NURS 6630 Assessing and Treating Patients With ADHD

Walden University NURS 6630 Assessing and Treating Patients With ADHD– Step-By-Step Guide

This guide will demonstrate how to complete the Walden University NURS 6630 Assessing and Treating Patients With ADHD assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for NURS 6630 Assessing and Treating Patients With ADHD

Whether one passes or fails an academic assignment such as the Walden University NURS 6630 Assessing and Treating Patients With ADHD depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for NURS 6630 Assessing and Treating Patients With ADHD

The introduction for the Walden University NURS 6630 Assessing and Treating Patients With ADHD is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for NURS 6630 Assessing and Treating Patients With ADHD

After the introduction, move into the main part of the NURS 6630 Assessing and Treating Patients With ADHD assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for NURS 6630 Assessing and Treating Patients With ADHD

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for NURS 6630 Assessing and Treating Patients With ADHD

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Sample Answer for NURS 6630 Assessing and Treating Patients With ADHD

The management of attention deficit hyperactivity disorder (ADHD) among the pediatric population is quite challenging due to the limited amount of evidence supporting the safety of several recommended drugs for this disorder. To illustrate further the management of ADHD, the case of an 8-year-old Caucasian female has been provided. The patient presents with symptoms of ADHD as suggested by her teacher who completed the Conner’s Teacher Rating Scale-Revised. Her teacher claims that the patient is forgetful most of the time, and easily distracted with a very short concentration time. The patient also displays poor language, spelling, and arithmetic skills, hurting her overall school performance. The teacher also reported that lately, the patient has been failing to follow instructions, leaving her homework incomplete. Despite the patient’s parents refusing their daughter has ADHD, the patient reports that she gets bored most of the time at school with a lack of interest in school work. She however denies bullying of any kind at school with a good home life experience. With the findings of the conducted mental status examination and the Conner’s Teacher Rating Scale-Revised, the patient has been diagnosed with Attention deficit hyperactivity disorder, predominantly inattentive presentation.  

Several factors were considered when deciding on the specific pharmacological agent and the right dosage to prescribe in the management of the patient’s condition. Such factors include the young age of the patient, her Caucasian race, her ADHD diagnosis, and the reported symptoms. The completed Conner’s Teacher Rating Scale-Revised can also help determine the severity of the patient’s condition which is crucial in determining the dosage of the selected drug. As such, this discussion aims at developing the most effective treatment plan for the 8-year-old patient in the management of ADHD, with a rationale for each decision made.  

Decision#1 

Selected Decision and Rationale 

Administering Methylphenidate 10mg chewable tablets once a day in the morning was selected as the initial intervention. Methylphenidate is a stimulant to the central nervous system that acts via noncompetitive blockage of noradrenalin and dopamine reuptake into the terminals, by inhibiting the action of the dopamine and noradrenaline transporters thus raising dopamine and noradrenaline levels in the synaptic cleft (American Psychiatric Association, 2013; Cipriani et al., 2018). Previous evidence supports the substantial effectiveness of Methylphenidate in the management of children diagnosed with ADHD, with a great safety profile and high tolerability levels (Hodgkins et al., 2012). The drug is only recommended for children of age 6 and above (Grimmsmann & Himmel, 2021). Finally, with consideration of the patient’s Caucasian race, the drug is metabolized in the liver via the CYP3A4 pathway, which is predominant among this ethnic population, hence limiting the risks of toxicity (Bonati et al., 2018). The chewable tablet formulation is normally recommended for children to promote compliance (Kikuchi et al., 2021).  

Intuniv was an inappropriate choice for this patient given that previous studies report that the drug being a non-stimulant is more effective in the management of ADHD when used together with a stimulant (Pelham III et al., 2022). Wellbutrin on the other hand is a norepinephrine-dopamine reuptake inhibitor (NDRI) discouraged among children below the age of 9 years old due to its elevated risks of seizures (Kikuchi et al., 2021). 

Expected Outcome. 

Up to 50% of the patient’s symptoms will be resolved within the following 4 weeks (Kikuchi et al., 2021). She will be able to concentrate for longer hours with increased attention and memory (Hodgkins et al., 2012). Her overall academic performance will also improve significantly. 

Ethical Consideration 

Based on the provisions of legal and ethical guidelines for nurses, the PMHNP is obliged to consider the patient ethnicity and race to promote culturally sensitive care (Bonati et al., 2018). The patient’s parents also have a legal right to information concerning the health of their child, for sound decision-making (American Psychiatric Association, 2013). Respecting the patient’s autonomy is key to promoting patient satisfaction. 

Decision#2 

Selected Decision and Rationale 

Out of the options provided, the most effective second intervention was to change the treatment regimen to a long-acting Ritalin 20mg administered once daily in the morning. The patient has reported the potential effectiveness of the drug in managing ADHD symptoms (Hodgkins et al., 2012). However, since the dose is quite limited to resolving the patient’s symptoms all day, using a long-acting agent will help prolong the duration of action, improving the patient’s attention, concentration, and memory the entire day (Cipriani et al., 2018). Studies show that long-acting Methylphenidate lasts in the body system for up to 10 to 12 hours (American Psychiatric Association, 2013). The side effect reported of elevated heart rate is common among pediatric patients on methylphenidate which resolves as the patient continues taking the drug (Pelham III et al., 2022). Consequently, previous evidence confirms that using a long-acting agent, hence reduces the concentration of the drug at one point, reducing the risks of toxic doses, when used for a long time (Kikuchi et al., 2021). 

