Young Caucasian Girl with ADHD Case Study
The Assignment
Examine Case Study: A Young Caucasian Girl with
ADHD
You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes. Young Caucasian Girl with ADHD Case Study.
At each decision point there will be three decisions. I will choose one out of the three and give the outcome. At each decision point these are the thoughts to ponder:
Decision #1
Which decision did you select?
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Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
Decision #2
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. Young Caucasian Girl with ADHD Case Study.
Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
Decision #3
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
***Also include how ethical considerations might impact your treatment plan and communication with clients.***
Finally: 1. Complete the decision tree (keep track of what you selected. come up with a rational reason why you chose it. Come up with patient specific rational reason behind not choosing the other two options not chosen).
2. Write paper addressing all section listed based on the decision tree.
Case Study: A Caucasian Man with Hip Pain
BACKGROUND
Katie is an 8 year old Caucasian female who is brought to your office today by her mother & father. They report that they were referred to you by their primary care provider after seeking her advice because Katie’s teacher suggested that she may have ADHD. Katie’s parents reported that their PCP felt that she should be evaluated by psychiatry to determine whether or not she has this condition. Young Caucasian Girl with ADHD Case Study.
The parents give the PMHNP a copy of a form titled “Conner’s Teacher Rating Scale-Revised”. This scale was filled out by Katie’s teacher and sent home to the parents so that they could share it with their family primary care provider. According to the scoring provided by her teacher, Katie is inattentive, easily distracted, forgets things she already learned, is poor in spelling, reading, and arithmetic. Her attention span is short, and she is noted to only pay attention to things she is interested in. The teacher opined that she lacks interest in school work and is easily distracted. Katie is also noted to start things but never finish them, and seldom follows through on instructions and fails to finish her school work.
Katie’s parents actively deny that Katie has ADHD. “She would be running around like a wild person if she had ADHD” reports her mother. “She is never defiant or has temper outburst” adds her father.
SUBJECTIVE
Katie reports that she doesn’t know what the “big deal” is. 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. “Sometimes” Katie reports “I will just be thinking about nothing and the teacher will call my name and I don’t know what they were talking about.”
Katie reports that her home life is just fine. She reports that she loves her parents and that they are very good and kind to her. Denies any abuse, denies bullying at school. Offers no other concerns at this time. Young Caucasian Girl with ADHD Case Study.
MENTAL STATUS EXAM
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 is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Self-reported mood is euthymic. Affect is bright. Katie denies visual or auditory hallucinations, no delusional or paranoid thought processes readily appreciated. Attention and concentration are grossly intact based on Katie’s attending to the clinical interview and her ability to count backwards from 100 by serial 2’s and 5’s. Insight and judgment appear age appropriate. Katie denies any suicidal or homicidal ideation.
Diagnosis: Attention deficit hyperactivity disorder, predominantly inattentive presentation
Decisions Made and Outcomes (Needed to formulate the paper) (Must use and formulate paper based off of the chosen decision. Then tell why the other two decision were not a good choice with in-text citations noted for each.)
Choices for Decision 1: Select what the PMHNP should do:
- Begin Wellbutrin (bupropion) XL 150 mg orally daily
- Begin Intuniv extended release 1 mg orally at BEDTIME
- Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING
Decision Choice Chosen: Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING
***Explain why other two choice were rejected (not adequate choices)***
Outcome: RESULTS OF DECISION POINT ONE:
- Client returns to clinic in four weeks
- Katie’s parents report that they spoke with Katie’s teacher who notices that her symptoms are much better in the morning, which has resulted in improvement in her overall academic performance. However, by the afternoon, Katie is “staring off into space” and “daydreaming” again
- Katie’s parents are very concerned, however, because Katie reported that her “heart felt funny.” You obtain a pulse rate and find that Katie’s heart is beating about 130 beats per minute Young Caucasian Girl with ADHD Case Study
Choices for Decision 2: Select what the PMHNP should do:
- Continue same dose of Ritalin and re-evaluate in 4 weeks
- Change to Ritalin LA 20 mg orally daily in the MORNING
- Discontinue Ritalin and begin Adderall XR 15 mg orally daily
Decision Choice Chosen: Change to Ritalin LA 20 mg orally daily in the MORNING
***Explain why other two choice were rejected (not adequate choices)***
Outcome: RESULTS OF DECISION POINT TWO:
- Client returns to clinic in four weeks
