Assignment 2: Practicum: Week 3 Decision Tree
Mary Ndungu
Walden University
NURS-6660N
Practicum Placement Agency's Name: Connectiona Wellness Group
Preceptor Name (First and Last): Gurjeet S. Kalra
Preceptor E-mail Address: [email protected]
Site Name:1Connectiona Wellness Group
Instructor: ANNA WALDNER
December 27th, 2020
Introduction
Attention-Deficit/Hyperactivity Disorder (ADHD) disease has been extended to all age groups
with the understanding that the illness is life-long. This awareness has led to a rise in age limits
both above and below the traditionally considered school-age children, so that there is an interest
in diagnosing and addressing problems in adults and children younger than 5 years of age. In
order to understand its position with these children, it is important to understand the history and
current state of the art of ADHD (American Psychiatric Association, 2013).
Decision # 1
After evaluating Katie's symptoms and how long she had symptoms, the PMHNP would
diagnose Katie with ADHD, a predominantly inattentive form (314.00). Note: the symptoms are
not simply a manifestation of oppositional behavior, resistance, aggression, or inability to
comprehend tasks or orders. Sometimes it fails to pay careful attention to information or to make
sloppy errors in school job, work or other tasks (e.g. forgetting or missing details, work is
incorrect).b. It is also difficult to maintain interest in tasks or play activities (e.g. it is difficult to
stay concentrated during classes, conversations, or lengthy readings) (Shier, Reichenbacker,
Ghuman, & Ghuman, 2013).
First this client could have Anxiety Disorder. The DSM-5 lists social anxiety disorder, and
generalized anxiety disorder as symptoms (American Psychiatric Association, 2013). While
some of these symptoms are present, a different diagnosis would be more fitting.
The client may also have bipolar disorder. Bipolar disorder may confuse with symptoms of
ADHD. High energy, constant talking, racing thoughts, and impulsive decision making are signs
of bipolar disorder (American Psychiatric Association, 2013).
ADHD is characterized by severe inattentive symptoms. This child has classic signs of this
disorder. According to her teacher, she makes reckless errors in her schoolwork. She is often
susceptible to concentration issues unless it is interesting. Katie is easily distracted and often
forgets stuff that she's already known. In order to diagnose ADHD you must have at least six
signs. The criteria for the condition include both hyperactivity and impulsivity (American
Psychiatric Association, 2013).
Decision # 2
Katie returns four weeks after her diagnosis of ADHD, an inattentive type. The PMHNP will
prescribe Adderall XR 10 mg daily. The decision is based on Stahl, 2017, which states that
Adderall XR is used to treat children aged 6-17 years. Behavioral therapies for children are
effective for preschool-aged children. Successful therapy requires preparation, supervision, and
intervention. Atomoxetine and guanfacine are less effective than psychostimulants, and their
success rate is lower. All factors and symptoms should be reported during follow-up visits (Ng,
2017).
Decision # 3 Treatment Plan for Psychopharmacology
The family and client returned to their next four-week visit feeling better than they did before.
Parents are happy with their child's development, but are concerned about the child's decreased
appetite. Family counseling will help both the patient and her parents. I will take half of a 2mg
tablet of Adderall in the early afternoon. My decision to start treatment was that by the time the
afternoon arrived, Katie started a daydream. In addition, this will help Katie have more energy in
the afternoon. Tracking Katie's weight ensures she remains at a good weight for her age.
Ethical Considerations
Ethical issues are involved in treating any psychiatric illnesses. 3.5% of children under 18
years of age in the U.S. are prescribed stimulants (Pitts, 2013). These results suggest that in
2008, more than 2.8 million children received stimulant care for ADHD. The issue with starting
teenagers on this drug is that there have not been enough studies done with younger teens. There
are significant side effects associated with activating drugs, including cardiovascular risk, growth
suppression, and development (Sadock, Sadock & Ruiz, 2014). It is up to us, as future doctors, to
recommend what is best for the client and their future.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.).
Felt, B. T., & Biermann, B. (2014). Diagnosis and Management of ADHD. American Family
Physician, 90(7), 456-464. Retrieved from www.aafp.org/afp/2014/1001/p456.html
Ng, X. Q. (2017). A systematic review of the use of bupropion for attention-deficit hyperactivity
disorder in children and adolescents. Journal of Child and Adolescent
Psychopharmacology, 27(2), 112-116. https://doi.org/10.1089/cap.2016.0124
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.
Shier, A. C., Reichenbacker, T., Ghuman, H. S., & Ghuman, J. K. (2013). Pharmacological
treatment for attention deficit hyperactivity disorder in children and adolescents: Clinical
strategies. Journal of Central Nervous System Disease, 5, 1-17.
https://doi.org/10.4137/JCNSD.S6691
Stahl, S. M. (2017). Prescriber’s guide (6th ed.). New Delhi, India:
