Title: NURS 6630 Assessing and Treating Patients With ADHD<\/strong><\/h2>\nNURS 6630 Assessing and Treating Patients With ADHD<\/em><\/p>\nAttention-deficit\/hyperactivity disorder (ADHD) is a developmental psychiatric condition<\/a> 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\u2019s 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\u2019s treatment plan.<\/p>\nCase Overview<\/strong><\/h3>\nThe case depicts an 8-year-old child, Katie, referred for psychiatric assessment<\/a> 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. \u00a0However, 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.<\/p>\nADHD 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\u2019 treatment preferences (Childress, 2021).<\/p>\n
Decision #1<\/strong><\/h3>\nBegin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING.<\/p>\n
Why This Decision was Selected<\/strong><\/h3>\nThe 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.<\/p>\n
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).<\/p>\n
What I Hoped To Achieve <\/strong><\/h3>\nI hoped that Ritalin would alleviate ADHD symptoms within four weeks and that Katie\u2019s 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.<\/p>\n
Ethical Considerations That May Affect the Treatment Plan<\/strong><\/h3>\nEthical 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.<\/p>\n
Decision #2<\/strong><\/h3>\nSwitch to Ritalin LA 20 mg orally daily in the morning.<\/p>\n
Why This Decision was Selected<\/strong><\/h3>\nRitalin 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\u201312 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.<\/p>\n
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.<\/p>\n
What I Hoped To Achieve <\/strong><\/h3>\nI expected that switching to a long-acting formulation would maintain the Ritalin\u2019s 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.<\/p>\n
Ethical Considerations That May Affect the Treatment Plan<\/strong><\/h3>\nBeneficence 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.<\/p>\n
Decision #3<\/strong><\/h3>\nMaintain the current Ritalin LA dose and reevaluate in 4 weeks.<\/p>\n
Why This Decision was Selected<\/strong><\/h3>\nThis 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.<\/p>\n
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).<\/p>\n
What I Hoped To Achieve <\/strong><\/h3>\nI expected that maintaining Ritalin LA would continue to alleviate the patient\u2019s 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.<\/p>\n
Ethical Considerations That May Affect the Treatment Plan<\/strong><\/h3>\nNonmaleficence 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.<\/p>\n
NURS 6630 Assessing and Treating Patients With ADHD Conclusion<\/strong><\/h3>\nKatie 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.<\/p>\n
The long-acting formulation adequately sustained the drug’s desired effects the whole school day. As a result, the patient\u2019s 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\u2019s safety.<\/p>\n
\u00a0<\/strong><\/p>\nNURS 6630 Assessing and Treating Patients With ADHD References<\/strong><\/h3>\nBipeta, R. (2019). Legal and Ethical Aspects of Mental Health Care.\u00a0Indian journal of psychological medicine<\/em>,\u00a041<\/em>(2), 108\u2013112. https:\/\/doi.org\/10.4103\/IJPSYM.IJPSYM_59_19<\/a><\/p>\nBrown, K. A., Samuel, S., & Patel, D. R. (2018). Pharmacologic management of attention deficit hyperactivity disorder in children and adolescents: a review for practitioners.\u00a0Translational Pediatrics<\/em>,\u00a07<\/em>(1), 36\u201347. https:\/\/doi.org\/10.21037\/tp.2017.08.02<\/a><\/p>\nCabral, M. D. I., Liu, S., & Soares, N. (2020). Attention-deficit\/hyperactivity disorder: diagnostic criteria, epidemiology, risk factors and evaluation in youth.\u00a0Translational Pediatrics<\/em>,\u00a09<\/em>(Suppl 1), S104. https:\/\/doi.org\/10.21037\/tp.2019.09.08<\/a><\/p>\nChildress, A. C. (2021). Novel Formulations of ADHD Medications: Stimulant Selection and Management.\u00a0Focus (American Psychiatric Publishing)<\/em>,\u00a019<\/em>(1), 31\u201338. https:\/\/doi.org\/10.1176\/appi.focus.20200032<\/a><\/p>\nSteingard, R., Taskiran, S., Connor, D. F., Markowitz, J. S., & Stein, M. A. (2019). New Formulations of Stimulants: An Update for Clinicians.\u00a0Journal of child and adolescent psychopharmacology<\/em>,\u00a029<\/em>(5), 324\u2013339. https:\/\/doi.org\/10.1089\/cap.2019.0043<\/a><\/p>\n <\/p>\n
Sample Answer for NURS 6630 Assessing and Treating Patients With ADHD Included After Question<\/strong><\/h2>\nNot only do children and adults have different presentations for ADHD<\/a>, but males and females may also have vastly different clinical presentations<\/a>. 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.<\/p>\nTo prepare for this Assignment:<\/strong><\/h3>\n\n- Review this week\u2019s Learning Resources, including the Medication Resources indicated for this week.<\/li>\n
- Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients with ADHD.<\/li>\n<\/ul>\n
The Assignment: 5 pages<\/strong><\/h3>\nExamine\u00a0Case Study: A Young Caucasian Girl with ADHD.<\/em>\u00a0You 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\u2019s pharmacokinetic and pharmacodynamic processes.<\/p>\nAt 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.<\/p>\n
Introduction to the case (1 page)<\/strong><\/h3>\n\n- 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.<\/li>\n<\/ul>\n
Decision #1 (1 page)<\/strong><\/h3>\n![\"NURS](\"https:\/\/nursingassignmentcrackers.com\/wp-content\/uploads\/2021\/10\/NURS-6630-Assessing-and-Treating-Patients-With-ADHD-300x133.png\")
NURS 6630 Assessing and Treating Patients With ADHD<\/figcaption><\/figure>\n\n- Which decision did you select?<\/li>\n
- Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources,including the primary literature.<\/li>\n
