Decision Point Three
BASED ON THE ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECIS
Case #1A young girl with difficulties in school
*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.
Practicum: Decision Tree:A Young Girl with Difficulties in school Paper.
*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.
*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.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 home and spends a lot of time watching TV.
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.Practicum: Decision Tree:A Young Girl with Difficulties in school Paper”
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’.Practicum: Decision Tree:A Young Girl with Difficulties in school Paper. No reports of delusional or paranoid thought processes. Attention and concentration are somewhat limited based on Katie’s short answers to your questions.
These are the decisions that I need to reflect in the new essay
Decision Point One
I selected Attention Deficit Hyperactivity Disorder, predominantly inattentive presentation.
Answer the following based on your selection.:
· 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?
RESULTS OF DECISION POINT ONE
1-Client returns to clinic in four weeks
2-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 #2: Treatment Plan for Psychotherapy
I Chose Adderall XR 10mg Orally Daily for the next 4 weeks due to the efficacy of decreasing hyperactivity and inattentiveness (Stahl, 2018).
*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? I was hoping to 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.
Katie Moms reported that Katie has improved but in the afternoon she loses her focus. Why were they different? They were different because Katie needed an additional dose of Adderall XR.
Decision #3: Treatment Plan for Psychopharmacology
I chose to add a small dose of immediate release of Adderall IR in the afternoon.
Why did you select this Decision? Support your response with evidence and references to the Learning Resources. When taken this medication in the morning, it often
What were you hoping to achieve by making this Decision?
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.
American Psychiatric Association;. (2013). Diagnostic and Statistical Manual of Mental Disorders:DSM-5 (5 ed.). Arlington, VA.Practicum: Decision Tree:A Young Girl with Difficulties in school Paper
Sadock, B., Sadock, V., & Ruiz, P. (2015). Synopssis of Psychiatry (11 ed.). Philadelphia: Wolters Kluwer.
Stahl, S. (2018). Amphetamine (d,l). (Cambridge, Producer) Retrieved June 25, 2018, from Stahl Online: https://stahlonline-cambridge-org.ezp.waldenulibrary.org/prescribers_drug.jsf?page=9781316618134c8.html.therapeutics&name=Amphetamine%20(d,l)&title=Therapeutics