Posted: September 8th, 2022

Assessing and Treating Clients with ADHD Essay

Assignment: Walden University
NURS 6630N

Assessing and Treating Clients with ADHD Essay Example.

Attention Deficit Hyperactivity Disorder (ADHD) is a condition that affects over 6.1 million children in the United States. The prevalence of ADHD has been increasing over the years, making it a significant public health concern. The condition affects the social and academic life of a child. Children with ADHD often experience difficulties in paying attention, following instructions, and completing tasks. Symptoms of ADHD can be mild, moderate, and severe in both adults and children. The severity of the symptoms can vary depending on the individual and the situation. One of the common symptoms of the condition is inattention. Inattention can manifest in different ways, such as difficulty sustaining focus, following instructions, or completing tasks. Children such as Katie experience challenges in their school work due to ADHD. Katie’s teacher has reported that she has difficulty paying attention in class and often gets lost in thought. Although the symptoms are not severe, it is essential to assess and treat a patient to avoid deterioration. Untreated ADHD can lead to significant impairment in social, academic, and occupational functioning. The best medication among the three options is Ritalin (methylphenidate). Ritalin is a stimulant medication that has been widely used to treat ADHD in children and adults. One of the reasons for selecting the drug is that it has fewer side effects and it has sufficient evidence from previous studies (Madsen et al., 2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers). The efficacy of Ritalin in treating ADHD has been consistently demonstrated in numerous studies.

Decision #1

The first decision is to prescribe Ritalin (methylphenidate) chewable tablets 10mg orally in the morning. This dosage is intended to manage symptoms effectively throughout the day.

Rationale

Ritalin is a preferred medication for the treatment of ADHD among children due to sufficient evidence that it is safe. Its safety profile makes it a reliable choice for pediatric patients. Compared to the other available options, Ritalin has fewer side effects and it is more effective. This effectiveness is supported by numerous clinical studies. PMHNP have also used the drug successfully as first-line medication (Solleveld et al., 2017). Their experiences further validate its use in clinical practice. Therefore, it is one of the best options while beginning the treatment. Starting with a proven medication can enhance treatment success. ADHD, which causes learning abilities need medication such as Ritalin. Effective medication can significantly improve learning outcomes. One of the benefits of taking Ritalin is helping students to focus on their studies (Solleveld et al., 2017). Improved focus can lead to better academic performance. According to previous studies, it generates 70-90 percent positive results in 80 percent of all patients. These statistics underscore its high efficacy rate.

Ritalin improves concentration, attention, and listening skills. These improvements can enhance a child’s ability to engage in classroom activities. It increases the level of dopamine in the brain thus boosting attention and focus. Dopamine plays a crucial role in regulating attention and behavior. Dopamine is a neurotransmitter that affects concentration (Yoo et al., 2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers). Its modulation is key to managing ADHD symptoms. Ritalin helps improve the amount of dopamine and norepinephrine activity in the brain. This dual action contributes to its therapeutic effects. It also hinders the reabsorption of the neurotransmitters in the brain (Stahl, 2013). This mechanism prolongs their action, enhancing symptom control. One of the symptoms that Katie is suffering from is a lack of concentration on her classwork. This symptom can be particularly disruptive to her learning process. Katie acknowledges that she is sometimes lost in thoughts until the teacher calls her name. Such episodes can lead to missed learning opportunities. Therefore, the medication is effective for her condition. It addresses the core symptoms that interfere with her academic performance.

PMHNP prefers to prescribe Ritalin 10mg to children since it does not trigger negative side effects. This consideration is important for maintaining patient safety. Starting with a low dose is also important to ensure that sufficient time is available to monitor a child (Yoo et al., 2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers). Gradual dose adjustments can help optimize treatment outcomes. The organs such as the liver which are involved in processing drugs in children are still developing. This developmental stage necessitates careful dosing to avoid toxicity. Therefore, psychiatrists are careful to prescribe a low dose while beginning treatment. This approach minimizes the risk of adverse effects. PMHNP can be held liable for prescribing a high dose that can cause adverse effects. Legal accountability underscores the importance of cautious prescribing. For example, a high dose of Ritalin can cause tachycardia which can lead to death. Such severe side effects highlight the need for careful monitoring. In other cases, it can lead to drowsiness, blurred vision, and dizziness (Yoo et al., 2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers). These side effects can interfere with daily functioning. Clinicians should take precautions and assess patients to prevent negative effects. Regular follow-ups can help detect and manage any adverse reactions.

