NURS 6630 Assignment Assessing and Treating Patients With ADHD

NURS 6630 Assignment Assessing and Treating Patients With ADHD

Sample Answer for NURS 6630 Assignment Assessing and Treating Patients With ADHD 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.

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 formatting.

 

By Day 7

Submit your Assignment.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

• Please save your Assignment using the naming convention “WK9Assgn+last name+first initial.(extension)” as the name.
• Click the Week 9 Assignment Rubric to review the Grading Criteria for the Assignment.
• Click the Week 9 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
• Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK9Assgn+last name+first initial.(extension)” and click Open.
• If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
• Click on the Submit button to complete your submission.

A Sample Answer For the Assignment: NURS 6630 Assignment Assessing and Treating Patients With ADHD

Title: NURS 6630 Assignment Assessing and Treating Patients With ADHD

Attention deficit hyperactive disorder (ADHD) is a neurodevelopmental disorder that psychiatric mental health nurse practitioners (PMHNP) experience in their practice. The affected patients present with symptoms that include impulsive behaviors, inattention, and hyperactivity. Patients with ADHD have difficulties in engaging mentally tasking activities such as arithmetic and tend to focus on things that are of interest to them. PMHNP are responsible for developing effective care plans that improve the functioning and learning of the patients diagnosed with ADHD. Therefore, this essay examines a case study involving an 8-year-old child who has been diagnosed with ADHD. The paper develops a treatment plan and focuses on ethical considerations that would affect treatment decisions.

The patient in the case study is Katie. She is an 8-year-old Caucasian female brought to the office by her parents after being referred by her primary care provider. Katie’s teacher thinks that Katie may have ADHD, hence, the need for psychiatric review. The report entitled Conner’s Teacher Rating Scale-Revised shows that Katie is inattentive, easily distracted, forgets things easily, poor in spelling, arithmetic, and reading. She also has short attention span, lacks interest in schoolwork, easily distracted, starts things and never finishes them, and rarely follows through instructions. She also fails to finish her schoolwork. Katie agrees with the report that some subjects are boring, feels lost at times, wanders, inattentive, and denies bullying or abuse. Mental status examination is unremarkable except her euthymic mood and grossly intact attention. She has been diagnosed with attention deficit hyperactive disorder, predominantly inattentive presentation. The patient factors that will influence treatment decisions include her age and presenting symptoms.

Week 9: Therapy for Patients With ADHD/ODD 

Diego, a 9-year-old third grader, had always been an energetic child with a short attention span. For years, his mother attributed his behaviors to him being “all boy” and assumed it would improve as he grew older. Instead, daily tasks like chores and homework became increasingly overwhelming for Diego, resulting in disruptive behaviors at home and school. After being evaluated by his healthcare provider, Diego was diagnosed with and treated for attention deficit hyperactivity disorder (ADHD). 

ADHD is a prevalent disorder for patients across the lifespan, as more than 6 million children (CDC, n.d.) have been diagnosed with the disorder. Further, consider that about 60% of children with ADHD in the United States become adults with ADHD (ADAA, n.d.). Like Diego, individuals of all ages find that symptoms of ADHD can make life challenging. However, when properly diagnosed and treated, patients often respond well to therapies and have positive health outcomes. 

This week, as you study ADHD therapies, you examine the assessment and treatment of patients with ADHD. You also explore ethical and legal implications of these therapies. 

References:
Centers for Disease Control and Prevention. (n.d.). Data and statistics about ADHD. https://www.cdc.gov/ncbddd/adhd/data.html 

Anxiety and Depression Association of America. (n.d.). Adult ADHD (Attention Deficit Hyperactive Disorder). https://adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/adult-adhd 

Learning Objectives 

Students will: 

• Assess patient factors and history to develop personalized therapy plans for patients with ADHD 
• Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients requiring therapy for ADHD 
• Synthesize knowledge of providing care to patients presenting for ADHD 
• Analyze ethical and legal implications related to prescribing therapy for patients with ADHD 
• Identify concepts related to psychopharmacologic treatments and therapy for patients across the lifespan 

 

Learning Resources 

 

Required Readings (click to expand/reduce)  

 

