Case Analysis Exercise

Case Analysis Exercise

Introduction

The case involves a 12-year old child who has cerebral palsy, Attention Deficit Hyperactivity Disorder (ADHD), and experiences seizures. Nonetheless, she is on medication for her seizure. Cases of patients who have more than one condition have been experienced in many hospitals, which makes it sensitive for health care practitioners. Also, patients who react to medications can encounter more complications. Consequently, the case was selected since many health care professionals have faced similar situations, which need a lot of care and attention.

Also, the practicum objective for this case was how to treat patients with more than one disease. Adderall 10mg was not working for the patient, and there was the need to focus on other prescriptions that can treat her conditions.  The patient also provided the opportunity for determining how different patients respond to drugs. In many cases, health care practitioners encounter challenges when handling cases of people who do not respond to specific treatments. Thus, the patient assisted in determining other drugs that can be used to treat ADHD. Besides, it is essential to learn about how to handle different conditions in a patient using various drugs and avoiding any reaction.

SOAP

SOAP is also essential in health care as it allows practitioners to share information in a systematic way that can be read and understood by other people. Typically, SOAP entails documentation used by health providers to input notes into patient’s medical records. In this case, a SOAP note was considered since it is vital in health care..

Patient Description

The patient is a 12-year old child who came to the clinic with her mother to follow up since the Adderall 10mg is not working. The patient also has cerebral palsy, ADHD, and suffers from seizures. Also, she has been on medication for her seizures.

Subjective: Symptoms: COLDSPA       

Characteristics: ADHD symptoms entailed lack of focus, emotional turmoil, self-focused behavior, fidgeting, unfinished tasks, daydreaming, forgetfulness, staring spell, and loss of consciousness were also some of the symptoms due to seizure. Lack of balance, tremors, and stiff muscles were also symptoms due to cerebral palsy

Onset: The symptoms of ADHD were of regular beginning since they started gradually and improved due to delayed treatment. On the other hand, the symptoms of cerebral palsy were noticed after the child attained three years.  The seizure began when the child was 11 years old.

Lingering: the patient states that she has been experiencing emotional turmoil, forgetfulness, and lack of balance for a lengthy period. Also, lingering inattention was recorded, which was steered by her ADHD condition.

Duration: the symptoms of ADHD have persisted for two months, while the signs for cerebral palsy have persisted for four months. On the extreme, the symptoms for seizure have persisted for one year.

Stressors: Physical activities, toxic chemicals, stress, exposure to toxins.

Precipitating Factors: The precipitating factors that are associated with seizures include head injuries, brain infections, and stroke. The cerebral palsy precipitating factors include low birth weight and infertility treatment. ADHD precipitating factors include exposure to environmental toxins such as lead, and maternal drug uses such as smoking and alcohol use (Sayal et al., 2018).

Alleviating Factors: the alleviating factors for ADHD include therapy, atomoxetine, methylphenidate, dexamphetamine, and lisdexamfetamine. Alleviating factors for cerebral palsy include physical therapy, occupational therapy, and surgery. The alleviating factors in seizures are acetaminophen and Advil.

Objective: Treating more than one condition in patients.

Review of the system:

Brain: losing consciousness due to seizure. Low levels of norepinephrine due to     ADHD. Inability to control movement due to cerebral palsy.

Respiratory: mouth breathing associated with ADHD, frequent upper respiratory   infections due to cerebral palsy, and abnormally low level of oxygen due to seizures.

Cardiac: Interrupted heart rhythm due to seizures.

Vision: abnormal eye movement caused by seizure and strabismus caused by cerebral palsy.

Dermatological: cutaneous manifestations caused by seizures, and rashes, and skin break down caused by cerebral palsy.

Musculoskeletal: Muscular pains, floppy muscles, poor balance, and dystonia.

Neurological: Severe headache and convulsions.

Gastrointestinal: vomiting and abdominal pain steered by cerebral palsy. Constipation and diarrhea caused by ADHD.

Treatment for ADHD:  Ritalin is essential in the treatment of ADHD in children since it helps them to focus their thoughts and ignore distractions (Sayal et al., 2018).

Frequency: once daily.

Duration: until the patient improves.

Therapeuticandsideeffects: Drowsiness, headache, and nausea.

Compliance: proper medication improves the condition of the patient and limits the risk of deterioration.

Other treatments: Adzenys XR-ODT, Vyvanse, Concerta, Focalin, Daytrana, and Quillivant XR.             Adderall is also another treatment; nonetheless, it cannot be used in this case since the patient has been using Adderall 10mg, which has not been working for her.

