ADHD Attention-Deficit hyperactivity Disorder Student

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ADHD Attention-Deficit hyperactivity Disorder
Student names Benjamin A. Quiroz, Audrey Falk,
Raquel Bolender, Danielle Hower, Clint Ludlow,
Heidi C Ritting
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Diagnostic Criteria for Attention-Deficit/Hyperact
ivity Disorder
ADHD

• 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
• 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

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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
ADHD
Diagnostic Criteria for Attention-Deficit/Hyperact
ivity Disorder

• 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)

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ADHD

• Some hyperactive-impulsive or inattentive
  symptoms that caused impairment were present
  before 7 years old
• Some impairment from the symptoms is present in
  tow or more settings (ex. At school or work and
  at home)
• There must be clear evidence of clinically
  significant impairment in social, academic, or
  occupational functioning
• 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

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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
• Explain side effects and dosage times
• Explain that it is not a cure all pill
• Recommend support groups (psychoeducation)

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

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ADHD Treatment modalities

• Behavioral techniques Positive reinforcement
• Time-out
• Response Cost
• Token economy system
• Adults Coaching
• 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
• Neurotherapy History
• Does it work?

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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.
•  
• Adverse Effects 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.
•  
• 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.

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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
  extended- release
  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 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 professional.
• -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.

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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)

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Nursing Diagnosis From Ackley

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

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Nursing Care Plan
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Questions

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

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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

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References

• Fowler, M. (1994). ADHD How is it treated?
  Retrieved October 27, 2007 from
  http//school.familyeducation.com/learning-disabil
  ities/treatments/30086.html?detoured1
• Townsend, M.C. (2006). Psychiatric Mental Health
  Nursing Concepts of Care in Evidence-Based
  Practice (5th ed.). Philadelphia, PA F.A. Davis
  Company.
• Ackley, J. B., Ladwig, B. G. (2006). Nursing
  Diagnosis Handbook A guide to planning care.
  (7th ed.). St. Louis, Missouri Mosby Elsevier.