Teopiz, Mark Jovan Jr BSN 3-A3

CASE STUDY ON ATTENTION DEFICITY HYPERACTIVITY DISORDER

Coverage Date: November 27, 2020
Instructions:
• This case study is equivalent to one whole day of Related Learning Exposure.
• Read the case provided below thoroughly and answers all questions and activities below.
• Use a short bondpapers when answering the activities in this case study.
• Upload the activities to your Group Google Drive at the prescribed time by your Clinical
Instructor

A . CASE
A 7 year old male grade 1 student lives with parent, He is the only child. He was seen by a
physician due to his behaviour manifested. According to her mother he is an intelligent and caring young
boy who presents with significant potential to excel academically. He enjoyed spending time with friends
and even participating in physical activities like running and skating. He interacts well with peers of his
own age. Family history, reveals that there is an extended family history of Attention deficit hyperactivity
disorder (ADHD).
Child’s past history when he was still at the age of four, reveals difficulties at home with following
routines and remembering instructions. His parents describe emotional reactivity as well as
confrontational behaviours demonstrated both at home and at school. His teacher noted that the child’s
behaviour is very defiant towards listening to instructions, He easily gets frustrated and emotionally
impulsive several incidents of hitting, crying outbursts, and inappropriate-behavi. Behavioural concerns
with aggression, lying, arguments, and disruptive behaviour.
For her present manifestation, her mother also noted that the child did not know his address or
home phone number, could not print his surname, and recognized only a few pre-primer words They
also report that the child easily gets upset when he does not receive recognition or feels that he has
been ignored. Even his teacher notes that he sometimes acts 'socially immature', and that he often
demonstrates attention-seeking behaviour. He recognizes that he is able to 'hyper focus' on some
activities of interest, however he often has difficulty sustaining his attention at school.
His parents and teacher indicate that the child is restless, and often requires reminders to help
him stay on task. He is described as "constantly running around" and presenting with difficulties listening
and following instructions. Child’s teacher indicates that he often blurts out answers and interrupts other
students in the classroom.
Reveals that the child had challenges falling asleep, and sometimes finds that he wakes up in
the middle of the night. When he wakes up he finds that he has a difficult time getting back to sleep -
sometimes staying awake for as long as an hour and a half. His mother reports difficulties at home with
following routines and remembering instructions. Because of this manifestation the child was placed on
Methyphenidate (Ritalin) 5mg. orally twice daily given before meal and lunch, was also advise to go on
series of modification techniques.

B. MENTAL HEALTH ASSESSMENT FINDINGS

List down significant mental health assessment findings and provide brief discussion of each finding. You
may add more spaces if you believe there are more assessment findings in the case.
Teopiz, Mark Jovan Jr BSN 3-A3
ASSESSMENT FINDINGS DISCUSSION
Health History Child’s family history shows hereditary evidence in
manifesting ADHD Risk factors for ADHD may include: Blood
relatives, such as a parent or sibling, with ADHD or another
mental health disorder. Exposure to environmental toxins —
such as lead, found mainly in paint and pipes in older
buildings. Maternal drug use, alcohol use or smoking during
pregnancy.
Behavior concerns and emotionally The most common problems in kids with ADHD are defiant
unstable (Emotionally impulsive and aggressive behavior. This includes resistance (more
several incidents of hitting, crying often than other children) to follow directions from
outbursts, and inappropriate behavior. “authorities”. Kids may have emotional outbursts when
Behavioral concerns with aggression, asked to do things they find difficult or challenging.
lying, arguments, and disruptive
behavior.)
Hyperactivity/restlessness It is common for clients with ADHD to be hyperactive and
restless due to the fact that they can hyperfocus with
anything of interest yet can also have difficulty in
maintaining focus on different activities or aspects

