General Directions
Review the provided case study to complete this week’s discussion.
Include the following sections:
- Application of Course Knowledge: Answer all questions/criteria with explanations and detail.
- Select one drug to treat the diagnosis(es) or symptoms.
*******USE LISDEXAMFETAMINE AS THE MEDICAITON*********
- List medication class and mechanism of action for the chosen medication.
- Write the prescription in prescription format.
- Provide an evidence-based rationale for the selected medication using at least one scholarly reference. Textbooks may be used for additional references but are not the primary reference.
- List any side effects or adverse effects associated with the medication.
- Include any required diagnostic testing. State the time frame for this testing (testing is before medication initiation or q 3 months, etc.). Includes normal results range for any listed laboratory tests.
- Provide a minimum of three appropriate medication-related teaching points for the client and/or family.
- Integration of Evidence: Integrate relevant scholarly sources as defined by program expectations:
- Cite a scholarly source in the initial post.
- Cite a scholarly source in one faculty response post.
- Cite a scholarly source in one peer post.
- Accurately analyze, synthesize, and/or apply principles from evidence with no more than one short quote (15 words or less) for the week.
- Include a minimum of two different scholarly sources per week. Cite all references and provide references for all citations.
- Engagement in Meaningful Dialogue: Engage peers and faculty by asking questions, and offering new insights, applications, perspectives, information, or implications for practice.
- Peer Response: Respond to at least one peer on a topic other than the initially assigned topic.
- Faculty Response: Respond to at least one faculty post.
- Communicate using respectful, collegial language and terminology appropriate to advanced nursing practice.
- Professionalism in Communication: Communicate with minimal errors in English grammar, spelling, syntax, and punctuation.
- Reference Citation: Use current APA format to format citations and references and is free of errors.
NR 546 Week 7 Case Study- child and adolescent
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Subjective |
Objective |
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The client is an 7-year-old male accompanied by his mother and 9-year-old brother. Client’s Chief Complaints: “My son is getting in trouble at school due to his behaviorl. He has endless energy; he can’t sit still. When he plays, he is too rough with other kids.” History of Present Illness The mother presents with the client due to academic and behavioral concerns. The mother presents a school report that states that he cannot stay seated, frequently calls out in class, is disorganized, cannot complete his assignments, and has been known to be disrespectful to adults. According to his mother, he is very impatient, distractable, and impulsive. Past psychiatric history: At age 4, the child was in a Head Start Program, and it was noted that he was demonstrating extreme hyperactivity, poor impulse control, and difficulty sustaining focus. Peer interactions were marked by aggression, such as kicking and biting others. When told “no,” he would have extreme temper tantrums, where he would cry, scream, and destroy property. Such behaviors resulted in being permanently expelled from the program. At age 5, he was evaluated and diagnosed with ADHD, combined type. Medication was not prescribed at that time due to age. Past Medical History: healthy Perinatal history: full-term pregnancy, uneventful. NSVD. Breastfed x 5 months. Developmental: mother reports client demonstrates age-appropriate gross and fine motor skills. He is able to dress and undress, can tie his shoes, and colors within the lines; he can balance on one foot, catch a tennis ball, and ride a bicycle with training wheels. Family History · Father is alive and well. · Mother is alive, has anxiety · One brother, age 10, alive and well Social History · Lives with parents and brother · 1st grader at local public school · does not have any friends Trauma history: no reports of trauma Review of Systems · appetite good, weight stable · sleeps 5-7 hours at night; difficulty falling asleep Allergies: NKDA |
