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NURS 6630 Assignment Assessing and Treating Patients With ADHD

NURS 6630 Assignment Assessing and Treating Patients With ADHD

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This assignment’s case study is on Katie, an 8-year-old female whose parents brought her to the clinic today. Since Katie’s instructor thought she might have ADHD, the primary care physician recommended the client to the clinic for screening. According to the teacher’s report on the Conner’s Teacher Rating Scale-Revised, Katie is inattentive, forgets things easily, inattentive, and struggles with spelling, reading, and mathematics. Additionally, the teacher remarked that Katie’s attention span is short, that she pays attention to what she is interested in and that she is uninterested in school activities. Katie’s parents have vehemently refuted the report. Katie described school as “good,” confesses that she finds subjects uninteresting, and acknowledges that her mind wanders during class time. Katie was suitably dressed for the occasion, had euthymic mood, bright affect, and grossly intact concentration and attention, and denies any visual or aural hallucinations in addition to suicide or homicidal thinking. Katie was diagnosed with attention deficit hyperactivity disorder, primarily inattentive presentation, based on the aforementioned results. As a result, the patient’s treatment strategy will be guided by the symptoms listed above.

Decision Point One

Selected Decision

The selected decision is beginning Ritalin (methylphenidate) chewable tablets 10 mg orally in the morning.

Reason for the Selection

Ritalin was selected for the patient because it is a drug that is commonly used in the treatment of children suffering from ADHD. Ritalin works by managing the symptoms of ADHD such as lack of attention and learning deficits (Ruuskanen et al., 2019). Ritalin works by improving the cognitive function of the affected children. The improvement in cognitive functioning is attributable to the ability of the drug to raise the levels of norepinephrine and dopamine in the brain. Accumulation of dopamine and norepinephrine causes an improvement in the cognitive functioning of the patient (Feldman et al., 2018). Ritalin also has a quicker peak performance in ADHD when compared to the other alternatives (J. Bachmann et al., 2017).

Why the Other Options were not Selected

The decision to administer Wellbutrin (bupropion) or Intuniv extended release was not selected because of the low peak performance level when compared to Ritalin. In addition, Wellbutrin was not selected, as it is the drug of choice for adults with ADHD. The use of Wellbutrin in children may result in side effects such as suicidal ideations and attempts (Hile, 2020). Intuniv was also not selected because of its side effects such as sedation that will affect the attention span of the children (Verbeeck et al., 2017). NURS 6630 Assignment Assessing and Treating Patients With ADHD

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What I was Hoping to Achieve

Ritalin improves the cognitive functioning in children with ADHD (Pakdaman et al., 2018). Therefore, I was hoping to witness an

NURS 6630 Assignment Assessing and Treating Patients With ADHD

NURS 6630 Assignment Assessing and Treating Patients With ADHD

improvement in the client’s attention span. I was also expecting an improvement in Katie’s academic performance. I also expected to witness improvement in memory since the client does not have a history of sleep deprivation.

How Ethical Considerations May Impact Treatment Plan and Communication with Patients

The ethical consideration of informed assent may influence the treatment plan for the client since Katie’s parents may decline the selected treatment. The ethical consideration of non-maleficence and benevolence may also influence the selection of treatment since options with minimal harm must be selected. Lastly, the PMHNP must ensure privacy and confidentiality of the client’s data (Buka, 2020).

NURS 6630 Assignment Assessing and Treating Patients With ADHD

Decision Point Two

Selected Decision

Change to Ritalin LA 20 mg orally daily in the morning.

