NURS 4430 Assignment: Assessing and Treating Patients With ADHD
NURS 4430 Assignment Assessing and Treating Patients With ADHD
Attention-deficit/hyperactivity disorder (ADHD) is a developmental psychiatric condition common in pediatric populations, although it also diagnosed in the adult population. It is diagnosed based on features attention deficits, hyperactivity, or impulsivity. The symptoms affect a patient’s level of functioning and cognitive ability (Cabral et al., 2020). The purpose of this assignment is to discuss the case of a child with ADHD, propose treatment interventions, and explain how ethical considerations impacted the patient’s treatment plan.
Case Overview
The case depicts an 8-year-old child, Katie, referred for psychiatric assessment of ADHD. Her teacher expressed concerns that she could have ADHD based on her behavior. Results from the ADHD assessment questionnaire filled by her teacher, shows that she has attention deficits, distracted, memory deficits, and has challenges in spelling, reading, and calculation. Besides, the child has a limited attention span, which is only better when doing things that she likes. Katie has less interest in school, fails to complete tasks, hardly adheres to instructions, and does not do her assignments. However, her parents do not believe that she has ADHD because she is not defiant or have temper outbursts. Katie admits that her mind wanders in class and she often feels lost in her schoolwork. She is diagnosed with ADHD, inattentive presentation.
ADHD treatment comprises both pharmacological and psychotherapy interventions. However, various actors in this patient may impact treatment decisions, including her age, severity of ADHD symptoms, presence of other psychiatric comorbidities, drug allergies, and the parents’ treatment preferences (Childress, 2021).
Decision #1
Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING.
Why This Decision was Selected
The patient was initiated on Ritalin because it is recommended as a first-line agent in treating ADHD in children older than six years. Ritalin is a psychostimulant and acts by increasing the activity of central dopamine and norepinephrine, the neurotransmitters involved in attention and executive function (Childress, 2021). Besides, Ritalin has tolerable side effects, which will promote medication compliance.
Bupropion was not selected since it is not approved by the FDA for ADHD in chuldren. It is usually prescribed off-label when stimulants are unsuccessful in treating ADHD and patients with comorbid conditions (Brown et al., 2018). Intuniv was not initiated because it is recommended as a second-line agent due to a lower efficacy than stimulants. The drug causes rebound hypertension if stopped abruptly and is thus a less ideal choice (Brown et al., 2018).
What I Hoped To Achieve
I hoped that Ritalin would alleviate ADHD symptoms within four weeks and that Katie’s teacher would report improved concentration and attention span in class. Feldman et al. (2018) explain that stimulants such as Ritalin improve academic performance in children with ADHD and their overall quality of life and lower the risk of children developing anxiety and depressive disorders later in life.
Ethical Considerations That May Affect the Treatment Plan
Ethical principles of nonmaleficence and beneficence influenced treatment decisions because the provider was obligated to select a treatment that would promote the best possible outcomes while promoting patient safety (Bipeta, 2019). Ritalin was selected because the evidence supports its efficacy in treating ADHD and its safety profile.
Decision #2
Switch to Ritalin LA 20 mg orally daily in the morning.
Why This Decision was Selected
Ritalin was changed to a long-acting formulation since the effects of the immediate-release preparation were only sustained for a
limited duration. The half-life of immediate-release preparation is about four hours and should be administered 2-3 times per day to sustain the effects (Steingard et al., 2019). However, the long-acting preparation has a longer half-life of 10–12 hours, and its effects are sustained a whole day. Therefore, a long-acting formulation was the ideal choice for this patient so that she could concentrate in class the entire day.
The choice to continue the same Ritalin dose and reassess after four weeks was not appropriate because the patient had low concentration levels and was daydreaming in the afternoon. The symptoms would have persisted or worsened if the dose was not adjusted to either a long-acting formulation or 2-3 times daily dosing (Steingard et al., 2019). Besides, stopping Ritalin and starting Adderall XR was not ideal because stimulants should only be stopped if the maximum dose is not effective.
What I Hoped To Achieve
I expected that switching to a long-acting formulation would maintain the Ritalin’s effects for longer period. Katie’s teacher would report that she had adequate attention and concentration levels throughout the day. Long-acting stimulants act in phases to suppress ADHD symptoms throughout the day. A fraction of the dose is released immediately, while the rest goes into effect hours later (Steingard et al., 2019). Long-acting stimulants usually wear off in 12 to 16 hours.
Ethical Considerations That May Affect the Treatment Plan
Beneficence impacted the treatment plan since the clinician had to change the Ritalin dose to a formulation with better treatment outcomes than the initial one (Bipeta, 2019). The decision was selected with the patient’s well-being in mind, which means that beneficence was upheld.
