Attention Deficit Hyperactivity Disorder Comprehensive Case Study Nursing Essay Example

Attention Deficit Hyperactivity Disorder Comprehensive Case Study Nursing Essay Example

Subjective:

CC: “I am depressed with Joshua’s emotional outbursts. I have difficulty providing consistent caretaking Joshua and his sibling sister and sending them to school.”(Attention Deficit Hyperactivity Disorder Comprehensive Case Study Nursing Essay Example)

HPI: Joshua is a 12-year-old boy. He is in 6^th grade. According to the grandmother, Joshua has had a decline in behavior since his sibling was placed with him. The grandmother reports that Joshua believes the sibling is receiving more attention than he is. As a result, he is easily angered and reactive to the attention paid to his sibling. He is often volatile with frequent outbursts of anger, and multiple arousal signs, including impaired concentration, irritability, insomnia, and nervousness. Joshua’s behavioral change had affected his school performance. Prior to the placement with the grandmother, Joshua suffered parental neglect and physical abuse, leaving him with bruises on his legs and arms. The mother once admitted that Joshua is slow to develop. Joshua loves art and dislikes remedial reading classes, and he is about two years behind in reading. Joshua is talkative and social when in a happy mood.(Attention Deficit Hyperactivity Disorder Comprehensive Case Study Nursing Essay Example)

Past Medical Hx: None Reported.

Past Psychiatric Hx: Diagnosed with Oppositional Defiant Disorder (ODD) and Attention Deficit Hyperactivity Disorder.

Current Medications: None reported.

Medication trials: None reported.

Family psychiatric/substance use: Grandmother had childhood trauma. Parents have a history of drug and alcohol abuse

Allergies: None reported.

Social: Currently lives with the grandmother and her sibling sister. The parents are separated. Has a history of neglect, physical abuse, and parental substance abuse. Mother has a history of stress from an abusive husband.(Attention Deficit Hyperactivity Disorder Comprehensive Case Study Nursing Essay Example)

Review of Systems

General: No fever or chills

HEENT: No headache. Normal eyesight. Normal hearing. No nasal congestion or runny nose. No sore throat.

Skin: No bruises.

Cardiovascular: No chest discomfort or pain.

Respiratory:

Pulmonary: No cough or shortness of breath.

Gastrointestinal: No loss of appetite.

Genitourinary: Not sexually active

Musculoskeletal: No joint or muscle pain.

Neurological: No hallucinations or seizures.

Hematologic: No hemophilia.(Attention Deficit Hyperactivity Disorder Comprehensive Case Study Nursing Essay Example)

Lymphatics: No enlarged nodes.

Objective:

Temp: 98 F, BP: 128/80, HR: 84, R: 18, O2: 99, Ht: 4’7’’, Wt.: 85lbs, BMI: 19.8 kg/m²

Diagnostic results:

Lab findings: WNL

Assessment.

Mental Status Examination: Joshua is a 12-year-old boy who looks his age. He is alert and oriented. He is well kempt and appears to be in distress. He is interactive and demonstrates a good understanding of the occasion. Eye contact avoidant and appears restricted. Psychomotor agitation was observed during the examination. Mood and effects are congruent. Has difficulty concentrating and maintaining attention. Insights and judgment are poor, with limited cognition.

Differential Diagnosis

Diagnostic Impression: The psychiatric indicates support for Oppositional Defiant Disorder (ODD), Attention-Deficit /Hyperactivity Disorder (ADHD), or Reactive Attachment Disorder (RAD). DSM5 code for ODD is 313.81 (F91.3).(Attention Deficit Hyperactivity Disorder Comprehensive Case Study Nursing Essay Example)

1. Oppositional Defiant Disorder (ODD) (F91.3)

ODD is defined by an irritable pattern lasting about six months and characterized by loss of temper, touchiness, angriness, or defiance of authority (American Psychiatric Association [APA], 2019). This is the primary diagnosis since the client meets all the DSM- criteria for ODD diagnosis.(Attention Deficit Hyperactivity Disorder Comprehensive Case Study Nursing Essay Example)

