DECISION TREE 2 Running head: DECISION TREE 1 Practicum: Decision Tree Walden University (Nurs. 6660 Decision Tree Case#1 A Young Girl with Difficult in School. Decision #1: Attention Deficit Hyperactivity Disorder, mainly inattentive presentation Katie is an 8-year-old Caucasian female with the following presenting symptoms which are inattentive; easily distracted; short attention span; organization issues; poor coordination; difficulty with spelling, reading and math (Laureate Education, 2017b). Basic on the DSM IV there are three subtypes of ADHD which are inattentive and hyperactive and impulsive type with the predominant symptom pattern for the last 6 months. Patient suffering from ADHD are easily distracted, overactive, inability to sit still, excessively talking, overemotional, calling out answers before the questions had been completed and inattentive (Sridhar, 2017). It is crucial for a complete assessment to be done to come up with a diagnosis. In the case of ADHD, the nurse practitioner would have to get information from the parent, guardians or teacher about the child conduct. The information collected is then evaluated with children of the same milestones to see if there any issues. If there are symptoms of ADHD which lasted for more than six months. The Conners’ Rating Scale-Revised (CRS-R) is part of a complete examination tool that is used to evaluates children with behavioral issues and ADHD. This tool assists in determining whether children between the ages of three and 17 years might have ADHD. It consists of a checklist of behavioral questions which are used by parents and teachers. Expected Result with this Decision My goal is to provide the best care to the patient with proper evaluation and diagnosis. Providing the right treatment directly results in good health, offers the best care, and strength. My goal is to explain to her parent that their child had ADHD because of her presenting symptoms of inattentive, distraction, difficulty remembering things, difficulty with her academic, difficulty socializing with peers, short attention span, Poor coordination, lack organization skills and trouble following directions (Miller, 2018). Difference between Expected Result and the Achieved Result with decision # 1 The patient returned to the clinic about a month, the expected result and the achieved result are the same. The symptoms presented by the child is indicative of ADHD, predominantly inattentive presentation (Laureate Education, 2017b). Decision #2: Treatment Plan for Psychotherapy Begin Adderall XR 10mg orally daily Reason for .

1. DECISION TREE
2
Running head: DECISION TREE
1
Practicum: Decision Tree
Walden University
(Nurs. 6660
Decision Tree
Case#1 A Young Girl with Difficult in School.
Decision #1: Attention Deficit Hyperactivity Disorder, mainly
inattentive presentation
Katie is an 8-year-old Caucasian female with the following
presenting symptoms which are inattentive; easily distracted;
short attention span; organization issues; poor coordination;
difficulty with spelling, reading and math (Laureate Education,
2017b). Basic on the DSM IV there are three subtypes of ADHD
which are inattentive and hyperactive and impulsive type with
the predominant symptom pattern for the last 6 months. Patient
suffering from ADHD are easily distracted, overactive, inability
to sit still, excessively talking, overemotional, calling out
answers before the questions had been completed and

2. inattentive (Sridhar, 2017).
It is crucial for a complete assessment to be done to
come up with a diagnosis. In the case of ADHD, the nurse
practitioner would have to get information from the parent,
guardians or teacher about the child conduct. The information
collected is then evaluated with children of the same milestones
to see if there any issues. If there are symptoms of ADHD
which lasted for more than six months.
The Conners’ Rating Scale-Revised (CRS-R) is part of a
complete examination tool that is used to evaluates children
with behavioral issues and ADHD. This tool assists in
determining whether children between the ages of three and 17
years might have ADHD. It consists of a checklist of behavioral
questions which are used by parents and teachers.
Expected Result with this Decision
My goal is to provide the best care to the patient with
proper evaluation and diagnosis. Providing the right treatment
directly results in good health, offers the best care, and
strength. My goal is to explain to her parent that their child had
ADHD because of her presenting symptoms of inattentive,
distraction, difficulty remembering things, difficulty with her
academic, difficulty socializing with peers, short attention span,
Poor coordination, lack organization skills and trouble
following directions (Miller, 2018).
Difference between Expected Result and the Achieved Result
with decision # 1
The patient returned to the clinic about a month, the expected
result and the achieved result are the same. The symptoms
presented by the child is indicative of ADHD, predominantly
inattentive presentation (Laureate Education, 2017b).
Decision #2:
Treatment Plan for Psychotherapy
Begin Adderall XR 10mg orally daily
Reason for the Selection

