Assessing and Treating Patients with ADHD – Discussion Solution

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Assessing and Treating Patients with ADHD

Introduction to the Case

The case involves Katie, an 8-year white female. She is brought in for assessment by her parents. Her parents report that a PCP has recommended a psychiatric evaluation following a suggestion by Katie’s teacher over possible ADHD. A Conner’s Teacher Rating Scale-Revised (CTRS-R) score as conducted by Kati’s teacher shows that she is unobservant, easily distracted, keeps forgetting what she has previously known, poor in spelling, reading, and arithmetic. Because of this distraction, Katie’s teacher believes that she lacks interest in school. The CTRS-R test score revealed that Katie has a short attention span and only pays attention to things or activities of interest to her.(Assessing and Treating Patients with ADHD) Furthermore, it is noted that Katie is unable to accomplish things or follow instructions to completion, including her schoolwork. Despite these symptoms, her parents deny her ADHD diagnosis. Her mother argues that if she had ADHD, she would be running around wildly. Equally, her father believes that if Katie had ADHD, she would be having a temper outburst or defiant.  However, a CTRS-R test is appropriate for assessing ADHD by teachers of young people aged three through 17 (Conners et al., 1998; Patanella et al., 2011).(Assessing and Treating Patients with ADHD) As you continue, has the top and most qualified writers to help with any of your assignments. All you need to do is place an order with us. (Assessing and Treating Patients with ADHD) Subjective data reveals that Katie is contented and okay with her status. She admits being interested in Art and recess while other subjects are uninteresting and complex, as she often feels lost.  She acknowledges that her mind wanders throughout class time and thinks about more fun things and sometimes about nothing. Katie believes her life at home is okay and loves her parents, who are good and kind. Equally, she denies school bullying or abuse.(Assessing and Treating Patients with ADHD) Mental exams reveal Katie has achieved appropriate development for her age. She has clear, coherent, and logical speech. She shows awareness of herself, her surrounding, time, and circumstance. Her dressing is appropriate. Her mannerism, gestures, and tics are not appropriate. Her mood is euthymic and has a bright effect. She experiences no auditory or visual hallucination, no paranoia, or delusional thought process. She demonstrates intact concentration, attention, and capacity to count backward from 100 by 2’s and 5’s. Lastly, Katie shows appropriate insight and judgment and denies any suicide or homicide ideation.(Assessing and Treating Patients with ADHD)

Decision One

My first choice was for Katie to start Ritalin chewable tablets 10 mg orally in the morning. Methylphenidate is considered a first-choice medication for children diagnosed with ADHD. According to Storebø et al. (2018), children/ adolescents may improve ADHD symptoms reported by teachers and those reported by parents. This is because the drug is a stimulant and acts by boosting and balancing the levels of dopamine and noradrenaline hormones affecting the prefrontal cortex’s performance responsible for executive function and associated with ADHD (Storebø et al., 2015). As a stimulant, methylphenidate is crucial in reducing the hypersensitivity and impulsive nature of individuals diagnosed with ADHD.(Assessing and Treating Patients with ADHD) Intuitive was not selected because it is recommended as adjunctive therapy for ADHD (Strange, 2008). Intuniv has also been shown to have side effects of sedation, somnolence, and fatigue (Bernknopf, 2011). Wellbutrin was not selected because it is not recommended for children since its safety and effectiveness have not been broadly established (Ng, 2017). Wellbutrin XL is approved for major depressive disorder by the FDA; thus, it would not significantly meet the patient’s needs (Stahl, 2013). The patient reports positive and exciting moments in school and at home, which are not characteristic of depression.(Assessing and Treating Patients with ADHD) As you continue, has the top and most qualified writers to help with any of your assignments. All you need to do is place an order with us. (Assessing and Treating Patients with ADHD) The expectation following the prescription of methylphenidate is a reduction in symptoms of ADHD and improved general behavior of the child. It is also expected that Katie will respond positively to the medication. According to Storebø et al. (2018), methylphenidate does not have serious adverse effects on a child. Besides, I expect that Katie’s quality of life will improve. For instance, I expected her classroom concentration and attention to increase, and she will start performing favorably in her class activities and relationships with other pupils.(Assessing and Treating Patients with ADHD) The ethical concept that would influence decision-making at this stage is informed consent. According to Haddad & Geiger (2018), nurses’ role is to promote health and safety. In this case, the patient’s parents are concerned about their daughter’s condition. Therefore, a patient must be well informed of his/her condition to make rational decisions. Moreover, the practitioner’s responsibility is to correctly communicate medical information to the patient or the person in charge of the patient’s treatment and make clinical decisions consistent with proper medical practice.

