Assessing and Treating Patients with ADHD Essay Example
A condition known as attention deficit hyperactivity disorder (ADHD) is usually believed to occur exclusively in children and is branded as a disease that affects only children’s focus and concentration. The National Institute of Mental Health (NIH) reports that there is growing evidence that ADHD also includes hyperactivity and impulsive behavior related to particular dysfunctional neural pathways in the prefrontal cortex, which perhaps is a condition that affects adults more. Attention deficit hyperactivity disorder (ADHD) is usually diagnosed in early infancy, before the age of 6 or 7, and persists throughout adulthood. The primary symptoms of ADHD include lack of attention, hyperactivity, and impulsive behavior. ADHD may manifest itself in a variety of ways, including incapacity to think properly, trouble conveying emotions or creating relationships, behavioral issues, and poor academic performances (Krull, 2019)Assessing and Treating Patients with ADHD Essay Example.
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The client is an 8-year-old Caucasian girl who was brought to the facility for mental assessment. The child was diagnosed with attention deficit hyperactivity disorder. The child is frequently unfocused, preoccupied, and incapable of recalling things properly. She has a difficult time learning and solving arithmetic problems. Because of her behavior, her tutor presumes that she may be suffering from attention deficit hyperactivity disorder, but her parents continue to dispute this. This paper seeks to evaluate the three decisions for treating individuals with attention deficit hyperactivity disorder (ADHD).
Decision #1: Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the morning
My rationale for selecting Ritalin is that it is a stimulant that the FDA has authorized for the management of attention deficit hyperactivity disorder. It is the first-line therapeutic intervention for ADHD, with approximately 90 percent of individuals with ADHD reporting recovery. When dopamine and norepinephrine are increased to their optimum quantities in the prefrontal cortex, Ritalin has the effect of restoring the patient’s capacity to focus and pay attention well again (Stahl, 2013)Assessing and Treating Patients with ADHD Essay Example.
I did not select Intuniv because, despite the fact that it is a non-stimulant drug authorized for treating ADHD, it is not recommended as first-line therapy for the condition. It may take weeks for Intuniv to begin producing positive benefits, while Ritalin begins producing results within minutes after consuming the first dosage (Stahl, 2014). On the other hand, I did not select Wellbutrin since it is a mild NRI and DAT inhibitor, and its usage as a therapy for ADHD has not been thoroughly studied. Furthermore, it has not been recommended by the FDA for the management of attention deficit hyperactivity disorder in children (Stahl, 2014).
By making this decision, I was hoping that the patient will be capable of restoring her focus and concentration and that she will be able to thrive and succeed academically. I would want to achieve improvements as soon as possible, with a 50 percent reduction in symptoms without any negative side effects.
Since Ritalin appears to be one of the medicines with the fewest adverse effects, I grounded my ethical concern on the principle of non-maleficence. It is also important to take into account the ethical principle of consent and autonomy since it gives sufficient knowledge to both the patient and her parents about ways to make rational choices and viable ways of treating ADHD Assessing and Treating Patients with ADHD Essay Example.
Decision #2: Change to Ritalin LA 20 mg orally daily in the morning
I made this choice since Ritalin LA would provide an instant release formulation that would induce tachycardia, thereby alleviating the patient’s funny feeling. Because Ritalin LA has a longer half-life than the original Ritalin, it is anticipated that treatment benefits would be seen for an extended period (Colzato & Arntz, 2017).
In this case, continuing with the same dose of Ritalin and re-evaluating after four weeks is not the best course of action because it minimizes the afternoon lapse in concentration but does not address the tachycardia side effect. A good medication is one that has lasting positive health benefits while also having few adverse effects, as determined by the FDA (Staudt et al., 2019). On the other hand, the switch from Ritalin to Extra Release Adderall would be a fine decision were it not for the fact that Ritalin has been shown to be effective, albeit with a few mild adverse effects that can be controlled with close monitoring.
I expect that the patient’s tachycardia will be addressed and that her increased attention and focus will last all through the day, instead of only in the morning, that her condition will stay stable.
The ethical principles of beneficence and maleficence were taken into consideration at this stage. The switch to an extended-release version of Katie’s Ritalin appears to be the superior option in terms of giving her longer-lasting medical benefits while also eliminating the tachycardia-inducing negative side effects Assessing and Treating Patients with ADHD Essay Example.
Decision #3: Maintain current dose of Ritalin LA and re-evaluate in 4 weeks
I made this choice because the medication appears to be functioning as anticipated, as shown by her heart rate returning to normal, her ability to maintain focus all through the entire day, and the absence of any reports of further adverse effects.
I did not choose to raise her Ritalin LA dose to 30 mg since her symptoms seem to be sufficiently managed by her current daily dose of 20 mg. Furthermore, the smallest feasible doses must be administered because increasing the dose may subject the patient to further or other side effects (Wolraich et al., 2019). On the other hand, an electrocardiogram (EKG) focused on Katie’s real heart rate would be unnecessary since her heartbeat is appropriate for her age. An EKG would be required if there were additional indications of cardiac abnormalities in addition to tachycardia.
