Attention Deficit Hyperactivity Disorder Comprehensive Nursing Paper Example

Attention Deficit Hyperactivity Disorder Comprehensive Nursing Paper Example

Patient Initials: P.C Age: 16 years Gender: Male Race: Non-Hispanic White

Subjective

Chief Complaint: “Yeah, that’s true. My grades have been getting worse, and I have difficulty listening to teachers.”

The patient admits he does not like any particular subject, but it is worse in Mathematics. He reports finding history more appealing, although he still experiences challenges concentrating well in class as he somehow gets distracted by something. The patient is currently negative about taking part in any sports, but he reckons having participated in baseball and basketball in high school. However, with school performance in the dip, he feels he cannot get time even though the mother would allow sports. He affirms forgetting his take-home assignments for one reason, like, a forgotten notebook, missing pen, or even some necessary materials. He thinks his progress disappoints his mother but admits hardly taking any initiative to change as he feels it’s beyond his control. Patient reports having a poor relationship with his father and a sister. He denies enjoying video games as they distract him from his everyday life but admits liking outdoor activities since they allow him to be active. He feels ‘mum doesn’t think I am doing anything. The patient also reports getting inadequate sleep due to video games, but he can’t establish a connection between his dropping school performance and poor concentration in class(UMass Nursing 690M (2016). (Attention Deficit Hyperactivity Disorder Comprehensive Nursing Paper Example)

Objective:

Mental Status Exam (MSE) findings

The patient can accurately repeat words in the order provided (in this case, he repeated three words). He can effectively remember and repeat the three words after a few minutes. The patient can also correctly spell the words provided (Soltan & Girguis, 2017). (Attention Deficit Hyperactivity Disorder Comprehensive Nursing Paper Example)

MSE

Orientation: A.O.*4, meaning the patient is alert and can correctly identify himself, tell the time, place, and situation as evidenced by his response to questions Who are you?/What’s your name? Where are you at the moment? What day of the week are we in, and the date?, Do you know why you are here? (Attention Deficit Hyperactivity Disorder Comprehensive Nursing Paper Example)

Appearance: The patient was well-groomed, appropriately dressed, and appeared his stated age.

Speech and Language: The patient spoke slightly fast on average, speaking more than 150 words per minute.

Attitude: The patient was composed and cooperative.

Mood: The patient kept on fidgeting, indicative of an anxious disposition.

Concentration: The patient had impaired concentration. (Attention Deficit Hyperactivity Disorder Comprehensive Nursing Paper Example)

Thought processes and associations: Logical and coherent as the organization and formulation of thought was clear, easy to follow, and logical. There was circumstantiality in the thoughts as the patient gave lots of extra details but still got to the point.

Suicidal /homicidal ideations: The patient did not exhibit any suicidal or homicidal ideations. 

Memory: Found to be intact.

Insight: Altered since the patient could not see the connection between the times spent playing video games and his lack of sleep at home or concentration in class. (Attention Deficit Hyperactivity Disorder Comprehensive Nursing Paper Example)

Judgment: Poor-The patient could not reach a sensible conclusion when presented with information to help in sound decision making.

Labs, test results, and vitals were not applicable as none was taken or administered.

Review of Systems (ROS) –

The patient denies having a headache or head trauma, no ear, eye, nose, or throat infections. He reports negative for fever, chills, malaise, weight loss, neck pain, or chest stiffness. He denies dyspnea, abdominal pain, diarrhea, constipation, urinary symptoms, and joint or back pain. (Attention Deficit Hyperactivity Disorder Comprehensive Nursing Paper Example)

General Physical examination reveals an overweight but well-appearing adolescent. Temperature 37.7 blood pressure 18/77, and pulse 85. The patient is negative for proptosis, conjunctiva infection, lid swelling, or chemosis. The cardiac exam found a regular rate and no murmurs. (Attention Deficit Hyperactivity Disorder Comprehensive Nursing Paper Example)

 Psychiatric screening measure results 

The NICHQ Vanderbilt Assessment Scales tool was administered, and results met the DSM-IV criteria for diagnosis of ADHD. (Attention Deficit Hyperactivity Disorder Comprehensive Nursing Paper Example)

Risk Assessment

The patient denies suicidal ideations and homicidal ideations. He has no reported history of domestic violence, although he admits frustrations due to his symptoms. Be that as it may, the patient is at risk of legal implications due to impulsivity with ADHD condition, putting him at a high risk of engaging in criminal activity and subsequent legal action(Philipp- Weigman et al., 2018). (Attention Deficit Hyperactivity Disorder Comprehensive Nursing Paper Example)