Reason for the Selection

Ritalin LA is the long-acting type of Ritalin that provides prolonged therapeutic effect to children with ADHD. The prolonged therapeutic effect implies that the client will remain attentive throughout the day in the school and at home (Ruuskanen et al., 2019). The administration of Ritalin chewable tablets 10 mg orally in the morning was effective. However, the teacher reported that Katie began staring off into space and daydreaming by afternoon. The implication of the symptoms is that the peak performance of Ritalin chewable was reached by afternoon, hence, the client experiencing symptoms of ADHD. The client however experienced the side effect of tachycardia that is associated with Ritalin chewable tablets. The administration of the long-acting form of Ritalin is therefore safe since it is associated with minimal side effects (Schwarz, 2017). NURS 6630 Assignment Assessing and Treating Patients With ADHD

Why the Other Options were not Selected

The decision to continue with the same dose of Ritalin and re-evaluate in 4 weeks was not selected because the desired therapeutic effect of Ritalin had not been achieved. Katie will relapse to the previous symptoms of ADHD. The decision to discontinue Ritalin and begin Adderall RX 15 mg orally daily was not chosen because Ritalin had resulted in moderate improvement in symptoms. Changing to Adderall was likely to increase the side effects of the drug, hence, safety issues in treatment (Schwarz, 2017).

What I was Hoping to Achieve

Ritalin LA has long-lasting therapeutic effects. As a result, it was expected that the client will remain attentive throughout the day. It was also expected that the client’s experiences of side effects of Ritalin would be minimal. Lastly, the cognitive skills of the client were expected to improve (Schwarz, 2017).

How Ethical Considerations May Impact Treatment Plan and Communication with Patients

The ethical aspect of safety in patient care influences the selection of the above treatment option. Ritalin was safer when compared to the alternatives that were presented in the case study. The ethical aspect of informed consent would have impacted the treatment since the parents should assent the treatment. Lastly, promotion of patient autonomy should be considered by educating the patient and the family about the benefits and risks of the different treatment options (Buka, 2020). NURS 6630 Assignment Assessing and Treating Patients With ADHD

Decision Point Three

Selected Decision

The selected decision is maintaining the current dose of Ritalin LA and re-evaluate after 4 weeks.

Reason for the Selection

The above decision was made because the optimum therapeutic effect of Ritalin LA has been reached. The symptoms of ADHD that the client experienced earlier have been managed. The client also did not experience any side effects of Ritalin LA (Pakdaman et al., 2018). Therefore, continuing with the current dose of Ritalin LA is the most effective solution to consider in the treatment process.

Why the Other Options were not Selected

The decision to increase the dose of Ritalin LA to 30 mg orally daily was not selected because the desired therapeutic effect of Ritalin had been achieved. Increasing the dosage would have also predisposed the patient to side effects such as tachycardia and suicidal ideations. Obtaining EKG based on the current heart rate was not selected because the pulse rate is normal. Therefore, there is no indication for EKG (Schwarz, 2017).

What I was Hoping to Achieve

I was hoping to achieve sustained therapeutic effect of Ritalin LA by making the above decision. I was also hoping to eliminate any side effects that the patient could have experienced by using Ritalin. I was also hoping to witness sustained improvement in the client’s cognitive functioning due to the effects of Ritalin LA (Schwarz, 2017).

How Ethical Considerations May Impact Treatment Plan and Communication with Patients

The ethical consideration of benevolence and non-maleficence would affect the treatment of the patient in the case study. The PMHNP is expected to prioritize the safety of the selected treatment interventions. The PMHNP also has the responsibility of ensuring data integrity. The data of the patient should be kept private and confidential (Buka, 2020).