The other two drugs, Wellbutrin 150mg orally daily and Intuniv extended release 1mg orally at bedtime were not preferred drugs due to various reasons. These reasons include their side effect profiles and lack of efficacy data. Case studies indicate that Wellbutrin is not a first-line medication for treating ADHD especially among children (Lionarons et al., 2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers). Its use is more common in treating depression. Additionally, Wellbutrin is an antidepressant that cannot achieve the specific goals of treating ADHD. Its mechanism of action does not align with the needs of ADHD treatment. Treatment of ADHD requires stimulants that are responsible for increasing dopamine in the brain. Stimulants are the mainstay of ADHD pharmacotherapy. For example, Ritalin is a stimulant that helps increase dopamine levels in the brain (Stahl, 2013). This increase is crucial for improving attention and focus. ADHD patients require high levels of dopamine to boost their attention and focus. Adequate dopamine levels can significantly enhance cognitive function. For example, the patient in the case study has attention problems. Addressing these problems is essential for academic success. The teacher confesses that she is experiencing difficulties concentrating in class. This difficulty can lead to poor academic performance. Lionarons et al. (2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers) state that dopamine also helps improve focus which can help the patient to start and complete tasks such as homework. Completing tasks is an important aspect of academic achievement. One of the complaints of the teacher is that Katie does not complete her homework. This issue can be addressed by improving her focus and attention. Intuniv is also not a preferred medication since there is insufficient data to justify its safety in children (Storebo et al., 2018: 2024 – Write My Essay For Me | Essay Writing Service For Your Papers Online). Safety data is crucial for making informed treatment decisions. It is also a non-stimulant and thus it cannot generate the necessary results. Non-stimulants are typically used when stimulants are ineffective or contraindicated. Therefore, the two drugs are not effective and preferable in the treatment of ADHD in children. Their limitations make them less suitable for first-line therapy.

Expected Outcomes

The expected outcomes are related to the current symptoms of the patient. These outcomes will guide the evaluation of treatment efficacy. It is expected that her concentration in classwork will improve gradually. Gradual improvement is a realistic expectation for ADHD treatment. For example, she should no longer get lost in thought since according to Storebo et al. (2018: 2024 – Write My Essay For Me | Essay Writing Service For Your Papers Online) Ritalin improves the concentration span. Improved concentration can enhance her academic performance. She should also not get wandering thoughts that take her away from the class activities. Reducing these thoughts can help her stay engaged in learning. Her focus should also improve gradually to ensure when she starts something she will surely finish it. Completing tasks is an important skill for academic success. Her ability to follow instructions should also improve consistently as she continues to take the medication. Following instructions is crucial for classroom learning. According to Storebo et al. (2018: 2024 – Write My Essay For Me | Essay Writing Service For Your Papers Online), Ritalin is an effective drug that improves the concentration and focuses on ADHD patients. Its effectiveness is well-documented in the literature. Her attention span should also increase significantly. An increased attention span can lead to better academic outcomes. Other improvements that she should make include remembering things she has learned, boost her spelling and reading capabilities. These cognitive improvements can enhance her overall academic performance. It is also important that after four weeks of taking the medication, the patient should stop staring. Reducing staring episodes can help her stay focused on tasks. Overall, Katie should experience an improvement in her academic performance. This improvement can boost her confidence and motivation.

The drug may also trigger some negative outcomes such as increased heart rate. Monitoring for these outcomes is important for patient safety. Other effects include dizziness and drowsiness. These side effects can interfere with daily activities. Therefore, when the client resumes to the clinic, it is important to carry out an assessment. Regular assessments can help detect and manage any adverse effects. Katie’s parents should also be informed about the side effects of the drug. Parental education is crucial for informed consent. Educating the parents is also a way of ensuring they consent to the medication. Informed consent is a key ethical consideration in pediatric care. Ethical considerations indicate that PMHNP should inform parents of children below 18 years about the medication they are prescribing (Storebo et al., 2018: 2024 – Write My Essay For Me | Essay Writing Service For Your Papers Online). Transparency in communication is essential for building trust.

