// Attention Deficit Hyperactivity Disorder

Attention Deficit Hyperactivity Disorder A Young Girl With ADHD

 

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 re-start 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 StudentBupropion 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.

Start Over

Do nothing, and explain to the parents that Katie’s ADHD will most likely improve with age as her prefrontal cortex grows and matures

Guidance to StudentBupropion 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.

Start Over

Discuss the use of a medication such as Adderall and its evidence for treating ADHD

Guidance to StudentBupropion 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.

Start Over

Discontinue Wellbutrin and begin Strattera (atomoxetine) 10 mg orally daily

RESULTS OF DECISION POINT TWO

• Client returns to clinic in four weeks
• Katie’s parents report that they spoke with Katie’s teacher who notices that her symptoms are getting a bit better
• They are very concerned, however, about Katie’s decreased appetite. They say that Katie was never a “big eater” but have become concerned that her appetite has worsened

Decision Point Three

Select what the PMHNP should do next:

Maintain current dose of Strattera and reevaluate side effects at next office visit in 4 weeks

Guidance to StudentWellbutrin is used off-label for ADHD but is used more commonly in adults. Its 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), Wellbutrin can increase dopamine neurotransmission in this part of the brain, which may explain its effectiveness in ADHD. However, Wellbutrin, as well as other antidepressants, has been linked to suicidal ideation in children and adolescents. Despite the fact that it is being used to treat ADHD, it is still an antidepressant.

After discontinuing the Wellbutrin and beginning Strattera (atomoxetine), a decrease in symptoms was noted by Katie’s teacher. This indicates that the drug is working. However, the parents are concerned about Katie’s decreased appetite. This side effect may improve with the passage of time, but the PMHNP will need to monitor it. Keep in mind that if the PMHNP decides to increase the dose at this point, the side effects may worsen. Additionally, Strattera can take up to 8 to 12 weeks to demonstrate the full therapeutic actions of the drug; therefore, it may be prudent at this point to maintain the current dose.

The development of common side effects are not an indication to discontinue one drug and begin a different medication unless they are severe enough to warrant intervention (i.e., they are severe or incapacity for the individual); therefore, it would not be appropriate to discontinue Strattera and begin Intuniv.

Start Over

Discontinue Strattera and begin Intuniv extended release, 1 mg orally daily

Guidance to StudentWellbutrin is used off-label for ADHD but is used more commonly in adults. Its 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), Wellbutrin can increase dopamine neurotransmission in this part of the brain, which may explain its effectiveness in ADHD. However, Wellbutrin, as well as other antidepressants, has been linked to suicidal ideation in children and adolescents. Despite the fact that it is being used to treat ADHD, it is still an antidepressant.

After discontinuing the Wellbutrin and beginning Strattera (atomoxetine), a decrease in symptoms was noted by Katie’s teacher. This indicates that the drug is working. However, the parents are concerned about Katie’s decreased appetite. This side effect may improve with the passage of time, but the PMHNP will need to monitor it. Keep in mind that if the PMHNP decides to increase the dose at this point, the side effects may worsen. Additionally, Strattera can take up to 8 to 12 weeks to demonstrate the full therapeutic actions of the drug; therefore, it may be prudent at this point to maintain the current dose.

The development of common side effects are not an indication to discontinue one drug and begin a different medication unless they are severe enough to warrant intervention (i.e., they are severe or incapacity for the individual); therefore, it would not be appropriate to discontinue Strattera and begin Intuniv.

Start Over

Increase Strattera to 25 mg orally daily and reevaluate at next office visit in 4 weeks

Guidance to StudentWellbutrin is used off-label for ADHD but is used more commonly in adults. Its 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), Wellbutrin can increase dopamine neurotransmission in this part of the brain, which may explain its effectiveness in ADHD. However, Wellbutrin, as well as other antidepressants, has been linked to suicidal ideation in children and adolescents. Despite the fact that it is being used to treat ADHD, it is still an antidepressant.

