Examine Case Study: A Young Caucasian Girl with ADHD. https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6630/DT/week_09/index.html. 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.
Formal Decision Tree Instructions
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.
- Be aware that the writing template and grading rubric require your introduction to end with one sentence that is your thesis statement. See the writing template for format and the grading rubric for details on how you are graded on this statement.
Body of your document
- The body of your document should contain three sections that are labeled as follows: decision #1, decision #2, and decision #3. Each section should address the topics below. In your writing, you should be concise, clear, and thorough. Pharmacokinetics, pharmacodynamics, and specific patient factors must be considered in your writing in order to get full credit.
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. *Ethical considerations must be clearly identified/labeled. You can identify them within the decision section (“My ethical considerations are…”), or you can identify them separately in a section labeled “Ethical Considerations.” Either option is acceptable.
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.
A Young Caucasian Girl with ADHD
Student’s Name
Institutional Affiliation
Course
Instructor’s Name
Date
A Young Caucasian Girl with ADHD
Introduction
Attention-deficit/hyperactivity disorder (ADHD) is one of the most common mental health disorders affecting children across the world. ADHD is a brain disorder that affects how one pays attention, sits still, and controls their behavior. The mental illness affects children and teens and may extend to adulthood (Barkley, 2018). It is the most commonly diagnosed disorder in children and boys are more likely to develop it than girls. Attention deficit hyperactive disorder is often diagnosed during the early school years when the child starts to have problems paying attention. Although ADHD cannot be prevented or cured, early diagnosis may help the patient manage the symptoms. Some of the problems experienced by patients diagnosed with ADHD include difficulty maintaining attention, hyperactivity, and impulsive behavior (Cortese, 2020). They may also experience low self-esteem, troubled relationships, and poor performance in school.
The patient in the care study is called Katie. She is an 8-year-old Caucasian female who was brought to the clinic by her father and mother. The parents stated that they were referred to the clinic by their primary care provider on learning that their daughter could be suffering from ADHD (Taylor, 2018). The results of the Conner’s teacher rating scale revised showed that Katie is inattentive, easily distracted, forgets things she already learned, is poor in spelling, reading, and arithmetic. Katie says the school is okay and she does not see any big deal. However, she admits that her mind sometimes wanders during class thinking about things she believes are more fun. She states that sometimes she thinks about nothing and the teacher calls her name and she does not know what they were talking about. In that regard, this paper provides the best three decisions to help the patient.
Decision Point One
The selected decision point two is to begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING. Ritalin (methylphenidate) is a central nervous system (CNS) stimulant prescription medicine (Cortese, 2020). The medication is widely used for the treatment of attention deficit hyperactivity disorder (ADHD). Ritalin (methylphenidate) works by increasing attention and reducing impulsiveness and hyperactivity in patients diagnosed with ADHD (Taylor, 2018). It may be used alone or with other medication. Ritalin affects both dopamine and norepinephrine activity in the brain. For this reason, Ritalin (methylphenidate) was selected to treat the patient.
Ritalin (methylphenidate) was considered better than the other two options. Wellbutrin (bupropion) is majorly approved for the treatment of major depressive disorder and seasonal affective disorder (Cortese, 2020). It can also help people quit tobacco smoking. Wellbutrin (bupropion) is also recognized for its association with suicidal ideation in children. Additionally, Intuniv is often associated with sedating effects. Intutiv is an alpha-2 adrenergic agonist while Ritalin is a stimulant. Intutiv is associated with other side effects such as dry mouth, tiredness, low blood pressure (Barkley, 2018). Considering all these facts, the therapist believed that Ritalin (methylphenidate) was the best option over Wellbutrin and intutiv.
The expectation was the patient would be returned to the hospital in four weeks. The patient would show improvement in the ADHD symptoms. For example, the patient’s score on the Conner’s Teacher Rating Scale would reduce to below 60 (Barkley, 2018). A score below 60 usually means the patient does not have attention deficit hyperactive disorder. The child would be able to maintain attention in class. She will regain interest in school work and no easily distracted. The actual results did not match the expected ones. In four weeks, the patient reported slight improvement. She also had overall academic improvement (Barkley, 2018). However, she is staring off into space and daydreaming by the afternoon. She has a higher heartbeat and states that her heartfelt funny. Ethical considerations include beneficence, non-maleficence, and patient autonomy (Haddad & Geiger, 2018). All the decisions must be beneficial and harmless. Patients’ preferences must be respected.
