Attention Deficit Hyperactivity Disorder ADHD

Attention Deficit Hyperactivity Disorder ADHD Nursing Care Plans Diagnosis and Interventions

Attention Deficit Hyperactivity Disorder ADHD NCLEX Review Care Plans

Nursing Study Guide on ADHD

Attention Deficit Hyperactivity Disorder (ADHD) is a behavior disorder in the brain wherein the person has trouble paying attention and concentrating. It is the most common mental disorder diagnosed in children, and can also be seen in adolescents.

ADHD can continue into adulthood as it cannot be cured. However, people with ADHD can cope and manage symptoms with proper education and good compliance to treatment and therapy.

Signs and Symptoms of ADHD

The signs and symptoms of ADHD are usually recognizable before the age of 6. The symptoms emerge not just in one setting such as either home or school, but can manifest anytime, anywhere. The general signs and symptoms of ADHD include:

  • Inability to pay attention or short attention span
  • Inability to concentrate on doing tasks
  • Inability to carry out instructions
  • Inability to sit still

Once the child with ADHD turns into an adult, the following symptoms may also be noted:

  • Frequent lateness
  • Low self-esteem
  • Work or relationship problems
  • Anxiety
  • Procrastination
  • Easily bored and/or frustrated
  • Substance addiction
  • Inability to control anger or other strong emotions
  • Mood swings
  • Depression
  • Impulsiveness

Types of ADHD

There are 3 types of ADHD and each has some distinct features. These include:

  1. Inattentive. Aside from the general ADHD symptoms, child with an inattentive type of ADHD can be observed to have the following signs and symptoms:
  • Forgetfulness
  • Easily distracted
  • Trouble organizing daily tasks
  • Dislikes activities that require sitting still such as being in class and listening to the teacher
  • Doesn’t appear to be actively listening
  • Often daydreams
  • Often loses things

2. Hyperactive-Impulsive. In this type of ADHD, the child may exhibit the following signs and symptoms:

  • Fidgeting, bouncing, or squirming while sitting
  • Talking excessively
  • Appears very energetic and “always on the go”
  • Interrupts other people when they are talking or doing something
  • Blurts out answers as soon as he/she is asked a question
  • Finds it hard to wait for his/her turn
  • Restlessness – always running around, climbing, jumping, or moving things unnecessarily

3. Combined. This type of ADHD features both the signs and symptoms of inattentive and hyperactive-impulsive types of ADHD.

Causes and Risk Factors of ADHD

The root cause of ADHD is still unknown. However, the following risk factors are related to ADHD, such as:

  • Genetics – there is a tendency for ADHD to be passed to the next generations in a family
  • Brain structure– research shows that children with ADHD has smaller frontal lobes than children who do not have this condition
  • Brain chemistry – the neurotransmitter dopamine is not properly regulated by the central nervous system
  • Toxins – toxic substances such as lead may affect the development of a fetus inside the womb, or a child while he/she is growing up; some research shows evidence of the maternal diet having an effect in modulating symptoms of ADHD in a fetus
  • Brain disorder or injury – brain damage may lead to trouble controlling emotions, mood, thoughts, and impulses
  • Pregnancy-related issues – smoking, substance abuse, drinking, poor nutrition or infections during pregnancy may affect the development of baby’s brain.

Contrary to common belief, sugar, stress, food allergies, or watching too much TV/ using gadgets excessively do not cause or trigger ADHD.

Complications of ADHD

  • Accidents and injuries
  • Substance abuse
  • Overweight or obesity
  • Eating disorders
  • Sleep problems
  • Delinquent or risky behavior
  • Poor self-esteem
  • Trouble interacting with family, friends, and peers
  • Relationship difficulties

Diagnosis of ADHD

  • Medical and social history of the child and family – to check for any genetic involvement, pregnancy issues, social problems, presence of any brain injury or disorder, exposure to chemicals and toxins, etc.
  • Physical exam – includes neurological assessment of the senses, motor, and verbal skills
  • Cognitive tests – to check for aptitude, intelligence, processing skills, or personality traits
  • Neuropsychiatric EEG-Based Assessment Aid (NEBA) System – to measure the beta and theta waves in the brain; the ratio of these two waves can help determine ADHD in children and teens

Treatment for ADHD

Currently there is no cure for ADHD; however, there are many approaches to manage the symptoms of ADHD that can allow the child to live a normal life as much as possible. These include:

