25 Sep Attention Deficit Hyperactivity Disorder (ADHD) Th
Attention Deficit Hyperactivity Disorder (ADHD) This disorder is classified as an ongoing pattern of behavior that interferes with attention and with hyperactive impulses(NIMH,n.d.) Attention Deficit disorder can be classified as ADD without hyperactivity. The Conner’s testing would be reviewed to determine if the patient had ADHD or ADD. The patient was determined to have ADHD with predominantly inattentive. The decision to place the patient on Ritalin (Methylphenidate)10mg tablet given in the morning prior to the start of the school day. The patient returned in four weeks for a recheck check appointment. The patient’s parents are reporting an improvement in her school performance. The teacher is reporting that by the afternoon the patient is starting to “daydream” and “stare off into space”. The parents are also reporting that the patient is stating that her heart feels funny. On exam the patient has a heart rate of 130 ppm. The side effect that the patient is experiencing can lead to non compliance so the medication was changed. The patient was given Ritalin LA 20mg to be taken in the morning before the start of the school day. The patient returns to the office in four weeks. She continues to have marked improvement in her school performance. The medication Ritalin LA is lasting through the entire school day. No reported problems with “day dreaming”. The patient is no longer complaining of the funny feeling in her heart. Heart rate on exam is now 92 ppm. This is a normal heart rate for an 8 year old. The decision was made to keep her on the current dose and have her return in four weeks for another medication check. Using the lowest effective dose of medication is recommended. Since the heart rate is normal an Ekg is not warranted at this time (Laureate Education,2019). Pharmacotherapeutics The choice to use a stimulant to treat this patient is a safe and effective one. In ADHD functional abnormalities of the prefrontal cortex have been found on neuroimaging studies (Rosenthal,and Burchum,2018). The prefrontal cortex is responsible for motor activity, regulation of attention and impulse behavior (Rosenthal,and Burchum,2018). The prefrontal cortex is aroused boosting dopamine neurotransmission and norepinephrine in response of the stimulant (Brown, Samuel,and Patel, 2018). The response to the stimulant can help the patient with attention and control of behaviors. The use of stimulants have also had effects on the patient’s desire to eat (Brown, Samuel,and Patel, 2018). Monitoring the patient’s weight is important in the monthly medication rechecks. Drug holidays are encouraged to maintain a healthy weight. Drug holidays can be practiced on weekends for short term trails and during longer school holidays(Ibrahim,Vogt and Donyai, n.d.). Treatment plans Encouraging the parents to give the medication at the same time of day will help with the effects during the school day. Some school districts will allow parents to send a small amount of the medication to school for the nurse to dispense if the parents have trouble remembering to give the medication. The importance of a healthy dinner and a bedtime snack can help with any decrease in appetite. Monitoring the patient’s weight at home is also recommended. Encourage parents to have real-time communication with the patient’s teachers to help with the treatment plan and to catch any problems that may indicate the need for a dose change. Brown, K. A., Samuel, S., & Patel, D. R. (2018). Pharmacologic management of attention deficit hyperactivity disorder in children and adolescents: a review for practitioners. Translational pediatrics, 7(1), 36. Ibrahim, K., Vogt, C., & Donyai, P. (n.d.). Caught in the eye of the storm: a qualitative study of views and experiences of planned drug holidays from methylphenidate in child and adolescent ADHD treatment. CHILD AND ADOLESCENT MENTAL HEALTH, 21(4), 192–200. https://doi-org.ezp.waldenulibrary.org/10.1111/camh.12156 Laureate Education (Producer). (2019c) Attention deficit hyperactivity disorder (interactive media file). Baltimore, MD: Author. National Institute of Mental Health (n.d.) Attention deficit hyperactivity disorder Retrieved from: https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.Discussion Week 8: ADHD In the presented scenario an 8-year-old is having difficulty concentrating at school, she is functioning at her age level but is inattentive. After an assessment it is determined the child is suffering from ADHD. Attention Deficit Hyperactivity Disorder (ADHD) is defined as a condition with inability to focus and hyperactive behavior. It typically causes difficulty in performing in school, work or social settings (Block, Macdonald & Pitotrowski, 2019). The first line of treatment in the decision steps was to start the patient on Ritalin 10mg chew tablets. After a few weeks the patient returns improving in school and more focused in the morning but having difficulty still in the afternoons. The patient is also complaining of side effects of racing heart rate and found with a heart rate in the 130s. Because this medication is a stimulant it can have this adverse effect. The patient medication treatment is then changed to Adderall XR 10 mg orally. When the patient returns in 6 weeks, she is feeling better, keeping attention all day unlike when on the Ritalin and also improving overall performance in school. The patient is still feeling some tachycardia, the next decision step would be to decrease the dose of Adderall to 5mg a day and reassess in 4 weeks, increasing as needed. The patient will be more likely to continue with the medication if she has lesser adverse effects. Impacts These medication impacts would help determine treatment plans for the patient. Initially, according to Granato, Ferraro, Lellis & Casella, the patient should be placed into counseling and behavioral therapy to assist in school (2018). Families should also be educated. In additional to these therapies’ medications can be combined for the best outcome. Stimulants have positive impacts on patients, although cause side effects such as mood changes, decreased appetite and tachycardia and insomnia (Block, Macdonald & Pitotrowski, 2019). Although these may impact the patient, with effective dosing patients will benefit from them. For example, in the provided scenario the patient had an initial positive effect from the Ritalin however was experiencing increased heart rate and only was proven effective in the morning. The medication was discontinued. The patient was then started on Adderall which gave longer effect and a smaller dose may decrease the side effects such as tachycardia. According to Danielson et al., combining behavioral therapy and medication is the most effective treatment plans (2018). Because of the medication impacts on the patients, patients are encouraged to take the medication in the morning to prevent insomnia. Patients who experience appetite changes can also take meal supplements to ensure healthy weight. Monitoring the patient every 6 weeks will help providers determine appropriate treatment plans. References Block, R. W., MD, Macdonald, N. E., PhD, & Piotrowski, N. A., PhD. (2019). Attention deficit hyperactivity disorder (ADHD). Magill’s Medical Guide (Online Edition). Retrieved from https://search-ebscohost- com.ezp.waldenulibrary.org/login.aspx?direct=true&db=ers&AN=86193914&site=eds- live&scope=site Danielson, M. L., Bitsko, R. H., Ghandour, R. M., Holbrook, J. R., Kogan, M. D., & Blumberg, S. J. (2018). Prevalence of parent-reported ADHD diagnosis and associated treatment among US Children and adolescents, 2016. Journal of Clinical Child and Adolescent Psychology, 47(2), 199–212. https://doi- org.ezp.waldenulibrary.org/10.1080/15374416.2017.1417860 Granato, M. F., Ferraro, A. A., Lellis, D. M., & Casella, E. B. (2018). Associations between Attention-Deficit Hyperactivity Disorder (ADHD) Treatment and Patient Nutritional Status and Height. Behavioural Neurology, 2018, 7341529. https://doi- org.ezp.waldenulibrary.org/10.1155/2018/7341529 please response to each.
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