Projected Outcomes vs. Results

The child should report back to the clinic after 4 weeks. This follow-up is important for assessing treatment progress. When the 9-year-old girl comes back, there is a need to carry out several assessments such as heart rate. These assessments can help identify any adverse effects. It is also critical to ask some questions about the progress and compliance with the medication. Patient feedback is important for evaluating treatment efficacy.

The assessment shows that the patient has made considerable progress. This progress indicates that the treatment is effective. According to a teacher’s report submitted during the clinic, the student has improved in various areas. Teacher reports provide valuable insights into the patient’s daily functioning. They include concentration in class since she is no longer experiencing wandering thoughts. Improved concentration can enhance her learning experience. Katie has also improved in terms of completing homework and other tasks in school. Completing tasks is an important aspect of academic success. Her reading and spelling capabilities have also improved significantly. These improvements can boost her academic performance. Her memory about what she learned before is also better compared to four weeks ago. Improved memory can enhance her ability to retain and apply new information.

The teacher’s report also indicates that symptoms worsen as the day progresses. This pattern suggests that the medication’s effects may be wearing off. Also, the patient has a high heart rate is 130 whereas at her age it should be between 70 and 110. This elevated heart rate is a concerning side effect. Tachycardia is an indication of a drug overdose. This side effect necessitates a dose adjustment. Therefore, it is important to change the dose in the second decision to avert such negative effects. Adjusting the dose can help manage the side effects while maintaining efficacy.

Decision #2

The second decision is to prescribe Ritalin chewable tablets 5mg QID. This adjustment aims to maintain symptom control while reducing side effects.

Rationale

The current medication, Ritalin is generating the expected outcomes. Its effectiveness justifies its continued use. Therefore, it is not prudent to change the drug. Maintaining the same medication can prevent unnecessary disruptions in treatment. Stahl (2013) also recommends that PMHNP should be careful in abruptly changing medications since they can trigger negative effects. Abrupt changes can lead to withdrawal symptoms or loss of efficacy. Medication for ADHD may also take time before they trigger the full recovery of a patient. Patience is important in managing expectations. The heart rate is also one of the expected outcomes and thus it cannot be the basis for changing the drug (Barragán et al., 2017). Monitoring and managing side effects is part of the treatment process. For example, Adderall is one of the best medications that PMHNP can use when Ritalin does not work. It is an alternative option if Ritalin proves ineffective. However, it is not a preferred option since the current drug is already helping the patient to improve various symptoms (Barragán et al., 2017). Continuing with Ritalin can maintain the positive progress observed. It is also expected that the patient will record better progress in the next four weeks. Continued improvement is a realistic expectation with ongoing treatment.

The heart rate or tachycardia is risky especially in children since it can cause death. This risk necessitates careful monitoring and dose adjustments. It is thus important to adjust the dose but maintain the medication. Adjusting the dose can help manage side effects while maintaining efficacy. For example, changing the drug from 10mg to 5mg is one of the best options (Martin et al., 2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers). This lower dose can reduce the risk of tachycardia. The patient should take the medication several times a day to suppress the negative outcomes, at most four times (Martin et al., 2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers). Dividing the dose can help maintain stable drug levels throughout the day. According to the previous report from the teacher, the symptoms worsen as the day progresses. This pattern suggests that more frequent dosing may be beneficial. Therefore, it will be crucial to take the medication more times in a day to avoid any progression of the symptoms. More frequent dosing can help maintain symptom control throughout the day.

Taking the medication four times a day will ensure that Katie can concentrate in school throughout the day. This dosing schedule can help maintain consistent symptom control. It will also help her to increase her memory, concentration span, and avoid wandering thoughts (Martin et al., 2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers). These improvements can enhance her academic performance. Taking 5mg four times a day will also help to complete tasks such as homework and stop staring while in class. This dosing strategy aims to optimize her daily functioning and academic success.

