P age |1

A. INTRODUCTION Background of the Study ADHD (attention deficit hyperactivity disorder) is the most common behavioral disorder that starts during childhood. However, it does not only affect children - people of all ages can suffer from ADHD. Psychiatrists say ADHD is a neurobehavioral developmental disorder. An individual with ADHD finds it much more difficult to focus on something without being distracted. He has greater difficulty in controlling what he is doing or saying and is less able to control how much physical activity is appropriate for a particular situation compared to somebody without ADHD. In other words, a person with ADHD is much more impulsive and restless. Health care professionals may use any of the following terms when describing a child (or an older person) who is overactive and has difficulty concentrating - attention deficit, attention deficit hyperactivity disorder, hyperkinetic disorder, hyperactivity. North Americans commonly use the terms ADD (attention deficit disorder) or ADHD (attention deficit hyperactivity disorder). In the UK hyperkinetic disorder is the official term - however, ADD and ADHD have become widely used. ADHD in children is completely different from normal childhood excited and boisterous behavior. Many children, especially very young ones, are inattentive and restless without necessarily being affected by ADHD. The Centers for Disease Control and Prevention (CDC) estimates that approximately 4.4 million children aged 4 to 17 have been diagnosed with ADHD in the USA by a

P age |2

healthcare professional. As of 2003 two-and-a-half million American children aged 4 to 17 are being treated for ADHD with medicines. The CDC adds that in 2003 7.8% of all school-aged American children were reported to have an ADHD diagnosis by their parent. Three types of ADHD According to the CDC, there are three types of ADHD. They are defined according to which symptoms stand out the most. 1. Predominantly Inattentive Type The person finds it very difficult to organize or finish a task. They find it hard to pay attention to details and find it difficult to follow instructions or conversations.

2. Predominantly Hyperactive-Impulsive Type The person finds it hard to keep still - they fidget and talk a lot. A smaller child may be continually jumping, running or climbing. They are restless and impulsive - interrupting others, grabbing things and speaking at inappropriate times. They have difficulty waiting their turn and find it hard to listen to directions. A person with this type of ADHD will have more injuries and/or accidents than others.

3. Combined Type A person whose symptoms include all those of 1 and 2, and whose symptoms are equally predominant. In other words, all the symptoms in 1 and 2 stand out equally.

P age |3

Objective of the Study

The main scheme for this study could be very helpful for everyone potentially at risk to have the disease. What I hope to achieve after this study are the following:

 To be able to identify and analyze etiology of the underlying cause of the disease  To be able to give relation between another theoretical framework and the chosen diagnosis; which is ADHD or Attention-Deficit/Hyperactivity Disorder .  To discuss Anatomy and Physiology of the of the related disease.  To establish essential nursing intervention to be implemented for the patients wellness and recovery Theoretical Framework

Joyce Travelbee Joyce Travelbee was a psychiatric nurse practitioner, educator, and writer. Born in 1926, she completed her basic nursing preparation in 1946 at Charity Hospital School of Nursing in New Orleans. She earned a B.S degree in nursing education from Louisiana State University in 1956 and an M.S degree in nursing from Yale in 1959. In the summer of 1973, Travelbee began a doctoral program in Florida; however, she was unable to complete the program because she died later that year. She died at the age of 47 after a brief illness, leaving no survivors.

P age |4

Travelbee began her career as a nursing educator in 1952, teaching psychiatric nursing at Depaul Hospital Affiliate School, New Orleans, while working on her baccalaureate degree. She also taught psychiatric nursing at Charity Hospital School of Nursing, Louisiana State University, New York University in New York City, and the University of Mississippi in Jackson. In 1970, she was named Project Director at Hotel Dieu School of Nursing in New Orleans. At the time of her death, Travelbee was the director of graduate educate at Lousiana State University School of Nursing. Travelbee began publishing articles in nursing journals in 1963. Her first book, Interpersonal Aspects of Nursing, was published in 1966 and 1971, a second book, Intervention in Psychiatric Nursin: Process in the the One-to-One Relationship, was published in 1969. It was edited by Doona and published in 1979 as Travelbee Intervention in Psychiatric Nursing. HUMAN-TO-HUMAN RELATIONSHIP A human-to-human relationship is primarily an experience or series of experiences between a nurse and the recipient of her care. The major characteristic of these experiences is that the nursing needs of the individual (or family) are met. The human-to-human relationship, in nursing situations, is the means through which the purpose of nursing is accomplished. The human-to-human relationship is established when the nurse and the recipient of his or her care attain a rapport after having progressed through the stages of the original encounter, emerging identities, empathy, and sympathy.

