Introduction
Attention deficit hyperactivity disorder (ADHD) is a mental condition that affects neurodevelopment and causes symptoms such as excessive activity, difficulty paying attention, and problems controlling inappropriate behavior for a person’s age. People with ADHD have trouble focusing, acting impulsively, and sitting still. The disorder can begin in childhood and continue into adulthood, and it is not curable. It can cause problems at home, work, school, and relationships. This essay aims to evaluate the condition of an eight-year-old Caucasian girl with ADHD and suggests appropriate medication to manage the disorder.
Background
Katie is an 8-year-old Caucasian female brought to the office by her parents. They were referred to the office by their primary care provider after the teacher suggested that Katie may have ADHD. The primary care provider felt that Katie should be evaluated by psychiatry to determine whether she has this condition. The parents provided the PMHNP with a copy of Conner’s Teacher Rating Scale-Revised which was filled out by the teacher and sent home to the parents for them to share with the primary care provider.
Decision One
Decision Selected: The initial treatment plan for managing ADHD is, to begin with, medication. There are various options available, but the best choice, in this case, is to start with Wellbutrin (bupropion) XL 150 mg orally daily.
Reason: The reason for choosing Wellbutrin (bupropion) XL 150 mg orally daily is that it is not advisable to introduce the patient to a higher drug dosage (Hile, 2020). This dosage would be suitable for an 8-year-old patient. The medication helps individuals focus and concentrate on tasks, reducing impulsive behavior, a common symptom of ADHD (Hile, 2020). Starting with a lower dosage allows for monitoring of the patient’s reactions. It results in the medication, which will assist in making further treatment decisions, including increasing the dosage as treatment continues.
Expected Results: I expect a gradual improvement in the patient’s condition after one month of medication. Specifically, I anticipate an improvement in the patient’s inattentiveness and an increased ability to concentrate on tasks (Hile, 2020). The oral Ritalin dosage is a suitable recommendation for her condition and should help alleviate some of the symptoms associated with ADHD. Since this is the beginning of her treatment, I expect that the patient will show some improvement, but it may take some time for the full effects of the medication to be seen (Hile, 2020).
Differences between expectations and results: I anticipated a slight enhancement in the patient’s condition with the medication dosage. However, after four weeks, the patient’s parents reported that her teacher had observed an improvement in her overall academic performance (Hile, 2020). This change was observed during morning classes, but there was no significant improvement in the afternoon classes (Cortese, 2020). Thus, there was a need to take action to prevent her from daydreaming during afternoon sessions and staring into space.
Ethical Considerations when using Wellbutrin
Using Wellbutrin is a good case of psychopharmacologic medication to manage attention deficit hyperactivity disorder. However, despite its positive results, healthcare practitioners must be wary of its side effects, including suicidal ideation.
Decision Two
Decision Selected: The second decision was made because the initial treatment did not produce the desired results. Therefore, another intervention was needed to better help the patient manage her ADHD. The decision was to Discontinue Wellbutrin and begin Strattera (atomoxetine) 10 mg orally daily.
Reason: discontinuing Discontinuing Wellbutrin and beginning Strattera (atomoxetine) 10 mg daily because the side effects of Wellbutrin orally daily caused Katie to develop suicidal ideations (Hile, 2020). Furthermore, based on the medical examination results, Katie is experiencing symptoms such as forgetfulness, inattentiveness, lack of interest in schoolwork, and poor spelling. These mental issues can worsen if not treated (Cortese, 2020). Therefore, discontinuing Wellbutrin and beginning Strattera (atomoxetine) 10 mg orally daily would likely alleviate her ADHD condition.
Expected Results: Despite being oriented in time pleasant person, Katie is suffering from a mental illness that causes excessive daydreaming, staring, and the potential to experience hallucinations without any external influences and suicidal ideations (Yadav, 2021). Therefore, it was expected that discontinuing Wellbutrin and beginning Strattera (atomoxetine) 10 mg orally daily would help to alleviate these behavioral deficits or symptoms and reduce Katie’s risk of wanting to hurt herself.
Differences between expectations and results: as expected, Katies significantly reduced after discontinuing Wellbutrin and starting Strattera (atomoxetine) 10 mg orally daily since Katie’s teachers report that her symptoms have improved slightly (Arns et al., 2020). However, this symptom improvement was also associated with a great reduction in Katie’s appetite. Katie’s mother reports that although Katie is not a big eater, her appetite since the start of Wellbutrin has significantly reduced. This is an unexpected side effect of using Strattera (atomoxetine) 10 mg orally (Arns et al., 2020). With time, this new onset lack of appetite may reduce, but PMNHP should monitor her.
