Posted: September 7th, 2024

Assessing and Treating Clients with ADHD

Walden University
NURS 6630N

Assessing and Treating Clients with ADHD
Introduction
Attention Deficit Hyperactivity Disorder (ADHD) is a condition that affects over 6.1 million children in the United States. The condition affects the social and academic life of a child. Symptoms of ADHD can be mild, moderate, and severe in both adults and children. One of the common symptoms of the condition is inattention. Children such as Katie experience challenges in their school work due to ADHD. Although the symptoms are not severe, it is essential to assess and treat a patient to avoid deterioration. The best medication among the three options is Ritalin (methylphenidate). One of the reasons for selecting the drug is that it has fewer side effects and it has sufficient evidence from previous studies (Madsen et al., 2019). The treatment will involve making a series of decisions while assessing the progress of the patient. It is also essential to observe ethical considerations such as the consent of the patient. The purpose of the paper is to provide a comprehensive description of various decisions and outcomes in the treatment of ADHD.
Decision #1
The first decision is to prescribe Ritalin (methylphenidate) chewable tablets 10mg orally in the morning.
Rationale
Ritalin is a preferred medication for the treatment of ADHD among children due to sufficient evidence that it is safe. Compared to the other available options, Ritalin has fewer side effects and it is more effective. PMHNP have also used the drug successfully as first-line medication (Solleveld et al., 2017). Therefore, it is one of the best options while beginning the treatment. ADHD, which causes learning abilities need medication such as Ritalin. One of the benefits of taking Ritalin is helping students to focus on their studies (Solleveld et al., 2017). According to previous studies, it generates 70-90 percent positive results in 80 percent of all patients.
Ritalin improves concentration, attention, and listening skills. It increases the level of dopamine in the brain thus boosting attention and focus. Dopamine is a neurotransmitter that affects concentration (Yoo et al., 2019). Ritalin helps improve the amount of dopamine and norepinephrine activity in the brain. It also hinders the reabsorption of the neurotransmitters in the brain (Stahl, 2013). One of the symptoms that Katie is suffering from is a lack of concentration on her classwork. Katie acknowledges that she is sometimes lost in thoughts until the teacher calls her name. Therefore, the medication is effective for her condition.
PMHNP prefers to prescribe Ritalin 10mg to children since it does not trigger negative side effects. Starting with a low dose is also important to ensure that sufficient time is available to monitor a child (Yoo et al., 2019). The organs such as the liver which are involved in processing drugs in children are still developing. Therefore, psychiatrists are careful to prescribe a low dose while beginning treatment. PMHNP can be held liable for prescribing a high dose that can cause adverse effects. For example, a high dose of Ritalin can cause tachycardia which can lead to death. In other cases, it can lead to drowsiness, blurred vision, and dizziness (Yoo et al., 2019). Clinicians should take precautions and assess patients to prevent negative effects.
The other two drugs, Wellbutrin 150mg orally daily and Ituiniv extended release 1mg orally at bedtime were not preferred drugs due to various reasons. Case studies indicate that Wellbutrin is not a first-line medication for treating ADHD especially among children (Lionarons et al., 2019). Additionally, Wellbutrin is an antidepressant that cannot achieve the specific goals of treating ADHD. Treatment of ADHD requires stimulants that are responsible for increasing dopamine in the brain. For example, Ritalin is a stimulant that helps increase dopamine levels in the brain (Stahl, 2013). ADHD patients require high levels of dopamine to boost their attention and focus. For example, the patient in the case study has attention problems. The teacher confesses that she is experiencing difficulties concentrating in class. Lionarons et al. (2019) state that dopamine also helps improve focus which can help the patient to start and complete tasks such as homework. One of the complaints of the teacher is that Katie does not complete her homework. Intuiniv is also not a preferred medication since there is insufficient data to justify its safety in children (Storebo et al., 2018). It is also a non-stimulant and thus it cannot generate the necessary results. Therefore, the two drugs are not effective and preferable in the treatment of ADHD in children.
Expected Outcomes
The expected outcomes are related to the current symptoms of the patient. It is expected that her concentration in classwork will improve gradually. For example, she should no longer get lost in thought since according to Storebo et al. (2018) Ritalin improves the concentration span. She should also not get wandering thoughts that take her away from the class activities. Her focus should also improve gradually to ensure when she starts something she will surely finish it. Her ability to follow instructions should also improve consistently as she continues to take the medication. According to Storebo et al. (2018), Ritalin is an effective drug that improves the concentration and focuses on ADHD patients. Her attention span should also increase significantly. Other improvements that she should make include remembering things she has learned, boost her spelling and reading capabilities. It is also important that after four weeks of taking the medication, the patient should stop staring. Overall, Katie should experience an improvement in her academic performance.
The drug may also trigger some negative outcomes such as increased heart rate. Other effects include dizziness and drowsiness. Therefore, when the client resumes to the clinic, it is important to carry out an assessment. Katie’s parents should also be informed about the side effects of the drug. Educating the parents is also a way of ensuring they consent to the medication. Ethical considerations indicate that PMHNP should inform parents of children below 18 years about the medication they are prescribing (Storebo et al., 2018).
Projected Outcomes vs. Results
The child should report back to the clinic after 4 weeks. When the 9-year old girl comes back, there is a need to carry out several assessments such as heart rate. It is also critical to ask some questions about the progress and compliance with the medication.
The assessment shows that the patient has made considerable progress. According to a teacher’s report submitted during the clinic, the student has improved in various areas. They include concentration in class since she is no longer experiencing wandering thoughts. Katie has also improved in terms of completing homework and other tasks in school. Her reading and spelling capabilities have also improved significantly. Her memory about what she learned before is also better compared to four weeks ago.
The teacher’s report also indicates that symptoms worsen as the day progresses. Also, the patient has a high heart rate is 130 whereas at her age it should be between 70 and 110. Tachycardia is an indication of a drug overdose. Therefore, it is important to change the dose in the second decision to avert such negative effects.
Decision #2 .
The second decision is to prescribe Ritalin chewable tablets 5mg QID.

