Week 9 discussion
Discussion: Presentations of ADHD
Although ADHD is often associated with children, this disorder is diagnosed in clients across the lifespan. While many individuals are properly diagnosed and treated during childhood, some individuals who have ADHD only present with subsyndromal evidence of the disorder. These individuals are often undiagnosed until they reach adulthood and struggle to cope with competing demands of running a household, caring for children, and maintaining employment. For this Discussion, you consider how you might assess and treat individuals presenting with ADHD.
Required Readings
Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.
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.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.
Chapter 12, “Attention Deficit Hyperactivity Disorder and Its Treatment”
Stahl, S. M., & Mignon, L. (2012). Stahl’s illustrated attention deficit hyperactivity disorder. New York, NY: Cambridge University Press.
To access the following chapter, click on the Illustrated Guides tab and then the ADHD tab.
Chapter 4, “ADHD Treatments”
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.
Review the following medications:
- For ADHD
- armodafinil
- amphetamine (d)
- amphetamine (d,l)
- atomoxetine
Case 1: Volume 1, Case #13: The 8-year-old girl who was naughty
Case 2: Volume 1, Case #14: The scatter-brained mother whose daughter has ADHD, like mother, like daughter
Case 3: Volume 2, Case #21: Hindsight is always 20/20, or attention deficit hyperactivity disorder
Review this week’s Learning Resources and reflect on the insights they provide.
Go to the Stahl Online website and examine the case study you were assigned.
Take the pretest for the case study.
Review the patient intake documentation, psychiatric history, patient file, medication history, etc. As you progress through each section, formulate a list of questions that you might ask the patient if he or she were in your office.
Based on the patient’s case history, consider other people in his or her life that you would need to speak to or get feedback from (i.e., family members, teachers, nursing home aides, etc.).
Consider whether any additional physical exams or diagnostic testing may be necessary for the patient.
Develop a differential diagnoses for the patient. Refer to the DSM-5 in this week’s Learning Resources for guidance.
Review the patient’s past and current medications. Refer to Stahl’s Prescriber’s Guide and consider medications you might select for this patient.
Review the posttest for the case study.
Week 9 assignment
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 Resources
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Required Readings
Note: Review all materials from the Discussion.
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.
Note: Retrieved from Walden Library databases.
Required Media
Laureate Education (2016d). Case study: A young Caucasian girl with ADHD [Interactive media file]. Baltimore, MD: Author
Note: This case study will serve as the foundation for this week’s Assignment.
To prepare for this Assignment:
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.
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.
Walden NURS 6630 Week 9 Sample Paper
(Assessing and Treating Clients With ADHD)
Assessing and Treating Clients with ADHD
Student’s Name:
Institutional Affiliation:
Assessing and Treating Clients with ADHD
ADHD is a condition that makes it difficult for the individual affected to pay attention or control impulsive behavior. Patients suffering from ADHD might appear to be restless and continuously active. ADHD symptoms will begin in childhood among many patients and can continue as the child matures. Adults and children will show different ADHD presentations, while gender will also affect how ADHD progresses (Keilow, Holm, & Fallesen, 2018). In the treatment of ADHD patients, it will be important to consider the pharmacodynamics and pharmacokinetics of different medication therapies. PMHNPs need to perform careful evaluations and assessments to determine the risks and benefits of medication therapies they administer to ADHD patients. This paper reviews and supports the decisions that would be made in the treatment of a young girl with ADHD.
Decision #1
For the first decision, I selected administering Ritalin (methylphenidate) chewable tablets 10 mg to the patient. The patient was to take the medication orally every morning for a month until their next appointment. My decision to administer Ritalin was based on scholarly evidence that supported the effectiveness of the drug in treating ADHD among children while having less adverse side effects. According to Van der Schans, Çiçek, Vardar, et al. (2017). Ritalin will be effective in reducing ADHD among children. It will increase the production of chemicals in the brain that is responsible for increasing concentration, controlling behavior problems, and helping one pay attention.
The other decision of administering Intuniv or Wellbutrin would be less advantageous to the patient because of the adverse effects that the drugs are known to cause on children. According to Patel, Allen, Haque, et al. (2016), Wellbutrin may cause severe mood changes among patients that can drive them to want to hurt themselves. According to Martinez-Raga, Knecht, & de Alvaro (2015), Intuniv may cause severe dizziness and sluggishness in a patient, which may affect their productivity. Therefore, the decision to administer the two drugs would be avoided to avoid the adverse side effects.