P age |5

The human-to-human relationship model, shown in figure 1.1, represents the interaction between the nurse and the patient. The first circles on the bottom at the point of the original encounter indicates possibility of and need for developing the encounter into a therapeutic relationship. As the interaction process progresses toward rapport, the circles join into one full circles, representing that the potential for a therapeutic relationship has been attained. Original encounter. The original encounter is characterized by the first impression by the nurse of the ill person and by the ill person of the nurse. The nurse and patient perceive each other in stereotype roles.

P age |6

Emerging identities. The emerging identities phase is characterized by the nurse and patient perceiving each other as unique individuals. The bond of a relationship is beginning to form. Empathy. The empathy phase is characterized by the ability to share in the other persons experience. The result of the empathic process is the ability to predict the behavior of the individual with whom he or she has empathized . Travelbee believed that two qualities that enhanced the empathy process were similarities of experience and the desire to understand another person. Sympathy. Sympathy goes beyond empathy and occurs when the nurse desires to alleviate the cause of the patients illness and suffering. When one sympathizes, one is involved but not incapacitated by the involvement. The nurse is to create helpful nursing action as a result of reaching the phase of sympathy. This helpful nursing action requires a combination of the disciplined intellectual approach combined with the therapeutic use of self Rapport. Rapport is characterized by nursing actions that alleviate a patients distress. The nurse and ill person are relating as human being. The ill person exhibits both trust and confidence in the nurse. A nurse is able to establish rapport because she possesses the necessary knowledge and skills required to assists ill persons, and because she is able to perceive, respond to, and appreciate the uniqueness of the ill human being.

P age |7

B. PATIENTS DATA BASE y Name: Address: Age: Sex: Civil Status: Religion: Medical Diagnosis: Patients Profile Patient LU Quezon City 13 years old Male Single Roman Catholic Attention-deficit/hyperactivity disorder (ADHD)

Past Medical History According to patient Lu. He was born via breech position forcep delivery. He had

asthma before, the last time he suffer from it was in the year 2009 and the other was just a simple fever, cough and colds. He declared that he have complete vaccination / immunizations taken in the past. Last 2004 his head was bump by the car door leaving a scar on his forehead. Family Medical History Lu stated that on his father side they have a history of skin diseases and on the side of his mother they have a history of having tuberculosis.

P age |8

Social History Patient Lu is a grade 3 student. He likes to play basketball with his friends. He

drinks alcoholic beverages like matador and he started smoking when he was 10 years old. He usually goes to Albay with his family every summer. Environmental Histor They live in a depressed area near the highway. Thier house is made up of stones. There is a small canal beside their kitchen. Their street is full of bystanders that was always fighting and arguing. His parents are always fighting because of financial problem.

P age |9

PHYSICAL ASSESSMENT

Physical examination follows a methodical head to toe format in the Cephalocaudal assessment. This is done systematically using the techniques of inspection, palpation, percussion and auscultation with the use of materials and investments such as the penlight, and stethoscope and also the senses. During the procedure, I made every effort to recognize and respect the patients feelings as well as to provide comfort measures and follow appropriate safety precautions. This was taken on March 4, 2011

General Appearance and Mental Status: He wears a polo shirt and a khaki pants as school uniform with black undershirt and a black shoes. He takes a bath before going to school and there is the presence of curiosity.

Body Part

Techniques used

Normal Findings

Actual Findings

Interpretation

A.HEAD Skull y Inspection y Palpation Proportional to the body size of the body, round with prominence in the frontal area The skull is proportion on the body size. The skull is tilted to the left for about The depression is due to breech presentation with forcep delivery.

P a g e | 10

anteriorly and the occipital area posteriorly symmetrical in all planes gently curve.

70 degree. The skull is smooth ,nontender but there is a presence of depression along the parietal bone.