Decision Point Two
The selected decision two is to discontinue Ritalin and begin Adderall XR 15 mg orally daily. This decision was selected because Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING are associated with severe cardiovascular side effects. The patient developed faster than abnormal heartbeats. The patient also reported funny feelings in her heart. Therefore, it was appropriate to change the medication to avoid further damage to the patient’s heart. Changing medication is recommended when the results are not appealing (Barkley, 2018). Adderall is another good medication widely used for the treatment of ADHD.
Continuing with the same dose of Ritalin and re-evaluating in 4 weeks for not a good option since the patient had already shown severe side effects. Continuing with the same medications could worsen the situation and put a patient’s life at risk. Additionally, changing the dose to Ritalin LA 20 mg orally daily in the morning would only worsen the situation (Taylor, 2018). It is not recommended to increase the dose when the patient is experiencing serious side effects. The option may lead to dangerous effects and even death. The statement above explains why the two other options were not selected.
The therapist expected that the patient would report significant symptom improvement in four weeks. 50% of the symptoms associated with attention deficit hyperactive disorder are expected to resolve (Cortese, 2020). The patient is expected to maintain attention in class. Her interest in school work is expected to regain fully. The medication side effects related to tachycardia are expected to resolve. The actual results and the expected results in four weeks did not have a significant difference. The patient’s performance is still improved. Her attention is now sustained throughout the day. However, the tachycardia symptoms persisted. Some of the ethical considerations include giving attention and priority to the patient’s preferences. Parents are allowed to make decisions on behalf of the patient, who is still a minor (Haddad & Geiger, 2018). Beneficence and non-maleficence are also put into consideration.
Decision Point Three
The selected decision point three is to decrease the dose to Adderall XR 10 mg orally daily. This decision was selected because Adderall XR should be initiated at 10 mg orally daily and increased by 5–10 mg/day at weekly intervals (Taylor, 2018). The maximum dose for this particular medication is recommended at 30 mg/day. Tachycardia is one of the side effects of Adderall and may worsen because it was started at a higher dose (Taylor, 2018). Therefore, reducing the dose to Adderall XR 10 mg orally daily is a good option to resolve the tachycardia symptoms.
Maintaining the dose again was not a good option because of the persistent tachycardia-related symptoms. Maintaining the current dose (Adderall XR 15 mg orally daily) would worsen the drug side effects, hence, putting the patient’s life at risk (Taylor, 2018). Additionally, it was not necessary to discontinue Adderall XR and begin Strattera 10 mg orally daily. There is no indication to move to the second line of defense medication at this point. The statement above explains why the other two options were not selected.
The results will be evaluated in four weeks. The expectation is that the patient’s symptoms associated with ADHD will disappear completely. For example, the patient will have excellent attention in class and interest in school work (Barkley, 2018). The patient will improve in her academic performance. Also, the tachycardia symptoms are expected to resolve. The patient is expected to operate normally in four weeks (Taylor, 2018). Ethical considerations include patient autonomy and informed consent, beneficence, and non-maleficence (Haddad & Geiger, 2018). A proper follow-up plan should be developed to ensure the full recovery of the patient.
Conclusion
Attention-deficit/hyperactivity disorder (ADHD) is a brain disorder that impacts how individuals pay attention, sit still, and control their behavior. The illness is most common among children and teens and may extend to adulthood. Attention deficit hyperactive disorder is often diagnosed during the early school years when the child starts to have problems paying attention. Even though attention deficit disorder can neither be prevented nor cured, early diagnosis may help the child manage the illness before it is out of hand.
The patient in the care study is an 8-year-old Caucasian female named Katie. She was brought to the clinic by her father and mother. The patient was diagnosed with ADHD. Three decisions were made to help improve the patient’s condition. The selected decision point two is to begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING. The selected decision two is to discontinue Ritalin and begin Adderall XR 15 mg orally daily. The selected decision point three is to decrease the dose to Adderall XR 10 mg orally daily. All these points have been discussed in the paper.
References
Barkley, R. A. (2018). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment. The Guilford Press.
Cortese, S. (2020). Pharmacologic treatment of attention deficit–hyperactivity disorder. New England Journal of Medicine, 383(11), 1050-1056. https://doi.org/10.1056/NEJMra1917069
Haddad, L. M., & Geiger, R. A. (2018). Nursing ethical considerations. https://europepmc.org/article/nbk/nbk526054
Taylor, D. (2018). The Maudsley Prescribing Guidelines in Psychiatry. John Wiley & Sons.