Nursing Care Plans Attention Deficit Hyperactivity Disorder (ADHD)

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common childhood disorders and can continue through adolescence and adulthood. Attention-deficit hyperactivity disorder (ADHD) is characterized by a persistent pattern of inattention or hyperactivity impulsivity that is more frequent and severe than is typically observed in individuals at a comparable level of development (APA, 2000). The patient with attention deficit hyperactivity disorder has difficulty focusing his attention, engaging in quiet passive activities, or both. Some patients have an attention deficit without hyperactivity; they're less likely to be diagnosed and receive treatment. Although attention deficit hyperactivity disorder is present at birth, diagnosis before age 4 or 5 is difficult unless the child exhibits severe symptoms. Some patients, however, aren't diagnosed until they reach adulthood. Males are three times more likely to be affected than females. The presence of other psychiatric disorders also needs to be determined, this disorder occurs in roughly 3% to 5% of school-age children.

Causes for Attention Deficit Hyperactivity Disorder (ADHD)

Attention deficit hyperactivity disorder is thought to be a physiologic brain disorder with a familial tendency. Some studies indicate that it may result from altered neurotransmitter levels in the brain. Scientists are not sure what causes ADHD, although many studies suggest that genes play a large role. Like many other illnesses, ADHD probably results from a combination of factors. In addition to genetics, researchers are looking at possible environmental factors, and are studying how brain injuries, nutrition, and the social environment might contribute to ADHD

Complications for Attention Deficit Hyperactivity Disorder (ADHD)

Emotional and social complications can result from the child's impulsive behavior, inattentiveness, and disorganization in school. Hyperactivity can also lead to poor nutrition.

Assessment Nursing Care Plans Attention Deficit Hyperactivity Disorder (ADHD)

The patient is usually characterized as a fidgeted and a daydreamer. He may also be described as inattentive and lazy. The parents may state that their child is intelligent but that his school or work performance is sporadic. They may also report that he has a tendency to jump quickly from one partly completed project, thought, or task to another. If the child is younger, the parents may note that he has difficulty waiting in line, remaining in his seat, waiting his turn, or concentrating on one activity long enough to complete it.  An older child or an adult may be described as impulsive and easily distracted by irrelevant thoughts, sights, or sounds. He may also be characterized as emotionally labile, inattentive, or prone to daydreaming. His disorganization becomes apparent when, for example, he has difficulty meeting deadlines and keeping track of school or work tools and materials.

• Difficulties in performing age-appropriate tasks
• Highly distractible
• Extremely limited attention span
• Shifts from one uncompleted activity to another
• Impulsivity, or deficit in inhibitory control, is common
• Difficulty forming satisfactory interpersonal relationships
• Disruptive and intrusive behaviors inhibit acceptable social interaction
• Difficulty complying with social norms
• Some children with ADHD are very aggressive or oppositional. Others exhibit more regressive and immature behaviors.
• Low frustration tolerance and outbursts of temper are common.
• Boundless energy, exhibiting excessive levels of activity, restlessness, and fidgeting
• Often described as “perpetual motion machines,” continuously running, jumping, wiggling, or squirming
• They experience a greater than average number of accidents, from minor mishaps to more serious incidents that may lead to physical injury or the destruction of property.

Predisposing Factors for Attention Deficit Hyperactivity Disorder (ADHD)

The patient with attention deficit hyperactivity disorder has difficulty focusing his attention, engaging in quiet passive activities, or both. Some patients have an attention deficit without hyperactivity; they're less likely to be diagnosed and receive treatment. Although attention deficit hyperactivity disorder is present at birth, diagnosis before age 4 or 5 is difficult unless the child exhibits severe symptoms. Some patients, however, aren't diagnosed until they reach adulthood. Attention deficit hyperactivity disorder is thought to be a physiologic brain disorder with a familial tendency. Some studies indicate that it may result from altered neurotransmitter levels in the brain. Scientists are not sure what causes ADHD, although many studies suggest that genes play a large role. Like many other illnesses, ADHD probably results from a combination of factors. In addition to genetics, researchers are looking at possible environmental factors, and are studying how brain injuries, nutrition, and the social environment might contribute to ADHD

Predisposing Factors for Attention Deficit Hyperactivity Disorder (ADHD)
Physiological

Genetics. A number of studies have indicated that hereditary factors may be implicated in the predisposition to ADHD. Siblings of hyperactive children are more likely than normal children to have the disorder.

Biochemical. Abnormal levels of the neurotransmitters dopamine, norepinephrine, and possibly serotonin have been suggested as a causative factor.

