Question

Neurodevelopmental Disorder Critical Thinking Assignment

Jimmy, age 9, has been admitted to the child psychiatric unit with a diagnosis of attention-deficit/hyperactivity disorder. He has been unmanageable at school and at home, and has had several suspensions from school for continuous disruption of his class. He refuses to sit in his chair or do his work. He yells out in class, interrupts the teacher and the other students, and lately has become physically aggressive when he cannot have his way. Most recently, he was suspended after hitting his teacher when she asked him to return to his seat. Jimmy’s mother describes him as a restless and demanding baby, who grew into a restless and demanding toddler. He has never gotten along well with his peers. Even as a small child, he would take his friends’ toys away from them or bite them if they tried to hold their own with him. His 5-year-old sister is afraid of him and refuses to be alone with him. During the nurse’s intake assessment, Jimmy paced the room or rocked in his chair. He talked incessantly on a superficial level and jumped from topic to topic. He told the nurse that he did not know why he was there. He acknowledged that he had some problems at school but said that was only because the other kids picked on him and the teacher did not like him. He said he got into trouble at home sometimes but that was because his parents liked his little sister better than they liked him. The physician has ordered methylphenidate 5 mg twice a day for Jimmy. His response to this order is, “I’m not going to take drugs. I’m not sick!” Answer the following question related to Jimmy: Remember to include in-text citations and your references at the end

1. What are the pertinent assessment data to be noted by the nurse?

2. What is the primary nursing diagnosis for Jimmy?

3. Aside from patient safety, to what problems would the nurse want to direct intervention with Jimmy?

Answer 1

1. The assessment data includes a) difficulty in sitting still b) disruptive in the classroom and home c) feelings of low self-esteem d) parental behavior or negligance to the child e) explosive behavior of the child at school and f) poor peer relations.

2. Situational low self-esteem possibly related to rejection by family members, peers and friends. In this case, this is the most effective analysis needed to be sort out first to decrease the disruptive behavior of the child.

3. It is imperative for the nurse to develop an individualized health education programs for parents, caregivers and family members to have reasonable and realistic expectations.The other management includes a) scheduling time with the child to avoid negligence b) establishing house rules and routines to make response to interventions c) making frequent eye contact while communicating with the child to decrease the feelings of loneliness d) focusing on the child's strength e) reducing the feelings of self-esteem f) avoiding negligence with peer groups and friends to avoid more stress g) malnutrition and h) depression.

Answer 2

Impaired social interaction related to impulsive behavior