration, easily get distracted, and forgetful. The patient, in this case, has most of the symptoms of ADHD, including symptoms of impulsivity, hyperactivity, and inattention.
Plan
Management of ADHD patients includes the use of pharmacotherapy and psychotherapy. Pharmacologic agents commonly used in ADHD patients include psychostimulants such as methylphenidate (Drechsler et al., 2020). Psychostimulants aim at targeting impulsivity, distractibility, poor task adherence, hyperactivity, and lack of attention. Atomoxetine, a serotonin-noradrenaline receptor inhibitor (SNRI), is a non-psychostimulant that has also been used in patients who fail to tolerate methylphenidate (Nunez-Jaramillo et al., 2021). Other medications that have been utilized include antidepressants such as selective serotonin receptor inhibitors, SNRIs, and tricyclic antidepressants. The drugs can be used as adjunctive therapy for the management of anxiety and depression symptoms that may be present in ADHD patients.
Behavioral psychotherapy is crucial in the management of ADHD symptoms. Psychotherapy aims to improve attention and organizational skills and decrease distractibility (Drechsler et al., 2020). Another form of psychotherapy used is cognitive behavioral therapy, which helps alleviate depression and anxiety symptoms. Additionally, psychosocial treatments such as behavioral parent training and classroom management can allow the patients to adapt to school and home environments(Nunez-Jaramillo et al., 2021). Neuropsychological treatment, a cognitive training intervention, utilizes cognitive exercises to work on memory and impulsivity.
Follow-up for these patients includes looking into symptom alleviation, side effects of drugs used, and the response to the form of therapy used. Additional doses and more intensified psychotherapy are commonly used when the response is sub-optimal. Referrals to psychiatrists are vital while managing patients when the response is sub-optimal or non-tolerant to the medications, allowing for further evaluation (Price et al., 2020). One major social determinant of health I would advocate for ADHD patients is education access and equity. I would advocate for special schools and trained personnel to ensure the facilities can provide a good quality education while meeting their needs in an understanding environment. I would advocate for a health promotion program that engages in physical activity, stress adjustment, and mindfulness relaxation that may help the patient learn how to improve attention, impulsivity, and hyperactivity (Hahn, 2021). For such kind of patient with a previous medication non-adherence, it is crucial to educate the patient about the condition he is experiencing and why he needs to take the prescribed medication.
Reflection Notes
First, I would ensure I address what is causing the medication non-compliance, such as inadequate funds and lack of a therapist or psychiatrist. I would also encourage open communication that would help get more unmentioned concerns the patient may be facing in his employment and at school. I would also recommend the patient to a support group for patients with ADHD to help him adjust. I would need to reintroduce the patient to pharmacotherapy and psychotherapy as part of his treatment plan and schedule for follow-up (Price et al., 2020). The interventions would be successful if the patient is compliant, is reintroduced to medical insurance to cover the costs, can go to his psychiatrists’ or therapists’ consultation visits, and has a supportive social support group. The interventions may fail due to non-compliance, or the case may be a treatment-resistant form of ADHD. Referral is vital, especially when one cannot follow up on the patient (Streeter et al., 2023). examples of referrals include other therapists who may be close to where he works, social workers, or leaders of various ADHD support groups. One may contact the various persons for follow-up on the patient’s progress.
Conclusion
Inattention and hyperactivity are characteristic of ADHD patients. Proper diagnosis is needed to ensure prompt management of the patient. Treatment of ADHD involves psychotherapy, pharmacotherapy, and a good follow-up plan. Close follow-up and patient education for ADHD patients have been associated with positive health outcomes and an improved quality of life.