Maintaining the dose of methylphenidate was not necessary as the patient will continue experiencing limited effectiveness of the drug later in the day (Grimmsmann & Himmel, 2021). Administering Adderall in place of Methylphenidate was also inappropriate at the moment given that the former is associated with increased risks of cardiovascular complications which would compromise the health of the patient (Bonati et al., 2018). 

Expected Outcome 

The patient will be able to attain full concentration and attention level with the use of the drug for 4 weeks (Pelham III et al., 2022). This should help promote her overall academic performance and interest in school activities. The side effect of increased heart rate is expected to return to normal within this period (Grimmsmann & Himmel, 2021). 

Ethical Considerations 

“Not harm” is one of the main ethical obligations of nurses, especially when taking care of children (Bonati et al., 2018). As such, the PMHNP needed to explain to the parents of the patient why the side effect occurred and the main cause of action to resolve the side effect and promote the health of their child (Kikuchi et al., 2021). 

Decision#3 

Selected Decision and Rationale 

Advising the patient to continue taking the long-acting Methylphenidate 20mg once daily and report for reevaluation after 4 weeks was considered the final decision. The patient reported completely resolved side effects with improved effectiveness of the drug in the management of ADHD symptoms all day (Hodgkins et al., 2012). Previous evidence demonstrates that patients on Ritalin may exhibit maximum benefit within 8 to 12 weeks of treatment therapy (American Psychiatric Association, 2013; Cipriani et al., 2018). Most pediatric patient on Methylphenidate has reported great tolerance to the medication with a desirable safety profile in long-term use (Grimmsmann & Himmel, 2021). However, in rare cases, the patient may exhibit ineffectiveness to the medication which might call for the dose titration, hence the need for reevaluating the patient after four weeks (Kikuchi et al., 2021).  

At this point, it was not appropriate to increase the dose of methylphenidate to 30mg as studies show that low effective doses are safer for use by children, with reduced risks of adverse effects (Pelham III et al., 2022). Consequently, based on the current patient heart rate, it is not necessary to obtain EKG, as her pulse is within the normal limits of a child of her age (Bonati et al., 2018). 

Expected Outcome 

For the next four weeks, the patient will report further improvement in ADHD symptoms all day (Grimmsmann & Himmel, 2021). She should display appropriate language, spelling, and arithmetic skills, with improved attention and concentration level (Hodgkins et al., 2012). No side effects are expected.  

Ethical Consideration 

In the final decision, the PHMNP had to consider several ethical principles including nonmaleficence, beneficence, and justice (American Psychiatric Association, 2013). Since the patient was fully satisfied with the treatment outcome, the clinician needed to utilize his/her clinical judgment to advise the patient to continue using the medication for optimal benefits (Pelham III et al., 2022). 

Also Read:

Psychopharmacologic Approaches to Treatment of Psychopathology

Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction

Conclusion 

The pediatric patient described in the case study provided presents with symptoms of ADHD as reported by her teacher. In the development of the treatment plan for this patient, her young age, Caucasian gender, ADHD diagnosis, and presenting symptoms were considered in the selection of the safest and most effective drug. As such, the initial decision was to administer methylphenidate 10mg once daily in the morning (American Psychiatric Association, 2013). Methylphenidate is a stimulant medication that has been proven to be safe and effective in managing ADHD symptoms in both children and adults. Wellbutrin and Intuniv were not considered in this decision as a result of safety issues among children associated with increased risks of side effects (Hodgkins et al., 2012). After 4 weeks, the patient reported significantly improved ADHD symptoms earlier in the day, with minimal effect of the medication later in the day, in addition to side effects of elevated heart rate (Pelham III et al., 2022). It was thus necessary to administer long-acting Methylphenidate 20mg once daily to promote management of the patient’s symptoms the entire day. The long-acting formulation has a longer duration of action (Bonati et al., 2018). Maintaining the dose of Methylphenidate or switching the drug with Adderall was not appropriate at this point (Kikuchi et al., 2021). 

The patient reported resolved side effects with well-managed ADHD symptoms the entire day after 4 weeks. This shows that she was tolerant to the drug with great safety and effectiveness hence the need to continue the same medication at the same dose for another 4 weeks before the reevaluation (Grimmsmann & Himmel, 2021). Increasing the dose of Methylphenidate or obtaining an EKG was not appropriate at this point. The PMHNP also encountered several ethical considerations when taking care of the patient with the main one being “no harm.” Additional ethical principles observed include justice, nonmaleficence, and beneficence (Cipriani et al., 2018). 