- 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.<\/li>\n
- 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).<\/li>\n
- Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.<\/li>\n<\/ul>\n
Decision #2 (1 page)<\/strong><\/h3>\n\n- Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.<\/li>\n
- 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.<\/li>\n
- 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).<\/li>\n
- Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.<\/li>\n<\/ul>\n
Decision #3 (1 page)<\/strong><\/h3>\n\n- Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.<\/li>\n
- 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.<\/li>\n
- 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).<\/li>\n
- Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.<\/li>\n<\/ul>\n
Conclusion (1 page)<\/strong><\/h3>\n\n- 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.<\/li>\n<\/ul>\n
Note:<\/em><\/strong>\u00a0Support 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.<\/em><\/p>\nReminder : 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.<\/a><\/u><\/strong><\/p>\n <\/p>\n
By Day 7 <\/strong><\/p>\nSubmit<\/strong> your Assignment.<\/h3>\nSubmission and Grading Information<\/strong><\/h3>\nTo submit your completed Assignment for review and grading, do the following:<\/strong><\/h4>\n\n- Please save your Assignment using the naming convention \u201cWK9Assgn+last name+first initial.(extension)\u201d as the name.<\/li>\n
- Click the\u00a0Week 9 Assignment Rubric\u00a0<\/strong>to review the Grading Criteria for the Assignment.<\/li>\n
- Click the\u00a0Week 9 Assignment\u00a0<\/strong>link. You will also be able to \u201cView Rubric\u201d for grading criteria from this area.<\/li>\n
- Next, from the Attach File area, click on the\u00a0Browse My Computer<\/strong>\u00a0button. Find the document you saved as \u201cWK9Assgn+last name+first initial.(extension)\u201d and click\u00a0Open<\/strong>.<\/li>\n
- If applicable: From the Plagiarism Tools area, click the checkbox for\u00a0I agree to submit my paper(s) to the Global Reference Database<\/strong>.<\/li>\n
- Click on the\u00a0Submit<\/strong>\u00a0button to complete your submission.<\/li>\n<\/ul>\n
NURS 6630 Assessing and Treating Patients With ADHD Grading Criteria<\/strong><\/h3>\nTo access your rubric:<\/u><\/p>\n
Week 9 Assignment Rubric<\/u><\/p>\n
<\/p>\n
Check Your Assignment Draft for Authenticity<\/strong><\/h3>\nTo check your Assignment draft for authenticity:<\/u><\/p>\n
Submit your Week 9 Assignment draft and review the originality report.<\/u><\/p>\n
<\/p>\n
Submit Your Assignment by Day 7 of Week 9<\/strong><\/h3>\nTo participate in this Assignment:<\/u><\/p>\n
Week 9 Assignment<\/u><\/p>\nIntroduction to the case (1 page)<\/h3>\n
\uf0b7 Briefly explain and summarize the case for this Assignment. Be sure to include the
\nspecific patient factors that may impact your decision making when prescribing
\nmedication for this patient.
\nDecision #1 (1 page)
\n\uf0b7 Which decision did you select?
\n\uf0b7 Why did you select this decision? Be specific and support your response with clinically
\nrelevant and patient-specific resources, including the primary literature.
\n\uf0b7 Why did you not select the other two options provided in the exercise? Be specific and
\nsupport your response with clinically relevant and patient-specific resources, including
\nthe primary literature.
\n\uf0b7 What were you hoping to achieve by making this decision? Support your response with
\nevidence and references to the Learning Resources (including the primary literature).
\n\uf0b7 Explain how ethical considerations may impact your treatment plan and communication
\nwith patients. Be specific and provide examples.
\nDecision #2 (1 page)
\n\uf0b7 Why did you select this decision? Be specific and support your response with clinically
\nrelevant and patient-specific resources, including the primary literature.
\n\uf0b7 Why did you not select the other two options provided in the exercise? Be specific and
\nsupport your response with clinically relevant and patient-specific resources, including
\nthe primary literature.
\n\uf0b7 What were you hoping to achieve by making this decision? Support your response with
\nevidence and references to the Learning Resources (including the primary literature).
\n\uf0b7 Explain how ethical considerations may impact your treatment plan and communication
\nwith patients. Be specific and provide examples.
\nDecision #3 (1 page)
\n\uf0b7 Why did you select this decision? Be specific and support your response with clinically
\nrelevant and patient-specific resources, including the primary literature.
\n\uf0b7 Why did you not select the other two options provided in the exercise? Be specific and
\nsupport your response with clinically relevant and patient-specific resources, including
\nthe primary literature.
\n\uf0b7 What were you hoping to achieve by making this decision? Support your response with
\nevidence and references to the Learning Resources (including the primary literature).
\n\uf0b7 Explain how ethical considerations may impact your treatment plan and communication
\nwith patients. Be specific and provide examples.<\/p>\n
Conclusion (1 page)<\/h3>\n
\uf0b7 Summarize your recommendations on the treatment options you selected for this patient.
\nBe sure to justify your recommendations and support your response with clinically
\nrelevant and patient-specific resources, including the primary literature.
\nNote:\u00a0Support your rationale with a minimum of five academic resources. While you may use the
\ncourse text to support your rationale, it will not count toward the resource requirement. You
\nshould be utilizing the primary and secondary literature.
