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Decision #1
3 This decision is basically designed for start up medication for patients with Attention Deficit Hyperactive Disorder. 1 Several drugs have been advanced towards solving the medical condition. However, the best decision is starting Ritalin (methylphenidate) chewable tablets 10 mg orally in the morning. Ritalin is an FDA approved medication for ADHD in children as well as in adult (Stahl,2017). It is also refers to as stimulants. It increases norepinephrine action especially dopamine action by blocking its reuptake. 4 It also enhances dopamine and norepinephrine actions in certain brain regions (e.g dorsolateral prefrontal cortex) may improve attention, concentration, executive function and wakefulness (Stahl,2017). The usual dose range is usually up to 2mg/kg pe day in children 6years and older with a maximum daily dose of 60mg per day. However, the dosing of Ritalin is dependent on the form of the Ritalin as it come in different forms. There are immediate release, sustained release and Extended release form of Ritalin. Also, the right dose varies from child to child. The initial dose of the immediate release form provided in this case study is 5mg in the morning and 5mg at lunch time and can be increased by 5-10mg each week with a maximum dose of 60mg/day. 5 According to Anna and Thomas (2012), Stimulants are approved by FDA to treat ADHD in children and adolescent and are considered first- line pharmacological agents in the treatment of ADHD. Since this is the first time presenting to the PMHNP office for the treatment of ADHD, starting the patient of first-line pharmacological agent for the treatment this condition will be an ideal selection, Also, according to Stahl (2017), the therapeutic effect of Ritalin can be felt with the first dosing of the medication as the child attends school and school is still in session. It’s considered effective and relatively safe and side effect are usually mild and short lived and only occur early in treatment.
Intuniv is non stimulant FDA approved medication for ADHD in children age 6-17 years. According to Stahl (2017), it has central action on postsynaptic alpha2 receptors in the prefrontal cortex. It is also beneficial for children with ADHD who also has tics and sleep problem. It is not a controlled substance unlike Stimulants. The initial dose is 1 mg per day and can increased by 1mg per week. Its not good choice for this patient at this time because it takes several weeks before it therapeutic effect can be felt. Also, according to Annali (2020), Intuniv is an option that should be considered either as an adjunct to other ADHD medications or as monotherapy when the client’s current medication is not working well or when a patient has not able to tolerate stimulants. appropriate for Katie since it has fatal side effects that can affect her performance. It causes sluggish behavior in a person during the morning hours and has drowsiness side effect thus will affect how Katie wakes up in the morning therefore not suitable for her and school schedule.
6 Bupropion (Wellbutrin) is an antidepressant and it a non-FDA approved prescription for the treatment of ADHD. Wellbutrin is a norepinephrine and dopamine reuptake inhibitor and it works by keeping the neurotransmitters dopamine available to the brain’s neuron for longer. This helps to improve concentration, focus and other symptoms of ADHD (Jacquelin, 2020). Wellbutrin comes in three forms, Wellbutrin, Wellbutrin SR and Wellbutrin XL. 6 According to Jacqueline (2020), The Wellbutrin XL is usually prescribed for ADHD as adjunct to patient experiencing depression with ADHD or when stimulants are not effective, so that the medication is effective throughout the day and the possibility of side effect is reduced. It is also considered a second line pharmacological treatment for ADHA. Bupropion is not suitable for children and has been linked with suicidal thoughts in children as well as adolescents therefore it is not a choice in this case. Also, it is not FDA approved medication for children under the age of 17 years. Ritalin would be the most appropriate medicine in this case since it’s a stimulant and considered as a first-line pharmacological agent for the treatment of ADHD. the side effects regarding tachycardia can be associated with the immediate release Ritalin.
7 The results I expected were an improvement or rather a slight difference in what was recorded before the patient started the medication. 1 At the introduction of this dosage, the patient will start experiencing an improvement in her predominant inattentive presentation. 8 To some level, it is anticipated that she will have an elongated time span of attention while paying attention to everything; 1 not just what she is interested. 3 The oral dosage of Ritalin (methylphenidate) is a good recommendation for the problem and no doubt few symptoms would be worked out with this therapy because this is just a start.