3. Adderall XR 10mg orally daily is the drug of choice. The
FDA approves Adderall XR for the treatment of ADHD. It
works by enhancing dopamine and norepinephrine in the brain
to reduce the signals from the outside stimuli affecting
attention, concentration, wakefulness and executive function
(Stahl 2013). Adderall causes cognitive and emotional effects
like increased wakefulness, euphoria, improved cognitive
control (Heal, et al., 2013). The treatment plan for
psychotherapy will be Cognitive Behavior therapy (CBT) if
needed by the patient. CBT is effective at increasing the
behaviors and skills needed for self-management and improve
sensitive and interpersonal self-regulation CHADD, 2018).
Expected Result with this Decision
Kate returned to the clinic in about a month, the parent
stated that Kate is paying more attention in school only in the
morning but day dreams in the afternoon with a decline in
appetite since she started taking the medication. Kate is
exhibiting the side effect of Adderall by having the poor
appetite. This expected result is indicative of the side effect of
Adderall. Adderall has the following side effect of decreased
appetite, insomnia, delayed growth, weight loss, increased
blood pressure, mood swings, dry mouth, anxiety and headaches
(Stahl, 2014).
Difference between Expected Result and the Achieved Result
with Decision #2
The patient reported to the clinic in about a month with the
sign of improvement as expected but with an expected side
effect of poor appetite from using the medication. The
following are expected side effect decreased appetite, insomnia,
delayed growth, weight loss, increased blood pressure, mood
swings, dry mouth, anxiety and headaches. Adderall may
increase the risk for mental health problems such as bipolar
disorder, depression, seizure, hostile behavior or aggressiveness
which must be reported immediately to the nurse practitioner
(Stahl, 2014).
Decision #3: Treatment Plan for Psychopharmacology

4. Add a small dose of immediate release Adderall in the
early afternoon.
Expected Result with this Decision
Katie showed improvement from her earlier dose of
Adderall XR 10mg orally daily but daydreams in the afternoon.
Extended-release d,l-amphetamine has up to 8-hour duration of
clinical action For children ages 6–12, half-life for d-
amphetamine is 9 hours and for l-amphetamine is 11 hours
(Stahl, 2014)A small dose of immediate release of Adderall in
the early afternoon will help in improving her attention and help
retain her attention throughout the evening so she can focus on
her homework.
Difference between Expected Result and the Achieved Result
with Decision #3
The medication was effective patient performing well in
school and home. There was no difference between expected
resulted and achieved result noted. The patient is now during
well in school.
Ethical Considerations That Might Impact the Treatment Plan
The ethical considerations are that there is no cure for
ADHD, but medication and therapy can help decrease the
symptoms It is crucial the following should be considered
before treatment that the practitioner must do no harm and
consider what is in the patient best interest. It is essential to
make sure they do not have a family history of Hypertension or
cardiac disease. Patient periodic monitoring of blood pressure,
weight, CBC, liver function and platelet. Children less than
three years old should not take Adderall, and children less than
six years old should not take Adderall XR. People on prolonged
use or daily more massive doses of Adderall are at risk for
addiction (Miller, 2018).
References

