NURS 6521 Decisions Making when Treating Psychological Disorders

NURS 6521 Decisions Making when Treating Psychological Disorders

NURS 6521 Decisions Making when Treating Psychological Disorders

 

Attentiondeficit hyperactivity disorder (ADHD) is one of the most prevalent neuropsychiatric disorders of childhood and adolescence and is associated with significant impairment in academic, social, and occupational functioning (Ng, 2017). “Neuroimaging studies indicate structural and functional abnormalities in multiple brain areas, including the frontal cortez, basal ganglia, brainstem, and cerebellum- regoins involved with regulating attention , impulsivity, and motor activity” (Rosenthal & Burchum, 2021, p. 250-251).

Case Scenario

My selected scenario describes an eight year old girl (Katie), who was referred to psychiatry by her primary care provider to be evaluated for ADHD. Background information consists of a completed Conner’s Teacher Rating Scale-Revised along with the teacher’s report. Katie exhibited inattention, forgetfulness, was easily distracted, had poor follow through, and struggled in spelling and math. The diagnosis is confirmed as attention deficit hyperactivity disorder-predominantly inattentive type.

First medication to be prescribed would be Ritalin 10mg chewable tablet every morning. Stimulants are the first line choice for treatment of ADHD (Rosenthal & Burchum, 2021). Intuniv would not be my choice for the patient as it is a nonstimulant medication. On the same lines, Wellbutrin XR is not considered a stimulant and has not been well studied in its safety and efficacy in children (Ng, 2017). Nonstimulants are less affective that stimulants and are considered second –choice drugs (Rosenthal & Burchum, 2021). The search for nonstimulant alternatives for the management of ADHD in children is ongoing. As many as 20% of patients do not respond to stimulants, and stimulants may also worsen comorbid sleep, mood, and anxiety disorders and lead to problems of misuse and diversion (Ng, 2017).

At the four week follow up visit, the teacher reports seeing improvement in her behavior and performance during the morning hours but little improvement through the afternoon. Katie also reports a “funny feeling in her chest” with a heart rate in the 130’s. Stimulants will produce a small increase in heart rate and blood pressure at recommended doses. In the absence of cardiovascular disease, this increase in heart rate and blood pressure lacks clinical significance (Rosenthal & Burchum, 2021). A provider at this point could do additional testing to rule out any heart defects or heart disease. Additionally, obtaining an EKG could be done to confirm rhythm and rate.

My choice would be to continue with the Ritalin in an extended release form.  I would then change the medication to Ritalin LA 20mg to be taken in the morning. Taking a long acting form of the medication will enable Katie to have positive effects for a longer duration which will sustain her focus and academic success throughout the school day.

The four week follow up with the Ritalin LA shows the medication is helping Katie throughout her school day and heart rate is within normal limits. I would maintain this current dosing of medication as it seems to be effective with no reported negative side effects at this time.

Other Considerations

As a provider, I would want documentation of testing done to rule of a learning disorder as some of Katie’s symptoms could also be attributed to this. Identifying a learning disorder in the presence of ADHD could change the course of treatment. Attention deficit hyperactivity disorder–predominantly inattentive presentation and specific learning disorder (SLD) are commonly co-occurring conditions (Friedman et al., 2019).  Children with ADHD and SLD are poorer responders to psychostimulant medications than those with ADHD alone (Friedman et al., 2019).

There also needs to be additional education for Katie’s parents, explaining the diagnosis of ADHD and the differences between the sub classifications; the predominately hyperactive-impulsive type, predominately inattentive type, or combined type. The parents currently deny the idea of ADHD because they do not have an accurate understanding of an ADHD diagnosis and that it can exist without the presence of hyperactivity.

 

References

Friedman, L. M., McBurnett, K., Dvorsky, M. R., Hinshaw, S. P., & Pfiffner, L. J. (2019). Learning disorder confers setting-specific treatment resistance for children with ADHD, predominantly inattentive presentation. Journal of Clinical Child & Adolescent Psychology, 49(6), 854-867. https://doi.org/10.1080/15374416.2019.1644647

Ng, Q. X. (2017). A systematic review of the use of Bupropion for attention-deficit/Hyperactivity disorder in children and adolescents. Journal of Child and Adolescent Psychopharmacology, 27(2), 112-116. https://doi.org/10.1089/cap.2016.0124

Rosenthal, L., & Burchum, J. (2021). Lehne’s Pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Elsevier Health Sciences.

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Discussion: Decision Making When Treating Psychological Disorders

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.

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

 Rubric Detail

Select Grid View or List View to change the rubric’s layout.

Content

Name: NURS_6521_Week8_Discussion_Rubric

• Grid View
• List View

		Excellent	Good	Fair	Poor
Main Posting		Points Range: 45 (45%) – 50 (50%) Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources. Supported by at least three current, credible sources. Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.	Points Range: 40 (40%) – 44 (44%) Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module. At least 75% of post has exceptional depth and breadth. Supported by at least three credible sources. Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.	Points Range: 35 (35%) – 39 (39%) Responds to some of the discussion question(s). One or two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Post is cited with two credible sources. Written somewhat concisely; may contain more than two spelling or grammatical errors. Contains some APA formatting errors.	Points Range: 0 (0%) – 34 (34%) Does not respond to the discussion question(s) adequately. Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible sources. Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness		Points Range: 10 (10%) – 10 (10%) Posts main post by day 3	Points Range: 0 (0%) – 0 (0%)	Points Range: 0 (0%) – 0 (0%)	Points Range: 0 (0%) – 0 (0%) Does not post by day 3
First Response		Points Range: 17 (17%) – 18 (18%) Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. . Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.	Points Range: 15 (15%) – 16 (16%) Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. . Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.	Points Range: 13 (13%) – 14 (14%) Response is on topic and may have some depth. Responses posted in the discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.	Points Range: 0 (0%) – 12 (12%) Response may not be on topic and lacks depth. Responses posted in the discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Second Response		Points Range: 16 (16%) – 17 (17%) Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. . Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.	Points Range: 14 (14%) – 15 (15%) Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.	Points Range: 12 (12%) – 13 (13%) Response is on topic and may have some depth. Responses posted in the discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. . Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.	Points Range: 0 (0%) – 11 (11%) Response may not be on topic and lacks depth. Responses posted in the discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Participation		Points Range: 5 (5%) – 5 (5%) Meets requirements for participation by posting on three different days.	Points Range: 0 (0%) – 0 (0%)	Points Range: 0 (0%) – 0 (0%)	Points Range: 0 (0%) – 0 (0%) Does not meet requirements for participation by posting on 3 different days
Total Points: 100

Name: NURS_6521_Week8_Discussion_Rubric