OUR LADY OF FATIMA UNIVERSITY

COLLEGE OF NURSING

Km. 311 Maharlika Highway, 3100 Cabanatuan,

Nueva Ecija

In Partial Fulfilment of the Requirements in NCMB317

Related Learning Experience
For the Degree of Bachelor of Science in Nursing

Care of a Child with Attention Deficit Hyperactive Disorder

Presented by:
RAZELLE S. ALMIN
BSN 3Y2-
General Objective:

This case study aims to broaden the students’ knowledge regarding Care of a Child with
Attention Deficit Hyperactive Disorder, and it is designed to develop and enhance the skills and attitude
in the application of different nursing processes and management of the patient with Care of a Child
with Attention Deficit Hyperactive Disorder

Specific Objectives:

1. To be able to acquire knowledge regarding Client with Attention Deficit Hyperactive

Disorder, its background and epidemiology through research.
2. To recognize the contributing risk factors and signs and symptoms associated in the
development of Attention Deficit Hyperactive Disorder.
3. Discuss the pathophysiology of Attention Deficit Hyperactive Disorder.
4. To formulate a comprehensive nursing care plan in the care for the patient with Attention
Deficit Hyperactive Disorder.
5. To acquire the knowledge on the role of drug therapy and medical and nursing
management.
6. To learn the nursing implications and prioritize responsibilities to improve patient’s
condition.
7. To provide recommendations to ensure the continuity of the nursing care management.
8. To provide health teaching patient with Attention Deficit Hyperactive Disorder
I. 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. ADHD is the most commonly diagnosed mental disorder in children.
Boys are more likely to have it than girls. It’s usually spotted during the early school years, when
a child begins to have problems paying attention. ADHD can't be prevented or cured. But
spotting it early, plus having a good treatment and education plan, can help a child or adult with
ADHD manage their symptoms. There are three different types of ADHD, depending on which
types of symptoms are strongest in the individual:

 Predominantly Inattentive Presentation: It is hard for the individual to organize or

finish a task, to pay attention to details, or to follow instructions or conversations. The
person is easily distracted or forgets details of daily routines.
 Predominantly Hyperactive-Impulsive Presentation: The person fidgets and talks a
lot. It is hard to sit still for long (e.g., for a meal or while doing homework). Smaller
children may run, jump or climb constantly. The individual feels restless and has
trouble with impulsivity. Someone who is impulsive may interrupt others a lot, grab
things from people, or speak at inappropriate times. It is hard for the person to wait
their turn or listen to directions. A person with impulsiveness may have more
accidents and injuries than others.
 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.

Reference: https://www.webmd.com/add-adhd/childhood-adhd/attention-deficit-hyperactivity-disorder-
adhd

https://www.cdc.gov/ncbddd/adhd/facts.html#:~:text=ADHD%20is%20one%20of%20the,)%2C%20or
%20be%20overly%20active.

EPIDEMIOLOGY
The epidemiological rates for attention deficit hyperactivity disorder (ADHD) vary
considerably throughout the world. This is thought to be due to environmental and behavioral
changes, in addition to differences in diagnostic criteria used throughout the world. It is more
common in boys than in girls. As it is diagnosed in childhood and the symptoms may improve
with time, the prevalence is higher in children than in adults.

References: https://www.news-medical.net/health/ADHD-Epidemiology.aspx

SIGNS AND SYMPTOMS

Some people with ADHD have fewer symptoms as they age, but some adults continue to have
major symptoms that interfere with daily functioning. In adults, the main features of ADHD may
include difficulty paying attention, impulsiveness and restlessness. Symptoms can range from
mild to severe.
Many adults with ADHD aren't aware they have it — they just know that everyday tasks can be
a challenge. Adults with ADHD may find it difficult to focus and prioritize, leading to missed
deadlines and forgotten meetings or social plans. The inability to control impulses can range
from impatience waiting in line or driving in traffic to mood swings and outbursts of anger.
Adult ADHD symptoms may include:

 Impulsiveness
 Disorganization and problems prioritizing
 Poor time management skills
 Problems focusing on a task
 Trouble multitasking
 Excessive activity or restlessness
 Poor planning
 Low frustration tolerance
 Frequent mood swings
 Problems following through and completing tasks
 Hot temper
 Trouble coping with stress
Symptoms in children
 Symptoms are grouped into three types:
INATTENTIVE. 