References 

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596 

Bonati, M., Reale, L., Zanetti, M., Cartabia, M., Fortinguerra, F., Capovilla, G., … & Lombardy ADHD Group. (2018). A regional ADHD centre-based network project for the diagnosis and treatment of children and adolescents with ADHD. Journal of attention disorders, 22(12), 1173-1184. https://doi.org/10.1177/1087054715599573 

Cipriani, A., Adamo, N., Del Giovane, C., Coghill, D., Banaschewski, T., Hollis, C., … & Cortese, S. (2018). Unbalanced risk-benefit analysis of ADHD drugs–Authors’ reply. The Lancet Psychiatry, 5(11), 871-873. https://doi.org/10.1016/S2215-0366(18)30396-1 

Grimmsmann, T., & Himmel, W. (2021). The 10-year trend in drug prescriptions for attention-deficit/hyperactivity disorder (ADHD) in Germany. European journal of clinical pharmacology, 77(1), 107-115. https://doi.org/10.1007/s00228-020-02948-3 

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. https://doi.org/10.2165/11599630-000000000-00000 

Kikuchi, D., Obara, T., Tokunaga, M., Shiozawa, M., Takahashi, A., Ito, M., … & Watanabe, Y. (2021). Drug prescription for attention deficit hyperactivity disorder drugs in pediatric outpatients: A retrospective survey of Japanese Administrative Data (2012–2018). Asian Journal of Psychiatry, 57, 102512. https://doi.org/10.1016/j.ajp.2020.102512 

Pelham III, W. E., Altszuler, A. R., Merrill, B. M., Raiker, J. S., Macphee, F. L., Ramos, M., … & Pelham Jr, W. E. (2022). The effect of stimulant medication on the learning of academic curricula in children with ADHD: A randomized crossover study. Journal of consulting and clinical psychology, 90(5), 367. https://doi.org/10.1037/ccp0000725 

Sample Answer 2 for NURS 6630 Assessing and Treating Patients With ADHD

This paper is an examination of Katie’s case study. Katie is an 8-year-old Caucasian female that has been brought to the clinic by her parents. They were referred to the facility by their primary care provider after Katie’s teacher suggested she could be suffering from ADHD. The parents handover the Conner’s Teacher Rating Scale-Revised report by Katie’s teacher, which shows that Katie is inattentive, forgets things she already learned, easily distracted, poor in spelling, arithmetic, and reading. Katie also has a short attention span and pays attention to things she is only interested in. She also lacks interest in A and is easily distracted. She starts things but never finishes them and rarely follows through instructions. There is no evidence of childhood trauma. Katie confirmed her teacher’s comments about her learning challenges. Mental status examination performed showed that she has grossly intact attention and concentration. A diagnosis of attention deficit hyperactivity disorder, predominantly inattentive is made. Therefore, this paper explores the treatments that will be adopted for Katie. The patient factors that will affect the selected treatment decisions include Katie’s age, presenting symptoms, learning difficulties, and ability to concentrate on learning tasks.  

Decision 1 

Selected Decision  

Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the morning.  

Reason for the Selection  

The first decision I selected for Katie is initiating her on Ritalin (methylphenidate) chewable table 10 mg orally in the morning. This selection was based on the finding that methylphenidate is the recommended drug of choice for children with ADHD. The drug produces its effects by increasing the concentration of norepinephrine and dopamine by inhibiting their reuptake from the synapses. An increase in the concentration of these neurotransmitters improve attention, mood, and behavior. Methylphenidate has been found in studies to improve the core symptoms of ADHD through the reduction of impulsivity and hyperactivity. As a result, significant improvements in learning, social skills, and attention span are achieved (Matthijssen et al., 2019). In another study, Pertermann et al., (2019) assert that methylphenidate produces its effect by modulating neural noise among ADHD children, which increase behavioral performance.  

Why the Other Two were not Selected? 

I did not select the decision to start Katie on Wellbutrin (bupropion) XL 150 mg orally daily. This is because it is an antidepressant that is largely used for patients that intent to quit smoking. It is an off-label medication for patients with ADHD, hence, not a priority for Katie. Bupropion also has side effects such as irritability, which may lead to its discontinuation in most of the children with ADHD (Kweon & Kim, 2019). I did not select the decision to begin Katie on Intuniv extended release 1 mg orally at bedtime because of its associated side effects. Intuniv causes undesired side effects such as fatigue, hypotension, and sedation, which makes methylphenidate the drug of choice for the patient.  

What I was Hoping to Achieve  

I made the above selection with the hope of achieving a reduction of ADHD symptoms. I also intended to achieve an improvement in Katie’s school performance. Methylphenidate has been shown to enhance ADHD symptoms, hence, my intentions to achieve these outcomes (Pertermann et al., 2019).  

Ethical Considerations  

Treating children suffering from psychiatric conditions such as ADHD may be challenging to the psychiatric nurses and other healthcare providers. They must weigh the benefits and risks of the different treatments to their patients. As a result, I selected methylphenidate since it is the most recommended drug for ADHD for children. It also has minimal side effects, which may enhance treatment outcomes, hence, protecting the needs of the patient (Matthijssen et al., 2019).  

Decision 2 

Selected Decision  

Change to Ritalin LA 20 mg orally daily in the morning 

Reason for the Selection  

I selected the above decision based on the assessment findings discovered after four weeks. Accordingly, Katie’s parents returned her to the clinic with reports that her teacher noticed significant improvement in her symptoms during morning hours. The teacher also noted her overall improvement in academic performance. However, she noted that Katie stares off into space and daydreams in the afternoon. In addition, Katie’s parents were concerned because Katie reported that her heart felt funny, as confirmed by pulse rate of 130 beats per minute. Based on these findings, an effective solution would be to prescribe Katie Ritalin LA 20 mg, which would release half of its peak in the morning and the remaining half in the afternoon. This means that therapeutic effectiveness of the drug will be spread throughout the day (Müller et al., 2021). Methylphenidate is associated with the side effect of elevated pulse, which resolves over time as the patient tolerates the treatment.  