Ethical Considerations when using Strattera (atomoxetine) 10 mg orally daily
Strattera (atomoxetine) 10 mg orally daily is a good choice to replace my button for attention deficit hyperactivity disorder, especially due to the latter’s tendency to cause suicidal ideations (Arns et al., 2020). Therefore, healthcare practitioners must be careful and watch out for Strattera (atomoxetine) 10 mg orally daily tendency to result in loss of appetite. This can be quite distressing for many parents concerned about their child’s health.
Decision Three
Decision Selected: The third decision is to maintain the current course orally with Strattera (atomoxetine) 10 mg. Although the loss of appetite was observed after using Strattera (atomoxetine) 10 mg orally, no other side effects were observed (Mechler et al., 2022). The decision was made to continue administering the same dosage and to reassess the patient’s progress in another four weeks to determine if any changes were necessary.
Reason: If the medication is not having a positive effect on the client, it is important to make adjustments, such as increasing or decreasing the dosage (Arns et al., 2020). However, in this case, it may not be necessary to make any changes in the administration of the drug as it may still yield positive results over time, while the only side effect observed is expected, can be reduced over time, and managed easily.
Expected Results: Since the medication had previously produced positive results for Katie, it may be beneficial to continue administering the same dose. This is expected to significantly improve her symptoms and decrease her ADHD disorder (Yadav, 2021). It is important to provide proper guidance for the patient to avoid any potential side effects from the medication.
Differences between expectations and results: The patient demonstrated significant improvement while taking the medication, so it is recommended to continue with the same drug and dosage under professional guidance (Cortese, 2020). This improved her attention at school and her academic performance, indicating that it is unnecessary to change her medication as it effectively manages her ADHD condition.
Ethical Considerations
When treating ADHD, it is ethical to prescribe the appropriate medication dosage to avoid any potential side effects. The physician should determine the severity of the patient’s condition before administering the drug (Mechler et al., 2022). Properly administering the medication and following guidelines is crucial to ensure the patients receive the correct dosage. Adjusting the dosage as needed for quick and effective therapy is also ethical. Patient education is also an important ethical consideration in healthcare, as it is important to inform the patient about what to expect during treatment and the potential side effects of the medication (Mechler et al., 2022).
Conclusion
In conclusion, attention deficit hyperactivity disorder is a condition that affects many children. However, it can be treated with medications such as Wellbutrin (bupropion) XL 150 mg orally daily and Strattera (atomoxetine) 10 mg orally daily. With proper dosages of the right drug, such as Wellbutrin, desired effect of suppressed symptoms of attention deficit hyperactivity disorder can be achieved. Doctors and parents must be careful and watch out for the side effects of using medications for ADHD to prevent serious complications from occurring.
References
Arns, M., Clark, C. R., Trullinger, M., DeBeus, R., Mack, M., & Aniftos, M. (2020). Neurofeedback and attention-deficit/hyperactivity disorder (ADHD) in children: Rating the evidence and proposed guidelines. Applied psychophysiology and biofeedback, 45(2), 39-48. https://doi.org/10.1007/s10484-020-09455-2
Cortese, S. (2020). Pharmacologic treatment of attention deficit–hyperactivity disorder. New England Journal of Medicine, 383(11), 1050–1056. https://doi.org/10.1056/NEJMra1917069
Hile, A. L. (2020). Bupropion for the Treatment of ADHD. Lynchburg Journal of Medical Science, 2(1), 15. https://digitalshowcase.lynchburg.edu/dmscjournal/vol2/iss1/15/
Mechler, K., Banaschewski, T., Hohmann, S., & Häge, A. (2022). Evidence-based pharmacological treatment options for ADHD in children and adolescents. Pharmacology & Therapeutics, 230, 107940. https://doi.org/10.1016/j.pharmthera.2021.107940
Yadav, P. (2021). Pharmacological Treatment of ADHD. In New Developments in Diagnosing, Assessing, and Treating ADHD (pp. 132–145). IGI Global. https://www.igi-global.com/chapter/pharmacological-treatment-of-adhd/259300
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