ADHD
Olayinka1
ADHD9.pdf
Running head: TREATING PATIENTS WITH ADHD 1
Treating Clients with ADHD
Tracie Grider
Walden University
October 27, 2019
NURS 6630
This study source was downloaded by 100000795183161 from CourseHero.com on 04-30-2021 19:52:51 GMT -05:00
https://www.coursehero.com/file/51126345/wk9-assgn-TGrider-ADHD-decision-treedocx/
Th is
stu dy
re so
ur ce
w as
sh ar
ed v
ia C
ou rs
eH er
o. co
m
TREATING ADHD 2
This week’s scenario is concerning an 8-year-old Caucasian female with symptoms of
possible Attention-Deficient Hyperactivity Disorder (ADHD) per her primary care provider.
ADHD is primarily a problem with sustained attention, concentration, and task persistence.
Statistics show that, in 2016, 9.4 percent of 2 to 17-year-olds in the United States had received a
diagnosis of ADHD at some time (CDC, 2019). ADHD has three forms: Inattentive,
Hyperactive/impulsive, and Combined.
This patient will be assessed for a medication regime which can decrease or control her
behavior issues related to her diagnosis of ADHD inattentive and engage the patient with some
counseling for additional support and techniques useful for this disorder.
Decision #1
Which decision did you select? I chose to start Ritalin (methylphenidate) chewable
tablets 10mg orally in the am.
Why did you select this decision? Support your response with evidence and
references to the Learning Resources. Stimulants are considered the first-line of
therapy for children with ADHD and appears to be more favorable in children than
amphetamine-type stimulants (Stahl, 2008). Methylphenidate is a stimulant which works
to enhance arousal in the prefrontal cortex and acts explicitly to boost norepinephrine and
dopamine neurotransmission in the prefrontal cortex (Sulkes, 2019). Common side
effects may include: sleep disturbances, appetite suppression, depression, sadness,
anxiety, headaches, stomachaches and elevated heart rate and blood pressure (Stahl,
2008).
I didn’t choose to use Intuniv extended release because it is a non-simulant and used as
second-line or third-line therapy. It also has side effects such as bradycardia, sedation,
This study source was downloaded by 100000795183161 from CourseHero.com on 04-30-2021 19:52:51 GMT -05:00
https://www.coursehero.com/file/51126345/wk9-assgn-TGrider-ADHD-decision-treedocx/
Th is
stu dy
re so
ur ce
w as
sh ar
ed v
ia C
ou rs
eH er
o. co
m
TREATING ADHD 3
and hypotensive effects that need to be closely monitored (Stahl, 2008) Wellbutrin was
not chosen due to it also being a non-stimulant medication which has unwanted side
effects such as possible increase thoughts of suicide in young children (Stahl, 2008).
What were you hoping to achieve by making this decision? Support your response
with evidence and references to the Learning Resources. To decrease the patient’s
inattentive behavior that disrupts her schoolwork by increasing her attention span.
Explain any difference between what you expected to achieve with Decision #1 and
the results of the decision. Why were they different? I expected the patient to respond
by having better days at school and less behavior problems that don’t disrupt her in the
class. According to the results after four weeks, the parents state the teacher has seen
improvement in symptoms in the morning time but by afternoon the patient is losing
focus and not productive. The patient has also voiced she feels like her heart is racing and
upon assessing the pulse rate it was elevated to 130 beats per minute. Despite the side
effects of this medication the patient has shown some improvement in her attentiveness in
school but some adjustments will need to be made to increase positive therapeutic
response to the medication prescribed.
Decision #2
I selected to change to Ritalin LA 20mg orally daily in the morning.
Why did you select this decision? Support your response with evidence and
references to the Learning Resources.
Due to the original dosage of medication only lasted for a short portion of the day, I opted
to switch a longer-acting stimulate medication such as Ritalin LA to hopefully have
coverage of symptoms from morning throughout most of the evening. The recommended
This study source was downloaded by 100000795183161 from CourseHero.com on 04-30-2021 19:52:51 GMT -05:00
https://www.coursehero.com/file/51126345/wk9-assgn-TGrider-ADHD-decision-treedocx/
Th is
stu dy
re so
ur ce
w as
sh ar
ed v
ia C
ou rs
eH er
o. co
m
TREATING ADHD 4
starting dose for Ritalin LA is 20 mg once daily. Increase dosage gradually, in increments
of 10 mg weekly. Ritalin LA produces a bi-modal plasma concentration-time that peaks
approximately 4 hours apart when administered orally to children diagnosed with ADHD
and healthy adults (Stahl,2008)
What were you hoping to achieve by making this decision? Support your response
with evidence and references to the Learning Resources. I would like to continue her
response of a positive classroom performance while increasing that effect throughout the
entire day.