After discontinuing the Wellbutrin and beginning Strattera (atomoxetine), a decrease in symptoms was noted by Katie’s teacher. This indicates that the drug is working. However, the parents are concerned about Katie’s decreased appetite. This side effect may improve with the passage of time, but the PMHNP will need to monitor it. Keep in mind that if the PMHNP decides to increase the dose at this point, the side effects may worsen. Additionally, Strattera can take up to 8 to 12 weeks to demonstrate the full therapeutic actions of the drug; therefore, it may be prudent at this point to maintain the current dose.

The development of common side effects are not an indication to discontinue one drug and begin a different medication unless they are severe enough to warrant intervention (i.e., they are severe or incapacity for the individual); therefore, it would not be appropriate to discontinue Strattera and begin Intuniv.

Start Over

Discontinue Wellbutrin and begin Adderall (amphetamine d, l) extended release 5 mg orally daily

RESULTS OF DECISION POINT TWO

• Client returns to clinic in four weeks
• Katie’s parents report that they spoke with Katie’s teacher who notices that her symptoms are getting a bit better
• They are very concerned, however, about Katie’s decreased appetite. They say that Katie was never a “big eater” but have become concerned that her appetite has worsened

Decision Point Three

Select what the PMHNP should do next:

Maintain current dose of Adderall and re-evaluate side effects at next office visit in 4 weeks

Guidance to StudentWellbutrin is used off-label for ADHD but is used more commonly in adults. Its 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), Wellbutrin can increase dopamine neurotransmission in this part of the brain, which may explain its effectiveness in ADHD. However, Wellbutrin, as well as other antidepressants, has been linked to suicidal ideation in children and adolescents. Despite the fact that it is being used to treat ADHD, it is still an antidepressant.

After discontinuing the Wellbutrin and beginning Adderall, a decrease in symptoms was noted by Katie’s teacher. This indicates that the drug is working. However, the parents are concerned about Katie’s decreased appetite. This side effect may improve with the passage of time, but the PMHNP will need to monitor it.

Increasing the dose of Adderall may worsen this side effect; however, if symptoms are still severe enough, an increase in dose may be warranted. At this point, the PMHNP needs to know what symptoms have improved and—based on overall functioning—must then determine whether or not there is an indication to increase the current dose of the medication.

The development of common side effects are not an indication to discontinue one drug and begin a different medication unless they are severe enough to warrant intervention (i.e., they are severe or incapacity for the individual); therefore, it would not be appropriate to discontinue Strattera and begin Intuniv.

Start Over

Discontinue Adderall and begin Intuniv extended release, 1 mg orally daily

Guidance to StudentWellbutrin is used off-label for ADHD but is used more commonly in adults. Its 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), Wellbutrin can increase dopamine neurotransmission in this part of the brain, which may explain its effectiveness in ADHD. However, Wellbutrin, as well as other antidepressants, has been linked to suicidal ideation in children and adolescents. Despite the fact that it is being used to treat ADHD, it is still an antidepressant.

After discontinuing the Wellbutrin and beginning Adderall, a decrease in symptoms was noted by Katie’s teacher. This indicates that the drug is working. However, the parents are concerned about Katie’s decreased appetite. This side effect may improve with the passage of time, but the PMHNP will need to monitor it.

Increasing the dose of Adderall may worsen this side effect; however, if symptoms are still severe enough, an increase in dose may be warranted. At this point, the PMHNP needs to know what symptoms have improved and—based on overall functioning—must then determine whether or not there is an indication to increase the current dose of the medication.

The development of common side effects are not an indication to discontinue one drug and begin a different medication unless they are severe enough to warrant intervention (i.e., they are severe or incapacity for the individual); therefore, it would not be appropriate to discontinue Strattera and begin Intuniv.

Start Over

Adderall to 10 mg extended release daily and reevaluate at next office visit in 4 weeks

Guidance to StudentWellbutrin is used off-label for ADHD but is used more commonly in adults. Its 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), Wellbutrin can increase dopamine neurotransmission in this part of the brain, which may explain its effectiveness in ADHD. However, Wellbutrin, as well as other antidepressants, has been linked to suicidal ideation in children and adolescents. Despite the fact that it is being used to treat ADHD, it is still an antidepressant.