Insomnia Lack of sleep is a common problem among people with

ADHD. The causes of sleep issues in people with ADHD
aren’t fully understood yet. But the relationship between
ADHD and poor sleep is clear.
-Falling asleep: Winding down at night can be a big
challenge for people with ADHD. They often struggle to “stop
thinking” when trying to get to sleep.
-Staying asleep: Kids with ADHD are more prone to
nightmares, bedwetting, and sleep disorders, such as
restless leg syndrome.
-Waking up in the morning: Staying up late makes it
harder to wake up in the morning. This can be a tough habit
to break, especially among people with ADHD who feel more
productive at night.
Teopiz, Mark Jovan Jr BSN 3-A3
C. PSYCHOSOCIAL THEORY
Discuss the particular psychosocial stage where the client is in. Highlight either the positive resolution
or negative resolution findings provided in the case and expected in the client.
Psychosocial Stage Age Range:
Discussion:

✓ The patient is only a child, 7 years of age which belongs to psychosocial stages of
industry vs. inferiority.
✓ School and social interaction play an important role during this time of a child’s life.
Through social interactions, children begin to develop a sense of pride in their
accomplishments and abilities. In the patient’s case, he has attention deficit
hyperactivity disorder (ADHD) which impends the progression of the child. The patient
who will be at risk of struggle to develop the sense of competence may emerge from
this stage with feelings of failure and inferiority. The interruption of his condition may
delay his maturity and improvement later on.

Source: Erik Erikson's Stages of Psychosocial Development By Kendra Cherry

 Teopiz, Mark Jovan Jr BSN 3-A3

D. DIAGNOSIS
Discuss the pathophysiology/progression of the diagnosis of the specified case

Diagnosis: ADHD

E. MEDICATION REVIEW (DRUG STUDY)

Create a Medication Review for all medications provided in the case. Use the format provided below:
 Teopiz, Mark Jovan Jr BSN 3-A3
Medication Indication Mechanism of Contradindication Adverse Nursing Responsibilities
action Effects
Generic Treatment of Blocks Hypersensitivity to Prolonged Baseline assessment
Name: attention reuptake of methylphenidate. administration ADHD:
Methylpheni deficit norepinephrine, Use during or to children with • Assess attention span,
date hyperactivity dopamine within ADHD may impulsivity, interaction
disorder into 14 days following delay normal with others,
(ADHD). presynaptic MAOI therapy; weight gain distractibility.
Management neurons. marked anxiety, pattern.
of narcolepsy. Therapeutic tension, Overdose may Intervention/evaluation
Effect: agitation, motor produce • Monitor B/P, pulse,
Decreases tics; family tachycardia, changes in ADHD
motor history or palpitations, symptoms. CBC with
restlessness , diagnosis of arrhythmias, differential should be
fatigue. Tourette’s performed routinely
chest pain,
Increases syndrome, during therapy. If
Brand psychotic
motor glaucoma. paradoxical return of
Name: episode,
activity, attention-deficit occurs,
Ritalin Metadate seizures, coma.
attention span, dosage should be
(additional): Hypersensitivity
mental reduced or discontinued.
Severe reactions, blood Monitor growth.
alertness.
hypertension, dyscrasias
Produces mild
HF, arrhythmia, occur rarely.
euphoria. Patient/family teaching
hyperthyroidism, • Avoid tasks that require
recent MI or alertness, motor skills until
angina. response to drug is
established.
• Sugarless gum, sips
of water may relieve dry
mouth. • Report any increase
Dosage: in seizures.
5mg BID • Take daily dose early
in morning to avoid
insomnia.
• Report anxiety,
palpitations, fever, vomiting,
skin rash.
• Report new or
worsened symptoms (e.g.,
behavior, hostility,
concentration ability).
• Avoid caffeine.
• Do not stop taking
abruptly after prolonged use.
 Teopiz, Mark Jovan Jr BSN 3-A3
Source: Nursing Drug Handbook, Saunders (Elsevier) 2019

F. PROBLEM LIST

Based on the case provided above, cite the top 3 Nursing Diagnosis of the identified client. Provide your
rationale/discussion on your choice and discuss briefly about the Nursing Diagnosis.

Problem Rationale
1.) Risk for parental role conflict A child with ADHD is really difficult to manage
especially when they are being aggressive and
with emotionally-driven attitudes. It can make
the parents feel confused and helpless because
of unexpected turn of events.