References
Cabral, M. D. I., Liu, S., & Soares, N. (2020). Attention-deficit/hyperactivity disorder: diagnostic criteria, epidemiology, risk factors and evaluation in youth. Translational pediatrics, 9(Suppl 1), S104–S113. https://doi.org/10.21037/tp.2019.09.08
Drechsler, R., Brem, S., Brandeis, D., Grünblatt, E., Berger, G., & Walitza, S. (2020). ADHD: Current Concepts and Treatments in Children and Adolescents. Neuropediatrics, 51(5), 315–335. https://doi.org/10.1055/s-0040-1701658
Hahn R. A. (2021). What is a social determinant of health? Back to basics. Journal of public health research, 10(4), 2324. https://doi.org/10.4081/jphr.2021.2324
Núñez-Jaramillo, L., Herrera-Solís, A., & Herrera-Morales, W. V. (2021). ADHD: Reviewing the Causes and Evaluating Solutions. Journal of personalized medicine, 11(3), 166. https://doi.org/10.3390/jpm11030166
Price, M. E., Done, N., & Pizer, S. D. (2020). The Relationship Between Follow-up Appointments and Access to Primary Care. Journal of general internal medicine, 35(6), 1678–1683. https://doi.org/10.1007/s11606-020-05785-3
Streeter, C., Dankyi, S., & Akin-Ojo, I. (2023). Quality Improvement Project: Referral Process for Adults With Suspected ADHD. BJPsych Open, 9(Suppl 1), S76. https://doi.org/10.1192/bjo.2023.247
Sample Answer 3 for NURS 6630 The Management of Attention Deficit Hyperactivity Disorder (ADHD)
Attention Deficit Hypersensitivity Disorder (ADHD) is a mental condition characterized by impulsiveness, difficulty in maintaining appropriate attention and excessive motor activity. In the young population, the disorder is associated with excitability, difficulties in maintaining high grades in school, and impaired interpersonal relationship with friends. The disorder is difficult to diagnose as the patient might be unable to display the symptoms in all settings or in one particular setting at every time (Johnston & Chronis-Tuscano, 2015). However, diagnosis is made when the symptoms persist for more than 6 months. This is based on the information provided by the child, parents, caregivers, teachers, and friends. The disorder is associated with changes in the functional and neuroanatomical brain. However, it can be managed by altering these parameters through the use of appropriate pharmacological agents. Non-pharmacological interventions such as behavioral counseling can be used as a complementary approach to managing this mental condition. Thus, the main purpose of this paper is to examine the case of an 8-year-old Caucasian girl diagnosed with ADHD, develop a treatment plan with high consideration of the pharmacokinetic and pharmacodynamic agents available for best treatment outcome and finally point out the ethical considerations necessary for the plan.
Decision Point One
Selected Decision
Start Ritalin (methylphenidate) chewable 10 mg tablets PO in the morning
Reasons for Selection
Most stimulants have been approved as the first line treatment for patients with ADHD. Ritalin has been used over the years for the treatment of ADHD as approved by the FDA and has proven to be the most effective pharmacological agent with an effect size of up to 0.9 as compared to non-stimulant agents such as Intuniv with an effect size of between 0.5 to 0.9 (Reale et al., 2017). the mode of action of Ritalin is by blocking both the dopamine and norepinephrine reuptake. Ritalin also produces a plasma bi-modal concentration-time profile when administered to children orally, hence the once-daily dose. It has a low plasma protein binding capacity with a bioavailability of 22±8% in children suggesting a marked pre-systemic metabolism. The drug has a rapid half-life of about 3.5 hours in children hence minimal side effects.
Other drugs such as Wellbutrin, which is an antidepressant has been approved by the FDA, but mainly effective in improving concentration and focus, although used as an off label treatment in children as its safety profile has not been demonstrated among these population. It is also accompanied by several undesired effects such as seizure at high dose, which is very dangerous for children. , on the other hand, is an optional non- stimulant agent but not approved by the FDA in the treatment of children with ADHD.
Expected Results
The pharmacological effects of Ritalin are expected within 2 to 4 weeks of medication therapy. The patient is expected to improve focus at school, improve class participation, and able to relate appropriately with peers. Given that the dose administered is low, the patient is not expected to experience any side effects at this stage.
Differences between Expected Results and Actual Results
Upon coming back for follow up after 4 weeks, the patient’s symptoms of inattentiveness are reported to have improved significantly in the morning and hence the teachers claim that her overall academic performance has also improved. the improvement is in line with the nurse’s expectations. However, this effect does not last the whole day as it is reported that the patient reverts to daydreaming and staring off into space later in the day. She is also reported of having an elevated heart rate which is a common side effect of Ritalin.
Decision Point Two
Selected Decision
Shift to 20MG Ritalin LA PO in the morning
Reason for Selection
The second decision is aimed at reducing the side effect of elevated heart rate while trying to manage the patient’s symptoms throughout the day. A long-acting Ritalin has a prolonged effect of up to 12 hours which will help control the patient’s symptoms all through the day when administered in the morning. It also has a slow and controlled release which will reduce the peak plasma concentration, hence reducing the cardiovascular side effects (Patel et al., 2017). The patient has also proved to be compliant to the medication based on the outcome reported during the first follow up visit. Changing the pharmacological agent to Adderall is not appropriate at this point since it is also a stimulant with similar side effects of increased heart rate as Ritalin.
