Health Medical Homework Help

Please respond to at least 2 of your peer’s posts with substantive comments using the following steps:

• Substantive comments add to the discussion and provide your fellow students with information that will enhance the learning environment.
• References and citations should conform to APA standards.
• Remember: Please respect the opinions of others, even if their views differ. In other words, disagree professionally and respectfully.

1. Lisa

Treatment Plans completed for current partial plan listed above:

1. ADHD: DSM-IV 314.01 / ICD-10 – F90.9 (this could change following the use of the screening tool of the Conner’s Parent and Teacher rating scale and the Conner’s Continuous Performance Test and could include F90.0, F90.1, or F90.2) (Wikes, Cobb, & Spratt, 2018).

• Plan – (need to complete the above screening tools). The APP guidelines show that the first-line treatment for ADHD for children 4-6 years old is classroom behavior management and behavior management with parental training. Therefore, a referral would be made for these therapies, also due to mom having apparent difficulties with this over the past four months since this issue was diagnosed and the current ongoing stress and concerns, the current guidelines for starting medication of which Methylphenidate (Ritalin) is suggested as the first-line medication (Wikes, Cobb, & Spratt, 2018). (This study lists Lisdexamfetamine (Vyvanse) in the partial plan, so this will be used in this plan per assignment). Start Vyvanse 30mg chewable tablets, dispense #30, take one by mouth each morning with two refills with follow-up in 3 months or sooner if needed. (I would personally only do a 30 day supply and have a follow up in 2 weeks to check for compliance and side effects of the medication with another follow up two weeks later for the same and new script, then if the patient appears to be improving, see once per month for a minimum of 6 months, then every three months. One main reason is to access growth and weight.
  • Diagnostics: Based on exam and parent interview. (should have screenings completed).
  • Therapeutics – Referral for therapy and Vyvanse 30mg chewable tablets, disp #30, take one by mouth each morning with two refills with follow up in 3 months. (should be as mentioned above).
  • Education – Educated on the importance of therapy and to take medication as directed. Educated on medication side effects to include common effects of diarrhea, nausea, insomnia, decreased weight, and severe effects of serotonin syndrome and rhabdomyolysis. Educated to seek medical care if the following are seen; fast heart rate, excessive sweating, confusion, diarrhea, agitation, muscle rigidity, high blood pressure, dark urine. Do not stop abruptly. Educate on mouth hygiene (frequent mouth rinse, hard candy/gum) (Sanoski & Vallerand, 2021).
  • Consultation/Collaboration – referral to therapy

References

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders: DSM-5 (5th ed.). Arlington, VA: American Psychiatric Association Publishing.

Frampton, J. (2018). Lisdexamfetamine dimesylate: A review in pediatric ADHD. Drugs, 78(10), 1025-1036. doi:http://dx.doi.org/10.1007/s40265-018-0936-0.

Sanoski, C. A., & Vallerand, A. H. (2021). Davis Drug Guide for Nurses, 17th Edition. F.A. Davis Company. Retrieved 03 2021, from https://www.drugguide.com.

Wikes, M., Cobb, S., & Spratt, E. (2018). Pediatric Attention Deficit Hyperactivity Disorder (ADHD) Treatment & Management. Retrieved May 2021, from Medscape: https://emedicine.medscape.com/article/912633-treatment.

2. Ron

ADHD, unspecified [ICD-10, F 90.9/ DSM-5, 314.01]- The American Psychiatric Association has defined consensus criteria for the diagnosis of ADHD in children below 17 years old, the DSM-5 requires 6 or more symptoms of hyperactivity and impulsivity or 6 more symptoms of inattention Based on interview with the mother and physical examination, patient has met the criteria for the diagnosis ADHD. Symptoms of hyperactivity and impulsivity may include: Excessive fidgetiness ( tapping the hands or feet, squirming in seat) ; Difficulty remaining seated when sitting is required (at school); Inappropriate running around or climbing in younger children; Difficulty playing quietly; Difficult to keep up with, seeming to always be “on the go”; Excessive talking; Difficulty waiting turns; Blurting out answers too quickly; Interruption or intrusion of others. Symptoms of inattention may include : Failure to provide close attention to detail, careless mistakes; Difficulty maintaining attention in play, school, or home activities; Seems not to listen, even when directly addressed; Fails to follow through; Difficulty organizing tasks, activities, and belongings; Avoids tasks that require consistent mental effort; Loses objects required for tasks or activities; Easily distracted by irrelevant stimuli; Forgetfulness in routine activities (Krull, 2019)

Plan:

Diagnostic: Screening completed.

Therapeutic: Treatment: Behavior Therapy as initial treatment. Per uptodate Behavior therapy and environmental changes can be used by parents or teachers to shape the behavior of children with ADHD. These includes maintaining a daily schedule; keeping distractions to a minimum; setting small reachable goals; rewarding a positive behavior; providing specific and logical places for the child to keep toys, cloth and schoolwork; using charts and checklist to help the child to stay on task; limiting choices; using calm discipline by distraction, time out or removing the child from the situation. If Target behaviors and child’s function do not improve with behavioral therapy medication can be added. I would start the patient on short acting form of stimulant, Ritalin (methylphenidate) 2.5 mg PO on day 1, then increase 2.5 mg every 3-7 days. Maximum dose is 35 mg PO daily for weight <25 kg (krull, 2021). Patient weighs only 22.7. Vyvance is recommended for school-aged children, 6 years old and above.

Education: Educate on the importance of regular communication between the parents and teachers through daily report or a weekly communication book. Provide information about ADHD and local support group if available. Educate to take medication as prescribed and keeping the medication in a safe location. I would discuss on the common side effects of the medication which includes poor growth, loss of appetite, sleeping difficulties.

Consultation: Referral to a child neurologist; education specialist; child psychologist; child psychiatrist or developmental-behavioral child specialist is indicated in children with mental retardation, developmental disorder, Seizure disorder, severe aggression, history of abuse, visual or hearing impairment, learning disabilities, coexisting learning and/or emotional problems, chronic illness that requires treatment with a medication that interferes with learning or children who continue to have problems in functioning despite treatment ( Krull, 2019)

References:

Krull, K. R. (2019, November 27). UpToDate. https://www.uptodate.com/contents/attention-deficit-hyperactivity-disorder-in-children-and-adolescents-clinical-features-and-diagnosis?search=adhd+children&topicRef=623&source=see_link.

Krull, K. R. (2021, May 13). UpToDate. https://www.uptodate.com/contents/pharmacology-of-drugs-used-to-treat-attention-deficit-hyperactivity-disorder-in-children-and-adolescents?search=adhd+medications+children&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1.