2.) Risk for delay in growth and development The child is at risk for development because of
inattentiveness with his surroundings. With their
short attention span, it can disturb the learning
skills that probably leads to delay of progression

3.) Risk for injury The child is very hyperactive where ever he is,
in this case the child is prone to injury.
 Teopiz, Mark Jovan Jr BSN 3-A3

NURSING CARE PLAN

Formulate an NCP for each of the 3 Nursing Diagnosis in your Problem List which applicable for the client using the format below:
Defining Nursing Scientific Goals of Care Nursing Intervention Rationale
Characteristics Diagnosis Analysis
 Teopiz, Mark Jovan Jr BSN 3-A3
Subjective Data: Risk for Parent’s After 3 hours of Independent:
parental role experience of rendering nursing care
“We don’t know conflict related role intervention the 1.) Establish rapport to the client 1.) To build trust within each other
what to do to children confusion patient/SO will be able and SO especially with the child
anymore” as with attention and conflict to: 2.) Assess and support parent’s 2.) Understanding what experience a
verbalized by deficit previous coping behaviors. parent has with coping will
in response
the parents hyperactivity Short term goals: enable the nurse to support the
to crisis
disorder as parents in the current situation
evidence by 1.) Exhibit assertiveness 3.) Determine parent/family sources 3.) Helping to identify stressors in a
frustrations and responsibility in of stress, usual methods of family’s life can help parents
active family coping, and perceptions of better cope with their child’s
decision-making illness/condition. illness
regarding care of the 4.) Encourage the family to use 4.) Parents use their support from
child social support. their family to help reduce
2.) Describe and select 5.) Consider the use of family- anxiety
Objective Data: available resources centered theory as the 5.) When planning care for a child,
to support parental conceptual foundation to help family is always the constant in
management of the guide interventions. their lives and should be included
child’s and family’s in all decision-making
• Perceived needs
loss of 6.) Be available to accept and 6.) The nurse’s ability to observe
control over support parents by listening and and listen to parents helps
discussing concerns. parents gain confidence in caring
decisions
Long term goals: 7.) Encourage the parent to meet for their child
relating to
child his/her own needs for rest, 7.) Children with an illness can have
After 3 days of rendering nutrition, and hygiene. Provide an impact on parent sleep, which
• Reluctance
nursing care intervention, bed space so that the parent may in turn can cause parental
to
the patient/SO will be stay with the sick child. fatigue and lead to other health
participate in
able to: problems
usual
caregiver Collaborative:
3.) Verbalize
activities
understanding about 8.) Refer parents to available
• Anxiety
the child’s condition telephone and/or Internet 8.) Many parents find that Internet
• Concern
4.) Acceptance of the support groups. support groups help in coping
about family
child’s situation and 9.) Involve new mother’s partner or with their child’s illness
to do a better care parents in clinical encounters and 9.) Health care providers realize the
with the child invite family members to discuss importance of involving partners
their expectations and parenting and family members in the care
experiences. of the infant to help the mother
caring for the infant

