Nursing Diagnoses and Interventions – Attention-deficit/hyperactivity Disorder (ADHD) (Nursing)

00:00 So what kind of nursing diagnosis do you think that we would come up with for a child who who has ADHD? I can even hear you say "Safety, safety, safety." Yes, risk for injury related to accident-prone behavior and impulsivity. These are the kids that are going to go full force and are going to end up injuring themselves because they don't know how to stop. We may have a child who has very low self-esteem and that would be related to the negative feedback that they are getting in all these different environments or perhaps the dysfunctional family system. If you know a family who has a child who has ADHD, the caregivers, the parents, the grandparents, this is a difficult situation to deal with unless you have some support and you know how to deal with clinical manifestations.

01:03 If you are thinking that your child is doing this to get under your skin rather than that it is a clinical manifestation of a disease process, we need to be able to help that parent understand how to help the child cope. Also, one of our nursing diagnosis might be noncompliance with task expectations. And what is that related to? Well the child has a short attention span, also low frustration tolerance. And finally, this impaired social interaction. This child does not learn the normal social cues that other children have learned. They do not know how to wait their turn because of their impulsivity. They cannot wait until they are called on if they have an answer, which is a reflection of immature behaviors. Their level of frustration is very very low, they become easily frustrated. So what do we want to do as nurses? What kind of interventions do you think that we can do to be able to help the child and the family with ADHD? Well, we want to have that therapeutic relationship. We want to develop that trusting therapeutic relationship with the patient, also with the family. We want to be able to give this child an opportunity to thrive. So let's reduce the environmental distractions that might get in the way with staying focused. We have to have good boundaries. This is what is allowed, this is what is not allowed. This is where you are allowed to go, this is where you are not allowed to go. The child will actually respect the boundaries once they are able to adhere to them. It is very difficult initially when you're setting boundaries, but just be consistent and kind. And then give the immediate positive feedback for acceptable behavior, "Oh I notice you were just about to go and pick up that ball and I noticed you stopped and I'm so proud of you 'cause I know that was hard to do, but I appreciate that because now is not the time to play with the ball. Let's move over here. I think I'll put a sunshine on your planner for today because that was really good." So that is your positive feedback and your rewording. You want to be able to set realistic goals. If your goals are unrealistic, you're setting the child up for failure and a child with ADHD by the time they are 7 years old understands what failure is. If they have not been diagnosed early, if they have not been having some interventions to help them to learn how to control some of their behaviors, they understand failure. And it is for nurses, for us to look at a child who comes in and who's defeated and still energetic and doing the wrong thing and getting yelled at any way, we want to help that child at least while they're with us to understand that we have realistic goals for them. We want to plan activities that give them the opportunity to achieve the goal and we want to be able to be kind. We want to have a positive and respectful regard for the child and show acceptance. When we give instructions, they have to be concrete, no abstractions.

04:54 "I need you to put the toothbrush in the holder and I need you to do it now." And if you can work one on one with the child whenever it is possible, if it is important that they do what you need them to do in the way you're asking them to do it, make a game, say "I'm going to say something I need you to say it after I say it." I used to have a game that I played with these kids that I work with and with their parents. I would say "I'd like you to turn on the light." And the child had to say to me "Oh, Dr. Marshall do you want me to turn on the light?" And I'd say "I would love for you to turn on the light." And then they would say "Okay, I'm going to turn on the light." What we found out was that when they ask me "Do you want me to turn on the light?" that was the first time they actually heard what I wanted them to do. Knowing that they had to repeat what I said made them pay attention. And so, that way of engaging them, they started doing it with their parents. So if their parents said "I need you to turn off the TV" instead of getting "uh-huh, uh-huh, uh-huh" the child had to say "You want me to turn off the TV?" and then it would register "Oh, you want me to turn off the TV." And vice versa the child had the right to say to the parent "I want you to take me to school now" and instead of getting "Don't you see I'm busy" mom had to stop and say "Oh, you want me to take you to school now?" and she then allowed him to know he was being heard. So, when you do that I "listen, repeat, listen, do, listen, repeat, listen, do." "I want you to." "Oh, you want me to?" "Yes, I want you to." "Okay, I'll do it." Also, you want to provide this environment as free as distractions as is possible when they have a task to do that is going to require some mental effort. How do we treat ADHD?