NURS 6630 Week 9 Assessing and Treating Clients With Attention Deficit Hyperactivity Disorder – Young Girl With ADHD
BACKGROUND
NURS 6630 Week 9 Assessing. 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 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 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.NURS 6630 Week 9 Assessing
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.NURS 6630 Week 9 Assessing
Diagnosis: Attention deficit hyperactivity disorder, predominantly inattentive presentation
RESOURCES
§ 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.
Decision Point One
Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING
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
Decision Point Two
Change to Ritalin LA 20 mg orally daily in the MORNING
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
Decision Point Three
Maintain current dose of Ritalin LA and reevaluate in 4 weeks
Guidance to Student
At this point, Katie’s symptoms are well controlled (her attention is sustained throughout the school day) and her side effects have gone away following change to a long-acting preparation. There is no indication at this point that the dose should be increased as it is always advisable to use the lowest effective dose of stimulant medication. Katie’s heart rate is appropriate for an 8 year old girl and an EKG would not be indicated based on her heart rate.
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. Assessing and Treating Clients With Attention Deficit Hyperactivity Disorder – Young Girl With ADHD.
At each decision point stop to complete the following:
• Decision #1
o Which decision did you select?
o Why did you select this decision? Support your response with evidence and references to the Learning Resources.
o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
o Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
• Decision #2
o Why did you select this decision? Support your response with evidence and references to the Learning Resources.
o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. Assessing and Treating Clients With Attention Deficit Hyperactivity Disorder – Young Girl With ADHD.
o Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
• Decision #3
o Why did you select this decision? Support your response with evidence and references to the Learning Resources.
o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
o 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.
Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.NURS 6630 Week 9 Assessing
NURS 6630 Week 9 Assessing Answer
Decision Tree for ADHD: A Holistic Approach
Attention Deficit Hyperactivity Disorder (ADHD) is a significant mental health condition characterized by hyperactivity, impulsivity, and inattention. These symptoms are most commonly observed during adolescence and can significantly impact an individual’s social life, academic performance, and day-to-day functioning. While there is no scientifically proven cure for ADHD, pharmacological interventions involving stimulant medications are commonly used to manage the symptoms (Schweren et al., 2019). These stimulant medications work by blocking the reuptake of dopamine and increasing the levels of norepinephrine in the synaptic cleft of the brain. It is important to note that different patients may respond differently to various stimulant drugs, making it crucial to individualize treatment decisions based on patient-specific factors.NURS 6630 Week 9 Assessing
In this particular case, we have an 8-year-old Caucasian female patient named Katie, who was brought to the primary care provider (PCP) by her parents after her teacher suggested she might have ADHD. Following the PCP’s recommendation, a psychiatric evaluation was conducted to confirm the diagnosis. Based on the Conner’s Teacher Rating Scale-Revised completed by Katie with the assistance of her teacher, it was evident that she exhibited symptoms such as being easily distracted, inattentive, poor performance in reading, spelling, and arithmetic, forgetfulness, loss of interest, and difficulty completing tasks. Katie herself acknowledged feeling lost, although her home life was reported as stable with no signs of abuse.NURS 6630 Week 9 Assessing
Regarding the mental status findings, Katie displayed appropriate developmental milestones for her age of 8 years. She was oriented in terms of person, place, time, and event, and her appearance was suitable for the weather. Her self-reported mood was euthymic, she exhibited a bright affect, intact attention, and denied paranoid or delusional thoughts, as well as auditory or visual hallucinations. Her judgment and insight were also age-appropriate, and she denied any suicidal or homicidal ideation.NURS 6630 Week 9 Assessing
Decision 1
The initial decision is to initiate treatment with Ritalin (Methylphenidate) chewable tablets at a dose of 10 mg in the morning.
Rationale
Considering the current symptoms reported, Ritalin is the most appropriate choice among the available options. ADHD is characterized by symptoms of hyperactivity, impulsivity, and inattention, and in Katie’s case, her challenges with inattention are evident. Therefore, the treatment with Ritalin aims to enhance her concentration. Ritalin, a central nervous system stimulant, acts by blocking the reuptake of neurotransmitters dopamine and norepinephrine, leading to increased levels of concentration (Karahmadi, Saadatmand, & Tarahi, 2020). While there may be a lack of comprehensive randomized trials to definitively establish the efficacy of Ritalin, many patients have reported improved concentration, focus, and the ability to complete tasks more efficiently. The use of Ritalin has also been associated with enhancements in academic performance, organizational skills, and the development of stronger attention span and focus in ADHD patients. It is essential to closely monitor Katie’s response to Ritalin and adjust the treatment plan as needed to ensure the best possible outcome and minimal side effects.NURS 6630 Week 9 Assessing
References: (Add references for Schweren et al., 2019; Karahmadi, Saadatmand, & Tarahi, 2020, and any other relevant sources as needed)