Why the Other Two were not Selected? 

I did not select the decision to continue with the same dose of Ritalin and re-evaluate in 4 weeks because it only lasted during the morning hours. The teacher reported relapse of ADHD symptoms by the afternoon hours, increasing the need for a higher drug dose. I did not select the decision to discontinue Ritalin and begin Adderall XR 15 mg orally daily because there is no indication to change the current treatment (Pertermann et al., 2019). The improvement in symptoms of ADHD does not warrant a change in treatment at this time.  

What I was Hoping to Achieve  

I was hoping to achieve a further improvement in ADHD symptoms. I hoped that Katie’s improvement in school activities would be sustained throughout the day. I was also hoping that she would tolerate the new increase in the dosage of Ritalin.  

Ethical Considerations  

Ethical considerations such as patient’s autonomy and beneficence influence the choice of treatment for psychiatric conditions. For Katie’s case, her parents have the responsibility of making treatment decisions for her. They can either chose to accept or decline the use of Ritalin in managing their daughter’s problem (Buka, 2020). On the other hand, psychiatric nurses must ensure that they do good for Katie in any decisions they make.  

Decision 3 

Selected Decision  

Maintain the current dose of Ritalin LA and reevaluate in 4 weeks.  

Reason for the Selection  

I selected the decision to maintain the current dose of Ritalin LA and reevaluate in four weeks because Katie continued to show further improvement in symptoms. Katie’s parents reported that her heart feeling funny has gone away and pulse rate was 92 during today’s visit to the office. Katie’s teacher also reports that her performance is still improved and the switch to the LA preparation is lasting her throughout the school day. As a result, these improvements in symptoms do not necessitate the adoption of any treatment at this stage (de Faria et al., 2022). It is appropriate to maintain the current dose, to ensure sustained improvements in ADHD symptoms.  

Why the Other Two were not Selected? 

I did not select the decision to increase Ritalin to 30 mg orally daily because the desired improvements in symptoms had been achieved. Increasing the dosage further may result in adverse reactions by the patient. I did not select the decision to obtain EKG based on the current heart rate because it is within the normal range for Katie.  

What I was Hoping to Achieve  

I was hoping to sustain the improvement in Katie’s symptoms after the increase in the dosage of Ritalin. I was also hoping to see a further improvement in her academic performance and tolerability to Ritalin LA 20 mg dosage (de Faria et al., 2022).  

Ethical Considerations  

Psychiatric mental health nurses must ensure that the decisions they make contribute to care outcomes such as enhanced safety and quality. Evidence-based data should inform their actions in psychiatric practice. For example, Katie has shown a considerable improvement in her symptoms of ADHD. As a result, it would be inappropriate to either increase the current dosage of Ritalin LA or change to a new treatment because of safety concerns (Buka, 2020). Therefore, the consideration of these aspects of care ensures the protection of patient’s right to access high-quality, safe, and efficient psychiatric care.  

Conclusion 

In conclusion, it is evident from the case study that methylphenidate proved effective in improving ADHD symptoms Katie experienced. Methylphenidate is the drug of choice for ADHD in children. It produces its effects by inhibiting the reuptake of dopamine and norepinephrine. The fist decision to administer Ritalin 10 mg orally led to mild improvement in symptoms. This informed the decision to increase the dose to Ritalin LA 20 mg as a way of ensuring sustained improvements in symptoms throughout the day. In the third decision, I selected the choice to continue with the current dose of Ritalin since the desired outcomes had been achieved (Matthijssen et al., 2019). A further increase in the patient’s dose of Ritalin would predispose her to unwanted side effects. The other options of treatment were not selected because they were not evidence-based. For example, Bupropion is an off-label for ADHD while Intuniv has negative side effects that may affect outcomes.  

Ethics informed the decisions made in Katie’s treatment. First, the psychiatric mental health nurse aimed at ensuring that evidence-based treatments were used. Methylphenidate is an evidence-based treatment for ADHD that has fewer side effects and more benefits as compared to the given options. The use of evidence-based interventions minimizes the potential harm that Katie could have been exposed in the treatment process. The other ethical considerations that could have affected the selected treatments include respecting patient’s autonomy and ensuring that nurses do good for the patient (Buka, 2020). For example, since Katie is a minor, her parents make decisions on her behalf. Therefore, their decision to reject the recommended treatments should be respected in psychiatry practice.  

References 

Buka, P. (2020). Essential Law and Ethics in Nursing: Patients, Rights and Decision-Making. Taylor & Francis Group. 

de Faria, J. C. M., Duarte, L. J. R., Ferreira, L. de A., da Silveira, V. T., Menezes de Pádua, C., & Perini, E. (2022). “Real-world” effectiveness of methylphenidate in improving the academic achievement of Attention-Deficit Hyperactivity Disorder diagnosed students—A systematic review. Journal of Clinical Pharmacy and Therapeutics, 47(1), 6–23. https://doi.org/10.1111/jcpt.13486 

Kweon, K., & Kim, H.-W. (2019). Effectiveness and Safety of Bupropion in Children and Adolescents with Depressive Disorders: A Retrospective Chart Review. Clinical Psychopharmacology and Neuroscience, 17(4), 537–541. https://doi.org/10.9758/cpn.2019.17.4.537 

