Introduction
Katie is a female 8 year-old Caucasian child who is brought to the clinic by her parents. She has a previous provisional diagnosis of attention deficit hyperactivity disorder or ADHD. Katie is having difficulties in school with concentration and performance. She is also not socializing well with her peers and likes to keep to herself. Her attention span is also short. Katie was born to mature parents (47 and 49 years old respectively) and had notable low wellness scores at birth. The parents bring with them the Connor’s Teacher Rating Scale form which had been filled by her teacher at school. This is helpful in assessing her condition and arriving at the correct diagnosis. Practicum Decision Tree – young girl with difficulties in school case study
Decision Point Number 1
In using the available assessment tools and based on what the parents and the teacher had reported, the diagnosis of ADHD with predominantly inattentive presentation was made as stated above. According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), inattention such as Katie’s must meet criterion A. 1 (a)-(i) for this diagnosis to be reached (APA, 2013). This was met by Katie because her Conner’s Teacher Rating Scale shows that she is easily distracted at school and has the habit of only paying attention to what she has interest in. She is also quite forgetful of what she has been taught in school, attributable too to her inattention. The hope in arriving at this diagnosis was that Katie would be started on ADHD treatment at the right time; a fact that would place her in a better position to be free of her symptoms in the shortest time possible (Wender & Tomb, 2017). However, on close assessment during the revisit session, subjective evidence showed clearly that Katie was also evidently hyperactive as she could not stay in one place during the interview with the psychiatric-mental health nurse practitioner or PMHNP. Apart from the fact that her answers were short, it was also revealed that she also wonders in thought while in class. Practicum Decision Tree – young girl with difficulties in school case study. Her mental status examination was however largely unremarkable. She was oriented in all aspects and was dressed appropriately for both the time of the day and the weather. The only thing that stood out was that she had an imaginary friend by the name “Audrey.” Because of these findings, the presentation of the diagnosis had to be reviewed from predominantly inattentive to combined presentation (APA, 2013; Wender & Tomb, 2017). This is because her symptoms largely agreed also with criterion A. 2 (a)-(i) on hyperactivity and impulsivity. Moreover, she also fitted in with the rest f the criteria B, C, D, and E (APA, 2013). Thus the summary of her definitive diagnosis is ADHD with inattention, hyperactivity, and impulsivity. There wasn’t much difference in the initial decision and the revised one in terms of the results as the diagnosis itself has not changed but only the presentation. The fact that she had not started to show any significant response to treatment is to be expected because ADHD response to pharmacologic treatment typically takes weeks (Stahl, 2014; Katzung, 2018). Practicum Decision Tree – young girl with difficulties in school case study.
Decision Point Number 2
On the return visit the girl was put on wellbutrin (bupropion) 75 mg daily to be taken by mouth. This decision was taken because this s a major norepinephrine dopamine reuptake inhibitor or NDRI approved by the Food and Drug Administration (FDA) for the treatment of ADHD (Stahl, 2014; Katzung, 2018; Nursingworld.org, n.d.). The other reason for choosing wellbutrin is that it continues to work for several years later and in the process deters the recurrence of symptoms (Stahl, 2014). This long term remission is what was intended to be achieved by this choice. Wellbutrin is one of the best pharmacotherapeutic agents available for treating ADHD. However, its effects are normally not felt immediately and its full therapeutic action may be evident from up to four weeks later (Stahl, 2014). The results of this decision to start wellbutrin and what was expected are not significantly different for two reasons. First is that as stated it takes weeks for the full impact of the drug to be felt (this patient returned after four weeks). Two is that the questions that Katie is asking are not part of the known side effects of the drug (Stahl, 2014).
Decision Point Number 3
As stated above, wellbutrin (bupropion)
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