Not only do children and adults have different presentations for ADHD, but males and females may also have vastly different clinical presentations. They 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 mental health nurse practitioner, you must perform careful assessments and weigh the risks and benefits of medication therapies for clients across the lifespan. For this Assignment, you consider how you might assess and treat clients presenting with ADHD.
This case study will serve as the foundation for this week’s Assignment.
The Assignment
Examine Case Study: A Young Caucasian Girl With ADHD You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes. Assessing and Treating Clients with ADHD Essay
At each decision point stop to complete the following:
Decision #1
Which decision did you select?
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
Decision #2
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
Decision #3
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
Also include how ethical considerations might impact your treatment plan and communication with clients.
References:
Conners, C. K., Sitarenios, G., Parker, J. D. A., & Epstein, J. N. (1998). Revision and restandardization of the Conners\’ Teacher Rating Scale (CTRS-R): Factors, structure, reliability, and criterion validity. Journal of Abnormal Child Psychology, 26, 279-291. Assessing and Treating Clients with ADHD Essay
Assessing and Treating Clients with ADHD
Introduction
This assignment focuses on an 8-year-old Caucasian girl with a suspected ADHD. ADHD is characterized by a pattern of inattention and hyperactivity-impulsivity that impair normal functioning and development (Gray & Climie, 2016). The client manifested symptoms such as inattentiveness, forgetfulness, easily distracted, and poor performance in reading, math, and spelling. The teacher reported that the client was disinterested with the classwork, left assignment unfinished, short attention span, and did not follow instructions. The client was diagnosed with attention deficit hyperactivity disorder (ADHD), predominantly inattentive presentation. In this assignment, three decisions about the medications to be prescribed for the client will be made. Lastly, the ethical aspects likely to impact the client’s treatment plan will be discussed.
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Decision Point One
The first decision is for the client to start Ritalin (methylphenidate) chewable tablets 10 mg. The reason why this medication was chosen is that it is FDA approved as the first-line treatment for ADHD in children. Ritalin working by increasing the level of norepinephrine and dopamine in the brain and thus improves symptoms in people with ADHD (Durand et al, 2015). The medication also has few side effects. Wellbutrin and Intuniv were not selected due to the side effects associated with the medications (Bello, 2015).
Excepted Outcome
Selection of Ritalin (methylphenidate) hoped that the ADHD symptoms would significantly improve because the medication has been shown to be effective in controlling ADHD symptoms (Wigal et al, 2017). Another expectation was that the client would not experience any side effect after starting the treatment. This is because the medication has been shown to have a good safety profile with few side effects (Durand et al, 2015).
Difference between Expected Outcome and the Decision Outcome
Just as expected, symptoms for the client reduced significantly as indicated by improved academic performance and the ability to maintain attention throughout the morning session. Nonetheless, in the afternoon the inattention would resurface. According to Jakob et al (2015), this was attributable to methylphenidate being an immediate release and short-acting agent and thus by the afternoon, the medication’s effect had weaned off. Moreover, the client also experienced increased pulse rate which is attributable to the medication’s side effects when starting the medication. Assessing and Treating Clients with ADHD Essay
Decision Point Two
The second decision was to change the client’s medication to Ritalin LA 20 mg. The reason for choosing this decision is to make the medication’s effect persist throughout the day to ensure that the client is able to maintain attention even in the afternoon because Ritalin LA 20 mg is a long-acting preparation (Durand et al, 2015). The decision to continue with Ritalin 10 mg was not selected because with this choice, the client was experiencing inattentiveness in the afternoon. Secondly, the decision to start Adderall XR was not chosen because the medication works the same way as Ritalin and hence there is no significance to change the medication choice (Durand et al, 2015).
Excepted Outcome
This decision to choose Ritalin LA 20 mg was selected in order to ensure that the medication’s effect would last throughout the day in for her to be able to maintain attention in the afternoon. Higher doses of Ritalin are associated with better efficacy when it comes to the treatment of ADHD symptoms (Wigal et al, 2017). Another expectation was that the side effect of high pulse rate would reduce as the client’s body got used to the drug.
Difference between Expected Outcome and the Decision Outcome
Just expected, the client’s ADHD symptoms continued to improve as indicated by improved educational performance and the client was able to maintain attention throughout the day. This is due to the increased efficacy of the higher doses of Ritalin. Additionally, the client reported that the heart rate had stabilized (Wigal et al, 2017).
Decision Point Three
The third decision was to have the current dose of Ritalin LA maintained 20 mg, and to have the client examined in 4 weeks. This decision was chosen because the symptoms of ADHD were improving as she was able to maintain attention throughout the day and her academic performance improved. This is due to increased efficacy of the long-lasting treatment agent and increased dosage (Jakob et al, 2015).
Expected Outcome
By selecting this decision, it was expected that the symptoms of ADHD would show complete remission. This is because of the increased efficacy of the long-lasting treatment agent and increased the dosage of Ritalin (Wigal et al, 2017). It was also expected that the client would not have any side effects due to the good safety profile of the medication (Jakob et al, 2015).
Ethical Considerations
The PMHNP should educate the client and her parents about the available treatment options, including the side effects of the available medications. This will ensure that the parents will make an informed decision regarding the medications. It is also important for PMHNP to ensure that privacy and confidentiality of the client’s information (Ghosh et al, 2016). Assessing and Treating Clients with ADHD Essay
Conclusion
The diagnosis of the client was ADHD. The first decision was for the client to begin (methylphenidate) 10 mg due to the efficacy of the medication in controlling ADHD symptoms. However, the client was not able to maintain attention throughout the day. As a result, the second decision for the client to begin Ritalin LA 20 mg because this is a long last lasting agent and higher dose would ensure increased efficacy. This would ensure the client is able to maintain attention throughout the day and further improve other symptoms. The third decision was to maintain the dose of Ritalin LA 20 mg because this dosage is effective in controlling symptoms without any side effects.
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References
Bello N. (2015). Clinical utility of guanfacine extended release in the treatment of ADHD in children and adolescents. Patient Prefer Adherence. 1(9), 877–885.
Durand A, Miguel E, Sanchez E & Celia R. (2015). Methylphenidate Efficacy: Immediate versus Extended-Release at Short Term in Mexican Children with ADHD Assessed by Conners Scale and EEG. Neurology Research International. 1(1): 1-9.
Ghosh M, Fisher C, Preen D & Holman C. (2016). “It has to be fixed”: a qualitative inquiry into perceived ADHD behavior among affected individuals and parents in Western Australia. BMC Health Serv Res. 16(141).
Gray C & Climie E. (2016). Children with Attention Deficit/Hyperactivity Disorder and Reading Disability: A Review of the Efficacy of Medication Treatments. Front Psychol. 7(988).
Jakob O, Krogh H, Holms M, Carlos M & Ramstad E et al. (2015). Methylphenidate for attention-deficit/hyperactivity disorder in children and adolescents: Cochrane systematic review with meta-analyses and trial sequential analyses of randomized clinical trials. BMJ. 1(351).
Wigal S, Berry S, Belden H, Walters F, Chappell P, Donna P & John O. (2017). Efficacy and Safety of a Chewable Methylphenidate Extended-Release Tablet in Children with Attention-Deficit/Hyperactivity Disorder. J Child Adolesc Psychopharmacology. 27(8), 690–699. Assessing and Treating Clients with ADHD Essay