Prenatal, Perinatal, and Postnatal Factors. Maternal smoking during pregnancy has been linked to ADHD . Premature birth, fetal distress, precipitated or prolonged labor, and perinatal asphyxia have also been implicated. Postnatal factors include cerebral palsy, epilepsy, and other central nervous system abnormalities resulting from trauma, infections, or other neurological disorders.

Psychosocial
Environmental Influences: Disorganized or chaotic environments or a disruption in family equilibrium may predispose some individuals to ADHD. A high degree of psychosocial stress, maternal mental disorder, paternal criminality, low socioeconomic status, and foster care have been implicated.
Nursing diagnosis Nursing Care Plans Attention Deficit Hyperactivity Disorder (ADHD)

Common Nursing Diagnosis and Interventions found on Nursing Care Plans Attention Deficit Hyperactivity Disorder (ADHD)

• Risk for self directed or other directed violence
• Defensive coping
• Impaired social interaction
• Ineffective coping
• Low self esteem
• Noncompliance
• Anxiety (moderate to severe)
• Compromised family coping
• Imbalanced nutrition: Less than body requirements
• Ineffective family therapeutic regimen management
• Interrupted family processes
• Risk for impaired parenting

Key outcomes nursing diagnosis Nursing Care Plans Attention Deficit Hyperactivity Disorder (ADHD)

• The patient and his family will report concern about difficulties in social interactions.
• The patient and his family will communicate understanding of special dietary needs.
• The patient will demonstrate effective social interaction skills.
• The patient and his family will comply with the prescribed treatment regimen.
• The patient's family will discuss the impact of the patient's illness and feelings about it with a health care professional.
• The parents will utilize support groups and other community resources.
• The patient will acknowledge and respond to efforts by others to establish communication.

Nursing interventions for ADHD

• Set realistic expectations and limits because the patient with attention deficit hyperactivity disorder is easily frustrated
• Always remain calm and consistent with the child.
• Keep all your instructions to the child short and simple.
• Provide praise and rewards whenever possible.
• Provide the patient with diversional activities suited to his short attention span.
• Help the parents and other family members develop planning and organizing systems to help them cope more effectively with the child's short attention span.

Nursing diagnosis Risk for self directed or other-directed violence

• Observe client’s behavior frequently.
• Observe for suicidal behaviors: Verbal statements, such as “ statement going to kill myself”
• Determine suicidal intent and available means. Ask how where and when you plan to kill yourself
• Obtain contract from client not to harm self and agreeing to seek out staff when ideation occurs.
• Help client to recognize when anger occurs and to accept those feelings
• Act as a role model for appropriate expression of angry feelings.
• Give positive reinforcement.

Nursing diagnosis Defensive coping

• Encourage client to recognize and verbalize feelings of inadequacy and need for acceptance from others and to recognize how these feelings provoke defensive behaviors
• Provide immediate, fact, nonthreatening feedback for unacceptable behaviors
• Help client identify situations that provoke defensiveness
• Practice with role play for appropriate responses
• Give positive feedback for acceptable behaviors
• Evaluate and discuss with client the effectiveness of the new behaviors and any modifications for improvement

Nursing diagnosis Impaired social interaction

• Develop trust relationship
• Give to the client’s constructive criticism and positive reinforcement for client’s efforts
• Give Positive feedback to client
• Provide group situations for client

Nursing diagnosis Ineffective coping

• Provide safe environment for continuous large muscle movement, If client is hyperactive
• Provide large motoric activities
• Do not debate, argue, rationalize, or bargain with the client.
• Explore with client and discus alternative ways of handling frustration that would be most suited for client

Nursing diagnosis Low self esteem

Nursing diagnosis Anxiety

• Establish a trusting relationship
• Maintain an atmosphere of calmness
• Offer support during times of elevated anxiety, Use of touch is comforting for some clients
• When anxiety diminishes, help client to recognize specific events that preceded onset of anxiety.
• Provide help to client to recognize signs of escalating anxiety
• On escalating anxiety provide tranquilizing medication, as ordered

Nursing diagnosis Compromised family coping

Nursing diagnosis Imbalanced nutrition: Less than body requirements

Nursing diagnosis Ineffective family therapeutic regimen management

Nursing diagnosis Interrupted family processes

Nursing diagnosis Risk for impaired parenting


Patient teaching Nursing Care Plans Attention Deficit Hyperactivity Disorder (ADHD)

• Make certain that the parents fully understand the child's prescribed medication regimen.
• Teach the patient and family about any adverse reactions that may occur, emphasizing those that may require immediate medical attention.
• Encourage the parents to provide the child with nutritious snacks such as fruit to supplement his dietary intake.
• Refer the parents to appropriate support groups.