 Is easily distracted
 Doesn't follow directions or finish tasks
 Doesn't seem to be listening
  Doesn't pay attention and makes careless mistakes
 Forgets about daily activities
 Has problems organizing daily tasks
 Doesn’t like to do things that require sitting still
 Often loses things
 Tends to daydream

HYPERACTIVE-IMPULSIVE
 Often squirms, fidgets, or bounces when sitting
 Doesn't stay seated
 Has trouble playing quietly
 Is always moving, such as running or climbing on things. (In teens and adults, this is more
often described as restlessness.)
 Talks excessively
 Is always “on the go,” as if “driven by a motor”
 Has trouble waiting for their turn
 Blurts out answers
 Interrupts others
COMBINED
 This involves signs of both other types.

Reference: https://www.mayoclinic.org/diseases-conditions/adult-adhd/symptoms-causes/syc-
20350878

II. PATIENT’S PROFILE

Patient’s Profile Name Patient Jack

Age 7-year-old
Sex Male
Nationality Filipino
Religion Roman Catholic
Address Makati City
Marital Status Child
Chief Complaints Hyperactivity, impulsiveness and
inattentiveness resulting to poor academic
performance and socialization difficulties
Admitting Diagnosis Attention Deficit Hyperactive Disorder
 Date of Admission September 28,2020 2:30PM

PATIENT PAST AND PRESENT HISTORY

Jack is a 7-year-old male Grade 1 student who lives in Makati City with his parents. He is the
only child to two parents, both of whom have completed post-graduate education. There is an
extended family history of Attention Deficit/Hyperactivity Disorder (ADHD), mental health
concerns as well as academic excellence.
Jack is an intelligent and caring young boy who presents with significant potential to excel
academically. In his spare time, Jack enjoys spending time with his friends, and participating in
physical activities such as swimming, running and skating. He also enjoys participating in social
events, and is often invited to play dates and birthday parties. It is noteworthy that he did not
know his address or home phone number, could not print his surname, and recognized only a
few pre-primer words.
While Jack interacts well with peers of his own age, his parents note that he can be easily led
and influenced by others. They also report that Jack gets upset when he does not receive
recognition or feels that he has been ignored. His teacher notes that he sometimes acts 'socially
immature', and that he often demonstrates attention-seeking behavior.
Jack describes difficulties with focusing, and sitting still in class. He recognizes that he is able to
'hyper focus' on some activities of interest; however, he often has difficulty sustaining his
attention at school. His parents and teacher indicate that Jack is restless, and often requires
reminders to help him stay on task. He is described as "constantly running around" and
presenting with difficulties listening and following instructions. Jack's teacher indicates that he
often blurts out answers and interrupts other students in the classroom. Jack recognizes this
tendency in himself, but says that he 'can't stop' in spite of his best intentions.
Jack has always had challenges falling asleep, and sometimes finds that he wakes up in the
middle of the night. When he wakes up, he finds that he has a difficult time getting back to
sleep - sometimes staying awake for as long as an hour and a half
His mother reports difficulties at home with following routines and remembering instructions.
His parents describe emotional reactivity as well as confrontational behaviors demonstrated
both at home and at school. His teacher notes that Jack is very defiant towards listening to
instructions, but generally interacts well with his peers. He is easily frustrated and emotionally
impulsive - Jack has had several incidents of hitting, crying outbursts, and inappropriate
behavior. Behavioral concerns with aggression, lying, arguments, and disruptive behavior were
noted in pre-school program at age 4.
The treatment goal for Jack is to help him follow rules, concentrate, and have good
relationships with parents, teachers, and peers. As part of the treatment plan, Jack was
 prescribed Ritalin (Methylphenidate) 5mg PO BID before breakfast and lunch and was referred
to Behavioral therapist. His parents will undergo parental education.