After discontinuing the Wellbutrin and beginning Adderall, a decrease in symptoms was noted by Katie’s teacher. This indicates that the drug is working. However, the parents are concerned about Katie’s decreased appetite. This side effect may improve with the passage of time, but the PMHNP will need to monitor it.

Increasing the dose of Adderall may worsen this side effect; however, if symptoms are still severe enough, an increase in dose may be warranted. At this point, the PMHNP needs to know what symptoms have improved and—based on overall functioning—must then determine whether or not there is an indication to increase the current dose of the medication.

The development of common side effects are not an indication to discontinue one drug and begin a different medication unless they are severe enough to warrant intervention (i.e., they are severe or incapacity for the individual); therefore, it would not be appropriate to discontinue Strattera and begin Intuniv.

Start Over

Health Care Marketing Plan Presentation

Create a hypothetical health care organization or social program, using a real organization or program as a model, and develop a comprehensive marketing plan to market it. Examples include cancer hospitals, home health agencies, nursing homes, durable medical equipment companies, weight loss programs, and insurance programs.

Develop a comprehensive marketing plan to market your organization or program.

Create a 20- to 25-slide Microsoft® PowerPoint® presentation, with speaker’s notes, detailing your plan. Speaker’s notes must be between 100 to 200 words per slide. Include the following:

•Background information

◦What is the name of the organization or program?

◦What is the geographic location?

◦What is the organizational mission?

•Industry background: Describe the industry’s historical background.

•Situational SWOT analysis: Assess the organization’s environment. Address why your marketing plan is necessary. Include the following:

◦Strengths (internal)

◦Weaknesses (internal)

◦Opportunities (external)

◦Threats (external)

•Market research

◦Why must market research be conducted?

◦What kind of data will you use: primary, secondary, or both? Why?

•Marketing objectives: List your quantifiable marketing objectives.

◦Explain what you want to achieve.

◦Define estimated dates by which you want to achieve those goals

•Marketing strategies: Describe the general approach or best way to meet your objectives.

•Consumer analysis

◦Determine the demographics of the program’s potential consumers.

◦Determine the psychographics of the program’s potential consumers.

◦Identify common consumer behaviors of the program’s potential consumers.

•Target market

◦Determine the primary market: What are the characteristics of the primary market?

◦Determine the secondary market: What are the characteristics of the secondary market?

◦Market segmentation: How will you segment the market? Why?

•Competitive analysis

◦Identify your competitors.

◦Briefly describe your competitors’ strategies.

•The four Ps

◦Product

◾What types of products, programs, or services are involved, as in a good, service, or idea?

◾What are the features? How is it positioned and differentiated from the competitors?

◾How is the product, program, or service identified, as in brand name, label, or packaging?

◦Place

◾What are the channels of distribution?

◾Where are the facilities located?

◦Pricing

◾What aspects must be considered in developing pricing?

◾Determine a suggested selling price.

◦Promotion

◾How will you promote the organization or program?

◾Personal selling

◾Advertising

◾Media mix: television, magazines, outdoor, direct mail, radio, or website

◾Slogan and message

◾Sales promotion activities: trade show or promotional materials

◾Public relations

•Regulations: Identify the regulations that affect your plan.

•Social marketing strategies

•Ethics and patient privacy

•Monitoring the plan: Create a way to monitor and evaluate your plan’s success.

Here is what we did in week 3

I. Background Information

A. Name of the organization

1. Health South Rehabilitation Center

B. Geographical Location

1. Woburn, Massachusetts

C. Organization’s Mission

1. Commitment to quality

2. Results driven care with specialization in services

3. Continuum of care for patients with traumatic injuries

II. Industry Background

A. Historical background of the industry

1. Importance of continuum of care

2. Little to no focus in the past on rehabilitation services

3. Patient care improvements

B. Historical background of the organization

1. Strong leadership efforts in staying current with most up to date technologies

2. Cost effectiveness for high quality care

(This is part of the assignment that you did for me on 1/21/18) This assignment is based on that one.