\nReminder : The College of Nursing requires that all papers submitted include a title page,
\nintroduction, summary, and references. The Sample Paper provided at the Walden Writing
\nCenter provides an example of those required elements (available at
\nhttps:\/\/academicguides.waldenu.edu\/writingcenter\/templates\/general#s-lg-box-20293632)<\/a>. All
\npapers submitted must use this formatting<\/p>\n <\/p>\n
Quiz: Assessing and Treating Patients With Psychopharmacology <\/strong><\/h3>\nPhoto Credit: Getty Images<\/p>\n
By Day 7<\/strong><\/p>\nComplete the 20-question Quiz to gauge your understanding of this module\u2019s content.<\/p>\n
Submission Information<\/strong><\/p>\nSubmit Your Quiz by Day 7<\/strong><\/p>\nTo submit your\u00a0Quiz\u00a0:<\/u><\/p>\n
Week 9 Quiz\u00a0<\/u><\/p>\n
<\/p>\n
What\u2019s Coming Up in Module 3?<\/strong><\/h3>\nPhoto Credit: [BrianAJackson]\/[iStock \/ Getty Images Plus]\/Getty Images<\/p>\n
In the next module,<\/strong>\u00a0you will begin to apply your assessment and therapy skills in treating patients for disorders with behavioral components.<\/p>\nNext Module <\/strong><\/p>\nTo go to the next module:<\/a><\/u><\/p>\nModule 3<\/a><\/u><\/p>\nClick here to ORDER an A++ paper from our MASTERS and DOCTORATE WRITERS: NURS 6630 Assessing and Treating Patients With ADHD<\/strong><\/a><\/span><\/em><\/h3>\n <\/p>\n
The management of attention deficit hyperactivity disorder (ADHD) among the pediatric population is quite challenging due to the limited amount of evidence supporting the safety of several recommended drugs for this disorder. To illustrate further the management of ADHD, the case of an 8-year-old Caucasian female has been provided. The patient presents with symptoms of ADHD as suggested by her teacher who completed the Conner\u2019s Teacher Rating Scale-Revised. Her teacher claims that the patient is forgetful most of the time, and easily distracted with a very short concentration time. The patient also displays poor language, spelling, and arithmetic skills, hurting her overall school performance. The teacher also reported that lately, the patient has been failing to follow instructions, leaving her homework incomplete. Despite the patient’s parents refusing their daughter has ADHD, the patient reports that she gets bored most of the time at school with a lack of interest in school work. She however denies bullying of any kind at school with a good home life experience. With the findings of the conducted mental status examination and the Conner\u2019s Teacher Rating Scale-Revised, the patient has been diagnosed with Attention deficit hyperactivity disorder, predominantly inattentive presentation.<\/p>\n
Several factors were considered when deciding on the specific pharmacological agent and the right dosage to prescribe in the management of the patient\u2019s condition. Such factors include the young age of the patient, her Caucasian race, her ADHD diagnosis, and the reported symptoms. The completed Conner\u2019s Teacher Rating Scale-Revised can also help determine the severity of the patient’s condition which is crucial in determining the dosage of the selected drug. As such, this discussion aims at developing the most effective treatment plan for the 8-year-old patient in the management of ADHD, with a rationale for each decision made.<\/p>\n
\u00a0<\/strong><\/p>\nDecision#1<\/strong><\/h3>\nSelected Decision and Rationale<\/strong><\/h3>\n\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/strong>Administering Methylphenidate 10mg chewable tablets once a day in the morning was selected as the initial intervention. Methylphenidate is a stimulant to the central nervous system that acts via noncompetitive blockage of noradrenalin and dopamine reuptake into the terminals, by inhibiting the action of the dopamine and noradrenaline transporters thus raising dopamine and noradrenaline levels in the synaptic cleft (American Psychiatric Association, 2013; Cipriani et al., 2018). Previous evidence supports the substantial effectiveness of Methylphenidate in the management of children diagnosed with ADHD, with a great safety profile and high tolerability levels (Hodgkins et al., 2012). The drug is only recommended for children of age 6 and above (Grimmsmann & Himmel, 2021). Finally, with consideration of the patient’s Caucasian race, the drug is metabolized in the liver via the CYP3A4 pathway, which is predominant among this ethnic population, hence limiting the risks of toxicity (Bonati et al., 2018). The chewable tablet formulation is normally recommended for children to promote compliance (Kikuchi et al., 2021).<\/p>\nIntuniv was an inappropriate choice for this patient given that previous studies report that the drug being a non-stimulant is more effective in the management of ADHD when used together with a stimulant (Pelham III et al., 2022). Wellbutrin on the other hand is a norepinephrine-dopamine reuptake inhibitor (NDRI) discouraged among children below the age of 9 years old due to its elevated risks of seizures (Kikuchi et al., 2021).<\/p>\n
Expected Outcome.<\/strong><\/h3>\n\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/strong>Up to 50% of the patient’s symptoms will be resolved within the following 4 weeks (Kikuchi et al., 2021). She will be able to concentrate for longer hours with increased attention and memory (Hodgkins et al., 2012). Her overall academic performance will also improve significantly.<\/p>\nEthical Consideration<\/strong><\/h3>\n\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/strong>Based on the provisions of legal and ethical guidelines for nurses, the PMHNP is obliged to consider the patient ethnicity and race to promote culturally sensitive care (Bonati et al., 2018). The patient’s parents also have a legal right to information concerning the health of their child, for sound decision-making (American Psychiatric Association, 2013). Respecting the patient’s autonomy is key to promoting patient satisfaction.<\/p>\nDecision#2<\/strong><\/h3>\nSelected Decision and Rationale<\/strong><\/h3>\nOut of the options provided, the most effective second intervention was to change the treatment regimen to a long-acting Ritalin 20mg administered once daily in the morning. The patient has reported the potential effectiveness of the drug in managing ADHD symptoms (Hodgkins et al., 2012). However, since the dose is quite limited to resolving the patient’s symptoms all day, using a long-acting agent will help prolong the duration of action, improving the patient’s attention, concentration, and memory the entire day (Cipriani et al., 2018). Studies show that long-acting Methylphenidate lasts in the body system for up to 10 to 12 hours (American Psychiatric Association, 2013). The side effect reported of elevated heart rate is common among pediatric patients on methylphenidate which resolves as the patient continues taking the drug (Pelham III et al., 2022). Consequently, previous evidence confirms that using a long-acting agent, hence reduces the concentration of the drug at one point, reducing the risks of toxic doses, when used for a long time (Kikuchi et al., 2021).<\/p>\n