Matthijssen, A.-F. M., Dietrich, A., Bierens, M., Kleine Deters, R., van de Loo-Neus, G. H. H., van den Hoofdakker, B. J., Buitelaar, J. K., & Hoekstra, P. J. (2019). Continued Benefits of Methylphenidate in ADHD After 2 Years in Clinical Practice: A Randomized Placebo-Controlled Discontinuation Study. American Journal of Psychiatry, 176(9), 754–762. https://doi.org/10.1176/appi.ajp.2019.18111296 

Müller, A. R., Zinkstok, J. R., Rommelse, N. N. J., van de Ven, P. M., Roes, K. C. B., Wijburg, F. A., de Rooij-Askes, E., Linders, C., Boot, E., & van Eeghen, A. M. (2021). Methylphenidate for attention-deficit/hyperactivity disorder in patients with Smith–Magenis syndrome: Protocol for a series of N-of-1 trials. Orphanet Journal of Rare Diseases, 16(1), 380. https://doi.org/10.1186/s13023-021-02003-z 

Pertermann, M., Bluschke, A., Roessner, V., & Beste, C. (2019). The Modulation of Neural Noise Underlies the Effectiveness of Methylphenidate Treatment in Attention-Deficit/Hyperactivity Disorder. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 4(8), 743–750. https://doi.org/10.1016/j.bpsc.2019.03.011 

Sample Answer 3 for NURS 6630 Assessing and Treating Patients With ADHD

In the case study provided, a primary care practitioner suggested the patient, a Caucasian girl of eight years old, for therapy after her teacher expressed concern that she could have attention-deficit/hyperactivity disorder (ADHD). Based on Katie’s teacher’s evaluation using the “Conner’s Teacher Rating Scale-Revised,” it has been observed that she displays signs of inattentiveness, being easily distracted, having difficulty retaining previously learned information, and struggling in spelling, reading, and arithmetic. She tends to focus on select topics and has a limited attention span. Her teacher says she seems disinterested and often gets distracted during her studies. Katie disregards instructions, initiates tasks without completing them, and overlooks her academic responsibilities. Katie’s parents strongly deny that their daughter has ADHD. According to the patient’s mother, Katie would exhibit hyperactive behavior if she had ADHD. She also notes that her daughter consistently displays respectful behavior and rarely shows signs of defiance or emotional outbursts. The patient’s diagnosis is Attention deficit hyperactivity disorder, predominantly inattentive presentation, as determined by the mental status examination results.

Developing a treatment plan for young children with mental health problems can be challenging due to the safety concerns associated with this age group. To ascertain the most efficacious prescription strategies, it is critical to consider the unique characteristics of each patient, which may influence how pharmaceuticals are metabolized within the organism and their interactions with its diverse systems. Several factors, including the child’s underlying condition, age, race or ethnicity, gender, and presence of symptoms, play a crucial role in determining the most appropriate treatment regimen (Nazarova et al., 2022). This paper centers on the decision-making process for managing an 8-year-old with ADHD who predominantly displays inattentive behavior.

Decision Point One

Decision and Justification

Katie will initially be started on chewable 10 mg Ritalin (methylphenidate) pills, which will be taken orally every morning. The 2018 National Institute for Health and Care Excellence (NICE) guideline suggests that methylphenidate should be the initial pharmacological intervention for children over five and adolescents with ADHD (Mechler et al., 2022). Methylphenidate inhibits the reabsorption of dopamine and norepinephrine, as demonstrated in a recent study by Nazarova et al. (2022). The selective inhibition of these neurotransmitter transporters causes an increase in dopamine and NE concentrations in the synaptic cleft (Groom and Cortese, 2022). The chewable version is often advised for youngsters since it contains sweeteners that assist in hiding the medication’s taste. Methylphenidate treatment for ADHD in youth is thought to be safe when used for two years (Drechsler et al., 2020). Following up on prescribed exams is essential, especially for heart rate and pulse monitoring.

When children take bupropion, their behavior may alter. They may become more aggressive and agitated, have depressed symptoms, or have thoughts of harming themselves (Castells et al., 2020). Therefore, it was not an optimal decision. For this reason, Intuniv was not chosen because of the significant risks associated with it, including syncope, bradycardia, and psychological symptoms such as depression, hallucinations, and thoughts of suicide (Lilja et al., 2022).

Expected Outcome

In the next four weeks, the patient is anticipated to have reduced symptoms associated with ADHD (Young et al., 2021). Throughout this timeframe, the individual is expected to enhance her capacity to concentrate, maintain attention, communicate with efficacy, execute mathematical assignments, and exhibit mastery in spelling. Her cognitive advancement will persist throughout this phase.

Ethical Considerations

Considering the kid’s age of eight, it falls within the parents’ legal jurisdiction to make decisions regarding her health. To assist them in making informed choices about their daughter’s health, the PMHNP should educate parents about the condition and available treatments (Rodrigues et al., 2020).

Decision Point Two

Decision and Justification

The second intervention was taking a 20 mg extended-release Ritalin dosage every morning. Extended-release medications typically exhibit a gradual onset of action. Medications are commonly administered in a controlled manner and gradually released into the patient’s circulatory system throughout the day. After consumption, some of the drug is quickly absorbed; this usually happens in the early morning (Mechler et al., 2022). These medications provide a practical choice for patients seeking a single tablet that provides long-lasting symptom relief (Groom & Cortese, 2022). According to Nazarova et al. (2022), the administration of this medication is limited to a single dose per day, which enhances its degree of simplicity and convenience. The patient exhibited an increased pulse rate, a known and extensively studied adverse effect of Ritalin. According to Drechsler et al. (2020), this effect is anticipated to diminish over time.

