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Attention Deficit Hyperactivity Disorder A Young Girl With ADHD BACKGROUND Katie

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Attention Deficit Hyperactivity Disorder
A Young Girl With ADHD
BACKGROUND
Katie is an 8-year-old Caucasian female who is brought to your office today by her mother & father. They report that they were referred to you by their primary care provider after seeking her advice because Katie’s teacher suggested that she may have ADHD. Katie’s parents reported that their PCP felt that she should be evaluated by psychiatry to determine whether or not she has this condition.
The parents give you a copy of a form titled “Conner’s Teacher Rating Scale-Revised”. This scale was filled out by Katie’s teacher and sent home to the parents so that they could share it with their family primary care provider. According to the scoring provided by her teacher, Katie is inattentive, easily distracted, forgets things she already learned, is poor in spelling, reading, and arithmetic. Her attention span is short, and she is noted to only pay attention to things she is interested in. The teacher opined that she lacks interest in school work and is easily distracted. Katie is also noted to start things but never finish them, and seldom follows through on instructions, and fails to finish her school work.
Katie’s parents actively deny that Katie has ADHD. “She would be running around like a wild person if she had ADHD” reports her mother. “She is never defiant or has temper outbursts” adds her father.
SUBJECTIVE
Katie reports that she doesn’t know what the “big deal” is. She states that school is “OK”- her favorite subjects are “art” and “recess.” She states that she finds her other subjects boring, and sometimes hard because she feels “lost”. She admits that her mind does wander during class to things that she thinks of as more fun. “Sometimes” Katie reports “I will just be thinking about nothing and the teacher will call my name and I don’t know what they were talking about.”
Katie reports that her home life is just fine. She reports that she loves her parents and that they are very good and kind to her. Denies any abuse, denies bullying at school. Offers no other concerns at this time.
MENTAL STATUS EXAM
The client is an 8-year-old Caucasian female who appears appropriately developed for her age. Her speech is clear, coherent, and logical. She is appropriately oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Self-reported mood is euthymic. Affect is bright. Katie denies visual or auditory hallucinations, no delusional or paranoid thought processes readily appreciated. Attention and concentration are grossly intact based on Katie’s attending to the clinical interview and her ability to count backward from 100 by serial 2’s and 5’s. Insight and judgment appear age-appropriate. Katie denies any suicidal or homicidal ideation.
Diagnosis: Attention deficit hyperactivity disorder, predominantly inattentive presentation
RESOURCES
§ Conners, C. K., Sitarenios, G., Parker, J. D. A., & Epstein, J. N. (1998). Revision and restandardization of the Conners’ Teacher Rating Scale (CTRS-R): Factors, structure, reliability, and criterion validity. Journal of Abnormal Child Psychology, 26, 279-291.
Decision Point One
Select what you should do:
Begin Wellbutrin (bupropion) XL 150 mg orally daily
Begin Intuniv extended release 1 mg orally at BEDTIME
Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING
Decision Point One
Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING
RESULTS OF DECISION POINT ONE
The client returns to the clinic in four weeks
Katie’s parents report that they spoke with Katie’s teacher who notices that her symptoms are much better in the morning, which has resulted in improvement in her overall academic performance. However, by the afternoon, Katie is “staring off into space” and “daydreaming” again
Katie’s parents are very concerned, however, because Katie reported that her “heartfelt funny.” You obtain a pulse rate and find that Katie’s heart is beating about 130 beats per minute
Decision Point Two
Change to Ritalin LA 20 mg orally daily in the MORNING
RESULTS OF DECISION POINT TWO
The client returns to the clinic in four weeks
Katie’s academic performance is still improved, and the switch to the LA preparation is lasting Katie throughout the school day
Katie’s reports of her heart feeling “funny” have gone away. Pulse was 92 during today’s office visit
Decision Point Three
Maintain current dose of Ritalin LA and reevaluate in 4 weeks
Guidance to Student
At this point, Katie’s symptoms are well controlled (her attention is sustained throughout the school day) and her side effects have gone away following change to a long-acting preparation. There is no indication at this point that the dose should be increased as it is always advisable to use the lowest effective dose of stimulant medication. Katie’s heart rate is appropriate for an 8-year-old girl and an EKG would not be indicated based on her heart rate.
Assignment: Assessing and Treating Patients With ADHD
Not only do children and adults have different presentations for ADHD, but males and females may also have vastly different clinical presentations. Different people may also respond to medication therapies differently. For example, some ADHD medications may cause children to experience stomach pain, while others can be highly addictive for adults. In your role, as a psychiatric nurse practitioner, you must perform careful assessments and weigh the risks and benefits of medication therapies for patients across the life span. For this Assignment, you consider how you might assess and treat patients presenting with ADHD.
To prepare for this Assignment:
Review this week’s Learning Resources, including the Medication Resources indicated for this week.
Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients with ADHD.
The Assignment: 5 pages
Examine Case Study: A Young Caucasian Girl with ADHD. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.
At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.
Introduction to the case (1 page)
Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.
Decision #1 (1 page)
Which decision did you select?
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #2 (1 page)
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #3 (1 page)
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Conclusion (1 page)
Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.
Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.
Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.
Rubric Detail
Select Grid View or List View to change the rubric’s layout.
Name: NURS_6630_Week9_Assignment_Rubric
Grid View
List View
Excellent
Point range: 90–100 Good
Point range: 80–89 Fair
Point range: 70–79 Poor
Point range: 0–69
Introduction to the case (1 page)
Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.
