Sample Answer for ASSSESSING AND TREATING CLIENTS WITH ADHD NURS 6630 Included After Question
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.
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
LEARNING RESOURCES
Required Readings
- Prince, J. B., Wilens, T. E., Spencer, T. J., & Biederman, J. (2016). Stimulants and other medications for ADHD. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 99–112). Elsevier.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disordersLinks to an external site. (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
- Hodgkins, P., Shaw, M., McCarthy, S., & Sallee, F. R. (2012). The pharmacology and clinical outcomes of amphetamines to treat ADHD: Does composition matter? CNS DrugsLinks to an external site., 26(3), 245–268. https://doi.org/10.2165/11599630-000000000-00000
- Martin, L. (2020). A 5-question quiz on ADHD. Psychiatric TimesLinks to an external site.. https://www.psychiatrictimes.com/view/5-question-quiz-adhd
- U.S. Food & Drug Administration. (n.d.). Drugs@FDA: FDA-approved drugsLinks to an external site.. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm
Links to an external site.
Note: To access the following medications, use the Drugs@FDA resource. Type the name of each medication in the keyword search bar. Select the hyperlink related to the medication name you searched. Review the supplements provided and select the package label resource file associated with the medication you searched. If a label is not available, you may need to conduct a general search outside of this resource provided. Be sure to review the label information for each medication as this information will be helpful for your review in preparation for your Assignments.
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Required Media
Note: This case study will serve as the foundation for this week’s Assignment.
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.
Reminder : The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formattingLinks to an external site..
BY DAY 7
Submit your Assignment.
SUBMISSION INFORMATION
Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.
- To submit your completed assignment, save your Assignment as WK9Assgn_LastName_Firstinitial
- Then, click on Start Assignment near the top of the page.
- Next, click on Upload File and select Submit Assignment for review.
Rubric
NURS_6630_Week9_Assignment_Rubric
| NURS_6630_Week9_Assignment_Rubric | ||||||
| Criteria | Ratings | Pts | ||||
| This criterion is linked to a Learning OutcomeIntroduction 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. |
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10 pts | ||||
| This criterion is linked to a Learning OutcomeDecision #1 (1–2 pages)• 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. |
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20 pts | ||||
| This criterion is linked to a Learning OutcomeDecision #2 (1–2 pages)• 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. |
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20 pts | ||||
| This criterion is linked to a Learning OutcomeDecision #3 (1–2 pages)• 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. |
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20 pts | ||||
| This criterion is linked to a Learning OutcomeConclusion (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. |
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15 pts | ||||
| This criterion is linked to a Learning OutcomeWritten Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria. |
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5 pts | ||||
| This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation |
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5 pts | ||||
| This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list. |
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5 pts | ||||
| Total Points: 100 | ||||||
A Sample Answer For the Assignment: ASSSESSING AND TREATING CLIENTS WITH ADHD NURS 6630
Title: ASSSESSING AND TREATING CLIENTS WITH ADHD NURS 6630
The management of attention deficit hyperactivity disorder (ADHD) among the pediatric population is quite challenging due to the limited amount of evidence supporting the safety of several recommended drugs for this disorder. To illustrate further the management of ADHD, the case of an 8-year-old Caucasian female has been provided. The patient presents with symptoms of ADHD as suggested by her teacher who completed the Conner’s Teacher Rating Scale-Revised. Her teacher claims that the patient is forgetful most of the time, and easily distracted with a very short concentration time. The patient also displays poor language, spelling, and arithmetic skills, hurting her overall school performance. The teacher also reported that lately, the patient has been failing to follow instructions, leaving her homework incomplete. Despite the patient’s parents refusing their daughter has ADHD, the patient reports that she gets bored most of the time at school with a lack of interest in school work. She however denies bullying of any kind at school with a good home life experience. With the findings of the conducted mental status examination and the Conner’s Teacher Rating Scale-Revised, the patient has been diagnosed with Attention deficit hyperactivity disorder, predominantly inattentive presentation.
