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

• 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

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 there will be three decisions. I will choose one out of the three and give the outcome. At each decision point these are the thoughts to ponder:

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.

Finally: 1. Complete the decision tree (keep track of what you selected. come up with a rational reason why you chose it. Come up with patient specific rational reason behind not choosing the other two options not chosen).

2. Write paper addressing all section listed based on the decision tree.

Case Study: A Caucasian Man with Hip Pain

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.

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

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.

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

Decisions Made and Outcomes (Needed to formulate the paper) (Must use and formulate paper based off of the chosen decision. Then tell why the other two decision were not a good choice with in-text citations noted for each.)

Choices for Decision 1: Select what the PMHNP should do:

1. Begin Wellbutrin (bupropion) XL 150 mg orally daily

2. Begin Intuniv extended release 1 mg orally at BEDTIME

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

4. Decision Choice Chosen: Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING

Explain why other two choice were rejected (not adequate choices)

Outcome: RESULTS OF DECISION POINT ONE:

· Client returns to clinic in four weeks

· Katie's parents report that they spoke with Katie's teacher who notices that her symptoms are much better in the morning, which has resulted in improvement in her overall academic performance. However, by the afternoon, Katie is "staring off into space" and "daydreaming" again

· Katie's parents are very concerned, however, because Katie reported that her "heart felt funny." You obtain a pulse rate and find that

Katie's heart is beating about 130 beats per minute

Choices for Decision 2: Select what the PMHNP should do:

1. Continue same dose of Ritalin and re-evaluate in 4 weeks

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

3. Discontinue Ritalin and begin Adderall XR 15 mg orally daily

4. Decision Choice Chosen: Change to Ritalin LA 20 mg orally daily in the MORNING

Explain why other two choice were rejected (not adequate choices)

Outcome: RESULTS OF DECISION POINT TWO:

· Client returns to clinic in four weeks

· Katie's academic performance is still improved, and the switch to the LA preparation is lasting Katie throughout the school day

· Katie's reports of her heart feeling "funny" have gone away. Pulse was 92 during today's office visit
 
Choices for Decision 3: Decision Point Three Select what the PMHNP should do next:

1. Maintain current dose of Ritalin LA and reevaluate in 4 weeks

2. Increase Ritalin LA to 30 mg orally daily

3. Obtain EKG based on current heart rate

4. Decision Choice Chosen: Maintain current dose of Ritalin LA and reevaluate in 4 weeks

Explain why other two choice were rejected (not adequate choices)