ADHD Nursing Diagnosis & Care Plan

Attention deficit hyperactivity disorder (ADHD) is a condition that affects mental functioning and behavior, marked by an ongoing pattern of restlessness, difficulty concentrating, hyperactivity, and impulsivity. People with ADHD may also present with anxiety, depression, and sleep disorders.

ADHD often becomes noticeable in childhood, usually when a child starts going to school and continues into adulthood. While the symptoms of inattention, hyperactivity, and impulsivity occur in most people at certain times, for those with ADHD, symptoms are more severe, frequent, and interfere with daily responsibilities.

Symptoms of inattention include:

  • Making careless mistakes
  • Difficulty maintaining concentration
  • Appearing not to listen when spoken to
  • Difficulty following instructions
  • Poor organization skills
  • Losing items necessary for completing tasks
  • Forgetfulness

Symptoms of hyperactivity and impulsivity include:

  • Fidgeting
  • Inability to sit still
  • Inability to work or play quietly
  • Excessive talking
  • Interrupting
  • Difficulty waiting for one’s turn

The exact cause is unknown, but several factors may contribute to ADHD:

  • Premature birth
  • Low birth weight
  • Smoking, alcohol, or drug abuse during pregnancy
  • Genetics
  • Environmental factors

Diagnosis is usually made through a physical exam to rule out other causes, questionnaires, and psychological testing. There is no cure for ADHD, but it is manageable with counseling, and medications if necessary.

Nursing Process

Nurses may care for patients with ADHD in an array of settings, such as schools, community settings, and when admitted for inpatient care. Nurses are involved with educating parents of children with ADHD and may recommend appropriate mental health services. Nurses collaborate with counselors, special education teachers, social workers, and more to care for patients with ADHD.

Nursing Care Plans Related to ADHD

Risk for Delayed Development

Patients with ADHD are at risk for delayed development in behavior, social skills, and learning.

Nursing Diagnosis: Risk for Delayed Development

Related to:

  • Delayed diagnosis
  • Developmental lag
  • Genetics
  • Prematurity
  • Lead exposure 

As evidenced by:

A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred, and the goal of nursing interventions is aimed at prevention.

Expected outcomes:

  • Patient will be able to perform self-care and self-control activities appropriate for their age.
  • Patient’s family will verbalize their understanding of the delay/deviation in development and plans for intervention.
  • Patient will demonstrate behavior and social skills appropriate to their age group.

Assessment:

1. Identify additional factors affecting development.
Along with ADHD, additional factors may affect development, such as other mental or physical disabilities, poverty, poor nutrition, failure to thrive, and abuse or neglect.

2. Assess the patient’s developmental levels continuously.
Monitoring ongoing growth through improvements on tests, following instructions, organization, and more will provide supporting evidence to evaluate whether interventions are effective and if any additional actions are needed.

Interventions:

1. Encourage psychological counseling.
Counseling can help the child learn time management skills, control impulsive behavior, improve self-esteem, and develop friendships.

2. Incorporate learning accommodations.
The child with ADHD should be given accommodations to meet their learning needs. This may include extended testing times, 1:1 tutoring, and reduced classwork loads.

3. Approach the patient according to their level of functioning.
Conversing with the patient appropriately will help promote intellectual conversations, encouraging them to feel capable of their own thoughts.

4. Do not place blame.
A child with ADHD may be unable to control their hyperactivity, outbursts, interruptions, and frustrations. Remain calm and patient when interacting with them to prevent feelings of inadequacy or shame.


Disturbed Thought Processes

ADHD causes low levels of the neurotransmitter dopamine, which helps control movements and emotions, and can cause altered thinking.

Nursing Diagnosis: Disturbed Thought Processes

Related to:

  • Neurological disorder
  • Dopamine imbalance

As evidenced by:

  • Inability to concentrate
  • Poor decision-making skills
  • Inability to follow instructions
  • Forgetfulness

Expected outcomes:

  • Patient will be able to complete a task without becoming distracted.
  • Patient will display improved control of emotions, concentration, and hyperactivity.
  • Patient will demonstrate appropriate decision-making.

Assessment:

1. Assess the patient’s attention span or distractibility.
This will help determine their level of decision-making and problem-solving to evaluate if they can participate in planning and carrying out interventions.

2. Review test results, questionnaires, and progress notes.
The nurse can review the results of physician progress notes or the evaluations of mental health professionals to determine how to handle further interactions.

Interventions:

1. Accept the patient as they are.
Considering their condition and communicating with them as an equal will boost their confidence and self-esteem.

2. Use simple and direct instructions.
Instructions should be clear and concise due to the patient’s short attention span. Visual aids or pictures may also be used for clarity.

3. Avoid stimulating, distracting surroundings.
Making sure that the environment is conducive to concentration will prevent the patient from becoming easily distracted and unable to concentrate.

4. Provide positive reinforcements.
Good deeds should be praised or rewarded. Positive feedback should be given immediately to encourage good behavior.


Compromised Family Coping

Family members may have difficulty providing efficient support or guidance to the client with ADHD.

Nursing Diagnosis: Compromised Family Coping

Related to:

  • Exhaustion of supportive system
  • Incorrect understanding of ADHD
  • Family disorganization or role changes

As evidenced by:

  • Frequent arguing
  • Defiance
  • Relationship problems
  • Increased conflict

Expected outcomes:

  • Patient and their family will interact appropriately with each other, providing support and assistance as indicated.
  • Patient and their family will verbalize knowledge and understanding of the condition.
  • Patient’s family will verbalize resources available for the client and themselves.

Assessment:

1. Assess the family’s understanding of ADHD.
A lack of knowledge may be a barrier to coping and effective communication. Inquire about the family’s understanding of how to best support the client.

2. Assess coping methods currently being used.
Families with maladaptive coping skills may need additional instruction on effective coping strategies.

Interventions:

1. Encourage family and marital counseling.
Families may require counseling to learn to express themselves and work through conflicts. Parents of a child with ADHD may need marital counseling as the disorder can be stressful on their relationship.

2. Suggest parental training.
Parents can take classes to learn how to manage, discipline, and reward their child with ADHD.

3. Educate on stress management.
Family members need to take time for personal stress management. This can include exercise, adequate sleep, time with friends, and time alone.

4. Encourage support groups.
The family can be directed toward support groups to vent and learn from other families with similar concerns.


References

  1. Attention deficit hyperactivity disorder. NHS. https://www.nhs.uk/conditions/attention-deficit-hyperactivity-disorder-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/adhd-dopamine#takeaway. Accessed Dec. 8, 2022
  5. Family Functioning, Psychological Distress, and Well-Being in Parents with a Child Having ADHD. Sage Journals. https://journals.sagepub.com/doi/10.1177/2158244015626767. Accessed Dec 8, 2022
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Maegan Wagner, BSN, RN, CCM

Maegan Wagner is a registered nurse with over 10 years of healthcare experience. She earned her BSN at Western Governors University. Her nursing career has led her through many different specialties including inpatient acute care, hospice, home health, case management, travel nursing, and telehealth, but her passion lies in educating through writing for other healthcare professionals and the general public.