Several factors were considered when deciding on the specific pharmacological agent and the right dosage to prescribe in the management of the patient’s condition. Such factors include the young age of the patient, her Caucasian race, her ADHD diagnosis, and the reported symptoms. The completed Conner’s Teacher Rating Scale-Revised can also help determine the severity of the patient’s condition which is crucial in determining the dosage of the selected drug. As such, this discussion aims at developing the most effective treatment plan for the 8-year-old patient in the management of ADHD, with a rationale for each decision made.
Decision#1
Selected Decision and Rationale
Administering Methylphenidate 10mg chewable tablets once a day in the morning was selected as the initial intervention. Methylphenidate is a stimulant to the central nervous system that acts via noncompetitive blockage of noradrenalin and dopamine reuptake into the terminals, by inhibiting the action of the dopamine and noradrenaline transporters thus raising dopamine and noradrenaline levels in the synaptic cleft (American Psychiatric Association, 2013; Cipriani et al., 2018). Previous evidence supports the substantial effectiveness of Methylphenidate in the management of children diagnosed with ADHD, with a great safety profile and high tolerability levels (Hodgkins et al., 2012). The drug is only recommended for children of age 6 and above (Grimmsmann & Himmel, 2021). Finally, with consideration of the patient’s Caucasian race, the drug is metabolized in the liver via the CYP3A4 pathway, which is predominant among this ethnic population, hence limiting the risks of toxicity (Bonati et al., 2018). The chewable tablet formulation is normally recommended for children to promote compliance (Kikuchi et al., 2021).
Intuniv was an inappropriate choice for this patient given that previous studies report that the drug being a non-stimulant is more effective in the management of ADHD when used together with a stimulant (Pelham III et al., 2022). Wellbutrin on the other hand is a norepinephrine-dopamine reuptake inhibitor (NDRI) discouraged among children below the age of 9 years old due to its elevated risks of seizures (Kikuchi et al., 2021).
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Expected Outcome.
Up to 50% of the patient’s symptoms will be resolved within the following 4 weeks (Kikuchi et al., 2021). She will be able to concentrate for longer hours with increased attention and memory (Hodgkins et al., 2012). Her overall academic performance will also improve significantly.
Ethical Consideration
Based on the provisions of legal and ethical guidelines for nurses, the PMHNP is obliged to consider the patient ethnicity and race to promote culturally sensitive care (Bonati et al., 2018). The patient’s parents also have a legal right to information concerning the health of their child, for sound decision-making (American Psychiatric Association, 2013). Respecting the patient’s autonomy is key to promoting patient satisfaction.
Decision#2
Selected Decision and Rationale
Out of the options provided, the most effective second intervention was to change the treatment regimen to a long-acting Ritalin 20mg administered once daily in the morning. The patient has reported the potential effectiveness of the drug in managing ADHD symptoms (Hodgkins et al., 2012). However, since the dose is quite limited to resolving the patient’s symptoms all day, using a long-acting agent will help prolong the duration of action, improving the patient’s attention, concentration, and memory the entire day (Cipriani et al., 2018). Studies show that long-acting Methylphenidate lasts in the body system for up to 10 to 12 hours (American Psychiatric Association, 2013). The side effect reported of elevated heart rate is common among pediatric patients on methylphenidate which resolves as the patient continues taking the drug (Pelham III et al., 2022). Consequently, previous evidence confirms that using a long-acting agent, hence reduces the concentration of the drug at one point, reducing the risks of toxic doses, when used for a long time (Kikuchi et al., 2021).
Maintaining the dose of methylphenidate was not necessary as the patient will continue experiencing limited effectiveness of the drug later in the day (Grimmsmann & Himmel, 2021). Administering Adderall in place of Methylphenidate was also inappropriate at the moment given that the former is associated with increased risks of cardiovascular complications which would compromise the health of the patient (Bonati et al., 2018).
Expected Outcome
The patient will be able to attain full concentration and attention level with the use of the drug for 4 weeks (Pelham III et al., 2022). This should help promote her overall academic performance and interest in school activities. The side effect of increased heart rate is expected to return to normal within this period (Grimmsmann & Himmel, 2021).
Ethical Considerations
“Not harm” is one of the main ethical obligations of nurses, especially when taking care of children (Bonati et al., 2018). As such, the PMHNP needed to explain to the parents of the patient why the side effect occurred and the main cause of action to resolve the side effect and promote the health of their child (Kikuchi et al., 2021).