Conclusion

This case study has explored the treatment of ADHD in children. The case study showed that Ritalin is the most effective drug of choice for children with ADHD. Ritalin produces its effect by increasing the levels of norepinephrine and dopamine in the brain. Since ADHD is associated with cognitive deficits, the improvement in the levels of dopamine and norepinephrine result in the improvement of the cognitive skills of the patient. The chewable forms of Ritalin was found to be associated with the side effect of tachycardia and reduced period of therapeutic effect. The teacher of the client reported that the symptoms of ADHD relapsed by afternoon following the depletion of Ritalin in the system. As a result, the decision to administered Ritalin LA was made. Ritalin LA proved effective in improving the attention span of the client throughout the day. The client also improved her cognitive skills as seen in the enhanced academic involvement and achievement. The administration of Ritalin LA also led to the reduction in the side effects that the client experienced with Ritalin (Pakdaman et al., 2018). Ethical considerations had an influence on the treatment decisions that were made in the case study. For example, the PMHNP aimed at ensuring that safety in the care given to the patient was promoted. The PMHNP selected the treatment options that were associated with optimum therapeutic effect and minimal harm to the patient. In addition, the PMHNP had the professional responsibility of ensuring that data privacy and confidentiality was promoted alongside seeking informed assent from the parents of the client (Buka, 2020). Therefore, PMHNP should be aware of the ethical considerations that influence the decisions that they make in practice.

References

Buka, P. (2020). Essential Law and Ethics in Nursing: Patients, Rights and Decision-Making. Taylor & Francis.

Feldman, M. E., Charach, A., & Bélanger, S. A. (2018). ADHD in children and youth: Part 2—treatment. Paediatrics & Child Health, 23(7), 462–472. https://doi.org/10.1093/pch/pxy113

Hile, A. (2020). Bupropion for the treatment of ADHD. Lynchburg Journal of Medical Science, 2(1). https://digitalshowcase.lynchburg.edu/dmscjournal/vol2/iss1/15

  1. Bachmann, C., Philipsen, A., & Hoffmann, F. (2017). ADHD in Germany: Trends in diagnosis and pharmacotherapy. Deutsches Ärzteblatt International, 114(9), 141–148. https://doi.org/10.3238/arztebl.2017.0141

Pakdaman, F., Irani, F., Tajikzadeh, F., & Jabalkandi, S. A. (2018). The efficacy of Ritalin in ADHD children under neurofeedback training. Neurological Sciences, 39(12), 2071–2078. https://doi.org/10.1007/s10072-018-3539-3

Ruuskanen, E., Leitch, S., Sciberras, E., & Evans, S. (2019). “Eat, pray, love. Ritalin”: A qualitative investigation into the perceived barriers and enablers to parents of children with ADHD undertaking a mindful parenting intervention. Complementary Therapies in Clinical Practice, 37, 39–46. https://doi.org/10.1016/j.ctcp.2019.08.005

Schwarz, A. (2017). ADHD Nation: Children, Doctors, Big Pharma, and the Making of an American Epidemic. Simon and Schuster.

Verbeeck, W., Bekkering, G. E., Noortgate, W. V. den, & Kramers, C. (2017). Bupropion for attention deficit hyperactivity disorder (ADHD) in adults. Cochrane Database of Systematic Reviews, 10. https://doi.org/10.1002/14651858.CD009504.pub2

Excellent

Point range: 90–100

Good

Point range: 80–89

Fair

Point range: 70–79

Poor

Point range: 0–69

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.

(9%) – 10 (10%)
The response accurately, clearly, and fully summarizes in detail the case for the Assignment.

The response accurately and clearly explains in detail the specific patient factors that impact decision making when prescribing medication for this patient.

(8%) – 8 (8%)
The response accurately summarizes the case for the Assignment.

The response accurately explains the specific patient factors that impact decision making with prescribing medication for this patient.

(7%) – 7 (7%)
The response inaccurately or vaguely summarizes the case for the Assignment.

The response inaccurately or vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient.

(0%) – 6 (6%)
The response inaccurately and vaguely summarizes the case for the Assignment, or is missing.

The response inaccurately and vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient.

Decision #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.

18 (18%) – 20 (20%)
The response accurately and clearly explains in detail the decision selected.

The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected.

The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response.

The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response.

The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients.

Examples provided fully support the decisions and responses provided.

16 (16%) – 17 (17%)
The response accurately explains the decision selected.

The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected.

The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response.

The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response.

The response accurately explains how ethical considerations impact the treatment plan and communication with patients.

Examples provided support the decisions and responses provided.