III. CAUSES, DIAGNOSIS, TREATMENT, MANAGEMENT

CAUSES
Scientists are studying cause(s) and risk factors in an effort to find better ways to manage and
reduce the chances of a person having ADHD. The cause(s) and risk factors for ADHD are
unknown, but current research shows that genetics plays an important role. Recent studies link
genetic factors with ADHD.
In addition to genetics, scientists are studying other possible causes and risk factors including:
 Brain injury
 Exposure to environmental risks (e.g., lead) during pregnancy or at a young age
 Alcohol and tobacco use during pregnancy
 Premature delivery
 Low birth weight
Research does not support the popularly held views that ADHD is caused by eating too much
sugar, watching too much television, parenting, or social and environmental factors such as
poverty or family chaos. Of course, many things, including these, might make symptoms worse,
especially in certain people. But the evidence is not strong enough to conclude that they are
the main causes of ADHD.

DIAGNOSIS
Deciding if a child has ADHD is a process with several steps. There is no single test to diagnose
ADHD, and many other problems, like anxiety, depression, sleep problems, and certain types of
learning disabilities, can have similar symptoms. One step of the process involves having a
medical exam, including hearing and vision tests, to rule out other problems with symptoms
like ADHD. Diagnosing ADHD usually includes a checklist for rating ADHD symptoms and taking
a history of the child from parents, teachers, and sometimes, the child.

TREATMENTS
In most cases, ADHD is best treated with a combination of behavior therapy and medication.
For preschool-aged children (4-5 years of age) with ADHD, behavior therapy, particularly
training for parents, is recommended as the first line of treatment before medication is tried.
What works best can depend on the child and family. Good treatment plans will include close
monitoring, follow-ups, and making changes, if needed, along the way.

MANAGEMENT
Being healthy is important for all children and can be especially important for children with
ADHD. In addition to behavioral therapy and medication, having a healthy lifestyle can make it
easier for your child to deal with ADHD symptoms. Here are some healthy behaviors that may
help:

 Developing healthy eating habits such as eating plenty of fruits, vegetables, and whole
grains and choosing lean protein sources
 Participating in daily physical activity based on age
 Limiting the amount of daily screen time from TVs, computers, phones, and other
electronics
 Getting the recommended amount of sleep each night based on age
 IV. PATHOPHYSIOLOGY

Generic Name, Mechanism of Indication Contraindication Common side effects Nursing

Brand Name, action Consideration
 Frequency,
Route, Dosage,
Classification
Generic Name: Blocks the First-line medication  Hypersensitivity  CNS:  Monitor vital
Methylphenidate dopamine choice for treatment to  Dizziness signs
transporter (DAT) of methylphenidate  Drowsiness  Monitor
Brand Name: and the attention-deficit/hyp or other  Nervousness closely for
Concerta, Ritalin norepinephrine eractivity disorders components of  Insomnia behavior
transporter (NET), (ADHD). Ritalin or Ritalin-  CV: change.
Dosage: 5mg leading to SR.  Palpitations  Administer 30-
increased Hypersensitivity  Changes in BP 45 min before
Route: PO dopamine and reactions such as and pulse rate meals.
norepinephrine angioedema and  Angina  Monitor
levels with the anaphylactic  Cardiac growth, both
Frequency: BID
inhibition of their reactions have arrhythmias weight in
reuptake been reported in  Exacerbation of children on
Classification:
patients treated underlying CV long-term
Central Nervous
with conditions therapy.
System (CNS)
methylphenidate  Special Senses:  Monitor for
stimulants
 Concomitant  Difficulty with signs of abuse
treatment with accommodation  Instruct the
monoamine blurred vison. client to take
oxidase inhibitors  GI: the medicine
(MAOIs), or  Dry throat to minimize
within 14 days  Anorexia the risk of
following  Nausea insomnia
 Hepatotoxity
discontinuation  Advice the
 Abdominal pain
of treatment client to avoid
 Others:
with an MAOI,  Hypersensitivity alcohol
because of the reactions (rash, fever,  Instruct the
risk of arthralgia, urticaria, client to check
hypertensive exfoliative, dermatitis, to check
crises. erythema multiforme) weight 2-
 Long-term growth 3times weekly.
suppression.  Advice to
client to use
sugarless gum
to relieve dry
mouth
V. DRUG STUDY

