Assessing And Treating Patients With ADHD Essay

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) Assessing And Treating Patients With ADHD Essay
• 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). Assessing And Treating Patients With ADHD Essay
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

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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). Assessing And Treating Patients With ADHD Essay
• 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). Assessing And Treating Patients With ADHD Essay
• 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 : The other option that they ask why you did not use are : Wellbutrin , Intuniv and methylphenidate ( please explain why we do not use them.) Assessing And Treating Patients With ADHD Essay

Case study

BACKGROUND

Katie is an 8-year-old Caucasian female who is brought to your office today by her mother & father. They report that they were referred to you by their primary care provider after seeking her advice because Katie’s teacher suggested that she may have ADHD. Katie’s parents reported that their PCP felt that she should be evaluated by psychiatry to determine whether or not she has this condition.

The parents give the PMHNP a copy of a form titled “Conner’s Teacher Rating Scale-Revised”. This scale was filled out by Katie’s teacher and sent home to the parents so that they could share it with their family primary care provider. According to the scoring provided by her teacher, Katie is inattentive, easily distracted, forgets things she already learned, is poor in spelling, reading, and arithmetic. Her attention span is short, and she is noted to only pay attention to things she is interested in. The teacher opined that she lacks interest in school work and is easily distracted. Katie is also noted to start things but never finish them, and seldom follows through on instructions and fails to finish her school work. Assessing And Treating Patients With ADHD Essay

Katie’s parents actively deny that Katie has ADHD. “She would be running around like a wild person if she had ADHD” reports her mother. “She is never defiant or has temper outburst” adds her father.
SUBJECTIVE Assessing And Treating Patients With ADHD Essay

Katie reports that she doesn’t know what the “big deal” is. She states that school is “OK”- her favorite subjects are “art” and “recess.” She states that she finds her other subjects boring, and sometimes hard because she feels “lost”. She admits that her mind does wander during class to things that she thinks of as more fun. “Sometimes” Katie reports “I will just be thinking about nothing, and the teacher will call my name and I don’t know what they were talking about.”

Katie reports that her home life is just fine. She reports that she loves her parents and that they are very good and kind to her. Denies any abuse, denies bullying at school. Offers no other concerns at this time. Assessing And Treating Patients With ADHD Essay

MENTAL STATUS EXAM

The client is an 8 year old Caucasian female who appears appropriately developed for her age. Her speech is clear, coherent, and logical. She is appropriately oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Self-reported mood is euthymic. Affect is bright. Katie denies visual or auditory hallucinations, no delusional or paranoid thought processes readily appreciated. Attention and concentration are grossly intact based on Katie’s attending to the clinical interview and her ability to count backwards from 100 by serial 2’s and 5’s. Insight and judgment appear age appropriate. Katie denies any suicidal or homicidal ideation.

Diagnosis: Attention deficit hyperactivity disorder, predominantly inattentive presentation. Assessing And Treating Patients With ADHD Essay

Decision Point One

Begin Wellbutrin (bupropion) XL 150 mg orally daily
RESULTS OF DECISION POINT ONE
• Client returns to clinic in four weeks
• Katie’s parents inform you that they stopped giving Katie the medication because about 2 weeks into the prescription, Katie told her parents that she was thinking about hurting herself. This scared the parents, but they didn’t want to “bother you” by calling the office, so they felt that it would be best to just stop the medication as they would be seeing you in two weeks
Decision Point Two Assessing And Treating Patients With ADHD Essay

Discontinue Wellbutrin and begin Adderall (amphetamine d, l) extended release 5 mg orally daily.
RESULTS OF DECISION POINT TWO

• Client returns to clinic in four weeks.
• Katie’s parents report that they spoke with Katie’s teacher who notices that her symptoms are getting a bit better.
• They are very concerned, however, about Katie’s decreased appetite. They say that Katie was never a “big eater” but have become concerned that her appetite has worsened. Assessing And Treating Patients With ADHD Essay

Decision Point Three

Maintain current dose of Adderall and re-evaluate side effects at next office visit in 4 weeks

Guidance to Student
Wellbutrin is used off-label for ADHD but is used more commonly in adults. Its mechanism of action results in increasing the neurotransmitters norepinephrine/noradrenaline and dopamine. Since dopamine is inactivated by norepinephrine reuptake in frontal cortex (which largely lacks dopamine transporters), Wellbutrin can increase dopamine neurotransmission in this part of the brain, which may explain its effectiveness in ADHD. However, Wellbutrin, as well as other antidepressants, has been linked to suicidal ideation in children and adolescents. Despite the fact that it is being used to treat ADHD, it is still an antidepressant. Assessing And Treating Patients With ADHD Essay

After discontinuing the Wellbutrin and beginning Adderall, a decrease in symptoms was noted by Katie’s teacher. This indicates that the drug is working. However, the parents are concerned about Katie’s decreased appetite. This side effect may improve with the passage of time, but the PMHNP will need to monitor it.
Increasing the dose of Adderall may worsen this side effect; however, if symptoms are still severe enough, an increase in dose may be warranted. At this point, the PMHNP needs to know what symptoms have improved and—based on overall functioning—must then determine whether or not there is an indication to increase the current dose of the medication.
The development of common side effects are not an indication to discontinue one drug and begin a different medication unless they are severe enough to warrant intervention (i.e., they are severe or incapacity for the individual); therefore, it would not be appropriate to discontinue Strattera and begin Intuniv. Assessing And Treating Patients With ADHD Essay