The Assignment

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

At each decision point stop to complete the following:

· Decision #1

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 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

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

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 

o 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.

Note: Support your rationale with a minimum of three academic resources no more than five years old in APA Format

Attention Deficit Hyperactivity Disorder
A Young Girl With ADHD

BACKGROUND

Katie is an 8 year old Caucasian female who is brought to your office today by her mother & father. They report that they were referred to you by their primary care provider after seeking her advice because Katie’s teacher suggested that she may have ADHD. Katie’s parents reported 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 Scale-Revised”. 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 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 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.

 
 

SUBJECTIVE

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 reports that she loves her parents and that they are very good and kind to her. Denies any abuse, denies bullying at school. Offers no other concerns at this time.

 
 

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 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 backwards from 100 by serial 2’s and 5’s. Insight and judgment appear age appropriate. Katie denies any suicidal or homicidal ideation.

Diagnosis: Attention deficit hyperactivity disorder, predominantly inattentive presentation

Decision Point One:

Begin Wellbutrin (bupropion) XL 150 mg orally daily

RESULTS OF DECISION POINT # ONE

Client returns to clinic in four weeks

Katie’s parents inform you that they stopped giving Katie the medication because about 2 weeks into the prescription, Katie told her parents that she was thinking about hurting herself. This scared the parents, but they didn’t want to “bother you” by calling the office, so they felt that it would be best to just stop the medication as they would be seeing you in two weeks

Decision Point #Two:

Select what the PMHNP should do next:

Educate the parents that Bupropion sometimes causes suicidal ideation in children and that this is normal, and restart the drug at the previous dose

RESULTS OF DECISION POINT TWO

Client returns to clinic in four weeks

Katie’s parents again report that after about a week of treatment with the Bupropion, Katie began telling her parents that she wanted to hurt herself and began having dreams about being dead. This scared her parents and they stopped giving her the medication

At this point, they are quite upset with the results of their daughter’s treatment and are convinced that medication is not the answer

Decision Point # Three:

Select what the PMHNP should do next:

Refer the parents to a pediatric psychologist who can use behavioral therapy to treat Katie’s ADHD

Guidance to Student

Bupropion is used off-label for ADHD and is used more commonly in adults. It’s mechanism of action results in increasing the neurotransmitters norepinephrine/noradrenaline and dopamine. Since dopamine is inactivated by norepinephrine reuptake in frontal cortex, (which largely lacks dopamine transporters) bupropion can increase dopamine neurotransmission in this part of the brain, which may explain its effectiveness in ADHD. However, Bupropion as well as other antidepressants have been linked to suicidal ideation in children and adolescents- despite the fact that it was being used initially to treat ADHD, it is still an antidepressant.

At this point, the parents are probably quite frustrated as no parent wants to hear their child talking about hurting themselves or having dreams about being dead. If the parents are adamant about no more medications, referral to a pediatric psychologist or similar therapist skilled in the use of behavioral therapies to treat ADHD in children. However, it should be noted that behavioral therapies work best when combined with medication, however, if the parents are insistent, then behavioral therapy may be the only alternative left in the treatment of Katie.

In terms of the pathophysiology of ADHD, whereas it may be true that increasing age may demonstrate some improvement in symptoms (some people will actually experience complete resolution of symptoms by adulthood), it is not helping Katie in the here and now. Katie still needs help with her symptoms which are causing academic issues.

The PMHNP should attempt to repair the rupture in the therapeutic alliance (the parents now believe that medications are not the answer) by explaining rationale for the use of Bupropion (many people like to start with Bupropion because it has a low-risk for addiction). The family should be encouraged to allow the PMHNP to initiate Adderall as it has a very good track record in terms of its efficacy in treating ADHD.

 

Week 3 Touchpoint Reflection: Financial and Budgeting Principle

Guidelines for Touchpoint Reflections

A downloadable version of the guidelines, which includes further information, is available for access in the week 1 discussion thread.

Reflection Information

EXPERIENCE

This week’s readings contained a great deal of information on financial and budgeting principles. Some of you may have had some familiarity with the concepts and maybe even experience in working with them. However, there is always something new to learn. Describe your prior experiences with financial and budgeting principles, whether personally or professionally. Include your current involvement in budgeting at your institution.

REFLECTION

What pre-conceived notions related to healthcare financial and budgeting principles did you hold before this week that you understand better now or for which you have a different perspective? Reflect on at least two specific concepts.  How have these new revelations influenced your thinking related to access, availability, and quality of healthcare?