Expected Outcomes
Katie should return to the clinic for an assessment of her condition. One of the expected outcomes, when she comes back, is that her heart rate will be within the normal range. A high heart rate is dangerous for a child since it can cause death (Lionarons et al., 2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers). When the heart rate is within the normal range it will be important since the patient will be out of danger. PMHNP who cause the death of a child for prescribing the wrong medication or an overdose are liable for their actions (Stahl, 2013). Another major expectation is that the patient will improve in academic performance. The performance is measured in terms of completing assignments, improving concentration span, spelling, learning abilities, and memory. For example, the teacher’s report should indicate that Katie is no longer staring in class. Previously, the symptoms were deteriorating as the day progresses. However, in the next four weeks of taking Ritalin 4mg QID, the patient should remain stable throughout the day.
Projected Outcomes vs. Results
When the patient reports back to the clinic, it is clear from her appearance and presentation that she has made significant progress. According to the teacher’s report, the student has made significant progress in class. For example, she is no longer experiencing wandering thoughts. Katie also concurs with the teacher’s report that she is always focusing and concentrating in class. She states that “I no longer experience wandering thoughts like I did before I started treatment.” The testimony is an indication that the medication is working. However, according to the report, the student is yet to improve the completion of homework tasks, especially during weekends. It is expected that the student will continue making significant progress.
The parents and the teacher also indicate that the patient has been taking the medication consistently. Non-compliance with medications for mental disorders is risky, especially for children since it can cause a relapse. A relapse can trigger negative effects and lengthen the recovery period. Katie’s teacher is also optimistic that if she continues to take the medication for another four weeks, she will record a significant improvement or full recovery.
An assessment report shows the heart rate is 92, which is within the normal range. The expectation was to reduce it below 100, which has been achieved. Therefore, Katie can continue taking the medication without any fear that her life is at risk.
The symptoms also did not deteriorate as the day went by thus enabling Katie to focus on her studies. It is also important to mention that the patient did not experience any weight changes. Other side effects such as drowsiness and dizziness were only minor and did not affect her studies.
Decision #3
The third decision is to prescribe Ritalin chewable tablets 5mg orally QID.
Rationale
It is important to continue with the medication since it is generating the expected outcomes. The drug was essential in helping Katie to improve her concentration in class, stop staring, complete tasks in class, boost her learning, spelling, and memory (Madsen et al., 2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers). It is evident from the teacher’s report that the patient is making considerable improvement (Madsen et al., 2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers). The dosage should also remain at 5mg to keep her out of danger. The assessment shows the heart rate is within the normal range. Therefore, an EKG or other diagnostic tests are not essential at this stage.
Adding another drug to the treatment plan is not prudent since polypharmacy is not encouraged in the treatment of mental disorders (Stahl, 2013). A combination of drugs can cause negative drug interaction thus undermining the recovery. It can also cause other side effects such as weight gain, vomiting, nausea, and dizziness which can interfere with her academics (Solleveld et al., 2017).
Expected Outcomes
The expected outcomes include improvements in academic performance. For example, she should continue recording gradual progress in completing academic tasks such as homework. She also not stare, but improve the concentration span. The patient should also record a better memory in the various lessons she learned before since Ritalin improves memory (Solleveld et al., 2017). She also has a better memory, learning ability, and spelling.
Katie should also continue taking the medication for another four weeks. It is expected that despite the improvements, she will not stop taking the medication. At this point, PMHNP should educate parents on the need to continue taking the medication despite the significant progress. Non-compliance can lead to negative outcomes such as relapse (Solleveld et al., 2017). Education materials should also be provided to caution them to avoid providing any other medication unless the current one is not functioning (Yoo et al., 2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers). The prescription should also be through a registered PMHNP.
Ethical Considerations
Treatment of patients with ADHD requires various ethical considerations. One of the critical ones is to gain the consent of the parents. The child is below 18 years and thus the consent of treatment is through the parents (Stahl, 2013). Ethical code of conduct indicates that patients should not be treated against their will. However, to ensure coercion does not take place, the parents should give informed consent. After assessing the condition of the patient, it is important to brief the parents on the diagnosis, possible treatment options, and their impact and side effects (Yoo et al., 2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers). Education materials can also be provided to the parents to ensure they learn more about the condition.
PMHNP should utilize their knowledge to prescribe the best medication. They should minimize the harm that medication can have on patients. For example, some medications such as Wellbutrin can trigger negative effects (Storebo et al., 2018: 2024 – Write My Essay For Me | Essay Writing Service For Your Papers Online). Healthcare workers should also ensure they assess patients and make critical decisions that will aid in improving the health and safety of a patient. For example, when Katie had a tachycardia, it was important to reduce the dose to keep her out of danger.
Healthcare providers should ensure patient data confidentiality. Confidentiality is important to enhance patient trust. HIPPA laws also indicate that clinicians are liable for any action to expose patient data to other people without the consent of a patient (Storebo et al., 2018: 2024 – Write My Essay For Me | Essay Writing Service For Your Papers Online). Ethical considerations are important in ensuring the treatment plan is professional, safe, and effective.
Conclusion
Treatment of ADHD in children is a process that practitioners should take with caution. The first stage of prescribing medication will involve a low dose and a safe medication. Ritalin is one of the best medications that PMHNP utilizes daily to treat ADHD conditions in patients. The medication is preferred since it has minimal side effects. For example, in the case of Katie, an 8-year-old girl, the medication only triggered tachycardia which was later controlled. Healthcare workers should also ensure they provide the necessary support such as educational materials to parents. They should also observe ethical issues that will be effective in providing safe treatment. PMHNP should strive to provide quality care to patients, minimize side effects, change the dosage when necessary, and observe ethical considerations.