Decision Two

I selected the option to change Katie’s prescription to Ritalin LA 20mg orally daily in the morning. The initial dosage could not last Katie a whole day. According to Rösler et al. (2009), the extended-release of low-medium methylphenidate is effective and safe in treating ADHD. Her teacher reported that Katie is responding positively to medication up to midday when her concentration relapses and she begins starring off into space and daydreaming. Besides, Katie did not show any significant side effects of the medication.(Assessing and Treating Patients with ADHD) I did not choose to discontinue Ritalin and begin Adderall for two reasons. Ritalin is an effective prescription for the management of ADHD in the short term, and Katie was already responding appropriately (Huss et al., 2017). Two, Adderall can cause adverse reactions such as increased blood pressure and heart rate. Other significant side effects of Adderall include drowsiness and irritability (Stahl, 2013). On the other hand, the option to continue the same prescription was not chosen because the dosage was not effective in managing Katie’s condition (Rösler et al., 2009). This is evidenced by Katie’s lack of concentration and attention in the afternoon.(Assessing and Treating Patients with ADHD) I expected that the dosage would last for Katie for the whole day. As a result, Katie would be able to concentrate and learn for the entire day without losing concentration. Consequently, Katie will improve her academic performance. Also, it is expected that Katie will begin to like other subjects as well and remain focused on assigned activities in school and at home. According to Kortekaas-Rijlaarsdam et al. (2019), methylphenidate improves primary school children’s academic performance by retaining their focus on assigned tasks.(Assessing and Treating Patients with ADHD) The ethical concept of beneficence can influence the decision at this stage. This is because the ethical principle of beneficence involves promoting good towards patients (Haddad & Geiger, 2018). At this stage, I would evaluate as a practitioner the presented side effects and treatment goals to determine whether the medication is suitable for the patient.  Since the prescription is lasting half a day and the heart feels funny, it was crucial to increase the dosage to achieve optimum medication response.(Assessing and Treating Patients with ADHD)

