Assessing and Treating ADHD
Attention, deficit hyperactivity disorder (ADHD) is a disease condition in which the person is categorized with inattentiveness, hyperactivity, and being impulsive. ADHD can be divided into three of these manifestations are, which can include: the individual may not pay attention; the hyperactive form may be excessively impulsive, and, most generally, the patient may have all of the traits (Saylor & Amann, 2016). Individuals with this condition typically present over six months or more, and the disease generally develops in children between 6 and 12 years of age. Although its use is not well understood but is believed to be a combination of environmental and genetic factors that contribute to low levels of norepinephrine and dopamine neurotransmitters. Treatments for ADHD include occupational psychotherapy and the application of drugs including stimulants. This paper discusses the management of an eight-year-old named Katie diagnosed with ADHD in three decision-making points and a discussion of how ethical considerations may impact the treatment plan and communication with families and the client.Assessing and Treating ADHD
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Summary of the patient Case
The patient’s name is Katie; an 8-year-old girl who is taken to the office today by her parents. They confirm that their primary care provider has referred them to the Psychiatric Mental Health Nurse Practitioner (PMHNP) after receiving help because Katie’s teacher has indicated that she might have ADHD. Katie’s parents report that their PCP thought that psychologists to decide whether she has this disorder should test her. The parents shall supply the PMHNP with a copy of the form entitled “Conner’s Teacher Assessment Scale-Revised.” Her teacher filled this scale after which she was sent home to her parents for them to share it with their primary care physician. According to the score given by her tutor, Katie is inattentive, easily confused, forgets things she has already learned, is poor in writing, reading, and arithmetic. Her concentration span is short, and it’s noticed that she’s only paying attention to things she’s involved in. The teacher said she loses enthusiasm in schoolwork and is easily distracted. Katie is often known to start activities but never finish them, and barely follows directions and struggles to complete her classwork. She states that school is “OK”- her favorite subjects are “art” and “recess.” She states that she finds her other subjects boring and sometimes hard because she feels “lost.” She admits that her mind does wander during class to things that she thinks of as more fun. Denies any abuse, denies bullying at school. Offers no other concerns at this time.
The client is an 8-year-old Caucasian female who appears appropriately developed for her age. Her speech is clear, coherent, and logical. She is appropriately oriented to person, place, time, and event. She has dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. The self-reported mood is euthymic. The purpose of this paper is to examine three different decision treatment options for this patient with ADHD and provide ethical and communication skills regarding patients with this disease.
Decision 1
In the hope to undertake medication, the PMHNP may either initiate the girl on Wellbutrin XL 150 mg PO daily, Intuniv extended-release 1 mg PO before going to bed, or Ritalin (Methylphenidate) chewable pills 10 mg PO Q AM. TPMHNP chooses to initiate the patient on Ritalin (Methylphenidate) chewable tablets 10 mg PO Q AM. Stimulants are often the first medication option for people with ADHD and Ritalin, most of all aids to Improve concentration in patients with inattentiveness because it inhibits the reuptake of DA and NE that allows these neurotransmitters to achieve peak levels in the presynaptic cleft (Busardo et al. , 2016). Since Wellbutrin has been used as a third-line therapy for ADHD since and it requires a few weeks for medicinal results to develop, the PMHNP does not recommend this medication as a first-line treatment for this case. Intuniv is often usually used as an adjunctive for the treatment of ADHD to target behavioral symptoms such as hostility and resistance, but not the core inattentive symptoms of ADHD (Arcangelo et al, 2017).
The girl returns after four weeks to the clinic, and her parents mention talking to Katie’s teacher, who notes that her symptoms are better in the morning, which has increased her general academic performance. The findings are predicted because the medicinal benefit of Ritalin is brief as the time of operation and this drug raises the amount of peripheral norepinephrine, contributing to autonomic side effects such as tachycardia and tremor.Assessing and Treating ADHD
Decision 2
Following these outcomes, the PMHNP can continue to obtain the same dosage of Ritalin as well as re-assessment after 4 weeks, switch to Ritalin LA 20 mg orally everyday QAM, or discontinue Ritalin, and start Adderall XR 15 mg orally daily. PMHNP agrees to turn to Ritalin LA 20 mg oral regular QAM. According to Arcangelo et al (2017), long-acting stimulant formulations are as effective as their short-acting equivalents and are more beneficial due to increased enforcement, the diminished risk for misuse, and more reliable and expanded day-to-day monitoring
It would not be advisable to administer the same dosage of the medication because the effects of the patient could worsen and this option would not resolve the needs of the patient. Initiating a patient with another stimulant is not recommended because, notwithstanding the effects observed, she reacts favorably to this drug. The patient comes back to the clinic after four weeks, her academic performance continues to improve, and the transition to LA planning appears during the school days. Katie also notes that her heart’s “funny” feeling is gone. In today’s office session, her pulse was 92. The result is predicted because Ritalin LA improves clinical efficiency in patients and retains this therapeutic effect for 24 hours.
Decision 3
At this stage in the treatment of the patient, the PMHNP can retain the current dosage of Ritalin LA and re-evaluate it within 4 weeks, whether to raise Ritalin LA to 30 mg orally daily or obtain an EKG given the current heart rate. The PMHNP prefers to retain the existing dosage of Ritalin LA and to re-evaluate it after 4 weeks because the clinical benefit of the treatment has not been met with any major side consequences and it is thus beneficial to continue the patient at this level (Mattingly, Wilson & Rostain,2017). The heart rate of 92 is sufficient for children 2-10 years of age and does not justify the need for an EKG. Plus the vulnerability of the infant to needless medical instruments without a significant need is not appropriate medical care. Finally, there is no therapeutic rationale to raise the dosage of Ritalin, since the patient seems to be reacting favorably to the dosage. The PMHNP should continue to track the patient and determine the result and side effects of the drug to modify if appropriate.
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Conclusion with Ethical Consideration and patient Communication
Attention, deficiency hyperactivity disorder (ADHD) is a syndrome characterized by inattentive, hyperactive, and impulsive behavior. This condition can develop in adults and children alike. Individuals of this ADHD typically show symptoms within six months or more. While the origin of ADHD is unknown, it can be due to a combination of environmental and genetic factors .Treatments for ADHD include psychotherapy and drugs such as stimulants.Assessing and Treating ADHD
A major ethical concern when caring for children is seeking permission from the guardians of the child when failure to do so should result in legal implications. It is important to collect details from parents of minors as well as better witnesses, but it is crucial to determine any neglect that may impact the treatment of the child. It is important to inform the patient and her parents about the signs and treatment of this disease to ensure that the disease does not progress in adulthood when it will affect her.
References
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017).
Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.
Busardo, F. P., Kyriakou, C., Cipolloni, L., Zaami, S., & Frati, P. (2016). From Clinical Application to Cognitive Enhancement: The Example of Methylphenidate. CURRENT NEUROPHARMACOLOGY, 14(1), 17–27.
Saylor, K. E., & Amann, B. H. (2016). Impulsive aggression as a comorbidity of attention-deficit/hyperactivity disorder in children and adolescents. Journal of child and adolescent psychopharmacology, 26(1), 19-25.
Mattingly, G. W., Wilson, J., & Rostain, A. L. (2017). A clinician’s guide to ADHD treatment options. Postgraduate medicine, 129(7), 657-666. Assessing and Treating ADHD