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Nursing Care Plan for Abortion

In nursing care plan for abortion definitions for Abortion is: Spontaneous abortion, miscarriage, or induced abortions, the products of conception are expelled from the uterus before fetal viability and gestation of less than 20 weeks is achieved.

Causes for Abortion
It’s May result from fetal, placental, or maternal factors:

• Fetal factors usually include defective embryologic development resulting from abnormal chromosome division (the most common cause of fetal death), faulty implantation of fertilized ovum, and failure of the endometrium to accept the fertilized ovum, usually cause such abortions between 9 and 12 weeks of gestation
• Placental factors usually include premature separation of the normally implanted placenta, abnormal placental implantation, and abnormal platelet function. Usually cause abortion around the 14th week of gestation.
• Maternal factors usually include maternal infection, severe malnutrition, and abnormalities of the reproductive organs. usually cause abortion between 11 and 19 weeks of gestation

Other maternal factors include endocrine problems, such as thyroid gland dysfunction or lowered estriol secretion, trauma, including any type of surgery that necessitates manipulation of the pelvic organs, blood  group incompatibility and Rh isoimmunization, and recreational drug use and environmental toxins.

Therapeutic abortion is performed to preserve the mother's mental or physical health in cases of unplanned pregnancy, or medical conditions, such as cardiac dysfunction or fetal abnormality.

Complications that may happen in Nursing Care Plan for Abortion

• Infections in case of the products of conception aren't completely expelled
• Hemorrhage
• Anemia
• Coagulation defects such as disseminated intravascular coagulation

Assessment Nursing Care Plan for Abortion

• Pink discharge for several days or a scant brown discharge for several weeks
• Cramps and increased vaginal bleeding
• If any contents remain, cramps and bleeding continue.

Assess the patient’s emotional status, as well as that of the baby’s father and other family members. Often this hospital admission is the first one for the patient, and it may cause anxiety and fear

Diagnostic tests Nursing Care Plan for Abortion

• HCG in the blood or urine confirms
• Decreased HCG level
• Laboratory test results reflect a decreased hemoglobin level
• Ultrasound examination; absence of fetal heart sounds

Nursing diagnosis
Primary Nursing Diagnosis found in Nursing Care Plan for Abortion
Anticipatory grieving related to an unexpected pregnancy outcome
Common nursing diagnosis found in Nursing Care Plan for Abortion

• Anxiety
• Disabled family coping
• Dysfunctional grieving
• Hopelessness
• Powerlessness
• Risk for infection

Nursing outcomes, Interventions, and Patient teaching Nursing Care Plan for Abortion

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Nursing Outcome, Nursing Interventions, and Patient Teaching For Inguinal Hernia

Common Nursing diagnoses found on Nursing care plan for Inguinal Hernia

• Activity intolerance
  
• Acute pain
  
• Ineffective tissue perfusion: Gastro Intestinal
  
• Risk for infection
  
• Risk for injury
  

Nursing outcomes nursing care plans for Inguinal Hernia 

• The patient will perform activities of daily living within the confines of the disease process.
  
• The patient will express feelings of comfort.
  
• The patient's bowel function will return to normal.
  
• The patient will remain free from signs or symptoms of infection.
  
• The patient will avoid complications.
  

Nursing interventions nursing care plans for Inguinal Hernia

• Apply a truss only after a hernia has been reduced. For best results, apply it in the morning before the patient gets out of bed.
  
• Assess the skin daily and apply powder for protection because the truss may be irritating.
  
• Watch for and immediately report signs of incarceration and strangulation.
  
• Closely monitor vital signs and provide routine preoperative preparation. If necessary, When surgery is scheduled
  
• Administer I.V. fluids and analgesics for pain as ordered.
  
• Control fever with acetaminophen or tepid sponge baths as ordered.
  
• Place the patient in Trendelenburg's position to reduce pressure on the hernia site.
  

After surgery,

• Provide routine postoperative care.
  
• Don't allow the patient to cough, but do encourage deep breathing and frequent turning.
  
• Apply ice bags to the scrotum to reduce swelling and relieve pain; elevating the scrotum on rolled towels also reduces swelling.
  
• Administer analgesics as necessary.
  
• In males, a jock strap or suspensory bandage may be used to provide support.
  

Patient teaching home health guide

• Explain what an inguinal hernia is and how it's usually treated.
  
