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The Assignment
Examine Case Study: A Young Caucasian Girl With ADHD You
will be asked to make three decisions concerning the medication
to prescribe to this client. Be sure to consider factors that might
impact the client’s pharmacokinetic and pharmacodynamic
processes.
At each decision point stop to complete the following:
At each decision point stop to complete the following:
· Decision #1
· Which decision did you select?
· Why did you select this decision? Support your response with
evidence and references to the Learning Resources.
· What were you hoping to achieve by making this decision?
Support your response with evidence and references to the
Learning Resources.
· Explain any difference between what you expected to achieve
with Decision #1 and the results of the decision. Why were they
different?
· Decision #2
· Why did you select this decision? Support your response with
evidence and references to the Learning Resources.
· What were you hoping to achieve by making this decision?
Support your response with evidence and references to the
Learning Resources.
· Explain any difference between what you expected to achieve
with Decision #2 and the results of the decision. Why were they
different?
· Decision #3
· Why did you select this decision? Support your response with
evidence and references to the Learning Resources.
· What were you hoping to achieve by making this decision?
Support your response with evidence and references to the
Learning Resources.
· Explain any difference between what you expected to achieve
with Decision #3 and the results of the decision. Why were they
different?
case Study and the decisions
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
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
Decision Point Two
Select what the PMHNP should do next:
Continue same dose of Ritalin and re-evaluate in 4 week
Change to Ritalin LA 20 mg orally daily in the MORNING
Discontinue Ritalin and begin Adderall XR 15 mg orally daily
Decision Point Three
Select what the PMHNP should do next:
Maintain current dose of Ritalin LA and reevaluate in 4 weeks
Increase Ritalin LA to 30 mg orally daily
Obtain EKG based on current heart rate
Decision Point One
Begin Ritalin (methylphenidate) chewable tablets 10 mg orally
in the MORNING
RESULTS OF DECISION POINT ONE
· Client returns to clinic in four weeks
· Katie’s parents report that they spoke with Katie’s teacher
who notices that her symptoms are much better in the morning,
which has resulted in improvement in her overall academic
performance. However, by the afternoon, Katie is “staring off
into space” and “daydreaming” again
· Katie’s parents are very concerned, however, because Katie
reported that her “heart felt funny.” You obtain a pulse rate and
find that Katie’s heart is beating about 130 beats per minute
Decision Point Two
Change to Ritalin LA 20 mg orally daily in the MORNING
RESULTS OF DECISION POINT TWO
· Client returns to clinic in four weeks
· Katie’s academic performance is still improved, and the
switch to the LA preparation is lasting Katie throughout the
school day
· Katie’s reports of her heart feeling “funny” have gone away.
Pulse was 92 during today’s office visit
Decision Point Three
Maintain current dose of Ritalin LA and reevaluate in 4 weeks
Guidance to Student
At this point, Katie’s symptoms are well controlled (her
attention is sustained throughout the school day) and her side
effects have gone away following change to a long-acting
preparation. There is no indication at this point that the dose
should be increased as it is always advisable to use the lowest
effective dose of stimulant medication. Katie’s heart rate is
appropriate for an 8 year old girl and an EKG would not be
indicated based on her heart rate.
Interprofessional Communication: Critical Thinking Incident
Description: The baccalaureate nurse will integrate critical
thinking as a process for quality
improvement.
Course Competencies: 1) Apply the concepts of critical thinking
to patient assessment. 2)
Interpret the impact of emotions on RN critical thinking
behaviors. 3) Compare methods to
assess nursing competency. 4) Discuss ways to improve
knowledge seeking behaviors in the
workplace. 5) Link complete and comprehensive quality nursing
assessment to expected patient
outcomes. 6) Propose ways to minimize conflict in the
workplace.
QSEN Competencies: 2) Teamwork and Collaboration 4)
Quality Improvement
BSN Essential II
Area
Gold
Mastery
Silver
Proficient
Bronze
Acceptable
Acceptable
Mastery not
Demonstrated
A description of a
critical incident in
the workplace
Fully details a
critical incident
that occurred in
the workplace that
had unintended
outcomes or did
not contribute to
the well-being of
the patient
Describes a
critical incident
that occurred in
the workplace that
had unintended
outcomes or did
not contribute to
the well-being of
the patient
Describes a
critical incident
that occurred in
the workplace but
does not discuss if
it had unintended
outcomes or did
not contribute to
the well-being of
the patient
Does not describe
a critical incident
in the workplace
An analysis of the
incident using the
questions from
box 5-4 in your
text
Fully analyzes the
incident using the
appropriate
questions from
box 5-4
Describes the
incident using the
questions from
box 5-4
Superficially
analyzes the
incident without
using the
questions from
box 5-4
Does not analyze
the incident using
the questions from
box 5-4
Reflect on the
incident
Fully reflects on
the incident and
identifies what
breakdowns
occurred and why
these breakdowns
in quality and
safety occurred
Provides a
reflection of the
incident and
discusses what
breakdowns
occurred but does
not identify why
the breakdowns
occurred
Provides a
reflection of the
incident but does
not discuss what
breakdowns
occurred or why
they occurred
Does not provide
a reflection of the
incident or
discussion of the
breakdown
Steps to take to
prevent this
Fully details what
steps to take as a
leader and
Describes steps to
take as a leader
and manager but
Superficially
identifies steps to
take to prevent the
Does not identify
steps to prevent
APA, Grammar,
Spelling, and
Punctuation
No errors in
APA, Spelling,
and Punctuation.
