Nursing care plans for Autistic disorder

Autistic disorder is a severe, pervasive developmental disorder marked by unresponsiveness to social contact, gross deficits in intelligence and language development, ritualistic and compulsive behaviors, restricted capacity for developmentally appropriate activities and interests, Autistic disorder is characterized by a withdrawal of the child into the self and into a fantasy world of his or her own creation. Activities and interests are restricted and may be considered somewhat bizarre. The disorder is rare, but occurs 4 to 5 times more often in males than in females. Onset of symptoms is prior to age 3. The course is chronic and often persists into adulthood.

Causes for Autistic disorder

The causes of autistic disorder remain unclear but are thought to include psychological, physiologic, and sociologic factors. Previously, it was thought that most parents of autistic children were intelligent, educated people of high socioeconomic status; recent studies suggest that this may not be true. The parents of an autistic child may appear distant and unaffectionate toward the child. However, because autistic children are clearly different from birth, and because they are unresponsive or respond with rigid, screaming resistance to touch and attention, parental remoteness may be merely a frustrated, helpless reaction to this disorder, not its cause.

Some theorists consider autistic disorder related to:

• Genetics. An increased risk of autistic disorder exists among siblings of individuals with the disorder (APA, 2000). Studies with both monozygotic and dizygotic twins have also provided evidence of a genetic involvement.
• Neurological Factors. Abnormalities in brain structures or functions have been correlated with autistic disorder (National Institute of Mental Health [NIMH], 2002). Certain developmental problems, such as postnatal neurological infections, congenital rubella, phenylketonuria, and fragile X syndrome, also have been implicated.

Complications for Autistic disorder

• Autistic disorder may be complicated by epileptic seizures
• Depression is common in adolescence and early adulthood
• During periods of stress, catatonic phenomena, such as excitement or posturing, or an undifferentiated psychotic state with delusions and hallucinations may occur.

Nursing Assessment nursing care plans for Autistic disorder

Primary characteristic of autistic disorder is unresponsiveness to people. Patient with this disorder won't cuddle, avoid eye contact and facial expression, and are indifferent to affection and physical contact. Parents may report that the child becomes rigid or flaccid when held, cries when touched, and shows little or no interest in human contact.  As the patient grows older, his smiling response is delayed or absent. He doesn't lift his arms in anticipation of being picked up or form an attachment to a specific caregiver.

• Failure to form interpersonal relationships.
• Impairment in communication verbal and nonverbal, nonverbal expressions may be inappropriate or absent.
• Bizarre responses to the environment.
• Extreme fascination for objects that move.
• Unreasonable insistence on following routines in precise detail.
• Marked distress over changes in trivial aspects of environment.
• Stereotyped body movements.

Common Nursing Diagnoses Found On Nursing Care Plans For Autistic Disorder

• Risk for self mutilation
• Impaired social interaction
• Impaired verbal communication
• Disturbed personal identity
• Anxiety
• Compromised family coping
• Delayed growth and development
• Dressing or grooming self-care deficit
• Interrupted family processes
• Risk for injury
• Risk for self-directed violence
• Social isolation

Nursing interventions, Key outcomes nursing care plans for Autistic disorder

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Nursing diagnosis Nursing Care Plans Attention Deficit Hyperactivity Disorder (ADHD)

Common Nursing Diagnosis and Interventions found on Nursing Care Plans Attention Deficit Hyperactivity Disorder (ADHD)

• Risk for self directed or other directed violence
• Defensive coping
• Impaired social interaction
• Ineffective coping
• Low self esteem
• Noncompliance
• Anxiety (moderate to severe)
• Compromised family coping
• Imbalanced nutrition: Less than body requirements
• Ineffective family therapeutic regimen management
• Interrupted family processes
• Risk for impaired parenting

Key outcomes nursing diagnosis Nursing Care Plans Attention Deficit Hyperactivity Disorder (ADHD)

• Patient and his family will report concern about difficulties in social interactions.
• Patient and his family will communicate understanding of special dietary needs.
• Patient will demonstrate effective social interaction skills.
• Patient and his family will comply with the prescribed treatment regimen.
• Patient's family will discuss the impact of the patient's illness and feelings about it with a health care professional.
• Parents will utilize support groups and other community resources.
• Patient will acknowledge and respond to efforts by others to establish communication.