By deciding to administer Ritalin to the young ADHD patients, I was hoping to help her improve her concentration in school while nursing the least side effects. What I was hoping to achieve with making the decision was different from the results in that the patient’s concentration in school increased only in the morning sessions. My expectations of side effects were similar to the results in that though the patients had an elevated heartbeat, it was within normal ranges, which was not dangerous for her health.
Decision #2
On the second decision, I choose to increase the dosage of the patient to Ritalin LA 20 mg orally taken daily in the morning. According to Storebø, Pedersen, Ramstad, et al. (2018), increasing the dosage of Ritalin can help a patient with ADHD to remain focused throughout the day if no adverse side effects had been observed previously. By making the decision to change the ADHD patient’s dosage to Ritalin LA 20 mg, I was hoping to improve the patient’s concentration throughout the day. I was also hoping that the patient would stop experiencing an elevated heartbeat. What I expected to achieve by increasing the dosage of Ritalin for the patient was similar to what I achieved in that the patient’s academic performance improved throughout the day while they stopped having an elevated heartbeat. According to Van der Schans et al. (2017), increasing the dosage of Ritalin among patients can help improve their concertation throughout the day. What I expected to achieve in making the decision to increase the dosage of Ritalin to the patient was similar to what I achieved.
Decision #3
For the third decision, I choose to maintain the dosage of Ritalin LA 20 mg to the young girl with ADHD and evaluate the patient’s performance after a month. According to Storebø et al. (2018), it is always advisable to maintain the lowest effective dose of a stimulant, especially among young patients. In making the decision, I was hoping that the concentration of the patient would be present throughout the day and that the patient would experience no side effects. What I expected to achieve in making the decision to maintain a dosage of Ritalin LA 20 mg to the patient was similar to what I achieved in that the patient’s concentration was maintained while they experienced no side effects.
Ethical Considerations
The two ethical considerations that would impact the treatment plans for the eight-year patient with ADHD would be the consideration of beneficence and informed consent (Howe, 2018). All the treatment plans would have to be approved by the patient’s parents as she is a minor, with parents being provided with necessary information relating to benefits and side effects to make the right decision. All the treatment decisions made would also be to benefit the patients.
References
Howe, E. (2018). Ethical considerations when treating patients with schizophrenia. Psychiatry
(Edgmont (Pa. : Township)), 5(4), 59–64.
Keilow, M., Holm, A., & Fallesen, P. (2018). Medical treatment of attention
Deficit/Hyperactivity Disorder (ADHD) and children’s academic performance. PloS one, 13(11), e0207905. https://doi.org/10.1371/journal.pone.0207905.
Martinez-Raga, J., Knecht, C., & de Alvaro, R. (2015). Profile of guanfacine extended release
and its potential in the treatment of attention-deficit hyperactivity disorder. Neuropsychiatric disease and treatment, 11, 1359–1370. https://doi.org/10.2147/NDT.S65735.
Patel, K., Allen, S., Haque, M. N., Angelescu, I., Baumeister, D., & Tracy, D. K. (2016).
Bupropion: a systematic review and meta-analysis of effectiveness as an antidepressant. Therapeutic advances in psychopharmacology, 6(2), 99–144. https://doi.org/10.1177/2045125316629071.
Storebø, O. J., Pedersen, N., Ramstad, E., Kielsholm, M. L., Nielsen, S. S., Krogh, H. B.,
Moreira-Maia, C. R., Magnusson, F. L., Holmskov, M., Gerner, T., Skoog, M., Rosendal, S., Groth, C., Gillies, D., Buch Rasmussen, K., Gauci, D., Zwi, M., Kirubakaran, R., Håkonsen, S. J., Aagaard, L., … Gluud, C. (2018). Methylphenidate for attention deficit hyperactivity disorder (ADHD) in children and adolescents – assessment of adverse events in non-randomised studies. The Cochrane database of systematic reviews, 5(5), CD012069. https://doi.org/10.1002/14651858.CD012069.pub2.
Van der Schans, J., Çiçek, R., Vardar, S. et al. (2017). Methylphenidate use and school
performance among primary school children: a descriptive study. BMC Psychiatry 17, 116 https://doi.org/10.1186/s12888-017-1279-1.
PLACE THIS ORDER OR A SIMILAR ORDER WITH NURSING PAPERS MARKET TODAY AND GET AN AMAZING DISCOUNT