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 disorders (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 Drugs, 26(3), 245–268. https://doi.org/10.2165/11599630-000000000-00000 

 

Martin, L. (2020). A 5-question quiz on ADHD. Psychiatric Times.  

https://www.psychiatrictimes.com/view/5-question-quiz-adhd 

 

 

Medication Resources (click to expand/reduce)  

 

 

U.S. Food & Drug Administration. (n.d.). Drugs@FDA: FDA-approved drugs. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm 

 

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. 

armodafinil  amphetamine (d)  amphetamine (d,l)  atomoxetine  bupropion  chlorpromazine  clonidine

guanfacine  haloperidol  lisdexamfetamine  methylphenidate (d)  methylphenidate (d,l)  modafinil  reboxetine

 

Required Media (click to expand/reduce)  

 

 

Case Study: A Young Caucasian Girl with ADHD 
Note: This case study will serve as the foundation for this week’s Assignment. 

Assignment: Assessing and Treating Patients With ADHD 

Not only do children and adults have different presentations for ADHD, but males and females may also have vastly different clinical presentations. Different people may also respond to medication therapies differently. For example, some ADHD medications may cause children to experience stomach pain, while others can be highly addictive for adults. In your role, as a psychiatric nurse practitioner, you must perform careful assessments and weigh the risks and benefits of medication therapies for patients across the life span. For this Assignment, you consider how you might assess and treat patients presenting with ADHD. 

To prepare for this Assignment: 

• Review this week’s Learning Resources, including the Medication Resources indicated for this week.  
• Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients with ADHD. 

The Assignment: 5 pages 

Examine Case Study: A Young Caucasian Girl with ADHD. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. 

At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.  

Introduction to the case (1 page) 

• Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient. 

Decision #1 (1 page) 

• Which decision did you select? 
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. 

• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. 
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature). 
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. 

Decision #2 (1 page) 

• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. 
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. 
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature). 
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. 

Decision #3 (1 page) 

• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. 
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. 
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature). 
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. 

Conclusion (1 page) 

• Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature. 

Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature. 

 

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 formatting. 

 

By Day 7  

Submit your Assignment.  

Submission and Grading Information 

To submit your completed Assignment for review and grading, do the following: 

• Please save your Assignment using the naming convention “WK9Assgn+last name+first initial.(extension)” as the name. 
• Click the Week 9 Assignment Rubric to review the Grading Criteria for the Assignment. 
• Click the Week 9 Assignment link. You will also be able to “View Rubric” for grading criteria from this area. 
• Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK9Assgn+last name+first initial.(extension)” and click Open. 
• If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database. 
• Click on the Submit button to complete your submission. 

Grading Criteria 

 

To access your rubric: 

Week 9 Assignment Rubric 

 

Check Your Assignment Draft for Authenticity 

 

To check your Assignment draft for authenticity: 

Submit your Week 9 Assignment draft and review the originality report. 

 

Submit Your Assignment by Day 7 of Week 9 

 

To participate in this Assignment: 

Week 9 Assignment 

 

 

Quiz: Assessing and Treating Patients With Psychopharmacology  

 

Photo Credit: Getty Images 

By Day 7 

Complete the 20-question Quiz to gauge your understanding of this module’s content. 

Submission Information 

Submit Your Quiz by Day 7 

 

To submit your Quiz : 

Week 9 Quiz  

 

 

What’s Coming Up in Module 3? 

 

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images 

In the next module, you will begin to apply your assessment and therapy skills in treating patients for disorders with behavioral components.  

Next Module  

 

To go to the next module: 

Module 3 

 

Rubric Detail  

Select Grid View or List View to change the rubric’s layout.  