Maintaining the dose of methylphenidate was not necessary as the patient will continue experiencing limited effectiveness of the drug later in the day (Grimmsmann & Himmel, 2021). Administering Adderall in place of Methylphenidate was also inappropriate at the moment given that the former is associated with increased risks of cardiovascular complications which would compromise the health of the patient (Bonati et al., 2018).<\/p>\n
Expected Outcome<\/strong><\/h3>\n\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/strong>The patient will be able to attain full concentration and attention level with the use of the drug for 4 weeks (Pelham III et al., 2022). This should help promote her overall academic performance and interest in school activities. The side effect of increased heart rate is expected to return to normal within this period (Grimmsmann & Himmel, 2021).<\/p>\nEthical Considerations<\/strong><\/h3>\n\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/strong>\u201cNot harm\u201d is one of the main ethical obligations of nurses, especially when taking care of children (Bonati et al., 2018). As such, the PMHNP needed to explain to the parents of the patient why the side effect occurred and the main cause of action to resolve the side effect and promote the health of their child (Kikuchi et al., 2021).<\/p>\nDecision#3<\/strong><\/h3>\nSelected Decision and Rationale<\/strong><\/h3>\n\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/strong>Advising the patient to continue taking the long-acting Methylphenidate 20mg once daily and report for reevaluation after 4 weeks was considered the final decision. The patient reported completely resolved side effects with improved effectiveness of the drug in the management of ADHD symptoms all day (Hodgkins et al., 2012). Previous evidence demonstrates that patients on Ritalin may exhibit maximum benefit within 8 to 12 weeks of treatment therapy (American Psychiatric Association, 2013; Cipriani et al., 2018). Most pediatric patient on Methylphenidate has reported great tolerance to the medication with a desirable safety profile in long-term use (Grimmsmann & Himmel, 2021). However, in rare cases, the patient may exhibit ineffectiveness to the medication which might call for the dose titration, hence the need for reevaluating the patient after four weeks (Kikuchi et al., 2021).<\/p>\nAt this point, it was not appropriate to increase the dose of methylphenidate to 30mg as studies show that low effective doses are safer for use by children, with reduced risks of adverse effects (Pelham III et al., 2022). Consequently, based on the current patient heart rate, it is not necessary to obtain EKG, as her pulse is within the normal limits of a child of her age (Bonati et al., 2018).<\/p>\n
Expected Outcome<\/strong><\/h3>\n\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/strong>For the next four weeks, the patient will report further improvement in ADHD symptoms all day (Grimmsmann & Himmel, 2021). She should display appropriate language, spelling, and arithmetic skills, with improved attention and concentration level (Hodgkins et al., 2012). No side effects are expected.<\/p>\nEthical Consideration<\/strong><\/h3>\n\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/strong>In the final decision, the PHMNP had to consider several ethical principles including nonmaleficence, beneficence, and justice (American Psychiatric Association, 2013). Since the patient was fully satisfied with the treatment outcome, the clinician needed to utilize his\/her clinical judgment to advise the patient to continue using the medication for optimal benefits (Pelham III et al., 2022).<\/p>\nConclusion<\/strong><\/h3>\nThe pediatric patient described in the case study provided presents with symptoms of ADHD as reported by her teacher. In the development of the treatment plan for this patient, her young age, Caucasian gender, ADHD diagnosis, and presenting symptoms were considered in the selection of the safest and most effective drug. As such, the initial decision was to administer methylphenidate 10mg once daily in the morning (American Psychiatric Association, 2013). Methylphenidate is a stimulant medication that has been proven to be safe and effective in managing ADHD symptoms in both children and adults. Wellbutrin and Intuniv were not considered in this decision as a result of safety issues among children associated with increased risks of side effects (Hodgkins et al., 2012). After 4 weeks, the patient reported significantly improved ADHD symptoms earlier in the day, with minimal effect of the medication later in the day, in addition to side effects of elevated heart rate (Pelham III et al., 2022). It was thus necessary to administer long-acting Methylphenidate 20mg once daily to promote management of the patient’s symptoms the entire day. The long-acting formulation has a longer duration of action (Bonati et al., 2018). Maintaining the dose of Methylphenidate or switching the drug with Adderall was not appropriate at this point (Kikuchi et al., 2021).<\/p>\n
The patient reported resolved side effects with well-managed ADHD symptoms the entire day after 4 weeks. This shows that she was tolerant to the drug with great safety and effectiveness hence the need to continue the same medication at the same dose for another 4 weeks before the reevaluation (Grimmsmann & Himmel, 2021). Increasing the dose of Methylphenidate or obtaining an EKG was not appropriate at this point. The PMHNP also encountered several ethical considerations when taking care of the patient with the main one being \u201cno harm.\u201d Additional ethical principles observed include justice, nonmaleficence, and beneficence (Cipriani et al., 2018).<\/p>\n