1 The expectations that there would be some changes were slightly corresponded to the outcome. 3 When the patient along with her parents made a visit to the physician after the four weeks of medication, it was reported, form what her teacher recorded, that the patient had improved in her general performance in academics. 8 This means the drug was at least effective for morning sessions but still something had to be done because in the afternoon, the symptoms get back as Patient starts daydreaming again and staring into space. 3 This was a necessity for another option to be met.
Decision #2
From the report at the 4 week’s visit, it is evidence that the patient is experiencing the therapeutic effect of Ritalin but for a short period. The teacher could testify to the reduction of the symptoms of inattentiveness, motor hyperactivity and impulsiveness that disrupt social activities which only last till mid-day and also experiencing the side effect of the medication which is tachycardia. At this point a Ritalin LA 20mg is an appropriate choice this patient at this time. According to Stahl (2017), switching to another formulation or adjusting the dose of the medication is appropriate when the medication is not giving the desired effect. 9 Long acting form of Ritalin is an extended release form of methylphenidate with a bi-modal release profile (Ianneli,2020). 10 Ritalin LA 20 mg orally daily that is taken in the morning. It has up to 8 hours duration of action. Ritalin LA releases in halves, 50% of the medication is released immediately to peak in the morning while the other 50% to peak in the afternoon. 3 This definitely could be the most effective therapeutic approach towards the patient. This will help to reduce the symptoms of ADHD throughout the day to aid concentration in school and also aid the patient academic performance as well as reducing the severity of the side effect.
Discontinuation regarding immediate release Ritalin to immediate Release Adderall is not efficient since it can be related with similar side effects as those of the dosage of Ritalin in decision one. Adderall belong to the same Stimulant class as Ritalin. The initially dose of Adderall XR is 10mg/day. It has the same duration of action as Ritalin. Nonetheless, maintaining the same of dose of Ritalin is considered to not be efficient because it not addressing the concern of the patient and the teacher as the efficiency does not last throughout the day at school to maintain the attentiveness of the school girl and according to Stahl (2017), it is appropriate to switch to another formulation or adjust the dose if the patient is not receiving the desired side effect.
It is anticipated that patient’s attention span will be improved for at least 8 hours which probably covers the entire time she will be in school. 8 She daydreams, stares a lot in space and could be at risk of hallucinating under no influence though she is oriented time, place, person and event oriented. 3 The high rate of heartbeat of 130 beats per minute which is one of the side effect of stimulant is just too unbearable. It is expected there would be at least a decrease in the same and more improvements in the mentioned symptoms.
1 The gradual changes that were expected from administering the new drug to the patient were not closest to what was exhibited at the end of the prescribed medication period. After four weeks of Ritalin LA 20 mg orally administration, there was a notable change in the symptoms. 3 The most tremendous results of the medication was the rate of the heartbeat that had reduced to 92 from the previous record of 130 per minute. It is however not imaginable that the new dose of Ritalin LA 20 mg orally keeps the patient normally functioning throughout a school day. This was not the case in the previous days when she could be okay in the morning but remains disturbed the remaining fraction of the day. Her heart does not feel funny anymore.
Decision #3 The third decision is not a different approach compare to the other prior medication because there are no special cases of persistent symptoms that have not been affected positively by the previous medications. 1 Maintaining the current dose of Ritalin LA ad having the patient reevaluated in four weeks would work better.
3 Whenever the prescribed dosage does not impact a patient in any positive manner, there must be changes. Sometimes there can be reduction of increase of dosage from the previous prescriptive medications. However, in this case there is no need to have the quantitative or qualitative changes in the drug administration because the medication therapy seems helpful to the patient. There is no evidence that states the need to have a STAT EKG since Katie’s pulse is 92 which is normal pulse for her age. There are no irregular nor abnormal signs regarding her cardiac activity noted.
