Attention Deficit Hyperactivity Disorder (ADHD) negatively impacts teens and children as well as adults. ADHD is classified as the most generally identified mental disorder that affects children (Stahl, 2012). Children with this condition are hyperactive and incapable of regulating their impulses, and they have difficulty in concentrating. These conditions affect their home and school life. Although ADHD affects boys more than in girls, it is normally diagnosed during the early childhood years in elementary school when a child begins to experience inattentiveness (Stahl, 2012). Most of the mature people with ADHD symptoms are unable to manage their time, set clear objectives, being organized, and maintain a career. They also experience difficulties with substance use addiction, self-confidence, and maintaining a healthy relationship (Sulkes, 2017). In this paper, I will assess the case of 8 years Caucasian girl with Attention Deficit Hyperactivity Disorder. I will create three treatment regimens and adjust the regimen as required to attain the best result. Pharmacodynamics and pharmacokinetic factors will guide my treatment regimen.
Decision 1
Start Ritalin (methylphenidate) chewable tablets 10 mg orally in the morning.
Ritalin (methylphenidate) is regarded as the safest and effective nervous system stimulant that is mainly used to treat ADHD in both children and children. Ritalin improve the main symptoms of ADHD through lowering hyperactivity and therefore increase the ability of a child to pay attention, stay focused on any activity and manage behavior problems. Ritalin functions by increasing the concentration level of noradrenaline, especially dopamine, which acts by controlling a person emotional responses and their movement. The right balance of dopamine in a person body is important for both mental and physical wellbeing. However, the common side effect of Ritalin includes headache, sleeping problems, stomach aches, mood swing, loss appetite, and increase the level of heart rate and blood pressure. The objective of this treatment is to improve the level of Katie's participation in home and class activities and classwork tasks. I also expect the child will be able to relate better with her friends, parents, teachers, classmates, and siblings.
Delegate your assignment to our experts and they will do the rest.
When Katie’s parents brought her back to the clinic after four weeks, they reported that Katie’s inability to pay attention had reduced immensely during daybreak, and her overall academic performances have improved, and this was in line with our treatment objectives. However, Katie’s improvement lasts for a half a day, and she reverts to daydreaming and staring off into space, and she also experiences increased heart pulse rate, which was not in line with our anticipated results.
Decision 2
Change to Ritalin LA 20 mg orally daily in the morning
Ritalin LA is a long-lasting stimulant that increases attention and decreases hyperactivity and impulsiveness with the ADHD patient. This decision involves continuing the patient on the same medication but increasing the dosage to Ritalin LA 20mg. The previous impact of Ritalin 10mg lasted for a half a day, and therefore increasing the dosage will help to counteract symptoms for a whole day. Switching to Ritalin LA 20mg helps manage the cardiac symptom (Hodgkins et al., 2015).
The objective of this treatment is to help Katie manage the side effect of Ritalin “the funny feeling the heart,” which was proven by the increased pulse rate. Moreover, the increased dose help maintain the symptoms the whole day. When Katie visited the clinic after four weeks, her parents reported that her overall academic performance has gotten better, and she remains attentive the whole day, and the funny feeling in the heart has gone away. Upon a physical exam, the pulse rate is at 92, proving the medication effectiveness and in line with our expected outcome.
Decision 3
Maintain current dose of Ritalin LA and reevaluate in 4 weeks
Continue the patient with the same dosage since this medication has proven to cure all the client symptoms. At this stage, there is no need to change the medication or increase the dose quantity since it will predispose the patient to side effects without necessarily adding value to his health. There is no need to perform an EKG because the patient cardiac side effects have been resolved fully (Stahl & Mignon, 2012). The main objective of this treatment is improving client self-esteem, maintain focus, and improve self-reliance.
Ethical Considerations
A psychiatric-mental health nurse practitioner should observe several ethical considerations when treating a patient with ADHD. These considerations include confidentiality, informed consent, and competence. A medical practitioner should maintain effective communication when preparing a treatment regimen with the patient as well as patient parents. A medical practitioner should be competent to engage in an appropriate, respectful and trusting and stable informed consent with the client. Furthermore, a medical practitioner should maintain up-to-date empirical results of patient psychiatric treatments for future references.
References
Hodgkins, P., Setyawan, J. & Mitra, D.(2013). Management of ADHD in children across Europe: patient demographics, physician characteristics, and treatment patterns. Eur J Pediatr . 172: 895. https://doi.org/10.1007/s00431-013-1969-8
Lorena Fernández et al. (2015). Treatment of Children With Attention-Deficit/Hyperactivity Disorder (ADHD) and Irritability. Journal of the American Academy of Child & Adolescent Psychiatry . 54.1
Sondheimer, A. (2010). Ethics and child and adolescent psychiatry. Psychiatric Times. Retrieved from http://www.psychiatrictimes.com/child-adolescent-psychiatry/ethics-and-child-and-adolescent-psychiatry
Stahl, S. M., & Mignon, L. (2012). Stahl’s illustrated attention deficit hyperactivity disorder. New York, NY: Cambridge University Press.
Sulkes, S. B. (2017). Attention-deficit/hyperactivity disorder (ADD, ADHD). Kenilworth, NJ: Merck Manual Professional Version . Retrieved from https://www.merckmanuals.com /professional/pediatrics/learning-and-developmental-disorders/attention-deficit-hyperactivity-disorder-add,-ADHD