2. Attention-Deficit /Hyperactivity Disorder (ADHD) (F90.0).

The DSM5 code for ADHD is 314.00 (F90.0). Predominantly inattentive ADHD is defined by an inattention pattern that affects development and functioning, characterized by the inability to pay attention to details, difficulty maintaining attention, and inability to listen when spoken to or follow instructions (APA, 2019). The client does not exclusively present six or more symptoms of inattention. The diagnosis is refuted.(Attention Deficit Hyperactivity Disorder Comprehensive Case Study Nursing Essay Example)

3. Reactive Attachment Disorder (RAD) (94.1)

The DSM5 code for RAD is 313.89 (94.1). RAD is defined by social neglect or deprivation, changes in primary caregivers, or living in unusual settings, limiting opportunities to establish selective attachment (APA, 2019). However, the disturbance should be experienced before five years. This diagnosis is refuted.(Attention Deficit Hyperactivity Disorder Comprehensive Case Study Nursing Essay Example)

Treatment Plan

Start the client on family behavioral therapy. Pharmacological treatments are not recommended as a first-line intervention for ODD (Riley, Ahmed, & Locke, 2016). Behavioral therapy for the client and the family would help improve the ODD symptoms among children and adolescents. Behavioral therapy is also crucial in improving self-control, self-esteem, and behavior (Centre for Disease Control and Prevention, 2020). The intervention aims to manage the client’s behavior towards her sibling and peers.(Attention Deficit Hyperactivity Disorder Comprehensive Case Study Nursing Essay Example)

1. Starts the client on Methylphenidate 5mg BID and adjusts appropriately (Huss et al., 2017). Methylphenidate is a Central Nervous System acting pharmaceutical agent and will be crucial in managing the client’s comorbid hyperactivity and inattentiveness.(Attention Deficit Hyperactivity Disorder Comprehensive Case Study Nursing Essay Example)
2. Recommend an Individualized Education Program (IEP). IEP is an ideal platform for a child to learn, considering how and what they learn depending on their educational needs and improving their education achievement (Spiel, Evans & Langberg, 2014).(Attention Deficit Hyperactivity Disorder Comprehensive Case Study Nursing Essay Example)
3. Educate the grandmother on medication side effects, strategies, and skills to help Joshua relate well with his sibling and peers. The grandmother is knowledgeable about the side effects of medication and voices an understanding of the clients’ conditions and the treatment intervention.

The client is to return to the clinic in four weeks.

References

Huss, M., Duhan, P., Gandhi, P., Chen, C. W., Spannhuth, C., & Kumar, V. (2017). Methylphenidate dose optimization for ADHD treatment: a review of safety, efficacy, and clinical necessity. Neuropsychiatric disease and treatment. https://dx.doi.org/10.2147%2FNDT.S130444

Spiel, C. F., Evans, S. W., & Langberg, J. M. (2014). Evaluating the content of Individualized Education Programs and 504 Plans of young adolescents with attention-deficit/hyperactivity disorder. School Psychology Quarterly, 29(4), 452. https://dx.doi.org/10.1037%2Fspq0000101

American Psychiatric Association. (2019). Diagnostic and statistical manual of mental disorders (7^th ed.). American Psychiatric Publishing, Inc.

Riley, M., Ahmed, S., & Locke, A. B. (2016). Common questions about the oppositional defiant disorder. American Family Physician, 93(7), 586-591.(Attention Deficit Hyperactivity Disorder Comprehensive Case Study Nursing Essay Example)

Centre for Disease Control and Prevention. (September 2020). Parent Training in Behavior Management for ADHD. Retrieved 9 September 2021, from https://www.cdc.gov/ncbddd/adhd/behavior-therapy.html