Respond to the 2 following discussion posts separately with separate reference lists. References to be no older than 5 years.
1. [Rajwant Bra]
Attention-Deficit/Hyperactivity Disorder (ADHD) is a common but burdensome condition that could have a major impact to children’s over-all well-being. ADHD not only affects the children but also have serious effects to the well-being of the parents. In many cases, the parents are exhausted and extremely frustrated by their kids’ behavioral problems. Therefore, I feel the most important thing the clinicians need to do is to be compassionate and allow them to their feelings and concerns. I believe it is also important to create a shared decision-making process with the parent. Fully disclose the details of the process, clinical guidelines, and recent clinical studies with the parents. I believe this will help creating a trust relationship with parents as I believe the parents have to be fully onboard with the treatment plan to achieve the best outcome. Children with multiple adverse childhood experiences are more likely to experience ADHD symptoms (Brown, et al., 2017).
According to the 2019 American Academy of Pediatrics ADHD guideline, the recommended approach to ADHD treatment for 8-year-old children is using FDA-approved medication along with PTBM and/or behavioral classroom intervention (Wolraich et al., 2019). Therefore, I will offer both medication and behavioral approach to the parents at the same time. This is because it is a strategy that is recommended by a well-recognized professional organization and is a good evidence-based practice (Wolraich et al., 2019).
If the parents want to wean off the medication, a tapering strategy should be in place to the patient transition and prevent withdrawal effects. It has been previously studied in children using methylphenidate for the discontinuation and long-term effects. In a study published in 2019, the discontinuation protocol used was decrease the dose by 25% of the original dose every 7 days (Matthijssen et al., 2020). In this process, the parents as well as the child’s teacher should be involved in addition to healthcare providers. A recent study showed that the benefit of previous medication treatment may remain after 2 years of discontinuation (Matthijssen et al., 2020).
References
Brown, N. M., Brown, S. N., Briggs, R. D., Germán, M., Belamarich, P. F., & Oyeku, S. O. (2017). Associations Between Adverse Childhood Experiences and ADHD Diagnosis and Severity. Academic Pediatrics, 17(4), 349–355. https://doi.org/10.1016/j.acap.2016.08.013
Matthijssen, A.-F. M., Dietrich, A., Bierens, M., Kleine Deters, R., van de Loo-Neus, G. H. H., van den Hoofdakker, B. J., Buitelaar, J. K., & Hoekstra, P. J. (2020). Effects of discontinuing methylphenidate on strengths and difficulties, quality of life and parenting stress. Journal of Child and Adolescent Psychopharmacology, 30(3), 159–165. https://doi.org/10.1089/cap.2019.0147
Wolraich, M. L., Hagan, J. F. J., Allan, C., Chan, E., Davison, D., Earls, M., Evans, S. W., Flinn, S. K., Froehlich, T., Frost, J., Holbrook, J. R., Lehmann, C. U., Lessin, H. R., Okechukwu, K., Pierce, K. L., Winner, J. D., & Zurhellen, W. (2019). Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics, 144(4). https://doi.org/10.1542/peds.2019-2528
2. [Onpaneeya Pataky]
FNP 591 Wk 8 DQ: Teen Pregnancy
You have a 17-year-old female that comes in with suspected pregnancy and limited family support. She is accompanied by her 18-year-old boyfriend who is the father of the child. While knowing she needs prenatal care, what resources and education would you try to provide and how would you encourage compliance in this vulnerable patient? What are some of the biggest risk factors that this patient faces and how can you provide quality care while being sensitive to the stigma that comes with teen pregnancy?
In 2019, the birth rate for teenagers was 16.7 per 1000, and out of all pregnant teenagers, 25% terminate pregnancy via abortion, 15% have miscarriages, and 61% result in birth (Chacko, 2021). Pregnant teens are at risk for nutritional deficiencies, increased risk for adverse pregnancy outcomes such as preterm birth, low birth rate babies, preeclampsia, and infant deaths, intimate partner violence, and postpartum depression (Chacko, 2021). Typically, many pregnant teenagers have low education, financial and social/familiar support and will need to be supported by a social worker to find adequate medical support during their pregnancy, including comprehensive pregnancy counseling, locating and enrolling in prenatal care, possibly transportation to insure attendance at appointments, and financial assistance programs (Chacko, 2021). Potentially pregnant teenagers need pre- and post-pregnancy test counseling to discuss the teen’s feelings about being pregnant, including the stigma, whether she is going to inform her parents, if she intends to keep the baby if pregnancy, what is her ideal caregiving scenario for the child, and what resources she is going to need to be successful (Chacko, 2021). This counseling should include discussion of the possibility of abortion, if she is interested, and would include ultimate referral to those services, in states where it is legal, since many states are now making it illegal (Chacko, 2021). Young mothers are more stigmatized when they are Caucasian, not married or engaged to their partner, feeling socially isolated, wanting to complete college, experiencing verbal abuse or anticipating family criticism, and the patient’s and family’s cultural attitudes towards pregnancy out of wedlock need to be considered by the NP when counseling the patient (Chacko, 2021). If the results of the pregnancy test are positive, and the patient is intending to or not sure about keeping the baby, she should be advised to immediately start taking a pregnancy vitamin with folate/folic acid and to refrain from recreational drugs and alcohol (Chacko, 2021). The patient should be advised that if she chooses abortion, the abortion clinic may have to report her intention to her parents in some states (Chacko, 2021). If the NP is not comfortable providing this pre- and post-counseling, s/he should refer the patient to a clinician who has that training and expertise (Chacko, 2021).
References
Chacko, M. R. (2021). Pregnancy in adolescents (A. B. Middleman, C. J. Lockwood & M. M. Torchia, Eds.). UpToDate. Retrieved August 18, 2022 from https://www.uptodate.com/contents/pregnancy-in-adolescents
