NR 566 Week 7 Presentation

10 August 2024

Management of Psychiatric Conditions in Primary Care: Attention-Deficit/Hyperactivity Disorder (ADHD)

Presented by: Dharmistha Patel Course: NR 566 Instructor: Dr. Landry Institution: Chamberlain College of Nursing

Patient Scenario

Patient Profile:

  • Name: David S.
  • Age: 20 years old
  • Current Status: Third-year college student
  • Presenting Complaints: Difficulty concentrating in class, tendency for the mind to wander, irritability, anger outbursts, internal restlessness, and frustration.
  • Substance Use: Daily marijuana use, smoking half a pack of cigarettes per day, and increasing alcohol use with binge drinking episodes.

History:

  • Chief Complaint (CC): Difficulty concentrating in class, frequent anger and frustration.
  • History of Present Illness (HPI): Diagnosed with ADHD in 2020, suffers from seasonal allergies and anxiety.
  • Social History (Social Hx): Smokes marijuana and cigarettes, drinks alcohol, concerned about substance use.
  • Family Medical History (FMHx): Father has hypertension; mother has ADHD.
  • Past Medical History (PMHx): Diagnosed with ADHD, anxiety, and seasonal allergies.
  • Current Medications: Adderall 5 mg once daily, Multivitamin.

Treatment Plan for ADHD

1. Behavioral and Psychological Therapies:

  • Behavior Therapy/Psychological Counseling: Essential in managing ADHD, particularly in patients with co-occurring substance use and emotional dysregulation.
  • Cognitive Behavioral Therapy (CBT): As recommended by the CDC, CBT is effective in helping individuals with ADHD develop coping strategies to manage symptoms, reduce impulsivity, and improve time management and organizational skills (CDC, 2018).
  • Support Groups: Involvement in ADHD support groups can provide David with peer support, education, and shared experiences, which can be crucial in improving his motivation and reducing feelings of isolation (CDC, 2018).
  • Family Therapy/Counseling: Given David’s family history and current concerns, family therapy can help address family dynamics, improve communication, and provide a support system for managing ADHD symptoms (CDC, 2018).

2. Pharmacotherapy:

  • Adderall (Amphetamine/Dextroamphetamine):
    • Current Dose: 5 mg once daily.
    • Proposed Adjustment: Increase the dose to 5 mg twice daily. This increment aims to manage David’s ADHD symptoms more effectively, particularly his concentration issues and restlessness. Close monitoring will be essential to assess efficacy and detect any potential side effects, especially considering his substance use history.

3. Education and Counseling:

  • Medication Education: Educate David on the importance of adherence to the prescribed Adderall regimen, potential side effects, and the reasons behind the dosage increase. Explain the role of Adderall in managing ADHD symptoms and how it might improve his academic performance and emotional stability.
  • Substance Use Counseling: Given David’s dependence on marijuana and increasing alcohol use, it is critical to provide education on the risks associated with these substances, particularly their interaction with ADHD and its treatment. David should be counseled on the benefits of reducing or eliminating substance use and offered resources for support, such as addiction counseling or referral to a specialist.

4. State and Federal Regulations:

  • Location: Illinois
  • Regulatory Considerations: As a Family Nurse Practitioner (FNP) in Illinois, the scope of practice includes prescribing ADHD medications. However, limitations exist in treating complex mental health needs without collaboration with or referral to a psychiatrist. David’s case, involving ADHD and substance use, may require multidisciplinary management to ensure comprehensive care.

Conclusion

Managing ADHD in primary care, particularly in a young adult like David S. with co-occurring substance use and emotional dysregulation, requires a multifaceted approach. The combination of pharmacotherapy with behavioral and psychological therapies is essential to address the full spectrum of David’s symptoms and improve his quality of life. The treatment plan should be tailored to his unique needs, with ongoing monitoring and adjustments as necessary.

References

Centers for Disease Control and Prevention (CDC). (2018). Treatment of ADHD. https://www.cdc.gov/ncbddd/adhd/treatment.html

Illinois Department of Financial and Professional Regulation. (2021). Advanced Practice Registered Nurse (APRN) Scope of Practice. https://www.idfpr.com/profs/AdvancedPracticeNursing.asp

Greenhill, L. L., Posner, K., Vaughan, B. S., & Kratochvil, C. J. (2008). Attention deficit hyperactivity disorder in children, adolescents, and adults. American Journal of Psychiatry, 165(6), 719-726. https://doi.org/10.1176/appi.ajp.2007.07091491

Wilens, T. E., & Spencer, T. J. (2010). Understanding attention-deficit/hyperactivity disorder from childhood to adulthood. Postgraduate Medicine, 122(5), 97-109. https://doi.org/10.3810/pgm.2010.09.2206