Expected Results
The patient is expected to experience controlled symptoms throughout the day within 4 weeks. her concentration should be appropriate from the morning and all day long, which should also reflect on her academic performance. The side effect of increased heart rate is also expected to resolve within this time.
Differences between Expected Results and Actual Results
Upon showing up for follow up after 4 weeks, it was reported that the patient was able to concentrate appropriately in class in the morning and even later in the day. Her academic performance had also improved as reported by her teachers. She no longer had an issue with elevated heart rate, as it recorded 92. This was what was expected by the nurse, hence an indication of high compliance.
Decision Point Three
Selected Decision
Maintain the same dose of Ritalin LA and re-evaluate the patient after 4 weeks.
Reason for Selection
From the results of the lust intervention, it is evident that the patient is responding appropriately to the current dose, with well-managed symptoms and reduced side effects of tachycardia. As a result, it is appropriate to maintain the same dose for further improvement and management of the patient’s symptoms. Increasing the dose to 30 mg is inappropriate as it will result in high plasma levels of Ritalin which will result in side effect of increased heart rate (Fernández et al., 2015). Currently, the heart rate of the patient is at 92, which is within the normal range of 75 to 118 for children between the age of 6 to 12 years. Consequently, the long term effects of Ritalin among children has not been systemically evaluated, hence the need for a re-evaluation after 4 weeks of treatment.
Expected Results
The patient is expected to continue displaying controlled symptoms. Her concentration is expected to improve even further all through the day, and as such, this will lead to an overall improvement in her academic performance. Her heart rate is also expected to remain within the normal range with no other side effect.
Differences between Expected Results and Actual Results
Upon showing up for re-evaluation, the patient symptoms had been suppressed significantly all day long. She was able to concentrate in class appropriately and maintain good relations with her peers. Her heart rate was within the normal range with no additional side effect. This showed that the patient was compliant with the drug, with beneficial long-term effects.
Ethical Considerations
When taking care of a patient with a prominent mental disorder, it is important to observe ethical consideration for effective treatment outcome, especially among the pediatric population. Such patient is usually unable to express themselves appropriately, and hence the nurse has to involve people around them for comprehensive clinical evaluation (Sayal et al., 2018). Ethically, the nurse has to discuss with the patient’s parents the treatment options, their advantages and limitations, and the reasons for the interventions made in the course of the treatment. The people around the patient’s life must also be informed of the patient’s mental condition so as to keep a close watch and be able to respond appropriately to how the patient is responding to medication. Lastly, the nurse needs to educate the patients family members, friends, and teachers, on how they can help the patient manage her condition for an effective care plan outcome.
Conclusion
ADHD is a common mental disorder responsible for most children poor performance at school. It is difficult to diagnose especially among children given that it has similar symptoms as other mental disorder and the fact that the symptoms are not consistent hence difficult to monitor. However, the disorder is managed using stimulants such as Ritalin, which should be closely monitored especially among the pediatric population for desired treatment outcome.
References
Johnston, C., & Chronis-Tuscano, A. (2015). Families and ADHD. In R. A. Barkley (Ed.), Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (pp. 191-209). New York, NY, US: The Guilford Press.
Sayal, K., Daley, D., Prasad, V., Sayal, K., Prasad, V., Daley, D., Ford, T., … Coghill, D. (February 01, 2018). ADHD in children and young people: prevalence, care pathways, and service provision. The Lancet Psychiatry, 5, 2, 175-186.
Reale, L., on behalf of Lombardy ADHD Group, Bartoli, B., Cartabia, M., Zanetti, M., Costantino, M. A., Canevini, M. P., … Bonati, M. (December 01, 2017). Comorbidity prevalence and treatment outcome in children and adolescents with ADHD. European Child & Adolescent Psychiatry, 26, 12, 1443-1457.
Patel, A., Medhekar, R., Ochoa-Perez, M., Aparasu, R. R., Chan, W., Sherer, J. T., Alonzo, J., … Chen, H. (January 01, 2017). Care Provision and Prescribing Practices of Physicians Treating Children and Adolescents With ADHD. Psychiatric Services (washington, D.c.), 68, 7, 681-688.
Fernández,. C. L., Simonoff, E., McGough, J. J., Halperin, J. M., Arnold, L. E., & Stringaris, A. (January 01, 2015). Treatment of Children with Attention-Deficit/Hyperactivity Disorder (ADHD) and Irritability: Results From the Multimodal Treatment Study of Children With ADHD (MTA). Journal- American Academy of Child and Adolescent Psychiatry, 54, 1, 62.