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.