14 (14%) – 15 (15%)
The response inaccurately or vaguely explains the decision selected.

The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected.

The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response.

The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response.

The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients.

Examples provided may support the decisions and responses provided.

(0%) – 13 (13%)
The response inaccurately and vaguely explains the decision selected.

The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing.

The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing.

The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing.

The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing.

Examples provided do not support the decisions and responses provided, or is missing.

Decision #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.

18 (18%) – 20 (20%)
The response accurately and clearly explains in detail the decision selected.

The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected.

The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response.

The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response.

The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients.

Examples provided fully support the decisions and responses provided.

16 (16%) – 17 (17%)
The response accurately explains the decision selected.

The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected.

The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response.

The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response.

The response accurately explains how ethical considerations impact the treatment plan and communication with patients.

Examples provided support the decisions and responses provided.

14 (14%) – 15 (15%)
The response inaccurately or vaguely explains the decision selected.

The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected.

The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response.

The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response.

The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients.

Examples provided may support the decisions and responses provided.

(0%) – 13 (13%)
The response inaccurately and vaguely explains in detail the decision selected.

The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing.

The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing.

The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing.

The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing.

Examples provided do not support the decisions and responses provided, or is missing.

Decision #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.

18 (18%) – 20 (20%)
The response accurately and clearly explains in detail the decision selected.

The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected.

The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response.

The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response.

The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients.

Examples provided fully support the decisions and responses provided.

16 (16%) – 17 (17%)
The response accurately explains the decision selected.

The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected.

The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response.

The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response.

The response accurately explains how ethical considerations impact the treatment plan and communication with patients.

Examples provided support the decisions and responses provided.

14 (14%) – 15 (15%)
The response inaccurately or vaguely explains the decision selected.

The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected.

The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response.

The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response.

The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients.

Examples provided may support the decisions and responses provided.

(0%) – 13 (13%)
The response inaccurately and vaguely explains in detail the decision selected.

The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing.

The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing.

The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing.

The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing.

Examples provided do not support the decisions and responses provided, or is missing.

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.

14 (14%) – 15 (15%)
The response accurately and clearly summarizes in detail the recommendations on the treatment options selected for this patient.

The response accurately and clearly explains a justification for the recommendations provided, including clinically relevant resources that fully support the recommendations provided.

12 (12%) – 13 (13%)
The response accurately summarizes the recommendations on the treatment options selected for this patient.

The response accurately explains a justification for the recommendation provided, including clinically relevant resources that support the recommendations provided.

11 (11%) – 11 (11%)
The response inaccurately or vaguely summarizes the recommendations on the treatment options selected for this patient.

The response inaccurately or vaguely explains a justification for the recommendations provided, including clinically relevant resources that inaccurately or vaguely support the recommendations provided.

(0%) – 10 (10%)
The response inaccurately and vaguely summarizes the recommendations on the treatment options selected for this patient, or is missing.

The response inaccurately and vaguely explains a justification for the recommendations provided, including clinically relevant resources that do not support the recommendations provided, or is missing.

Written 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.
(5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

(4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive.

3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.

Purpose, introduction, and conclusion of the assignment is vague or off topic.

(0%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.

No purpose statement, introduction, or conclusion were provided.

Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation
(5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors.
(4%) – 4 (4%)
Contains a few (1 or 2) grammar, spelling, and punctuation errors.
3.5 (3.5%) – 3.5 (3.5%)
Contains several (3 or 4) grammar, spelling, and punctuation errors.
(0%) – 3 (3%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Written 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.
(5%) – 5 (5%)
Uses correct APA format with no errors.
(4%) – 4 (4%)
Contains a few (1 or 2) APA format errors.
3.5 (3.5%) – 3.5 (3.5%)
Contains several (3 or 4) APA format errors.
(0%) – 3 (3%)
Contains many (≥ 5) APA format errors.
Total Points: 100
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