Decision Three

I selected the option to retain the current dose of Ritalin LA and re-evaluate in four weeks.  According to the American Academy of Paediatrics (AAP), medical personnel should titrate Ritalin dosage to achieve the maximum from which there is a minimum adverse effect and positive response (Wolraich et al., 2011). Katie’s academic performance improved, and the dosage is lasting her the whole day. Further, her pulse rate has significantly reduced to 92/hr., she is productive and able to have goals met.(Assessing and Treating Patients with ADHD) I did not decide to increase the current dosage, Ritalin LA, to 30mg per because a higher dosage of Ritalin is associated with addiction, hallucinations, and seizures (Storebø et al., 2015). Besides, there was no indication to increase the dosage since Katie’s response to the medication indicated an optimal dosage (Storebø et al., 2018). The decision to obtain Katie’s EKG since her heart rate was appropriate for her age (Saarel et al., 2018). Besides, EKG is recommended for screening for heart-related complications, while Katie did not show any sign of heart-related complications (Saarel et al., 2018).(Assessing and Treating Patients with ADHD) As you continue, has the top and most qualified writers to help with any of your assignments. All you need to do is place an order with us. (Assessing and Treating Patients with ADHD)
Assessing and Treating Patients with ADHD
Assessing and Treating Patients with ADHD
I expected that Katie would show a different positive response to the medication. In this sense, the dosage will continue to last Katie the whole day. Her concentration and attention to class-related activities will continue to improve. Her perception of school as a boring place will cease, and her performance in most subjects will improve. A follow-up in four weeks is necessary to ensure the patient keeps up with the positive treatment outcomes.(Assessing and Treating Patients with ADHD) The ethical principle of veracity can affect the decision at this phase of treatment. According to Sorrell (2017), a practitioner should provide comprehensive information regarding a patient’s condition. In this sense, there is a need for careful communication to help establish a sense of trust and respect. In this sense, Katie’s parents would contact the practitioner in case of any relapse or side effects of medication. (Assessing and Treating Patients with ADHD) Conclusion Since the patient showed signs of ADHD, i.e., hypersensitivity and impulsiveness, Ritalin was chosen as the first prescription. Ritalin effectively relieves the symptoms of ADHD, has no side effects, and is well tolerated. The second decision was to change Katie’s medication to Ritalin LA 20mg since the initial dosage of 10mg was no lasting for her a day. In the afternoon, Katie’s concentration relapsed, and her attention was subdued with thoughts that were not academic or school-related. Furthermore, the thirst decision was chosen to maintain the initial dosage because the patient responded well to the medication. The side effects were well tolerated, and her concentration was significant, as evidenced by her high academic performance. It was crucial to maintain the dosage since it was expected that the patient would regain her concentration and attention, leading to effective academic performance and a positive attitude towards school.(Assessing and Treating Patients with ADHD) Lastly, the communication and ethical elements of medical practice were put into consideration. Through effective communication with the patient and her parents, a practitioner can gain their clients’ trust and adherence to medication. Besides, effective communication allows a practitioner to uphold the ethical value of informed consent significant for patient-centered care.(Assessing and Treating Patients with ADHD) References Bernknopf, A. (2011). Guanfacine (Intuniv) for attention-deficit/hyperactivity disorder. American Family Physician83(4), 468. Conners, C. K., Sitarenios, G., Parker, J. D. A., & Epstein, J. N. (1998). Revision and standardization of the Conners’ Teacher Rating Scale (CTRS-R): Factors, structure, reliability, and criterion validity. Journal of Abnormal Child Psychology, 26, 279-291. 10.1023/a:1022606501530 Haddad, L. M., & Geiger, R. A. (2018). Nursing ethical considerations. Huss, M., Duhan, P., Gandhi, P., Chen, C. W., Spannhuth, C., & Kumar, V. (2017). Methylphenidate dose optimization for ADHD treatment: a review of safety, efficacy, and clinical necessity. Neuropsychiatric disease and treatment. 10.2147/NDT.S130444 Kortekaas-Rijlaarsdam, A. F., Luman, M., Sonuga-Barke, E., & Oosterlaan, J. (2019). Does methylphenidate improve academic performance? A systematic review and meta-analysis. European child & adolescent psychiatry28(2), 155-164. Ng, Q. X. (2017). A systematic review of the use of bupropion for attention-deficit/hyperactivity disorder in children and adolescents. Journal of child and adolescent psychopharmacology27(2), 112-116. 10.1089/cap.2016.0124 Patanella, D., Pavelka, L. C., Marrs, H., Noggle, C. A., Levin, S. E., Sander, J., … Noggle, C. A. (2011). Conners’ Teacher Rating Scales: Revised. Encyclopedia of Child Behavior and Development, 405–406. https://doi.10.1007/978-0-387-79061-9_671(Assessing and Treating Patients with ADHD) Rösler, M., Fischer, R., Ammer, R., Ose, C., & Retz, W. (2009). A randomized, placebo-controlled, 24-week study of low-dose extended-release methylphenidate in adults with attention-deficit/hyperactivity disorder. European archives of psychiatry and clinical neuroscience259(2), 120-129. 10.1007/s00406-008-0845-4 Saarel, E. V., Granger, S., Kaltman, J. R., Minich, L. L., Tristani-Firouzi, M., Kim, J. J., … & Pediatric Heart Network Investigators*. (2018). Electrocardiograms in healthy North American children in the digital age. Circulation: Arrhythmia and Electrophysiology11(7), e005808. Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.Schizophrenia. Psychiatric Services (11), 1185. Storebø, O. J., Krogh, H. B., Ramstad, E., Moreira-Maia, C. R., Holmskov, M., Skoog, M., … & Gluud, C. (2015). Methylphenidate for attention-deficit/hyperactivity disorder in children and adolescents: Cochrane systematic review with meta-analyses and sequential trial analyses of randomized clinical trials. BMJ, 351. Storebø, O. J., Pedersen, N., Ramstad, E., Kielsholm, M. L., Nielsen, S. S., Krogh, H. B., … & Gluud, C. (2018). Methylphenidate for attention deficit hyperactivity disorder (ADHD) in children and adolescents assesses adverse events in non-randomized studies. Cochrane Database of Systematic Reviews, (5). https://doi.10.1002/14651858.CD012069.pub2 Strange, B. C. (2008). Once-daily treatment of ADHD with guanfacine: patient implications. Neuropsychiatric disease and treatment4(3), 499. https://doi.10.2147/ndt.s1711 Wolraich, M., Brown, L., Brown, R.T, DuPaul, G., Earls, M., Feldman, H.M., … & Visser, S. (2011). ADHD: clinical practice guideline for diagnosing, evaluating, and treating attention-deficit/hyperactivity disorder in children and adolescents.

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