Examine 
Case Study: A Young Caucasian Girl with ADHD. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.

At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.

Introduction to the case (1 page)

· Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

Decision #1 (1 page)

· Which decision did you select?

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #2 (1 page)

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #3 (1 page)

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Conclusion (1 page)

· Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

Case

BACKGROUND

Katie is an 8 year old Caucasian female who is brought to your office today by her mother & father. They report that they were referred to you by their primary care provider after seeking her advice because Katie’s teacher suggested that she may have ADHD. Katie’s parents reported that their PCP felt that she should be evaluated by psychiatry to determine whether or not she has this condition.

The parents give the PMHNP a copy of a form titled 
“Conner’s Teacher Rating Scale-Revised”. This scale was filled out by Katie’s teacher and sent home to the parents so that they could share it with their family primary care provider. According to the scoring provided by her teacher, Katie is inattentive, easily distracted, forgets things she already learned, is poor in spelling, reading, and arithmetic. Her attention span is short, and she is noted to only pay attention to things she is interested in. The teacher opined that she lacks interest in school work and is easily distracted. Katie is also noted to start things but never finish them, and seldom follows through on instructions and fails to finish her school work.

Katie’s parents actively deny that Katie has ADHD. “She would be running around like a wild person if she had ADHD” reports her mother. “She is never defiant or has temper outburst” adds her father.

SUBJECTIVE

Katie reports that she doesn’t know what the “big deal” is. She states that school is “OK”- her favorite subjects are “art” and “recess.” She states that she finds her other subjects boring, and sometimes hard because she feels “lost”. She admits that her mind does wander during class to things that she thinks of as more fun. “Sometimes” Katie reports “I will just be thinking about nothing and the teacher will call my name and I don’t know what they were talking about.”

Katie reports that her home life is just fine. She reports that she loves her parents and that they are very good and kind to her. Denies any abuse, denies bullying at school. Offers no other concerns at this time.

MENTAL STATUS EXAM

The client is an 8 year old Caucasian female who appears appropriately developed for her age. Her speech is clear, coherent, and logical. She is appropriately oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Self-reported mood is euthymic. Affect is bright. Katie denies visual or auditory hallucinations, no delusional or paranoid thought processes readily appreciated. Attention and concentration are grossly intact based on Katie’s attending to the clinical interview and her ability to count backwards from 100 by serial 2’s and 5’s. Insight and judgment appear age appropriate. Katie denies any suicidal or homicidal ideation.

Diagnosis: Attention deficit hyperactivity disorder, predominantly inattentive presentation

RESOURCES

§ Conners, C. K., Sitarenios, G., Parker, J. D. A., & Epstein, J. N. (1998). Revision and restandardization of the Conners' Teacher Rating Scale (CTRS-R): Factors, structure, reliability, and criterion validity. Journal of Abnormal Child Psychology, 26, 279-291.

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

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

Refer the parents to a pediatric psychologist who can use behavioral therapy to treat Katie’s ADHD.

Guidance to Student

Bupropion 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.

For this assessment, you will create a 2-4 page plan proposal for an interprofessional team to collaborate and work toward driving improvements in the organizational issue you identified in the second assessment.

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Introduction

The health care industry is always striving to improve patient outcomes and attain organizational goals. Nurses can play a critical role in achieving these goals; one way to encourage nurse participation in larger organizational efforts is to create a shared vision and team goals (Mulvale et al., 2016). Participation in interdisciplinary teams can also offer nurses opportunities to share their expertise and leadership skills, fostering a sense of ownership and collegiality.

You are encouraged to complete the Budgeting for Nurses activity before you develop the plan proposal. The activity consists of seven questions that will allow you the opportunity to check your knowledge of budgeting basics and as well as the value of financial resource management. The information gained from completing this formative will promote success with the Interdisciplinary Plan Proposal. Completing this activity also demonstrates your engagement in the course, requires just a few minutes of your time, and is not graded.

