Posted: June 14th, 2023

Decision Tree on a pediatric patient with ADHD

Decision Tree on a pediatric patient with ADHD To prepare for this decision tree Assignment: 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. Link https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/… I want you to answer the questions given to you (decision points one, two, and three) before you click on the option. The answers will be based on your decisions made and patient outcomes during the decision tree. I am looking for an essay that is long enough to cover the topic BUT short enough to keep my interest. The course page suggests writing 1 page per decision – my opinion is that it will be very difficult to justify your treatment decisions and provide scientific evidence in 1 page (especially for decision #1). I do not need you to tell me about the patient or the treatment options available to you – I am very familiar with the cases. Your introductory page should be an overview of the disease state you are treating along with a purpose statement for the assignment. Remember this is a Pharmacology class that incorporates Pharmacotherapy and not a class on diagnosing disease. I want you to tell me why you selected an option – why is it the best option, using clinically relevant data from primary literature (clinical trials, treatment guidelines) and patient specific data AND why you did not choose the other options (with clinically relevant data from primary literature and patient specific data). Introduction to the case (1 page) Briefly explain and summarize the disease state you are treating this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient. Decision #1 (1.5+ pages) Which decision did you select?Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. Again, provide STRONG scientific evidence. Clinical studies or treatment guidelines are a good place to start! 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. You should provide me with a clear understanding of the stimulant vs. non-stimulant clinical decision you’ve made. Be sure to cite specific guidelines for pediatric ADHD. 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. Decision #2 (1 page) Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. Again, provide STRONG scientific evidence. Clinical studies or treatment guidelines are a good place to start! 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. Decision #3 (1 page) 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. Again, provide STRONG scientific evidence. Clinical studies or treatment guidelines are a good place to start! 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. Conclusion (1 page) Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature. After writing up your rationale at each decision point, I would ask yourself the following questions: Have I provided clinical data from a meta-analysis, case report or clinical trial to support the drug I picked being safe, efficacious and the best choice for this patient? Have I provided clinical data, etc. to support a clear rationale as to why the other treatment options are NOT optimal? Is the focus of my discussion on mechanism of action and receptors/neurotransmitters that the drug acts on? If the answer is YES, you should consider doing additional research to address the above two questions Also include how ethical considerations might impact your treatment plan and communication with clients. The rubric, as I interpret it, suggests 5 references cited with every assignment for full credit on this portion (20 points). References used for your introductory paragraph, ethical considerations or conclusion do not count towards the 5 references required. As a general rule of thumb, I would encourage you to reference AT LEAST two sources (not including the textbook) for each decision point – this will result in 6 references total for your clinical decision making. __________________________ Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that affects individuals of all ages, but it is most commonly diagnosed in children. ADHD is characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with daily functioning. The case study is about a young Caucasian girl with ADHD, who is experiencing difficulty in school and social settings. In this decision tree assignment, we will make three decisions concerning the medication to prescribe to this client, considering the patient's pharmacokinetic and pharmacodynamic processes.

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Decision #1: The first decision is to choose between a stimulant or non-stimulant medication for the patient. I would select a non-stimulant medication, such as atomoxetine. The main reason for choosing a non-stimulant medication is due to the patient's comorbidities, including anxiety and a family history of substance abuse. Studies have shown that non-stimulant medications are generally well-tolerated in patients with comorbid anxiety disorders and have a lower risk of abuse potential compared to stimulant medications (1). Furthermore, the American Academy of Pediatrics (AAP) recommends that non-stimulant medications be considered as the first-line treatment for ADHD in children with anxiety disorders (2). Although stimulant medications are effective in treating ADHD symptoms, they can increase anxiety symptoms in patients with anxiety disorders. Therefore, the use of non-stimulant medications can be beneficial in managing both ADHD and anxiety symptoms in these patients. I did not select the other two options, which were a stimulant medication and a combination of a stimulant and non-stimulant medication. Stimulant medications have a higher risk of abuse potential, which can be a concern for patients with a family history of substance abuse. Additionally, stimulant medications can exacerbate anxiety symptoms in patients with comorbid anxiety disorders. The combination of stimulant and non-stimulant medications may be effective in treating ADHD symptoms, but it may also increase the risk of adverse effects and medication interactions (3).

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The goal of selecting a non-stimulant medication is to manage ADHD and anxiety symptoms while minimizing the risk of adverse effects and medication interactions. This approach can lead to improved patient outcomes and increased adherence to treatment. Ethical considerations may impact the treatment plan and communication with patients. It is important to discuss the potential benefits and risks of non-stimulant medications with the patient and their family. Additionally, the patient's privacy and confidentiality must be maintained when discussing their medical history and medication options. Decision #2: The second decision is to choose the appropriate dose and titration schedule for the selected medication. I would choose to start the patient on a low dose of atomoxetine and titrate slowly to the target dose over several weeks. This approach can help minimize the risk of adverse effects and increase patient adherence to treatment.

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Studies have shown that a slow titration schedule can lead to better tolerability and improved efficacy in patients with ADHD (4). Additionally, the AAP recommends a slow titration schedule for atomoxetine in pediatric patients with ADHD (2). By following the recommended titration schedule, we can ensure that the patient is receiving the appropriate dose of medication without experiencing intolerable adverse effects. I did not select the other two options, which were to start the patient on the target dose immediately or to titrate the dose quickly. Starting the patient on the target dose immediately can increase the risk of adverse effects and decrease patient adherence to treatment. Titration the dose quickly can also increase the risk of adverse effects and may not provide optimal symptom relief. The goal of choosing a slow titration schedule is to optimize the patient's response to treatment while minimizing the risk of adverse effects. This approach can lead to improved patient outcomes and increased adherence to treatment. Ethical considerations may impact the treatment

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