NR 526 Week 6 Discussion: Asthma and ADHD
During your visit to Alicia in Urgent Care, Alicia tells you that she is worried about her nephew, Timmy, who
... [Show More] lives nearby and has asthma. She also says that “he just can’t sit still” and she is worried about him getting along in school. Timmy is already on your student’s case load and you tell Alicia that you and the student will visit him tomorrow. You ask your student to develop a brief tentative care plan for Timmy and his family. What comprehensive health assessments would you expect your student to include and why?
ANSWER
According to Harvey, Lennen, Whitted (2018), the Asthma Control Test (ACT) is a simple questionnaire and the standard for inquiring about asthma control in the pediatric population over the previous four weeks. The ACT can be varied according to the age of the child, using a five-question Likert-style score for older kids, and for younger children, there is a seven-question version with pictures to choose how they feel, as well as questions for parents (Harvey et al., 2018). The peak expiratory flow (PEF) test or peak flow meter test is another important test in measuring asthma control in the pediatric population (Harvey et al., 2018). Peak flow meters have been around for years, and are an excellent and simple way to get a ‘snapshot’ of lung function.
For the reported inability to sit still, Timmy should be evaluated for ADHD by way of a thorough history from parents, caregivers, and teachers, where possible academic or behavioral issues may have taken place (Wesemann & Van Cleve, 2018).
Additionally, completing a thorough neurological assessment in addition to a thorough physical assessment while looking for any risk factors in Timmy’s history such as abuse, poverty, or lead, are important (Wesemann & Van Cleve, 2018). The Vanderbilt Assessment Scale is a great comprehensive tool for the initial assessment for ADHD, and includes sections for parents and teachers (Wesemann & Van Cleve, 2018). While this assessment could not be completed in one clinical day, the discussion could start and an initial assessment could be completed, to start moving the process along.
References
Harvey, M., Lennen, N., & Whitted, K. (2018). Evidence-based asthma control assessments in pediatric care. Pediatric Nursing, 44(4), 163-168. Retrieved from https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx? direct=true&db=ccm&AN=131366564&site=eds-live&scope=site
Wesemann, D., & Van Cleve, S. N. (2018). ADHD: from childhood to young adult. The Nurse Practitioner, 43(3), 8-15. doi: 10.1097/01.NPR.0000530307.76316.cf
Initial Post
Dr. and Class,
This is a very interesting topic that an entire paper could be written on. It seems that so many children today are being diagnosed with ADHD and I do not know if I truly agree with all of the diagnosis. I personally think that in many of the preschool age children being diagnosed with behavioral issues may actually be parental issues. However, I will stick to the topic you have requested for the initial post.
One of the first questions that I would need to know is Timmy’s age. The possibility of having a dual diagnosis will require the nurse to collect detailed comprehensive data to report to the physician. There are many signs and symptoms of ADHD that can be the same signs and symptoms of other diagnosis or behavioral issues. The National Institute of Mental Health (NIMH) (2016) characterizes as ADHD as a child or adult with lack of focus, being excessively energetic, and as being impulsive over a period of time exceeding six months. The same symptoms can be characteristics of other disorders as well as ADHD. Today, ADHD is diagnosed quite often because a child meets the criteria of ADHD but could be easily misdiagnosed. Ji, Chen, Sundquist, and Sundquist (2018) have suggested that ADHD is often associated in children with brain disorders and include that the family history is important, especially if the child with ADHD has parents with diabetes mellitus Type 1.
The main comprehensive health assessments I would expect my student to include are a detailed family history due to the relationship of ADHD and different genetic diseases, the age of the child because at times what may be considered ADHD is normal for some age groups, the length of time the child has shown signs of ADHD, if they have received any counseling or consultations. It will also be important to determine how bad the asthma is for the child. A young child having asthma can have a psychosocial impact that could cause the misdiagnosis of ADHD. There are many tools available from NIMH and state resources that would help my student develop a comprehensive plan that would encourage both subjective and objective data that would need to be obtained to provide all of the data that the physician would need before seeing the patient.
Thank you,
Jamie Mears, BSN, RN
References
Ji, J., Chen, T., Sundquist, J., & Sundquist, K. (2018). Type 1 Diabetes in Parents and Risk of Attention Deficit/Hyperactivity Disorder in Offspring: A Population-Based Study in Sweden. Diabetes Care, 41(4), 770–774. https://doi-
org.chamberlainuniversity.idm.oclc.org/10.2337/dc17-0592 (https://doi-org.chamberlainuniversity.idm.oclc.org/10.2337/dc17- 0592)
National Institute of Mental Health. (2016). Attention deficit/hyperactivity disorder. Retrieved on February 8, 2019 from https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml [Show Less]