Demonstration of Proficiency

• Competency 1: Explain strategies for managing human and financial resources to promote organizational health.
  • Explain organizational resources, including a financial budget, needed for the plan to be a success and the impacts on those resources if nothing is done, related to the improvements sought by the plan.
• Competency 2: Explain how interdisciplinary collaboration can be used to achieve desired patient and systems outcomes.
  • Describe an objective and predictions for an evidence-based interdisciplinary plan to achieve a specific objective related to improving patient or organizational outcomes.
  • Explain the collaboration needed by an interdisciplinary team to improve the likelihood of achieving the plan’s objective. Include best practices of interdisciplinary collaboration from the literature.
• Competency 4: Explain how change management theories and leadership strategies can enable interdisciplinary teams to achieve specific organizational goals.
  • Explain a change theory and a leadership strategy, supported by relevant evidence, that are most likely to help an interdisciplinary team succeed in collaborating and implementing, or creating buy-in for, the project plan.
• Competency 5: Apply professional, scholarly, evidence-based communication strategies to impact patient, interdisciplinary team, and systems outcomes.
  • Organize content so ideas flow logically with smooth transitions; contains few errors in grammar/punctuation, word choice, and spelling.
  • Apply APA formatting to in-text citations and references, exhibiting nearly flawless adherence to APA format.

Reference

Mulvale, G., Embrett, M., & Shaghayegh, D. R. (2016). ‘Gearing up’ to improve interprofessional collaboration in primary care: A systematic review and conceptual framework. BMC Family Practice, 17.

Professional Context

This assessment will allow you to describe a plan proposal that includes an analysis of best practices of interprofessional collaboration, change theory, leadership strategies, and organizational resources with a financial budget that can be used to solve the problem identified through the interview you conducted in the prior assessment.

Scenario

Having reviewed the information gleaned from your professional interview and identified the issue, you will determine and present an objective for an interdisciplinary intervention to address the issue.

Note: You will not be expected to implement the plan during this course. However, the plan should be evidence-based and realistic within the context of the issue and your interviewee’s organization.

Instructions

For this assessment, use the context of the organization where you conducted your interview to develop a viable plan for an interdisciplinary team to address the issue you identified. Define a specific patient or organizational outcome or objective based on the information gathered in your interview.

The goal of this assessment is to clearly lay out the improvement objective for your planned interdisciplinary intervention of the issue you identified. Additionally, be sure to further build on the leadership, change, and collaboration research you completed in the previous assessment. Look for specific, real-world ways in which those strategies and best practices could be applied to encourage buy-in for the plan or facilitate the implementation of the plan for the best possible outcome.

Using the Interdisciplinary Plan Proposal Template [DOCX] Download Interdisciplinary Plan Proposal Template [DOCX]will help you stay organized and concise. As you complete each section of the template, make sure you apply APA format to in-text citations for the evidence and best practices that inform your plan, as well as the reference list at the end.

Additionally, be sure that your plan addresses the following, which corresponds to the grading criteria in the scoring guide. Please study the scoring guide carefully so you understand what is needed for a distinguished score.

• Describe an objective and predictions for an evidence-based interdisciplinary plan to achieve a specific goal related to improving patient or organizational outcomes.
• Explain a change theory and a leadership strategy, supported by relevant evidence, that is most likely to help an interdisciplinary team succeed in collaborating and implementing, or creating buy-in for, the project plan.
• Explain the collaboration needed by an interdisciplinary team to improve the likelihood of achieving the plan’s objective. Include best practices of interdisciplinary collaboration from the literature.
• Explain organizational resources, including a financial budget, needed for the plan to succeed and the impacts on those resources if the improvements described in the plan are not made.
• Communicate the interdisciplinary plan, with writing that is clear, logically organized, and professional, with correct grammar and spelling, using current APA style.

Additional Requirements

• Length of submission: Use the provided template. Remember that part of this assessment is to make the plan easy to understand and use, so it is critical that you are clear and concise. Most submissions will be 2–4 pages in length. Be sure to include a reference page at the end of the plan.
• Number of references: Cite a minimum of 3 sources of scholarly or professional evidence that support your central ideas. Resources should be no more than 5 years old.
• APA formatting: Make sure that in-text citations and reference list follow current APA style.

Note: Faculty may use the Writing Feedback Tool when grading this assessment. The Writing Feedback Tool is designed to provide you with guidance and resources to develop your writing based on five core skills. You will find writing feedback in the Scoring Guide for the assessment, once your work has been evaluated.

Portfolio Prompt: Remember to save the final assessment to your ePortfolio so that you may refer to it as you complete the final Capstone course.