Scalp

Inspection Palpation

White clean, free from masses, lumps, scars, nits seborrhea, and lesion

White, free from masses and lumps. Slighty presence seborrhea Slightly presence of oiliness, thin, black hair and evenly distributed and covers the whole scalp with no presence of split ends.

normal

Hair

Inspection Palpation

Black evenly distributed and covers the whole scalp, thick, shiny, free from split ends

normal

P a g e | 11

There is slighty presence of lice in other part. Face Inspection Palpation Oblong or oval or square or heartshaped, symmetrical facial expression that is dependent on the mood or true feelings smooth and free from wrinkles, in involuntary muscle movement Eyes and Eyebrows Inspection Parallel and evenly placed symmetrical. Nonprotruding with scant amount of secretion. Both eyes black and clear The eyes and eyebrows are not evenly placed symmetrically. The left eye is much smaller than the right Due to his head deformities The face is assymmetrical, but free from wrinkles and in any involuntary muscle. Due to his head deformities.

P a g e | 12

eye. There is no drooping or tumors. Both eyes are black and clear. Eye lashes Inspection Black evenly distributed and turned outward Eye lids Inspection Upper lids cover a small portion of the iris and the cornea and the sclera when the eyes are closed the lids meet completely. Symmetrical color is the same the surrounding skin. Sclera Inspection White and clear White and clear. No presence of dark spot. Iris and Pupil Inspection Proportional to the Dark brown color Normal Normal Long and black evenly distributed Covers a small portion of the iris and the cornea and the sclera when the eyes are closed the lids meet completely Normal Normal

P a g e | 13

size of the eye round. Black/brown and symmetrical. Constrict with increasing light and accommodation when the light closely constrict the size of the pupil it get smaller than the normal size Ears Inspection Parallel symmetrically proportion to the size of the head. Bean-shaped, helix is in line with the outer canthus of the eye, skin is the same color as

and both symmetrical. Constricting effect when there is increasing light and accommodation when the light closely constricts the size of the pupil it gets smaller than the normal size. Bean-shaped, unsymmetrically proportion to the size of head. The ears are not centrally positioned to the head but the ears have same Due to head deformities

P a g e | 14

the surrounding area, clean Ear canal Inspection Pinkish clean with scant amount of cerumen and a few cilia.

color with the skin. Presence of cilia, slightly pinkish and scant amount of cerumen. Normal

Hearing acuity

Senses

Able to hear whisper spoken 2 feet away.

Able to hear whisper

Normal

Nose

Inspection

Midline, symmetrical and patent

Midline, symmetrical and patent. Same color and tender.

normal

Mouth

Inspection

Pinkish symmetrical Lip margin well defined, smooth and moist

Dark color lip

Due to smoking

Gums

Inspection

Pinkish. Smooth. No swelling no retraction, no discharge

dark color, smooth and no swelling.

Due to smoking

P a g e | 15

Teeth

Inspection

32 permanent teeth aligned free from caries or feeling. No halitosis

Yellowish teeth with dental carries. 32 Permanent teeth are aligned.. Medium sized white color on top and freely movable.

Due to smoking

Tongue

Inspection Palpation

Large medium red or pink slightly rough on top smooth along the lateral margins, moist, shiny, and free movable

Normal

Frenulum

Inspection

Midline. Straight. and moist

Midline, straight and moist Pinkish, smooth and moist Pinkish, smooth, and moist well modulated.

Normal

Cheeks

Inspection Palpation

Pinkish, smooth and moist Pinkish, smooth, and moist No hoarseness and well modulate

Normal

Soft palate

Inspection Palpation

Normal

Voice

Senses

Normal

Neck

Inspection Palpation

Proportional to the size of the body and head,

Proportion and symmetrical to the head and

Due to breech position forcep delivery

P a g e | 16

symmetrical and position

body. cannot move freely without difficulty.

Thorax & Lungs

Inspection Palpation Auscultation

The chest is symmetrical and the chest is twice as wide as deep. Bronchial sounds are hallowing high pitched whistling sounds.

The chest is symmetrical, no lamps and masses. Vibrations are prominent and occasional wheezing sound. Cardiac rate range from 120 bpm. Pulsation visible and palpable. Positive for two heart sound

Presence of occasional wheezing sound

Heart

Inspection Palpation Auscultation

Pulsation visible and palpable Cardiac rate range from 82 beats per/minute

Normal

Breast/Chest

Inspection Palpation

Female: variable in size depending on body builds in obese, large and pendulous.

