Bipolar disorder<\/a> is a unique disorder that causes shifts in mood and energy, which results in Bipolar disorder is a unique disorder that causes shifts in mood and energy, which results in depression and mania for patients. Proper diagnosis of this disorder is often a challenge for two reasons: 1) patients often present as depressive or manic but may have both; and 2) many symptoms of bipolar disorder are similar to other disorders. Misdiagnosis is common, making it essential for you to have a deep understanding of the disorder\u2019s pathophysiology. For this Assignment, as you examine the patient case study in this week\u2019s Learning Resources, consider how you might assess and treat patients presenting with bipolar disorder.<\/p>\n Examine\u00a0Case Study: An Asian American Woman. Diagnosis-Bipolar Disorder.<\/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\u00a0<\/a><\/strong><\/p>\n https:\/\/academicguides.waldenu.edu\/writingcenter\/templates\/general#s-lg-box-20293632). All papers submitted must use this formatting.<\/a><\/p>\n <\/p>\n Submit<\/strong> your Assignment.<\/p>\n Week 5 Assignment Rubric<\/p>\n <\/p>\n Submit your Week 5 Assignment draft and review the originality report.<\/p>\n <\/p>\n In the provided case study, the 8-year-old Caucasian female patient came to the clinic accompanied by her parents for psychiatric evaluation<\/a>. The patient’s teacher suggested that the patient might be having attention deficit hyperactivity disorder (ADHD). Their family physician also suggested that the patient should see a psychiatrist for further evaluation of her mental disorder. The patient parents came with a completed Conner\u2019s Teacher Rating Scale-Revised screening tool, which revealed that the patient is easily distracted at school, and with a short attention span. The patient also displayed poor arithmetic, spelling, and reading skills in addition to being inattentive and forgetful most of the time. Her teacher claims that the patient even failing to complete her homework will lack interest in school activities. She also fails to follow instructions at times. Despite the patient’s parents being in denial that their daughter has ADHD, mental status examination results proved otherwise together with the Conner\u2019s Teacher Rating Scale-Revised screening tool completed by the teacher, supporting the diagnosis of attention deficit hyperactivity disorder (ADHD), predominantly inattentive presentation.<\/p>\n Developing a treatment plan for pediatric patients with mental disorders is quite challenging given the safety issues associated with this age group. However, appropriate prescriptive practice will involve considering patient-specific factors that might affect the pharmacokinetic and pharmacodynamic processes. Such factors which will affect the decision on which drugs to prescribe include the patient young age, Caucasian race, female gender, ADHD diagnosis, and presenting symptoms. The purpose of this discussion is thus to demonstrate the appropriate decision-making process in the selection of the most appropriate intervention in the treatment of the 8-year-old attention deficit hyperactivity disorder (ADHD), predominantly inattentive presentation.<\/p>\n From the listed options, initiating Ritalin (methylphenidate) 10mg chewable tablets taken every morning was decided on as the initial intervention. Ritalin is recommended by most clinical guidelines as the first-line medication for the management of ADHD among both children and adults (Rodrigues et al., 2021). Despite the psychostimulant not being approved by the FDA, it has displayed great effectiveness in the management of ADHD with a desirable safety profile in most children from ages 6 to 15 years (American Psychiatric Association, 2013; Castells et al., 2021)). It has demonstrated a substantial impact in managing ADHD symptoms such as inattention, forgetfulness, impulsivity, diminished interest, and hyperactivity among children (Hodgkins et al., 2012). The chewable formulation is considered the best option for children with sweeteners to mask the bitter taste of the drug (Breaux et al., 2022). Consequently, the drug has a short onset of action of between 1 to 2 hours with a long duration of action of between 7.5 to 10.5 hours after oral administration (Mechler et al., 2021). This helps in the management of the patient’s symptoms all day long (Coghill et al., 2021).<\/p>\n Bupropion is associated with increased risks of seizures among children below the age of 10 years, hence not an appropriate decision (Coghill et al., 2021). Intuniv on the other hand is associated with cardiovascular side effects, hence should only be considered in case there is no other safer and more effective drug for use in the pediatric population (Rodrigues et al., 2021).<\/p>\n The patient will experience improved symptoms of ADHD in the next four weeks (Coghill et al., 2021). She should be able to improve her spelling, arithmetic, and language skills, in addition to being more attentive and able to concentrate on school work (Hodgkins et al., 2012). Her school performance will improve significantly within this period.