Therapy: play therapy and talk therapy.

Treatment for Cerebral palsy: No cure for the condition, but physical therapy can improve the quality of the child’s life.

Duration: 2 months

Therapeuticandsideeffects: Minimal side effects are encountered, such as aching muscles.

Compliance: Good physical therapy helps the child improve his or her movement. Therefore, it is should be done systematically.

Other treatment: Speech therapy.

Treatment for seizure: Topiramate.

Duration: Until the patient improves.

Therapeuticandsideeffects: nausea and vomiting.

Compliance: Adherence to medication improves the condition of the patient.

Other treatments: Oxcarbazepine, Levetiracetam, Valproic acid, and Lamotrigine.

Diagnostic tools findings:

CT scan (Cerebral palsy)-Positive

VADRS (ADHD)-Positive

MRI (Seizure) – positive

Appearance:

Weak legs and unable to walk due to cerebral palsy. Losing concentration and having hyperactive –impulse behavior.

General behavior:

The patient keeps on leaning on the mother since she is weak. Also, the patient keeps on losing focus when being addressed. The patient is also unable to take a lot of work due to ADHD. Additionally, the child gets easily overwhelmed and has emotional responses to new challenges. Furthermore, the child is anxious since she has cerebral palsy.

Altitude: Anxious and emotional.

LOC: Emotional.

Orientation: person, place-Both Present

Plan:

Diagnostic:

Obtain blood tests and carry CT scans. Further observation of the behavior and questioning.

Specifictreatment:

Since the patient has more than one condition, it is also essential to focus on different procedures that can be used to treat patients with these cases. Therefore, therapies can be offered as special treatment. For instance, offering physical therapies will help the patient to learn ways to move.  Moreover, counseling sessions can be used to improve the patient to handle her emotions. On the extreme, treatment will be conducted to reduce stress and minimize the pains such as a headache that are experienced by the patient. The use of specific drugs can also lead to nausea and vomiting. Therefore, it will be necessary to ensure that the patient can ask for help in case she experiences complications after treatment.

Disposition:

Skilled nursing facility, home with home care.

Differential Diagnosis

Based on DSM-5 diagnostic criteria for ADHD, patients with ADHD show various symptoms within two years. Also, the common symptom amongst many patients includes forgetting and lack of concentration (Sayalet al., 2018). Typically, six or more symptoms of inattention are experienced by children up to the age of 16 years (Sayal et al., 2018). For instance, some of the children often do not seem to listen when spoken to directly. The standard diagnosis of ADHD is ICD-10, which is widely used in Europe. The following are the four differentia diagnosis of ADHD.

Diagnosing cerebral palsy takes time, and there is no test that can be used to confirm cerebral palsy. Typically, a child can be diagnosed soon after birth in severe cases. However, in many cases, diagnosis can be made in the first two years. The following are the four differential diagnoses of cerebral palsy. Imaging tests such as X-ray and an electroencephalogram (EEG) are used in the diagnosis of cerebral palsy in children. The following are the four differential diagnoses of cerebral palsy.

Diagnosis of seizure includes medical tests that may involve blood tests or brain scans using EEG to check the electrical activity in the brain. The symptoms of seizures can also be experienced in other diseases. Thus, learning about the differential diagnosis of seizures is essential.

Epidemiology

Many children have been reported to suffer from ADHD; nonetheless, boys are more likely to be diagnosed with ADHD than girls. Correspondingly, the rate of ADHD appears to be higher in white than in Hispanic Americans and African Americans (Sayal et al., 2018). ADHD has also been termed as one of the most common neurobehavioral childhood disorders. Typically many teenagers with ADHD struggle with maintaining attention. Therefore, for kids, ADHD is likely to interfere with their school work. Also, it is estimated that ADHD affects more than 6.4 million children in the United States (Sayal et al., 2018). Also, many children with ADHD show symptoms before the age of 6 (Sayal et al., 2018). Nonetheless, the symptoms vary and are sometimes difficult to recognize in some children. For instance, it is normal for children to forget, get fidgety, or daydream occasionally. Conversely, inattention, impulsivity, and hyperactivity are not frequent in children.