5. Children and Adults with Attention-Deficit/Hyperactivity
Disorder (2018). Treatment of ADHD. Retrieved from
http://www.chadd.org/understanding-adhd/about-
adhd/treatment-of-adhd.aspx
Heal, D. J., Smith, S. L., Gosden, J., & Nutt, D. J. (2013).
Amphetamine, past and present – a pharmacological and clinical
perspective. Journal of Psychopharmacology (Oxford, England),
27(6), 479–496. Retrieved from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3666194/
Laureate Education. (Producer). (2017b). A Young Girl with
Difficulties in School (Multimedia file). Baltimore, MD:
Author.
Miller, C. (2018). What We Know About the Long-Term Effects
of ADHD Medications. Retrieved from
https://childmind.org/article/know-long-term-effects-adhd-
medications/
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan &
Sadock’s synopsis of psychiatry: Behavioral
sciences/clinical psychiatry (11th ed.). Philadelphia, PA:
Wolters Kluwer.
Stahl, S.M. (2014). Prescriber's Guide: Stahl's Essential
Psychopharmacology
(5th ed) New York, NY Cambridge University Press
Sridhar, C., Bhat. S., Acharya, U.R, Adeli, H., & Bairy, G.
M.(2017). Diagnosis of Attention Deficit Hyperactivity
Disorder Using Imaging and Signal Processing Techniques.
Computer Biol Med. 1; 88: 93-99. Retrieved from:
https://www.ncbi.nlm.nih.gov/pubmed/28709145
777286 Topic: Decision Tree
Number of Pages: 5 (Double Spaced)
Number of sources: 5

6. Writing Style: APA
Type of document: Case Study
Academic Level:Master
Number of Pages: 5 (Double Spaced)
Category: Nursing
VIP Support: N/A
Language Style: English (U.S.)
Order Instructions: ATTACHED
Assignment 1: Practicum: Decision Tree
For this Assignment, you examine the client case study in this
week’s Learning Resources. Consider how you might assess and
treat pediatric clients presenting with symptoms noted in the
case.
Note: This Assignment is the first of three assignments that are
based on interactive client case studies. For these assignments,
you will be required to make decisions about how to assess and
treat clients. Each of your decisions will have a consequence.
Some consequences will be insignificant, and others may be life
altering. You are not expected to make the “right” decision
every time; in fact, some scenarios may not have a “right”
decision. You are, however, expected to learn from each

7. decision you make and demonstrate the ability to weigh risks
versus benefits to prescribe appropriate treatments for clients.
Learning Objectives
Students will:
•
Evaluate clients for treatment of mental health disorders
•
Analyze decisions made throughout diagnosis and treatment of
clients with mental health disorders
The Assignment:
Examine Case 1. You will be asked to make three decisions
concerning the diagnosis and treatment for this client. Be sure
to consider co-morbid physical as well as mental factors that
might impact the client’s diagnosis and treatment.
At each Decision Point, stop to complete the following:
•
Decision #1: Differential Diagnosis
o
Which Decision did you select?
o
Why did you select this Decision? Support your response with
evidence and references to the Learning Resources.
o
What were you hoping to achieve by making this Decision?
Support your response with evidence and references to the

8. Learning Resources.
o
Explain any difference between what you expected to achieve
with Decision #1 and the results of the Decision. Why were they
different?
•
Decision #2: Treatment Plan for Psychotherapy
o
Why did you select this Decision? Support your response with
evidence and references to the Learning Resources.
o
What were you hoping to achieve by making this Decision?
Support your response with evidence and references to the
Learning Resources.
o
Explain any difference between what you expected to achieve
with Decision #2 and the results of the Decision. Why were they
different?
•
Decision #3: Treatment Plan for Psychopharmacology
o
Why did you select this Decision? Support your response with
evidence and references to the Learning Resources.
o
What were you hoping to achieve by making this Decision?
Support your response with evidence and references to the
Learning Resources.

9. o
Explain any difference between what you expected to achieve
with Decision #3 and the results of the decision. Why were they
different?
•
Also include how ethical considerations might impact your
treatment plan and communication with clients and their
families.
The Case study
A young girl with difficulties in school
BACKGROUND
In psychopharmacology you met Katie, an 8-year-old Caucasian
female, who was brought to your office by her mother (age 47)
and father (age 49). You worked through the case by
recommending possible ADHD medications. As you progress in
your PMHNP program, the cases will involve more information
for you to sort through.
For this case, you see Katie and her parents again. The parents
have reported that the medication given to Katie does not seem
to be helping. This has prompted you to reconsider the
diagnosis of ADHD. You will consider other differential
diagnoses and determine what information you need to
accurately assess the DSM-5 criteria to make the diagnosis of
ADHD or another disorder with similar diagnostic features.
When parents bring their child to your office, they may have
read symptoms on the internet or they may have been told by
the school “your child has ADHD”. Your diagnosis will either
confirm or refute that diagnosis.