Rationale
The current medication, Ritalin is generating the expected outcomes. Therefore, it is not prudent to change the drug. Stahl (2013) also recommends that PMHNP should be careful in abruptly changing medications since they can trigger negative effects. Medication for ADHD may also take time before they trigger the full recovery of a patient. The heart rate is also one of the expected outcomes and thus it cannot be the basis for changing the drug (Barragán et al., 2017). For example, Adderall is one of the best medications that PMHNP can use when Ritalin does not work. However, it is not a preferred option since the current drug is already helping the patient to improve various symptoms (Barragán et al., 2017). It is also expected that the patient will record better progress in the next four weeks.
The heart rate or tachycardia is risky especially in children since it can cause death. It is thus important to adjust the dose but maintain the medication. For example, changing the drug from 10mg to 5mg is one of the best options (Martin et al., 2019). The patient should take the medication several times a day to suppress the negative outcomes, at most four times (Martin et al., 2019). According to the previous report from the teacher, the symptoms worsen as the day progresses. Therefore, it will be crucial to take the medication more times in a day to avoid any progression of the symptoms.
Taking the medication four times a day will ensure that Katie can concentrate in school throughout the day. It will also help her to increase her memory, concentration span, and avoid wandering thoughts (Martin et al., 2019). Taking 5mg four times a day will also help to complete tasks such as homework and stop staring while in class.