Furthermore, some children with ADHD may experience challenges when sitting still and following directions. Therefore, it is essential for parents to monitor their kids and ensure that they do not show any symptoms. On the other hand, parents with kids who show any symptoms should seek medical care before the condition persists (Pastor, 2015). In this case, children who show several ADHD symptoms both at home and at school should be taken to health care practitioners for testing (Pastor, 2015). Also, parents with children with ADHD can ensure that they support the kids at home, ensure they exercise, and have proper nutrition (National Collaborating Centre for Mental Health, 2018).  While there is no cure for ADHD, symptoms can be managed with the right treatment, and the patient can reduce the symptoms (Pastor, 2015). Also, cognitive behavioral therapy is conducted to help patients gain coping skills for day-to-day challenges. Therefore, children with ADHD can learn to build the life skills that are necessary for them to thrive in schools

Cases of cerebral palsy among the children have also been experienced in various hospitals. Typically, the condition affects the muscle tone and the movement of the patient (Tang et al., 2015). Therefore, children with cerebral palsy have challenges when moving. The condition is caused by brain damage, which usually happens before or during the birth of a child (Dewar et al., 2015). Also, brain damage can occur during the first five years of the child. Cerebral palsy has also been termed as the most common motor disability in childhood. Furthermore, cerebral palsy causes problems with posture and balance (Dewar et al., 2015). Therefore, most of the children with cerebral palsy need support. Also, some patients with worse conditions require wheelchairs to help them move (Braun et al., 2016). According to research, about 2 to 3 children out of every 1000 children in the United States have cerebral palsy (Dewar et al., 2015). Thus, the condition is common, and parents should be educated about the disease. Moreover, over 10000 babies in the United States are born annually with cerebral palsy (Dewar et al., 2015). Therefore, it is also essential for parents to monitor their children to ensure that they can notice any symptom that is associated with cerebral palsy (Dewar, Love, & Johnston, 2015). Although cerebral palsy is a permanent movement disorder, patients can seek help from the health practitioners to acquire vital information that can be used to curb challenges encountered by people with the condition (Tang et al., 2015).  For instance, parents can be educated on how to perform physical therapies that help in the movement of children with cerebral palsy.

Seizures in many children occur due to various reasons. For instance, seizures may be part of an epileptic disorder, which is common in many children below the age of 12 years (Offringa et al., 2017). On the other hand, a febrile seizure may occur due to illnesses such as ear infection or chickenpox. Typically, seizures happen when brain cells fire too much, disrupting healthy brain electrical signals. Usually, the electrical activity in the brain involves neurons that send messages in different areas at different times. Nonetheless, during a seizure, many neurons send signals at once. Therefore, seizures can also be triggered by head injuries or brain tumors (Offringa et al., 2017). Seizures are too frequent, and researchers believe that about 5 percent of people in the United States experience at least one seizure in their lives (Offringa et al., 2017). Nevertheless, children’s seizure activity changes as they grow since their brains are growing and developing.

Furthermore, some of the seizures are hard to recognize since they do not have outward signs, while others are easily known because they show symptoms such as twitching and stiffness. In most cases, children with seizures collapse or just stare into space and might be frightening (Bennett et al., 2017). Nonetheless, most seizures do not last for long (Zack & Kobau, 2017). Correspondingly, focal seizures are experienced by many children, whereby abnormal brain function occurs in one or more areas of one side of the brain. Children who experience focal seizures may also have an aura that may involve feelings, such as déjà vu, euphoria, and impending doom (Bennett et al., 2017). Also, some children may have visual changes, changes in the sense of smell, and hearing abnormalities. Consequently, the symptoms of a focal seizure depend on the area of the brain that is affected.

Clinical Manifestation

ADHD caused mood swings and learning inability to the patient. Also, the patient experienced drowsiness, headache, and colds, which were caused by ADHD. Cognitive experiences were also recorded, whereby the patient experienced absent-mindedness and short attention span. Additionally, the patient had challenges in focusing. Anger is also common in children with ADHD (Pastor, 2015). Consequently, the patient appeared to be angry in most cases. As regards the reduced capacity to remember things, the patient recorded instances of forgetfulness when asked to perform some tasks. Moreover, forgetfulness was experienced when conversing with the patient. Similarly, the patient was disorganized, which is mainly caused by inattention. The patient also exhibited low-self-esteem and a lack of social skills, which is common in children with ADHD (Pastor, 2015). Moreover, the patient appeared to be easily distracted and making careless mistakes. As with conversing, the patient talked excessively and interrupted others during conversations. The patient also kept on tapping her feet and hands, which his familiar in children with ADHD. The diagnostic test that is essential to distinguish ADHD from other differentials is by using an evaluation process. The process is also cost-effective since it does not require tools such as X-rays and MRI. Moreover, no further tests are needed after the evaluation process since it entails an in-depth assessment of ADHD. The evaluation process is also essential since it is not risky as it is carried out by health care professionals.