<\/p>\n The patient is 8 years of age, which gives the parents legal responsibility of making decisions concerning the health of their child (American Psychiatric Association, 2013). As such, the PMHNP must educate them adequately regarding the patient’s diagnosis and potential treatment options, to promote sound decision-making in promoting the health of their child (Rodrigues et al., 2021).<\/p>\n \u00a0<\/strong>The second decision was to change the treatment regimen to long-acting Ritalin 20mg administered orally in the morning. Based on the treatment outcome, Ritalin displayed potential effectiveness given that the patient’s ADHD symptoms improved evidenced by her improved school performance (Breaux et al., 2022). However, since the medication was not able to manage the patient’s symptoms throughout the entire day, it was necessary to introduce a long-acting formulation to prolong the duration of action of the drug (American Psychiatric Association, 2013). Studies show that long-acting Ritalin lasts for between 8 to 12 hours hence, helps in managing the patient’s symptoms throughout the day (Castells et al., 2021). It is also administered once daily which is more convenient and much easier. The patient also reported a side effect of elevated pulse, which is a common self-limiting side effect of Ritalin that is expected to diminish with time (Coghill et al., 2021).<\/p>\n Continuing with the same drug at the same dosage was inappropriate as the patient would still exhibit ADHD symptoms later in the day, once the drug wears off from the body system (Mechler et al., 2021). Replacing Ritalin with Adderall is also inappropriate as Adderall is associated with increased incidences of suicidal events when used among children (Hodgkins et al., 2012).<\/p>\n The long-acting formulation is expected to manage the patient’s symptoms all day long within the following four weeks (Breaux et al., 2022). The patient’s school performance will improve even further. The side effect of elevated heart rate will resolve completely within this time (Coghill et al., 2021).<\/p>\n I<\/b>n making this decision, the PMHNP had to consider several ethical principles including justice, beneficence, nonmaleficence, and respect for the patient’s autonomy (Breaux et al., 2022). The patient was quite comfortable with how the drug was working, but only concerned with the side effect, and effectiveness of the medication later in the day (Rodrigues et al., 2021). As such, it was necessary to respect the patient and display clinical judgment in making decisions that will promote the patient’s mental health.<\/p>\n Maintaining the patient on the current medication and reevaluating after four weeks, seemed to be the most appropriate decision for the third intervention. The patient reported great effectiveness and tolerance to the medication, with resolved side effects of an elevated pulse (Mechler et al., 2021). Previous evidence shows that once the optimal dose of Ritalin has been attained, it can take between 8 to 12 weeks to completely manage the patient’s symptoms of ADHD (American Psychiatric Association, 2013; Castells et al., 2021). Consequently, at safe doses, long-term use of the drug has been associated with limited possibilities of side effects, hence the need to reevaluate the patient within 4 weeks (Hodgkins et al., 2012). Studies also show that long-term use of Ritalin normally reduces the risks of side effects as the patient will display further tolerance to the drug, enhancing its safety profile (Breaux et al., 2022).<\/p>\n Increasing the dose of Ritalin to 30mg was not necessary at this point, as studies suggest that low effective doses are safer to use to promote positive outcomes, with reduced risks of side effects (Mechler et al., 2021). Consequently, obtaining EKG at this point was not necessary given that the patient’s pulse had already resolved back to normal for her age, with a recording of 92 during the current visit (Rodrigues et al., 2021).<\/p>\n With great compliance to the treatment regimen, the patient will report even further management of the ADHD symptoms over the following two weeks (Breaux et al., 2022). Her academic performance is also expected to improve (American Psychiatric Association, 2013). No side effects are expected.<\/p>\n The nurse’s main objective is to promote the health of the patient and not harm. At this point, the patient was satisfied with the treatment outcome (Hodgkins et al., 2012). It was thus necessary to respect the patient’s autonomy and maintain the dose for further evaluation of the treatment outcome (Mechler et al., 2021).<\/p>\n The 8-year-old patient in the case study presented with symptoms of ADHD. Formulating a treatment plan for the patient involved consideration of certain patient-specific factors which affect her pharmacokinetic and pharmacodynamic processes (American Psychiatric Association, 2013). Such factors which will affect the decision on which drugs to prescribe include the patient young age, Caucasian race, female gender, ADHD diagnosis, and presenting symptoms. Based on these factors, the first decision was to initiate a 10mg Ritalin chewable table once daily as recommended by most clinical guidelines given its effectiveness in the management of ADHD and safety for pediatric use (Coghill et al., 2021). Intuniv and bupropion were neglected because of their increased risks of side effects among children as reported by most studies (Mechler et al., 2021). After 4 weeks, the patient came back to the clinic reporting improved symptoms but with side effects of increased pulse rate. The second decision was thus to change the treatment regimen to long-acting Ritalin 20mg once daily in the morning, to prolong the duration of action of the medication throughout the day (Castells et al., 2021). Maintaining the dose would still lead to ineffectiveness, while Adderall display increased risks of suicidality hence neglected (Breaux et al., 2022).