Warm to touch and smooth. Color of the skin is same with the abdomen. No

Normal

P a g e | 17

Slender- thin and small. In young client firms, Elastic in consistence. Cone-shaped, symmetrical skin surface smooth. In older women, breast sag, nipples lower, stringy and nodular. Warm to touch and smooth Areola/Nipples Inspection Palpation Round or oval color darker than surrounding skin, symmetrical for dark skinned client color is darker that other skin surfaces. No masses and

lumps and masses.

Small, round darker than surrounding skin, symmetrical. No masses, tenderness and discharges.

Normal

P a g e | 18

area of tenderness Abdomen Inspection Palpation Auscultation Percussion Skin is unblemished, no scar, color is uniform or scaphoid, symmetrical movement caused by respiration. The umbilicus is flat or concave. Color is the same as the surrounding skin. Skin is unblemished, no scar and lesions. Color is uniform, symmetrical movement due to respiration. Umbilicus is flat, no bulging, masses. Presence of bowel sounds and distention. normal

Arm

Inspection Palpation

Skin color varies Symmetrical fine evenly distributed presence/absence of visible veins. Warm dry and elastic no areas of tenderness.

Same color with the body. Symmetrical and moves freely. Absence of scar. Warm and tender.

normal.

P a g e | 19

Hands and Palm

Inspection Palpation

Palm pinkish warm

Small, soft and pinkish palm. No presence of callus. Presence of 5 fingers on each hand.

Normal

Nails

Inspection Palpation

Nails are transparent smooth and convex with pink nail beds and white translucent As pressure applied to the nail bed, appears white or balance and pink color returns immediately as pressure is released.

Nails are transparent and smooth. No presence of nail polish. Pinkish white translucent tips. When pressured is applied the color is white and when released it returns to normal color.

Normal

Shoulder, Arms, Elbows,

Inspection Palpation

Perform on ease

Moves freely without difficulty.

Normal

P a g e | 20

Hand and wrists Legs Inspection Palpation skin is smooth fine hair evenly distributed absence of varicose vein muscle symmetrical length Muscle appear equal warm and with good muscle tone. Ankles, toes and nails Inspection Palpation Five toes in each foot sole and dorsal surface is smooth with pink nailbeds and white translucent tips. Range of motion

Uniform color.

Skin color is uniform. Symmetrical and muscles are tender and warm. No presence of edema. Moves freely without difficulty.

Normal

Pinkish white color of nails with translucent tips. No presence of nail polish. Five toes in each foot. Moves freely without any discomforts.

Normal

P a g e | 21

GORDONS PATTERN OF FUNCTIONING Patterns of Functioning Health perception management pattern Lu takes a multivitamins which is prescribed by the health center. He takes a same vitamins that his cousin takes. Before Diagnosis After Diagnosis Analysis/ Interpretation It shows a small difference in his personal hygiene.

He takes a bath once a day.

He takes a bath twice a day.

He already completed his EPI vaccines. Nutritional/Metabolic pattern He drinks coffee before going to school. He is not a picky eater. There is no significant changes was shown before and after diagnosis. He likes to eat fruits and vegetables especially ampalaya.

P a g e | 22

He eat 4 times a day.

He has no allergies on all foods.

He drinks 8-10 glasses of boiled water everyday

Elimination pattern

He usually urinate 7 times a day.

He use the public toilet when every he needs to urinate

The frequency of patients elimination is just the same

He usually defecates twice a day and the color is brown

and defecate.

He still urinate and defecate at the same rate

Activity-Exercise pattern

He wakes up around 5:00 to 7:00 in the morning.

He always want to

There is no

play and go outside significant changes. the house.

P a g e | 23

He sell rugs as his work every Sunday.

He play basketball every afternoon with his friends. Sleep and rest pattern He usually sleep at 9:00pm and woke up at 5:00am He didnt take a nap on the afternoon Patient needs to sleep to keep as much strength by resting and He feels that he is well rested Cognitive and perceptual pattern He can pronounce words clearly He wants to draw especially anime. He was always curious about what other people are doing There are no significant chages sleeping.

Self-perception/selfconcept pattern

He usually decide what kind of clothes he has to wear

He didnt care about what other people say to his physical and

He thinks that he is normal like other children.

