Attention, deficit hyperactivity disorder (ADHD), is a disease process where the
individual which is characterized by inattentive, hyperactive and impulsive. According to the
DSM-V manual (2013), ADHD may be classified
...
Attention, deficit hyperactivity disorder (ADHD), is a disease process where the
individual which is characterized by inattentive, hyperactive and impulsive. According to the
DSM-V manual (2013), ADHD may be classified into three subcategories of these symptoms
which can be: the patient may not be paying attention, the hyperactive type may be overly
impulsive, fidgety, squirmy or active and most commonly, the patient may have both
characteristics. Individuals with this disorder usually present within six months or more, and the
disease typically occurs in children ages 6-12 years old. The cause of ADHD is not entirely
known, but it can be attributed to combination to genetic factors, and environmental factors that
lead to lower amounts the neurotransmitters dopamine and norepinephrine (Stahl, 2013).
Treatments for ADHD involve behavioral psychotherapy and the use of medications such as
stimulants.
Summary of patient Case
The patient’s name is Katie; she is an 8-year-old Caucasian female who is brought to the
office today by her mother & father. They report that they were referred to the Psychiatric
Mental Health Nurse practitioner (PMHNP) by their primary care provider after seeking her
advice because Katie’s teacher suggested that she may have ADHD. Katie’s parents report 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 ScaleRevised.” 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
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Managing Care for Patients with ADHD 3
and is easily distracted. Katie is also noted to start things but never finish them, and seldom
follows through on instructions and fails to complete 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. 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 says that she loves her parents
and that they are excellent and kind to her. Denies any abuse, denies bullying at school. Offers
no other concerns at this time.
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 has 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 backward from 100 by serial 2’s and
5’s. Insight and judgment appear age appropriate. Katie denies any suicidal or homicidal
ideation. The patient is diagnosed with Attention deficit hyperactivity disorder, predominantly
inattentive presentation. The purpose of this paper is to examine three different decision
treatments options for this patient with ADHD and provide ethical and communication skills
regarding patients with this disease.
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Managing Care for Patients with ADHD 4
Decision 1
To begin treatment, the PMHNP can either start the patient on Wellbutrin XL 150mg PO
daily, Intuniv extended-release 1mg PO at bedtime or Ritalin (Methylphenidate) chewable
tablets 10mg PO Q AM. The PMHNP decides to
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