VI. NURSING CARE PLAN

Assessment Nursing Planning Intervention Rationale Nursing
Diagnosis Responsibilities
Subjective: “Risk  Treatment  Nursing interventions  The patient  Nursing
Jack factors outcomes for for clients with ADHD must get used planning are
describes injury clients with include: to the layout of met as
difficulties related to ADHD may the evidenced
with inability to include the  Ensuring safety. environment to by:
focusing remain still following: Ensuring the child’s avoid accidents.  The client
and sitting or seated a  The client will safety and that of Items that are was able to
still in class short be free of others; stop unsafe too far from the be free of
period of injury. behavior; provide close patient may injury
Objective: time”  The client will supervision; and give cause hazard.  The client
N/A not violate clear directions about  Signs are vital was able to
the acceptable and for patients at not violate
boundaries of unacceptable risk for injury. the
others. behavior. Healthcare boundaries
 The client will  Improving role providers need of others
demonstrate performance. Give to acknowledge  The client
age- positive feedback for e who has the was able to
appropriate meeting expectations; condition for demonstrate
socials kills. manage the they are age-
 The client will environment (e.g., responsible for appropriate
complete provide a quiet place implementing social skills.
tasks. free of distractions for actions to  The client
 The client will task completion). promote patient was able to
follow  Simplifying safety complete
directions instructions.  Patients with tasks.
Simplifying decreased  The client
instructions/directions; cognition or was able to
get child’s full sensory deficits follow
attention; break cannot directions.
complex tasks into discriminate
small steps; and allow extremes in
breaks. temperature.
 Promoting a structured
daily routine.
Structured daily
routine; establish a
daily schedule; and
minimize changes.
 Providing client and
family education and
support. The nurse
must listen to parents’
 feelings; including
parents in providing
and planning care for
the child with ADHD is
important.

Assessment Nursing Diagnosis Planning Intervention Rationale Nursing

Responsibilities
Subjective: ‘’risk for injury After 2-3  Provide an  To decrease After 2-3 hours
N/A related to hours of area hyperactivity of nursing
hyperactivity nursing where the intervention the
Objective: secondary to intervention child can parent and child
 Lack of ADHD the parents move were able to
concentration and the child around identify risk for
 Difficulty of will be able release injuries.,
sustaining his to identify excess
attention at the risks for energy.
 Remove/lessen
school injuries and
factors for
able to  Remove
injuries.
prevent. harmful
objects,
(example:
sharp
objects,
etc...,)
 Giving parents
information
 Discuss to about the
the disorder may
parents help them
how to provide a
manage a safety
child with environment
who has for their child
ADHD

VII. DISCHARGE PLANNING

M  Instruct the patient relatives to take medications within prescribed time and dosage as ordered by
 the physician, even if feeling better to maximize its effects and avoid further complications.
 Take religiously to maintain health improvement.
 Instruct the patient relatives to comply with the medication.
 Provide the patient relatives information regarding therapeutic treatment.
 Encourage the patient relatives reporting of any unusual changes observed when taking the
drugs.
 Inform the client relatives about the possible side effects of the medication

E  Instruct the patient to perform deep breathing and coughing exercises regularly.
 Encourage to continue performing active range of motion, exercise every morning, such a flexion,
extension etc.., as tolerated.

T  The doctor may ask you to make visits to the office to check on your progress. Be sure to keep
these visits.
 The doctor may send you to a special mental health doctor. This person will talk with you about
the problems you having. Then you can work together to find ways to help you manage them.

H  Inform the patient relatives about the importance of complying with the prescribed medications.
 Ask the doctor what you need to do when you go home. Make sure you ask questions if you do
not understand what the doctor says. This way will know what you need to do.
 Try to get enough sleep at night. Most often adults need to 7 to 8 hours each night and children
need 8 to 10 hours each night. Rest during the day if you are tired.
 Have a plan for where to keep things in your home. Use checklist, things to help you remember
ana alarms to help you remember when it is time do something. These can help you put things in
the right place and manage your time.
 Guide and support a child with this disorder. Share pleasant activities with your child. Give praise
when your child does a good job.
 Do not do too many things that might cause stress.

O  Instruct the patient relatives to come back for follow up check up on the date ordered to see new
changes and assess the development of the client.
 Instruct the patient and her family to report the physician if there is a recurrence of unusual
conditions are observed.

D  Make sure the child gets a healthy, varied diet, with plenty of fiber and basic nutrients
 Encourage the patient relatives to avoid food with preservatives, sugar and sweetened foods.
 Advise the patient relatives to ensure the proper diet is very important.

S  Encourage the patient relatives to continue trusting God and to pray.

 Encourage the patient relatives that God is always be here to guide us.