<\/p>\n The patient reported further improvement in ADHD symptoms all day long, with resolved side effects of elevated pulse, which led to the final decision of maintaining the treatment regimen and reevaluating the patient after 4 weeks. Obtaining EKG and increasing the dose of Ritalin was not necessarily due to safety issues (Hodgkins et al., 2012). Finally, the PMHNP encountered several ethical considerations in each decision process with the observation of ethical principles such as justice, respect for patient autonomy, not harm, and beneficence (Rodrigues et al., 2021).<\/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 Breaux, R., Dunn, N. C., Swanson, C. S., Larkin, E., Waxmonsky, J., & Baweja, M. D. (2022). A Mini-Review of Pharmacological and Psychosocial Interventions for Reducing Irritability Among Youth With ADHD.\u00a0Frontiers in Psychiatry<\/em>, 151. https:\/\/doi.org\/10.3389\/fpsyt.2022.794044<\/a><\/p>\n Castells, X., Ramon, M., Cunill, R., Oliv\u00e9, C., & Serrano, D. (2021). Relationship between treatment duration and efficacy of pharmacological treatment for ADHD: a meta-analysis and meta-regression of 87 randomized controlled clinical trials.\u00a0Journal of attention disorders<\/em>,\u00a025<\/em>(10), 1352-1361. https:\/\/doi.org\/10.1177\/1087054720903372<\/a><\/p>\n Coghill, D., Banaschewski, T., Cortese, S., Asherson, P., Brandeis, D., Buitelaar, J., … & Simonoff, E. (2021). The management of ADHD in children and adolescents: bringing evidence to the clinic: perspective from the European ADHD Guidelines Group (EAGG).\u00a0European Child & Adolescent Psychiatry<\/em>, 1-25. https:\/\/doi.org\/10.1007\/s00787-021-01871-x<\/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 Mechler, K., Banaschewski, T., Hohmann, S., & H\u00e4ge, A. (2021). Evidence-based pharmacological treatment options for ADHD in children and adolescents.\u00a0Pharmacology & Therapeutics<\/em>, 107940. https:\/\/doi.org\/10.1016\/j.pharmthera.2021.107940<\/a><\/p>\n
\ndepression and mania for patients. Proper diagnosis of this disorder is often a challenge for two
\nreasons: 1) patients often present as depressive or manic but may have both; and 2) many
\nsymptoms of bipolar disorder are similar to other disorders. Misdiagnosis is common, making it
\nessential for you to have a deep understanding of the disorder\u2019s pathophysiology. For this
\nAssignment, as you examine the patient case study in this week\u2019s Learning Resources, consider
\nhow you might assess and treat patients presenting with bipolar disorder.<\/p>\nTo prepare for this Assignment:<\/strong><\/h2>\n
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The Assignment: 5 pages<\/strong><\/h2>\n
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Introduction to the case (1 page)<\/strong><\/h2>\n
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Decision #1 (1 page)<\/strong><\/h2>\n
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Decision #2 (1 page)<\/strong><\/h2>\n
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Decision #3 (1 page)<\/strong><\/h2>\n
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Conclusion (1 page)<\/strong><\/h2>\n
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By Day 7 <\/strong><\/h2>\n
Submission and Grading Information<\/strong><\/h3>\n
To submit your completed Assignment for review and grading, do the following:<\/strong><\/h4>\n
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NURS 6630 Assessing and Treating Patients With Bipolar Disorder Grading Criteria<\/strong><\/h2>\n
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Check Your Assignment Draft for Authenticity<\/strong><\/h3>\n
To check your Assignment draft for authenticity:<\/h4>\n
Submit Your Assignment by Day 7 of Week 5<\/strong><\/h3>\n
To participate in this Assignment:<\/h4>\n
A Sample Answer For the Assignment: NURS 6630 Assessing and Treating Patients With Bipolar Disorder<\/strong><\/h2>\n
Title: <\/strong>\u00a0<\/strong>NURS 6630 Assessing and Treating Patients With Bipolar Disorder<\/h2>\n
Decision Point One<\/strong><\/h2>\n
Selected Decision and Rationale<\/strong><\/h3>\n
Expected Outcome<\/strong><\/h2>\n
Ethical Considerations<\/strong><\/h2>\n
Decision Point Two<\/strong><\/h2>\n
Selected Decision and Rationale<\/strong><\/h3>\n
Expected Outcome<\/strong><\/h2>\n
Ethical Considerations<\/strong><\/h2>\n
Decision Point Three<\/strong><\/h2>\n
Selected Decision and Rationale<\/strong><\/h3>\n
Expected Outcome<\/strong><\/h2>\n
Ethical Considerations<\/strong><\/h2>\n
NURS 6630 Assessing and Treating Patients With Bipolar Disorder <\/em>Conclusion<\/strong><\/h2>\n
NURS 6630 Assessing and Treating Patients With Bipolar Disorder <\/em>References<\/strong><\/h2>\n