Because the Ritalin LA seemed to be having a positive effect on Katie, I aimed to maintain her on the same drug for as long as possible and monitor her progress and response across time.
At this stage, beneficence and non-maleficence were incorporated as the ethical considerations. Increased Ritalin LA dose would be harmful to the patient because it would subject her to unpleasant side effects that would conflict with her existing dose. Moreover, non-maleficence and beneficence are considered to be ways of limiting needless EKGs without any reason, thus preventing the family from being exposed to additional expenses as a result of the procedure Assessing and Treating Patients with ADHD Essay Example.
Conclusion
Katie is an 8-year old child presented to the facility by her mother because she was exhibiting signs of ADHD. She is identified with attention deficit hyperactivity disorder by her teacher, who observes that Katie is inattentive, fails to finish assignments, is distracted, and has low academic performance. Additionally, Katie observes that her thinking sometimes goes off in other directions, and she believes that math is very difficult for her to be able to keep up with what the teacher teaches her. Katie’s psychiatric assessment is normal, as shown by her capacity to focus effectively throughout her examination and her capability to count backward from one hundred. As a result of her mostly unfocused behaviors, she was diagnosed with ADHD Assessing and Treating Patients with ADHD Essay Example.
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To begin treating the client, I decided to begin with Ritalin 10mg oral chewable tablets every morning. I made this decision because Methylphenidates such as Ritalin function well in children and teenagers. This medication is a stimulant that may be used to assist with the treatment of inattentiveness-related characteristics (Colzato & Arntz, 2017). After four weeks of taking this medicine, the client showed indications of progress, despite the fact that the symptoms remained. Secondly, Ritalin was changed to Ritalin LA, which assists prolong therapeutic benefits. As a result of this decision, she returned to the facility complaining of tachycardia, with a heart rate of 130 beats per minute. Due to the fact that she had reported feeling weird and that there had been no adverse effects, I opted to keep the present dose rather than switching to Ritalin LA 30mg and Adderall XR.
In order to determine whether or not the medication remains effective in treating ADHD, it is necessary to ensure close monitoring of the client (Colzato & Arntz, 2017). Increasing her dose would likely result in adverse effects that are presently undefined.
References
Colzato, L. S., & Arntz, F. E. (2017). Ritalin. In Theory-driven approaches to cognitive enhancement (pp. 71-80). Springer, Cham. https://link.springer.com/chapter/10.1007/978-3-319-57505-6_6
Krull, K. (2019). Attention deficit hyperactivity disorder in children and adolescents: Clinical features and diagnosis. Retrieved from https://www.uptodate.com/contents/attention-deficit-hyperactivity-disorder-in-children-and-adolescents-clinical-features-and-diagnosis
National Institute of Mental Health. (2019). Attention-Deficit/Hyperactivity Disorder. Retrieved from https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press. https://stahlonline.cambridge.org/essential_4th.jsf
Stahl, S. M. (2014). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press. https://stahlonline.cambridge.org/prescribers_guide.jsf
Staudt, M. D., Herring, E. Z., Gao, K., Miller, J. P., & Sweet, J. A. (2019). Evolution in the treatment of psychiatric disorders: From psychosurgery to psychopharmacology to neuromodulation. Frontiers in Neuroscience, 13. https://doi.org/10.3389/fnins.2019.00108
Wolraich, M. L., Chan, E., Froehlich, T., Lynch, R. L., Bax, A., Redwine, S. T., Ihyembe, D., & Hagan, J. F. (2019). ADHD diagnosis and treatment guidelines: A historical perspective. Pediatrics, 144(4), e20191682. https://doi.org/10.1542/peds.2019-1682
Assignment: Assessing and Treating Patients With ADHD Not only do children and adults have different presentations for ADHD, but males and females may also have vastly different clinical presentations. Different people may also respond to medication therapies differently. For example, some ADHD medications may cause children to experience stomach pain, while others can be highly addictive for adults. In your role, as a psychiatric nurse practitioner, you must perform careful assessments and weigh the risks and benefits of medication therapies for patients across the life span. For this Assignment, you consider how you might assess and treat patients presenting with ADHD. To prepare for this Assignment: Review this week’s Learning Resources, including the Medication Resources indicated for this week. Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients with ADHD. The Assignment: 5 pages Examine Case Study: A Young Caucasian Girl with ADHD. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature. Introduction to the case (1 page) Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient. Decision #1 (1 page) Which decision did you select? Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature). Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. Decision #2 (1 page) Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature). Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. Decision #3 (1 page) Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature). Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. Conclusion (1 page) Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature. Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature Assessing and Treating Patients with ADHD Essay Example