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Parents were concerned that the patient had reported her “heart felt funny” and noted a heart rate of 130 bpm in the clinic. During this visit, the medication was changed to Ritalin LA 20mg orally daily in the morning. This change will offer medication to be spread out over the day with a peak onset of four to seven hours and a duration of up to twelve hours (Davis’s Drug Guide, 2018).
After the patient returns for a follow-up visit in four weeks, the parents state improvement in the patients’ schoolwork and states medication is lasting throughout the day. The patient report that the heart feeling has gone away. This dose would be maintained for an additional four weeks with a medication check-up in the clinic.
Ritalin is the drug of choice for ADHD for the start of care and has proven efficacy (Rosenthal & Burchum, 2021). No studies suggest one drug over another, and therefore if the first drug seems ineffective, the clinician should start considering second-line medications (Rosenthal & Burchum, 2021). Stimulants have possible adverse effects such as insomnia and growth suppression (Rosenthal & Burchum, 2021).
Extended-release medications should be given as close to when the child wakes up to prevent insomnia as it will last up to twelve hours. If the child is experiencing decreased appetite, give medication after or during meals (Rosenthal & Burchum, 2021). Some providers recommend taking “drug holidays” where the child would not take medication on weekends; this is not recommended for all children (Rosenthal & Burchum, 2021).
References
Block, R., Macdonald, N. P., & Piotrowski, N. A. (2021). Attention deficit hyperactivity disorder (ADHD). Magill’s Medical Guide (Online Edition).
Davis’s Drug Guide. (2018). Davis’s drug guide for nurses (16th ed. ed.). F.A. Davis Company. Retrieved from Www.drugguide.com.: https://www.drugguide.com/ddo/mobile
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants (2nd Edition ed.). St. Louis, MO: Elsevier. Retrieved from vbk://9780323554954
Discussion: Decision Making When Treating Psychological Disorders NURS 6521
Psychological disorders, such as depression, bipolar, and anxiety disorders can present several complications for patients of all ages. These disorders affect patients physically and emotionally, potentially impacting judgment, school and/or job performance, and relationships with family and friends.
Since these disorders have many drastic effects on patients’ lives, it is important for advanced practice nurses to effectively manage patient care. With patient factors and medical history in mind, it is the advanced practice nurse’s responsibility to ensure the safe and effective diagnosis, treatment, and education of patients with psychological disorders.
Main Discussion Post:
Attention Deficit Hyperactivity Disorder
ADHD is one of the most widespread neuropsychiatric disorders of childhood and adolescents and is associated with substantial impairment in academic, social, and vocational performance (Ng, 2017). Multiple regions of the brain, including the frontal cortex, basal ganglia, brainstem, and cerebellum, are involved in controlling attention, impulsivity, and motor activity, as revealed by neuroimaging research (Rosenthal & Burchum, 2021, p. 250-251).
Case Scenario
Katie, an eight-year-old child, was referred to psychiatry by her primary care provider to be assessed for attention deficit hyperactivity disorder (ADHD). In addition to the teacher’s report, the completed Conner’s Teacher Rating Scale-Revised provides background information.
Katie displayed inattention, carelessness, was easily distracted, lacked persistence, and suffered in spelling and mathematics. The diagnosis is verified as inattentive-predominant attention deficit hyperactivity disorder.
First drug prescribed would be a morning dose of 10 mg of chewable Ritalin.
Stimulants are the initial therapeutic option for ADHD (Rosenthal & Burchum, 2021).
As a nonstimulant medicine, Intuniv would not be my first option for the patient. Similarly, Wellbutrin XR is not considered a stimulant and its safety and efficacy in youngsters have not been thoroughly investigated (Ng, 2017).
Nonstimulants are less effective than stimulants and are regarded as medications of second choice (Rosenthal & Burchum, 2021). The search for alternatives to stimulants for the treatment of ADHD in children continues. Twenty percent or more of patients
stimulants may exacerbate concomitant sleep, mood, and anxiety disorders, as well as contribute to overuse and diversion issues (Ng, 2017).
At the four-week follow-up appointment, the instructor notes that the student’s behavior and performance have improved in the morning but not in the afternoon. Katie describes a “strange feeling in her chest” and a heart rate of 130. At recommended doses, stimulants cause a little increase in heart rate and blood pressure.
This rise in heart rate and blood pressure has little clinical significance in the absence of cardiovascular illness (Rosenthal & Burchum, 2021). At this stage, a physician could perform additional tests to rule out heart abnormalities or heart disease. In addition, an EKG can be performed to validate rhythm and rate.
My preference would be to continue taking Ritalin in an extended release formulation. The medicine would subsequently be changed to 20 mg of Ritalin LA to be taken in the morning. Katie’s concentration and academic progress will be sustained throughout the school day if she takes a drug with a prolonged duration of action.
Katie’s heart rate is normal, and the four-week follow-up with Ritalin LA demonstrates that the medicine aids her during the school day. No adverse side effects have been documented at this point, therefore I would continue with the present dosage of this prescription as it appears to be effective with no reported adverse side effects.