Cerebral palsy also had an impact on the patient. As with mobility, the patient experienced challenges when moving due to her weak muscles. Equally, the patient seemed to have an abnormal posture, which is common among cerebral palsy patients (Tang, Li, Cao, Zhang, Wu, & Chen, 2015). Moreover, the patient appeared to be favoring one side of the body since she kept on reaching with one hand. As regards the vision, the patient had diffused seeing. Additionally, the patient experienced difficulties in hearing, which was noticed during a conversation. As with discussion, the patient recorded delays in speech development in some cases. The patient also recorded difficulties with swallowing and eating. Typically, children with cerebral palsy may experience excessive drooling (Tang, Li, Cao, Zhang, Wu, & Chen, 2015). Also, the patient appeared to have a crouched gait and walked on toes at some points. The patient also experienced seizures due to her brain damage. Typically, seizures are frequent in people with cerebral palsy.

The diagnostic tests that are appropriate to ensure that other differentials are ruled out are brain imaging tests, such as CT scan and MRI, since they show areas of brain damage or abnormal development that are used to distinguish cerebral palsy from other differentials. For instance, the MRI can produce a cross-sectional or detailed 3D images of the brain, which are appropriate in recognizing cerebral palsy from the differentials. Also, the test is painless, which makes it applicable to use in children. On the other hand, the risk of the test is that it is noisy and shock the child. The brain scans are cost-effective compared to laboratory tests, which involve blood, urine, or skin screening for genetic problems. However, further tests should be conducted to identify other issues associated with the disease, such as poor vision, hearing impairment, and slow growth and development.

The patient has experienced seizures and is on medication. Hence, a clinical manifestation of the condition is necessary (Zack & Kobau, 2017). In this case, the patient appeared to be jerking at some points during conversion. The patient recorded confusion and blinked rapidly. The face of the patient would also twitch, which is common among children with seizures. Moreover, the patient recorded sessions of staring. As with reduced mood most of the time, the child appeared sleepy and dizzy.

The appropriate diagnostic test for the condition is an EEG, which is used to determine electrical impulse on the brain. EEG is necessary since it shows the brain activities, unlike blood tests. Moreover, there are minimal risks of using EEG since it does not cause damage to the brain cells. However, EEG is expensive compared to other tests, such as MRI. Additional tests can also be carried out to ensure that the other differentials are distinguished from seizure. For instance, a CAT scan and MRI can be performed to obtain an image of the brain.

Final Assessment

Based on the final assessment, the patient is found to have mental issues and lacking concentration. Moreover, the tests show that the patient is easily distracted, which causes her to be depressed. A positive outcome of mental health was also recorded, whereby the patient was anxious and experienced challenges when following instructions. Vision and hearing abilities were also impaired, and the patient showed diminished hearing and vision abilities. Moreover, the patient recorded difficulties when engaging in a conversation due to her impaired hearing. Problems with movements were also documented, whereby the patient had issues when walking and moving.

Moreover, the patient’s legs are weak and cannot walk for a long distance. Also, the client recorded poor balance that was steered by the floppy muscles.  A positive outcome of dystonia was also recorded during the musculoskeletal test. Mood swings were recorded in the test for her emotions. Additionally, emotional turmoil was marked, which caused the patient to encounter challenges when socializing with others. On the other hand, the client recorded low-self-esteem on her test for social life. Also, the child had difficulties when socializing with people forcing her to be antisocial. On her test for performance, the patient recorded poor performance in many areas since she lost concentration with ease.

Management

Various procedures are used to treat patients with more than one condition. In this case, the patient will be introduced to therapy to ensure that she improves her movement. For instance, physical therapy will be essential to strengthen the muscles of the patient. Psychological treatment is also be used to improve the mental health of patients with seizures (Offringa, Newton, Cozijnsen, & Nevitt, 2017). In this case, the patient will be taught how to live with her condition. Medication is also essential in patients with ADHD and cerebral palsy. Therefore, the patient will be introduced to new medicines. Moreover, new prescriptions will be crucial to improve her ADHD condition since Adderall 10mg is not working for her. On the extreme, nutrition will be developed to ensure that the patient eats healthy food that can improve her condition. Moreover, a healthy diet will improve her mental state, and this can reduce the causes of seizures.

