[SOLVED] Please respond to at least 2 of your peer’s posts.

I need an explanation for this Medicine question to help me study.

Please respond to at least 2 of your peer’s posts, from an FNP perspective. To ensure that your responses are substantive, use at least two of these prompts:

• Do you agree with your peers’ assessment?
• Take an opposing view to a peer and present a logical argument supporting an alternate opinion.
• Share your thoughts on how you support their opinion and explain why.
• Present new references that support your opinions.

Please be sure to validate your opinions and ideas with citations and references in APA format. Substantive means that you add something new to the discussion, you aren’t just agreeing. This is also a time to ask questions or offer information surrounding the topic addressed by your peers. Personal experience is appropriate for a substantive discussion and should be correlated to the literature.Be sure to review your APA errors in your reference list, specifically you have capitalization errors in some words of the titles. Also, be sure you are italicizing titles of online sources.

Select ONE of the questions listed below and create a substantive initial post. Please post the question number you chose in the title of your post. (i.e. Question 2 parent history).

1. As a primary care provider working in an underprivileged free clinic you realize there are some challenges and barriers in your patient population. You are seeing a 13 year old boy for complaints of academic difficulties at school. He is currently receiving stimulants for control of symptoms of ADHD. List the components of your subjective and objective information which will identify whether or not the treatment plan is effective. Define your treatment plan and recommendations using evidenced based clinical guidelines for ADHD management.
2. You have just finished seeing a 10 year old girl for her routine well child exam. You recommend initiating the HPV series at this appointment. Mother responds that her daughter is not having sex until she is married so she does not need the vaccine series. What is your management approach and response to the mother? What are the requirements for the HPV series in your practice state?

CATHY”S RESPONSE:

U6 DB Initial Post Q1 ADHD Management

List the components of your subjective and objective information, which will identify whether or not the treatment plan is effective.

Attention deficit/hyperactivity disorder (ADHD) is one of the most frequently diagnosed disorders of childhood. It affects the behavior of the child all throughout their life. It is chronic and can continue to affect the individual from adolescence to adulthood. Symptoms have an affect on all aspects of the child’s life including educational, emotional, social function, and behavioral. The treatment for ADHD is targeted at the symptoms of inattention, hyperactivity, and impulsive behavior at home, work, and/or school. It is classified as mild, moderate or severe and can change over time. Diagnosis is based on subjective data reported by the parents and the school. The practitioner should utilize the DSM-5 to classify the ADHD as mild, moderate, and severe, it can also be used to identify if the treatment approach is effective.

Components of the subjective data to identify if the treatment for ADHD is effective.

Assessment of the effectiveness of the ADHD treatment depends largely on reported behaviors by the individuals in close contact with the child such as parents, and teachers. Questions to ask are does the child have less impulsiveness, and are their attention and behaviors more purposeful and focused. Ask if the child is able to concentrate, has decreased hyperactivity, and has their maladaptive behavior improved (Hall, Valentine, Groom, Walker, Sayal, Daley, & Hollis, 2016)

Families must be educated on monitoring the adverse effects and benefits of the medication. The adverse effects to watch for are weight loss, sleeplessness, abdominal pain, headaches, and decreased appetite. If the parents report any adverse effects including irritability, and rapid mood swings with exaggerated behaviors occurring the treatment plan should be adjusted (Burns, Dunn, Brady, Starr, Blosser, Garzon, & Gaylord, 2017).

Components of the Objective data to identify if the treatment for ADHD is effective.

Objective data can be used to diagnose and ascertain if the treatment plan is working. This objective data can be obtained by identifying differential diagnoses, utilizing a rating scale of the severity of the disorder, and using a computer program to conduct cognitive tests. There are repeat screening checklists that can show the benefits of interventions (Hall, …et al, 2016).

Define your treatment plan and recommendations using evidenced based clinical guidelines for ADHD management.

The treatment plan for this adolescent patient should include an assessment of substance abuse. Also a thorough history of the patients school performance, and childhood activities. Assess for symptoms of maladaptive behavior that impairs the child’s function and performance in at least two areas of the child’s life. A baseline blood pressure, pulse and BMI should be assessed and recorded. First line therapies for the treatment of ADHD in the adolescent are Methylphenidate, Dexmethylphenidate, destroamphetamine, or lisdexamfetamine. Side effects to monitor are hypertension, tachycardia, sleeplessness, weight loss, stomach upset, increased anxiety, irritability, and any tics the patient develops or already has that have worsened. Cognitive behavioral therapy with the medication will help the patient with the symptoms. Follow up should be planned to ascertain if the medication should be titrated up or down. The plan should include a repeat screening to see if the treatment plan is working, and reinforcement of behavior changes (Burns, …et al, 2017).

