Case study - Attention-deficit hyperactivity disorder: Nursing

Nurse, Sienna works in a family practice clinic and is caring for Paul, a 10 year old who was brought in by his caregiver, Erin for poor school performance over the past year.

In collaboration with a registered nurse, a and joy nurse, Sienna goes through the steps of the clinical judgment measurement model to make clinical decisions about Paul's care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action and evaluating outcomes.

First, nurse, Sienna recognizes important cues including Paul's vital signs which are temperature 98.6 °F or 37 °C, heart rate, 88 BPM, respiratory rate, 14 breaths per minute and BP 10 5/66 millimeters of mercury.

She notices that Paul is restless and regularly stands up to look at and touch objects in the examination room. Nurse, Sianna gathers more information from Aaron and Paul.

Hi, Paul, how are you doing today? Ok.

I guess I don't know why I have to be here. Paul's been having trouble in school.

His grades have been getting worse over the past few months. He's also been turning in his assignments late or not at all.

And when he does turn them in, they're incomplete. Yeah, it's hard to pay attention.

Aaron also reports that Paul's teachers say he often disrupts class by standing up and blurting out answers to questions instead of raising his hand and that he has difficulty following rules and waiting for his turn during group activities.

When asked about the home environment, Aaron reports that when Paulus asked to perform a household chore, he either forgets to do the chore or doesn't finish it.

Once he starts it, nurse CNN analyzes these cues. She reviews Paul's electronic health record or E hr and notes that he's been to the clinic twice in the past year for similar behavioral difficulties and tested negative for underlying vision, hearing or cognitive disorders.

Nurse Sienna confers with R and Joy and they speak to the healthcare provider who diagnoses Paul with attention deficit hyperactivity disorder or AD HD.

Nurse. Sienna knows that adhd is likely a group of disorders thought to be caused by abnormalities in the function of the central nervous system which regulates concentration, attention, focus and impulse control.

As a result, patients can experience inattention hyperactivity and impulsivity which may lead to disrupted learning school performance and difficulty completing tasks.

Nurse Sienna recognizes that Paul needs effective management of his AD HD symptoms. Now using the information she's gathered along with Paul's medical history.

Nurse Sienna reports her findings to R and joy and together they develop a priority hypothesis of ineffective impulse control.

Then they generate solutions to address Paul's impulse control and establish the expected outcome that after intervening, Paul will demonstrate improved ability to focus on tasks at school and at home by his follow up appointment, nurse, Sienna and a Joy, then take action to implement these solutions.

R and Joy notes that the healthcare provider prescribed methylphenidate and outpatient behavioral therapy for Paul. Then R and Joy teaches Erin and Paul about the medication.

She explains that methylphenidate is a stimulant that works in the brain to improve focus and attention and decrease impulsivity.

She also teaches them about management of Paul's ADHD symptoms. Then when A and O leaves the room, nurse, Senna reinforces the teaching Aaron and Paul.

Do you have any questions about what nurse Joy talked with you about? Nurse?

Joy said that I should find ways to help Paul use up his energy so he can focus more during classes. What activities do you recommend?

Great question, Paul. Do you enjoy playing any sports?

I love basketball. Gym class is my favorite.

Actually, Paul's school has a basketball league starting soon. I can sign him up for it.

Good idea. Now, remember you'll also need to tell Paul's teachers about his diagnosis to make sure that he has regular scheduled breaks during class.

He may need certain accommodations like extra time for exams and assignments as well as a distraction, free area to test in our clinic will provide you with the paperwork to give to his school.

Ok, thank you. Remind me again, what can I do at home to help him focus?

Sure. One strategy is to make a weekly schedule of his chores and school assignments that he can check off each day.

Does that sound like something you could do, Paul? I think.

So. Nurse CN that reminds Erin that Paul is scheduled to begin outpatient behavioral therapy the following week, which will help him develop daily routines and build organization and communication skills.

After one month, Paul returns to the clinic for his follow up appointment and nurse Sianna evaluates the outcomes of her actions.

His vital signs are temperature 98.6 °F or 37 °C, heart rate, 81 BPM, respiratory rate, 14 breasts per minute and BP, 10 1/65 millimeters of mercury.

Erin reports that Paul's been taking his methylphenidate as prescribed and is regularly attending behavioral therapy. Additionally, Paul's teachers report that he's been less distracted in class and outbursts have decreased.

Paul tells nurse CNA that he still has trouble sitting still during the entirety of class, but he thinks taking tests in a separate quiet space helps him concentrate.

Aaron also reports that using a weekly checklist has helped him finish chores at home. All right, as a quick recap, nurse CNN recognized and analyzed cues related to Paul's ineffective impulse control and in collaboration with R and Joy prioritized hypotheses and generated solutions to address this problem.

Nurse Sienna then took action and evaluated Paul's outcomes comparing them to the expected outcome. Since Paul reported improved ability to focus on tasks at school and home.

Nurse, Sienna determined that the plan of care was successful.