ADHD
ADHD (Attention-Deficit/Hyperactivity Disorder) — NCLEX Notes
Definition
ADHD is a neurodevelopmental disorder characterized by persistent:
Inattention
Hyperactivity
Impulsivity
Key Manifestations
Inattention
Easily distracted
Difficulty sustaining attention
Forgetful
Does not listen when spoken to
Difficulty following instructions
Frequently loses things
Hyperactivity
Fidgeting
Difficulty sitting still
Excessive talking
Runs/climbs excessively
Difficulty engaging in quiet activities
Impulsivity
Interrupts others
Difficulty waiting for a turn
Acts without thinking
Makes quick decisions without considering consequences
Nursing Interventions
1. Promote Safety FIRST
ADHD → impulsivity + hyperactivity → increased risk for injury
Remove hazards
Provide close supervision during high-risk activities
Maintain a safe, uncluttered environment
Set clear and consistent limits
2. Provide Structure
Establish a consistent daily routine
Use predictable schedules
Give short, simple instructions
Give one task at a time
Break large tasks into smaller steps
Example:
❌ “Clean your room, do your homework, and get ready for dinner.”
✅ “Put your books on the desk.”
Then give the next instruction.
3. Positive Reinforcement
Focus on and praise desired behaviors.
Example:
“You did a great job sitting quietly and listening.”
Use praise/rewards for appropriate behavior
Avoid excessive punishment
Be consistent with expectations and consequences
School Interventions
Reduce distractions:
Seat the child near the teacher
Place the child away from windows/doors
Reduce classroom clutter
Provide a quiet study area
Learning strategies:
Short assignments
Frequent short breaks
One task at a time
Clear, written/visual instructions
Medications
Stimulants
Common first-line medications:
Methylphenidate
Amphetamine
Dextroamphetamine
Lisdexamfetamine
Why stimulants?
Although they are stimulants, they can improve:
Attention
Focus
Impulse control
Ability to stay on task
Stimulant Adverse Effects
Remember:
“Eat Less + Sleep Less + Grow Less”
Appetite ↓
→ Decreased appetite
→ Weight loss
Sleep ↓
→ Insomnia
Growth ↓
→ Possible slowed growth with long-term therapy
Other adverse effects:
Headache
Abdominal pain
Irritability
Increased heart rate
Increased blood pressure
Medication Administration
Give stimulants in the MORNING
Why?
Stimulants → CNS stimulation → insomnia
Avoid giving the medication late in the day unless specifically prescribed.
Nutrition
Because stimulants can decrease appetite:
Encourage a high-calorie, nutritious breakfast BEFORE medication
Offer nutritious/high-calorie foods
Monitor weight regularly
Monitoring
Monitor:
❤ Cardiovascular
Blood pressure
Heart rate
📏 Growth
Height
Weight
🍽 Nutrition
Appetite
Weight loss
😴 Sleep
Insomnia
Sleep pattern
Priority Findings
Report/assess significant:
🚨 Chest pain
🚨 Severe tachycardia
🚨 Significant hypertension
🚨 Severe weight loss
🚨 Marked growth problems
NCLEX Priority:
Chest pain/cardiovascular symptoms > mild appetite loss or headache
Parent Teaching
Teach parents to:
Give stimulant medication in the morning
Encourage breakfast before medication
Monitor appetite and weight
Monitor sleep
Monitor height and weight regularly
Monitor BP/HR as instructed
Maintain a consistent routine
Use positive reinforcement
Give clear, short instructions
Never change the dose without the provider’s direction
NCLEX High-Yield
ADHD = 3 major symptoms
Inattention + Hyperactivity + Impulsivity
Best behavioral approach
Structure + consistency + positive reinforcement
Best communication
Short, simple, one-step instructions
Safety
Impulsivity → increased injury risk
Stimulant
Methylphenidate / Amphetamine
Stimulant adverse effects
Appetite ↓ → Weight ↓
Sleep ↓ → Insomnia
Growth ↓
HR ↑ / BP ↑
Administration
Morning
Nutrition
High-calorie breakfast BEFORE medication
Monitoring
Height + Weight + BP + HR