\u00a0<\/strong><\/p>\n\u00a0<\/strong><\/p>\nNURS 6630 Assessing and Treating Patients With ADHD References<\/strong><\/h3>\nAmerican Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https:\/\/doi.org\/10.1176\/appi.books.9780890425596<\/a><\/p>\nBonati, M., Reale, L., Zanetti, M., Cartabia, M., Fortinguerra, F., Capovilla, G., … & Lombardy ADHD Group. (2018). A regional ADHD centre-based network project for the diagnosis and treatment of children and adolescents with ADHD.\u00a0Journal of attention disorders<\/em>,\u00a022<\/em>(12), 1173-1184. https:\/\/doi.org\/10.1177\/1087054715599573<\/a><\/p>\nCipriani, A., Adamo, N., Del Giovane, C., Coghill, D., Banaschewski, T., Hollis, C., … & Cortese, S. (2018). Unbalanced risk-benefit analysis of ADHD drugs\u2013Authors’ reply.\u00a0The Lancet Psychiatry<\/em>,\u00a05<\/em>(11), 871-873. https:\/\/doi.org\/10.1016\/S2215-0366(18)30396-1<\/a><\/p>\nGrimmsmann, T., & Himmel, W. (2021). The 10-year trend in drug prescriptions for attention-deficit\/hyperactivity disorder (ADHD) in Germany.\u00a0European journal of clinical pharmacology<\/em>,\u00a077<\/em>(1), 107-115. https:\/\/doi.org\/10.1007\/s00228-020-02948-3<\/a><\/p>\nHodgkins, 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\u2013268. https:\/\/doi.org\/10.2165\/11599630-000000000-00000<\/a><\/p>\nKikuchi, D., Obara, T., Tokunaga, M., Shiozawa, M., Takahashi, A., Ito, M., … & Watanabe, Y. (2021). Drug prescription for attention deficit hyperactivity disorder drugs in pediatric outpatients: A retrospective survey of Japanese Administrative Data (2012\u20132018).\u00a0Asian Journal of Psychiatry<\/em>,\u00a057<\/em>, 102512. https:\/\/doi.org\/10.1016\/j.ajp.2020.102512<\/a><\/p>\nPelham III, W. E., Altszuler, A. R., Merrill, B. M., Raiker, J. S., Macphee, F. L., Ramos, M., … & Pelham Jr, W. E. (2022). The effect of stimulant medication on the learning of academic curricula in children with ADHD: A randomized crossover study.\u00a0Journal of consulting and clinical psychology<\/em>,\u00a090<\/em>(5), 367. https:\/\/doi.org\/10.1037\/ccp0000725<\/a><\/p>\nNURS 6630 Assessing and Treating Patients With ADHD Rubric Detail <\/strong><\/h3>\nSelect Grid View<\/em> or List View<\/em> to change the rubric’s layout.<\/p>\nContent<\/strong><\/p>\nName:\u00a0NURS_6630_Week9_Assignment_Rubric<\/strong><\/p>\n
Attention-deficit\/hyperactivity disorder (ADHD) is a developmental psychiatric condition<\/a> 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\u2019s 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\u2019s treatment plan.<\/p>\n The case depicts an 8-year-old child, Katie, referred for psychiatric assessment<\/a> 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. \u00a0However, 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.<\/p>\n 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\u2019 treatment preferences (Childress, 2021).<\/p>\n Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING.<\/p>\n 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.<\/p>\n 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).<\/p>\n I hoped that Ritalin would alleviate ADHD symptoms within four weeks and that Katie\u2019s 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.<\/p>\n 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.<\/p>\n Switch to Ritalin LA 20 mg orally daily in the morning.<\/p>\n 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\u201312 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.<\/p>\n 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.<\/p>\n I expected that switching to a long-acting formulation would maintain the Ritalin\u2019s 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.<\/p>\n 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.<\/p>\n Maintain the current Ritalin LA dose and reevaluate in 4 weeks.<\/p>\n 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.<\/p>\n 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).<\/p>\n I expected that maintaining Ritalin LA would continue to alleviate the patient\u2019s 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.<\/p>\n 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.<\/p>\n 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.<\/p>\n The long-acting formulation adequately sustained the drug’s desired effects the whole school day. As a result, the patient\u2019s 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\u2019s safety.<\/p>\n \u00a0<\/strong><\/p>\n Bipeta, R. (2019). Legal and Ethical Aspects of Mental Health Care.\u00a0Indian journal of psychological medicine<\/em>,\u00a041<\/em>(2), 108\u2013112. https:\/\/doi.org\/10.4103\/IJPSYM.IJPSYM_59_19<\/a><\/p>\n Brown, K. A., Samuel, S., & Patel, D. R. (2018). Pharmacologic management of attention deficit hyperactivity disorder in children and adolescents: a review for practitioners.\u00a0Translational Pediatrics<\/em>,\u00a07<\/em>(1), 36\u201347. https:\/\/doi.org\/10.21037\/tp.2017.08.02<\/a><\/p>\n Cabral, M. D. I., Liu, S., & Soares, N. (2020). Attention-deficit\/hyperactivity disorder: diagnostic criteria, epidemiology, risk factors and evaluation in youth.\u00a0Translational Pediatrics<\/em>,\u00a09<\/em>(Suppl 1), S104. https:\/\/doi.org\/10.21037\/tp.2019.09.08<\/a><\/p>\n Childress, A. C. (2021). Novel Formulations of ADHD Medications: Stimulant Selection and Management.\u00a0Focus (American Psychiatric Publishing)<\/em>,\u00a019<\/em>(1), 31\u201338. https:\/\/doi.org\/10.1176\/appi.focus.20200032<\/a><\/p>\n Steingard, R., Taskiran, S., Connor, D. F., Markowitz, J. S., & Stein, M. A. (2019). New Formulations of Stimulants: An Update for Clinicians.\u00a0Journal of child and adolescent psychopharmacology<\/em>,\u00a029<\/em>(5), 324\u2013339. https:\/\/doi.org\/10.1089\/cap.2019.0043<\/a><\/p>\n <\/p>\n Not only do children and adults have different presentations for ADHD<\/a>, but males and females may also have vastly different clinical presentations<\/a>. 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.<\/p>\n Examine\u00a0Case Study: A Young Caucasian Girl with ADHD.<\/em>\u00a0You 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\u2019s pharmacokinetic and pharmacodynamic processes.<\/p>\n 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.<\/p>\n Note:<\/em><\/strong>\u00a0Support 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.<\/em><\/p>\n 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.<\/a><\/u><\/strong><\/p>\n <\/p>\n By Day 7 <\/strong><\/p>\n To access your rubric:<\/u><\/p>\n Week 9 Assignment Rubric<\/u><\/p>\n <\/p>\n To check your Assignment draft for authenticity:<\/u><\/p>\n Submit your Week 9 Assignment draft and review the originality report.