Therapy for patients with ADHD

Therapy for patients with ADHD: Katie is an 8 year old Caucasian female who is brought to your office today by her mother & father…

Therapy for patients with ADHD

Attention Deficit Hyperactivity Disorder

Attention Deficit Hyperactivity DisorderA 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 the PMHNP 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 outburst” 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 backwards 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 the PMHNP 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

Link to Case study:  https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6630/DT/week_09/1.html

Clinical Journal Reflection
As a PMHNP, I was involved in patient confrontation when the patient involved (an elderly female patient diagnosed with generalized anxiety disorder and manic depressive disorder). She was under our in-patient general surgical team following a head injury arising from a fall after she fell off a one-story house. During our ward round, she was told she was fit for discharge but was subject to a social services report recommending the installation of banisters in her house and at least have someone close to check on her. However, the patient was adamant that she did not have the money to install the banisters and could not let her family know about the fall. I felt frustrated and thought the lady would not understand why I could be of help to her in the matter of the social services report. On reflection, I also feel I could have taken some time and not rushed through my explanation.
Becoming a PMHNP is a fantastic choice because it is bound to accord me a chance to improve the elderly population’s mental health after giving their prime life to the service of the society they live in. The incidence and prevalence of chronic illness and comorbidities increase with advancing age, thus increasing the acuity of care among the elderly (Woo et al., 2017). The patient’s socio-economic status only serves to compound the challenging issues a psychiatric nurse practitioner has to grapple with, considering that mentally ill patients are already a vulnerable population requiring special legal and mental health rights to be upheld.

My personal and academic/professional goals for taking a course in the adult/geriatric population merge easily. They include offering care for patients with acute and chronic illnesses, competently facilitating discharge planning, and offering palliative care to those in need of it. The PMHNP’s goals are to provide comprehensive care that incorporates the adult/geriatric patients’ needs at the physical, social, emotional, cultural, and psychological levels.
A good or bad patient encounter triggers a succession of stages beginning with the situation (precisely what, where, and who), the PMHNP’s emotional state, making sense of the situational encounter, and critical analysis and development of insight arising from the situation. Having solid reasons for selecting PMHNP as a nursing specialty will give one the necessary job satisfaction and motivation, but having personal and professional overcome these challenges.

References
Koshy, K., Limb, C., Gundogan, B., Whitehurst, K., & Jafree, D. J. (2017). Reflective practice in health care and how to reflect effectively. International journal of surgery. Oncology, 2(6), e20.
Woo, B. F. Y., Lee, J. X. Y., & Tam, W. W. S. (2017). The impact of the advanced practice nursing role on quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: a systematic review. Human resources for health, 15(1), 1-22.