ADHD

Attention-Deficit hyperactivity Disorder

Student names: Benjamin A. Quiroz, Audrey Falk, Raquel Bolender, Danielle Hower, Clint Ludlow, Heidi C Ritting

ADHD
Diagnostic Criteria for Attention-Deficit/Hyperactivity Disorder y Either (A) or (B):
A: Six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and Inconsistent with developmental level:
y y y y

y y y y y

Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities Often has difficulty sustaining attention in tasks or play activities Often does not seem to listen when spoken to directly Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions) Often has difficulty organizing tasks and activities Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework) Often loses things necessary for tasks or activities (ex. Toys, school assignments, pencils, books, etc.) Is often easily distracted by extraneous stimuli Is often forgetful in daily activities

Diagnostic Criteria for Attention-Deficit/Hyperactivity Disorder

B: Six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:
y y y

ADHD

y y y y y y

Often fidgets with hands or feet or squirms in seat Often leaves seat in classroom or in other situations in which remaining seated is expected Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness) Often has difficulty playing or engaging in leisure activities quietly Is often on the go or often acts as if driven by a motor Often talks excessively Often blurts out answers before questions have been completed Often has difficulty awaiting turn Often interrupts or intrudes on others (ex. Butts into conversations or games)

ADHD
y Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before 7 years old y Some impairment from the symptoms is present in tow or more settings (ex. At school [or work] and at home) y There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning y The symptoms do not occur exclusively during the course of a Pervasive Development Disorder, Schizophrenia, or other Psychotic Disorder and are not better accounted for by another mental disorder (ex. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or Personality D

ADHD- Client & Family Education

Educate the client/parents on the signs and symptoms so they can understand the nature of the disorder. Encourage the client/parents and provide positive feedback

Medications
yExplain side effects and dosage times yExplain that it is not a cure all pill

Recommend support groups (psychoeducation)

ADHD
Children With ADHD
Encourage the parents to change the environment and reactions to the behavior rather than changing the child's behavior. Children with ADHD respond better to a structured and predictable environment
y

Set rules and limitations from the beginning but do not make them too demanding Reward good behaviors and give minimal negative feedback Be consistent

ADHD Treatment modalities

y Behavioral techniques: Positive reinforcement

Time-out Response Cost Token economy system

y Adults: Coaching y Medications:

Non-stimulant: Stratterra Stimulant: Short-acting: Ritalin, Methylin, Focalin Intermediate acting: Ritalin LA, Metadate CD, Methylin ER Long-acting: Adderrall XR, Concerta, Focalin XR y Neurotherapy: History Does it work?

Medications used in treatment of ADHD

dextroamphetamine sulfate (Dexadrine; Dextrostat) (Chemical Class- amphetamines) Indications:
Narcolepsy. Adjunct management of ADHD. Unlabeled uses: Exogenous obesity.

Dosage Ranges:
PO (Adults)- 5-40mg/day in divided doses. PO (Children 6 yrs. or older)- 5mg 1-2 times daily, increase by 5mg daily at weekly intervals(Maximum: 40mg/day). PO (Children 3-5 yrs. old)- 2.5mg/day, increase by 2.5mg daily at weekly intervals. Hyperactivity, insomnia, restlessness, tremor, depression, dizziness, headache, irritability, palpitations, tachycardia, arrhythmias, hypertension, anorexia, constipation, cramps, diarrhea, dry mouth, metallic taste, nausea, vomiting, impotence, increased libido, urticaria, physical dependence and psychological dependence.

Adverse Effects:

Client Teaching:

-Instruct patient to take medication at least 6 hours before bedtime to avoid sleep disturbances. Take missed doses as soon as remembered up to 6 hours before bedtime. -Do not double doses. -Inform patient that the effects of drug-induced dry mouth can be minimized by rinsing frequently with water or chewing sugarless gum or candies. -Advise patient to avoid the intake of large amounts of caffeine. -Advise patient to notify health care professional if nervousness, restlessness, insomnia, dizziness, anorexia, or dry mouth becomes severe.

Medications used in treatment of ADHD

methylphenidate (Ritalin; Methylin; Concerta; Metadate) (Chemical Class- miscellaneous ADHD medication)
Indications: Treatment of ADHD (adjunct). Symptomatic treatment of narcolepsy. Unlabeled uses:

Management of some forms of refractory depression.

Dosage Ranges: PO (Adults)- 5-20mg 2-3 times daily as prompt-release tablets. When maintenance dose is

determined, may change to extended-release formulation.