• Explain that elective surgery is the treatment of choice and is safer than waiting until hernia complications develop, necessitating emergency surgery.
  
• Warn the patient that a strangulated hernia can require extensive bowel resection, involving a protracted hospital stay and, possibly, a colostomy.
  
• Tell the patient that immediate surgery is needed if complications occur.
  
• If the patient uses a truss, instruct him to bathe daily and apply liberal amounts of cornstarch or baby powder to prevent skin irritation.
  
• Warn against applying the truss over clothing, which reduces its effectiveness and may cause slippage. Point out that wearing a truss doesn't cure a hernia and may be uncomfortable.
  
• Tell the postoperative patient that he'll probably be able to return to work or school and resume all normal activities within 2 to 4 weeks.
  
• Explain that he or she can resume normal activities 2 to 4 weeks after surgery.
  
• Remind him to obtain his physician's permission before returning to work or completely resuming his normal activities.
  
• Before discharge, Instruct him to watch for signs of infection (oozing, tenderness, warmth, redness) at the incision site. Tell him to keep the incision clean and covered until the sutures are removed.
  
• Inform the postoperative patient that the risk of recurrence depends on the success of the surgery, his general health, and his lifestyle.
  
• Teach the patient signs and symptoms of infection: poor wound healing, wound drainage, continued incision pain, incision swelling and redness, cough, fever, and mucus production.
  
• Explain the importance of completion of all antibiotics. Explain the mechanism of action, side effects, and dosage recommendations of all analgesics.
  
• Caution the patient against lifting and straining.
  

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Cirrhosis: Nursing Outcomes, Nursing Interventions, and Patient Teaching

Cirrhosis is a chronic hepatic disease that is characterized by destruction of the functional liver cells, which leads to cellular death. In cirrhosis, the damaged liver cells regenerate as fibrosis areas instead of functional cells, causing alterations in liver structure, function, blood circulation, and lymph damage. The major cellular changes include irreversible chronic injury of the functional liver tissue and the formation of regenerative nodules. These changes result in liver cell necrosis, collapse of liver support networks, distortion of the vascular bed, and nodular regeneration of the remaining liver cells. This disease alters liver structure and normal vasculature, impairs blood and lymph flow, and ultimately causes hepatic insufficiency.

Nursing Key outcomes nursing care Plans for Cirrhosis 

The patient will:

• Perform ADL activities of daily living without excessive fatigue or exhaustion. 
• Remain oriented to his environment. 
• Show no signs of circulatory overload. 
• Participate in decisions about care. 
• Maintain adequate caloric intake. 
• Patient's fluid volume will remain within normal parameters. 
• Patient's skin integrity will remain intact. 
• Avoid or minimize complications.

Nursing interventions nursing care Plans for Cirrhosis

• Monitor vital signs, intake and output, and electrolyte levels to determine fluid volume status. 
• Assess fluid retention 
• Weigh the patient daily and document his weight. 
• Administer diuretics, potassium, and protein or vitamin supplements as ordered. 
• Restrict sodium and fluid intake as ordered. 
• Assist and provide oral hygiene before and after meals. 
• Determine food preferences and provide them within the patient's prescribed diet limitations. 
• Provide frequent, small meals. 
• Observe and document the degree of sclera and skin jaundice. 
• Give the patient frequent skin care. 
• Observe for bleeding gums, ecchymosed, epitasis, and petechiae. 
• Inspect stools for amount, color, and consistency. 
• Increase the patient's exercise tolerance by decreasing fluid volumes and providing rest periods before exercise. 
• Use appropriate safety measures to protect the patient from injury. 
• Watch for signs of anxiety , epigastric fullness, restlessness, and weakness. 
• Observe closely for signs of behavioral or personality changes. 
• Observe Report increasing stupor, lethargy, hallucinations, or neuromuscular dysfunction. Arouse the patient periodically to determine level of consciousness. Watch for asterixis, a sign of developing encephalopathy. 
• Allow the patient to express his feelings about having cirrhosis. 
• Provide psychological support and encouragement, when appropriate.