One to three
errors in APA,
Spelling, and
Punctuation.
Four to six errors
in APA,
Spelling, and
Punctuation.
Seven or more
errors in APA,
Spelling, and
Punctuation.
References Provides two or
more references.
Provides two
references.
Provides one
references.
Provides no
references.
incident from
occurring again
manager to
prevent the
incident from
occurring again
does not include
changes to the
environment
incident from
occurring again,
including changes
in the work
environment
the incident from
occurring

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The AssignmentExamine Case Study A Young Caucasian Girl With AD.docx

  • 1. The Assignment Examine Case Study: A Young Caucasian Girl With ADHD You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes. At each decision point stop to complete the following: At each decision point stop to complete the following: · Decision #1 · Which decision did you select? · Why did you select this decision? Support your response with evidence and references to the Learning Resources. · What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. · Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different? · Decision #2 · Why did you select this decision? Support your response with evidence and references to the Learning Resources. · What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. · Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different? · Decision #3 · Why did you select this decision? Support your response with evidence and references to the Learning Resources. · What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. · Explain any difference between what you expected to achieve
  • 2. with Decision #3 and the results of the decision. Why were they different? case Study and the decisions 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
  • 3. 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 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 Decision Point Two Select what the PMHNP should do next: Continue same dose of Ritalin and re-evaluate in 4 week Change to Ritalin LA 20 mg orally daily in the MORNING Discontinue Ritalin and begin Adderall XR 15 mg orally daily Decision Point Three
  • 4. Select what the PMHNP should do next: Maintain current dose of Ritalin LA and reevaluate in 4 weeks Increase Ritalin LA to 30 mg orally daily Obtain EKG based on current heart rate Decision Point One Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING RESULTS OF DECISION POINT ONE · Client returns to clinic in four weeks · Katie’s parents report that they spoke with Katie’s teacher who notices that her symptoms are much better in the morning, which has resulted in improvement in her overall academic performance. However, by the afternoon, Katie is “staring off into space” and “daydreaming” again · Katie’s parents are very concerned, however, because Katie reported that her “heart felt funny.” You obtain a pulse rate and find that Katie’s heart is beating about 130 beats per minute Decision Point Two Change to Ritalin LA 20 mg orally daily in the MORNING RESULTS OF DECISION POINT TWO · Client returns to clinic in four weeks · Katie’s academic performance is still improved, and the switch to the LA preparation is lasting Katie throughout the school day · Katie’s reports of her heart feeling “funny” have gone away. Pulse was 92 during today’s office visit Decision Point Three Maintain current dose of Ritalin LA and reevaluate in 4 weeks Guidance to Student At this point, Katie’s symptoms are well controlled (her attention is sustained throughout the school day) and her side effects have gone away following change to a long-acting preparation. There is no indication at this point that the dose should be increased as it is always advisable to use the lowest
  • 5. effective dose of stimulant medication. Katie’s heart rate is appropriate for an 8 year old girl and an EKG would not be indicated based on her heart rate. Interprofessional Communication: Critical Thinking Incident Description: The baccalaureate nurse will integrate critical thinking as a process for quality improvement. Course Competencies: 1) Apply the concepts of critical thinking to patient assessment. 2) Interpret the impact of emotions on RN critical thinking behaviors. 3) Compare methods to assess nursing competency. 4) Discuss ways to improve knowledge seeking behaviors in the workplace. 5) Link complete and comprehensive quality nursing assessment to expected patient outcomes. 6) Propose ways to minimize conflict in the workplace. QSEN Competencies: 2) Teamwork and Collaboration 4) Quality Improvement BSN Essential II Area Gold Mastery Silver Proficient Bronze
  • 6. Acceptable Acceptable Mastery not Demonstrated A description of a critical incident in the workplace Fully details a critical incident that occurred in the workplace that had unintended outcomes or did not contribute to the well-being of the patient Describes a critical incident that occurred in the workplace that had unintended outcomes or did not contribute to the well-being of the patient Describes a critical incident that occurred in the workplace but
  • 7. does not discuss if it had unintended outcomes or did not contribute to the well-being of the patient Does not describe a critical incident in the workplace An analysis of the incident using the questions from box 5-4 in your text Fully analyzes the incident using the appropriate questions from box 5-4 Describes the incident using the questions from box 5-4 Superficially analyzes the incident without using the questions from box 5-4 Does not analyze
  • 8. the incident using the questions from box 5-4 Reflect on the incident Fully reflects on the incident and identifies what breakdowns occurred and why these breakdowns in quality and safety occurred Provides a reflection of the incident and discusses what breakdowns occurred but does not identify why the breakdowns occurred Provides a reflection of the incident but does not discuss what breakdowns occurred or why they occurred Does not provide
  • 9. a reflection of the incident or discussion of the breakdown Steps to take to prevent this Fully details what steps to take as a leader and Describes steps to take as a leader and manager but Superficially identifies steps to take to prevent the Does not identify steps to prevent APA, Grammar, Spelling, and Punctuation No errors in APA, Spelling, and Punctuation. One to three errors in APA, Spelling, and
  • 10. Punctuation. Four to six errors in APA, Spelling, and Punctuation. Seven or more errors in APA, Spelling, and Punctuation. References Provides two or more references. Provides two references. Provides one references. Provides no references. incident from occurring again manager to prevent the incident from occurring again does not include changes to the environment
  • 11. incident from occurring again, including changes in the work environment the incident from occurring