Explain any difference between what you expected to achieve with Decision #2 and
the results of the decision. Why were they different? I expected the patient to return
with continued attentiveness in school and decrease in racing heart and pulse rate. The
patient returned to clinic in four weeks, and mom states the patient’s performance is
lasting throughout the day and her feelings of racing heartbeat have stopped. Upon
examination of the pulse rate it was 92. This shows the medication Ritalin LA has a
positive response for the patient which stopped her heart racing and is lasting throughout
the day.
Decision #3
I selected to continue the current dose of Ritalin LA and reevaluate in another 4 weeks.
Why did you select this decision? Support your response with evidence and references to
the Learning Resources.
The patient continues to show symptom improvement with the medication dosage and no
adverse effects, I will continue with the same dosage.
This study source was downloaded by 100000795183161 from CourseHero.com on 04-30-2021 19:52:51 GMT -05:00
https://www.coursehero.com/file/51126345/wk9-assgn-TGrider-ADHD-decision-treedocx/
Th is
stu dy
re so
ur ce
w as
sh ar
ed v
ia C
ou rs
eH er
o. co
m
TREATING ADHD 5
What were you hoping to achieve by making this decision? Support your response
with evidence and references to the Learning Resources. I was hoping to maintain the
patients well controlled symptoms with minimum side effects. With the use of Ritalin LA some
immediate effects can be seen with first dosing however it can take several weeks to attain
maximum therapeutic benefit.
Explain any difference between what you expected to achieve with Decision #3 and
the results of the decision. Why were they different? I expected continued therapeutic
response to the medication so the patient can remain in control of her ADHD and be a productive
person in her classroom and her social surroundings.
Ethical Considerations
Some ethical decisions about treatment with Stimulant medication are the side effects and
potential abuse of the substance. Before treatment, assess for presence of cardiac disease,
monitor weight and height and complete blood cell and platelet counts. Other problems
that girls and women with ADHD may experience include: chronic stress, low self-
esteem, underachievement and depression this is why therapy should also be considered
with starting medication management for any mental illness.
Summary
The goal of treatment of ADHD is reduction of symptoms of inattentiveness, motor
hyperactivity, and/or impulsiveness. Continuation of treatment may be needed until all symptoms
are under control or improved with the least amount of side effects for the patient.
This study source was downloaded by 100000795183161 from CourseHero.com on 04-30-2021 19:52:51 GMT -05:00
https://www.coursehero.com/file/51126345/wk9-assgn-TGrider-ADHD-decision-treedocx/
Th is
stu dy
re so
ur ce
w as
sh ar
ed v
ia C
ou rs
eH er
o. co
m
TREATING ADHD 6
References
Centers for Disease Control and Prevention. 2019. Attention-Deficit/Hyperactivity Disorder.
Retrieved from: https://www.cdc.gov/ncbddd/adhd/guidelines.html
Sulkes, S. B. (2019). Attention-deficit/hyperactivity disorder (ADHD). Merck Manual
Professional Version. Retrieved from: https://www.merckmanuals.com/home/children-s-
health-issues/learning-and-developmental-disorders/attention-deficit-hyperactivity-
disorder-adhd
Stahl, S. M. (2008). Essential Psychopharmacology Online. Retrieved October 28, 2019 from
https://stahlonline-cambridge-org.ezp.waldenulibrary.org/prescribers_drug.jsf?
page=9781316618134c77.html.dosing&name=METHYLPHENIDATE
%20(D,L)&title=Dos
Stahl, S. M. (2008). Essential Psychopharmacology Online. Retrieved October 28, 2019 from
https://stahlonline-cambridge-org.ezp.waldenulibrary.org/prescribers_drug.jsf?
page=9781316618134c17.html.therapeutics&name=BUPROPION&title=Therapeutics
Stahl, S. M. (2008). Essential Psychopharmacology Online. Retrieved October 28, 2019 from
https://stahlonline-cambridge-org.ezp.waldenulibrary.org/prescribers_drug.jsf?
page=9781316618134c54.html.therapeutics&name=GUANFACINE&title=Therapeutics
This study source was downloaded by 100000795183161 from CourseHero.com on 04-30-2021 19:52:51 GMT -05:00
https://www.coursehero.com/file/51126345/wk9-assgn-TGrider-ADHD-decision-treedocx/
Th is
stu dy
re so
ur ce
w as
sh ar
ed v
ia C
ou rs
eH er
o. co
m
Powered by TCPDF (www.tcpdf.org)