Content 

Name: NURS_6630_Week9_Assignment_Rubric 

• Grid View  
• List View  

		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.		Points Range: 9 (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.	Points Range: 8 (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.	Points Range: 7 (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.	Points Range: 0 (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.		Points Range: 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.	Points Range: 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.	Points Range: 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.	Points Range: 0 (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.		Points Range: 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.	Points Range: 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.	Points Range: 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.	Points Range: 0 (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.		Points Range: 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.	Points Range: 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.	Points Range: 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.	Points Range: 0 (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.		Points Range: 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.	Points Range: 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.	Points Range: 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.	Points Range: 0 (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.		Points Range: 5 (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.	Points Range: 4 (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.	Points Range: 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.	Points Range: 0 (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		Points Range: 5 (5%) – 5 (5%)   Uses correct grammar, spelling, and punctuation with no errors.	Points Range: 4 (4%) – 4 (4%)   Contains a few (1 or 2) grammar, spelling, and punctuation errors.	Points Range: 3.5 (3.5%) – 3.5 (3.5%)   Contains several (3 or 4) grammar, spelling, and punctuation errors.	Points Range: 0 (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.		Points Range: 5 (5%) – 5 (5%)   Uses correct APA format with no errors.	Points Range: 4 (4%) – 4 (4%)   Contains a few (1 or 2) APA format errors.	Points Range: 3.5 (3.5%) – 3.5 (3.5%)   Contains several (3 or 4) APA format errors.	Points Range: 0 (0%) – 3 (3%)   Contains many (≥ 5) APA format errors.
Total Points: 100

Name: NURS_6630_Week9_Assignment_Rubric 

 

A Sample Answer 2For the Assignment: NURS 6630 Assignment Assessing and Treating Patients With ADHD

Title: NURS 6630 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.

NURS 6630 Assignment Assessing and Treating Patients With ADHD 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 6630 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

A Sample Answer 3 For the Assignment: NURS 6630 Assignment Assessing and Treating Patients With ADHD

Title: NURS 6630 Assignment Assessing and Treating Patients With ADHD

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

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).

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).

NURS 6630 Assignment Assessing and Treating Patients With ADHD 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.

NURS 6630 Assignment Assessing and Treating Patients With ADHD 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

148. 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

A Sample Answer 4 For the Assignment: NURS 6630 Assignment Assessing and Treating Patients With ADHD

Title: NURS 6630 Assignment Assessing and Treating Patients With ADHD

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most prevalent disorders in child psychiatry with the prevalence increasing over the years. It is characterized by inattention, hyperactivity, and impulsivity. It has a male predilection with a male to female ratio of 2:1. The hyperactive and impulsive subtype is the most prevalent. The inattentive subtype occurs in 18.3% of the condition and mostly affects females (Magnus et al., 2020). ADHD is diagnosed before the age of 12 years. It affects an individual’s ability to form and maintain close social ties.

This week’s case study focuses on Katie an 8-year-old Caucasian female brought into the office by her parents following a referral. She is referred for a psychiatry assessment to determine if she has ADHD. From the Conner’s Teacher Rating Scale-Revised, Katie is inattentive, easily distracted, forgets things already learned, and poor in spelling, reading, and arithmetic. Of note is that she has a short attention span, lacks interest in school work, is easily distracted, starts things but never finishes them, seldom follows through on instructions, and fails to finish her school work. She has no open defiance or temper outbursts. In subjective history, her favorite subjects are art and recess. She finds other subjects hard and boring. She admits her mind wanders off from class most of the time. There is no history of abuse or bullying at school. She reports that her home life is fine and her parents are good to her. The Mental State Exam is normal. She is appropriately developed for her age. She has a clear, coherent, and logical speech. She is oriented to time, place, person, and event. She has no mannerisms or tics. Her subjective mood is euthymic with a bright affect. She has no hallucinations, delusions, or abnormalities of thought. Attention and concentration are intact. Insight and judgment are age appropriate. Her diagnosis is ADHD, predominantly inattentive presentation. Decision-making in the prescription of ADHD medication is influenced by the patient’s gender, the subtype of ADHD displayed, level of academic impairment, age, and the parent’s socioeconomic status (Kamimura-Nishimura et al., 2019). These factors act together to influence the drug to be used, the dosage, and the duration of therapy. The purpose of this paper is to discuss the decision points on the treatment of this patient in regards to the choice of drug, the expectations post initiation of therapy, and the ethical considerations.

Decision 1

Chewable Methylphenidate tablets 10mg orally in the morning

Reason for Selection

Methylphenidate is considered the first-line drug therapy for childhood, adolescent, and adult ADHD (Cortese et al., 2021). The American Academy of Pediatrics recommends parent training in behavior management, and classroom training, along with medications. Methylphenidate is highly efficacious in the resolution of emotional dysregulation, and propensity to violent behavior and increases susceptibility to learning and rehabilitation of social skills (Asherson et al., 2019). The availability of methylphenidate also influences its wide use.