10. Katie’s parents reported that their PCP felt that she should be
evaluated by psychiatry to determine a differential diagnosis
and to begin medication, if indicated. The PMHNP makes this
diagnostic decision based on interviews and observations of the
child, her parents, and the assessment of the parents and
teacher.
To start, consider what assessment tools you might need to
evaluate Katie.
•
Child Behavior Check List
•
Conners’ Teacher Rating Scale
The parents give the PMHNP a copy of a form titled “Conner’s
Teacher Rating Scale-Revised” (Available at:
http://www.doctorrudy.com/files/teacher_add_adhd_short.pdf).
This scale was filled out by Katie’s teacher and sent home to
the parents so that they could share it with their provider.
According to the scoring provided by her teacher, Katie is
inattentive, easily distracted, makes careless mistakes in her
schoolwork, 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. She has difficulty interacting with peers in the classroom
and likes to play by herself at recess.
When interviewing Katie’s parents, you ask about pre- and post-
natal history and you note that Katie is the first born with
parents who were close to 40 years old when she was born. She
had a low 5 minute Apgar score. The parents say that she met
normal developmental milestones and possibly had some
difficulty with sleep during the pre-school years. They notice
that Katie has difficulty socializing with peers, she is quiet at

11. home and spends a lot of time watching TV.
SUBJECTIVE
You observe Katie in the office and she is not able to sit still
during the interview. She is constantly interrupting both you
and her parents. Katie reports that school is “OK”- her favorite
subjects are “art” and “recess.” She states that she finds some
subjects boring or too difficult, and sometimes hard because she
feels “lost”. She admits that her mind does wander during class.
“Sometimes” Katie reports “I will just be thinking about
something else and not looking at the teacher or other students
in the class.”
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. She offers no other
concerns at this time.
Katie’s parents appear somewhat anxious about their daughter’s
problems. You notice the mother is fidgeting with her rings and
watch while you are talking. The father is tapping his foot.
Other than that, they seem attentive and straight forward in the
interview process.
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 neutral. Katie says that she doesn’t hear any ‘voices’
in her head but does admit to having an imaginary friend,
‘Audrey’. No reports of delusional or paranoid thought

12. processes. Attention and concentration are somewhat limited
based on Katie’s short answers to your questions.
Decision Point One
BASED ON THE INFORMATION PROVIDED IN THE
SCENARIO ABOVE, WHAT IS YOUR DIAGNOSIS FOR
KATIE?
In your write-up of this case, be certain to link specific
symptoms presented in the case to DSM–5 criteria to support
your diagnosis.
Diagnosis For KATIE : Attention Deficit Hyperactivity
Disorder, predominantly inattentive presentation
RESULTS OF DECISION POINT ONE
•
Client returns to clinic in four weeks
•
You selected Attention deficit hyperactivity disorder,
predominantly inattentive presentation. Based on this choice,
outline the remainder of the diagnostic evaluation that you will
conduct on this child and their parents. Be sure to include
standardized assessment instruments that you would administer
Decision Point Two
Begin Adderall XR 10 mg orally daily
RESULTS OF DECISION POINT TWO
Client returns to clinic in four weeks

13. Katie’s parents seem absolutely delighted upon their return
stating that Katie is paying more attention in school, but note
that there is still room for improvement, particularly in the
afternoon
They report that Katie’s teacher has reported that Katie is able
to maintain her attention throughout the morning classes but
come afternoon, she “daydreams.”
Katie’s parents are also concerned about her decrease in
appetite since starting the medication
Decision Point Three
Add a small dose of immediate release Adderall in the early
afternoon
Guidance to Student
Whereas weight loss is common with stimulant medication, this
option does not address Katie’s parents’ concerns about the
return of symptoms in the afternoon.
Augmentation with family therapy is also a good idea as it can
help Katie with her symptoms and further help her parents to
understand the unique challenges that Katie experiences, as well
as ways that they can help her with symptoms, however, this
option does not address the return of inattentive symptoms in
the afternoon.
Adding a small dose of immediate relate Adderall in the
afternoon can help Katie to maintain attention throughout the
afternoon and into the early evening when she must do
homework. This would be the best option.