Additional Considerations
Katie’s symptoms could possibly be attributable to a learning disability; therefore, as a provider, I would require confirmation of testing to exclude this possibility. detecting a learning issue in a student
The existence of ADHD could alter the treatment plan. Commonly co-occurring conditions include attention deficit hyperactivity disorder–predominantly inattentive presentation and specific learning disorder (SLD) (Friedman et al., 2019). Friedman et al. (2019) found that children with ADHD and SLD respond less favorably to psychostimulant drugs than those with ADHD alone.
Katie’s parents also require extra information regarding the diagnosis of ADHD and the distinctions between the subclassifications: predominantly hyperactive-impulsive, primarily inattentive, and mixed. The parents now reject the concept of ADHD because they lack an accurate understanding of the disorder and the fact that it can occur without hyperactivity.
References
Friedman, L. M., McBurnett, K., Dvorsky, M. R., Hinshaw, S. P., & Pfiffner, L. J. (2019).
For children with ADHD, predominantly inattentive presentation, a learning condition provides setting-specific resistance to treatment. 49(6):854-867 in Journal of Clinical Child & Adolescent Psychology. https://doi.org/10.1080/15374416.2019.1644647
Ng, Q. X. (2017). A systematic review of the usage of Bupropion in children and adolescents with attention deficit/hyperactivity disorder. 27(2), 112-116, Journal of Child and Adolescent Psychopharmacology. https://doi.org/10.1089/cap.2016.0124
Rosenthal, L., & Burchum, J. (2021). Advanced practice nurses and physician assistants use Lehne’s Pharmacotherapeutics (2nd ed.). The Elsevier Health Sciences journal.
Photo Credit: Getty Images/iStockphoto
For this Discussion, you will select an interactive media piece to practice decision making when treating patients with psychological disorders. You will recommend the most effective pharmacotherapeutic to treat the psychological disorder presented and examine potential impacts of pharmacotherapeutics on a patient’s pathophysiology.
To Prepare
Review this week’s interactive media pieces and select one to focus on for this Discussion.
Reflect on the decision steps in the interactive media pieces, and consider the potential impacts from the administration of the associated pharmacotherapeutics on the patient’s pathophysiology.
By Day 3 of Week 8
Post a brief explanation of the psychological disorder presented and the decision steps you applied in completing the interactive media piece for the psychological disorder you selected. Then, explain how the administration of the associated pharmacotherapeutics you recommended may impact the patient’s pathophysiology. How might these potential impacts inform how you would suggest treatment plans for this patient? Be specific and provide examples.
By Day 6 of Week 8
Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who selected a different interactive media piece on a psychological disorder, and provide recommendations for alternative drug treatments to address the patient’s pathophysiology.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
Submission and Grading Information
Grading Criteria
To access your rubric:
Week 8 Discussion Rubric
Post by Day 3 of Week 8 and Respond by Day 6 of Week 8
To Participate in this Discussion:
Week 8 Discussion
Week 8: Pharmacology for Psychological Disorders
How does an advanced practice nurse determine the best treatment option or pharmacotherapeutic to recommend for patients with psychological disorders?
Much like assessing or recommending pharmacotherapeutics for other conditions or disorders, as an advanced practice nurse, you may encounter a patient who presents with a psychological disorder. Understanding the guiding principles related to treating patients with psychological disorders as well as the effects of pharmacotherapeutics on a patient’s overall health and well-being is critical for the safe and effective delivery of care. Discussion: Decision Making When Treating Psychological Disorders NURS 6521
This week, you examine types of drugs prescribed to patients with psychological disorders. You also examine potential impacts of pharmacotherapeutics used to treat psychological disorders on a patient’s pathophysiology.
Learning Objectives
Students will:
Evaluate patients for treatment of psychological disorders
Analyze decisions made throughout the diagnosis and treatment of patients with psychological disorders
Analyze impacts of pharmacotherapeutics for psychological disorders on patient pathophysiology
Evaluate patients for treatment of neurological and musculoskeletal disorders
Analyze decisions made throughout the diagnosis and treatment of patients with neurological and musculoskeletal disorders
Justify decisions made throughout the diagnosis and treatment of patients with neurological and musculoskeletal disorders
Learning Resources
Required Readings (click to expand/reduce)
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
Chapter 26, “Antipsychotic Agents and Their Use in Schizophrenia” (pp. 203–213)
Chapter 27, “Antidepressants” (pp. 214–226)
Chapter 28, “Drugs for Bipolar Disorder” (pp. 228–233)
Chapter 29, “Sedative-Hypnotic Drugs” (pp. 234–242)
Chapter 30, “Management of Anxiety Disorders” (pp. 243–247)
Chapter 31, “Central Nervous System Stimulants and Attention-Deficit/Hyperactivity Disorder” (pp. 248–254)
Required Media (click to expand/reduce)
Laureate Education (Producer). (2019a). Adult geriatric depression [Interactive media file]. Baltimore, MD: Author.
In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat adult geriatric depression.
Laureate Education (Producer). (2019c). Attention deficit hyperactivity disorder [Interactive media file]. Baltimore, MD: Author.
In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat attention deficit hyperactivity disorder.
Laureate Education (Producer). (2019d). Bipolar therapy [Interactive media file]. Baltimore, MD: Author.
In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics for bipolar therapy.
Laureate Education (Producer). (2019g). Generalized anxiety disorder [Interactive media file]. Baltimore, MD: Author.
In this interactive media piece, you will engage in a set