Because the client may have symptoms later in the day after the drug’s effects have dissipated, it is recommended against continuing the methylphenidate dosage (Castells et al., 2020). Lilja et al. (2022) suggest a possible increase in non-suicidal behavior among young individuals linked to the use of Adderall. Based on the evidence, it may not be recommended to transition from Ritalin to Adderall.

Expected Outcome

The patient should expect the extended-release medication to sufficiently manage their symptoms throughout the day for the following four weeks (Young et al., 2021). Significant improvement will be observed in the patient’s execution within an educational setting. The negative impacts of an increased heart rate will dissipate during this stage.  

Ethical Considerations

The decision made by the PMHNP took into consideration the patient’s autonomy. The patient preferred gaining knowledge about the medication’s possible side effects and long-term efficacy rather than delving into its mode of action. To improve clients’ psychological well-being, it is essential to exercise professional judgment and make decisions with utmost consideration for their interests (Rodrigues et al., 2020).    

Decision Point Three

Decision and Justification

It was advised to maintain the patient’s medication regimen for the third intervention and reassess after four weeks. The patient said the medicine reduced the adverse effects of a raised heart rate. Existing research indicates that the reduction of ADHD symptoms usually occurs within a period of eight to twelve weeks after determining the optimal dosage of Ritalin (Mechler et al., 2022). The medicine may be administered for a lengthy period at safe levels with no notable adverse effects (Drechsler et al.,2020). As a consequence, it is recommended that patients be re-evaluated after four weeks. Extended use of Ritalin may minimize the frequency of adverse effects by creating drug tolerance, hence enhancing its safety profile (Groom & Cortese, 2022).  

Research has indicated that administering lower doses of Ritalin has been associated with favorable outcomes and a reduced risk of adverse effects (Castells et al., 2020). Therefore, there is no need to increase the dose to 30 mg. During the latest consultation, a patient’s heart rate peaked at 92, which falls within the expected range for her age. Thus, it was concluded that an ECG is unnecessary (Lilja et al., 2022).

Expected Outcome

It is expected that the child’s ADHD symptoms will improve in the following week if they continuously adhere to the prescribed treatment plan (Young et al., 2021). It is anticipated that she will succeed in her scholarly endeavors. There won’t be any adverse effects.    

Ethical Considerations

The primary ethical goal of a nurse is to give precedence to improving a patient’s overall health while preventing any possible damage. The patient conveyed contentment over the outcomes of the therapy. It is crucial to adhere to the recommended dosage while also considering the patient’s autonomy to consistently assess the efficacy of the treatment (Rodrigues et al., 2020).

Conclusion

An eight-year-old with symptoms consistent with attention deficit hyperactivity disorder (ADHD) was recruited as a case study participant. When devising a treatment strategy, it is essential to consider many patient-specific variables that influence the metabolism, elimination, absorption, distribution, and interactions of medications inside the body. The appropriate medications depend on the client’s clinical symptoms, mental diagnosis, and demographic traits, such as age, race, and gender (Young et al., 2021). Based on the factors mentioned, it was decided to administer a 10mg Ritalin tablet in an edible format daily (Mechler et al., 2022). The recommendations of medical experts primarily influenced the decision. These experts have conducted research and concluded that the treatment is effective for alleviating ADHD symptoms and safe for use in kids (Groom & Cortese, 2022). According to Castells et al. (2020), it has been found that bupropion and Intuniv may have a higher likelihood of leading to unfavorable outcomes in kids and teens. Following four weeks, the patient revisited the clinic and provided an update on their symptoms, noting a decrease in symptoms alongside an observed increase in heart rate.

The second strategy involved modifying the course of therapy to LA Ritalin 20mg, which was administered in the morning to ensure sustained therapeutic effects during the day (Drechsler et al., 2020). It is not recommended to use Adderall due to the heightened risk of suicide and the challenges in maintaining a proper dosage (Lilja et al., 2022). The decision to continue medication and reassess the patient after four weeks was predicated on the patient’s worsened symptoms of ADHD and the lack of adverse effects associated with an increased heart rate (Nazarova et al., 2022). Safety considerations may exclude the need for electrocardiograms or dose adjustments of Ritalin in some circumstances. In light of many moral quandaries, the PMHNP regularly demonstrated adherence to ethical norms, including but not limited to beneficence, fairness, and respect for patient autonomy, in our decision-making process (Rodrigues et al., 2020).

