Treatment options for Attention Deficit Hyperactivity Disorder
Attention Deficit Hyperactivity Disorder (ADHD) is one of the neurodevelopmental disorders that affect children. In childhood, the condition affects the mood, behavior, and cognitive ability of the patient (Sayal et al., 2018). A patient with ADHD may present with signs such as aggression, fidgeting, hypersensitivity, lack of restrain, and absentmindedness (Childress, 2016). Additionally, the patient may equally be forgetful and have difficulty paying attention. Although the condition manifests in children, it may persist to adulthood if it is not properly managed. Nurses and other healthcare service providers should understand the treatment therapies available for patients with ADHD. The paper presents the treatment therapy for a young Caucasian girl suffering from ADHD.
Decision Point 1
In this first decision, the options available for the patient include bupropion, Intuniv, and Ritalin. The decision that is appropriate for the patient is the prescription of Ritalin chewable tablets every morning. Ritalin inhibits the reuptake of dopamine (Childress, 2016). Through the inhibition, the dopamine is accessible in the frontal lobe of the cerebral cortex. Being a stimulant, the medication may have a positive outcome on the patient.
Although Intuniv is a medication that is recommended for patients with Attention Deficit Hyperactivity Disorder, it may not be the best option in the presented patient scenario because of the side effects that it may have on the patient compared to Ritalin (Leahy, 2018). Some of the adverse side effects of the medication that might affect the patient include sedation and hypersensitivity. Wellbutrin is a medication that is effective in the improvement of the signs and symptoms of Attention Deficit Hyperactivity Disorder (Childress, 2016). However, compared to Ritalin, the medication cannot be an appropriate option because it is not a stimulant (Leahy, 2018). ADHD management requires the use of stimulant medications because of their efficacy.
By selecting the medication, anticipated an improvement in the signs and symptoms of the patient. I anticipated improvement in the patient’s mood, behavior, and cognitive ability while at school. After four weeks, the patient returned to the healthcare facility. The patient’s parents stated that her symptoms had improved especially in the morning. However, the patient displayed symptoms of daydreaming in the afternoon hours. The patient has a heart rate of 130 beats per minute.
Decision Point 2
The treatment decision available for the patient includes the decision to continue the same dose of Ritalin for 4 weeks, the decision to change to Ritalin LA 20mg orally in the morning, and the decision to discontinue Ritalin and begin Adderall. The best decision is to change to Ritalin LA 20mg orally in the morning. Being that the patient has started displaying an improvement with the use of Ritalin therapy, continuing the medication is important (Leahy, 2018). However, the symptoms that the patient displays in the afternoon demand a change of the dosage from 10mg to 20mg. The decision to continue the same dose of Ritalin and re-evaluate the patient after 4 weeks is inappropriate because the dosage does not solve the symptoms exhibited by the patient in the afternoon hours. Discontinuing the Ritalin and beginning Adderall may not be an appropriate decision because the patient had started improving.
By choosing to change to Ritalin 20mg orally daily in the morning, I anticipate further improvement in the patient’s symptoms including the symptoms displayed in the afternoon hours. I equally look forward to educating the patient’s parents about the side effects of Ritalin such as the increased heart rate. The results of the decision include an improvement in the patient’s performance at school. The medication is equally lasting the patient throughout the day. Her heart rate is equally back to normal.
Decision Point 3
The third decision point available for the patient includes maintaining the current dose of Ritalin LA, increasing the dosage to 30mg orally daily, and obtaining EKG based on the patient’s current heart rate. Maintaining the current dosage of the medication (Ritalin 20mg) as the patient is evaluated is important. Increasing the patient’s dosage to 30mg may present other side effects (Pfiffner & DuPaul 2015). Besides, the patient is recording great improvements with the currently prescribed medication. Checking the patient’s heart rate may not be an appropriate decision since the heart rate is back to normal.
By deciding to continue with the current prescription, I anticipate seeing further improvements in the patient’s ADHD symptoms. The best results can only be achieved if the patient adheres to the prescribed medication. The education of the parents on the importance of monitoring adherence to medications is elementary.
Ethical Considerations
The most important ethical consideration in the provided case study is the proper education of the patient’s parents about the prescribed medications. The decision is important because the patient may not be able to understand the reasons why the medications are prescribed. The parents should be educated on the side effects of the medication. Due to the patient’s age, it is not appropriate to let him make critical clinical decisions.
References
Childress, A. C. (2016). Methylphenidate HCl for the treatment of ADHD in children and adolescents. Expert opinion on pharmacotherapy, 17(8), 1171-1178.
Leahy, L. G. (2018). Diagnosis and treatment of ADHD in children vs adults: What nurses should know. Archives of psychiatric nursing, 32(6), 890-895.
Pfiffner, L. J., & DuPaul, G. J. (2015). Treatment of ADHD in school settings.
Sayal, K., Prasad, V., Daley, D., Ford, T., & Coghill, D. (2018). ADHD in children and young people: prevalence, care pathways, and service provision. The Lancet Psychiatry, 5(2), 175-186.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.