Source: Nursing Diagnosis Handbook, EB Guide to Planning Care, Elsevier 12th Ed

Defining Nursing Diagnosis Scientific Goals of Care Nursing Intervention Rationale
Characteristics Analysis
 Teopiz, Mark Jovan Jr BSN 3-A3
Subjective Data: Risk for delay in Vulnerable to After 3 hours of rendering Independent:
growth and delay of nursing care intervention,
“The child did development related 25% or more the patient will be able to: 1.) Establish rapport to the 1.) To build trust within each
not know his to mental illness in one or client and SO other especially with the child
address or home (hyperactivity), lack more of the Short term goals:
phone number, of concentration as areas of 2.) Provide support and 2.) Parents should anticipate
could not print evidence by difficulty social or 1.) The child will education to parents of seeing moderate to significant
his surname, sustaining attention. self- participate in toddlers with delays in reaching
and recognized regulatory administering developmental disabilities developmental milestones
only a few pre- behavior, or interventions for his such as walking and
primer words” in cognitive, development communication
as verbalized by language, 2.) The child will achieve
the mother gross, or fine expected milestones in 3.) Screening for autism
motor skills, 3.) Encourage parents of
all areas of toddlers to obtain age- spectrum disorders should be
which may development. performed between ages 18
appropriate developmental
compromise 3.) Parents will verbalize and 24 months
screenings to detect early
health understanding of problems.
potential impediments
Objective Data: to normal development 4.) Teach parents the 4.) Confirmed previous research
and demonstrate importance of avoiding indicating that when the blood
• Short actions or lead-based paints in the lead level reaches about 50
attention environmental/lifestyle home as well as other mcg/L in the body of children,
span changes necessary to sources of lead in the it can impair growth, memory,
provide appropriate environment. intelligence, and behavior,
• Easily gets
care in a safe, even when there is no obvious
frustrated
nurturing environment clinical manifestation.
when he
doesn’t
received 5.) Explore the family’s feelings 5.) Encourages an attitude of
recognition Long term goals: regarding child’s health acceptance and adjustment to
• Developing condition and required child’s abilities and health
more slowly 4.) The child will be able to treatments. status.
than other achieve optimum level
children of wellness
same age. without the signs of Collaborative:
ADHD
6.) Initiate referral to an 6.) Behavioral therapy addresses
behavioral therapy as specific problem behaviors by
appropriate. structuring time at home,
establishing predictability and
routines, and increasing
positive attention.

7.) Administer medication as

7.) To reduce symptoms of ADHD
indicated
Source: Nursing Diagnosis Handbook, EB Guide to Planning Care, Elsevier 12 th Ed
 Teopiz, Mark Jovan Jr BSN 3-A3
Defining Nursing Scientific Goals of Care Nursing Intervention Rationale
Characteristics Diagnosis Analysis
 Teopiz, Mark Jovan Jr BSN 3-A3
Subjective Data: Risk for injury Vulnerable to After 3 hours of Independent:
related to physical rendering nursing care
• Describes as hyperactivity as damage due intervention, the 1.) Establish rapport to the client 1.) To build trust within each
“Constantly evidence by to patient will be able to: and SO other especially with the child
running restlessness environmental 2.) Provide a safe and comfortable 2.) To reduce risk factors of injury
around” conditions Short term goals: position.
• Several interacting 3.) Avoid use of physical and 3.) The use of restraints has been
incidents of with the 1.) Minimize chemical restraints if at all associated with serious
hiting individual’s hyperactivity over possible. injuries, including
adaptive and for a particular (for rhabdomyolysis, brachial
defensive hyperactive pts.) plexus injury, neuropathy, and
given task dysrhythmias, as well as
resources,
2.) The child will be strangulation, traumatic brain
which may
able to calm his injuries, and all the
compromise
behavior for the consequences of immobility
health time being
4.) Teach parents the need for 4.) State that drowning and
3.) The child will learn submersion injuries are one of
close supervision of young
about appropriate the most common, yet
children playing near water
behavior in dealing avoidable, causes of childhood
matters mortality and morbidity.
Objective Data:
5.) Risks for children’s thermal
5.) Never leave young children
Long term goals: injuries include inattentive
unsupervised around cooking
attention in a depressed
• Aggression, or open flames.
4.) The child will be mother, adult alcohol
lying, able to prolong overuse, and socioeconomic
arguments calmness level
• Disruptive 6.) Provide positive attention 6.) Positive playtime reduces
5.) The child will be
behavior able to behave attention-seeking behavior.
• Emotionally 7.) Encourage the parent to 7.) Reward systems can be a
appropriate for his
impulsive establish a reward system great way to help kids with
age
ADHD stay on track.

Collaborative:

8.) Encourage parents to 8.) When parents work together

collaborate or work with the with a child's teacher, it
child’s teacher increases the chances that a
child will be successful in
school. Some children need
modifications to their
schoolwork, such as being
allowed extra time on tests, to
be successful.
Source: Nursing Diagnosis Handbook, EB Guide to Planning Care, Elsevier 12 th Ed