References

Castells, X., Ramón, M. A., Cunill, R., Olivé, C., & Serrano, D. (2020). Relationship between treatment duration and efficacy of pharmacological treatment for ADHD: A Meta-Analysis and Meta-analysis of 87 randomized controlled clinical trials. Journal of Attention Disorders, 25(10), 1352–1361. https://doi.org/10.1177/1087054720903372

Drechsler, R., Brem, S., Brandeis, D., Grünblatt, E., Berger, G., & Walitza, S. (2020). ADHD: current concepts and treatments in children and adolescents. Neuropediatrics, 51(05), 315–335. https://doi.org/10.1055/s-0040-1701658

Groom, M. J., & Cortese, S. (2022). Current pharmacological treatments for ADHD. In Current topics in behavioral neurosciences (pp. 19–50). https://doi.org/10.1007/7854_2022_330

Lilja, M., Sandblom, E., Lichtenstein, P., Serlachius, E., Hellner, C., Bhagia, J., & Halldner, L. (2022). The effect of autistic traits on response to and side-effects of pharmacological ADHD treatment in children with ADHD: results from a prospective clinical cohort. Journal of Neurodevelopmental Disorders, 14(1). https://doi.org/10.1186/s11689-022-09424-2

Mechler, K., Banaschewski, T., Hohmann, S., & Häge, A. (2022). Evidence-based pharmacological treatment options for ADHD in children and adolescents. Pharmacology & Therapeutics, 230, 107940. https://doi.org/10.1016/j.pharmthera.2021.107940

Nazarova, V. A., Соколов, А. В., Chubarev, V. N., Tarasov, V. V., & Schiöth, H. B. (2022). Treatment of ADHD: Drugs, psychological therapies, devices, complementary and alternative methods, and trends in clinical trials. Frontiers in Pharmacology, 13. https://doi.org/10.3389/fphar.2022.1066988

Rodrigues, R., Lai, M., Beswick, A., Gorman, D. A., Anagnostou, E., Szatmári, P., Anderson, K. K., & Ameis, S. H. (2020). Practitioner Review: Pharmacological treatment of attention‐deficit/hyperactivity disorder symptoms in children and youth with autism spectrum disorder: a systematic review and meta‐analysis. Journal of Child Psychology and Psychiatry, 62(6), 680–700. https://doi.org/10.1111/jcpp.13305

Young, J. R., Yanagihara, A., Dew, R. E., & Kollins, S. H. (2021). Pharmacotherapy for Preschool Children with Attention Deficit Hyperactivity Disorder (ADHD): Current Status and Future Directions. CNS Drugs, 35(4), 403–424. https://doi.org/10.1007/s40263-021-00806-z

NURS 6630 Week 8 Mood Stabilizer Assignment Sample

 Introduction 

Mood stabilizers play a crucial role in the management of bipolar disorder and other related mood disorders. Among these, carbamazepine, lamotrigine, lithium, and valproate products are traditionally utilized for their efficacy in mood stabilization. This paper provides an in-depth analysis of these medications, focusing on their mechanisms of action, baseline assessments, laboratory considerations, special population considerations, FDA-approved indications, typical dosing, drug-drug interactions, and ethical, legal, and social implications. 

Carbamazepine 

Mechanism of Action 

Carbamazepine primarily acts by inhibiting voltage-gated sodium channels in neurons, reducing the propagation of abnormal electrical activity associated with mood disorders and epilepsy (Rogawski & Loscher, 2004). 

Baseline Assessment and Laboratory Considerations 

Initial assessment should include a complete blood count, liver function tests, renal function tests, and serum electrolyte levels. Ongoing monitoring every 2-3 months is recommended due to the risk of agranulocytosis, liver toxicity, and hyponatremia (Bauer & Mitchner, 2004). 

Special Population Considerations 

• Gender: Female patients of childbearing age should be counseled on the teratogenic risks. 

• Age: Elderly patients may require lower doses due to decreased hepatic metabolism. 

• Comorbidities: Patients with hepatic or renal impairment need careful dosing and monitoring (Weintraub et al., 2012). 

FDA Approval Indications 

Carbamazepine is FDA-approved for bipolar disorder, particularly for manic episodes, and for epilepsy and trigeminal neuralgia. 

Typical Dosing 

The typical dose ranges from 200-1600 mg per day, with therapeutic plasma levels between 4-12 µg/mL. Dose adjustments are based on clinical response and serum levels (Physician’s Desk Reference, 2020). 

Drug-Drug Interactions 

• Carbamazepine + Lurasidone: Carbamazepine induces CYP3A4, reducing lurasidone levels. Dose adjustments of lurasidone or alternative therapies may be necessary. 

• Carbamazepine + Grapefruit Juice: Grapefruit juice inhibits CYP3A4, increasing carbamazepine levels, potentially leading to toxicity. Patients should be advised to avoid grapefruit juice. 

Lamotrigine 

Mechanism of Action 

Lamotrigine stabilizes neuronal membranes by inhibiting voltage-sensitive sodium channels, reducing the release of excitatory neurotransmitters (Cunningham & Jones, 2000). 

Baseline Assessment and Laboratory Considerations 

Baseline assessment should include a complete medical history and liver function tests. Ongoing assessment for rash is crucial due to the risk of Stevens-Johnson syndrome. 

Special Population Considerations 

• Gender: Hormonal fluctuations can affect lamotrigine levels. 

• Age: Pediatric patients may require lower doses and careful titration. 

• Comorbidities: Dose adjustments may be necessary in patients with hepatic impairment (Patsalos et al., 2018). 

FDA Approval Indications 

Lamotrigine is FDA-approved for the maintenance treatment of bipolar I disorder and as adjunctive therapy in epilepsy. 

Typical Dosing 

Initial dosing starts at 25 mg daily, titrating up to 200 mg daily. Therapeutic endpoints focus on mood stabilization and seizure control (Goodwin et al., 2016). 

Drug-Drug Interactions 

• Lamotrigine + Valproate: Valproate increases lamotrigine levels; dose reduction of lamotrigine is necessary to avoid toxicity. 