Expected Outcomes
Katie should return to the clinic for an assessment of her condition. One of the expected outcomes, when she comes back, is that her heart rate will be within the normal range. A high heart rate is dangerous for a child since it can cause death (Lionarons et al., 2019). When the heart rate is within the normal range it will be important since the patient will be out of danger. PMHNP who cause the death of a child for prescribing the wrong medication or an overdose are liable for their actions (Stahl, 2013). Another major expectation is that the patient will improve in academic performance. The performance is measured in terms of completing assignments, improving concentration span, spelling, learning abilities, and memory. For example, the teacher’s report should indicate that Katie is no longer staring in class. Previously, the symptoms were deteriorating as the day progresses. However, in the next four weeks of taking Ritalin 4mg QID, the patient should remain stable throughout the day.
Projected Outcomes vs. Results
When the patient reports back to the clinic, it is clear from her appearance and presentation that she has made significant progress. According to the teacher’s report, the student has made significant progress in class. For example, she is no longer experiencing wandering thoughts. Katie also concurs with the teacher’s report that she is always focusing and concentrating in class. She states that “I no longer experience wandering thoughts like I did before I started treatment.” The testimony is an indication that the medication is working. However, according to the report, the student is yet to improve the completion of homework tasks, especially during weekends. It is expected that the student will continue making significant progress.
The parents and the teacher also indicate that the patient has been taking the medication consistently. Non-compliance with medications for mental disorders is risky, especially for children since it can cause a relapse. A relapse can trigger negative effects and lengthen the recovery period. Katie’s teacher is also optimistic that if she continues to take the medication for another four weeks, she will record a significant improvement or full recovery.
An assessment report shows the heart rate is 92, which is within the normal range. The expectation was to reduce it below 100, which has been achieved. Therefore, Katie can continue taking the medication without any fear that her life is at risk.
The symptoms also did not deteriorate as the day went by thus enabling Katie to focus on her studies. It is also important to mention that the patient did not experience any weight changes. Other side effects such as drowsiness and dizziness were only minor and did not affect her studies.
Decision #3
The third decision is to prescribe Ritalin chewable tablets 5mg orally QID.
Rationale
It is important to continue with the medication since it is generating the expected outcomes. The drug was essential in helping Katie to improve her concentration in class, stop staring, complete tasks in class, boost her learning, spelling, and memory (Madsen et al., 2019). It is evident from the teacher’s report that the patient is making considerable improvement (Madsen et al., 2019). The dosage should also remain at 5mg to keep her out of danger. The assessment shows the heart rate is within the normal range. Therefore, an EKG or other diagnostic tests are not essential at this stage.
Adding another drug to the treatment plan is not prudent since polypharmacy is not encouraged in the treatment of mental disorders (Stahl, 2013). A combination of drugs can cause negative drug interaction thus undermining the recovery. It can also cause other side effects such as weight gain, vomiting, nausea, and dizziness which can interfere with her academics (Solleveld et al., 2017).
Expected Outcomes
The expected outcomes include improvements in academic performance. For example, she should continue recording gradual progress in completing academic tasks such as homework. She also not stare, but improve the concentration span. The patient should also record a better memory in the various lessons she learned before since Ritalin improves memory (Solleveld et al., 2017). She also has a better memory, learning ability, and spelling.
Katie should also continue taking the medication for another four weeks. It is expected that despite the improvements, she will not stop taking the medication. At this point, PMHNP should educate parents on the need to continue taking the medication despite the significant progress. Non-compliance can lead to negative outcomes such as relapse (Solleveld et al., 2017). Education materials should also be provided to caution them to avoid providing any other medication unless the current one is not functioning (Yoo et al., 2019). The prescription should also be through a registered PMHNP.
Ethical Considerations
Treatment of patients with ADHD requires various ethical considerations. One of the critical ones is to gain the consent of the parents. The child is below 18 years and thus the consent of treatment is through the parents (Stahl, 2013). Ethical code of conduct indicates that patients should not be treated against their will. However, to ensure coercion does not take place, the parents should give informed consent. After assessing the condition of the patient, it is important to brief the parents on the diagnosis, possible treatment options, and their impact and side effects (Yoo et al., 2019). Education materials can also be provided to the parents to ensure they learn more about the condition.
PMHNP should utilize their knowledge to prescribe the best medication. They should minimize the harm that medication can have on patients. For example, some medications such as Wellbutrin can trigger negative effects (Storebo et al., 2018). Healthcare workers should also ensure they assess patients and make critical decisions that will aid in improving the health and safety of a patient. For example, when Katie had a tachycardia, it was important to reduce the dose to keep her out of danger.
Healthcare providers should ensure patient data confidentiality. Confidentiality is important to enhance patient trust. HIPPA laws also indicate that clinicians are liable for any action to expose patient data to other people without the consent of a patient (Storebo et al., 2018). Ethical considerations are important in ensuring the treatment plan is professional, safe, and effective.
Conclusion
Treatment of ADHD in children is a process that practitioners should take with caution. The first stage of prescribing medication will involve a low dose and a safe medication. Ritalin is one of the best medications that PMHNP utilizes daily to treat ADHD conditions in patients. The medication is preferred since it has minimal side effects. For example, in the case of Katie, an 8-year-old girl, the medication only triggered tachycardia which was later controlled. Healthcare workers should also ensure they provide the necessary support such as educational materials to parents. They should also observe ethical issues that will be effective in providing safe treatment. PMHNP should strive to provide quality care to patients, minimize side effects, change the dosage when necessary, and observe ethical considerations.