Decision#3
Selected Decision and Rationale
Advising the patient to continue taking the long-acting Methylphenidate 20mg once daily and report for reevaluation after 4 weeks was considered the final decision. The patient reported completely resolved side effects with improved effectiveness of the drug in the management of ADHD symptoms all day (Hodgkins et al., 2012). Previous evidence demonstrates that patients on Ritalin may exhibit maximum benefit within 8 to 12 weeks of treatment therapy (American Psychiatric Association, 2013; Cipriani et al., 2018). Most pediatric patient on Methylphenidate has reported great tolerance to the medication with a desirable safety profile in long-term use (Grimmsmann & Himmel, 2021). However, in rare cases, the patient may exhibit ineffectiveness to the medication which might call for the dose titration, hence the need for reevaluating the patient after four weeks (Kikuchi et al., 2021).
At this point, it was not appropriate to increase the dose of methylphenidate to 30mg as studies show that low effective doses are safer for use by children, with reduced risks of adverse effects (Pelham III et al., 2022). Consequently, based on the current patient heart rate, it is not necessary to obtain EKG, as her pulse is within the normal limits of a child of her age (Bonati et al., 2018).
Expected Outcome
For the next four weeks, the patient will report further improvement in ADHD symptoms all day (Grimmsmann & Himmel, 2021). She should display appropriate language, spelling, and arithmetic skills, with improved attention and concentration level (Hodgkins et al., 2012). No side effects are expected.
Ethical Consideration
In the final decision, the PHMNP had to consider several ethical principles including nonmaleficence, beneficence, and justice (American Psychiatric Association, 2013). Since the patient was fully satisfied with the treatment outcome, the clinician needed to utilize his/her clinical judgment to advise the patient to continue using the medication for optimal benefits (Pelham III et al., 2022).
Conclusion
The pediatric patient described in the case study provided presents with symptoms of ADHD as reported by her teacher. In the development of the treatment plan for this patient, her young age, Caucasian gender, ADHD diagnosis, and presenting symptoms were considered in the selection of the safest and most effective drug. As such, the initial decision was to administer methylphenidate 10mg once daily in the morning (American Psychiatric Association, 2013). Methylphenidate is a stimulant medication that has been proven to be safe and effective in managing ADHD symptoms in both children and adults. Wellbutrin and Intuniv were not considered in this decision as a result of safety issues among children associated with increased risks of side effects (Hodgkins et al., 2012). After 4 weeks, the patient reported significantly improved ADHD symptoms earlier in the day, with minimal effect of the medication later in the day, in addition to side effects of elevated heart rate (Pelham III et al., 2022). It was thus necessary to administer long-acting Methylphenidate 20mg once daily to promote management of the patient’s symptoms the entire day. The long-acting formulation has a longer duration of action (Bonati et al., 2018). Maintaining the dose of Methylphenidate or switching the drug with Adderall was not appropriate at this point (Kikuchi et al., 2021).
The patient reported resolved side effects with well-managed ADHD symptoms the entire day after 4 weeks. This shows that she was tolerant to the drug with great safety and effectiveness hence the need to continue the same medication at the same dose for another 4 weeks before the reevaluation (Grimmsmann & Himmel, 2021). Increasing the dose of Methylphenidate or obtaining an EKG was not appropriate at this point. The PMHNP also encountered several ethical considerations when taking care of the patient with the main one being “no harm.” Additional ethical principles observed include justice, nonmaleficence, and beneficence (Cipriani et al., 2018).
