COLLEGE OF NURSING

ATTENTION DEFICIT HYPERACTIVITY DISORDER

April 27, 2021

Tuesday

Level 3 Section B

Florita, Niño John S.

Gabiana, Audrey Nicole C.
Gabisay, Ayrcel Maye O.
Gargar, Franz Diane Shae R.
Lagahit, Cleiza Cake V.
Lozano, Princess Lyn P.
Melencion, Christian Van Joseph M.
Moliño, Niña Ley M.

Dr. Adriel Arman V. Pizarra, DCHM, MAN, RN

Clinical Instructor

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 TABLE OF CONTENTS

Introduction --------------------------------------------------------- 3
Goals ---------------------------------------------------------------- 8
Objectives ----------------------------------------------------------- 9
Significance of the study -------------------------------------------- 9
Definition of terms -------------------------------------------------- 9
Anatomy and Physiology ------------------------------------------- 13
Pathophysiology ----------------------------------------------------- 15
Cephalo - Caudal Assessment --------------------------------------- 16
Laboratory and Diagnostic Studies ---------------------------------- 19
5 Nursing Problem Lists ---------------------------------------------- 23
Drug Studies
Guanfacine --------------------------------------------------------- 24
Methylphenidate Hydrochloride ------------------------------------ 27
Atomoxetine -------------------------------------------------------- 30
Dextroamphetamine sulfate ---------------------------------------- 32
Lisdexamfetamine --------------------------------------------------- 35
NCP
NCP #1 -------------------------------------------------------------- 37
NCP #2 --------------------------------------------------------------- 42
Discharged plan ------------------------------------------------------ 45
Learning Outcomes -------------------------------------------------- 48
Conclusion ----------------------------------------------------------- 48
Recommendation ---------------------------------------------------- 49
References ----------------------------------------------------------- 50

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INTRODUCTION

Attention deficit hyperactivity disorder (ADHD) is a brain disorder that

affects how you pay attention, sit still, and control your behavior. It happens
in children and teens and can continue into adulthood.

According to American Psychological Association Attention-

deficit/hyperactivity disorder (ADHD) is one of the most common mental
disorders affecting children. ADHD also affects many adults. Scientists have
not yet identified the specific causes of ADHD. There is evidence that
genetics contribute to ADHD. For example, three out of four children with
ADHD have a relative with the disorder.

Based on diagnostic interview data from the National Comorbidity Survey

Replication (NCS-R), the estimated prevalence of adults aged 18 to 44 years
with a current diagnosis of ADHD has an overall prevalence of 4.4%.
Prevalence was higher for males (5.4%) versus females (3.2%). The non-
Hispanic white group (5.4%) had a higher prevalence than all other
race/ethnicity groups. Research studies have found that the prevalence of
Attention Deficit Hyperactivity Disorder (ADHD) ADHD ranges from 3% --
5% of the school-age population. Children with ADHD are more likely to
develop depression or anxiety, exhibit disruptive behavior, and have poorer
school performance, and more learning disabilities than do unaffected
children of the same age. ADHD symptoms start before age 12, and in some
children, they're noticeable as early as 3 years of age.

According to the Attention Deficit/Hyperactivity Disorder (AD/HD) Society of

the Philippines, an estimated 3 to 5 percent of the population aged 0 to 14
years in the Philippines have ADHD.

ADHD vs. ADD

Attention deficit disorder (ADD) is the old name for ADHD. It was officially
changed in the 1990s. Some people still use both names to talk about this
one condition.

There are three identified types of ADHD according to which what types of
symptoms an individual exhibit, these are as follows:

 Predominantly Inattentive Presentation- This is characterized by

individual’s difficulty to organize or finish a certain task. It also
includes their incapability to pay attention to details or follow

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 instructions and conversations. The person is susceptible to distraction
or being forgetful with details of daily routines. The person in falls in
this are unable to follow direction, develop carelessness and does not
like to do things that require sitting still. They often lose their own
things and likely tends to daydream.

 Predominantly Hyperactive-Impulsive Presentation- This

pertains to individual’s behavior of talking a lot and fidgeting. There is
difficulty in sitting for an amount of time but is constantly active in
running, jumping and climbing. This is observed with the individuals
feeling of restlessness and has trouble with impulsivity. This leads to
the individual to interrupt people, grab things from them and speak at
inappropriate times. They are impatient with their turns and are
inattentive to listing to directions. Moreover, their impulsivity can lead
to these individuals to accidents and injuries compared with others.
More than these, they often squirm and bounces when sitting which
has trouble to play in quite manner. They are always on the go and
blurts out answers.

 Combined Presentation: The symptoms as presented in the two

preceding type are equally characterized in the person.

Predisposing Factors

 Genetics

 Premature delivery

 Significantly low birth weight

 Postnatal injury to the prefrontal region of the brain

Precipitating Factors

 Prenatal exposure to alcohol and tobacco

 Postnatal injury to the prefrontal region of the brain.

 Environmental toxin exposure high lead levels

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ADHD symptoms can be mild, moderate or severe, and they may continue
into adulthood. ADHD occurs more often in males than in females, and
behaviors can be different in boys and girls.

Symptoms

 Overlook or miss details, make careless mistakes in schoolwork, at

work, or during other activities
 Have problems sustaining attention in tasks or play, including
conversations, lectures, or lengthy reading
 Seem to not listen when spoken to directly
 Fail to not follow through on instructions, fail to finish schoolwork,
chores, or duties in the workplace, or start tasks but quickly lose focus
and get easily sidetracked
 Have problems organizing tasks and activities, such as doing tasks in
sequence, keeping materials and belongings in order, keeping work
organized, managing time, and meeting deadlines
 Avoid or dislike tasks that require sustained mental effort, such as
schoolwork or homework, or for teens and older adults, preparing
reports, completing forms, or reviewing lengthy papers
 Lose things necessary for tasks or activities, such as school supplies,
pencils, books, tools, wallets, keys, paperwork, eyeglasses, and cell
phones
 Become easily distracted by unrelated thoughts or stimuli
 Forgetful in daily activities, such as chores, errands, returning calls,
and keeping appointments

Signs of hyperactivity and impulsivity

 Fidgeting and squirming while seated

 Getting up and moving around in situations when staying seated is
expected, such as in the classroom or in the office
 Running or dashing around or climbing in situations where it is
inappropriate, or, in teens and adults, often feeling restless
 Being unable to play or engage in hobbies quietly
 Being constantly in motion or “on the go,” or acting as if “driven by a
motor”
 Talking nonstop

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  Blurting out an answer before a question has been completed, finishing
other people’s sentences, or speaking without waiting for a turn in
conversation
 Having trouble waiting his or her turn
 Interrupting or intruding on others, for example in conversations,
games, or activities

COMPLICATIONS

o Often struggle in the classroom, which can lead to academic failure

and judgment by other children and adults
o Tend to have more accidents and injuries of all kinds than do children
who don't have ADHD
o Tend to have poor self-esteem
o Are more likely to have trouble interacting with and being accepted by
peers and adults
o Are at increased risk of alcohol and drug abuse and other delinquent
behaviour

COEXISTING CONDITIONS

Oppositional defiant disorder (ODD), generally defined as a

pattern of negative, defiant and hostile behavior toward authority
figures

Conduct disorder, marked by antisocial behavior such as stealing,

fighting, destroying property, and harming people or animals

Disruptive mood dysregulation disorder, characterized by

irritability and problems tolerating frustration

Learning disabilities, including problems with reading, writing,

understanding and communicating

Substance use disorders, including drugs, alcohol and smoking

Anxiety disorders, which may cause overwhelming worry and

nervousness, and include obsessive compulsive disorder (OCD)

Mood disorders, including depression and bipolar disorder, which

includes depression as well as manic behavior

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 Autism spectrum disorder, a condition related to brain development
that impacts how a person perceives and socializes with others

Tic disorder or Tourette syndrome, disorders that involve repetitive

movements or unwanted sounds (tics) that can't be easily controlled

PREVENTION

 During pregnancy, avoid anything that could harm fetal

development. For example, don't drink alcohol, use recreational drugs
or smoke cigarettes.

