Question

A mother brings her 9-year-old daughter into the pediatrician’s office for a follow-up appointment. The daughter had been diagnosed with attention-deficit hyperactivity disorder (ADHD) last year while repeating second grade. She has been taking methylphenidate (Ritalin) 10 mg twice a day for 7 months now. Initially, she had been started on methylphenidate (Ritalin) 10 mg three times a day, but complaints of headache and insomnia resulted in a series of changes. Initially, the last dose of the day was dropped from 10 to 5 mg at dinner time, but later, the parents stopped giving the third dose altogether, citing concerns about dependency and their desire to use a more conservative medication approach for managing the patient’s ADHD. A behavioral plan with school supports has also been in place for the past year.

Although the patient had been demonstrating good progress, today the mother reports that the patient’s grades are beginning to plummet again. Earlier this school year, the patient had been earning marks of “Satisfactory (S)” and “Satisfactory Plus (S+),” but now she is getting “Satisfactory Minus (S-)” and “Needs Improvement (NI).” The mother describes the patient as being more restless and “antsy” with difficulty completing her homework and reading assignments. In reviewing the patient’s family and home environment, you discover that the patient’s father has recently left the family because of the unexpected additional stress of the mother’s two teenage nephews moving in with the family in the past 6 weeks after their mother was arrested on drug charges. The patient tells you that the two boys tease and threaten her, and she says that she is fearful of them. The mother admits that the addition of the two teenage boys to the family has been problematic because the boys have been “unruly and disrespectful.” She admits to feeling somewhat trapped and overwhelmed; however, she says the boys have “nowhere else to go,” and family should look out for family.

1. What other areas of assessment are important to explore today with the patient and her mother?
2. Given the patient’s current signs and symptoms, do you believe there is a need for medication adjustment?
3. Identify two outcomes that are patient-centered and include specific time frames for evaluation.
4. Create two nursing interventions that are evidence-based and include rationales.
5. How would you evaluate the effectiveness of your nursing care?
6. What are your suggestions to the patient's school for increasing academic performance?
7. What supportive resources would you provide the patient's mother?

Answer 1

Answer :

Q. No. 1. Answer :

9 years old child is having ADHD disorder.

Assessment areas for ADHD includes :

There are so many areas to assess the child with ADHD.

1. Clinical Examinations : according to this we will see the signs and symptoms .

2. Interviews : here we will ask the parents regarding child experiencing problems.

3. behavioral observations : observation of the child behavior.

4. Completion of rating scales :

By using some of the ADHD assessment forms like teacher and parent version evaluation forms should be used.

Q. No. 2. Answer :

Yes, we need a medication adjustment.

Those are cognition enhancing medications, stimulant and Antihypertensive drug.

Cognition enhancing medications are caffeine and L Theanine.

And also behavioural therapy,

Social skill classes

Talking therapy

Environmental structures

IEP ( Individual Education plan) for school.

Q. No. 4. Answer :

Nursing interventions :

* Safety measurements should be provide that is physical safety and medication safety, because the child is not having attention so that she may get injuries.

* behavioural observation should be done continuously and record and report and inform to the physician if there any sudden changes or behavior.

* The nurse should not judge the behavior of child, just observe and provide support to the family.

Q. No. 5. Answer :

We can evaluate the effective ness of our nursing care by

* using reassessment check list.

* by assessing the child concentration levels through some observation techniques.

* by seeing improvement in the child performance.

* timely performance of activitiy by child.