PO (Children 6yrs. or older)- Prompt-release tablets: 0.3mg/kg/dose or 2.5-5mg before breakfast and lunch; increase by 0.1mg/kg/dose or by 5-10mg/day at weekly intervals (not to exceed 60mg/day or 2mg/kg/day. When maintenance dose is determined, may chance to extendedrelease formulation. Adverse Effects: Hyperactivity, insomnia, restlessness, tremor, dizziness, headache, irritability, blurred vision, hypertension, palpitations, tachycardia, hypotension, anorexia, constipation, cramps, diarrhea, dry mouth, metallic taste, nausea, vomiting, rashes, akathisia, dykinesia, fever, hypersensitivity reactions, physical dependence, psychological dependence, suppression of weight gain (children), and tolerance. Client Teaching: -Instruct patient to take medication as directed. If a dose is missed, take the remaining

professional.

doses for that day at regularly spaced intervals. -Do not double doses. -Advise patient to check weight 2-3 times weekly and report weight loss to health care

-May cause dizziness or blurred vision. Caution patient to avoid driving or activities requiring alertness until response to medication is known. -Inform patient and/or parents that shell of Concerta tablet may appear in the stool. This is no cause for concern.

Nursing Diagnosis
From Townsend Impaired social interaction R/T Intrusive and immature behavior. Risk for injury R/T Impulsive and accident-prone behavior and the inability to perceive self-harm. Low self-esteem R/T Dysfunctional family system and negative feedback. Non-compliance (with task expectation) R/T low frustration tolerance and short attention span.
(Townsend p.365-366)

Nursing Diagnosis
From Ackley y Disabled family coping R/T significant person with chronically unexpressed feelings of guilt, anxiety, hostility, and despair. y Impaired Adjustment R/T intense emotional state. y Risk for delayed development R/T behavior disorders. y Risk for impaired Parenting R/T lack of knowledge of factors contributing to child s behavior. y Risk for loneliness R/T social interaction. y Risk for spiritual distress R/T poor relationships.
(Ackley p.31)

Nursing Care Plan

Nursing Diagnosis Expected Outcomes Nursing Interventions & Rationale
-Develop trusting relationship, and convey acceptance separate from the unacceptable behavior. Rational: Unconditional acceptance increases feelings of self worth. -Assist client to decrease stimulation and distraction by a altering environment to reduce distraction, (ex. Client move to the front of classroom). Rational: decrease in environmental distractive stimuli will decrease clients distractibility and increase attention span. - Discuss and mutually decide on behaviors that are not acceptable, and outline consequences of unacceptable behavior, and follow through on consequences. Rational: Reluctant reinforcement can further undesirable behaviors.

Outcome Evaluation

- Impaired Social
interaction R/T impulsive and intrusive behavior, and overactive and inattentive conduct AEB observered unsuccessful or dysfunctional social interactions with peers, and others, interruptive behaviors, a inability to communicate sense of interest, and complete tasks.

-Client will identify barriers that cause impaired social interactions. -Client will manage disruptive behavior measured by the observed or reported decrease in the amount of interruptions and increased ability to interact appropriately with others. -Client will demonstrate and report improved attention span and increased ability to complete tasks. -Client will improve social interaction skills, evidenced by the client and peer report s of focused and positive interaction with peers, and or members of work group.

Met- client clearly identified barriers that impair social interaction. Met- client is able to interact appropriately with others. Met- client has shown to be able to complete tasks, and follow through after simple instructions. Met- client demonstrated management of disruptive behavior with decreased interruptions.

Questions
People with ADHD tend to display which of the following behaviors?
A. B. C. D. Intense emotions Loneliness Minimal attention span All of the above

Questions
In order to be diagnosed with ADHD the individual needs to display symptoms of inattention for at least 12 weeks to a degree that is maladaptive and inconsistent with developmental level A. True B. False

References
y Fowler, M. (1994). ADHD: How is it treated? Retrieved October 27, 2007 from

http://school.familyeducation.com/learningdisabilities/treatments/30086.html?detoured=1
y Townsend, M.C. (2006). Psychiatric Mental Health Nursing: Concepts of Care in

Evidence-Based Practice (5th ed.). Philadelphia, PA: F.A. Davis Company.

y Ackley, J. B., & Ladwig, B. G. (2006). Nursing Diagnosis Handbook: A guide to planning

care. (7th ed.). St. Louis, Missouri: Mosby Elsevier.