Assessment 

Differential Diagnosis 

1. Attention Deficit Hyperactivity Disorder (ADHD), unspecified type F90.9 Confirmed.

A primary diagnosis of ADHD, unspecified type ICD-Code F90.9 was confirmed as the patient exhibited more than six of the symptoms for ADHD lasting more than six months. According to Carr et al. (2016), these symptoms include but are not limited to challenges in sustaining attention, gets distracted easily, is forgetful, restless, and has poor organization. Likewise, the NICHQ Vanderbilt Assessment Scales tool was administered, and results met the DSM-IV criteria for diagnosis of ADHD.  (Attention Deficit Hyperactivity Disorder Comprehensive Nursing Paper Example)

2. Manic Depressive disorder (MDD) – Refuted

While MDD shares similar clinical manifestations like poor memory, attention, and concentration leading to challenges in completion, it was ruled out. This is because the patient did not exhibit enduring dysphoric mood and suicidal ideations. (Attention Deficit Hyperactivity Disorder Comprehensive Nursing Paper Example)

3. Anxiety Disorder Unspecified F41.9 Refuted

Despite fidgeting and difficulties in concentration that could indicate generalized anxiety disorder, GAD was refuted because the patient did not exhibit somatic symptoms of anxiety and exaggerated worry or apprehension. (Attention Deficit Hyperactivity Disorder Comprehensive Nursing Paper Example)

Obstacles to Treatment

The patient has a persistent problem of forgetfulness that could significantly interfere with his adherence to the prescribed medication. The patient lacks a cohesive social and family support network that would play a key role in helping the patient to become self-organized and self-management. As the social history indicates, the second-year high school student does not relate well with his high school mates. Likewise, poor relations between him, his father, and his sister existed. Nimmo- Smith et al. (2020) opine that these, amongst other factors, would limit the chances of optimal outcomes. (Attention Deficit Hyperactivity Disorder Comprehensive Nursing Paper Example)

Plan

The treatment plan comprises a medication intervention where Methylphenidate is initiated at a daily dose of 5 to 10mg to be raised incrementally to a target dose of 40 to 90 mg daily. Like dextroamphetamine, Methylphenidate is effective in improving attention and concentration. This medication is also known to reduce impulsivity in teenagers and adults diagnosed with ADHD. The patient will take medicine for four weeks before a review is conducted. (Attention Deficit Hyperactivity Disorder Comprehensive Nursing Paper Example)

Non-pharmacological interventions like psychotherapy, specifically cognitive behavioral therapy (CBT) and individual counseling, will be incorporated to act as adjunctive therapy to the medications. The treatment goal of CBT is to train the brain to appropriately respond to the primary roles of the patient’s life. The patient will receive a maximum of two sessions every week and last for four weeks. (Attention Deficit Hyperactivity Disorder Comprehensive Nursing Paper Example)

Referrals

The patient gets a referral to get neuropsychological Testing to assess an ADHD diagnosis. According to Ng et al. (2019), referral to get behavioral therapy intervention would significantly help monitor the symptoms. (Attention Deficit Hyperactivity Disorder Comprehensive Nursing Paper Example)

References

Carr, K., RHIT, CCS, CDIP, CCDS, & Trainer, A. I. (2016, May 16). Accurate ICD-10-CM coding for ADHD Assists with Research and Data Collection. ICD-10 News and Information – ICD10monitor

Ng, R., Heinrich, K., & Hodges, E. K. (2019). Brief Report: Neuropsychological Testing and Informant-Ratings of Children with Autism Spectrum Disorder, Attention-Deficit/Hyperactivity Disorder, or Comorbid Diagnosis. Journal of Autism & Developmental Disorders, 49(6), 2589–2596.

Nimmo-Smith, V., Merwood, A., Hank, D., Brandling, J., Greenwood, R., Skinner, L., … & Rai, D. (2020). Non-pharmacological Interventions for Adult ADHD: A Systematic Review. Psychological Medicine, 50(4), 529-541

Philipp-Wiegmann, F., Rösler, M., Clasen, O., Zinnow, T., Retz-Junginger, P., & Retz, W. (2018). ADHD modulates the course of delinquency: a 15-year follow-up study of young incarcerated man. European Archives of Psychiatry & Clinical Neuroscience, 268(4), 391–399. 

Soltan, M., & Girguis, J. (2017). How to approach the mental state examination. BMJ: British Medical Journal, 357.

UMass Nursing 690M. (2016). Psychiatric Interview and Mental Status Exam: Georgianna Shea, Case Study #2. YouTube. https://www.youtube.com/watch?v=pF12xCtHWwc