The few Randomized Control Studies done show that Bupropion is considered as effective as Methylphenidate in the treatment of ADHD. It also has fewer adverse symptoms compared to methylphenidate. For therapy, several trials agree that there is still a need for a further trial of the medication. Some serious adverse effects like paresthesia, agitation, and palpitations were marked in bupropion (Pozzi et al., 2020). For this reason, its suitability for treatment is reduced especially in children and adolescents.

In trials of Intuniv, there was significant symptomatology improvement in inattention, hyperactivity, and impulsivity. Intuniv is however associated with severe side effects such as polydipsia, hypotension, nasopharyngitis, and hypersomnolence (Iwanami et al., 2020). This limits its use despite having a decent efficacy.

Expectation

There is an expected beginning of the resolution of symptomatology within a few days of therapy. These changes include an enhanced concentration with a slightly increased concentration span, improved attention, reduced distractibility, and a reduction in antisocial behaviors like violence and breaking of school rules (Jaeschke et al., 2021). These changes must be supported by both classroom and parent training.

Ethical Considerations

The ethical considerations are hinged on the four principles of justice, do no harm, beneficence, and respect for autonomy. Considering the best treatment for the child’s condition is approved through research findings. The autonomy of children is an important factor. A child’s flexibility in preference is important in character development. A small room for guided autonomy is associated with better outcomes. For this reason, the parents act in the best interest of the child. Informed consent is key. Informed consent in children is proven to strengthen the morals and structure of the child by improving esteem and social interactions (Díaz-Pérez et al., 2020). Providing adequate information and education regarding the condition is n important tenet. Providing top-notch care in the best interest of the child through offering follow-up is vital.

Decision 2

Change to Ritalin LA 20mg orally daily in the morning

Reason for Selection

The slow-release long-acting Ritalin is considered effective in controlling symptoms of inattention and hyperactivity (Karahmadi et al., 2020). The long-acting Ritalin has increased compliance with medication. Although the adverse effects of the long-acting and short-acting Ritalin are comparatively the same, Ritalin LA could be responsible for a reduction in side effects as it causes a maintained plasma concentration of the drug over time.

Arrhythmias and increased systolic blood pressure are common adverse effects of Ritalin (Liang et al., 2018). Continuation with the same dose of Ritalin could cause further development in other side effects of cardiovascular disease such as stroke which would be detrimental (Nauman et al., 2021). Adderall has a very high potential for abuse and dependence. In women, Adderall can cause infertility. Sudden stoppage of the drug also comes with severe withdrawal effects such as suicidal ideas, delusions, and psychosis. These side effects occur in both the short term and the long term.

Expectations

Due to a change to Ritalin LA, there is expected maintenance in improved concentration and consequently a good performance. Resolution of the daydreaming in the afternoon. There is also an expected decrease in the presenting side effects like high heart rate; there is an expected reduction in heart rate.

Ethical Considerations.

Informed consent to the change of drug is important with adequate education on the dosage. Autonomy of the child should be guided by the parents as at the same time the child is allowed to express their preference (Díaz-Pérez et al., 2020). Continuous counseling of the family on how best to handle and train the child. A cordial patient-doctor relationship is very vital for this particular case as it eases subsequent clinic visits for follow-up.

Decision 3

Maintain current dose of Ritalin LA and reevaluate in 4 weeks

Reason for Selection

At this point, the current dose is effective in perfectly controlling the symptoms and the side effects have vanished. It is advised that in drug usage, the lowest effective dose is indicated. Here heart rate of 92 beats per minute falls in the range appropriate for her age. For this reason, maintaining the current dosage is the most plausible option. Increasing Ritalin LA  to higher doses is not advisable firstly because the symptoms are well controlled without any adverse effects. Secondly higher doses are associated with increased side effects (Karahmadi et al., 2020). Obtaining an EKG based on her heart rate is futile. The heart rate of 92 beats per minute is normal for her age.

