Assignment: Assessing and Treating Patients with ADHD Essay

Assignment: Assessing and Treating Patients with ADHD Essay

Assignment: Assessing and Treating Patients with ADHD

Attention deficit hyperactivity disorder (ADHD) is a syndrome that occurs in children presenting with features of inattention, hyperactivity, and impulsivity. It is a psyychiatric disorder that emerges early in childhood, usually pre-school (Sierawska et al., 2019). It impairs personal, academic, social, and occupational development. Children with ADHD have difficulties acquiring, retaining, and applying particular skills and information. The purpose of this paper is to describe the treatment approaches of a patient with ADHD using a decision tree and explain the ethical factors that were considered in deciding the treatment plan.

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Case Overview

The case scenario portrays Katie; an 8-year-old Caucasian girl accompanied to the clinic by her parents. Katie’s teacher implied that she might have ADHD and their PCP referred them for psychiatric evaluation. The teacher had filled out the “Conner’s Teacher Rating Scale-Revised” tool, which showed that Katie has low concentration levels, is easily distracted, has poor memory, and has spelling, reading, and calculation difficulties. Katie’s teacher mentioned that she has minimal interest in school work; she never finishes her tasks, hardly follows instructions, and does not complete her school work. Her diagnosis is ADHD, predominantly inattentive presentation.

Treatment of ADHD includes behavioral therapy and pharmacological treatment with stimulant and non-stimulant drugs. Various patient factors may influence prescription decisions, including the patient’s age, the need for a rapid onset of action, the major ADHD symptoms, psychiatric comorbidity, and the risk for adverse effects (Feldman et al., 2018). In addition, the parental preferences and expectations, attitudes towards medication, the potential of drug-to-drug interactions, and the patient’s variability in response to medication or adverse events will influence the decision on medication.

Decision #1

Start Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING.

Why Did You Select This Decision?

Ritalin was selected because it is a psychostimulant recommended as a first-line drug for ADHD for children above six years. It enhances the activity of central dopamine and norepinephrine, affecting executive functioning and attention (Faraone, 2018). Psychostimulants are established as the most effective drugs for treating core ADHD symptoms and generally have an acceptable side effects effect profile.

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

Bupropion was not selected because the FDA does not approve it for treating ADHD in children and is often used off-label when psychostimulants are ineffective and in treating comorbid conditions. Besides, its impact on ADHD symptoms is not as effective as stimulants (Geffen & Forster, 2018). In addition, Intuniv XR was not ideal because it is less effective than stimulants and is recommended as a second-line drug after a stimulant. Besides, it is associated with a side effect of rebound hypertension if stopped suddenly.

What Were You Hoping To Achieve By Making This Decision?

I hoped that prescribing Ritalin would improve the client’s ADHD symptoms of distractibility and inattention, resulting in improved academic performance. Feldman et al. (2018) assert that stimulants seem to enhance quality of life in persons with ADHD. Stimulants are connected with better academic attainment and reduced comorbid depression and anxiety rates in young adulthood.

How Ethical Considerations May Impact Your Treatment Plan And Communication With Patients.

The moral duty to promote better good and prevent harm on the patient impacted the treatment plan. The clinician evaluated the available treatment options and selected Ritalin because it is the most effective and has the best side effect profile. This upholds the principles of beneficence and nonmaleficence (Sierawska et al., 2019).

Decision #2

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

Why Did You Select This Decision?

I changed Ritalin from a short-acting to long-acting formulation because the latter’s effects were not sustained the whole day. Karahmadi et al. (2020) explain that the short-acting Ritalin has a half-life of approximately 4 hours and should thus be administered 2-3 times daily in children. On the other hand, the long-acting formulation has a half-life of 10–12 hours and is thus prescribed once a day.

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

I did not continue the initial Ritalin dose because it has a very short duration for a full-day single dose, and therefore its effects would not last the whole day unless prescribed twice (Karahmadi et al., 2020). I did not also change drug therapy to Adderall XR because it is recommended that an adequate dose and duration of the initial drug be provided before switching within the stimulant class or alternate drug therapy (Brown et al., 2018).

What Were You Hoping To Achieve By Making This Decision?

I hoped that switching to a long-acting formulation would help sustain the Ritalin’s effects of improved attention and concentration levels for longer hours. Brown et al. (2018) explain that drug therapy of children and adolescents should start with long-acting stimulant medications. Long-acting ADHD drugs have less potential to cause drug abuse or dependence.

How Ethical Considerations May Impact Your Treatment Plan And Communication With Patients.

            Beneficence impacted the treatment plan as the clinician had to evaluate if the current medication promoted the patient’s best outcome. The medication was changed to long-acting to promote a better outcome and help achieve the desired results. The clinician also assessed the drug’s side effects to determine the need for changing therapy, which upholds the moral duty to cause no harm (Sierawska et al., 2019).