 Protect the child from exposure to pollutants and

toxins, including cigarette smoke and lead paint.

 Limit screen time. Although still unproved, it may be prudent for

children to avoid excessive exposure to TV and video games in the first

five years of life.

TREATMENT

Medication

Stimulants: Although it may seem unusual to treat ADHD with a medication

that is considered a stimulant, it is effective. Many researchers think that
stimulants are effective because the medication increases the brain chemical
dopamine, which plays essential roles in thinking and attention.

Non-Stimulants: These medications take longer to start working than

stimulants, but can also improve focus, attention, and impulsivity in a
person with ADHD. Doctors may prescribe a non-stimulant if a person had
bothersome side effects from stimulants, if a stimulant was not effective, or
in combination with a stimulant to increase effectiveness. Two examples of
non-stimulant medications include atomoxetine and guanfacine.

Antidepressants: Although antidepressants are not approved by the U.S.

Food and Drug Administration (FDA) specifically for the treatment of ADHD,
antidepressants are sometimes used to treat adults with ADHD. Older
antidepressants, called tricyclics, sometimes are used because they, like
stimulants, affect the brain chemicals norepinephrine and dopamine.

Therapy

For Children and Teens: Parents and teachers can help children and teens
with ADHD stay organized and follow directions with tools such as keeping a

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routine and a schedule, organizing everyday items, using homework and
notebook organizers, and giving praise or rewards when rules are followed.

For Adults: A licensed mental health provider or therapist can help an adult
with ADHD learn how to organize his or her life with tools such as keeping
routines and breaking down large tasks into more manageable, smaller
tasks.

Special education helps a child learn at school. Having structure and a

routine can help children with ADHD a lot.

Behavior modification teaches ways to replace bad behaviors with good

ones. Let your child know what behaviors you expect of them. Make simple,
clear rules. When they lose control, have them face consequences that
you’ve set up, like time-outs or losing privileges. Keep an eye out for good
behavior. When they keep their impulses in check, reward them.

Psychotherapy (counseling) can help someone with ADHD learn better

ways to handle their emotions and frustration. It could help improve their
self-esteem. Counseling may also help family members better understand a
child or adult with ADHD.

Education and Training

Parenting skills training teaches parents the skills they need to encourage
and reward positive behaviors in their children.

Stress management techniques can benefit parents of children with

ADHD by increasing their ability to deal with frustration so that they can
respond calmly to their child’s behavior.

Support groups can help parents and families connect with others who
have similar problems and concerns.

GOALS:

The goal of this case study is to describe the case of the client, identify
underlying causes of Attention Deficit Hyperactivity Disorder and analyze the
case study. This case will cover up to the client’s final diagnosis of Attention
Deficit Hyperactivity Disorder. To identify and discuss the Anatomy and
Physiology, Pathophysiology, Laboratory and Diagnostic Studies as well as
identifying 5 nursing problem lists for the client’s condition.

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OBJECTIVES:

The goal of this case study is to describe the case of the client, identify
underlying causes of Attention Deficit Hyperactivity Disorder and analyze the
case study. This case will cover up to the client’s final diagnosis of Attention
Deficit Hyperactivity Disorder. To identify and discuss the Anatomy and
Physiology, Pathophysiology, Laboratory and Diagnostic Studies as well as
identifying 5 nursing problem lists for the client’s condition.

GENERAL OBJECTIVES:

After 3 – 4 days’ exposure at Vicente Sotto Memorial Medical Center: Center

for Behavioral Sciences (Psychiatric and Psychological Services), being aided
with the concept of, Care of Clients with Maladaptive Patterns of Behavior,
Acute and Chronic, we will be able to demonstrate competencies in
knowledge, skills, and attitudes of an effective clinician in evaluating and
caring for patients with ADHD and other mental disorders in the health care
setting. We will be able to learn the need to study for ADHD in school, for
professors, and students. Lastly, to be able to present data about ADHD.

SPECIFIC OBJECTIVES:

1. Identify the individual factors in experiencing the ADHD

2.Apply the practice guidelines for the treatment of patients with ADHD.
3.To be able to present the signs and symptoms of ADHD.
4.Recognize the importance of effective detection and treatment of ADHD in
adults/children.
5.Formulate management plans for the longitudinal care of patients with
ADHD.
6.Develop prevention plans, including health education and behavioral
change strategies, for patients with ADHD.
6.Discuss behaviors with patients, in an empathic, respectful and non
judgmental manner.
7.Use information technology to access patient and family education
resources on ADHD.
8.Critically review the medical literature regarding new evidence based
clinical trials and its implication on current treatment guidelines of ADHD and
other mental illness.

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9.Improve patient care outcomes through effective communication with
other health care professionals, partnerships through community resources,
and government agencies.
10.To be able to tackle the medications related and is applicable to ADHD
mental illness

SIGNIFICANCE OF THE STUDY

The aim of the study includes:
1. Understanding the ADHD more precisely in order to develop a better
medical and or non-medical multimodal intervention plan.
2. Provide knowledge about the process of this disorder.
3. Expand on what is known about ADHD.
4. Information learned will improve knowledge about the factors that
increase the risk for ADHD, as well as the causes, and best
treatments, and will aid the development of resources.
5. Add a growing body of knowledge in this area.

This study is deemed beneficial to the following:

Family: This study can shift routines and relationships in ways that affect
the whole family, not just the person who has the condition and for them to
know the importance of early diagnosis and treatment. In addition, to aid a
big job which is parenting , that is a challenge with raising a person with
ADHD.
Educators: This study can develop strategies that will help students with
ADHD focus, stay on task, and learn to their full capabilities with proper
accommodations, instruction and interventions.
Society: This study will raise awareness to them about the disorder and
reinforce that ADHD is a real condition.
Healthcare Professionals: This study achieves the goal of diagnosis and
treatment is to help clients to be more effective in day-to-day life and
reduce the extent to which untreated ADHD interferes with getting things
done and happiness.
School: This will serve as an output that they can use in the future studies
regarding ADHD.

DEFINITION OF TERMS
ADD: This refers to “Attention Deficit Disorder,” an older term for ADHD
which some people still use, especially in reference to the presentation of
ADHD that has less hyperactivity and is more characterized by inattention.

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This term has been replaced with the term “ADHD” to include all
presentations of this disorder.
ADHD-Combined Type (ADHD-C): A subtype of ADHD characterized by
both inattentive and hyperactive/impulsive symptoms of ADHD.
ADHD-Predominantly Hyperactive-Impulsive (ADHD PH-I): A subtype
of ADHD characterized by impulsivity and hyperactivity, but lacking the
symptoms of inattention.
ADHD-Predominantly Inattentive (ADHD-PI): A subtype of ADHD
characterized by inattentive symptoms, but lacking hyperactivity and
impulsivity symptoms.
Anxiety: Uneasiness of the mind, typically shown by apprehension, worry
and fear about everyday situations. Anxiety can co-exist with ADHD.

Attention-deficit/hyperactivity disorder (ADHD): is a disorder marked

by an ongoing pattern of inattention and/or hyperactivity-impulsivity that
interferes with functioning or development.

Attention: is the ability to actively process specific information in the

environment while tuning out other details.

Behavior Modification (or Behavior Therapy): A type of treatment

provided by a trained mental health professional that teaches clients how to
identify the interconnection between thoughts, feelings and behaviors, and
learn new skills that replace negative behaviors with positive ones.

Behavioral Contract: A simple positive-reinforcement contract between

student and teacher, or between parent and child, that is designed to
change behavior. The contract explains the desired behavior that will be
increased and the reinforcement that will be earned. In addition,
inappropriate behavior is often listed, including the consequences for the
behavior.

Child Behavior Checklist: A behavioral rating scale used by parents and

teachers to evaluate emotional and behavioral problems in children.

Co-Existing Conditions: When two or more mental health conditions are

present in the same individual, they are said to be co-existing (also called
co-occurring or co-morbid). For example, ADHD can co-exist with depression
or anxiety.

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Combined Presentation: Symptoms of the above two types are equally
present in the person. Because symptoms can change over time, the
presentation may change over time as well.

Co morbidity: Two or more disorders occurring in an individual at the same

time.

Conduct Disorder: A condition characterized by behaviors such as lying,

stealing, fighting, or bullying.

Deficit: a lack or impairment in mental or physical functioning.

Distractibility: The inability to sustain attention on the task at hand so that

it disrupts a person’s concentration.

Executive Function: Mental skills that allow us to control and coordinate

other mental functions and abilities, such as planning or task completion.
This deficit is common in those with ADHD.

Functional Impairment Difficulties: These are life challenges which

interfere with a personʼs ability to function in major life activities, including
social situations, school, employment and in the community.

Inattention: means a person wanders off task, lacks persistence, has

difficulty sustaining focus, and is disorganized; and these problems are not
due to defiance or lack of comprehension.

Hyperactivity: means a person seems to move about constantly, including

in situations in which it is not appropriate; or excessively fidgets, taps, or
talks. In adults, it may be extreme restlessness or wearing others out with
constant activity.

Impulsivity: means a person makes hasty actions that occur in the moment
without first thinking about them and that may have a high potential for
harm, or a desire for immediate rewards or inability to delay gratification. An
impulsive person may be socially intrusive and excessively interrupt others
or make important decisions without considering the long-term
consequences.

Speech or Language Impairment: A communication disorder including

difficulties with articulation, stuttering, or a language impairment that
adversely affects a person’s educational performance.

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ANATOMY AND PHYSIOLOGY

Cerebrum: outer part of the brain, controls reading, thinking, learning,

speech, emotions and planned muscle movements like walking. It also
controls vision, hearing and other senses.

Frontal Lobe: The frontal lobe is important for cognitive functions and
control of voluntary movement or activity. Parts of the frontal lobe may
mature a few years later in people with ADHD .

Parietal Lobe: processes information about temperature, taste, touch and

movement. Loss of parietal cortices.

Occipital Lobe: primarily responsible for vision. Volume enlargement in the

brain of ADHD patients was located in the right occipital lobe.

Temporal Lobe: processes memories, integrating them with sensations of

taste, sound, sight and touch.
- Amygdala: thought to play important roles in emotion and behavior.
- Hippocampus: It has a major role in learning and memory.

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 ❖ Amygdala and hippocampus are smaller in the brains of people
with ADHD. These areas are responsible for emotional processing
and impulsivity

Cerebellum: controls balance, coordination and fine muscle control (e.g.,

walking). It also functions to maintain posture and equilibrium. Cerebellar
dysfunction is evident in attention deficit hyperactivity disorder (ADHD), and
damage to the cerebellum early in development can have long-term effects
on movement, cognition, and affective regulation.

The brain stem: includes the midbrain, the pons, and the medulla. It
controls fundamental body functions such as breathing, eye movements,
blood pressure, heartbeat, and swallowing. There are brain stem
abnormalities in ADHD.

Spinal cord: the pathway for messages sent by the brain to the body and
from the body to the brain.

BRAIN WITH ADHD

- Smaller brain volume

- Smaller cerebellar veins
- Smaller size in brain

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PATHOPHYSIOLOGY

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CEPHALO - CAUDAL ASSESSMENT

Skin: The client’s skin is evenly light brown color and no edema.
Excoriations noted and presence of foul odor. He has a good skin turgor
when held and released, skin snaps rapidly back to its normal position.
Skin’s temperature is warm to touch. Nail Beds are pink without clubbing.
When nails pressed between the fingers nails return to usual color in less
than 4 seconds. Nails are soiled and untrimmed.

Scalp and Hair: Skull is generally round, there are no nodules or masses
and depressions when palpated. The hair of the client is thick, silky hair is
evenly distributed. There are also no signs of infestation observed.

Head and Face: Head symmetrically round, hard, and smooth without
lesions or bumps. Face oval, smooth, symmetrical, and no observed
drooping of the face on both sides.

Eyes: The client’s eyebrows are symmetrically aligned. Darting of eyes

noted. Evelids in normal position with no abnormal widening or ptosis. No
redness, discharge, or crusting noted on lid margins. Conjunctiva and sclera
appear moist and smooth. Sclera white with no lesions or redness. No
swelling or redness over the lacrimal gland. Cornea is transparent, smooth,
and moist with no opacities, lens is free of opacities. Irises are round, flat,
and evenly colored. Pupils are equal in size and reactive to light and
accommodation.

Ear: Ears are equal in size bilaterally. Auricles are aligned with the corner of
each eye. Skin smooth, no lumps, lesions, nodules. No discharge.
Nontender on palpation. Small amount of moist yellow cerumen in the

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external canal. Whisper test : patient cannot repeat words due to
inattentiveness.

Nose: Nose somewhat large but smooth and symmetric. Able to sniff
through nostrils. No purulent drainage noted. Frontal and maxillary sinuses
are not tender to palpation and percussion. No nasal flaring noted.

Mouth and Throat: Lips pink, smooth, and moist without lesions. Buccal
mucosa pink, moist, and without exudates. 28 teeth are present. Broken
teeth and dental caries noted. Uvula is in midline, pinkish, with no swelling
or lesions noted. The uvula moves up when saying “ahh” and the patient
can swallow with ease and has no hoarseness when talking.

Upper Extremities: Absence of deformities. No swelling and redness.

Fidgety with the hands noted.

Neck: Trachea is in midline with no presence of mass or lumps. The neck is

straight, symmetrical. No swell lymph nodes noted. Jugular vein not
distended upon palpation.

Chest: Chest expansion symmetric. No retraction or bulging of interspaces.

No pain or tenderness on palpation. Tactile fremitus symmetric. Percussion
tones resonant over all lung fields. Vesicular breath sounds auscultated over
lung fields. No adventitious sounds present.

Back: Patient’s back is symmetrical. No tenderness is noted on palpation of

the spinous processes. Spinous processes are midline. Cervical, thoracic, and
lumbar paraspinal muscles are not tender and are without spasm. No
lesions, bruises, deformities and edema noted.

Abdomen: Skin of abdomen is free of striae, scars, lesions, or rashes.

Umbilicus is midline and recessed with no bulging. Abdomen is flat and
symmetric with no bulges or lumps. No tenderness or guarding in any
quadrant with light palpation.

Lower Extremities: Both extremities are equal in size and no edema.

Presence of scars on the knee. Temperature is warm and even to touch.
Fidgety with the feet noted. Extra squirmy sitting in a chair.

Genitals: Male- Circumcised penis is free of rashes, lesions, and lumps and
is soft, flaccid and nontender on palpation. No masses or swelling noted in
scrotum and the left side hangs slightly lower than the right side. Female-
Labia majora pink, smooth, and free of lesions, excoriation, and swelling.

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Labia minora dark pink, moist, and free of lesions, excoriation, swelling or
discharge. No discharge from urethral opening. No malodorous discharge
noted from vagina.

Mental Status: Patient is alert and oriented with no sensory or perceptual

alterations such as hallucinations. Ability to pay attention or to concentrate
is markedly impaired. The child’s attention span is 2 or 3 minutes for severe
2-3 seconds. Has limited communication. Very distractible and rarely able to
complete tasks.

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LABORATORY AND DIAGNOSTIC STUDIES

Diagnostic Procedure Indication/Purpose Result/and or possible Normal Values Nursing Responsibilities

results (before, during and after)

Neuropsychiatric The NEBA system uses an
Electroencephalograph- electroencephalograph (EEG) to
Based ADHD Assessment provide an interpretation of the
Aid (NEBA patient’s neuropsychiatric
condition.
Low theta/beta ratio(TBR):
Strongly recommend for further
clinical testing of other
conditions.
Moderate TBR: Suggested
further clinical testing of other
conditions.
High TBR: confirmatory
support for ADHD as primary
diagnosis.
Low theta/beta ratio (TBR):
Negative for ADHD as primary
diagnosis.
Moderate TBR: Negative for
ADHD as primary diagnosis.
High TBR: Negative for ADHD
as primary diagnosis.
BEFORE
-Establish rapport with the patient
and
Explain the procedure.
-Maintain a calm environment free
From negative stimuli.
-encourage the pt. to ask any
question for the procedure is not
understood well.
-Explain to the patient events which
will occur prior to the
electroencephalogram.
DURING
- Approach the child at his current
level of functioning.
- Patient will be asked to relax in a
reclining chair or lie on a bed, and
electrodes will be attached to the
scalp.
- Assure the patient that the
electrodes will not cause electrical
shocks.
- instructed to relax with the eyes
closed and remain still.

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MRI can be used to identify people
with attention-
deficit/hyperactivity disorder
from patients without the
condition, according to a new
study.
Alterations in the shape of the
left temporal lobe, bilateral
cuneus, and areas around the
left central sulcus distinguish
ADHD from typically developing
patients.
Normal brain structure, not
smaller nor with alterations in
the shape.
AFTER
-Analyze and interpret data.
-Providing client and family
education and support.
Before:
- Remove any metal devices
- The staff may ask you to
wear a hospital gown or clothing
that doesn’t contain metal
fasteners.
- You can’t have electronic
devices in the MRI room.
- Tell the medical staff if
you’re pregnant. An MRI’s magnetic
field affects unborn children in a
way that isn’t yet fully understood.
During:
- Stay still to obtain clear
image.
- You will lie down on a table
that slides into the MRI machine.
- You may have a plastic coil
placed around your head.
- After the table slides into the
machine, a technician will take
several pictures of your brain, each
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DSM - 5 ADHD The DSM 5 recognizes
substance-related disorders
resulting from the use of 10
separate classes of drugs:
alcohol; caffeine; cannabis;
hallucinogens (phencyclidine or
similarly acting
arylcyclohexylamines, and
other hallucinogens, such as
LSD); inhalants; opioids;
sedatives, hypnotics, or
anxiolytics; stimulants
(including amphetamine-type
substances, cocaine, and other
stimulants); tobacco; and other
or unknown substances.
1. Five or more symptoms of
inattention and/or ≥5
symptoms of
hyperactivity/impulsivity must
have persisted for ≥6 months
to a degree that is inconsistent
with the developmental level
and negatively impacts social
and academic/occupational
activities.
2. Several symptoms
(inattentive or
hyperactive/impulsive) were
present before the age of 12
years.
3. Several symptoms
(inattentive or
hyperactive/impulsive) must be
present in ≥2 settings (eg, at
home, school, or work; with
friends or relatives; in other
activities).
of which will take a few minutes.
- There will be a microphone
in the machine that allows you to
communicate with staff.
After:
- you can get dressed and
leave the testing facility
- A radiologist will analyze your
MRI images and provide your
doctor with the results.
No presence of symptoms. Before:
-Establish rapport with the patient
and
Explain the procedure.
-Maintain a calm environment free
From negative stimuli.
-encourage the pt. to ask any
question for the procedure is not
understood well.
-Secure privacy.
During:
- Approach the child at his current
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4. There is clear evidence that level of functioning.
the symptoms interfere with or
reduce the quality of social, -Guide the client in answering the
academic, or occupational
functioning. Questionnaire.
5. Symptoms do not occur
exclusively during the course of -Avoid using jargon and technical
schizophrenia or another
psychotic disorder, and are not Language.
better explained by another
mental disorder (eg, mood -Simplifying instructions.
disorder, anxiety disorder,
dissociative disorder, After:
personality disorder, substance
intoxication, or withdrawal). -Analyze and interpret data.

-Providing client and family

education and support.

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5 NURSING PROBLEM LISTS

Nursing Diagnosis:

1. Risk for injury related to hyperactivity secondary to ADHD

2. Impaired Social Interaction related to Altered Thought

Process as evidenced by reports of easy distractibility

3. Ineffective Role Performance Related to Mental Health Issue

Secondary to ADHD

4. imbalance in nutrition: less than body requirements Related

to Inability to procure adequate amounts of food as evidence by
Loss of weight

5. Compromised Family Coping Related to Developmental Crisis

as evidence by Attention-deficit

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DRUG STUDIES

NAME OF MECHANISM OF INDICATION SIDE EFFECTS NURSING RESPONSIBILITIES

DRUG ACTION

GENERIC Guanfacine stimulates · CNS:Headache, Dizziness 1. Do not administer with high-fat meals due to potential
NAME: postsynaptic alpha-2A for increased serum levels
INTUNIV is indicated for the Cardiovascular: Slow heart
adrenergic receptors so it treatment of Attention
Guanfacine rate, palpitations 2. Swallow tablets whole; do not crush, chew, or
inhibits the production of Deficit Hyperactivity
Disorder (ADHD) as break tablets because this will increase the rate of
cAMP and closes HCN
monotherapy and as guanfacine release
channels enhancing the adjunctive therapy to
BRAND NAME: effectiveness of the signal stimulant medications.
3. Missed dose: Repeat dosage titration based on
of the pyramidal neurons
patient tolerability
Intuniv, Tenex
of the prefrontal cortex
(PFC), thus improving 4. Store at room temperature away from light and
working memory and moisture. Do not store in the bathroom. Keep all
CLASSIFICATIO attention. medications away from children and pets.
N:
5. tablets should be swallowed whole with water, and

24
alpha 2A- not broken, crushed or chewed
adrenergic CONTRAINDICATION ADVERSE EFFECTS
6. Guanfacine should not be taken with fatty foods
receptor CNS: Paresthesias, vertigo
Hypersensitivity and/or grapefruit juice-containing products as these
agonists, ADHD
GI: Abdominal pain, may interact with guanfacine and alter its effects
Agents Pregnancy, lactation
constipation, diarrhea,
7. if drowsiness is a problem, teenagers should avoid
indigestion
driving or operating machinery
DOSAGE: Liver/biliary: Abnormal liver
8. not to stop taking guanfacine without talking to
function tests
1mg, 2mg their doctor, as stopping treatment suddenly can lead

Musculoskeletal: Joint pain, to serious side effects such as high blood pressure

leg cramps, leg pain, muscle

9. if they forget a dose, they should wait until the
ROUTE: pain
next day and take the usual (not double) dose. If two
or more doses are missed they should talk to their
PO
doctor or pharmacist as re-titration may be required.

10.Educate and provide written instructions to the

25
FREQUENCY: patient and family (or caregiver) regarding prescribed
medications for use when at home and verify their
OD
understanding prior to discharge

TIMING:

8PM

26
Name of drug Mechanism of action Indications Side effects Nursing Responsibilities

Generic Name: Piperidine derivative with Adjunctive therapy in CNS: nervousness, BEFORE:
actions and abuse potential hyperkinetic syndromes irritability, difficulty falling
METHYLPHENIDATE qualitatively similar to those of characterized by attention asleep or staying, asleep, 1. Ensure proper diagnosis
HYDROCHLORIDE amphetamine. Acts mainly on deficit disorder, narcolepsy, dizziness, headache, before administering to children
the cerebral cortex exerting a mild depression, and apathetic drowsiness, heavy sweating for behavioral syndromes; drugs
Brand Name: stimulant effect. or withdrawn senile behavior.
should not be used until other
GI: nausea, vomiting, loss of
Concerta causes or concomitants of
appetite, weight loss,
stomach pain, diarrhea, abnormal behavior (learning
Classification: heartburn, dry mouth disability, EEG abnormalities,
neurologic deficits) are ruled out.
CENTRAL NERVOUS SYSTEM MUSCULOSKELETAL:
(CNS) AGENT; CEREBRAL muscle tightness, 2. Lab tests: Obtain periodic
STIMULANT uncontrollable movement of a CBC with differential and platelet
Contraindications part of the body,
counts during prolonged therapy.
Dosage: restlessness, back pain

5-10 mg Hypersensitivity to drug; history 3. Dispense the least feasible

of marked anxiety, agitation; Adverse Effects dose to minimize risk of
Route: motor tics or Tourette's overdose.
disease; substance abuse;
PO severe anxiety, psychosis, CNS: Dizziness, drowsiness, DURING:
major depression, suicidal nervousness, insomnia.
Frequency: ideation; glaucoma; pregnancy 4. Ensure that all timed-release
(category C), lactation, children CV: Palpitations, changes in
tablets and capsules are
OD <6 y of age. BP and pulse rate, angina,
cardiac arrhythmias, swallowed whole, not chewed or
Timing: exacerbation of underlying CV crushed.
conditions.
8 AM 5. Monitor BP and pulse at
Special Senses: Difficulty appropriate intervals.
with accommodation, blurred

27
vision. 6. Assess the patient's condition
with periodic drug-free periods
GI: Dry throat, anorexia, during prolonged therapy.
nausea; HEPATOTOXICITY;
abdominal pain. 7. Supervise drug withdrawal
carefully following prolonged use.
Body as a Whole: Abrupt withdrawal may result in
Hypersensitivity reactions severe depression and psychotic
(rash, fever, arthralgia, behavior.
urticaria, exfoliative
dermatitis, erythema 8. Interrupt drug dosage
multiforme); long-term periodically in children to
growth suppression. determine if symptoms warrant
continued drug therapy.

AFTER:

9. Take this drug exactly as

prescribed. Timed-release tablets
and capsules must be swallowed
whole, not chewed or crushed.
Metadate CD capsules may be
opened and entire contents
sprinkled on soft food—do not
chew or crush granules.

10. Take drugs before 6 PM to

avoid nighttime sleep
disturbance.
11. Avoid alcohol and OTC drugs,
including nose drops, cold
remedies; some OTC drugs could
cause dangerous effects.

28
12. Monitor CBC and platelet
counts periodically in patients on
long-term therapy.

13. Report adverse effects to

physician, particularly
nervousness and insomnia. These
effects may diminish with time or
require reduction of dosage or
omission of afternoon or evening
dose.

14. Check weight at least 2 or 3

times weekly and report weight
loss. Check height and weight in
children; failure to gain in either
should be reported to a
physician.

15. Do not breast feed while

taking this drug without
consulting a physician.

29
NAME OF DRUG MECHANISM OF ACTION INDICATION SIDE EFFECTS NURSING RESPONSIBILITIES
Atomoxetine is known to be a
Generic Name: potent and selective inhibitor of Atomoxetine is indicated for the CNS: Dizziness, headache, Before:
the norepinephrine transporter treatment of attention deficit somnolence, crying, tearfulness,
(NET), which prevents cellular hyperactivity disorder (ADHD) irritability, mood swings,
Atomoxetine 1. Ensure that drug is being used as
reuptake of norepinephrine in children and adults. insomnia
throughout the brain, which is part of an overall treatment program
Brand Name: thought to improve the CV: Increased blood pressure,
including education and psychosocial
symptoms of ADHD tachycardia, palpitations.
interventions.
Strattera
GI: Upper abdominal pain,
constipation, dyspepsia,
2. Administer drug exactly as prescribed
Classification: vomiting,
time, frequency and dosage.
Musculoskeletal: Arthralgia,
SNRI (selective norepinephrine
myalgia.
3. Assess BP early in treatment,
reuptake inhibitors) CONTRAINDICATION
Respiratory: Cough, particularly with adult patients.
rhinorrhea, nasal congestion,
Route:
Allergy to atomoxetine, use of sinusitis.
4. Ensure proper diagnosis before
an MAOI within the last 14
PO days, narrow-angle glaucoma Skin: Pruritus, increased administering to children for behavioral
and cardiac disorders which sweating.
syndromes: drug should not be used until
cannot tolerate increases in
Dosage:
blood pressure or heart rate other causes and concomitants of
abnormal behavior (learning disability,
25mg
EEG abnormalities, neurological deficits)

ADVERSE EFFECTS are ruled out.

Frequency: CNS: Depression, tremor, early 5. Assess for lactation and pregnancy
morning awakenings,
paresthesias, abnormal dreams, through asking LMP.
OD decreased libido, sleep disorder,
suicidal ideation. 6. If desired to be given at night
Timing:
Skin: Dermatitis. administer the drug before 6 PM to

8 am prevent insomnia if that is a problem.

30
During:

7. Tell patient to report irritability as it

indicate a need to discontinue the drug

8. Arrange to interrupt drug dosage

periodically in children being treated for
behavioral disorders to determine if
symptoms recur at an intensity that
warrants continued drug therapy.

9. Advise to slowly change position if

experiencing dizziness with arising from a
lying or sitting position.

10. Tell patient not to breast feed while

taking this drug.

After:

11. Monitor cardiovascular status

especially with preexisting hypertension.

12. Evaluate for continuing therapeutic

effectiveness.

13. Assess for level of functioning and

behaviour.