He is not conscious

psychological

P a g e | 24

on her physical image

disabilities.

He always wear short and sando. Role-relationship pattern He is the youngest in the family He is aware that he also needs to work for the family He is the one who always wash the dishes. Coping stress tolerance pattern He go back home whenever people starts to make fun of him. He ignore those people who tease him. There is no significant changes shown Theres no change in her relationship to his family.

He go to his friends house when he was bored.

Value-belief pattern

He pray to God when he feels he was alone.

He pray to thank God for the life he gave.

He became more religious when he found out about his

P a g e | 25

He go to church alone .

condition

P a g e | 26

C. CLINICAL DISCUSSION Anatomy and Physiology

Central Nervous System Spinal Cord The spinal cord is a long bundle of neural tissue continuous with the brain that occupies the interior canal of the spinal column and functions as the primary communication link between the brain and the rest of the body. The spinal cord receives signals from the peripheral senses and relays them to the brain.

P a g e | 27

Brain Stem The brain stem is the part of the brain that connects the cerebrum and diencephalons with the spinal cord. Medulla Oblongata The medulla oblongata is located just above the spinal cord. This part of the brain is responsible for several vital autonomic centers including: 4. the respiratory center, which regulates breathing. 5. the cardiac center that regulates the rate and force of the heartbeat. 6. the vasomotor center, which regulates the contraction of smooth muscle in the blood vessel, thus controlling blood pressure. The medulla also controls other reflex actions including vomiting, sneezing, coughing and swallowing. Pons Continuing up the brain stem, one reaches the Pons. The pons lie just above the medulla and acts as a link between various parts of the brain. The pons connect the two halves of the cerebellum with the brainstem, as well as the cerebrum with the spinal cord. The pons, like the medulla oblongata, contain certain reflex actions, such as some of the respiratory responses. Midbrain The midbrain extends from the pons to the diecephalon. The midbrain acts as a relay center for certain head and eye reflexes in response to visual stimuli. The midbrain is also a major relay center for auditory information.

P a g e | 28

Diencephalon The diencephalons is located between the cerebrum and the mid brain. The diencephalons houses important structures including the thalamus, the hypothalamus and the pineal gland. Thalamus The thalamus is responsible for "sorting out" sensory impulses and directing them to a particular area of the brain. Nearly all sensory impulses travel through the thalamus. Hypothalamus The hypothalamus is the great controller of body regulation and plays an important role in the connection between mind and body, where it serves as the primary link between the nervous and endocrine systems. The hypothalamus produces hormones that regulate the secretion of specific hormones from the pituitary. The hypothalamus also maintains water balance, appetite, sexual behavior, and some emotions, including fear, pleasure and pain. Cerebellum The functions of the cerebellum include the coordination of voluntary muscles, the maintenance of balance when standing, walking and sitting, and the maintenance of muscle tone ensuring that the body can adapt to changes in position quickly. Cerebrum The largest and most prominent part of the brain, the cerebrum governs higher mental processes including intellect, reason, memory and language skills. The cerebrum can be divided into 3 major functions:

P a g e | 29

Sensory Functions - the cerebrum receives information from a sense organ; i.e., eyes, ears, taste, smell, feelings, and translates this information into a form that can be understood. Motor Functions - all voluntary movement and some involuntary movement. Intellectual Functions - responsible for learning, memory and recall. Meninges The meninges are made up of three layers of connective tissue that surround and protect both the brain and spinal cord. The layers include the dura mater, the arachnoid and the pia matter. Cerebrospinal-Fluid The cerebrospinal fluid is a clear liquid that circulates in and around the brain and spinal cord. Its function is to cushion the brain and spinal cord, carry nutrients to the cells and remove waste products from these tissues.

P a g e | 30

Pathophysiology
Predisposing factors:
-Age: 14 -Gender: Male -Genetics

Precipitating factors:
-Environment -Depression

Defect in dopamine receptors d4 (DRD4)

Uses (DA) dopamine (NE) norepineprine neuro transmitter

To modulate attention and response to one s environment

Dopamine transporter 1 (DAT1)

Pre synaptic to post synaptic receptors with action potential

INATTENTION

COMBINED TYPE

HYPERACTIVE