Assignment: Assessing and Treating Clients With ADHD

Assignment: Assessing and Treating Clients With ADHD Essay

Attention Deficit Hypersensitivity Disorder (ADHD) is a mental condition characterized by impulsiveness, difficulty in maintaining appropriate attention and excessive motor activity. In the young population, the disorder is associated with excitability, difficulties in maintaining high grades in school, and impaired interpersonal relationship with friends. The disorder is difficult to diagnose as the patient might be unable to display the symptoms in all settings or in one particular setting at every time (Johnston & Chronis-Tuscano, 2015). However, diagnosis is made when the symptoms persist for more than 6 months. This is based on the information provided by the child, parents, caregivers, teachers, and friends. The disorder is associated with changes in the functional and neuroanatomical brain. However, it can be managed by altering these parameters through the use of appropriate pharmacological agents. Non-pharmacological interventions such as behavioral counseling can be used as a complementary approach to managing this mental condition. Thus, the main purpose of this paper is to examine the case of an 8-year-old Caucasian girl diagnosed with ADHD, develop a treatment plan with high consideration of the pharmacokinetic and pharmacodynamic agents available for best treatment outcome and finally point out the ethical considerations necessary for the plan.

Decision Point One

Selected Decision

Start Ritalin (methylphenidate) chewable 10 mg tablets PO in the morning

Reasons for Selection

Most stimulants have been approved as the first line treatment for patients with ADHD. Ritalin has been used over the years for the treatment of ADHD as approved by the FDA and has proven to be the most effective pharmacological agent with an effect size of up to 0.9 as compared to non-stimulant agents such as Intuniv with an effect size of between 0.5 to 0.9 (Reale et al., 2017). The mode of action of Ritalin is by blocking both the dopamine and norepinephrine reuptake. Ritalin also produces a plasma bi-modal concentration-time profile when administered to children orally, hence the once-daily dose. It has a low plasma protein binding capacity with a bioavailability of 22±8% in children suggesting a marked pre-systemic metabolism. The drug has a rapid half-life of about 3.5 hours in children hence minimal side effects.

Other drugs such as Wellbutrin, which is an antidepressant, have been approved by the FDA, but mainly effective in improving concentration and focus, although it is used as an off label treatment in children as its safety profile has not been demonstrated among these population. It is also accompanied by several undesired effects such as seizure at high dose, which is very dangerous for children. On the other hand is an optional non- stimulant agent but not approved by the FDA in the treatment of children with ADHD.

Expected Results

The pharmacological effects of Ritalin are expected within 2 to 4 weeks of medication therapy. The patient is expected to improve focus at school, improve class participation, and able to relate appropriately with peers. Given that the dose administered is low, the patient is not expected to experience any side effects at this stage.

Differences between Expected Results and Actual Results

Upon coming back for follow up after 4 weeks, the patient’s symptoms of inattentiveness are reported to have improved significantly in the morning and hence the teachers claim that her overall academic performance has also improved. The improvement is in line with the nurse’s expectations. However, this effect does not last the whole day as it is reported that the patient reverts to daydreaming and staring off into space later in the day. She is also reported of having an elevated heart rate which is a common side effect of Ritalin.

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Decision Point Two

Selected Decision

Shift to 20MG Ritalin LA PO in the morning

Reason for Selection

The second decision is aimed at reducing the side effects of elevated heart rate while trying to manage the patient’s symptoms

Assignment Assessing and Treating Clients With ADHD Essay
Assignment Assessing and Treating Clients With ADHD Essay

throughout the day. A long-acting Ritalin has a prolonged effect of up to 12 hours, which will help control the patient’s symptoms all through the day when administered in the morning. It also has a slow and controlled release, which will reduce the peak plasma concentration, hence reducing the cardiovascular side effects (Patel et al., 2017). The patient has also proved to be compliant to the medication based on the outcome reported during the first follow up visit. Changing the pharmacological agent to Adderall is not appropriate at this point since it is also a stimulant with similar side effects of increased heart rate as Ritalin.

Expected Results

The patient is expected to experience controlled symptoms throughout the day within 4 weeks. Her concentration should be appropriate from the morning and all day long, which should also reflect on her academic performance. The side effect of increased heart rate is also expected to resolve within this time.

Differences between Expected Results and Actual Results

Upon showing up for follow up after 4 weeks, it was reported that the patient was able to concentrate appropriately in class in the morning and even later in the day. Her academic performance had also improved as reported by her teachers. She no longer had an issue with elevated heart rate, as it recorded 92. This was what was expected by the nurse, hence an indication of high compliance.

Decision Point Three

Selected Decision

Maintain the same dose of Ritalin LA and re-evaluate the patient after 4 weeks.

Reason for Selection

From the results of the last intervention, it is evident that the patient is responding appropriately to the current dose, with well-managed symptoms and reduced side effects of tachycardia. As a result, it is appropriate to maintain the same dose for further improvement and management of the patient’s symptoms. Increasing the dose to 30 mg is inappropriate as it will result in high plasma levels of Ritalin, which will result in the side effect of increased heart rate (Fernández et al., 2015). Currently, the heart rate of the patient is at 92, which is within the normal range of 75 to 118 for children between the age of 6 to 12 years. Consequently, the long term effects of Ritalin among children has not been systemically evaluated, hence the need for a re-evaluation after 4 weeks of treatment.

Expected Results

The patient is expected to continue displaying controlled symptoms. Her concentration is expected to improve even further all through the day, and as such, this will lead to an overall improvement in her academic performance. Her heart rate is also expected to remain within the normal range with no other side effect.

Differences between Expected Results and Actual Results

Upon showing up for re-evaluation, the patient symptoms had been suppressed significantly all day long. She was able to concentrate in class appropriately and maintain good relations with her peers. Her heart rate was within the normal range with no additional side effect. This showed that the patient was compliant with the drug, with beneficial long-term effects.

Ethical Considerations

When taking care of a patient with a prominent mental disorder, it is important to observe ethical consideration for effective treatment outcome, especially among the pediatric population. Such patient is usually unable to express themselves appropriately, and hence the nurse has to involve people around them for comprehensive clinical evaluation (Sayal et al., 2018). Ethically, the nurse has to discuss with the patient’s parents the treatment options, their advantages and limitations, and the reasons for the interventions made in the course of the treatment. The people around the patient’s life must also be informed of the patient’s mental condition so as to keep a close watch and be able to respond appropriately to how the patient is responding to medication. Lastly, the nurse needs to educate the patients family members, friends, and teachers, on how they can help the patient manage her condition for an effective care plan outcome.

Conclusion

ADHD is a common mental disorder responsible for most children’s poor performance at school. It is difficult to diagnose especially among children given that it has similar symptoms as other mental disorder and the fact that the symptoms are not consistent hence difficult to monitor. However, the disorder is managed using stimulants such as Ritalin, which should be closely monitored especially among the pediatric population for desired treatment outcome.

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