Assessing and Treating Clients With ADHD Essay

Posted: December 15th, 2022

Assessing and Treating Clients With ADHD Essay

Assignment: Assessing and Treating Clients With ADHD 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. Learning Objectives Students will: • Assess client factors and history to develop personalized therapy plans for clients with ADHD • Assessing and Treating Clients With ADHD Essay. Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring therapy for ADHD • Evaluate efficacy of treatment plans • Evaluate ethical and legal implications related to prescribing therapy for clients with ADHD To prepare for this Assignment: Review the reading resources (see attachment doc) The Assignment Examine Case Study: 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. (Decisions have already been made. See decision results in the attached case study) 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. I want you to answer the questions given to you (decision points one, two, and three) before you click on the option. The answers will be based on your decisions made and patient outcomes during the decision tree (see results of decision tree in the attachment doc). I am looking for an essay that is long enough to cover the topic BUT short enough to keep my interest. I do not need you to tell me the treatment options available to you – I am very familiar with the cases. Remember this is a Pharmacology class that incorporates Pharmacotherapy and not a class on diagnosing disease. I want you to tell me why you selected an option (why is it the best option- using clinically relevant and patient specific data) AND why you did not choose the other options (with clinically relevant and patient specific data). At each decision point, stop to complete the following: * Decision #1 Select what the PMHNP should do next: • You decided to start patient on Ritalin (Methylphenidate) chewable tablets 10 mg orally in the morning. (see attachment for result of decision#1) • Why did you select this decision? Support your response with evidence and references to the Learning Resources. • Assessing and Treating Clients With ADHD Essay. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. • Why did you not choose the option to begin Wellbutrin (bupropion) XL 150 mg orally daily or Intuniv extended-release 1 mg orally at bedtime? • Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different? Decision #2 Select what the PMHNP should do next: • You decide to increase to Ritalin LA 20 mg orally daily. (see attachment for result of 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. • Why did you not choose the options to discontinue Ritalin and begin Adderall XR 15 mg by mouth daily or continue the same dose of Ritalin and re-evaluate in 4 weeks. • Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different? Decision #3 Select what the PMHNP should do next: • You decide to maintain the current dose of Ritalin LA and reevaluate in 4 weeks. (see attachment for result of 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. • Why did you not choose the options to either increase Ritalin LA to 30 mg orally daily or obtain EKG based on current heart rate? • 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. Assessing and Treating Clients With ADHD Essay

Introduction

ADHD is a common mental disorder among children and teenagers more often diagnosed in boys than girls. It causes uncontrolled impulse and hyperactivity and also affects attention capabilities in home and school activities. Treatment involves the management of symptoms. Some adults also suffer from ADHD which causes disorganization and difficulties in time management among other sympeoms.

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Decision One

Starting patient on Ritalin (Methylphenidate) chewable tablets 10 mg

Ritalin (Methylphenidate) stimulates the nervous system by increasing the production of dopamine and norepinephrine in the extraneuronal space and as well blocking their reuptake into the presynaptic neuron(Clancy, Change, Slutsky& Fox, 2011). The Patient was started on this medication because of its stimulation activity which would keep her active for at least four hours. 10mg was more tolerable to the 8 year old patient to prevent the occurrence of adverse side effects from higher doses which would otherwise affect her daily activities. She also did not present severe symptoms and thus the reason for starting with a lower dosage. As such, it facilitated adaptation of the body to the drug. The dosage is still sufficient to alleviate the symptoms of the patient. This decision sort to create an adaptive environment for increase of the dosage. Moreover, it aimed at alleviating the symptoms of ADHD which were manifested through lack of concentration, day dreaming and inability to be attentive(Stahl, 2014b). Assessing and Treating Clients With ADHD Essay

Wellbutrin (bupropion) XL 150 mg is used to manage the depressive symptoms of seasonal affective disorder and major depressive disorders and not a first line treatment for ADHD. The antidepressant aids people in stopping addictions, withdrawal effects and cravings particularly the smokers. The fact the patient reported no signs of depression disqualified the use of this drug since it restores norepinephrine and dopamine for mood enhancement other than concentration and attention management as is the case with Katie. On the other hand, Intuniv extended-release 1 mg was not prescribed because of its severe side effects includes headache, somnolence and fatigue which would affect the concentration of the patient in school.

After the administration of this treatment, I expected that the patient’s symptoms will improve significantly particularly in her studies. I expected her attention and concentration to increase. Moreover, I was hoping that her daydreaming and lack of interest in some subjects would end. The results revealed that the patient was able to concentrate in the morning hours and resumed daydreaming in the afternoon and lack of attentiveness. She also complained of increased heartrate. The difference could have been due to the side effects of the medication as well as its stimulating function in the nervous system. Assessing and Treating Clients With ADHD Essay

Decision Two

Continuation of Ritalin LA 20 mg Orally Daily

The increase of Ritalin LA 20 mg orally dailyis a slight upward trend used to increase the effectiveness of the drug. Depending on the efficacy and tolerability of the patient, the appropriate dosage was increased by 10mg to prevent the occurrence of extreme impacts(Stahl & Mignon, 2012). The patient also did not respond effectively to 10mg and thus the increase to 20mg would facilitate optimal response through the alleviation of all symptoms. I chose to increase the dosage because the child reported heart rate increase and insufficient attention and concentration after the administration of 10mg of the drug.

I did not choose to substitute Ritalin with Adderall XR 15mg because I intended to increase the dosage of Ritalin in the event that the small level did not alleviate the symptoms completely. Moreover, I did not want to subject the patient to withdrawal effects which would interfere with the recovery process. The medicine use also requires to be stopped occasionally to confirm the progress and this might have affected the patient’s performance in school(Stahl, 2013). Besides, I intended to achieve the best dosage for the treatment since Ritalin presents different performance in different individuals and that’s why I did not continue 10mg for four weeks. As such, changing medication would subject the patient to the Ritalin withdrawal side effects as well as the side effects of Adderall XR 15mg as the body of the patient tries to adjust and adapt to the new change. Assessing and Treating Clients With ADHD Essay

During the increase of the dosage, I expected the patient to recover completely from the symptoms of ADHD. This included getting the heart rates to normal to prevent the “heart funny feeling” of the patient. Moreover, improved academic performance and concentration as well as attention were expected. These expectations were achieved since the patient reported the end of the “funny” feeling of the heart. Her academic performance had also improved significantly and the concentration lasted through out the school day. However, the heartrate was still higher than normal. Even though it had gone down, the stimulation effect of the drug at higher dosage must have resulted in the slightly elevated heartrate(Conners et al., 1998).

Decision Three

Increase Ritalin LA to 30 mg orally daily

The heart rate of the patient suggested that the Ritalin dosage administered was sufficient to produce optimum impacts. In this case, the medication was not increased by 10mg since the symptoms were already manageable using the current dosage.Therefore, 20mg of Ritalin administered orally daily was the best option for the patient. Assessing and Treating Clients With ADHD Essay

The decision sought to re-evaluate the effectiveness of the drug for the period of four weeks. Moreover, it the decision was intended to achieve complete prevention of symptoms and result in full recovery without the relapse of symptoms. Katie’s performance in school was to remain improving as well as her concentration. Her heartrate was expected to remain normal too. At the correct dosage tolerable by the patient, Ritalin produces consistent positive results which suggest the optimum concentration suitable for the patient(Stahl, 2013). With complete recovery of the patient, a patient is withdrawn from the medication. The optimum dose also is determined when the patient’s results turn out positive after for weeks of re-evaluation.

The dosage of Ritalin is increased when the current dose does not present improvement in the patient’s symptoms. In this case, the patient responded effectively to the 20mg dose. This was revealed through the normalizing of the heart rate, increase in performance and elevated concentration and attention. As such, there was no need for the introduction of EKG or increase of Ritalin to 30mg for the management of the current heartrate of the patient. Increasing the concentration of the drug would result to overdose and development of side effects which occurs beyond the tolerance threshold. Assessing and Treating Clients With ADHD Essay

Ethics

Ethical issues affect the controversial health condition ADHD(American Psychiatric Association, 2013). The treatment plan must follow the four ethical principles namely justice, non‐maleficence, beneficence and autonomy. In this case, the consent, confidentiality and respect of the patient must be respected. However, this challenges treatment since the practitioners actions are supposed to produce positive effects and thus does not accommodate possibility of the side effects caused by medication.Additionally, confidentiality is breached when the parents and teachers are involved in the diagnosis and treatment process without the legal approval of the child.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Clancy, C.M., Change, S., Slutsky, J., & Fox, S. (2011). Attention deficit hyperactivity disorder: Effectiveness of treatment in at-risk preschoolers; long-term effectiveness in all ages; and variability in prevalence, diagnosis, and treatment. Table B. KQ2: Long-term(>1 year) effectiveness of interventions for ADHD in people 6 years and older.

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.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University

Stahl, S. M., & Mignon, L. (2012).Stahl’s illustrated attention deficit hyperactivity disorder. New York, NY: Cambridge University Press. Assessing and Treating Clients With ADHD Essay