14. Advise to avoid the use of alcohol and

OTC drugs, including nose drops, cold
remedies, and herbal therapies while
taking this drug; some of these products
cause dangerous effects.
31
15. Advise women patient of childbearing
age to use contraceptives (effects of this
NAME OF DRUG MECHANISM OF ACTION INDICATION SIDE EFFECTS NURSINGF
RESPONSIBILITIES
Dextroamphetamine acts by CV: fast heartbeat
GENERIC NAME: preventing reuptake, increasing Treatment of attention- CNS: tremors, headache, BEFORE:
release, and stimulating deficit hyperactivity
reverse-transport of dopamine
trouble sleeping, dizziness,
Dextroamphetamine sulfate
in synaptic clefts in the
disorder (ADHD), Narcolepsy feeling anxious 1. Assess for patients’ history
striatum. GI: upset stomach, weight for cardiovascular disease,
loss, dry mouth, hypertension and diabetes
decreased appetite
mellitus.
BRAND NAME:
CONTRAINDICATION
2. Assess current medications
Dexedrine Spansule, DextroStat ADVERSE EFFECTS
Hypersensitivity to drug
especially MAO inhibitors.
Glaucoma Anxiety, agitation,
tension, Family history or CNS: hyperactivity, insomnia,
diagnosis of Tourette syndrome restlessness, tremor, behavioral 3. Assess for hypersensitivity of
disturbances, depression,
CLASSIFICATION: dizziness, hallucinations, dextroamphetamine.
headache, irritability, mania,
Sympathomimetic amine, CNS thought disorder. 4. Assess if patient is pregnant
CV: palpitations, tachycardia,
stimulant arrhythmias, hypertension. or breastfeeding.
GI: anorexia, constipation,
cramps, diarrhea, dry mouth, 5. Administer correct dosage as
metallic taste, nausea,
vomiting. prescribe by physician
GU: erectile dysfunction,
increased libido. DURING:
DOSAGE: 5 mg, 10 mg Derm: urticaria.
Misc: physical dependence,
psychologic dependence. 6. Monitor patient for new or
ROUTE: P.O.
worsening aggressive behavior.

32
FREQUENCY: OD BID 7. Monitor blood and urine
glucose levels carefully in
diabetic patient.

8. Advise patient not to breast

feed while taking the drug.
TIMING: 8 AM, 6:00 AM- 6:00
PM / 12:00 AM- 12:00 PM
9. Inform Advise patient about
the potential cardiac and CNS
risks of amphetamines,

10. Monitor signs of excessive

CNS stimulation, including
hyperactivity, restlessness,
tremor, hallucinations, mania,
irritability, or disordered
thoughts.

AFTER:

11. Advise patient to take drug

early in day to avoid insomnia.

12. Assess all other significant

and life-threatening adverse
effects.

13. Caution patient not to stop

33
therapy abruptly but to taper
dosage gradually.

34
 DRUG STUDY
NAME OF DRUG MECHANISM OF ACTION INDICATION SIDE EFFECTS NURSING
RESPONSIBILITIES

GENERIC NAME:
Lisdexamfetamine Enhances action of dopamine, Treatment of ADHD. CNS: insomnia, headache, BEFORE
norepinephrine by blocking Maintenance treatment Of irritability, dizziness
BRAND NAME: reuptake from synapses, ADHD in adults.
Vyvanse increasing levels in extra GI: Decreased appetite, upper -Baseline assessment
neuronal Space. abdominal
CLASSIFICATION: -Assess B/P, pulse, respirations
CNS stimulant pain, vomiting, immediately before administration.
weight decrease, Nausea, dry
DOSAGE:
mouth,
30mg
-May be given in the morning without
SKIN: rash
ROUTE: Regard to food.
PO Contraindications
DURING
FREQUENCY:
Contraindications: Advanced Adverse Effects
OD - Swallow capsule whole do not chew.
arteriosclerosis, Symptomatic
TIMING: cardiovascular disease, - Capsules may be opened and
moderate to severe OTHERS:
8am dissolved in water and taken
hypertension, hyperthyroidism, immediately.
known hypersensitivity to Abrupt withdrawal following
sympathomimetic amines, prolonged administration of
-Avoid tasks that require alertness,
glaucoma, Agitated mental high dosage may produce
motor
states, history of drug abuse, Extreme fatigue (may last for
and use of MAOIs within 14 wks.). Prolonged administration
Skills until response to drug is

35
days (hypertensive crisis may to children with ADHD may established.
result). Cautions: History of produce a suppression Of
preexisting psychosis, bipolar weight and/or height patterns. AFTER
disorder, aggression, tics, May produce cardia
Tourette’s syndrome, Structural irregularities, psychotic - Assess attention span, impulse
cardiac abnormalities, coronary Syndrome. control,
artery disease (CAD) (adults),
seizure disorder. Interaction with others.

- Monitor for CNS stimulation, increase

in

B/P, weight loss, pulse, sleep pattern,

appetite.

- Observe for signs of hostility,

aggression,

Depression.

- Report pronounced dizziness,

decreased appetite, dry mouth, weight
loss, new or worsened psychiatric
problems, palpitations, and dyspnea.

36
NCP #1

DEFINING NURSING SCIENTIFIC GOAL NURSING RATIONALE EVALUATION

CHARACTERISTICS DIAGNOSIS ANALYSIS OF CARE INTERVENTIONS

Risk for Injury related Attention deficit Short term:

Subjective: to Hyperactivity hyperactivity disorder Short term: After 8 hours of
secondary to (ADHD) After 8 hours of nursing
“Di man gyud mag Attention Deficit is characterized by nursing intervention pt. Was
Independent:
urong akong anak sir. Hyperactivity Disorder inattentiveness, intervention pt. will able to:
Lisod I control” as (ADHD) overactivity, and be able to: A. Identify the
verbalized by impulsiveness.The A. Identify the 1. Discuss and explain 1. Attempting to talk Harmful objects and
patient’s mother. essential feature of Harmful objects and be free from injuries.
with the patient the to or reason with a
ADHD is a persistent be free from injuries. -Goal was met
pattern of inattention reason why an object child en- gaged in
and/or
is harmful during the activity is unlikely to
Objective: hyperactivity and
impulsivity patient is not in succeed because his
*Fidgety with the
activity. or her ability to pay
hands and feet Studies have shown
that the injuries are attention and to lis-
*Extra squirmy sitting associated with 2. Provide medical
ten is limited.
ADHD. Several
identification
*Runs excessively studies have also 2. Healthcare
been specifically bracelets for patients
providers need to
*Difficulty remaining conducted to show an
at risk for injury from
seated association between acknowledge who has
ADHD and various dementia, seizures, or
the condition for they
*RR-31cpm types of injuries in
other medical
childhood. It has been are responsible for
*PR- 111 bpm reported that ADHD disorders.
implementing actions
may be associated
with burns, fractures, to promote patient
dental trauma, and
safety.
traffic injuries

37
 3. Put call light within 3. Items that are too
According to Nanda
reach and teach how far from the patient
the definition of risk
for injury is the state to call for assistance; may cause hazard.
in which an individual
respond to call light
is at risk for harm
because of a immediately.
perceptual or
4. Keep the patient
physiologic deficit, a 4. This is to prevent
lack of awareness of room clutter free at
the patient from any
hazards, or
all times by rooming
maturational age. In unpleasant experience
order for a patient to any hazardous,
due to dangerous
qualify for the nursing
skidding, or sharp
diagnosis of risk for objects.
injury the nurse must objects from the
assess the patient for
room. 5. Patient might be
possible risk factors.
These risk factors can 5. Avoid stimulating easily distracted with
include,
or distracting settings what he/she sees that
pathophysiologic,
treatment-related, by removing things may trigger
maturational, and
that look like toys. hyperactivity
situational.

