Diagnostic Criteria for Attention-Deficit/Hyperactivity Disorder. Either (A) or (B):A: Six (or more) of the following symptoms of inattention havepersisted for at least 6 months to a degree that is maladaptive andInconsistent with developmental level:Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activitiesOften has difficulty sustaining attention in tasks or play activitiesOften does not seem to listen when spoken to directlyOf9451
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2. Diagnostic Criteria for Attention-Deficit/Hyperactivity Disorder 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
3. 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: 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)
4. 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
5. 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
Explain side effects and dosage times
Explain that it is not a cure all pill
Recommend support groups (psychoeducation)
6. 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
7. ADHD Treatment modalities Behavioral techniques: Positive reinforcement
Token economy system
Stimulant: Short-acting: Ritalin, Methylin, Focalin
Intermediate acting: Ritalin LA, Metadate CD, Methylin ER
Long-acting: Adderrall XR, Concerta, Focalin XR
Does it work?
8. Medications used in treatment of ADHD dextroamphetamine sulfate (Dexadrine; Dextrostat) (Chemical Class- amphetamines)
Indications: Narcolepsy. Adjunct management of ADHD. Unlabeled uses: Exogenous obesity.
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.
9. 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.
Medications used in treatment of ADHD
10. 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.
Nursing Diagnosis From Townsend
11. 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.
12. Nursing Care Plan
13. Questions People with ADHD tend to display which of the following behaviors?
A. Intense emotions
C. Minimal attention span
D. All of the above
14. 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
B. False Questions
15. References Fowler, M. (1994). ADHD: How is it treated? Retrieved October 27, 2007 from http://school.familyeducation.com/learning-disabilities/treatments/30086.html?detoured=1
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.