<\/u><\/p>\n <\/p>\n To participate in this Assignment:<\/u><\/p>\n Week 9 Assignment<\/u><\/p>\n \uf0b7 Briefly explain and summarize the case for this Assignment. Be sure to include the \uf0b7 Summarize your recommendations on the treatment options you selected for this patient. <\/p>\n Photo Credit: Getty Images<\/p>\n By Day 7<\/strong><\/p>\n Complete the 20-question Quiz to gauge your understanding of this module\u2019s content.<\/p>\n Submission Information<\/strong><\/p>\n Submit Your Quiz by Day 7<\/strong><\/p>\n To submit your\u00a0Quiz\u00a0:<\/u><\/p>\n Week 9 Quiz\u00a0<\/u><\/p>\n <\/p>\n Photo Credit: [BrianAJackson]\/[iStock \/ Getty Images Plus]\/Getty Images<\/p>\n In the next module,<\/strong>\u00a0you will begin to apply your assessment and therapy skills in treating patients for disorders with behavioral components.<\/p>\n Next Module <\/strong><\/p>\n To go to the next module:<\/a><\/u><\/p>\n Module 3<\/a><\/u><\/p>\n <\/p>\n The management of attention deficit hyperactivity disorder (ADHD) among the pediatric population is quite challenging due to the limited amount of evidence supporting the safety of several recommended drugs for this disorder. To illustrate further the management of ADHD, the case of an 8-year-old Caucasian female has been provided. The patient presents with symptoms of ADHD as suggested by her teacher who completed the Conner\u2019s Teacher Rating Scale-Revised. Her teacher claims that the patient is forgetful most of the time, and easily distracted with a very short concentration time. The patient also displays poor language, spelling, and arithmetic skills, hurting her overall school performance. The teacher also reported that lately, the patient has been failing to follow instructions, leaving her homework incomplete. Despite the patient’s parents refusing their daughter has ADHD, the patient reports that she gets bored most of the time at school with a lack of interest in school work. She however denies bullying of any kind at school with a good home life experience. With the findings of the conducted mental status examination and the Conner\u2019s Teacher Rating Scale-Revised, the patient has been diagnosed with Attention deficit hyperactivity disorder, predominantly inattentive presentation.<\/p>\n Several factors were considered when deciding on the specific pharmacological agent and the right dosage to prescribe in the management of the patient\u2019s condition. Such factors include the young age of the patient, her Caucasian race, her ADHD diagnosis, and the reported symptoms. The completed Conner\u2019s Teacher Rating Scale-Revised can also help determine the severity of the patient’s condition which is crucial in determining the dosage of the selected drug. As such, this discussion aims at developing the most effective treatment plan for the 8-year-old patient in the management of ADHD, with a rationale for each decision made.<\/p>\n \u00a0<\/strong><\/p>\n \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/strong>Administering Methylphenidate 10mg chewable tablets once a day in the morning was selected as the initial intervention. Methylphenidate is a stimulant to the central nervous system that acts via noncompetitive blockage of noradrenalin and dopamine reuptake into the terminals, by inhibiting the action of the dopamine and noradrenaline transporters thus raising dopamine and noradrenaline levels in the synaptic cleft (American Psychiatric Association, 2013; Cipriani et al., 2018). Previous evidence supports the substantial effectiveness of Methylphenidate in the management of children diagnosed with ADHD, with a great safety profile and high tolerability levels (Hodgkins et al., 2012). The drug is only recommended for children of age 6 and above (Grimmsmann & Himmel, 2021). Finally, with consideration of the patient’s Caucasian race, the drug is metabolized in the liver via the CYP3A4 pathway, which is predominant among this ethnic population, hence limiting the risks of toxicity (Bonati et al., 2018). The chewable tablet formulation is normally recommended for children to promote compliance (Kikuchi et al., 2021).<\/p>\n Intuniv was an inappropriate choice for this patient given that previous studies report that the drug being a non-stimulant is more effective in the management of ADHD when used together with a stimulant (Pelham III et al., 2022). Wellbutrin on the other hand is a norepinephrine-dopamine reuptake inhibitor (NDRI) discouraged among children below the age of 9 years old due to its elevated risks of seizures (Kikuchi et al., 2021).<\/p>\n \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/strong>Up to 50% of the patient’s symptoms will be resolved within the following 4 weeks (Kikuchi et al., 2021). She will be able to concentrate for longer hours with increased attention and memory (Hodgkins et al., 2012). Her overall academic performance will also improve significantly.<\/p>\n \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/strong>Based on the provisions of legal and ethical guidelines for nurses, the PMHNP is obliged to consider the patient ethnicity and race to promote culturally sensitive care (Bonati et al., 2018). The patient’s parents also have a legal right to information concerning the health of their child, for sound decision-making (American Psychiatric Association, 2013). Respecting the patient’s autonomy is key to promoting patient satisfaction.<\/p>\n Out of the options provided, the most effective second intervention was to change the treatment regimen to a long-acting Ritalin 20mg administered once daily in the morning. The patient has reported the potential effectiveness of the drug in managing ADHD symptoms (Hodgkins et al., 2012). However, since the dose is quite limited to resolving the patient’s symptoms all day, using a long-acting agent will help prolong the duration of action, improving the patient’s attention, concentration, and memory the entire day (Cipriani et al., 2018). Studies show that long-acting Methylphenidate lasts in the body system for up to 10 to 12 hours (American Psychiatric Association, 2013). The side effect reported of elevated heart rate is common among pediatric patients on methylphenidate which resolves as the patient continues taking the drug (Pelham III et al., 2022). Consequently, previous evidence confirms that using a long-acting agent, hence reduces the concentration of the drug at one point, reducing the risks of toxic doses, when used for a long time (Kikuchi et al., 2021).<\/p>\n Maintaining the dose of methylphenidate was not necessary as the patient will continue experiencing limited effectiveness of the drug later in the day (Grimmsmann & Himmel, 2021). Administering Adderall in place of Methylphenidate was also inappropriate at the moment given that the former is associated with increased risks of cardiovascular complications which would compromise the health of the patient (Bonati et al., 2018).