Health Promotion and Counseling

Health promotion theories are of great significance for patients with various conditions.  In this case, proper health promotion theories should be used to facilitate the improvement of each state that the patient has. The family should also be counseled on how to live with the child who has these conditions. Moreover, diseases that cannot be cured are stressing, and there is a need to ensure that the family is counseled and can handle the challenges that are associated with the diseases. The patient can also be advised on how to improve her conditions. In essence, proper health care promotion and counseling can improve the health of the patient.

Patient and Family Education

Patient education is always essential as it helps the patient to learn more about his or her condition. Therefore, the patient will be educated about her health and ways to ensure that the states do not persist. For instance, the patient will be encouraged to ask for assistance when she faces changes in her body. Also, the patient will be educated on how to move and improve her concentration. On the other hand, the family will be trained on how to take care of the patient and improve her condition. For instance, the family will be educated about therapies.

Christian Worldview

Patients with incurable diseases should always be encouraged that God loves them. Also, reminding the patient that God has a purpose for their life is essential since it motivates them. Moreover, patients with more than one condition should be encouraged using the scriptures that support people to be courageous and be ready to face a new day regardless of the challenges they face. Therefore, the scriptures can be used to promote the patient about God’s power and the need to face each day with courage. Similarly, patients are encouraged to pray about their condition and always have hope in life. Consequently, people need to learn the significance of the Christian worldview in patients with incurable diseases.

Level of Evaluation and Management

Management and evaluation of the patient’s history were conducted successfully since the patient, and the guardian cooperated. Moreover, the patient is a child and does not have that complicated history. Correspondingly, the required information was presented by both the guardian and the patient, which made it easy to evaluate the conditions of the patient. The level of management was also reasonable since the procedures were followed with ease using the available information. Therefore, the available data was essential as it helped in analyzing the patient’s health and drawing a conclusion on how to treat her conditions.

References

Bennett, K. S., DeWitt, P. E., Harlaar, N., & Bennett, T. D. (2017). Seizures in children with        severe traumatic brain injury. Pediatric critical care medicine: a journal of the Society of       Critical Care Medicine and the World Federation of Pediatric Intensive and Critical            Care Societies, 18(1). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5218863/

Braun, K. V. N., Doernberg, N., Schieve, L., Christensen, D., Goodman, A., & Yeargin-Allsopp,             M. (2016). Birth prevalence of cerebral palsy: a population-based          study. Pediatrics, 137(1). https://pediatrics.aappublications.org/content/137/1/e20152872

Dewar, R., Love, S., & Johnston, L. M. (2015). Exercise interventions improve postural control    in children with cerebral palsy: a systematic review. Developmental Medicine & Child          Neurology, 57(6), 504-520. https://onlinelibrary.wiley.com/doi/full/10.1111/dmcn.12660

National Collaborating Centre for Mental Health (UK. (2018). Attention deficit hyperactivity      disorder: diagnosis and management of ADHD in children, young people and adults.   British Psychological Society. https://www.ncbi.nlm.nih.gov/pubmed/29634174

Offringa, M., Newton, R., Cozijnsen, M. A., & Nevitt, S. J. (2017). Prophylactic drug       management for febrile seizures in children. Cochrane Database of Systematic Reviews,       (2). https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003031.pub3/abstract

Pastor, P. N. (2015). Association Between Diagnosed ADHD and Selected Characteristics             Among Children Aged 4-17 Years, United States, 2011-2013 (No. 2015). US Department      of Health and Human Services, Centers for Disease Control and Prevention, National            Center for Health Statistics.

Sayal, K., Prasad, V., Daley, D., Ford, T., & Coghill, D. (2018). ADHD in children and young     people: prevalence, care pathways, and service provision. The Lancet Psychiatry, 5(2),   175-186. https://www.sciencedirect.com/science/article/abs/pii/S2215036617301670

Tang, L., Li, F., Cao, S., Zhang, X., Wu, D., & Chen, X. (2015). Muscle synergy analysis in          children with cerebral palsy. Journal of neural engineering, 12(4), 046017.            https://iopscience.iop.org/article/10.1088/1741-2560/12/4/046017/meta

Zack, M. M., & Kobau, R. (2017). National and state estimates of the numbers of adults and        children with active epilepsy—United States, 2015. MMWR. Morbidity and mortality       weekly report, 66(31), 821. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5687788/