Question Answered step-by-step The Assignment: 5 pagesExamine 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 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 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 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 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.=============================================================================================================IntroductionKatie is an 8-year-old female who is a new diagnosis with ADHD. ADHD is a neurodevelopmental disorder described by hyperactivity, impulsivity, and difficulty maintaining attention. ADHD persists over time, is manifested in various social environments, and interferes with the child’s functioning and development. ADHD is an indication of the inability to attention component. It can consist of daydreaming, distractibility, and difficulty focus on a simple task. However, hyperactivity can be expressed as fidgeting, talkative, and restlessness. Katie’s teacher said that Katie is having some difficulty in class. Katie also speaks to her PCP that she has problems with not focusing and having a hard time paying attention to the teacher. Katie’s parents do not feel like she has ADHD because she does not have hyperactive behavior. They are also not having any problems with Katie at home. The parents give you 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 to share with their family primary care provider. The purpose of this paper is to correctly determine a treatment to assist Katie’s behavior during school.Decision #1The PMHNP wants to educate and teach Katie’s parents about ADHD and the importance of starting on medications. Moreover, on proper medication from the three choices are a risk for suicide and blood pressure issues. Wellbutrin XL is an antidepressant. Antidepressants may increase suicidal thoughts or behavior in children, adolescents, and young adults, especially during the first few months of treatment or changing the dose. All patients starting antidepressants should be monitored and observed closely for new or worsening symptoms of feeling depression, suicidal thoughts or behavior, or unusual changes in behavior (Patient Information Sheet,2017). Intuniv XR may cause serious side effects such as low blood pressure, low heart rate, fainting, or sleepiness. It is essential to check Katie’s heart rate and blood pressure before starting Intuniv XR, changing the dose, and regularly during treatment (Guanfacine extended release (Brand: Intuniv, 2012). I decided to start Katie on Ritalin 10mg of chewable in the morning. School-age children are a different story. Stimulants such as Ritalin (methylphenidate), Dexedrine, and Adderall are highly effective for kids in the school-age group. Parents should not feel guilty about employing them along with behavioral and educational interventions. None of these drugs will cure ADHD. However, I hope when they are practical, they can improve attention, reduce restlessness, and foster better relations with peers, parents, and teachers. Treatment hopes to reach a 50% improvement in the patient’s condition, reduce her ADHD behavior. The patient should be scheduled to return to the clinic in four weeks for retesting for a 25 % decrease in her Conner’s Teacher Rating Scale-Revised score. Each of the three stimulant medications has roughly a 75 percent response rate–and kids who do not respond well to one of them will often respond to another. Overall, an estimated 90 percent of school-age children with ADHD respond well to treatment with these drugs (Adesman,2000).Ethical considerationOffers an ethical perspective in the management of attention-deficit behavioral disorder (ADHD), ethical considerations in distinguishing between children’s illness behavior and behavior that communicates emotional states such as anxiety, panic, sadness, grief, frustration, and resentment (Halasz, 2002).Decision #2My selection is changed to Ritalin LA 20 mg orally daily in the morning. Proper medication from the three choices has the least minor side effects, such as tachycardia, and will last the whole school day. The PMHNP decided to switch Katie to Ritalin LA. Ritalin LA is an efficacious, safe, and well-tolerated treatment option. Compared with placebo demonstrated a strong treatment effect on core inattentive and hyperactive symptoms for up to 7.5 hours in children with ADHD in a laboratory classroom. I did not pick Adderall because the Ritalin was working, but it just needed to last longer. Study shows that Ritalin LA should last Katie until the end of the school day (Schulz,2010). The PMHPN’s goal of treatment is to obtain a 60% improvement in the patient’s condition; Ritalin LA 20 mg helps Katie’s mood stabilize and well in school. The patient should be scheduled to return to the clinic in four weeks for retesting for a 50 % decrease in his Conner’s Teacher Rating Scale-Revised. The behavioral profiles in N=69 index Children with attention-deficit/hyperactivity disorder (ADHD) (Conners et al., 2012).Ethical considerationsMethylphenidate treats attention-deficit hyperactivity disorder (ADHD) in adults, children. It treats narcolepsy, a sleep disorder. Methylphenidate must take with Ritalin LA. Side-effects of methylphenidate include heart-related problems and mental problems (Methylphenidate extended-release capsules, 2014). Decision #3The ethical considerations to keep in mind when picking the proper medication is safety. Katie had some issues with tachycardia. As her