Psychiatric &Mental Health Nursing Department

Case study
ADHD
Attention Deficit Hyperactivity Disorder
Under Supervision:
Assist. prof. Dr. Hend Ahmed Mostafa
Assistant Professor of Psychiatric & Mental Health Nursing
Dr. Hoda AbdElmoaty Arafa
Lecturer of Psychiatric & Mental Health Nursing
A.L/ Dalia Abd El Haleem Elsayed
Assistant lecturer of psychiatric & Mental Health Nursing
Faculty of Nursing
Benha University
2023-2024
(4th year)
( 2nd term)
G:4 (B1)
 Name Role
Mirna Tarek Mohamed Signs & symptoms
Merna Emad Fawzey Situation
Mirand Ali Abd-elsalam Vedio & presentation
Nadia Eslam Mohamed Vedio & presentation
Nadia Adel Mahmoud Non pharmacological
Nariman Ayman Ahmed Presentation
Nansy Mohamed Elshrief Pharmacological
Nansy Mansour Mahmoud Presentation
Mohamed Reda Mohamed Nursing care plane (1)
Mohamed Refaat Mohamed Nursing care plan (2)
Mohamed Refaat Mahmoud Presentation
Mohamed Rafea Helmy Word
Mohamed Rafeq Hamam Nursing care plan (3)
Mohamed Ramadan Hassan Nursing care plane (4)
Mohamed Saeed Elshahat Nursing care plan (5)
 Case study
Situation
Manar is 13 years old, she came to the psychiatric clinic with her mother
,they came to the clinic because her mother concerned to hear that Manar has
fallen significantly behind in some subjects , she has been struggling with her
school work also she has been difficulties in friendship groups and she is
often involved in argument in the playground, she become more disorganised
over 15 months, her mother complained that she has lost many items of
school equipment and she is hyperactive at school and also at home, the
psychiatric talk to her and notice that she didn't concrete on the psychiatric
talking and talked quickly about another topic ,also she was walking more
than normal .. the doctor put the case under diagnosis and prescribed a
medication as (Methylphenidate) and behavioral therapy.
What is the psychiatric diagnosis of this case?
1) ADHD (Attention deficit hyperactivity disorder )
What are The common psychiatric problem of this case?
1-Hyperactivity

2-Easily distraction
3-Inability to coping with family
4-Suffuring from disorganization
5-Difficult to make friendship
6-Inability to perform daily task
7-Forget things ex :lost items of school equipment
What are the signs and symptoms of this case?
1-Inattention(Short attention span for age ,difficulty attention sustaining)
2-Difficulty listening to others
3-Difficulty attending to details
4-Easily distracted
5-Forgetfulness
6-Talks excessively
7-Often interrupts others
8-Unable to finish her work and becomes quickly distracted
9-Unable to sit still for any length time
10-Having difficulty organising tasks and activities
What are the management plan of this case?
i. Pharmacological Management
1)Stimulants:
Stimulants are believed to work by increasing dopamine levels in the brain.
Dopamine is a neurotransmitter associated with motivation, pleasure,
attention, and movement. For many people with ADHD, stimulant
medications boost concentration and focus while reducing hyperactive and
impulsive behaviors.
1-Short –acting amphetamine: Dexedrine, Detrostat
2-Short -acting methylphenidate:( focalin, Methylin)
3-Intermediate-acting methylphenidate:( MetadateCD).
4-Long-acting amphetamine(Adderall-XR, Dexedrine)
2)Non-stimulants:
Non-stimulant ADHD medications tend to carry a lower risk of abuse or
addiction. And while they are less likely to cause agitation or insomnia
like stimulants, all medications come with some risk of side effects.
1-Atomoxetine: strattera
2- Guanfacins: Intuniv (long-acting),tenex(short -acting)
3- Clonidine:kapvay, Bupropio
ii. Non _Pharmacological therapy:
Psychotherapy includes:
1-Behavioral therapy:
is a type of psychotherapy that aims to help a Person change his or her
behavior, It might involve practical assistance as help organize tasks or
completing school work, or working through emotionally difficult event
2-Positive reinforcement:
refer to introductions of a desire stimuli after behavior: example give the
child reward when he became Calm and polite stranger
3-Modeling:
refers to the learning of new behaviors by imitating the behavior in others. It
can also occur in a therapy session in which the child watches a model
demonstrate appropriate behaviors in a role-play of the child's problem .
4-Therapeutic play:
play techniques are used to understand the Child's thoughts and feelings
and to promote communication .
5-Education and training
parenting skills training Teaches parents the skills they need to encourage
and reward positive Behavior in their children
6-Stress management techniques:
Can benefit parents of Children with ADHD by increasing their ability to
deal with frustration so that they can respond Calmly-support groups that the
families connect with others who have Similar problems and concerns
7-School-based programs:
school apply special education services to the Children.
8- Counseling families:
1-Provide the family with basic information about ADHD, explaining its
symptoms, challenges, and how it can impact daily life.
2-Encourage open and empathetic communication within the family.
3-Offer practical strategies and tools that family members can incorporate
into their daily routines to support the individual with ADHD.
Formutate at least 4 Nursing diagnosis and make nursing
intervention for them?
1-Disturbed thought processes related to neurological disorder, dopamine
imbalance, as evidenced by: inability to concentrate, poor decision making
skills, inability to follow instructions, forgetfulness.
2- Compromised family coping related to: exhaustion of supportive system,
incorrect understanding of ADHD, family disorganization or role changes.
as evidenced by: frequent arguing, relationship problems, increased conflict.
3- Impaired social interaction related to hyperactivity secondary to ADHD
as evidenced by restlessness, inability to listen and verbalization of low self-
esteem
4-Risk for injury related to inability to remain still or seated for a short
period of time.
5-Risk for delayed development related to: delayed diagnosis,
developmental lag, genetics, prematurity, lead exposure .
 Actual
Nursing Goals Planning Nursing intervention Evaluation
diagnosis