  1. Medications. Stimulants are prescribed to control the impulsive and/or hyperactive thinking and behavior in children with ADHD. Taking stimulants may promote a longer attention span and help the child think about his/her actions before doing them. In some cases of ADHD, non-stimulant medications are more beneficial. These non-stimulants include the use of anti-depressants. It is important to note that ADHD drugs may cause several side effects, such as gastrointestinal upset, fatigue, loss of appetite, headache and anxiety. Omega-3 containing supplements may also provide some benefit for ADHD clients.
  2. Therapy. The following therapies may help a patient with ADHD:
  • Cognitive behavioral therapy (CBT) – this can effectively facilitate behavior modification so the child with ADHD may be able to function properly in the society. Through CBT, “good” behaviors can be nurtured, while the bad ones can be pruned out or modified.
  • Social skills sessions – these sessions can help to train a child with ADHD on how to talk, behave, and act around other people.
  • Psychotherapy – also known as counselling, psychotherapy can help an ADHD patient to explore repressed feelings and thoughts. It is also effective in exercising relaxation techniques and encouraging compliance to treatment and therapy sessions. The family and significant others of the patient should be encouraged to undergo counseling as needed.
  • Support groups – involving an ADHD client in a group of people who also have ADHD or have family members who has the condition can help the patient cope with it by listening to others and also by speaking about his/her own experience with ADHD.

3. Lifestyle Changes. Getting enough sleep and exercise, lessening distractions in the child’s room, and eating a healthy and balanced diet can help manage the symptoms of ADHD.

Nursing Care Plans for ADHD

Nursing Care Plan 1

Nursing Diagnosis: Disturbed Thought Process related to dopamine imbalance secondary to ADHD as evidenced by forgetfulness, inability to concentrate and pay attention, inability to do tasks as instructed, blurting of words, poor decision-making skills, and difficulty handling complex tasks

Desired Outcome: The child will perform activities of daily living as he is able to do, while being able to vent out feelings of frustration and being able to retain memory through memory techniques.

InterventionsRationales
Assess the child’s current level of functioning and approach him/her through his/her “mental” age and not the chronological age.To encourage the child to speak up, and to be open and honest about what he/she thinks and feels.
Assist the patient while performing activities of daily living.To promote autonomy by allowing the patient to perform their ADLs while maintaining safety.
Simplify tasks for the child by using simple words and instructions Use written notes and other memory devices when necessary.A child with ADHD may have difficulty handling complex tasks and may also tend to be forgetful.  
Provide opportunities for the patient to have meaningful social interaction.To prevent feelings of isolation.
Allow the patient to take time and think about what to say or do.To help the patient have enough time to communication as he/she can be forgetful and also unable to make fast decisions.    
Provide gentle instructions to the patient using a step-by-step method. For example: When bathing: “damp your face first using a washcloth, lather soap on hands and gently apply on the face.”ADHD features a low level of concentration, so breaking down tasks into simple steps can help organize thoughts and actions.  
Ensure that the patient takes medications on time and as prescribed. Encourage the child and parent to attend therapy sessions religiously.To ensure adherence to medical and therapy regimen.

Nursing Care Plan 2

Nursing Diagnosis: Impaired Social Interaction related to hyperactivity secondary to ADHD as evidenced by restlessness, inability to listen, verbalization of low self-esteem, conflict with parents and other people, talking excessively, anxiety, blurting words, and tendency to interrupt other people when they are talking or doing something

Desired Outcome: The patient will demonstrate improved social interaction by increased participation in social events.

InterventionsRationales
Explore the patient’s thoughts and feelings about relationship with family and other people, without judging or giving suggestions at first. Assess the anxiety level of the patient, anxiety triggers and symptoms by asking open-ended questions.To establish a baseline observation of the anxiety level of the patient. Open-ended questions can help explore the thoughts and feelings of the patient regarding social isolation.
In the beginning of the talking therapy, allow the patient to continue ADHD behavior without any judgment or verbalization of disapproval.The child may become more relaxed and open for discussion if he/she is allowed to precipitate the heightened anxiety by continuing ADHD-related behaviors.
Initially, support the patient by meeting dependency needs if deemed necessary.The patient can become more anxious if the avenues for dependency are suddenly and/or complete eliminated.
Encourage the patient to be independent and provide positive reinforcement for being able to do self-care and other independent behaviors.To enhance the patient’s self-esteem and encourage him/her to repeat desired behaviors.  
Discuss with the patient and significant other/s the available treatments for anxiety.Psychotherapy involves speaking with a licensed therapist and going through how to gradually cope with the symptoms. Medications such as anxiolytics and antidepressants can help the patient cope with the symptoms of ADHD.
Provide a supportive approach when gradually teaching the child simple social skills such as active listening and letting others have enough time to speak.To promote better social interaction between the child and other people.  
Encourage him/her to join social events. Include his/her interests/previous hobbies in the activities of the social group.To provide chances for the patient to interact socially.
Encourage the patient to perform activities like crafts and games with one or more persons during the day and discourage sleeping during the day.Sleeping during the day can make the patient less sleepy at night, which can cause insomnia. Encouraging socialization can help the patient cope with the symptoms and complications of ADHD.
Teach the patient to perform relaxation techniques such as deep breathing exercises, guided imagery, meditation, and progressive muscle relaxation.To promote relaxation and reduce stress levels.

Other possible nursing diagnoses:

  • Risk for Injury related to hyperactivity and impulsiveness secondary to ADHD
  • Risk for Parental Role Conflict
  • Risk for delay in growth and development related to ADHD

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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