What is adhd?
- developmentally inappropriate degree of inattention, hyperactivity and impulsivity
what the dsm-5 diagnosis?
persistent pattern of innatention and/or hyperactivity-impulsivity that is more freq displayed and more severe than is observed in individuals at a comparable lvl of development
what are signs of inattention?
- doesnt pay attention
- daydreaming
- easily distracted from work or play
- doesnt follow through w instructions
- disorganized
- avoidance of doing task that req mental focus
- forgetful of daily activities
what are signs of hyperactivity?
- in constant motion
- cant stay still
- fidgets
- runs, jumps, climbs when not permitted
- diff w engaging in leisure activity quietly
what are signs of impulsivity?
- freq acts or speaks without thinking
- running into traffic without looking
- impatient
- calls out answer without raising hand
- interrupts others
- difficulty waiting for turn
How is ADHD displayed in adults?
- trouble concentrating
- restlessness
- diff completing task
- disorganized
- impulsive
- low frustration tolerance
- freq mood swings
- hot temp
- trouble coping w stress
- unstable relationship
what are some myths related to adhd?
these things cause adhd:
- sugar
- food dyes
- watching tv
- poor family life (however, can have negative impact on fx of home)
what is the etiology of adhd?
genetics
brain inju
exposure to env toxins
exposure to harmful subs during pregnancy
what conditions mimic adhd? its important to rule these out
- emotional problem/ abuse
- learning disabilities
- petit mal (absent) seizure
- vision and hearing problem
- brain injury
- sleep disorder
what is the phenomology of adhd?
- poor school performance
- trouble w law
- problems at work
- alcohol and drug abuse
- freq car accidents
- unstable rel
- financial stress
- poor physical and mental well being
how do you diagnose adhd? what are the 4 criterias?
1) must have at least 6-9 symp for one of the adhd subtypes
2) childhood onset of symp (age 7 or younger)
3) impairment in at least 2 of the following:
- work
- school
- social setting
4) symp cant be episodic (must exist for at least 6mo)
what are the subtypes of adhd?
- innatentive
- hyperactive
- impulsive
what are some strategies for parents with kids whi have adhd?
- be consistent, set limits and have clear consequences for childs behavior
- put together daily routine (bedtime, morningtime, mealtime, simple chores, tv)
- avoid multitasking when taking to child, make eye contact when giving instructions
- set aside couple minutes q day to praise child
- work w teacher
- simplify childs schedule
- quite work environemnt
- encourage engagement in sports and social activities
- limit amount of time spent on tv and video games
- set clear expectation and rules
- encourage healthy eating habits
- encourage friendships
what pharmacological medications are used for adhd?
- psychostimulants
- non stimulants (SSRI, selective aplha 2 adrenergic receptor antagonist, TCA)
What are psychostimulants?
1st line therapy => improves focus, self-control, working memory and creative thinking
increases dopamine (may produce euphoria -> abuse for recreational use = aggression and paranoia)
must be tapered bcz associated w withdrawal syndrome
2 kinds:
1) methylphenidate (concerta, biphentin, ritalin)
2) amphetamine (vyvanse, adderall)
what are nursing considerations related to concerta?
ages 6-65
not for pt w underlying heart cond
extended rel tabs only
what are nursing considerations related to biphentin?
not available in short acting (action = 10-12 hr)
for kids w diff swallowing pills
what are nursing considerations related to ritalin?
short and long acting (up to 4h or 8h)
prefer prescribing long acting and adding short prn as “top off”
dont crush
what are nursing considerations related to vyvanse?
NOT ON EXAM
minimun 6 yo
cant be used w moai
can be used for being eating disorder
action = 10-12 h
what are nursing considerations related to adderall?
NOT ON EXAM
short acting (4-6h) and extended rel (10-12h)
may cause slow growth in children
what are the side effects of psychostimulants? what should you immediately report?
- decreased appetite
- peaks at lunch time
- eat nutritious breakfast before taking pill in am
- provide snack (at lunch + hungry as med wears off) - insomnia
- takes time to readjust (4-6 wks)
- encourage quiet activity before bed
- provide bed time routine
- avoid TV, caffeine, large meals before bed
- encourage child to keep an open dialogue abt stress
inducing situations - anxiety
- irritability
- nausea
- take w food
- eventually subsides - dizziness
- increased bp + hr + temp
immediately report:
- heart palpitations
- suicidal thoughts
- changes in mood and personality
- irritability for long periods of time
- tics
- aggressive or paranoid thoughts
what are nursing considerations related to the ssri: atomoxetine?
NOT ON EXAM
for ppl w underlying anxiety
first line for non stimulants
action = 24h
side effects: nausea, upset stomach, decreased appetite, wt loss, fatigue, mood swings, drowsiness
what are nursing considerations related to the selective alpha 2 adrenergic receptor agonist: guanfacine?
NOT ON EXAM
dont dc abruptly (can increase bp and hr)
action 24h
avoid grapejuice
side effects: bradycardia, syncope, dry mouth, drowsiness, irritability, wt gain, nausea, irritability upset stomach
what are nursing considerations related to TCAs?
NOT ON EXAM
used if underlying depression
adjunctive therapy
increases serotonin and norepi
side effects: dry mouth, constipation or urinary ret
