Question

Jimmy, age 9, has been admitted to the child psychiatric unit with a diagnosis of attention-deficit/hyperactivity disorder. He has been unmanageable at school and at home, and has had several suspensions from school for continuous disruption of his class. He refuses to sit in his chair or do his work. He yells out in class, interrupts the teacher and the other students, and lately has become physically aggressive when he cannot have his way. Most recently, he was suspended after hitting his teacher when she asked him to return to his seat.

Jimmy’s mother describes him as a restless and demanding baby, who grew into a restless and demanding toddler. He has never gotten along well with his peers. Even as a small child, he would take his friends’ toys away from them or bite them if they tried to hold their own with him. His 5-year-old sister is afraid of him and refuses to be alone with him.

During the nurse’s intake assessment, Jimmy paced the room or rocked in his chair. He talked incessantly on a superficial level and jumped from topic to topic. He told the nurse that he did not know why he was there. He acknowledged that he had some problems at school but said that was only because the other kids picked on him and the teacher did not like him. He said he got into trouble at home sometimes but that was because his parents liked his little sister better than they liked him.

The physician has ordered methylphenidate 5 mg twice a day for Jimmy. His response to this order is, “I’m not going to take drugs. I’m not sick!”

1. What are the pertinent assessment data to be noted by the nurse?

2. Aside from patient safety, to what problems would the nurse want to direct intervention with Jimmy?

Answer 1

Assessment data to be noted by the nurse are as follows:

• difficulty in standing still
• disruptive in the clasroom and home
• low self esteem feelings
• behaviour of the parents and negligence to the child
• behaviour of the child at school
• relationship of the child with his peers

Aside from patient safety, the problems the nurse would want to direct intervention with Jimmy are as follows:

• health education for parents,caregivers and family members
• spending time with child to avoid negligence
• organizing routines and house rules
• focusing child's strength
• to decrease the feeling of loneliness maintain eye cntact witth the child
• reducing feelings of self low steem
• malnutrition
• depression
• helping the child to engage with his peer groups