Introduction
ADHD is a disease that strikes children and adults, causing severe mental problems to present throughout their lifetime. The given case study tells about an eight-year-old Caucasian girl, Katie, who is suspected of having this problem (CDN, n.d.). As a result, deep analysis and assessment are needed to determine whether the child acquired ADHD.
The official notice from Katie’s teacher was sent to her parents, who decided to refer her to the specialist right away; however, they refused to accept it, stating that their daughter is calm at home and that her temper is adequate (CDN, n.d.). The following deviations in Katie’s behavior were observed: inattentiveness, constant distraction, ignorance of learning material, and weak memory (CDN, n.d.). It leads to a decrease in perceptions of curriculum knowledge and may lead to the decision to transfer her to a specialized school.
Considering all the information above, it is clear that the girl is developing normally for her age, as young children are often bored in class. As mentioned, Katie speaks clearly, coherently, and logically, is aware of her environment, and understands the events occurring (CDN, n.d.). There are many factors to consider before deciding on treatment, namely the teacher’s concerns about her short attention span and memory, her tendency to be distracted, and her struggles with learning new things (CDN, n.d.).
The girl herself feels normal and does not possess physical disorders, abnormal gestures, hallucinations, or suicidal intentions (CDN, n.d.). This factor leads to the conclusion that the disease may still exist, but with a low or moderate impact, which will be determined after the assessment. A psychiatric nurse practitioner must evaluate the information received, analyze the factors, and draw conclusions before prescribing.
Decision #1
After analyzing the case and the patient’s symptoms, it was decided to begin with Ritalin (methylphenidate) 10 mg tablets each morning. This medication is chosen as the “number 1 solution” because its effectiveness was proven for adolescents with ADHD between ages 6 and 17 (U.S. Food & Drug Administration, n.d.). The second option is presented by prescribing Wellbrutin (bupropion) XL 150 mg daily. It is not selected because it is expected that this drug-taking may result in suicidal intentions.
The third variant of prescribing Intuniv 1 mg in the evening is also abandoned. The reason is the same as for the second one, and there is also a risk that behavioral habits will not change, leading the child to become slow and unenthusiastic (CDN, n.d.). Consequently, the decision to choose the pills with the best outcomes is taken and approved.
As a psychiatric nurse practitioner, I hope to achieve the best possible outcomes for my patients. For this reason, I evaluated the offered remedies’ benefits and selected the one with the best characteristics for the given age category. The aim is to initiate the organism’s regular activity by improving it starting from the beginning of the day. It can help motivate Katie, as she may see the results she can achieve during classes once the medication takes effect.
This option is a starting point of communication with the child and her parents. The aspect is emphasized because it demonstrates the effects of the chosen drug, which is adequately explained in a non-discriminatory manner (Stahl, 2021). For example, if I, as a qualified professional, communicate with the family in this way, there is an ethical advantage that enhances the medical care plan by increasing trust.
Decision #2
The following decision is to change the pills to Ritalin LA 20 mg, which should also be taken each morning. The reason for this is the treatment’s efficacy in adolescents aged 6 to 12 (U.S. Food & Drug Administration, n.d.). It is defined as a treatment that helps address symptoms such as inattention, poor listening, difficulty following more complex tasks, and easy distraction (U.S. Food & Drug Administration, n.d.). It is expected that after treatment, the child’s school performance will remain stable, and her heart rate will decrease closer to normal.
The other two options, namely, continuing the same dose of Ritalin and discontinuing Ritalin LA to begin Adderall XR 15 mg daily, are excluded. Firstly, the consequences can include increased pulse and worsening of attention (CDN, n.d.). The National Institute for Health and Clinical Excellence defined d-amphetamine as a means for a “third-line treatment variant” because of the threat of increased addiction and abuse (Hodgkins et al., 2012). Consequently, the decision is justified and approved for its implications.
When selecting the given option, it is expected to achieve better indicators in a heartbeat. After the first solution, the rate increases, which signals the need to accommodate the medication plan. The pulse shows 130 beats per minute, which is abnormal for a healthy person; consequently, Ritalin LA is prescribed (CDN, n.d.). It is necessary to remain ethical in this case and choose the right words to explain the decision to change the treatment plan to the parents (Martin, 2020). For instance, the remedy’s effect may be explained to them, which will eventually help them understand and allow medical care to continue.
Decision #3
The final decision is to stop the treatment procedure and provide the EKG based on the current pulse. It is decided to follow this path as the patient’s symptoms are controlled at this stage, and her productivity is improved (CDN, n.d.). The second alternative is not selected because maintaining the current portion of Ritalin LA could cause heart rate failure and worsen the situation. For this reason, the total check should be done before continuing or increasing any dose (Stahl, 2021). The third variant is not chosen because, as mentioned above, increasing Ritalin LA to 30 mg daily could cause severe cardiovascular damage; moreover, there is no indication that the medication should be continued (CDN, n.d.). Consequently, the decision taken is the best option for further treatment of ADHD.
At this point, I hope to see the finest results of medical care presented by Katie’s behavioral and psychological improvements. Ceasing any drug application and continuing with EKG for better control of pulse aims to develop mental health and stabilize physical state (Hodgkins et al., 2012). When it comes to ethical considerations, the dialogue with Katie’s parents is still crucial because they need to ensure that the experience of the curing process ends.
In this case, specific practice should be offered to help them maintain the treatment results. For example, to express my ethical attitude, I can involve the parents in training that provides principles and theories on how to motivate positive behavior in their child (Martin, 2020). It guarantees better communication between me, as their psychiatric nurse, and them, as the drivers for Katie’s mental health enhancement.
Conclusion
In conclusion, the planning of the patient’s treatment and medication prescribing is mainly based on the following factors: memory failures, short attention span, frequent distractions during the learning process, and struggles in acquiring new study material. As a result, there are risks and benefits to the chosen therapy options. The first variant is effective because Katie began succeeding in her studies, and her academic performance improved. The danger is the high pulse rate – 130 beats per minute.
The second alternative’s advantage is its effectiveness in treating the symptoms of attention deficit, poor listening, and distraction. However, there is a threat of arrhythmia and a decrease in activity level. The last preference is positive because it helps monitor results and keep them stable; at the same time, the risk is posed by stagnation of the previous progress.
Based on the information provided, the recommendations on the treatment options should be offered. First, when initiating the curing procedure, a physician must consider the most suitable medication for the patient’s age (Stahl, 2021). Consequently, Ritalin (methylphenidate) 10 mg, taken as tablets every morning, is the preferred option in this case.
Second, the side effects should be analyzed after the first phase of treatment, and the remedy’s type and dose should be increased to avoid the risks associated with pulse (U.S. Food & Drug Administration, n.d.). Third, after a considerable period of curing, it is recommended to discontinue it and initiate a health monitoring process to maintain therapeutic benefits and stabilize heart rate (Hodgkins et al., 2012). Ultimately, the received information is evaluated, factors are analyzed, and logical conclusions are drawn regarding the medications’ prescribing and treatment of ADHD.
References
CDN (n.d.) Attention deficit hyperactivity disorder: A young girl with ADHD.
Hodgkins, P., Shaw, M., McCarthy, S., & Sallee, F. R. (2012). The pharmacology and clinical outcomes of amphetamines to treat ADHD: Does composition matter?CNS Drugs, 26(3), 245–268.
Martin, L. (2020). A 5-question quiz on ADHD. Psychiatric Times.
Stahl, S. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications, 5th ed. Cambridge University Press.
U.S. Food & Drug Administration (n.d.). FDA-approved drugs.