Expectations

The current dose of Ritalin in conjunction with the psychosocial treatments should be able to abate the symptoms. There should be a net effect of improved concentration and learning. The girl should be able to get better grades. There will be improved interest in school work and not easily distractible. There will be minimal side effects of the drug as it is set at the lowest effective dose.

Ethical Considerations

The mere fact of not doing any harm and providing recommended drug treatment at the minimal effective dose is not enough. Respectful handling of the patient in a child-friendly manner and her parents by the healthcare provider is an essential part of treatment as it builds patient confidentiality and trust (Díaz-Pérez et al., 2020). The success of long-term follow-up is also greatly dependent on this relationship. Sound patient education on the side effects and dosage of the drug is key.

Conclusion

ADHD is a common encounter in child psychiatry. It is mostly overdiagnosed even in patients who show a few symptoms but don’t meet the diagnostic criteria (Magnus et al., 2020).  It is characterized by reduced attention, hyperactivity, and impulsivity. These symptoms have to occur for no less than 6 months and the patient less than 12 years for a primary diagnosis to be made. Although ADHD is more common in boys, the inattention subtype is common in girls. This case study provides a perfect example of the inattention subtype. It involves an 8-years-old Caucasian girl who displays markedly reduced attention in class, easy distractibility, and poor academic performance but does not have violent properties. There is no demarcated precipitating factor for her condition. Methylphenidate is the first-line drug used in the management of ADHD in all age groups (Cortese et al., 2021). Methylphenidate is highly efficacious in the resolution of emotional dysregulation, and violent behavior and increases susceptibility to learning and rehabilitation of social skills (Asherson et al., 2019). The availability of methylphenidate also influences its wide use. Studies show that Bupropion is as effective as Methylphenidate in the treatment of ADHD. For therapy, several trials agree that there is still a need for a further trial of the medication. Intuniv use is marred by adverse effects such as increased thirst, nasopharyngitis, and somnolence which makes its use unpopular  (Iwanami et al., 2020). Studies comparing the efficacies of Ritalin LA and the short-acting Ritalin show only a minimal difference in their profiles. The slow release of Ritalin reduces the dosing interval hence improving medication adherence. In the dissolution of symptoms, there is no major difference although clinically, Ritalin LA is associated with reduced side effects (Karahmadi et al., 2020). The principle of monotherapy and usage of the lowest effective dose is a key facet in the treatment of ADHD. The drug choice is influenced by the pharmacokinetic profile of the drug, availability, age of the patient, symptomatology, level of academic and social impairment, subtype of ADHD, gender, and the socio-economic status of the patient (Kamimura-Nishimura et al., 2019). Ethical considerations include informed consent, guided autonomy, providing the best treatment possible, formation of meaningful patient and healthcare provider relationships that improve treatment, and constant counseling and education of the patient concerning the different aspects of management.

 

 

NURS 6630 Assignment Assessing and Treating Patients With ADHD References

Asherson, P., Johansson, L., Holland, R., Fahy, T., Forester, A., Howitt, S., Lawrie, S., Strang, J., Young, S., Landau, S., & Thomson, L. (2019). Randomised controlled trial of the short-term effects of OROS-methylphenidate on ADHD symptoms and behavioural outcomes in young male prisoners with attention-deficit/hyperactivity disorder (CIAO-II). Trials, 20(1). https://doi.org/10.1186/s13063-019-3705-9

Cortese, S., Newcorn, J. H., & Coghill, D. (2021). A Practical, Evidence-informed Approach to Managing Stimulant-Refractory Attention Deficit Hyperactivity Disorder (ADHD). CNS Drugs, 35(10), 1035–1051. https://doi.org/10.1007/s40263-021-00848-3

Díaz-Pérez, A., Navarro Quiroz, E., & Aparicio Marenco, D. E. (2020). Moral structuring of children during the process of obtaining informed consent in clinical and research settings. BMC Medical Ethics, 21(1). https://doi.org/10.1186/s12910-020-00540-z

Iwanami, A., Saito, K., Fujiwara, M., Okutsu, D., & Ichikawa, H. (2020). Efficacy and Safety of Guanfacine Extended-Release in the Treatment of Attention-Deficit/Hyperactivity Disorder in Adults. The Journal of Clinical Psychiatry, 81(3). https://doi.org/10.4088/jcp.19m12979