Disturbed Long term 1. Assess the 1)Accept the patient as they 1-Patient able to
Thought 1-Patient and family's are. Considering their complete a task
Processes related their family will understanding of condition and without
to: Interact ADHD communicating with them becoming
Neurological appropriately 2-effective as an equal will boost their distracted
disorder with each other communication confidence and self-esteem 2-Patient
Evidenced by: 2-Patient and Inquire about the 2)use simple and direct display
Forgetfulness, their family will family's instructions. Should be clear improved
inability to verbalize understanding of and concise. control of
concentrate and knowledge and how to best 3)Visual aids or pictures emotions,
pay attention. understanding of support the may also be used for clarity concentration.
the condition client. 3)Avoid stimulating, and
.Short term: 3. Assess coping distracting surroundings. hyperactivity.
1)Patient will be methods 4) Provide positive 3-Patient
able to complete currently being reinforcements. demonstrate
a task without used Good deeds should be appropriate
becoming praised or rewarded. decision
distracted, Positive feedback should be making
2)Patient will given immediately to
display encourage good behavior
improved control 5) give patient his
of emotions, opportunity to express his
concentration, feelings
and hyperactivity 6)give patient simple
3), Patient will exercise can do it
demonstrate by himself to foster his
appropriate confidence.
decision 7)teach the patient new
making methods to
express his feelings 8)make
him integrate in new
exercises
which Provide his state
9. Encourage family and
marital counseling.
10) Educate on stress
management.
 Actual
Nursing diagnosis Goals Planning Nursing intervention Evaluation

Compromise Long term : 1. Assess the 1. Encourage family 1. The patient and
family coping 1-patient and their current level of and marital his family
related to : family will interact functioning of counseling. interacted
Incorrect appropriately with family 2. Suggest parental appropriately
understanding of each other, 2. Assess the training. with each other.
ADHD providing support patient's support 3. Educate on stress 2. The patient and
Evidenced by : and assistance as system and management his family
Relation problems indicated available resources 4. Encourage support understood of
2- Patient and their 3. Assess family groups condition and
family will history explore 5. Develop a trusting verbalized
verbalize roles of family relationship knowledge.
knowledge and members and with child convey 3. The patient's
understanding of circumstances acceptance of family verbalized
the condition. the child separate from available
Short-term: the unacceptable resources.
Patient's family will behaviors.
verbalize resources 6. Discuss with the
available for the child with those
client and behaviors that are not
themselves. acceptable.
7. Provide group
Situations for child
8. use therapeutic
communication
Using techniques such
as active listening,
reflecting, open-ended
questions, and even
silence, nurses can
foster trusting
relationships with
patients and
further explore barriers
to their ability to cope.
9. Offer positive
responses without false
reassurances.
10. Arrange for the
support.
 Actual
Nursing diagnosis goals Planning Nursing intervention Evaluation

