McKenna's Pharmacology for Nursing, 2e

349

C H A P T E R 2 2 Psychotherapeutic agents

■■ An attention-deficit disorder is a behavioural syndrome characterised by hyperactivity and a short attention span. ■■ Narcolepsy is a disorder characterised by daytime sleepiness and sudden loss of wakefulness. ■■ CNS stimulants, which stimulate cortical levels and the RAS to increase RAS activity, are used to treat attention-deficit disorders and narcolepsy. These drugs improve concentration and the ability to filter and focus incoming stimuli. and evaluation to enhance knowledge about drug therapy and to promote compliance. Offer support and encouragement to help the person to cope with the drug regimen. Evaluation ■ ■ Monitor response to the drug (decrease in manifestations of behavioural syndromes, decrease in daytime sleep and narcolepsy). ■ ■ Monitor for adverse effects (CNS stimulation, CV effects, rash, physical or psychological dependence, GI dysfunction). ■ ■ Evaluate effectiveness of the teaching plan (person can give the drug name and dosage, name possible adverse effects to watch for and specific measures to help avoid adverse effects and describe the need for follow-up and evaluation). ■ ■ Monitor effectiveness of comfort measures and compliance with the regimen. for assessing children’s response to the drug and for coordinating the teacher’s and healthcare providers’ input into each individual case, including the incidence of adverse effects and the appropriateness of the drug therapy.The nurse should: • Ensure that the proper diagnosis is made before supporting the use of the drug. • Constantly evaluate and work with the primary healthcare provider to regularly challenge children without the drug to see whether the drug is doing what is expected or whether the child is maturing and no longer needs the drug therapy. The school nurse needs to be prepared to be an advocate for the best therapeutic intervention for a particular child. Because long-term methylphenidate therapy is associated with many adverse effects, use of the drug should not be taken lightly. KEY POINTS

to determine baseline status before beginning therapy and for any potential adverse effects. Also obtain a FBC. Implementation with rationale ■ ■ Ensure proper diagnosis of behavioural syndromes and narcolepsy because these drugs should not be used until underlying medical causes of the problem are ruled out. ■ ■ Arrange to interrupt the drug periodically in children who are receiving the drug for behavioural syndromes to determine whether symptoms recur and therapy should be continued. ■ ■ Arrange to dispense the least amount of drug possible to minimise the risk of overdose and abuse. ■ ■ Administer drug before 6 p.m. to reduce the incidence of insomnia. ■ ■ Monitor weight, FBC and ECG to ensure early detection of adverse effects and proper interventions. ■ ■ Consult with the school nurse or counsellor to ensure comprehensive care of school-aged children receiving CNS stimulants (Box 22.7). ■ ■ Provide safety measures such as side rails and assistance with ambulation if CNS effects occur to prevent injury. ■ ■ Provide thorough teaching, including drug name, prescribed dosage, the need to secure the drug as a controlled substance, measures for avoidance of adverse effects, warning signs that may indicate possible problems and the need for monitoring School nursing and Ritalin administration In the last several years, the number of school children receiving diagnoses of attention-deficit disorder or minimal brain dysfunction and being prescribed methylphenidate (Ritalin) has increased dramatically. Because this drug needs to be given two or three times each day, it has become the responsibility of the school nurse to dispense the drug during the day. Some school nurses reportedly spend between 50% and 70% of their time administering these drugs and completing the necessary paperwork. In 2000–2001, several long-acting formulations of methylphenidate became available. Concerta, previously available in an extended- release tablet in 18- and 36-mg strengths, is now also available in a 54-mg strength.This form is suggested for every-12-hours dosing.The advantage of these extended- release forms is expected to be a decrease in the number of students who must see the nurse for medication during the school day and, perhaps, a decrease in the stigma that may be associated with needing this drug. The school nurse has additional responsibilities besides administering the drug.The school nurse is responsible The evidence BOX 22.7