Case study #i A Young Girl with Difficult in School.
Decision #1: Attention Deficit Hyperactivity Disorder, mainly inattentive presentation
Katie is an 8-year-old Caucasian female with the following presenting symptoms which are inattentive; easily distracted; short attention span; organization issues; poor coordination; difficulty with spelling, reading and math (Laureate Education, 2017b). Basic on the DSM IV there are three subtypes of ADHD which are inattentive and hyperactive and impulsive type with the predominant symptom pattern for the last 6 months. Patient suffering from ADHD are easily distracted, overactive, inability to sit still, excessively talking, overemotional, calling out answers before the questions had been completed and inattentive (Sridhar, 2017).
It is crucial for a complete assessment to be done to come up with a diagnosis. In the case of ADHD, the nurse practitioner would have to get information from the parent, guardians or teacher about the child conduct. The information collected is then evaluated with children of the same milestones to see if there any issues. If there are symptoms of ADHD which lasted for more than six months.
The Conners’ Rating Scale-Revised (CRS-R) is part of a complete examination tool that is used to evaluates children with behavioral issues and ADHD. This tool assists in determining whether children between the ages of three and 17 years might have ADHD. It consists of a checklist of behavioral questions which are used by parents and teachers.
Expected Result with this Decision
My goal is to provide the best care to the patient with proper evaluation and diagnosis. Providing the right treatment directly results in good health, offers the best care, and strength. My goal is to explain to her parent that their child had ADHD because of her presenting symptoms of inattentive, distraction, difficulty remembering things, difficulty with her academic, difficulty socializing with peers, short attention span, Poor coordination, lack organization skills and trouble following directions (Miller, 2018).
Difference between Expected Result and the Achieved Result with decision # 1
The patient returned to the clinic about a month, the expected result and the achieved result are the same. The symptoms presented by the child is indicative of ADHD, predominantly inattentive presentation (Laureate Education, 2017b).
Decision #2:
Treatment Plan for Psychotherapy
Begin Adderall XR 10mg orally daily
Reason for the Selection
Adderall XR 10mg orally daily is the drug of choice. The FDA approves Adderall XR for the treatment of ADHD. It works by enhancing dopamine and norepinephrine in the brain to reduce the signals from the outside stimuli affecting attention, concentration, wakefulness and executive function (Stahl 2013). Adderall causes cognitive and emotional effects like increased wakefulness, euphoria, improved cognitive control (Heal, et al., 2013). The treatment plan for psychotherapy will be Cognitive Behavior therapy (CBT) if needed by the patient. CBT is effective at increasing the behaviors and skills needed for self-management and improve sensitive and interpersonal self-regulation CHADD, 2018).
Expected Result with this Decision
Kate returned to the clinic in about a month, the parent stated that Kate is paying more attention in school only in the morning but day dreams in the afternoon with a decline in appetite since she started taking the medication. Kate is exhibiting the side effect of Adderall by having the poor appetite. This expected result is indicative of the side effect of Adderall. Adderall has the following side effect of decreased appetite, insomnia, delayed growth, weight loss, increased blood pressure, mood swings, dry mouth, anxiety and headaches (Stahl, 2014).
Difference between Expected Result and the Achieved Result with Decision #2
The patient reported to the clinic in about a month with the sign of improvement as expected but with an expected side effect of poor appetite from using the medication. The following are expected side effect decreased appetite, insomnia, delayed growth, weight loss, increased blood pressure, mood swings, dry mouth, anxiety and headaches. Adderall may increase the risk for mental health problems such as bipolar disorder, depression, seizure, hostile behavior or aggressiveness which must be reported immediately to the nurse practitioner (Stahl, 2014).
Decision #3: Treatment Plan for Psychopharmacology
Add a small dose of immediate release Adderall in the early afternoon.
Expected Result with this Decision
Katie showed improvement from her earlier dose of Adderall XR 10mg orally daily but daydreams in the afternoon. Extended-release d,l-amphetamine has up to 8-hour duration of clinical action For children ages 6–12, half-life for d-amphetamine is 9 hours and for l-amphetamine is 11 hours (Stahl, 2014)A small dose of immediate release of Adderall in the early afternoon will help in improving her attention and help retain her attention throughout the evening so she can focus on her homework.
Difference between Expected Result and the Achieved Result with Decision #3
The medication was effective patient performing well in school and home. There was no difference between expected resulted and achieved result noted. The patient is now during well in school.
Ethical Considerations That Might Impact the Treatment Plan
The ethical considerations are that there is no cure for ADHD, but medication and therapy can help decrease the symptoms It is crucial the following should be considered before treatment that the practitioner must do no harm and consider what is in the patient best interest. It is essential to make sure they do not have a family history of Hypertension or cardiac disease. Patient periodic monitoring of blood pressure, weight, CBC, liver function and platelet. Children less than three years old should not take Adderall, and children less than six years old should not take Adderall XR. People on prolonged use or daily more massive doses of Adderall are at risk for addiction (Miller, 2018).
References
Children and Adults with Attention-Deficit/Hyperactivity Disorder (2018). Treatment of ADHD. Retrieved from http://www.chadd.org/understanding-adhd/about-adhd/treatment-of-adhd.aspx
Heal, D. J., Smith, S. L., Gosden, J., & Nutt, D. J. (2013). Amphetamine, past and present – a pharmacological and clinical perspective. Journal of Psychopharmacology (Oxford, England), 27(6), 479–496. Retrieved from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3666194/
Laureate Education. (Producer). (2017b). A Young Girl with Difficulties in School (Multimedia file). Baltimore, MD: Author.
Miller, C. (2018). What We Know About the Long-Term Effects of ADHD Medications. Retrieved from https://childmind.org/article/know-long-term-effects-adhd-medications/
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral
sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.
Stahl, S.M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology
(5th ed) New York, NY Cambridge University Press
Sridhar, C., Bhat. S., Acharya, U.R, Adeli, H., & Bairy, G. M.(2017). Diagnosis of Attention Deficit Hyperactivity Disorder Using Imaging and Signal Processing Techniques. Computer Biol Med. 1; 88: 93-99. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/28709145