<\/p>\n \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/strong>The patient will be able to attain full concentration and attention level with the use of the drug for 4 weeks (Pelham III et al., 2022). This should help promote her overall academic performance and interest in school activities. The side effect of increased heart rate is expected to return to normal within this period (Grimmsmann & Himmel, 2021).<\/p>\n \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/strong>\u201cNot harm\u201d is one of the main ethical obligations of nurses, especially when taking care of children (Bonati et al., 2018). As such, the PMHNP needed to explain to the parents of the patient why the side effect occurred and the main cause of action to resolve the side effect and promote the health of their child (Kikuchi et al., 2021).<\/p>\n \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/strong>Advising the patient to continue taking the long-acting Methylphenidate 20mg once daily and report for reevaluation after 4 weeks was considered the final decision. The patient reported completely resolved side effects with improved effectiveness of the drug in the management of ADHD symptoms all day (Hodgkins et al., 2012). Previous evidence demonstrates that patients on Ritalin may exhibit maximum benefit within 8 to 12 weeks of treatment therapy (American Psychiatric Association, 2013; Cipriani et al., 2018). Most pediatric patient on Methylphenidate has reported great tolerance to the medication with a desirable safety profile in long-term use (Grimmsmann & Himmel, 2021). However, in rare cases, the patient may exhibit ineffectiveness to the medication which might call for the dose titration, hence the need for reevaluating the patient after four weeks (Kikuchi et al., 2021).<\/p>\n At this point, it was not appropriate to increase the dose of methylphenidate to 30mg as studies show that low effective doses are safer for use by children, with reduced risks of adverse effects (Pelham III et al., 2022). Consequently, based on the current patient heart rate, it is not necessary to obtain EKG, as her pulse is within the normal limits of a child of her age (Bonati et al., 2018).<\/p>\n \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/strong>For the next four weeks, the patient will report further improvement in ADHD symptoms all day (Grimmsmann & Himmel, 2021). She should display appropriate language, spelling, and arithmetic skills, with improved attention and concentration level (Hodgkins et al., 2012). No side effects are expected.<\/p>\n \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/strong>In the final decision, the PHMNP had to consider several ethical principles including nonmaleficence, beneficence, and justice (American Psychiatric Association, 2013). Since the patient was fully satisfied with the treatment outcome, the clinician needed to utilize his\/her clinical judgment to advise the patient to continue using the medication for optimal benefits (Pelham III et al., 2022).<\/p>\n The pediatric patient described in the case study provided presents with symptoms of ADHD as reported by her teacher. In the development of the treatment plan for this patient, her young age, Caucasian gender, ADHD diagnosis, and presenting symptoms were considered in the selection of the safest and most effective drug. As such, the initial decision was to administer methylphenidate 10mg once daily in the morning (American Psychiatric Association, 2013). Methylphenidate is a stimulant medication that has been proven to be safe and effective in managing ADHD symptoms in both children and adults. Wellbutrin and Intuniv were not considered in this decision as a result of safety issues among children associated with increased risks of side effects (Hodgkins et al., 2012). After 4 weeks, the patient reported significantly improved ADHD symptoms earlier in the day, with minimal effect of the medication later in the day, in addition to side effects of elevated heart rate (Pelham III et al., 2022). It was thus necessary to administer long-acting Methylphenidate 20mg once daily to promote management of the patient’s symptoms the entire day. The long-acting formulation has a longer duration of action (Bonati et al., 2018). Maintaining the dose of Methylphenidate or switching the drug with Adderall was not appropriate at this point (Kikuchi et al., 2021).<\/p>\n The patient reported resolved side effects with well-managed ADHD symptoms the entire day after 4 weeks. This shows that she was tolerant to the drug with great safety and effectiveness hence the need to continue the same medication at the same dose for another 4 weeks before the reevaluation (Grimmsmann & Himmel, 2021). Increasing the dose of Methylphenidate or obtaining an EKG was not appropriate at this point. The PMHNP also encountered several ethical considerations when taking care of the patient with the main one being \u201cno harm.\u201d Additional ethical principles observed include justice, nonmaleficence, and beneficence (Cipriani et al., 2018).<\/p>\n \u00a0<\/strong><\/p>\n \u00a0<\/strong><\/p>\n American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https:\/\/doi.org\/10.1176\/appi.books.9780890425596<\/a><\/p>\n Bonati, M., Reale, L., Zanetti, M., Cartabia, M., Fortinguerra, F., Capovilla, G., … & Lombardy ADHD Group. (2018). A regional ADHD centre-based network project for the diagnosis and treatment of children and adolescents with ADHD.\u00a0Journal of attention disorders<\/em>,\u00a022<\/em>(12), 1173-1184. https:\/\/doi.org\/10.1177\/1087054715599573<\/a><\/p>\n Cipriani, A., Adamo, N., Del Giovane, C., Coghill, D., Banaschewski, T., Hollis, C., … & Cortese, S. (2018). Unbalanced risk-benefit analysis of ADHD drugs\u2013Authors’ reply.\u00a0The Lancet Psychiatry<\/em>,\u00a05<\/em>(11), 871-873. https:\/\/doi.org\/10.1016\/S2215-0366(18)30396-1<\/a><\/p>\n Grimmsmann, T., & Himmel, W. (2021). The 10-year trend in drug prescriptions for attention-deficit\/hyperactivity disorder (ADHD) in Germany.\u00a0European journal of clinical pharmacology<\/em>,\u00a077<\/em>(1), 107-115. https:\/\/doi.org\/10.1007\/s00228-020-02948-3<\/a><\/p>\n 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\u2013268. https:\/\/doi.org\/10.2165\/11599630-000000000-00000<\/a><\/p>\n Kikuchi, D., Obara, T., Tokunaga, M., Shiozawa, M., Takahashi, A., Ito, M., … & Watanabe, Y. (2021). Drug prescription for attention deficit hyperactivity disorder drugs in pediatric outpatients: A retrospective survey of Japanese Administrative Data (2012\u20132018).\u00a0Asian Journal of Psychiatry<\/em>,\u00a057<\/em>, 102512. https:\/\/doi.org\/10.1016\/j.ajp.2020.102512<\/a><\/p>\n Pelham III, W. E., Altszuler, A. R., Merrill, B. M., Raiker, J. S., Macphee, F. L., Ramos, M., … & Pelham Jr, W. E. (2022). The effect of stimulant medication on the learning of academic curricula in children with ADHD: A randomized crossover study.\u00a0Journal of consulting and clinical psychology<\/em>,\u00a090<\/em>(5), 367. https:\/\/doi.org\/10.1037\/ccp0000725<\/a><\/p>\n Select Grid View<\/em> or List View<\/em> to change the rubric’s layout.<\/p>\n Content<\/strong><\/p>\n Name:\u00a0NURS_6630_Week9_Assignment_Rubric<\/strong><\/p>\nCase Overview<\/strong><\/h3>\n