medical provider, The PMHNP must make sure that her heart rate is stable. Katie’s heart rate is 92 beats per minute and is a normal heartbeat for a child Katie’s age. The safety of stimulants in patients with cardiac disease is a concern for psychiatrists—supraventricular tachycardia relation with the initiation of methylphenidate treatment (Come & Shapiro 2005). However, EKG is not necessary to order currently. Increase Ritalin LA to 30mg daily does not seem to be a good idea right now because Katie’s current dose is working for her. I am choosing Decision Point Three. Decision Point Three maintain an everyday amount of Ritalin LA and re-evaluate in 4 weeks. I did not select Adderall XR should be initiated at 10 mg orally daily and increased by 5 to 10 mg daily at weekly: highest dose generally 30 mg per day. Tachycardia is one of the significant side effects of Adderall, and it could get worse because it started at a higher dose. You should cut down the amount to 10 mg orally daily and re-evaluate at the next office visit. Stay on the same dose will most likely not enough improve the side effect of tachycardia, so keep the current amount of medication would not be practical as Katie may not take medicine if it causes unpleasant side effects. I did not choose to discontinue Adderall XR and begin Strattera 10 mg orally daily. There is no indication to move to a second-line agent due to a side effect that a high starting dose of medication may cause.I hope to maintain medication and the goal of treatment is for the patient to reach an 80% or more improvement. Conner’s Teacher Rating Scale-Revised N = 35 siblings without ADHD, and N = 36 normal controls were compared using standardized parent and teacher rating scales (Conners et al., 2012).Ethical considerationsAmong young people up to 18 years of age, approximately 5% have attention deficit hyperactivity disorder (ADHD), many of whom have symptoms persisting into adulthood. ADHD is related with an increased risk of co-morbid psychiatric disorders, including substance misuse. Many will be prescribed medication, namely methylphenidate, atomoxetine, dexamphetamine, and lisdexamfetamine. If so, it is essential to know if interactions exist and are potentially toxic (Barkla, McArdle & Newbury-Birch, 2015). ConclusionAttention-deficit/hyperactivity disorder is a well-recognized common disorder in children and adolescents. Its clinical presentation features different clinical symptoms. The hallmarks of the disease are attention deficits and hyperactive and impulsive disturbances that lead to impaired functioning in many settings. Treatment with methylphenidate has been applied for more than 50 years and is still considered the gold standard. The longest known treatment consists of immediate-release methylphenidate (MPH). Ritalin LA is a modified-release formulation precisely engineered to deliver a bimodal release of MPH to mimic a twice-a-day (BID). Since Katie started the Ritalin LA 20mg daily, her symptoms are well controlled. Katie has been able to stay focused in a class all day, and she no longer has side effects from Ritalin’s immediate release (Schulz,2010).Reference:Adesman A. (2000). Focus on your health. Patient power. Does my child need Ritalin? Newsweek, 135(17), 81. Barkla, X. M., McArdle, P. A., & Newbury-Birch, D. (2015). Are there any potentially dangerous pharmacological effects of combining ADHD medication with alcohol and drugs of abuse? A systematic review of the literature. BMC Psychiatry, 15, 270. https://doi-org.ezp.waldenulibrary.org/10.1186/s12888-015-0657-9Come, C. E., & Shapiro, P. A. (2005). Supraventricular Tachycardia Associated With Methylphenidate Treatment in a Heart Transplant Recipient. Psychosomatics: Journal of Consultation and Liaison Psychiatry, 46(5), 461-463. https://doi-org.ezp.waldenulibrary.org/10.1176/appi.psy.46.5.461Conners, C. K., Steinhausen, H.-C., Zulli-Weilenmann, N., Brandeis, D., Muller, U. C., Valko, L., & Drechsler, R. (2012). Conners’ Teacher Rating Scale–Revised. [German Version]. European Child & Adolescent Psychiatry, 21, 157-164.Eberhard Schulz, Christian Fleischhaker, Klaus Hennighausen, Philip Heiser, Klaus-Uwe Oehler, Martin Linder, Frank Haessler, Michael Huss, Andreas Warnke, Martin Schmidt, Michael Schulte-Markworth, Christian Sieder, Jan Klatt, & Ferenc Tracik. (2010). A Double-Blind, Randomized, Placebo/Active Controlled Crossover Evaluation of the Efficacy and Safety of Ritalin®LA in Children with Attention-Deficit/Hyperactivity Disorder in a Laboratory Classroom Setting. Journal of Child & Adolescent Psychopharmacology, 20(5), 377-385. https://doi-org.ezp.waldenulibrary.org/10.1089/cap.2009.0106Halasz, G. (2002). An ethical perspective. Australian & New Zealand Journal of Psychiatry, 36(4), 472-475.Guanfacine extended-release (Brand: Intuniv). (2012). Brown University Child & Adolescent Psychopharmacology Update, 14, 1-2. Patient Information Sheet. (2017). Brown University Child & Adolescent Psychopharmacology Update, 19, 1-2. https://doi-org.ezp.waldenulibrary.org/10.1002/cpu.30237Methylphenidate extended-release capsules. (2014). Brown University Child & Adolescent Psychopharmacology Update, 16, 1-2.Please proofread for me. Thank you. Health Science Science Nursing NURS 6630 Share QuestionEmailCopy link Comments (0)

Needs help with similar assignment?

We are available 24x7 to deliver the best services and assignment ready within 3-4 hours? Order a custom-written, plagiarism-free paper

Get Answer Over WhatsApp Order Paper Now