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Bonati, M., Reale, L., Zanetti, M., Cartabia, M., Fortinguerra, F., Capovilla, G., … & Lombardy ADHD Group. (2018). A regional ADHD centre-based network project for the diagnosis and treatment of children and adolescents with ADHD. Journal of attention disorders, 22(12), 1173-1184. https://doi.org/10.1177/1087054715599573
Cipriani, A., Adamo, N., Del Giovane, C., Coghill, D., Banaschewski, T., Hollis, C., … & Cortese, S. (2018). Unbalanced risk-benefit analysis of ADHD drugs–Authors’ reply. The Lancet Psychiatry, 5(11), 871-873. https://doi.org/10.1016/S2215-0366(18)30396-1
Grimmsmann, T., & Himmel, W. (2021). The 10-year trend in drug prescriptions for attention-deficit/hyperactivity disorder (ADHD) in Germany. European journal of clinical pharmacology, 77(1), 107-115. https://doi.org/10.1007/s00228-020-02948-3
Hodgkins, P., Shaw, M., McCarthy, S., & Sallee, F. R. (2012). The pharmacology and clinical outcomes of amphetamines to treat ADHD: Does composition matter? CNS Drugs, 26(3), 245–268. https://doi.org/10.2165/11599630-000000000-00000
Kikuchi, D., Obara, T., Tokunaga, M., Shiozawa, M., Takahashi, A., Ito, M., … & Watanabe, Y. (2021). Drug prescription for attention deficit hyperactivity disorder drugs in pediatric outpatients: A retrospective survey of Japanese Administrative Data (2012–2018). Asian Journal of Psychiatry, 57, 102512. https://doi.org/10.1016/j.ajp.2020.102512
Pelham III, W. E., Altszuler, A. R., Merrill, B. M., Raiker, J. S., Macphee, F. L., Ramos, M., … & Pelham Jr, W. E. (2022). The effect of stimulant medication on the learning of academic curricula in children with ADHD: A randomized crossover study. Journal of consulting and clinical psychology, 90(5), 367. https://doi.org/10.1037/ccp0000725
Grading Rubric
| Performance Category | 100% or highest level of performance
100% 16 points |
Very good or high level of performance
88% 14 points |
Acceptable level of performance
81% 13 points |
Inadequate demonstration of expectations
68% 11 points |
Deficient level of performance
56% 9 points
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Failing level
of performance 55% or less 0 points |
| Total Points Possible= 50 | 16 Points | 14 Points | 13 Points | 11 Points | 9 Points | 0 Points |
| Scholarliness
Demonstrates achievement of scholarly inquiry for professional and academic topics. |
Presentation of information was exceptional and included all of the following elements:
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Presentation of information was good, but was superficial in places and included all of the following elements:
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Presentation of information was minimally demonstrated in all of the following elements:
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Presentation of information is unsatisfactory in one of the following elements:
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Presentation of information is unsatisfactory in two of the following elements:
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Presentation of information is unsatisfactory in three or more of the following elements
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| 16 Points | 14 Points | 13 Points | 11 Points | 9 Points | 0 Points | |
| Application of Course Knowledge
Demonstrate the ability to analyze and apply principles, knowledge and information learned in the outside readings and relate them to real-life professional situations |
Presentation of information was exceptional and included all of the following elements:
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Presentation of information was good, but was superficial in places and included all of the following elements:
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Presentation of information was minimally demonstrated in the all of the following elements:
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Presentation of information is unsatisfactory in one of the following elements:
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Presentation of information is unsatisfactory in two of the following elements:
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Presentation of information is unsatisfactory in three of the following elements
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| 10 Points | 9 Points | 6 Points | 0 Points | |||
| Interactive Dialogue
Initial post should be a minimum of 300 words (references do not count toward word count) The peer and instructor responses must be a minimum of 150 words each (references do not count toward word count) Responses are substantive and relate to the topic. |
Demonstrated all of the following:
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Demonstrated 3 of the following:
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Demonstrated 2 of the following:
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Demonstrated 1 or less of the following:
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| 8 Points | 7 Points | 6 Points | 5 Points | 4 Points | 0 Points | |
| Grammar, Syntax, APA
Points deducted for improper grammar, syntax and APA style of writing. The source of information is the APA Manual 6th Edition Error is defined to be a unique APA error. Same type of error is only counted as one error. |
The following was present:
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The following was present:
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The following was present:
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The following was present:
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The following was present:
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The following was present:
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| 0 Points Deducted | 5 Points Lost | |||||
| Participation
Requirements |
Demonstrated the following:
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Failed to demonstrate the following:
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| 0 Points Lost | 5 Points Lost | |||||
| Due Date Requirements | Demonstrated all of the following:
A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT. |
Demonstrates one or less of the following.
A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT. |