Impaired Social - Short term: 1- Collaborate with 1: Establish trust and develop The patient
Interaction The patient the patient, family a therapeutic relationship performed
related to : will report members, and with the patient activities of
hyperactivity increased interdisciplinary team 2: Act upon inappropriately daily living as
secondary to satisfaction in to establish realistic behavior immediately. he became able
ADHD socialization goals for improving 3: Rotate staff who work to do while
Evidenced by and social interaction. with the patient. being able to
restlessness. relationships 2-Develop a 4: Explore the patient's vent out
inability to listen, Long term comprehensive plan of thoughts and feelings about feelings of
verbalization of 1)The patient care that includes relationship with family and frustration and
low self-esteem, will identify individualized other people. being able o
conflict with personal interventions to without judging or giving retain memory
parents and other behaviors that address the impaired suggestions at first Through
people are social interaction 5: Assess the anxiety level of memory
responsible 3- Prioritize the patient, anxiety triggers techniques.
for impaired interventions based on and symptoms by asking
social the patient's needs and open-ended questions.
interaction the identified barriers 6: Encourage the patient to
2)The patient to social interaction be independent and provide
will 4-Consider evidence- positive reinforcement for
participate in based practices and being able to do self-care and
group therapy interventions that have other independent behaviors.
twice per been successful in 7: Discuss with the patient
week improving social skills and significant others the
in individuals with available treatments for
developmental anxiety.
disabilities and 8: Encourage her to join
hyperactivity social events. Include her
5 - Collaborate with interests/previous hobbies in
other healthcare the activities of the social
professionals, such as group.
psychologists 9: Teach the patient to
occupational perform relaxation
therapists, speech techniques such as deep
therapists, or breathing exercises, guided
behavioral therapists, imagery, meditation, and
to develop a progressive muscle
comprehensive relaxation.
approach to address 10:Encourage the patien to
the patient's impaired comply with cognitive and
social interaction. behavioral therapies.
 Potential
Nursing diagnosis Goals Planning Nursing intervention Evaluation

Risk for Delayed Short term: 1- Identify additional 1. Identify additional factors
Development Patient will be factors affecting affecting development.
related to: able to perform development 2. Assess the patient's
Delayed self-care and 2- identify mental developmental levels
diagnosis self-control and physical continuously
Genetics Factor activities disabilities 3. Encourage psychological
appropriate for 3 Assess nutrition counseling.
their age. stats that can help the child learn
Long term: 4- assess the parent's time management skills,
1- Patient's development level control impulsive behavior
family will continuously and develop friendships.
verbalize their 4- Do not place blame.
understanding A child with ADHD may be
of the unable to control their
delay/deviation hyperactivity.
in development 5- Approach the patient
and plans for according to their level of
intervention. functioning.
2- Patient will 6- teach the child new way to
demonstrate develop mental state and
behavior and decrease distracting
social skills 7- make him interact with
appropriate to other to acquire skills
their age group 8- organize Educational
seminars for families to
notice these disorder early
9- Make Medical campaigns
to
diagnose these cases early
 Potential
Nursing diagnosis Goals Planning
Risk for injury Long term: - During assessment, the nurse
related to The client will gathers information through
inability to demonstrate direct observation and from
remain still or age the child's parents, daycare
seated for short appropriate providers (if any), and
period of time social skills. teachers.
-The client 1-History. Parents may
will complete report that child is fussy and
tasks. had problems as an infant; or
Short term they may have not noticed
-The client the hyperactive behavior
will be free of until the child was a toddler
injury. or entered daycare or school
The client will 2-General appearance and
not violate the motor behavior. The child
boundaries of cannot sit still in a chair and
others squirms and wiggles while
trying to do so: he or she
may dart around the room
with little or no apparent
purpose; the child may
appear immature or lag
behind in developmental
milestones.
3-Mood and affect. Mood
may be labile, even to the
point of verbal outbursts or
temper tantrums;
anxiety, frustration, and
agitation may be common.
4-Sensorium and intellectual
processes.
Ability to pay attention or to
concentrate is markedly
impaired; the child's
attention span may be as
little as 2 or 3 seconds with
severe ADHD or 2 or 3
minutes in milder forms of
the disorder.
Nursing intervention Evaluation
1)Provide an area
where the child can
move
around and release
excess energy
2)Remove harmful
objects (e.g. sharp
objects, etc.
3)Help the parents
identify risks for
injury
4)Discuss to the
parents how to
manage a
child who has ADHD.
5) Use side rails if
necessary
6put child In good
light environment
7)reassure child family
8) avoid unnecessary
movement
9)monitor sign of
complication
10)document patient
response to any
intervention
11)keep patient calm
as you can
1-Attention deficit hyperactivity disorder. NHS.
https://www.nhs.uk/conditions/attention-deficit-
hyperactivitydisorder-adhd/. Accessed Dec. 4, 2022
2-ADHD. Nemours Kids Health. https://kidshealth.
org/en/parents/adhd.html. Accessed Dec. 4, 2022
3-Doenges, M. E., Moorhouse, M. F. (1993). Nurses’s Pocket
Guide: Nursing Diagnoses with Interventions (4th Ed.). F.A. Davis
Company.
4-Attention Deficit Hyperactivity Disorder (ADHD): The Role of
Dopamine. Healthline.
https://www.healthline.com/health/adhd/adhddopamine#takeaway.
Accessed Dec. 8, 2022

5-https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3173906/