Provide a healthy lifestyle: encouraged nutritious food intake, lots of physical activity , and sufficient sleep are important; they can help keep ADHD symptoms from getting worse (Millchap and Yee,2012). Medication: Continue Focalin but change it to extended release for better compliance Focalin 5mg XR daily with breakfast Clonidine 0.1 mg 2 hrs. before bedtime Follow-up/next visit: Will follow up the patient in two weeks. Instructed parents to call for persistent or worsening symptoms, questions or concerns. The evaluation form is given to the school to evaluate the patient in 2 weeks Conclusion and Reflection note There are so many things I learned this week; I saw a considerable amount of patient with Autism, ADD, ADHD, and other anxiety disorder. There are so many theories, and research has been done to understand the pathophysiology of the disease. However, we do not have a straight answer to the pathophysiology. In the past, several stimulant and non-stimulant medication are used to treat the symptoms. However, specifically with the pediatric population, it is a challenge to choose the right medication. My nurse preceptor Nurse practitioner Emily Schadt give me the insight of the methylenetetrahydrofolate reductase (MTHFR) gene that produces essential enzyme and deficiency of this gene is related to ADHD. The presence of an MTHFR mutation has seen to alter the response to medications, including antidepressants and some chemotherapy drugs(Stein,2014). MTHFR is related to mental health issues such as depression, bipolar disorder schizophrenia, attention-deficit hyperactivity disorder (ADHD), and autism. Not only it affects
Week 6 Episodic SOAP NOTE MTHFR mutations psychologically also seen to increase the risk of several health problems like cardiovascular disease and stroke, recurrent early miscarriage, migraine with aura, osteoporosis, and some cancers. At my clinical site, if the 1 st line treatment does not work, a genetic test is done to choose the right medication and to avoid the side effects. This clinical experience gives me 1 st hand experience with pharmacogenomics. I agree with Emily Schadt intervention and treatment plan. Preceptor Signature Date References: Stein, T., PHd. (2014.). A Genetic Mutation That Can Affect Mental & Physical Health. Retrieved from - mutation-can-affect-mental-physical-health Attention-Deficit / Hyperactivity Disorder (ADHD). (2018, December 20). Retrieved from American Academy of Pediatrics, Subcommittee on Attention-Deficit/Hyperactivity Disorder, Steering Committee on Quality Improvement and Management, Wolraich, M., Brown, L., Brown, R. T., DuPaul, G., . . . Visser, S. (2011). ADHD: Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics, 128 , 1007-1022. doi:10.1542/peds.2011-2654 Visser, S. N., Bitsko, R. H., Danielson, M. L., Gandhour, R., Blumberg, S. J., Schieve, L., Holbrook, J., Wolraich, M., Cuffe, S. (2015). Treatment of attention-deficit/hyperactivity
Week 6 Episodic SOAP NOTE disorder among children with special health care needs. Journal of Pediatrics. Published online April 1, 2015, DOI: .
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- Summer '14
- Attention-deficit hyperactivity disorder, Focalin