2. Attention deficit - hyperactivity disorder (ADHD); behavioral disorder (DSM - 1V)
1. Introduction: As defined by the American Psychiatric Association (APA), this diagnostic term includes a persistent pattern of inattention or hyperactivity - impulsivity. The exact cause and pathophysiology remain unknown. The major symptoms include a greatly shortened attention span and difficulty in integrating and synthesizing information. This disorder is 10 times more common in boys than girls, with onset before age 7; the diagnosis is based on the child s history rather than on any specific diagnostic test.
2. Assessment:
1. The behaviors exhibited by children with ADHD are not unusual behaviors seen in children. The behavior of children with ADHD differs from the behavior of non - ADHD children in both quality and appropriateness:
1. Motor activity is excessive.
2. Developmentally "younger" than chronological age.
2. Inattention
1. Does not pay attention to detail.
2. Does not listen when spoken to.
3. Does not do what he or she is told to do.
3. Hyperactivity
1. Fidgets and squirms excessively.
2. Cannot sit quietly.
3. Has difficulty playing quietly.
4. Seems to be constantly in motion, moving or talking; always “on."
4. Impulsiveness
1. Blurts out answers before question is completed.
2. Has difficulty awaiting turn. Interrupts others.
3. Analysis/nursing diagnosis:
1. Altered thought processes related to inattention and impulsiveness.
2. Impaired physical mobility related to hyperactivity.
3. Risk for injury related to impulsivity.
4. Self-esteem disturbance related to hyperactivity and impulsivity.
5. Knowledge deficit related to behavioral modification program, medications, and follow - up care.
4. Nursing care plan/implementation:
1. Goal: teach family and child about ADHD.
1. Provide complete explanation about disorder, probable course, treatment, and prognosis.
2. Answer questions directly, simply.
3. Encourage family to verbalize; offer support.
2. Goal: provide therapeutic environment using principles of behavior modification.
1. Reduce extraneous or distracting stimuli,
2. Reduce stress by decreasing environmental expectations (home, school).
3. Provide firm, consistent limits.
4. Special education programs.
5. Special attention to safety needs.
3. Goal: reduce symptoms by means of prescribed medication.
1. Medications; Ritalin and Cylert - both are CNS stimulants but have a paradoxical calming effect on the child's behavior. Tofranil and Norpramin - both are tricyclic antidepressants that stimulate the CNS, but also can have paradoxical calming effect on child’s behavior; must monitor for arrhythmias.
2. Health teaching (child and parents).
1. Need to take medication regularly, as ordered. Avoid taking medication late in the day because it may cause insomnia; monitor cardiac status.
2. Need for long - term administration, with decreased need as child nears adolescence.
4. Goal: provide safe outlet for excess energy.
1. Alternate planned periods of outdoor play with schoolwork or quiet indoor play.
2. Channel energies toward safe, large - muscle activities: running track, swimming, bicycling, hiking.
5. Evaluation/outcome criteria:
1. Family and child verbalize understanding of “attention deficit disorders.”
2. Therapeutic environment enhances socially acceptable behavior.
3. Medication taken regularly, with behavioral improvements noted.
4. Excess energy directed appropriately.
5. Dietary modification implemented