- Katie’s academic performance is still improved, and the switch to the LA preparation is lasting Katie throughout the school day
- Katie’s reports of her heart feeling “funny” have gone away. Pulse was 92 during today’s office visit
Choices for Decision 3: Decision Point Three Select what the PMHNP should do next:
- Maintain current dose of Ritalin LA and reevaluate in 4 weeks
- Increase Ritalin LA to 30 mg orally daily
- Obtain EKG based on current heart rate
Decision Choice Chosen: Maintain current dose of Ritalin LA and reevaluate in 4 weeks
***Explain why other two choice were rejected (not adequate choices)***
Outcome: Guidance to Student
RESULT FROM CHOOSING TO MAINTAIN CURRENT DOES OF RITALIN LA AND REEVALUATE IN 4 WEEKS
Guidance to Student
At this point, Katie’s symptoms are well controlled (her attention is sustained throughout the school day) and her side effects have gone away following change to a long-acting preparation. There is no indication at this point that the dose should be increased as it is always advisable to use the lowest effective dose of stimulant medication. Katie’s heart rate is appropriate for an 8 year old girl and an EKG would not be indicated based on her heart rate. Young Caucasian Girl with ADHD Case Study
***Write on each decision. Make sure that in each decision choice that you explain why the other two decisions were not good choices. Use cited sources to validate points. Make sure that this paper has at least 7 References. Please use in-text citations for each section of each decision. Don’t forget the ethical considerations for this assignment. Make it a section by itself.***
***Also please make sure when looking at the ethical consideration for this assignment that you look at how the Caucasian (male) ethnicity and pain medications interact.***
Please use the following format when formulating the paragraphs for each section. Don’t forget the intext citations. Remember to use at least 7 references.
Introduction
Decision #1
Reasons for Choosing the Decision (Why is it the best choice out of the 3 choices)
Anticipated Results (of Chosen Decision)
Difference in Results (Anticipated VS Actual)
Decision #2
Reasons for Choosing the Decision (Why is it the best choice out of the 3 choices)
Anticipated Results (of Chosen Decision)
Difference in Results (Anticipated VS Actual)
Decision #3
Reasons for Choosing the Decision (Why is it the best choice out of the 3 choices)
Anticipated Results (of Chosen Decision)
Difference in Results (Anticipated VS Actual)
Ethical Considerations
Conclusion
References
Case Study; Young Caucasian Girl with ADHD
Student’s Name
Institution’s Affiliation
Lecturer
Date
Decision #1
This decision is basically designed for start up medication for patients with Attention Deficit Hyperactive Disorder. Several drugs have been advanced towards solving the medical condition. However, the best decision is starting Ritalin (methylphenidate) chewable tablets 10 mg orally in the morning.
Reasons for choosing the decision
Normally the patient will not be immediately introduced to a higher amount of prescriptions of the oral dosages or rather, be subjected to other drugs meant for progressive medication. Therefore, the reason for this decision is to introduce the patient to Ritalin (methylphenidate) chewable tablets 10 mg that is taken orally every morning on a daily basis. This is where physicians can determine the drug reactions and the outcome to pick on another decision to work in case this does not materialize.
Anticipated results of the decision
The results I expected were an improvement or rather a slight difference in what was recorded before the patient started the medication. At the introduction of this dosage, the patient will start experiencing an improvement in her predominant inattentive presentation. To some level, it is anticipated that she will have an elongated time span of attention while paying attention to everything; not just what she is interested. The oral dosage of Ritalin (methylphenidate) is a good recommendation for the problem and no doubt few symptoms would be worked out with this therapy because this is just a start. Young Caucasian Girl with ADHD Case Study.
Difference in expected results and the real initial results of the decision
The expectations that there would be some changes were slightly corresponded to the outcome. When the patient along with her parents made a visit to the physician after the four weeks of medication, it was reported, form what her teacher recorded, that Katie had improved in her general performance in academics. This means the drug was at least effective for morning sessions but still something had to be done because in the afternoon, the symptoms get back as Katie starts day dreaming again and staring into space. This was a necessity for another option to be met Young Caucasian Girl with ADHD Case Study.
Decision #2
Decision #2 is the most effective and appropriate for the Attention Deficit Hyperactive Disorder patient. Results from the first decision demand for another intervention to be carried out. Out of varied remedies at hand I chose to introduce the patient to a new dosage of Ritalin LA 20 mg orally daily that is taken in the morning. This definitely could be the most effective therapeutic approach towards the patient. The patient’s condition requires altered medical approach where there is increased dose and with a different property of the drug.