Decision #3
Maintain the current Ritalin LA dose and reevaluate in 4 weeks.
Why This Decision was Selected
This was an ideal decision since the patient responded adequately to the Ritalin LA 20 mg. The patient had an improved academic performance and the effects of LA Ritalin lasted the entire day. The dose was also maintained since there were no reported side effects of the drug, and it was thus safe to continue. Brown et al. (2018) explain that pharmacologic treatment of ADHD in children and adolescents should start with long-acting stimulant drugs in most cases.
It was not ideal for increasing Ritalin LA to 30 mg since the initial 20 mg dose worked effectively and lasted the whole day with a single dose. Besides, a higher dose may result in side effects, which would be undesirable. An EKG was not also requested since the palpitations had diminished and the heart rate was normal. Advanced cardiac exams such as EKG are recommended if a patient presents with side effects of chest pain, loss of consciousness, and symptoms suggestive of heart disease (Brown et al., 2018).
What I Hoped To Achieve
I expected that maintaining Ritalin LA would continue to alleviate the patient’s ADHD and improve her school grades. Childress (2021) explains that daytime functioning and evening commitments should influence the chosen stimulant formulation. A long-acting formulation should be chosen as an alternative to an immediate release to improve adherence and lower the risk of misuse.
Ethical Considerations That May Affect the Treatment Plan
Nonmaleficence impacted the treatment plan since the clinician had to choose the safest treatment intervention with a lower risk of harming the patient (Bipeta, 2019). Interventions that pose a risk to the patient were not selected, such as increasing the dose or changing the drug.
Conclusion
Katie presented with symptoms of distractibility and inattention mainly observed in school. The patient factors that would impact prescribing decisions include age, the severity of symptoms, the presence of other psychiatric comorbidities, drug allergies, and the parents’ treatment preferences (Childress, 2021). The patient was initiated with Ritalin chewable tablets 10 mg since it is an FDA-approved drug for treating ADHD in children from six years. The drug also has a tolerable safety profile (Childress, 2021). Although the patient’s concentration and attention improved, the drug did not sustain the effects the whole day, and the symptoms recurred in the afternoon. As a result, immediate release Ritalin was switched to a LA formulation to maintain its effects for longer.
The long-acting formulation adequately sustained the drug’s desired effects the whole school day. As a result, the patient’s academic performance improved, and she reported the palpitations had abated. The patient was maintained on the Ritalin LA 20 mg dose since there were no reported side effects and the desired treatment outcomes were attained (Steingard et al., 2019). Increasing the dose might have resulted in side effects and was thus not recommended. Beneficence and nonmaleficence impacted the treatment plan. The clinician had to select treatment interventions associated with the best outcomes and least side effects to promote the best treatment outcomes without compromising the patient’s safety.
NURS 4430 Assignment: Assessing and Treating Patients With ADHD References
Bipeta, R. (2019). Legal and Ethical Aspects of Mental Health Care. Indian journal of psychological medicine, 41(2), 108–112. https://doi.org/10.4103/IJPSYM.IJPSYM_59_19
Brown, K. A., Samuel, S., & Patel, D. R. (2018). Pharmacologic management of attention deficit hyperactivity disorder in children and adolescents: a review for practitioners. Translational Pediatrics, 7(1), 36–47. https://doi.org/10.21037/tp.2017.08.02
Cabral, M. D. I., Liu, S., & Soares, N. (2020). Attention-deficit/hyperactivity disorder: diagnostic criteria, epidemiology, risk factors and evaluation in youth. Translational Pediatrics, 9(Suppl 1), S104. https://doi.org/10.21037/tp.2019.09.08
Childress, A. C. (2021). Novel Formulations of ADHD Medications: Stimulant Selection and Management. Focus (American Psychiatric Publishing), 19(1), 31–38. https://doi.org/10.1176/appi.focus.20200032
Steingard, R., Taskiran, S., Connor, D. F., Markowitz, J. S., & Stein, M. A. (2019). New Formulations of Stimulants: An Update for Clinicians. Journal of child and adolescent psychopharmacology, 29(5), 324–339. https://doi.org/10.1089/cap.2019.0043
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.
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NURS 4430 Assignment: Assessing and Treating Patients With ADHD 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:
AND
AND
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The following was present:
AND/OR
AND/OR
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The following was present:
AND/OR
AND/OR
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The following was present:
AND/OR
AND/OR
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The following was present:
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The following was present:
AND/OR
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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. |