References

Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., Blosser, C. G., Garzon, D. L., & Gaylord, N.M. (2017). Pediatric primary care. (6th Ed.). St. Louis, MO. Elsevier.

Hall, C. L., Valentine, A. Z., Groom, M. J., Walker, G. M., Sayal, K., Daley, D., & Hollis, C. (2016). The clinical utility of the continuous performance test and objective measures of activity for diagnosing and monitoring ADHD in children: A systematic review. European Child & Adolescent Psychiatry, 25(7), 677-699. doi:http://dx.doi.org/10.1007/s00787-015-0798-x

Samantha’s Response

Question #2

Controversy about HPV vaccination involves its high cost (approximately $150 per injection), uncertain duration of protection, and concerns that it provides tacit approval of sexual activity and a false sense of security(Juckett , & Hartman-Adams, 2010). In addition, the necessity of vaccinating girls as young as nine to 11 years, before they become sexually active, unsettles many parents (Juckett , & Hartman-Adams, 2010). Some parents are concerned that the HPV vaccine is unsafe or that administration may encourage sexual activity, thereby increasing their child’s risk of a sexually transmitted infection (Muncie, & Labato, 2015). Parental safety concerns about the HPV vaccine increased from 4.5% in 2008 to 16% in 2010, although the reported adverse effects have been minor (Muncie, & Labato, 2015). Studies have shown that adolescents who receive the HPV vaccine do not initiate sexual activity earlier, nor is their risk of acquiring an STI increased (Muncie, & Labato, 2015). Some parents desire to wait until their child has been sexually active however, to be effective, the HPV vaccine must be given before exposure to covered serotypes, and often many times the parents doesn’t know when the child becomes sexually active (Muncie, & Labato, 2015). Parental approach recommendations from the American Family Physician are instead of discussing the vaccine as a means of STI prevention, physicians can present it as a way to prevent cervical cancer in women and oropharyngeal cancer in men (Muncie, & Labato, 2015). They can mention that immunologic response is greater in younger adolescents, so earlier immunization is prudent (Muncie,& Labato, 2015). Physicians should encourage HPV vaccine administration at the same time that other adolescent vaccines are given. They should review immunization status at every visit, and administer the HPV vaccine at any time—including during sick visits (Muncie, & Labato, 2015). The CDC recommends practitioners explain to parents that vaccines protect their child before they are exposed to a disease (CDC, 2019). That’s why we give the HPV vaccine earlier rather than later, to protect them long before they are ever exposed (CDC 2019).

Also, if your child gets the shot now, they will only need two doses. If you wait until your child is older, he/she may end up needing three shots (CDC, 2019).

Vaccine Schedule

The two FDA-approved HPV vaccines consist of noninfectious virus-like particles derived from the HPV L1 capsid protein. The quadrivalent recombinant HPV vaccine (Gardasil) protects against HPV types 6, 11, 16, and 18, and was approved in 2006 for girls and women nine to 26 years of age for prevention of genital warts and cervical cancer (Juckett , & Hartman-Adams, 2010). The bivalent HPV vaccine (Cervarix) protects against types 16 and 18, but not types 6 and 11. It is approved for girls and women 10 to 25 years of age, and is given as a series of three vaccinations (at months 0, 1 to 2, and 6) (Juckett , & Hartman-Adams, 2010). The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices recommends routine HPV vaccination of girls at 11 to 12 years of age, with catch-up vaccination for girls 13 to 26 years of age (Juckett , & Hartman-Adams, 2010).

Center for Disease Control (CDC). (2019, February 2). HPV | For clinicians | Answering parents questions | CDC. Retrieved from https://www.cdc.gov/hpv/hcp/answering-questions.html.

Juckett , G., & Hartman-Adams, H. (2010). Human papillomavirus: Clinical manifestations and prevention. American Family Physician . Retrieved from https://www.aafp.org/afp/2010/1115/p1209.html

Muncie , H., & Labato, A. (2015). HPV vaccination: Overcoming parental and physician impediments. American Family Physician . Retrieved from https://www.aafp.org/afp/2015/0915/p449.html.