9 (9%) – 10 (10%)
The response accurately, clearly, and fully summarizes in detail the case for the Assignment.
The response accurately and clearly explains in detail the specific patient factors that impact decision making when prescribing medication for this patient.
8 (8%) – 8 (8%)
The response accurately summarizes the case for the Assignment.
The response accurately explains the specific patient factors that impact decision making with prescribing medication for this patient.
7 (7%) – 7 (7%)
The response inaccurately or vaguely summarizes the case for the Assignment.
The response inaccurately or vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient.
0 (0%) – 6 (6%)
The response inaccurately and vaguely summarizes the case for the Assignment, or is missing.
The response inaccurately and vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient.
Decision #1 (1–2 pages)
• Which decision did you select?
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
18 (18%) – 20 (20%)
The response accurately and clearly explains in detail the decision selected.
The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected.
The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response.
The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response.
The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients.
Examples provided fully support the decisions and responses provided.
16 (16%) – 17 (17%)
The response accurately explains the decision selected.
The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected.
The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response.
The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response.
The response accurately explains how ethical considerations impact the treatment plan and communication with patients.
Examples provided support the decisions and responses provided.
14 (14%) – 15 (15%)
The response inaccurately or vaguely explains the decision selected.
The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected.
The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response.
The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response.
The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients.
Examples provided may support the decisions and responses provided.
0 (0%) – 13 (13%)
The response inaccurately and vaguely explains the decision selected.
The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing.
The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing.
The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing.
The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing.
Examples provided do not support the decisions and responses provided, or is missing.
Decision #2 (1–2 pages)
• Which decision did you select?
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
18 (18%) – 20 (20%)
The response accurately and clearly explains in detail the decision selected.
The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected.
The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response.
The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response.
The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients.
Examples provided fully support the decisions and responses provided.
16 (16%) – 17 (17%)
The response accurately explains the decision selected.
The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected.
The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response.
The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response.
The response accurately explains how ethical considerations impact the treatment plan and communication with patients.
Examples provided support the decisions and responses provided.
14 (14%) – 15 (15%)
The response inaccurately or vaguely explains the decision selected.
The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected.
The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response.
The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response.
The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients.
Examples provided may support the decisions and responses provided.
0 (0%) – 13 (13%)
The response inaccurately and vaguely explains in detail the decision selected.
The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing.
The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing.
The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing.
The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing.
Examples provided do not support the decisions and responses provided, or is missing.
Decision #3 (1–2 pages)
• Which decision did you select?
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
18 (18%) – 20 (20%)
The response accurately and clearly explains in detail the decision selected.
The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected.
The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response.
The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response.
The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients.
Examples provided fully support the decisions and responses provided.
16 (16%) – 17 (17%)
The response accurately explains the decision selected.
The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected.
The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response.
The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response.
The response accurately explains how ethical considerations impact the treatment plan and communication with patients.
Examples provided support the decisions and responses provided.
14 (14%) – 15 (15%)
The response inaccurately or vaguely explains the decision selected.
The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected.
The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response.
The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response.
The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients.
Examples provided may support the decisions and responses provided.
0 (0%) – 13 (13%)
The response inaccurately and vaguely explains in detail the decision selected.
The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing.
The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing.
The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing.
The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing.
Examples provided do not support the decisions and responses provided, or is missing.
Conclusion (1 page)
• Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.
14 (14%) – 15 (15%)
The response accurately and clearly summarizes in detail the recommendations on the treatment options selected for this patient.
The response accurately and clearly explains a justification for the recommendations provided, including clinically relevant resources that fully support the recommendations provided.
12 (12%) – 13 (13%)
The response accurately summarizes the recommendations on the treatment options selected for this patient.
The response accurately explains a justification for the recommendation provided, including clinically relevant resources that support the recommendations provided.
11 (11%) – 11 (11%)
The response inaccurately or vaguely summarizes the recommendations on the treatment options selected for this patient.
The response inaccurately or vaguely explains a justification for the recommendations provided, including clinically relevant resources that inaccurately or vaguely support the recommendations provided.
0 (0%) – 10 (10%)
The response inaccurately and vaguely summarizes the recommendations on the treatment options selected for this patient, or is missing.
The response inaccurately and vaguely explains a justification for the recommendations provided, including clinically relevant resources that do not support the recommendations provided, or is missing.
Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.
5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.
4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.
Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive.
3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.
Purpose, introduction, and conclusion of the assignment is vague or off topic.
0 (0%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided. Written Expression and Formatting - English writing standards: Correct grammar, mechanics, and proper punctuation 5 (5%) - 5 (5%) Uses correct grammar, spelling, and punctuation with no errors. 4 (4%) - 4 (4%) Contains a few (1 or 2) grammar, spelling, and punctuation errors. 3.5 (3.5%) - 3.5 (3.5%) Contains several (3 or 4) grammar, spelling, and punctuation errors. 0 (0%) - 3 (3%) Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. Written Expression and Formatting - The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list. 5 (5%) - 5 (5%) Uses correct APA format with no errors. 4 (4%) - 4 (4%) Contains a few (1 or 2) APA format errors. 3.5 (3.5%) - 3.5 (3.5%) Contains several (3 or 4) APA format errors. 0 (0%) - 3 (3%) Contains many (≥ 5) APA format errors. Total Points: 100 Name: NURS_6630_Week9_Assignment_Rubric *7 Academic Sources needed*.

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