6. The priority is
safety
B. Adopt behavioral
6. Stop unsafe
B. Adopt behavioral changes/restrictions.
changes/restrictions. behavior, when -Goal was met
hyperactivity is over
and the child is safe,
by talking to the child
directly about the

38
 expectations for
behavior.
7. To minimize
7. Implement a hyperactivity and
scheduled routine become oriented to
everyday by offering time.
a daily routine chart.
8. Break complex
C.Comply to
C.Comply to 8. Use simple and tasks into simple instructions given.
instructions given. -Goal was met
direct instructions by tasks and for easy
saying specific comprehension.
instructions.
9. To be goal oriented
9. Provide praise and with the tasks.
reward by showing
simple smile, nod or a
star’ praise him for
achieving his goals for
the day or a task that
was finished
10. Taking
Dependent: medications may put
D.Perform the right
D.Perform the right 10. Administer drug the patient into risk. way of taking
way of taking medication
by teaching proper
medication -Goal was met
intake(
Dextroamphetamine

39
 ,by mouth , 10 mg, 11. Medications are
once a day.) often more effective
11. Explain the in decreasing
importance and the hyperactivity and
reason of drug improving attention.
dextroamphetamine
by telling the purpose
and the adverse
effects.
12. Parents feel
Collaborative
empowered and
relieved to have
12. Include parents
E.Improve patient- specific strategies E.Improve patient-
in planning, providing
parents relationship. parents relationship.
that can both help
care and instituting -Goal was met
both of them and
safety for the child by
their child be more
discussing their
successful.
importance and role
in providing care to
13. To assess
the patient.
readiness of parents
to support patients
13. Assess parents
intervention.
feelings by letting
them explain what
they feel and
thoughts about their 14. To assess both

40
 child’s condition. states of relationship.

14. Assess a patient's

dependency and trust
towards his/her
parents by observing
15. The most effective
Long term goal: cues such as crying treatment combines
After 3-4 days of pharmacotherapy with
when parents are not
nursing intervention behavioral,
patient will be able to: around. psychosocial, and
F. Promote effective educational
adherence to interventions.
15.Refer patient to
treatment.
psychiatrist and
Long term goal:
assess positive
After 3-4 days of
outcome by
nursing intervention
comparing past and
patient was able to:
present behavior.
F. Promote effective
adherence to
treatment.
-Goal was partially
met because therapy
may take more time

41
 NCP #2

DEFINING NURSING SCIENTIFIC GOAL NURSING RATIONALE EVALUATION

CHARACTERISTICS DIAGNOSIS ANALYSIS OF CARE INTERVENTIONS

SUBJECTIVE: Impaired Social ADHD is SHORT TERM: INDEPENDENT: SHORT TERM:

“He can’t stay still and Interaction frequently After 8 hours of 1. Develop trusting relationship 1. To impose unconditional After 8 hours of nursing
usually darts around related to associated with nursing and convey acceptance acceptance which increases intervention the client
the room. Most of the altered thought impaired social intervention the separate from the feelings of self worth. will be able to:
time he is overactive process as functioning. These client will be able unacceptable behavior.
and often doesn’t evidenced by social behavioral to: - Identify and clarify the
listen to others unlike reports easy difficulties begin possible reasons for
the rest of his distractibility in childhood for - Identify and impairment in
classmates. Also gets children with clarify the interacting with others
easily distracted.” as ADHD, and possible reasons such as decreased
verbalized by the SO. continue through for impairment in 2. Assist client to decrease 2. To decrease client’s ability to self-regulate
adolescence and interacting with stimulation and distraction by distractibility and increase their actions and
OBJECTIVE: into adulthood. others such as altering the environment to attention span. reactions towards
- Very active The nonstop decreased ability reduce distraction. others, social rejection,
- Do not attend to activity, impulsive to self-regulate and interpersonal
instructions provided actions, and more their actions and 3. Advise SO to cooperate and 3. To allow cooperation that relationship problems as
- Talk excessively frequent reactions towards help with interventions done to will help the condition be less a result of their
- Fidgets with hands aggressiveness of others, social the child. challenging to handle. inattention, impulsivity
and feet children with the rejection, and and hyperactivity.
- Young male hyperactive or interpersonal (GOAL WAS MET)
- Ages from 3-6 combined types of relationship
ADHD are obvious problems as a 4. Motivate the patient to 4. To reduce physiological - Maintain a good
sources of result of their express feelings and distress. relationship with others.
annoyance to inattention, perceptions of problems. (GOAL WAS MET)
peers. They are impulsivity and
more likely than hyperactivity. - Develop a therapeutic
other children to 5. Involve client to other 5. To enhance social skills nurse-client relationship
argue and start - Maintain a good groups. through frequent, brief
fights. But relationship with 6. To concentrate better, be contacts and an
children with the others. 6. Provide a quiet place free of less impulsive, feel calmer, accepting attitude.
inattentive form distractions for task and learn and practise new (GOAL WAS MET)

42
of ADHD can also - Develop a completion. skills.
have social therapeutic nurse-
problems. They client relationship LONG TERM:
may appear through frequent, After 2 days of nursing
withdrawn or not brief contacts and 7. Give clear directions about 7. To ensure safety and that intervention, the client
interested in an accepting acceptable and unacceptable of others. will be able to:
others. They may attitude. behavior.
also make social - Habitually minimize
blunders due to a 8. Simplify instructions by 8. To get a child's attention. pacing in different
lack of awareness breaking complex tasks into directions when talked
of others’ feelings small steps and allow breaks. to. (GOAL WAS MET)
or difficulty
managing their LONG TERM: 9. Provide a structured routine, 9. To allow a sense of - Feel satisfied by
own emotions. After 2 days of establish a daily schedule and control. having effective social
nursing minimize changes. interaction skills in both
Impaired social intervention, the one on one and group
interaction is a client will be able DEPENDENT: settings. (GOAL WAS
consistent lack of to: 1. Administer 1. To treat disorder MET)
orientation to a medications such as stimulants effectively.
person, place, - Habitually and antidepressants as - Promote a positive
circumstances or minimize pacing indicated. interaction with peers
time for a period. in different and other people.
It causes direction when (GOAL WAS MET)
disorientation of talked to. COLLABORATIVE: 1. To provide proper
the mental 1. Consult a psychiatrist. diagnosis and prescribe
functioning.Indivi - Feel satisfied by medication appropriate for
duals with ADHD having an the child.
often experience effective social
social difficulties, interaction skills 2. To discuss how to work
social rejection, in both one on together to support child
and interpersonal one and group 2. Setting up a meeting with a continuously on a regular
relationship settings. classroom teacher. basis to discuss updates and
problems as a progress.
result of their - Promote a
inattention, positive
impulsivity and interaction with
hyperactivity. peers and other

43
Such negative people.
interpersonal
outcomes cause
emotional pain LONG TERM:
and suffering. After 4 days of
nursing
Distractibility intervention, the
refers to the client will be able
attention is easily to:
shifted. They get
distracted by - Habitually
outside stimuli or minimize pacing
even by their own in different
thoughts. Often direction when
inattention can be talked to.
the consequence
of being - Feel satisfied by
distracted. having an
According to a effective social
small 2020 study, interaction skills
people with ADHD in both one on
are often easily one and group
distracted. They settings.
may also have
something called
- Promote a
hyperfocus. A positive
person with ADHD
interaction with
can get so peers and other
engrossed in people.
something that
they can become
unaware of
anything else
around them.

44
DISCHARGED PLAN

DISCHARGE PLANNING

Subjective “Okay na ako anak. Ma-control na niya gamay iya attitude and
Data behavior. Makig-socialize napud siya sa mga lain bata. Tas
makafocus na siya sa iyang mga buhatonon, di na siya dali mapul-
an and makalimot. Dili napud siya dali mairita.” As verbalized by
the patient’s SO.