Decision #3

Maintain Ritalin LA dose and reevaluate in 4 weeks.

Why Did You Select This Decision?

The current Ritalin LA dose was maintained because the patient demonstrated an adequate response, and its effects lasted throughout the day. The palpitation side effect had also abated, and thus there was no side effect necessitating a change in dose or the drug. According to Karahmadi et al. (2020), hyperactivity is better managed in most instances with long-acting ADHD drugs.

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

The Ritalin LA was not increased to 30 mg because the initial dose effectively promoted the desired outcomes. Increasing the dose may put the patient at risk of side effects, which would reduce the compliance rate. Besides, I did not obtain an EKG because the patient’s palpitations had abated, and heart rate was within the normal range. Brown et al. (2018) explain that cardiac examination is indicated if a patient develops chest pain, unexplained blackouts, and other symptoms indicating cardiac disease.

What Were You Hoping To Achieve By Making This Decision?

I hoped that maintaining the current Ritalin dose would help improve the ADHD symptoms, and the drug’s effects would last throughout the day leading to improved academic performance. Karahmadi et al. (2020) explain that long-acting stimulant drugs have a good safety profile and have a lower risk of abuse and diversion, which improves medication adherence.

How Ethical Considerations May Impact Your Treatment Plan And Communication With Patients

The clinician assessed if the current treatment was associated with any side effects to ensure the drug therapy does not cause any harm to the patient, which upholds nonmaleficence (Sierawska et al., 2019). Besides, the current treatment was continued to improve the patient’s treatment outcomes.

Conclusion

            Katie was diagnosed with ADHD based on her symptoms of distractibility and inattentiveness. Patient factors that would affect decision-making in prescribing treatment include age, the desired onset of action, the core ADHD symptoms, psychiatric comorbidity, and the risk for potential adverse effects. The first treatment decision was to prescribe Ritalin chewable tablets since it is a stimulant approved by the FDA to treat ADHD in children above six years (Feldman et al., 2018). Although the Ritalin improved ADHD symptoms, its effects did not last the whole day, and the patient would daydream in the afternoon. Therefore, it was essential to change the Ritalin from a short-acting to a long-acting formulation to sustain its effects the whole day. A short-acting formulation lasts 4-6 hours, while the long-acting lasts 10-12 hours (Karahmadi et al., 2020). The long-acting formulation led to a sustained effect of Ritalin, resulting in the patient’s improved academic performance.

The Ritalin LA dose was maintained for re-evaluation after four weeks because the patient demonstrated an adequate response to the formulation. There was no need to increase the dose since there was an adequate response, and the patient needed to be monitored for any side effects. An EKG was unnecessary at this point because the patient’s heart rate was within the normal range, and there were cardiovascular-associated side effects. Beneficence and nonmaleficence impacted the treatment plan. The clinician had to evaluate the available treatment options and select the one associated with the best treatment outcomes and least side effects.

References

Brown, K. A., Samuel, S., & Patel, D. R. (2018). Pharmacologic management of attention deficit hyperactivity disorder in children and adolescents: a review for practitioners. Translational Pediatrics, 7(1), 36–47. https://doi.org/10.21037/tp.2017.08.02

Faraone, S. V. (2018). The pharmacology of amphetamine and methylphenidate: Relevance to the neurobiology of attention-deficit/hyperactivity disorder and other psychiatric comorbidities. Neuroscience and biobehavioral reviews, 87, 255–270. https://doi.org/10.1016/j.neubiorev.2018.02.001

Feldman, M. E., Charach, A., & Bélanger, S. A. (2018). ADHD in children and youth: Part 2-Treatment. Paediatrics & child health, 23(7), 462–472. https://doi.org/10.1093/pch/pxy113

Geffen, J., & Forster, K. (2018). Treatment of adult ADHD: a clinical perspective. Therapeutic advances in psychopharmacology, 8(1), 25–32. https://doi.org/10.1177/2045125317734977

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

Sierawska, A., Prehn-Kristensen, A., Moliadze, V., Krauel, K., Nowak, R., Freitag, C. M., … & Buyx, A. (2019). Unmet needs in children with attention deficit hyperactivity disorder—can transcranial direct current stimulation fill the gap? Promises and ethical challenges. Frontiers in psychiatry, 10, 334. https://doi.org/10.3389/fpsyt.2019.00334

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

To prepare for this Assignment:
Review this week’s Learning Resources, including the Medication Resources indicated for this week.
Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients with ADHD.
The Assignment: 5 pages
Examine Case Study: A Young Caucasian Girl with ADHD. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.
At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.

Introduction to the case (1 page)

Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.
Decision #1 (1 page)

Which decision did you select?
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #2 (1 page)

Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #3 (1 page)

Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Conclusion (1 page)

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

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