Boyd 8e

788

UNIT VII • Care of Children and Adolescents

CLINICAL JUDGMENT NURSING CARE PLAN 37.1 The Child With ADHD

Jamie was referred to a home health agency for evaluation by the school counselor who was alerted by the teacher of impulsive and disruptive behavior in class. His mother Lillian had not realized that Jamie’s behavior as unusual but willingly followed up with an appointment.

Setting: Psychiatric Home Care Agency Assessment Cues: Jamie is a 6-year-old with prominent hyperactivity and disruptive behavior. He lives with Lillian, his single mother. These issues interfere with his interpersonal relationships and academic progress. Lillian is discouraged and feels unable to manage Jamie’s behavior.

Associated Psychiatric Diagnosis

Medications

Attention-deficit hyperactivity disorder (ADHD)

Methylphenidate 7.5 mg at breakfast and lunch (i.e., at 8 am and 12 noon) and then adding 5 mg at 7 pm

Priority Hypothesis: Difficulty in Social Relationships

Important Characteristics

Associated Considerations

Impulsive behavior Overactive Inattentive Risk-taking behavior (tried to climb out the window to get away from his mother) Failure to recognize effects of his behavior on others

Cannot establish and maintain developmentally appropriate social relationships Has interpersonal difficulties at school Is not well accepted by peers

Is easily distracted Interrupts others Cannot wait his turn in games Speaks out of turn in the classroom

Planning Recovery and Wellness Outcomes

Initial

Discharge

Decrease hyperactivity and disruptive behavior. Improve attention and decrease distractibility. Decrease frequency of acting without forethought.

Improve capacity to identify alternative responses in con flicts with peers. Improve capacity to interpret behavior of age mates.

Taking Action: Nursing Interventions

Intervention

Rationale

Ongoing Assessment

Educate mother and teach about ADHD and use of stimulant medi cation.

Better understanding helps to ensure adherence; also, parents and teachers often miscast children with ADHD as “troublemakers.” Uneven adherence may contribute to failed trial of medication.

Determine the extent to which parent or teacher “blames” Jamie for his issues. Administer parent and teacher ques tionnaires; inquire about behavior across entire day. Administer parent and teacher ques tionnaires; check height and weight; ask about sleep and appetite.

Monitor adherence to medication schedule.

Ensure that medication is both effective and well tolerated.

Stimulants can affect appetite and sleep.

Evaluation

Outcomes

Revised Outcomes

Interventions

Jamie shows decreased hyperactivity and less disruption in the classroom.

Improve ability to identify disruptive classroom behavior.

Initiate point system to reward appro priate behavior.

Copyright © 2026 Wolters Kluwer, Inc. Unauthorized reproduction of this content is prohibited.