References
Barragán, E., Breuer, D., & Döpfner, M. (2017). Efficacy and safety of omega-3/6 fatty acids, methylphenidate, and combined treatment in children with ADHD. Journal of Attention Disorders, 21(5), 433-441. https://doi.org/10.1177/1087054713518239
Cooper, S. (2024). (357) The Importance of Assessing Adult ADHD/ADD Diagnoses in Patients Presenting with Concomitant Sexual Disorders and Sexuality Related Challenges to Both Sex Therapists and Medical Providers. The Journal of Sexual Medicine, 21(Supplement_1), qdae001-342.
Lionarons, J. M., Hellebrekers, D. M., Klinkenberg, S., Faber, C. G., Vles, J. S., & Hendriksen, J. G. (2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers). Methylphenidate use in males with Duchenne muscular dystrophy and a comorbid attention-deficit hyperactivity disorder. European Journal of Paediatric Neurology, 23(1), 152-157. https://doi.org/10.1016/j.ejpn.2018: 2024 – Write My Essay For Me | Essay Writing Service For Your Papers Online.09.005
Madsen, M. B., Kaalund-Brok, K., Jeppesen, P., Pagsberg, A. K., Houmann, T., Plessen, K., … & Rasmussen, H. (2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers). Pharmacogenomics of Methylphenidate Treatment of Danish Children With ADHD. European Neuropsychopharmacology, 29, S868. https://doi.org/10.1016/j.euroneuro.2017.08.157
Martin, J., Brikell, I., Ghirardi, L., Taylor, M., Riglin, L., Eyre, O., … & Lichtenstein, P. (2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers). The Manifestation of Genetic Risk For Attention Deficit Hyperactivity Disorder In Females And Males In The General Population. European Neuropsychopharmacology, 29, S723-S724. https://doi.org/10.1016/j.euroneuro.2017.06.040
Pagán, A. F., & Flint, D. D. (2024). Adult Attention Deficit/Hyperactivity Disorder: Clinically Focused Recommendations. Journal of Health Service Psychology, 50(1), 27-35.
Schneider, B. C., Schöttle, D., Hottenrott, B., Gallinat, J., & Moritz, S. (2023). Assessment of adult ADHD in clinical practice: Four letters—40 opinions. Journal of attention disorders, 27(9), 1051-1061.
Solleveld, M. M., Schrantee, A., Puts, N. A., Reneman, L., & Lucassen, P. J. (2017). Age-dependent, lasting effects of methylphenidate on the GABAergic system of ADHD patients. NeuroImage: Clinical, 15, 812-818. https://doi.org/10.1016/j.nicl.2017.06.003
Stahl, S. M., & Stahl, S. M. (2013). Stahl’s essential psychopharmacology: neuroscientific basis and practical applications. Cambridge university press.
Storebo, O. J., Pedersen, N., Ramstad, E., Kielsholm, M. L., Nielsen, S. S., Krogh, H. B., … & Skoog, M. (2018: 2024 – Write My Essay For Me | Essay Writing Service For Your Papers Online). Methylphenidate for attention deficit hyperactivity disorder (ADHD) in children and adolescents–assessment of adverse events in non-randomized studies. Cochrane Database of Systematic Reviews, (5). https://doi.org/10.1002/14651858.CD012069.pub2
Yoo, J. H., Sharma, V., Kim, J. W., McMakin, D. L., Hong, S. B., Zalesky, A., … & Ryan, N. D. (2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers). Prediction of sleep side effects following methylphenidate treatment in ADHD youth. NeuroImage: Clinical, 102030. https://doi.org/10.1016/j.nicl.2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers.102030

Order | Check Discount