psychiatry nursing

1. Attention-Deficit/Hyperactivity
Disorder (ADHD)

2. DEFINITION
Attention deficit-hyperactivity
disorder (ADHD) is a persistent
pattern of inattention and/or
hyperactivity-impulsivity that
is more frequent and severe than
is typically observed in
individuals at a comparable
level of development.

3. Hyperactivity
Excessive psychomotor activity accompanied by
physical movements and verbal sounds that are
usually more rapid than normal.
Inattention
Failure to carefully think about, listen to, or watch
someone or something : lack of attention.

4. Impulsiveness
 The trait of acting without thought to
the consequences of the behavior.
Inability to resist acting.

5.  Symptoms present before age 6
 In ICD11 it comes under F90
Hyperkinetic disorder.
 These kind of children are highly
distractible.
 Motor activity is excessive and
movements are random and impulsive.

6. EPIDEMIOLOGY
 More common in boys than in girls
 10 percent prevalence in school-age children.

7. ETIOLOGICAL FACTORS
GENETIC FACTORS
 Biological parents have higher risk of
transmission.
 Greater risk in monozygotic than in
dizygotic twins

8. BIOCHEMICAL THEORY
 Neurotransmitter differences,
particularly in levels of:Low
 Dopamine
 Norepinephrine
 Serotonin
 Their involvement is still under
investigation.

9. Brain Structure abnormality
 Abnormalities in
Prefrontal cortex( maintain
attention)
Basal ganglia(regulate motor
movements)

10. Prenatal and Postnatal Factors
 Includes :
 prematurity or low birth weight,
 signs of fetal distress,
 exposure to toxic substances including
alcohol and maternal smoking during
pregnancy.
 prolonged labor
 Birth asphyxia

11.  Postnatal factors that have been
implicated include central
nervous system (CNS)
abnormalities resulting from
trauma, infections.

12. Psychosocial Influences
 A high degree of psychosocial
stress, maternal mental disorder,
paternal criminality, low
socioeconomic status, growing up
in orphanage may increase risk in
predisposed individual.

13.  Environmental Influences
Environmental Lead
 Studies provide evidence of adverse
effects on cognitive and behavioral
development in children with
elevated body levels of lead.

14. A Possible Developmental Pathway for ADHD

15. SIGN AND SYMPTOMS

16. INATTENTION
 fails to give close attention or makes
careless mistakes in schoolwork, work
or other activities.
 difficulty sustaining attention in tasks or
play activities.

17. INATTENTION
 does not seem to listen when spoken to
directly.
 Often does not follow instructions and
fails to finish schoolwork or duties in
the workplace.
 has difficulty organizing tasks and
activities.

18.  avoids, dislikes or does not engage in tasks
that require sustained mental effort (e.g.,
homework).
 loses things necessary for tasks or activities
(e.g., toys, pencils, books)
 easily distracted by extraneous stimuli.
 Is often forgetful in daily activities.

19. Hyperactivity
 Often fidgets[small movement] with
hands or feet.
 leaves seat in classroom or in other
situations in which remaining seated is
expected.
 runs about or climbs excessively

20. Hyperactivity
 has difficulty playing or engaging in
leisure activities quietly.
 talks excessively.

21. Impulsivity
 Often blurts out answers before
questions have been completed.
 Often has difficulty waiting turn.
 Often interrupts or intrudes on others
(e.g. butts into conversations or games).

22. DIAGNOSIS
 Detailed history from parent and
caretaker
 Complete medical evaluation with
emphasis on neurological evaluation .

23. DIAGNOSIS
 Assess intellectual ability, academic
achievement and learning disorder
problem.
 Direct observation, teacher school
report, parents report.
 Based on Icd-11/DSM-V.

24. DIAGNOSIS
ICD-11 criteria for the diagnosis of ADHD
 Occurrence before 6 yrs of age
 Any two symptoms must be present
 Poor attention span with distractibility.
 Hyperactivity
 Impulsivity
 Should not be associated with other
psychiatric disorder

26. PHARMACOTHERAPY
 CNS Stimulant.
 Methylphenidate
 Dextroamphetamine
 These medications
reduce ADHD symptoms by:
 releasing NOR and DOP availability in in
certain brain regions: PFC and basal
ganglia

27. Other medication includes
 Antidepressant:
 Nortriptyline
 Imipramine
 sertraline
 Clonidine - Ccentrally
acting drug

28. PSYCHOLOGICAL THERAPIES
Behavioural therapy:
It trains parents and teachers how to
help children's set goals and meet
them by using rewards and punishment

29.  Behavioural modification technique.
• Structured routines for children
• Clear rules/expectations
• rewards
• Planned ignoring
• Effective commands
• Time out/loss of privileges
• Point/token systems

30.  Psycho education about ADHD
 Social skill training
 Family education

31. NURSING
MANAGEMEN
T

32. NURSING ASSESSMENT
 Complete history from parents and caretaker
 Developmental milestone assessment
 Complete medical evaluation with emphasis on
neurological evaluation.
 Assess intellectual ability, academic
achievement and learning disorder problem.

33. Nursing Diagnosis
● Risk for injury related to impulsive and accident prone
behavior and the inability to perceive self harm as evidenced
by hyperactivity and restlessness.
● Impaired social interaction related to intrusive and immature
behavior as evidenced by poor social interaction.
● Noncompliance with task expectations related to short
attention span as evidenced by inattention and distractibility.
● Low self-esteem related to dysfunctional family system and
negative feedback as evidenced by negative evaluation and
lack of confidence.

34. NURSING DIAGNOSIS: RISK FOR INJURY
 Ensure that client has a safe environment.
 Remove objects from immediate area on which
client could injure self as a result of random
hyperactive movements.
 Identify behaviors that put the child at risk for
injury.
 If there is risk of injury associated with specific
activities, provide adequate supervision and
assistance.

35. NURSING DIAGNOSIS: IMPAIRED
SOCIAL INTERACTION
 Develop a trusting relationship with the child.
 Convey acceptance of the child separate from
the unacceptable behavior.
 Discuss with client those behaviors that are
and are not acceptable.
 Describe in a matter-of-fact the consequences
of unacceptable behavior.
 Provide group situations for client.

36. NURSING DIAGNOSIS: LOW SELF-
ESTEEM
 Ensure that goals are realistic.
 Plan activities that provide opportunities for
success.
 Convey unconditional acceptance and
positive regard.
 Offer positive reinforcement for attempts
made.
 Give immediate positive feedback for
acceptable behavior.

37. NURSING DIAGNOSIS:
NONCOMPLIANCE (WITH TASK
EXPECTATIONS)
 Provide an environment for task efforts
that is as free of distractions as possible.
 Provide assistance on a one-to one basis,
beginning with simple, concrete
instructions.
 Ask client to repeat instructions to you.
 Establish goals that allow client to
complete a part of the task, rewarding
each step completion with a break for
physical activity.

38.  Gradually decrease the amount of assistance given, while
assuring the client that assistance is still available if
deemed necessary

39. NURSING
EVALUATION

40. THANK YOU