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The parents give the PMHNP a copy of a form titled “Conner’s Teacher Rating Scale-Revised” The scale was filled out by Katie’s teacher and sent home to the parents so that they could share it with their family PCP. 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 schoolwork 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 schoolwork.

Katie parents actively deny that Katie has ADHD. She would be running around like a wild person if she had ADHD, report 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, she finds her other subjects boring, and sometimes hard because she feels lost. She states, “my mind wander during class to think about more fun things. “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 denies any bullying at school and reports no other concerns. 

 

Mental Status Exam

Speech: clear, coherent and logical. Alert & Orient x3, Dress appropriate for weather and time of the year. No tics, gestures, or noteworthy mannerism. Mood: euthymic. Affect: Bright Katie denies visual or auditory Hallucinations, or delusional or paranoid thought processes readily appreciated. Attention and concentration are grossly intact. Able 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 by PMHNP Attention deficit hyperactivity disorder, Predominantly inattentive presentation

 Use each Medication in the Decision Tree Questions

Wellbutrin (Bupropion XL) 150 mg orally daily

Intuniv extended release 1 mg orally at bedtime

 

Case Study: A Young Caucasian Girl with ADHD. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.

At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.

 

Prescribing Wellbutrin 150 mg orally

Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Prescribing Intuniv extended release 1 mg at bedtime

Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

These are homework questions that I am trying to understand how to answer using Decision Tree #1 and #2 methods. 

 

SCIENCE
HEALTH SCIENCE
NURSING
NURS 6630