References
Barragán, E., Breuer, D., & Döpfner, M. (2017). Efficacy and safety of omega-3/6 fatty acids, methylphenidate, and combined treatment in children with ADHD. Journal of Attention Disorders, 21(5), 433-441. https://doi.org/10.1177/1087054713518239
Lionarons, J. M., Hellebrekers, D. M., Klinkenberg, S., Faber, C. G., Vles, J. S., & Hendriksen, J. G. (2019). Methylphenidate use in males with Duchenne muscular dystrophy and a comorbid attention-deficit hyperactivity disorder. European Journal of Paediatric Neurology, 23(1), 152-157. https://doi.org/10.1016/j.ejpn.2018.09.005
Madsen, M. B., Kaalund-Brok, K., Jeppesen, P., Pagsberg, A. K., Houmann, T., Plessen, K., … & Rasmussen, H. (2019). Pharmacogenomics of Methylphenidate Treatment of Danish Children With ADHD. European Neuropsychopharmacology, 29, S868. https://doi.org/10.1016/j.euroneuro.2017.08.157
Martin, J., Brikell, I., Ghirardi, L., Taylor, M., Riglin, L., Eyre, O., … & Lichtenstein, P. (2019). The Manifestation of Genetic Risk For Attention Deficit Hyperactivity Disorder In Females And Males In The General Population. European Neuropsychopharmacology, 29, S723-S724. https://doi.org/10.1016/j.euroneuro.2017.06.040
Solleveld, M. M., Schrantee, A., Puts, N. A., Reneman, L., & Lucassen, P. J. (2017). Age-dependent, lasting effects of methylphenidate on the GABAergic system of ADHD patients. NeuroImage: Clinical, 15, 812-818. https://doi.org/10.1016/j.nicl.2017.06.003
Stahl, S. M., & Stahl, S. M. (2013). Stahl’s essential psychopharmacology: neuroscientific basis and practical applications. Cambridge university press.
Storebo, O. J., Pedersen, N., Ramstad, E., Kielsholm, M. L., Nielsen, S. S., Krogh, H. B., … & Skoog, M. (2018). Methylphenidate for attention deficit hyperactivity disorder (ADHD) in children and adolescents–assessment of adverse events in non-randomized studies. Cochrane Database of Systematic Reviews, (5). https://doi.org/10.1002/14651858.CD012069.pub2
Yoo, J. H., Sharma, V., Kim, J. W., McMakin, D. L., Hong, S. B., Zalesky, A., … & Ryan, N. D. (2019). Prediction of sleep side effects following methylphenidate treatment in ADHD youth. NeuroImage: Clinical, 102030. https://doi.org/10.1016/j.nicl.2019.102030

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