3 Since the medication has exhibited positive effect to the eight-year old patient, continued administration of the same dosage is preferable. This means there would be improvements in the symptoms and eventually the diminishing of the disorder. The patient requires to be directed on the appropriate use of the drug for there might arise side effects of the treatment measures.
1 The patient has shown total improvement in her symptoms and therefore there is need to use the same medication but under the necessary prescriptions of health professional. The Patient’s attention has gained stability throughout the school day. 3 These results may not call for any more alterations in the dosage as to whether there should be an increase or reduction of the dose. With the heartbeat, she is well if she maintained the current record in respect to her age.
7 Ethical considerations in treatment plan and communication with clients · Appropriate prescriptions for each level of disorder
11 In treatment of ADHD, this ethical consideration helps physicians to administer the most appropriate prescriptions to each case as whether mild, moderate of severe conditions of ADHD.
· Proper administration
12 This reminds physicians that patients should take the right course of drug administration ensuring they follow all instructions given (Eden, D. 2011). 13 For example, patients may need to take the drug with food or be subjected to taper dosage in cases of discontinuation of the drug. 2 Sometimes it could be a change in the type of medication being offered where there should be a shift from the previous drug.
· Modifications of dosage
13 Just like for prescriptions as discussed above, modifying the correct dosage for a given disorder is an ethical consideration. This may help nursing team to reduce the dosage as appropriate depending on the condition of the patient.
14 · Provision of Patient-education This is mostly knowledge about what to expect during the medication and after. This helps nurses to highlight potential side effects (Eden, D. 13 2011) of the prescribed treatment for patients to get to know what might happen in the end. 15 It also helps clients understand that they need to stick to a certain drug even when they do not want use it. Administering the medication in the morning or before 6:00pm when a dose is missed is more beneficial to the patient so as to prevent insomnia should also be well communicated with the patient and the mother. Also, knowledge about drug to drug interaction should be communicated to the patient and the mother.
References
Anna .B & Thomas. K, (2012). 5 Pharmacologic management of Attention deficit hyperactivity disorder in children and adolescent: A review for practitioners
16 Attention-Deficit Hyperactivity Disorder, Fourth Edition. (2014). s.l. Guilford Publications.
3 Feinstein, D., & Eden, D. (2011). 3 Ethics handbook for energy healing practitioners: A guide for the professional practice of energy medicine and energy psychology. Fulton, CA: 3 Energy Psychology Press.
Ianneli. V, (2020). 6 How can Non Stimulant treatment Intuniv can help Children with ADHD. https://www.verywellmind.com/intuniv-non-stimulant-adhd-medication-for-children-2633131
Jacquelin. S.,(2020). 6 Can I use Wellbutrin for ADHD. 17 Retrieved from https://www.verywellmind.com/using-wellbutrin-for-adhd-4137671
Mash, E. 3 J., & Wolfe, D. A. (2016). 3 Abnormal child psychology.
13 Resident & staff physician. (1969). 3 Port Washington, NY, etc. Romaine Pierson Publishers, etc.
Retz, W., & Klein, R. G. (2010). 3 Attention-deficit hyperactivity disorder (ADHD) in adults. Basel: Karger.
Silver, L. B. (2003). 3 Attention-Deficit/Hyperactivity Disorder: A Clinical Guide to Diagnosis and Treatment for Health and Mental Health Professionals. Arlington: 3 American Psychiatric Pub.
Stahl, S. M. (2014b). 18 The prescriber’s guide (5th ed.). 19 New York, NY: Cambridge University
The post 3 This decision is basically designed for start up medication for patients with Attention Deficit Hyperactive Disorder. 1 Several drugs have been advanced towards solving the medical condition. However, the best decision is starting Ritalin (methylphenidate) chewable tablets 10 mg orally in the morning appeared first on Infinite Essays.
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