NURS 6521 Discussion: Decision Making When Treating Psychological Disorders
NURS 6521 Discussion: Decision Making When Treating Psychological Disorders
A Sample Answer For the Assignment: NURS 6521 Discussion: Decision Making When Treating Psychological Disorders
This week I chose ADHD Attention-Deficit/Hyperactivity Disorder; both my children suffer from this disease, and I do not fully understand it. I do not feel they have ever gotten adequate treatment for it, and I have seen them struggle throughout childhood into adolescence with all aspects of life due to this partially understood disease.
ADHD affects 5% to 11% of school-aged children being the most common neuropsychiatric disorder of childhood (Rosenthal & Burchum, 2021, p. 251). This disorder affects boys more than girls by two-thirds (Rosenthal & Burchum, 2021). This disease is not well understood but is thought to have a genetic component related to a mutation of the dopamine D4 receptor gene (DRD4) or a variation of the catechol-O-methyltransferase gene (COMT) (Block et al., 2021). Clinical manifestations include inattention, hyperactivity, and impulsivity (Rosenthal & Burchum, 2021).
These individuals are frequently late, have forgetfulness in daily activities, distractibility, hyperactivity, and forgetfulness (Block et al., 2021). Not all these people will be hyperactive. Symptoms must be present before age twelve to be diagnosed (Block et al., 2021). These children cannot separate important stimuli from unimportant stimuli, which leads to difficulty staying on task and maintaining focus (Block et al., 2021). This disease may be related to brain development, including abnormalities in the “dopaminergic and noradrenergic neurotransmission system” (Block et al., 2021). Several other factors have been suggested to be a possible association with this disease that I will not be listed for this discussion.
The pharmacotherapeutics I chose for this patient’s pathophysiology started with Ritalin (methylphenidate) chewable tablet 10 mg orally in the morning. Eight-year-old female with a new diagnosis of ADHD and had not been on any medications in the past. On her first follow-up appointment four weeks after starting medication, her parents reported improvement in symptoms in the morning; however, the medication seems to be wearing off by the afternoon. 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).
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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
BACKGROUND INFORMATION
He admits that he still has problems with tightness in the chest and episodes of shortness of breath- he now terms these “anxiety attacks.” He will also report occasional feelings of impending doom, and the need to “run” or “escape” from wherever he is at. Generalized Anxiety Disorder Middle-Aged White Male With Anxiety NURS 6521
In your office, he confesses to occasional use of ETOH to combat worries about work. He admits to consuming about 3-4 beers/night. Although he is single, he is attempting to care for aging parents in his home. He reports that the management at his place of employment is harsh, and he fears for his job. You administer the HAM-A, which yields a score of 26.
Client has never been on any type of psychotropic medication.
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MENTAL STATUS EXAM
The client is alert, oriented to person, place, time, and event. He is appropriately dressed. Speech is
clear, coherent, and goal-directed. Client’s self-reported mood is “bleh” and he does endorse feeling “nervous”. Affect is somewhat blunted, but does brighten several times throughout the clinical interview. Affect broad. Client denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment is grossly intact, as is insight. He denies suicidal or homicidal ideation. Generalized Anxiety Disorder Middle-Aged White Male With Anxiety NURS 6521
You administers the Hamilton Anxiety Rating Scale (HAM-A) which yields a score of 26.
Diagnosis: Generalized anxiety disorder
RESOURCES
§ Hamilton, M. (1959). Hamilton Anxiety Rating Scale. Psyctests, doi:10.1037/t02824-0
Decision Point One
Select what you should do:
RESULTS OF DECISION POINT ONE
- Client returns to clinic in four weeks
- Client informs you that he has no tightness in chest, or shortness of breath
- according to NURS 6521 Discussion: Decision Making When Treating Psychological Disorders, client states that he noticed decreased worries about work over the past 4 or 5 days
- HAM-A score has decreased to 18 (partial response)
Decision Point Two
RESULTS OF DECISION POINT TWO
- Client returns to clinic in four weeks
- Client reports an even further reduction in his symptoms
- HAM-A score has now decreased to 10. At this point- continue current dose (61% reduction in symptoms)
Decision Point Three
Maintain current dose
Begin Tofranil (imipramine) 25 mg orally BIDRESULTS OF DECISION POINT ONE
- Client returns to clinic in four weeks
- Client reports a “slight” decrease in symptoms
- Client’s states that he no longer gets chest tightness, but still has occasional episodes of shortness of breath
- HAM-A score decreased from 26 to 22
Increase Tofranil to 50 mg orally BIDRESULTS OF DECISION POINT TWO
- Client returns to clinic in four weeks
- Client client reports that he was taken to the Emergency Room two weeks after the medication dose was increased. He was at work, and co-workers stated that he appeared to get “spacy” and lost consciousness. He states that the physician in the ER suggested that he stop taking the Tofranil because of an issue with his heart. The client brought a copy of his records from the ER, which included an EKG. The EKG shows right bundle branch block which was believed to have caused the clients syncopal episode. Generalized Anxiety Disorder Middle-Aged White Male With Anxiety NURS 6521
Restart Tofranil at 25 mg orally BIDGuidance to Student
NURS 6521 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.
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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.
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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