IMPLICATIONS FOR THE FUTURE

• How has your enhanced knowing affected the way you view your proposed project?
• What areas of additional financial or budgeting data gathering have you identified as a need for your plan?

If you talk about a possible poor health outcome, do you believe that outcome will occur? Do you believe eye contact and personal contact should be avoided?

You would have a difficult time practicing as a nurse if you believed these to be true. But they are very real beliefs in some cultures. 

Differences in cultural beliefs, subcultures, religion, ethnic customs, dietary customs, language, and a host of other factors contribute to the complex environment that surrounds global healthcare issues. Failure to understand and account for these differences can create a gulf between practitioners and the public they serve.

In this Assignment, you will examine a global health issue and consider the approach to this issue by the United States and by one other country.

To Prepare:

• Review the World Health Organization’s (WHO) global health agenda and select one global health issue to focus on for this Assignment.
• Select at least one additional country to compare to the U.S. for this Assignment.
• Reflect on how the global health issue you selected is approached in the U.S. and in the additional country you selected.
• Review and download the Global Health Comparison Matrix provided in the Resources.

The Assignment: (1- to 2-page Global Health Comparison Matrix; 1-page Plan for Social Change)

Part 1: Global Health Comparison Matrix

Focusing on the country you selected and the U.S., complete the Global Health Comparison Matrix. Be sure to address the following:

• Consider the U.S. national/federal health policies that have been adapted for the global health issue you selected from the WHO global health agenda. Compare these policies to the additional country you selected for study.
• Explain the strengths and weaknesses of each policy.
• Explain how the social determinants of health may impact the global health issue you selected. Be specific and provide examples.
• Using the WHO’s Organization’s global health agenda as well as the results of your own research, analyze how each country’s government addresses cost, quality, and access to the global health issue selected. 
• Explain how the health policy you selected might impact the health of the global population. Be specific and provide examples.
• Explain how the health policy you selected might impact the role of the nurse in each country.
• Explain how global health issues impact local healthcare organizations and policies in both countries. Be specific and provide examples.

Part 2: A Plan for Social Change

Reflect on the global health policy comparison and analysis you conducted in Part 1 of the Assignment and the impact that global health issues may have on the world, the U.S., your community, as well as your practice as a nurse leader. 

In a 1-page response, create a plan for social change that incorporates a global perspective or lens into your local practice and role as a nurse leader. 

• Explain how you would advocate for the incorporation of a global perspective or lens into your local practice and role as a nurse leader. 
• Explain how the incorporation of a global perspective or lens might impact your local practice and role as a nurse leader. 
• Explain how the incorporation of a global perspective or lens into your local practice as a nurse leader represents and contributes to social change. Be specific and provide examples.

  

As you build your project/presentation, be sure to provide the evidence/research in the literature that supports your evidence based PRIMARY LEVEL OF PREVENTION intervention. Provide the citation on the slide of your interventions that demonstrates the evidence. For example, education is not a solution unless you have research evidence that demonstrates that it solves your identified problem.  I look forward to all the great ideas you each have for solutions to your topics.

Tips for creating the powerpoint:

1.  Bullet points only, no complete sentences

2.  Do not use first person or vague pronouns

3.  Goals need to be outcomes focused on a pre/post measure of change related to your interventions

4.  Use pictures on the slides

You all have clearly discussed interventions at the community and system levels. How does this presentation on the web of causation help to expand on the complexity of your population? 

THIS IS VERY IMPORTANT

Answer the following questions as you develop your evidence-based, culturally appropriate intervention for your community:

What health issue, problem, or disparity in health outcomes is of concern to you as a scholar practitioner in your community? What gaps in knowledge and care do you see as possible causes for the health issue? What does the health data tell you about the health issue? What does the literature tell you about the health issue? How can you learn about the health issue and about possible solutions from the viewpoint of families, community as a whole, and health professionals in your community? What evidence is there to support your proposal? What is one avenue you could advocate for improved health outcomes and know when a change has taken place?

Suggestions for the Project

Each week’s activities are geared to help you move along with your proposal. Use this time well and utilize some aspect of discussion and assignments in this course (e.g. windshield survey) to support your proposal as well. Read about the whole project before you start. 

Week 1: Identification of a Population in Your Community

Week 2: Practicum: Epidemiology: Define Your Population and Selected Problem

Week 3: Practicum: Population Cultural Considerations and Genetic Predisposition

Week 4: Evidence-Based Practice and Evaluation of the Project Through Measureable Goals