Physical Examination: Physical Examination (Obtained by Pediatrician 2 Days Earlier) Height 48″, weight: 85lb Vital signs: B/P, 100/60; P, 78; R, 16; T, 98.4 General: Well-nourished 7-year-old male HEENT: PERRLA, EOMI, vision is 20/20, and hearing acuity is unremarkable. Neck: No masses Pulmonary: No wheezing, rhonchi, or rales Cardiac: S1, S2 Abdomen: No distension, bowel sounds × four quadrants, no masses or hernias Lymph nodes: No swelling Extremities: 2+ pulses bilaterally Skin: No lesions or edema Neuro: CN II-XII intact |
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Mental status exam: Appearance: a well-nourished 6-year-old male who appears to be stated age. He is dressed in a striped collared shirt, jeans, and sneakers, appropriate for age and weather. Hygiene and grooming are good. Alertness and Orientation: fully oriented to person‚ place‚ time‚ and situation, Alert Behavior: He separates easily from his mother and brother to come with the interviewer. When he enters the office, he sits in the chair, puts his hands on the desk, and states, “Let’s get to work.” Initially, he stays seated with good posture, but after several minutes, he becomes hyperactive and cannot stay seated. Boundaries are poor, and he often grabs objects off the desk. He frequently interrupts. Speech: Speech is spontaneous. At times, tone is loud. The rate is fast, and he talks excessively. He has a mild lisp and some age-appropriate articulation errors. Mood: “happy” Affect: constricted Impulse control: Poor. He was touching items on the provider’s desk despite multiple reprimands from his mother. Thought content: Suicidal and/or homicidal ideations: Cannot be elicited when questioned Perceptions: No evidence of psychosis, not responding to internal stimuli, reports auditory hallucinations. Memory: Remote memory appears fair. He can repeat three objects immediately but not after 5 minutes. Concentration: When focused, he is able to sing the ABCs and count to 99. Otherwise, he has a very short attention span and is distracted. Attention and observed intellectual functioning: Intelligence appears to be average. Fund of knowledge: Good general fund of knowledge and vocabulary Musculoskeletal: normal gait and station |
Diagnosis: (F90.2) Attention-Deficit/Hyperactivity Disorder, Combined Presentation
5.23 CCK
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Select one drug to treat the diagnosis(es) or symptoms.
Lisdexamfetamine (Vyvanse)
List the medication class and mechanism of action for the chosen medication.
According to Stahl, Lisdexamfetamine (LDX) is a stimulant and a dopamine and norepinephrine reuptake inhibitor and releaser (2020). LDX is FDA- approved for ADHD for individuals 6 years and older. It targets symptoms of decreased concentration, decreased attention, and increased hyperactivity and impulsiveness. LDX is a prodrug of dextroamfetamine and does not become active until absorption in the gastrointestinal tract occurs to convert it to an active form.
Write the prescription in prescription format.
Patient Name: XX
Age/DOB: xx/xx/xxxx
Pt Address: if not automatically generated
NKDA
Date: April 16th, 2023
RX: Lisdexamfetamine (Vyvanse) 30mg capsules
SIG: Take one capsule, by mouth, (30mg) every morning
Dispense: #30 (thirty) tablets
Refills: zero refills
CMW, MSN, RN, PMHNP
NPI: 123456789
DEA: 987654321
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The brand-only, generic, or voluntary formulary may be indicated per clinician practice.
**No refills were written for this prescription since this is the initial prescription and follow-up should be indicated before refills authorized
Provide an evidence-based rationale for the selected medication using at least one scholarly reference. Textbooks may be used for additional references but are not the primary reference.
According to the American Academy of Pediatrics (AAP), FDA-approved medications for ADHD are a Grade A, strong recommendation, for the treatment of ADHD in children between the ages of 6 years and the 12th birthday (2019). According to a randomized, double-blind, placebo- controlled trial by Newcorn et al., LDX and Methylphenidate (MPH) both demonstrated a high level of efficacy in adolescents with ADHD (2017). Although this study was back in 2017, a comprehensive review by Quintero et al. in 2022 also showed that both LDC and MPH increase dopamine (DA) and norepinephrine (NE) which results in the downregulation of dopamine and norepinephrine transmitters (DAT, NET) presynaptically (2022). Additionally, LDX targets more receptors than MPH but MPH can have a positive impact on neurodegeneration and oxidative stress modulation. However, since LDX targets more receptors, it has a beneficial impact on inflammation cytokines, which may contribute to worsening ADHD symptoms.