Reason for choosing the decision
From the medical exam results, the patient experiences a series of symptoms such as inattentiveness, forgetfulness, poor spelling and generally lack of interest in school work. This is can be considered to a mental problem which is likely to be elevated if not countered. Introducing the patient to Ritalin LA 20 mg orally medication could definitely work the problem out because the patient has been prescribed that medication before and it has proved to be positively effective. Recycling decision #1, by improving the dosage and trying out on a new strategy could help. Ritalin LA 20 mg orally is the most appropriate drug for such symptoms as concentration deficits and inattentiveness.
Anticipated results of the decision
From the medical examinations of the patient’s mental status done, the patient probably has something to do with mental problem. She day dreams, stares a lot in space and could be at risk of hallucinating under no influence though she is time, place, person and event oriented. The high rate of heartbeat of 130 beats per minute is just too unbearable Young Caucasian Girl with ADHD Case Study. I expected there would be at least a decrease in the same and more improvements in the mentioned symptoms.
Difference in expected results and the real initial results of the decision
The gradual changes that were expected from administering the new drug to the patient were not closest to what was exhibited at the end of the prescribed medication period. After four weeks of Ritalin LA 20 mg orally administration, there was a notable changes in the symptoms. The most tremendous results of the medication was the rate of the heartbeat that had reduced to 92 from the previous record of 130 per minute. It is however not imaginable that the new dose of Ritalin LA 20 mg orally keeps Katie normally functioning throughout a school day. This was not the case in the previous days when she could be okay in the morning but remains disturbed the remaining fraction of the day. Her heart does not feel funny anymore.
Decision #3
The third decision is not a different approach compare to the other prior medication because there are no special cases of persistent symptoms that have not been affected positively by the previous medications. Maintaining the current dose of Ritalin LA ad having the patient reevaluated in four weeks would work better.
Reasons for choosing the decision
Whenever the prescribed dosage does not impact a patient in any positive manner, there must be changes. Sometimes there can be reduction of increase of dosage from the previous prescriptive medications. However, in this case there is no need to have the quantitative or qualitative changes in the drug administration because the medication therapy seems helpful to the patient.
Anticipated results of the decision
Since the medication has exhibited positive effect to the eight-year old patient, continued administration of the same dosage is preferable. This means there would be improvements in the symptoms and eventually the diminishing of the disorder. The patient requires to be directed on the appropriate use of the drug for there might arise side effects of the treatment measures.
Difference in expected results and the real initial results of the decision
The patient has shown total improvement in her symptoms and therefore there is need to use the same medication but under the necessary prescriptions of health professional. The Patient’s attention has gained stability throughout the school day. These results may not call for any more alterations in the dosage as to whether there should be an increase or reduction of the dose. With the heartbeat, she is well if she maintained the current record in respect to her age.
Ethical considerations in treatment plan and communication with clients
- Appropriate prescriptions for each level of disorder
In treatment of ADHD, this ethical consideration helps physicians to administer the most appropriate prescriptions to each case as whether mild, moderate of severe conditions of ADHD.
Proper administration
This reminds physicians that patients should take the right course of drug administration ensuring they follow all instructions given (Eden, D. 2011). For example, patients may need to take the drug with food or be subjected to taper dosage in cases of discontinuation of the drug. Sometimes it could be a change in the type of medication being offered where there should be a shift from the previous drug.
- Modifications of dosage
Just like for prescriptions as discussed above, modifying the correct dosage for a given disorder is an ethical consideration Young Caucasian Girl with ADHD Case Study. This may help nursing team to reduce the dosage as appropriate depending on the condition of the patient.
- Provision of Patient-education
This is mostly knowledge about what to expect during the medication and after. This helps nurses to highlight potential side effects (Eden, D. 2011) of the prescribed treatment for patients to get to know what might happen in the end. It also helps clients understand that they need to stick to a certain drug even when they do not want use it.
References
Attention-Deficit Hyperactivity Disorder, Fourth Edition. (2014). s.l.: Guilford Publications.
Feinstein, D., & Eden, D. (2011). Ethics handbook for energy healing practitioners: A guide for the professional practice of energy medicine and energy psychology. Fulton, CA: Energy Psychology Press.
Mash, E. J., & Wolfe, D. A. (2016). Abnormal child psychology.
Resident & staff physician. (1969). Port Washington, NY, etc.: Romaine Pierson Publishers, etc.
Retz, W., & Klein, R. G. (2010). Attention-deficit hyperactivity disorder (ADHD) in adults. Basel: Karger.
Silver, L. B. (2003). Attention-Deficit/Hyperactivity Disorder: A Clinical Guide to Diagnosis and Treatment for Health and Mental Health Professionals. Arlington: American Psychiatric Pub. Young Caucasian Girl with ADHD Case Study