Case 6: Operative Report PREOPERATIVE DIAGNOSIS: Post tonsillectomy hemorrhage POSTOPERATIVE
Summary for Case Study: Parkyr Litchfield Hiya doc. I’m Parkyr—with a y. So my old doc … well, he’s not all that old, but he was my doctor since I was born, he can’t see me anymore because he’s only a pediatrician. And I’m 22 and an adult. And I need a refill on my ADHD meds, so I got a referral to you. What I need is Vyvnase. I’ve had to ration them because I couldn’t get the refill right away. So I saved my pills for test days. I’m at the tech school—I’ve got most of my core courses done, and now I’m focusing on the pipefitting courses. I’m going to get my associate’s degree. If I can make it through the classes, which has been tough without the med. I was diagnosed back in grade school. I think I was about 9. Mom says it made all the difference knowing what was going on with me. They tried a bunch of different meds. They’d work for a while, then not so much. So Mom kept saying I needed higher doses. I don’t remember all the different meds, but Vyvanse seems to work the best. I’ve been on it for years, at least since I was a senior in high school. I’ve tried both stimulants and non-stimulants. The stimulants always worked better. I think that covers it. How about that refill now? Personal History Had problems with drugs after high school graduation; sober for two years after nearly flunking out of first year of college. HPI SI: None Mood swings: None Psychosis: None Sleep: “Does okay falling asleep and staying asleep.” Anxiety: “I’m worried about this med and how I’m doing at school, but otherwise, no.” Depression: “Not really a lot of depression.” Appetite: “Not much.” Parkyr is taking Vyvanse 80 mg in the morning, 30 mg at noon. Questions 1. What concerns, if any, do you have about this medication and/or dose for him? 2. Would you refill Vyvanse at the same dose? If so, why? If not, what are two viable alternatives for Parkyr? Explain why, as well as the starting dose, indications, and possible side effects. 3. What screening tests or referrals, if any, would you like to do to get an accurate diagnosis of ADHD? 4. What tests and/or lab work would you order for Parkyr? Why? 5. Explain the treatment plan to Parkyr, including medication recommendations. If you don’t prescribe Vyvanse, also explain to Parkyr what Vyvanse is and how it works. 6. What are the recommendations for patient education?
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