Jaeschke, R. R., Sujkowska, E., & Sowa-Kućma, M. (2021). Methylphenidate for attention-deficit/hyperactivity disorder in adults: a narrative review. Psychopharmacology, 238(10), 2667–2691. https://doi.org/10.1007/s00213-021-05946-0

Kamimura-Nishimura, K. I., Epstein, J. N., Froehlich, T. E., Peugh, J., Brinkman, W. B., Baum, R., Gardner, W., Langberg, J. M., Lichtenstein, P., Chen, D., & Kelleher, K. J. (2019). Factors Associated with Attention Deficit Hyperactivity Disorder Medication Use in Community Care Settings. The Journal of Pediatrics, 213, 155-162.e1. https://doi.org/10.1016/j.jpeds.2019.06.025

Karahmadi, M., Saadatmand, S., & Tarahi, M. J. (2020). Investigation of Efficacy of Short-Acting Methylphenidate (Ritalin) and Long-Acting (Matoride) on Symptoms of Attention Deficit Hyperactivity Disorder in Children Aged 6–18 Years: A Single-Blind, Randomized Clinical Trial. Advanced Biomedical Research, 9. https://doi.org/10.4103/abr.abr_9_20

Liang, E. F., Lim, S. Z., Tam, W. W., Ho, C. S., Zhang, M. W., McIntyre, R. S., & Ho, R. C. (2018). The Effect of Methylphenidate and Atomoxetine on Heart Rate and Systolic Blood Pressure in Young People and Adults with Attention-Deficit Hyperactivity Disorder (ADHD): Systematic Review, Meta-Analysis, and Meta-Regression. International Journal of Environmental Research and Public Health, 15(8), 1789. https://doi.org/10.3390/ijerph15081789

Magnus, W., Nazir, S., Anilkumar, A. C., & Shaban, K. (2020). Attention Deficit Hyperactivity Disorder (ADHD). PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK441838/

Nauman, M., Hahn, C., Nketiah, E., Ahmad, S., & Karmali, R. (2021). Adderall induced dilated cardiomyopathy in an adult male with ADHD. Journal of the American College of Cardiology, 77(18), 2325. https://doi.org/10.1016/s0735-1097(21)03680-9

Pozzi, M., Bertella, S., Gatti, E., Peeters, G. G. A. M., Carnovale, C., Zambrano, S., & Nobile, M. (2020). Emerging drugs for the treatment of attention-deficit hyperactivity disorder (ADHD). Expert Opinion on Emerging Drugs, 25(4), 1–13. https://doi.org/10.1080/14728214.2020.1820481

 

Decision #2

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

Why Did You Select This Decision?

Ritalin was changed to a long-acting (LA) formulation because the drug’s effects were not sustained the entire school day. The LA formulation lasts more than 8 hours (Childress, 2021). Thus, Ritalin LA was ideal to ensure the drug’s effects last the whole school day without Katie losing concentration in the afternoon.

Why Did You Not Select The Other Two Options Provided In The Exercise?

It was not ideal to continue the same dose of Ritalin since it had already been demonstrated that its effects were short-term and the effects only lasted in the morning hours. The clinical effects of the instant-release formulation are short-term lasting 3-4 hours (Childress, 2021). Changing treatment to Adderall was inappropriate since the initial drug demonstrated a positive impact in alleviating ADHD symptoms. Jerome and Jerome (2020) explain that stimulants should only be substituted if the initial stimulant was ineffective or untolerated

What I Was Hoping To Achieve By Making This Decision

The PMHNP hoped that the clinical effects of Ritalin LA formulation would be sustained the whole day and Katie’s concentrations would improve. Zahed et al. (2022) found that LA methylphenidate is effective in improving attention and impulsivity in 6 to 12 year-olds children with ADHD.

Ethical Considerations Impact on Treatment Plan and Communication

The ethical principle of beneficence impacted treatment since the clinician had to change the drug’s formulation to one that has better outcomes. Communication may be impacted by confidentiality since the PMHNP must assure the child’s parents that her health information will not be shared without their consent.

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 formatting

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