Competencies Measured

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:

• Competency 1: Explain strategies for managing human and financial resources to promote organizational health.
  • Explain organizational resources, including a financial budget, needed for the plan to succeed and the impacts on those resources if nothing is done to make the improvements sought by the plan.
• Competency 2: Explain how interdisciplinary collaboration can be used to achieve desired patient and systems outcomes.
  • Explain the collaboration needed by an interdisciplinary team to improve the likelihood of achieving the plan’s objective, including best practices of interdisciplinary collaboration from the literature.
• Competency 3: Describe ways to incorporate evidence-based practice within an interdisciplinary team.
  • Describe an objective and predictions for an evidence-based interdisciplinary plan to achieve a specific goal related to improving patient or organizational outcomes.
• Competency 4: Explain how change management theories and leadership strategies can enable interdisciplinary teams to achieve specific organizational goals.
  • Explain a change theory and a leadership strategy, supported by relevant evidence, that is most likely to help an interdisciplinary team succeed in collaborating and implementing, or creating buy-in for, the project plan.
• Competency 5: Apply professional, scholarly, evidence-based communication strategies to impact patient, interdisciplinary team, and systems outcomes.
  • Organize content so ideas flow logically with smooth transitions; contains few errors in grammar/punctuation, word choice, and spelling.
  • Apply APA formatting to in-text citations and references, exhibiting nearly flawless adherence to APA format.

Practicum Experience Plan 

Overview:

Your Practicum experience includes working in a clinical setting that will help you gain the knowledge and skills needed as an advanced practice nurse. In your practicum experience, you will develop a practicum plan that sets forth objectives to frame and guide your practicum experience. 

As part of your Practicum Experience Plan, you will not only plan for your learning in your practicum experience but also work through various patient visits with focused notes as well as one (1) journal entry. 

Complete each section below.

Part 2: Individualized Practicum Learning Objectives

Refer to the instructions in Week 2 to create individualized practicum learning objectives that meet the requirements for this course. These objectives should be aligned specifically to your Practicum experience. Your objectives should address your self-assessment of the skills found in the “PMHNP Clinical Skills Self-Assessment Form” you completed in Week 1. 

As you develop your individualized practicum learning objective, be sure to write them using the SMART format. Use the resources found in Week 2 to guide your development. Once you review your resources, continue and complete the following. Note: Please make sure each of your objectives are connected to your self-assessment. Also, consider that you will need to demonstrate how you are advancing your knowledge in the clinical specialty.

** YOU MUST HAVE 3 NEW OBJECTIVES EACH QUARTER.  You may include previous practicum objectives; however, you still must have 3 new objectives for your current course. 

Objective 1: (Note: this objective should relate to a specific skill you would like to improve from your self-assessment)

Planned Activities:

Mode of Assessment: (Note: Verification will be documented in Meditrek)

PRAC Course Outcome(s) Addressed: 

·  (for example) Develop professional plans in advanced nursing practice for the practicum experience

·  (for example) Assess advanced practice nursing skills for strengths and opportunities 

Objective 2: (Note: this objective should relate to a specific skill you would like to improve from your self-assessment)

Planned Activities:

Mode of Assessment: (Note: Verification will be documented in Meditrek)

PRAC Course Outcome(s) Addressed:

·   

Objective 3: (Note: this objective should relate to a specific skill you would like to improve from your self-assessment)

Planned Activities:

Mode of Assessment: (Note: Verification will be documented in Meditrek)

PRAC Course Outcome(s) Addressed:

Individualized Practicum Learning Objectives: Explain three Individualized Practicum Learning Objectives that address your self-assessment of the skills found in the Clinical Skills Self-Assessment, are SMART (i.e., Specific, Measurable, Attainable, Results-focused, Time-focused), and meet the requirements for this course. Each Practicum Learning Objective must describe planned activities, mode of assessment, and PRAC course outcome(s) addressed for the skills you would like to improve from your self-assessment. Select one nursing theory and one counseling/psychotherapy theory to best guide your clinical practice, explaining these 2 chosen theories with supporting evidenced-based literature.

 review the case study and answer all questions with a scholarly response using APA and include 2 scholarly references.  All answers to case studies must-have reference cited in the text for each answer and a minimum of 2 Scholarly References (Journals, books) (No websites)  per case Study  

Attached you can find both case study