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:

At each decision point stop to complete the following:

• Decision #1
  • Which decision did you select?
  • 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?
• Decision #2
  • 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 #2 and the results of the decision. Why were they       different?
• Decision #3
  • 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 #3 and the results of the decision. Why were they       different?

case Study and the decisions

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

Select what the PMHNP should do:

Begin Wellbutrin (bupropion) XL 150 mg orally daily

Begin Intuniv extended release 1 mg orally at BEDTIME

Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING

Decision Point Two

Select what the PMHNP should do next:

Continue same dose of Ritalin and re-evaluate in 4 week

Change to Ritalin LA 20 mg orally daily in the MORNING

Discontinue Ritalin and begin Adderall XR 15 mg orally daily

Decision Point Three

Select what the PMHNP should do next:

Maintain current dose of Ritalin LA and reevaluate in 4 weeks

Increase Ritalin LA to 30 mg orally daily

Obtain EKG based on current heart rate

Decision Point One

Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING

RESULTS OF DECISION POINT ONE

• Client      returns to clinic in four weeks
• Katie’s      parents report that they spoke with Katie’s teacher who notices that her      symptoms are much better in the morning, which has resulted in improvement      in her overall academic performance. However, by the afternoon, Katie is      “staring off into space” and “daydreaming” again
• Katie’s      parents are very concerned, however, because Katie reported that her      “heart felt funny.” You obtain a pulse rate and find that Katie’s heart is      beating about 130 beats per minute

Decision Point Two

Change to Ritalin LA 20 mg orally daily in the MORNING

RESULTS OF DECISION POINT TWO

• Client      returns to clinic in four weeks
• Katie’s      academic performance is still improved, and the switch to the LA      preparation is lasting Katie throughout the school day
• Katie’s      reports of her heart feeling “funny” have gone away. Pulse was 92 during      today’s office visit

Decision Point Three

Maintain current dose of Ritalin LA and reevaluate in 4 weeks

Guidance to Student

 

At this point, Katie’s symptoms are well controlled (her attention is sustained throughout the school day) and her side effects have gone away following change to a long-acting preparation. There is no indication at this point that the dose should be increased as it is always advisable to use the lowest effective dose of stimulant medication. Katie’s heart rate is appropriate for an 8 year old girl and an EKG would not be indicated based on her heart rate.

Health Care Reform Project: Health Care Reform Analysis Paper [Objective(s) 7.1, 7.2, Value: 16 points]

• Write a 4- to 6-page paper on why is it important to understand how the U.S. health care system is evolving and how to forecast the short- and long-term effects of such changes. 
  • Your paper should reflect at least 2 issues you believe to be of significance importance to you. 
  • Consider the medical and legal issues that may arise.
  • Provide an analysis of the pros and cons of the issue that you choose to address. 
• Cite evidence to support your claims.
• Click the Submit Assignment link in the upper right corner to upload your assignment.

Rubric

Health Care Reform Project: Health Care Reform Analysis Paper RubricHealth Care Reform Project: Health Care Reform Analysis Paper RubricCriteriaRatingsPtsThis criterion is linked to a Learning OutcomePaper analyzes why is it important to understand how the U.S. health care system is evolving and how to forecast the short- and long-term effects of such changes.4.0 pts
This criterion is linked to a Learning OutcomePaper reflects at least 2 issues the student believes to be of significance importance to him or her.2.0 pts
This criterion is linked to a Learning OutcomePaper considers the medical and legal issues that may arise.2.0 pts
This criterion is linked to a Learning OutcomePaper provide an analysis of the pros and cons of the issue that the student chooses to address.2.0 pts
This criterion is linked to a Learning OutcomePaper cites evidence to support the student’s claims.2.0 pts
This criterion is linked to a Learning OutcomePaper is 4 to 6 pages, is formatted based on APA guidelines, and includes in-text citations and a reference page.2.0 pts
This criterion is linked to a Learning OutcomePaper meets basic writing standards including grammar, usage, spelling, punctuation, and organization.2.0 pts
Total Points: 16.0

Develop a concept map of the responses of the assigned system to burn injury. identify aspects important to patient survival during the resuscitation and acute phase of the burn injury , Include lab values that may be impacted one of the following body systems:

 Respiratory

 Cardiovascular

 Neurological

 Gastrointestinal

 Renal

 Psychosocial

Note: Word Document, APA Style. 

 Exercise One:

Mrs. V, a healthy 45-year-old woman, gives birth to a child. There are no outward complications associated with the birth but, when examined by the pediatrician, the child exhibits abnormal facies, a single palmar crease, hypotonic muscles, and loose pelvic joints. Following chromosomal analysis, a diagnosis of Down syndrome is made.

Discussion Questions (Provide answers based on evidence and reference your responses using APA format)

1. Discuss the cause of Down syndrome. 

2. What risks factors exist in the family history? Why are these thought to be risk factors? 

3. Discuss further characteristics that the child may show as he gets older.

Exercise two:

Charlie is a 3-year-old in a community preschool. The staff reports that he tends to put everything in his mouth and is frequently found eating dirt. A home visit by a school staff member to discuss the problems with his parents reveals a generally clean environment in a very old home that was being renovated. Recently, Charlie has been falling behind in academic skills compared with the other children in his class; his linear growth has slowed, and he is tired and irritable. His physician noted pallor and what look like “pencil lines” on the gums adjacent to his teeth. He ordered blood tests, which revealed a low hemoglobin level and an elevated lead level.

Discussion Questions (Provide answers based on evidence and reference your responses using APA format)

1. Based on the patient history, signs and symptoms, and lab test results, discuss the probable environmental factors responsible for Charlie’s ingestion of lead. 

2. Discuss the other toxic effects of lead poisoning that Charlie might experience if the situation is not addressed. 

3. Discuss other possible sources in children’s environments that have been identified as containing lead. 

What are your thoughts?

According to Beeler et al. (2019), despite the studies to show effectiveness in port disinfection in reducing CLASBI the consistent use of this practice is not being implemented. The article shows that when nurses were given proper education on the use and importance with consistent data to show decrease in numbers as they put into practice, the use of caps was increased and CLASBI decreased. This means that many units likely carry the product and tell nurses to use, but there is no follow-through plan to ensure it’s being used, which seems like a waste of resources all the way around.