Overall, the rationale for selecting LDX was due to its longer duration and decreased risk of addiction. According to Stahl, LDX has a 10–12-hour duration whereas even the sustained-release MPH has a maximum duration of 8 hours (2020). (other than extended-release Concerta). The longer duration will help this child throughout the school day and possibly when they come home from school to do homework. Finally, LDX is FDA approved for binge eating disorder and could have an unintended positive impact on this child being around 20 pounds overweight for his age and height. According to the CDC, this child is in the 99th percentile for 8-year-old boys, is considered obese, and is at risk for type 2 diabetes, high blood pressure, and other conditions (2023).
List any side effects or adverse effects associated with the medication.
According to Stahl, the notable side effects of LDX include insomnia, headaches, irritability, overstimulation, tremor, dizziness, nervousness, anorexia, nausea, dry mouth, constipation, diarrhea, and weight loss (2020).
This study source was downloaded by 100000782256171 from CourseHero.com on 08-22-2023 15:38:54 GMT -05:00
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According to the FDA, decreased appetite (39%), insomnia (23%), abdominal pain (12%), irritability (10%), vomiting (9%), and decreased weight (9%) (2017). All other side effects, according to the FDA, were a 6% or less incidence.
Include any required diagnostic testing. State the time frame for this testing (testing is before medication initiation or q 3 months, etc.). Includes normal results range for any listed laboratory tests.
According to Stahl, it is important to assess for a cardiac history prior to treatment initiation due to the central nervous system stimulation that occurs and its possible impact on cardiac function (increases heart rate, increases blood pressure, etc.) (2020). Additionally, blood pressure should be monitored routinely throughout treatment and the child’s height and weight is important to consistently document.
Provide a minimum of three appropriate medication-related teaching points for the client and/or family.
This medication is a stimulant, which is a controlled substance. Tt must be taken strictly as prescribed. Call your prescriber immediately if your child is experiencing any symptoms of cardiac reactions like chest pain, shortness of breath, or fainting. Also, call your prescriber right away if your child has new or worsening behaviors or thought patterns, hearing or seeing things that are not there, paranoia, or thoughts about things that are not true. Also, let your prescriber know immediately if your child becomes increasingly hyperactive or has an increased problem with sleep. It will be important for your child to take this medication in the morning to avoid problems falling asleep. This medication should last throughout the school day and may still have therapeutic effects when he comes home. This medication may cause a decreased appetite, weight loss, insomnia, and irritability, and although the medication should start working the first day of taking it, it may take a week to get the full therapeutic effect. It will be imperative that you keep all medications, especially controlled substances, in a locked cabinet in your house.
CDC. (2023). BMI Percentile Calculator for Child and Teen: Results. Retrieved from https://www.cdc.gov/healthyweight/bmi/result.html? &method=english&gender=m&age_y=8&age_m=0&hinches=48&twp=85
This study source was downloaded by 100000782256171 from CourseHero.com on 08-22-2023 15:38:54 GMT -05:00
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FDA. (2017). Vyvanse. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/208510lbl.p df
Newcorn et al. (2017). Randomized, Double-Blind, Placebo-Controlled Acute Comparator Trials of Lisdexamfetamine and Extended-Release Methylphenidate in Adolescents With Attention-Deficit/Hyperactivity Disorder. CNS drugs, 31(11), 999–1014. https://doi.org/10.1007/s40263-017-0468-2
Wolraich et al. (2019). Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics October 2019; 144 (4): e20192528. 10.1542/peds.2019-2528
Stahl, S. M. (20201119). Prescriber’s Guide, 7th Edition. [VitalSource Bookshelf 10.3.1]. Retrieved from vbk://9781108915755
Quintero, J., Gutiérrez-Casares, J. R., & Álamo, C. (2022). Molecular Characterisation of the Mechanism of Action of Stimulant Drugs Lisdexamfetamine and Methylphenidate on ADHD Neurobiology: A Review. Neurology and therapy, 11(4), 1489–1517. https://doi.org/10.1007/s40120- 022-00392-2
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