• Lamotrigine + Rifampin: Rifampin induces lamotrigine metabolism, requiring increased lamotrigine doses to maintain therapeutic levels. 

Lithium 

Mechanism of Action 

Lithium modulates neurotransmission by altering sodium transport in nerve and muscle cells, affecting serotonin and norepinephrine reuptake (Malhi et al., 2013). 

Baseline Assessment and Laboratory Considerations 

Baseline assessment includes renal and thyroid function tests, and serum electrolytes. Monitoring lithium levels (0.6-1.2 mEq/L) and thyroid/renal function every 3-6 months is crucial due to potential nephrotoxicity and hypothyroidism. 

Special Population Considerations 

• Gender: Pregnant women should avoid lithium due to teratogenic risks. 

• Age: Elderly patients require lower doses and frequent monitoring. 

• Comorbidities: Caution in patients with renal or cardiovascular diseases (McKnight et al., 2012). 

FDA Approval Indications 

Lithium is FDA-approved for the treatment of manic episodes and maintenance therapy in bipolar disorder. 

Typical Dosing 

Dosing typically ranges from 600-1200 mg per day, aiming for serum levels between 0.6-1.2 mEq/L (Nolen et al., 2016). 

Drug-Drug Interactions 

• Lithium + Furosemide: Increased risk of lithium toxicity due to decreased renal clearance. Close monitoring of lithium levels is required. 

• Lithium + Lisinopril: ACE inhibitors can increase lithium levels, necessitating frequent serum level checks. 

Valproate Products 

Mechanism of Action 

Valproate enhances GABAergic activity and inhibits voltage-gated sodium channels, leading to mood stabilization and anticonvulsant effects (Johannessen & Johannessen, 2003). 

Baseline Assessment and Laboratory Considerations 

Initial assessments include liver function tests, complete blood count, and serum ammonia levels. Regular monitoring is necessary due to risks of hepatotoxicity, thrombocytopenia, and hyperammonemia. 

Special Population Considerations 

• Gender: Teratogenic risks necessitate caution in women of childbearing age. 

• Age: Elderly patients may require lower doses due to reduced metabolic clearance. 

• Comorbidities: Liver dysfunction necessitates dose adjustments and careful monitoring (Ketter & Wang, 2003). 

FDA Approval Indications 

Valproate is FDA-approved for the treatment of manic episodes associated with bipolar disorder, epilepsy, and migraine prophylaxis. 

Typical Dosing 

Doses range from 750-3000 mg per day, with therapeutic plasma levels between 50-125 µg/mL. Dosing adjustments are based on clinical response and serum levels (Bowden, 2003). 

Drug-Drug Interactions 

• Valproate + Estrogen-containing Birth Control: Estrogen can reduce valproate levels; dose adjustments may be necessary. 

• Valproate + Amitriptyline: Increased risk of CNS depression; monitoring for enhanced side effects is needed. 

Ethical, Legal, and Social Implications 

Prescribing mood stabilizers for bipolar and other related mood disorders involves complex ethical, legal, and social considerations. Informed consent is paramount, particularly regarding potential side effects and teratogenic risks. Prescribers must balance the benefits and risks, ensuring patients are fully aware of the implications. Additionally, legal responsibilities include adhering to FDA guidelines and monitoring requirements to prevent adverse outcomes. Social implications encompass addressing the stigma associated with psychiatric medications and supporting patients in their treatment adherence. 

Summary 

Mood stabilizers such as carbamazepine, lamotrigine, lithium, and valproate play essential roles in managing mood disorders. Understanding their mechanisms, appropriate assessments, special population considerations, dosing, and interactions is crucial for optimizing treatment outcomes. Ethical, legal, and social considerations further underscore the importance of comprehensive patient care in psychiatric practice. 

References 

Bauer, M., & Mitchner, L. (2004). What is the diagnosis? Bipolar disorder. Journal of Clinical Psychiatry, 65(5), 715-716. 

Bowden, C. L. (2003). Valproate. Journal of Clinical Psychiatry, 64(6), 24-28. 

Cunningham, M. O., & Jones, R. S. G. (2000). Mechanisms of action of lamotrigine: A review. Epilepsia, 41(4), 48-51. 

Goodwin, G. M., Haddad, P. M., Ferrier, I. N., et al. (2016). Evidence-based guidelines for treating bipolar disorder: Revised third edition recommendations from the British  

Association for Psychopharmacology. Journal of Psychopharmacology, 30(6), 495-553. 

Johannessen, C. U., & Johannessen, S. I. (2003). Valproate: Past, present, and future. CNS Drug Reviews, 9(2), 199-216. 

Ketter, T. A., & Wang, P. W. (2003). Valproate and its clinical use in mood disorders. Epilepsy & Behavior, 4(5), 21-27. 

Malhi, G. S., Tanious, M., Das, P., Coulston, C. M., & Berk, M. (2013). Potential mechanisms of action of lithium in bipolar disorder. Neuroscience & Biobehavioral Reviews, 37(1), 329- 347

McKnight, R. F., Adida, M., Budge, K., Stockton, S., Goodwin, G. M., & Geddes, J. R. (2012).  

Lithium toxicity profile: A systematic review and meta-analysis. The Lancet, 379(9817), 721-728. 

Nolen, W. A., Licht, R. W., Young, A. H., Malhi, G. S., Tohen, M., & Vieta