Patient teaching nursing care Plans for Cirrhosis

• Warn the patient against taking nonsteroidal anti-inflammatory drugs, straining to defecate, and blowing his nose or sneezing too vigorously. To minimize the risk of bleeding. 
• Suggest using a soft toothbrush and a electric razor 
• Advise the patient that rest and good nutrition conserve energy and decrease metabolic demands on the liver. 
• Suggest the patient to eat frequent, small meals. Teach him to alternate periods of rest and activity to reduce oxygen demand and prevent fatigue. 
• Tell the patient how he can conserve energy while performing activities of daily living. For example, suggest that he sit on a bench while bathing or dressing. 
• Stress the need to avoid infections and abstain from alcohol. Refer the patient to alcohol abuse treatment Anonymous, if appropriate 
• Alcohol abuse treatment. Emphasize to the patient with alcoholic liver cirrhosis that continued alcohol use exacerbates the disease. Stress that alcoholic liver disease in its early stages is reversible when the patient abstains from alcohol. Encourage family involvement in. Assist the patient in obtaining counseling or support for her or his alcoholism. 
• Encourage the patient to seek frequent medical follow-up and  Refer the patient to an alcohol support group or liver transplant support group.

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COPD: Nursing Interventions, Nursing Outcomes, and Patient Teaching

Chronic obstructive pulmonary disease (COPD) is a disease characterized by airflow obstruction that is not fully reversible. Airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lungs to noxious particles and gases. Its results from emphysema, chronic bronchitis, asthma, or any combination of these disorders. Most patients have more than one of the underlying conditions; in most cases, bronchitis and emphysema occur together. COPD doesn't always produce symptoms and causes only minimal disability in many patients; however, it tends to worsen with time.

Nursing Diagnosis for COPD

Impaired gas exchange, Ineffective airway clearance, Ineffective breathing pattern, Anxiety , Fatigue, Fear, Interrupted family processes, Risk for infection

Nursing Outcomes Nursing Care Plans for COPD , patient will:

• Identify strategies to reduce anxiety.
  
• Verbalize the importance of balancing activity with adequate rest periods.
  
• Discuss fears and concerns.
  
• Maintain adequate ventilation and oxygenation.
  
• Maintain a patent airway.
  
• Maintain a respiratory rate within five breaths of baseline.
  
• Remain free from signs or symptoms of infection.
  
• Family members will identify and contact available support systems as needed.
  

Nursing Interventions for patient with COPD

• Maintaining a patent airway is a priority. Use a humidifier at night to help the patient mobilize secretions in the morning. Encourage the patient to use controlled coughing to clear secretions that might have collected in the lungs during sleep. Instruct the patient to sit at the bedside or in a comfortable chair, hug a pillow, bend the head downward a little, take several deep breaths, and cough strongly 
• Ad minister low concentrations of oxygen as ordered. Perform blood gas analysis to determine the patient's oxygen needs and to avoid carbon dioxide narcosis. 
• Teach patients and family that excessive oxygen therapy may eliminate the hypoxic respiratory drive, causing confusion and drowsiness, signs of carbon dioxide narcosis. 
• Emphasize the importance of a balanced diet. Because the patient may tire easily consider using oxygen, administered by nasal cannula, during meals. 
• Help the patient and his family adjusts their lifestyles to accommodate the limitations imposed by this debilitating chronic disease. 
• Instruct the patient to allow for daily rest periods and to exercise daily as his physician directs. 
• As the disease progresses, encourage the patient to discuss his fears. 
• To help prevent COPD, advise all patients, especially those with a family history of COPD or those in its early stages, not to smoke. 
• Assist in the early detection of COPD by urging persons to have periodic physical examinations, including spirometry and medical evaluation of a chronic cough, and to seek treatment for recurring respiratory infections promptly.

Patient teaching for patient with COPD

• Teach the patient and his family how to recognize early signs of infection; warn the patient to avoid contact with people with respiratory infections. Encourage good oral hygiene to help prevent infection. Pneumococcal vaccination and annual influenza vaccinations are important preventive measures. 
• To promote ventilation and reduce air trapping, teach the patient to breathe slowly, prolong expirations to two to three times the duration of inspiration, and to exhale through pursed lips. 
• To help mobilize secretions, teach the patient how to cough effectively. 
• If the patient is to continue oxygen therapy at home, teach him how to use the equipment correctly. 
• Be sure the patient and family understand any medication prescribed, including dosage, route, action, and side effects. 
• Instruct the patient to report any signs and symptoms of infection to the primary healthcare provider. Explain necessary dietary adjustments to the patient and family. 
• Recommend eating small, frequent meals, including high-protein, high-density foods. 
• Encourage the patient to plan rest periods around his or her activities, conserving as much energy as possible. Arrange for return demonstrations of equipment used by the patient and family. 
• Refer the patient to the appropriate rental service, and explain the hazards of combustion and increasing the flow rate without consultation from the primary healthcare provider, if the patient requires home oxygen therapy.

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