• Alert
Objective • Focused
Data • Socializes with other kids
• Patient

Interventions:

Analysis From being impatient, having a hard time waiting to talk or react,
frequently interrupting or intrude others, frequently move from one
uncompleted activity to another, has difficulty sustaining focus, and
disorganized, the patient now has exhibits improvement in his/her
behavior such as being patient, completing his/her tasks, and
happily socializing with other kids. The patient was taught different
appropriate memory retraining techniques, such as keeping a
calendar, writing list, memory cue games. Patient’s SO understands
what ADHD is and does the best to train and guide the patient.

Planning After 15-30 minutes of patient teaching, the patient and his/her
family were encouraged to do these:

● Be patient with your child.

● Praise your child for good behavior.
● Help the patient understand tasks he or she needs to do.
● Help the patient manage stress.
● Feed the patient healthy foods.
● Create a schedule for the patient.

Activity Instructed SO to encourage him or her to join a physical activity

that he or she likes as this may also help him or her make friends
with other children; allow him or her to exert his or her energy
productively but do not let him or her get over fatigued, too;
physical activity helps in getting good sleep but over fatigue might
as well make him uneasy and irritable. Make his or routine
predictable and something like ritualistic so that it will only be
easy for him or her to grasp for his independent functioning.

45
Medications Educated SO with the purpose of each drugs and its side effects;
instructed not to take other medications without consulting with the
physician to prevent harmful drug-drug interactions; and instructed
SO to comply strictly with the following prescribed medications:

1. Methylphenidate, 5-10 mg, once a day (8am);

2. Lisdexamfetamine, 30 mg, once a day (8am);

3. Dexamfetamine, 5-10 mg, once a day or twice a day (8am and

6pm);

4. Atomoxetine, 25 mg, once a day (8 am);

5. Guanfacine, 20 mg, once a day (8 am).

Encouraged the patient and the family to make sure that the
Environment environment is clean and must be a good place to stay.
Homemaking services and emotional and economic support
systems are in place.Encouraged the family to involve the child in
his or her daily activities in a quiet and non-stimulating area to
prevent him or her from becoming easily distracted and
hyperactive. Encouraged the family to make sure that the
environment is clean and free from objects that could potentially
harm the child (e.g. sharp objects such as knife, cutter; electric
objects).

Advised family to follow instructions on the patient’s treatments.

Treatment Advised family to report immediately by any changes in symptoms.
Emphasized importance of compliance to home medications
prescribed by the physician.

Health The patient and the family were taught how to administer drugs and
Teaching treatments when necessary. Instructed the family to monitor the
child’s behavior all the time. Educated the family to accept the child
or individual as what he/she is. Consider his/her condition and
communicate with him/her as an equal. Encouraged the family to
help the child get the most out of school. Promoting school success
will help the child academically, socially, and developmentally.
Educated family to approach the child at his/her current level of
functioning. Do not use baby talk nor direct him/her as to his/her
chronological age; encourage him/her to express his/her thoughts or
emotions and respond to him/her therapeutically. Advised the family
to use simple and direct instructions. They may repeat their
instructions more than once and at times, they may utilize visual
aids or pictures in order for him/her to relate well; in educating the
child, the lessons should only be brief in duration due to his/her
short attention span. Encouraged the family to give positive
reinforcements. Every good deed done should be rewarded even with
a simple smile, nod or a star’ praise him/her for achieving his/her

46
 goals for the day or a task that was finished; provide immediate
reinforcement since they sometimes have decreased tolerance to
frustration. Educated the patient and family that eating well is
important for both physical and mental health.

Outpatient · The family were instructed to have available telephone numbers

Referral of referred physicians and agencies. A written discharge will be
provided. It will be reviewed and explained to the family.

· Instructed the family to strictly comply with the follow-up check

ups which is important to check the overall results from the given
medications and health teachings.

· Follow-up care in Vicente Sotto Memorial Medical Center: Center

for Behavioral Sciences (Psychiatric and Psychological Services) on
04/27/2020 by Dr. Wendell with all repeat laboratory results will be
arranged. The family will know the time, date, and location of
appointments given by the physician.

Diet The family was taught foods that the child is sensitive for (e.g.
milk, chocolate, soy, wheat, eggs, beans, corn, tomatoes, grapes,
and oranges). Emphasized consuming a diet that emphasizes fruits
and vegetables, whole grains, healthful unsaturated fats, and good
sources of protein; go easy on unhealthy saturated and trans fats,
rapidly digested carbohydrates, and fast food; and balance healthy
eating with plenty of physical activity.

Spiritual Encouraged the family to go to church and attend mass every

Sunday. And pray for the betterment of the child’s condition.

Evaluation The goals were met. The patient exhibits improvement in his/her
condition and the family knows what to do to train and guide the
child. Records are completed. Labs and Diagnostic Tests were
already transcribed.

47
LEARNING OUTCOMES

1. Identify the etiology and disorder’s process.

2. Assess the history, onset and prognosis of the disorder.

3. Recognize the prevalence of occurrence in adults and school age with

ADHD.

4. Explain the anatomy and physiology affected with the disorder.

5. Recognize the signs and symptoms associated with the disorder.

6. Properly select and study the licensed medication used to treat ADHD.

7. Identify the nursing problems with regard to the given condition.

8. Formulate strategies and proper management on how to properly handle

a person with ADHD.

9. Practice therapeutic communication between nurse and patient

relationship.

10. Assess the patient’s level of cognitive and behavioral function.

CONCLUSION

Attention Deficit Hyperactivity Disorder is a common disorder found in

children and adults of all ages. This disorder begins to present within the
first five years of a child’s life. Medications may be administered after the
child is beyond the preschool age. Children with ADHD tend to be very
restless when it comes to daily activities which may make getting an
education difficult. Also, has many medical concerns in the development
process in children. Children with this condition may need more positive
reinforcement rather than negative. They will have to live their lives trying
to adjust to schedules, maintaining journals or notes and always leaving
constant reminders for themselves to manage daily as progressed into
adulthood.

48
This is a neurodevelopmental condition which affects around 6 in 100
children and adolescents, and around 3 in 100 adults. The condition has
three core symptoms: inattention, impulsivity and hyperactivity. It is also
associated with difficulties in social interactions and a range of comorbid
conditions.The condition is known to be highly heritable but genetic studies
have yet to reveal a clear genetic basis. The brain basis of ADHD is likely to
revolve around the brain circuitry involved in selective attention, including
structures such as the prefrontal cortex and a range of neurotransmitters,
but most notably dopamine.

Living with ADHD may give the person a different perspective on life and
encourage them to approach tasks and situations with a thoughtful eye. As a
result, some with ADHD may be inventive thinkers. Other words to describe
them may be original, artistic, and creative.

RECOMMENDATION

Behavior therapy is an effective treatment for patients experiencing

attention deficit/hyperactivity disorder (ADHD). Improving a child's behavior,
self-control, and self- esteem is extremely beneficial in developing
relationships with others and with their parents. Behavioral therapy focuses
on specific problem behaviors by organizing time at home, establishing
predictability and routines, and increasing positivity, a co-treatment for
children who take stimulant medications and it may even allow you to
reduce the dosage of the medication.

Exclusion diets have shown positive outcomes in patients,and

supplementation of Omega-3 fatty acids, B-complex vitamins has shown
small clinical effects. Exercise aids in the expenditure of energy, reduces
stress and anxiety, and increases socialization and self-esteem.

49
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