Decision #1<\/strong><\/h3>\n
Why This Decision was Selected<\/strong><\/h3>\n
What I Hoped To Achieve <\/strong><\/h3>\n
Ethical Considerations That May Affect the Treatment Plan<\/strong><\/h3>\n
Decision #2<\/strong><\/h3>\n
Why This Decision was Selected<\/strong><\/h3>\n
What I Hoped To Achieve <\/strong><\/h3>\n
Ethical Considerations That May Affect the Treatment Plan<\/strong><\/h3>\n
Decision #3<\/strong><\/h3>\n
Why This Decision was Selected<\/strong><\/h3>\n
What I Hoped To Achieve <\/strong><\/h3>\n
Ethical Considerations That May Affect the Treatment Plan<\/strong><\/h3>\n
NURS 6630 Assessing and Treating Patients With ADHD Conclusion<\/strong><\/h3>\n
NURS 6630 Assessing and Treating Patients With ADHD References<\/strong><\/h3>\n
Sample Answer for NURS 6630 Assessing and Treating Patients With ADHD Included After Question<\/strong><\/h2>\n
To prepare for this Assignment:<\/strong><\/h3>\n
\n
The Assignment: 5 pages<\/strong><\/h3>\n
Introduction to the case (1 page)<\/strong><\/h3>\n
\n
Decision #1 (1 page)<\/strong><\/h3>\n
\n
Decision #2 (1 page)<\/strong><\/h3>\n
\n
Decision #3 (1 page)<\/strong><\/h3>\n
\n
Conclusion (1 page)<\/strong><\/h3>\n
\n
Submit<\/strong> your Assignment.<\/h3>\n
Submission and Grading Information<\/strong><\/h3>\n
To submit your completed Assignment for review and grading, do the following:<\/strong><\/h4>\n
\n
NURS 6630 Assessing and Treating Patients With ADHD Grading Criteria<\/strong><\/h3>\n
Check Your Assignment Draft for Authenticity<\/strong><\/h3>\n
Submit Your Assignment by Day 7 of Week 9<\/strong><\/h3>\n
Introduction to the case (1 page)<\/h3>\n
\nspecific patient factors that may impact your decision making when prescribing
\nmedication for this patient.
\nDecision #1 (1 page)
\n\uf0b7 Which decision did you select?
\n\uf0b7 Why did you select this decision? Be specific and support your response with clinically
\nrelevant and patient-specific resources, including the primary literature.
\n\uf0b7 Why did you not select the other two options provided in the exercise? Be specific and
\nsupport your response with clinically relevant and patient-specific resources, including
\nthe primary literature.
\n\uf0b7 What were you hoping to achieve by making this decision? Support your response with
\nevidence and references to the Learning Resources (including the primary literature).
\n\uf0b7 Explain how ethical considerations may impact your treatment plan and communication
\nwith patients. Be specific and provide examples.
\nDecision #2 (1 page)
\n\uf0b7 Why did you select this decision? Be specific and support your response with clinically
\nrelevant and patient-specific resources, including the primary literature.
\n\uf0b7 Why did you not select the other two options provided in the exercise? Be specific and
\nsupport your response with clinically relevant and patient-specific resources, including
\nthe primary literature.
\n\uf0b7 What were you hoping to achieve by making this decision? Support your response with
\nevidence and references to the Learning Resources (including the primary literature).
\n\uf0b7 Explain how ethical considerations may impact your treatment plan and communication
\nwith patients. Be specific and provide examples.
\nDecision #3 (1 page)
\n\uf0b7 Why did you select this decision? Be specific and support your response with clinically
\nrelevant and patient-specific resources, including the primary literature.
\n\uf0b7 Why did you not select the other two options provided in the exercise? Be specific and
\nsupport your response with clinically relevant and patient-specific resources, including
\nthe primary literature.
\n\uf0b7 What were you hoping to achieve by making this decision? Support your response with
\nevidence and references to the Learning Resources (including the primary literature).
\n\uf0b7 Explain how ethical considerations may impact your treatment plan and communication
\nwith patients. Be specific and provide examples.<\/p>\nConclusion (1 page)<\/h3>\n
\nBe sure to justify your recommendations and support your response with clinically
\nrelevant and patient-specific resources, including the primary literature.
\nNote:\u00a0Support your rationale with a minimum of five academic resources. While you may use the
\ncourse text to support your rationale, it will not count toward the resource requirement. You
\nshould be utilizing the primary and secondary literature.
\nReminder : The College of Nursing requires that all papers submitted include a title page,
\nintroduction, summary, and references. The Sample Paper provided at the Walden Writing
\nCenter provides an example of those required elements (available at
\nhttps:\/\/academicguides.waldenu.edu\/writingcenter\/templates\/general#s-lg-box-20293632)<\/a>. All
\npapers submitted must use this formatting<\/p>\nQuiz: Assessing and Treating Patients With Psychopharmacology <\/strong><\/h3>\n
What\u2019s Coming Up in Module 3?<\/strong><\/h3>\n
Click here to ORDER an A++ paper from our MASTERS and DOCTORATE WRITERS: NURS 6630 Assessing and Treating Patients With ADHD<\/strong><\/a><\/span><\/em><\/h3>\n
Decision#1<\/strong><\/h3>\n
Selected Decision and Rationale<\/strong><\/h3>\n
Expected Outcome.<\/strong><\/h3>\n
Ethical Consideration<\/strong><\/h3>\n
Decision#2<\/strong><\/h3>\n
Selected Decision and Rationale<\/strong><\/h3>\n
Expected Outcome<\/strong><\/h3>\n
Ethical Considerations<\/strong><\/h3>\n
Decision#3<\/strong><\/h3>\n
Selected Decision and Rationale<\/strong><\/h3>\n
Expected Outcome<\/strong><\/h3>\n
Ethical Consideration<\/strong><\/h3>\n
Conclusion<\/strong><\/h3>\n
NURS 6630 Assessing and Treating Patients With ADHD References<\/strong><\/h3>\n
NURS 6630 Assessing and Treating Patients With ADHD Rubric Detail <\/strong><\/h3>\n