Nursing interventions for ADHD

• Set realistic expectations and limits because the patient with attention deficit hyperactivity disorder is easily frustrated
• Always remain calm and consistent with the child.
• Keep all your instructions to the child short and simple.
• Provide praise and rewards whenever possible.
• Provide the patient with diversional activities suited to his short attention span.
• Help the parents and other family members develop planning and organizing systems to help them cope more effectively with the child's short attention span.

Nursing interventions for ADHD related to nursing diagnosis:
Nursing diagnosis Risk for self directed or other-directed violence

•  Observe client’s behavior frequently.
•  Observe for suicidal behaviors: Verbal statements, such as “ statement going to kill myself”
• Determine suicidal intent and available means. Ask how where and when you plan to kill yourself
• Obtain contract from client not to harm self and agreeing to seek out staff when ideation occurs.
• Help client to recognize when anger occurs and to accept those feelings
• Act as a role model for appropriate expression of angry feelings.
• Give positive reinforcement.

Nursing diagnosis Defensive coping

• Encourage client to recognize and verbalize feelings of inadequacy and need for acceptance from others and to recognize how these feelings provoke defensive behaviors
• Provide immediate, fact, nonthreatening feedback for unacceptable behaviors
• Help client identify situations that provoke defensiveness
• Practice with role play for appropriate responses
• Give positive feedback for acceptable behaviors
• Evaluate and discuss with client the effectiveness of the new behaviors and any modifications for improvement

Nursing diagnosis Impaired social interaction

• Develop trust relationship
• Give to the client’s constructive criticism and positive reinforcement for client’s efforts
• Give Positive feedback to client
• Provide group situations for client

Nursing diagnosis Ineffective coping

• Provide safe environment for continuous large muscle movement, If client is hyperactive
• Provide large motoric activities
• Do not debate, argue, rationalize, or bargain with the client.
• Explore with client and discus alternative ways of handling frustration that would be most suited for client

Nursing diagnosis Low self esteem

Nursing diagnosis Anxiety

• Establish a trusting relationship
• Maintain an atmosphere of calmness
• Offer support during times of elevated anxiety, Use of touch is comforting for some clients
• When anxiety diminishes, help client to recognize specific events that preceded onset of anxiety.
• Provide help to client to recognize signs of escalating anxiety
• On escalating anxiety provide tranquilizing medication, as ordered

Nursing diagnosis Compromised family coping
Nursing diagnosis Imbalanced nutrition: Less than body requirements
Nursing diagnosis Ineffective family therapeutic regimen management
Nursing diagnosis Interrupted family processes
Nursing diagnosis Risk for impaired parenting


Patient teaching Nursing Care Plans Attention Deficit Hyperactivity Disorder (ADHD)

• Make certain that the parents fully understand the child's prescribed medication regimen.
• Teach the patient and family about any adverse reactions that may occur, emphasizing those that may require immediate medical attention.
• Encourage the parents to provide the child with nutritious snacks such as fruit to supplement his dietary intake.
• Refer the parents to appropriate support groups.

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Predisposing Factors for Attention Deficit Hyperactivity Disorder (ADHD)

The patient with attention deficit hyperactivity disorder has difficulty focusing his attention, engaging in quiet passive activities, or both. Some patients have an attention deficit without hyperactivity; they're less likely to be diagnosed and receive treatment. Although attention deficit hyperactivity disorder is present at birth, diagnosis before age 4 or 5 is difficult unless the child exhibits severe symptoms. Some patients, however, aren't diagnosed until they reach adulthood. Attention deficit hyperactivity disorder is thought to be a physiologic brain disorder with a familial tendency. Some studies indicate that it may result from altered neurotransmitter levels in the brain. Scientists are not sure what causes ADHD, although many studies suggest that genes play a large role. Like many other illnesses, ADHD probably results from a combination of factors. In addition to genetics, researchers are looking at possible environmental factors, and are studying how brain injuries, nutrition, and the social environment might contribute to ADHD

Predisposing Factors for Attention Deficit Hyperactivity Disorder (ADHD)

Physiological

• Genetics. A number of studies have indicated that hereditary factors may be implicated in the predisposition to ADHD. Siblings of hyperactive children are more likely than normal children to have the disorder.
• Biochemical. Abnormal levels of the neurotransmitters dopamine, norepinephrine, and possibly serotonin have been suggested as a causative factor.
• Prenatal, Perinatal, and Postnatal Factors. Maternal smoking during pregnancy has been linked to ADHD . Premature birth, fetal distress, precipitated or prolonged labor, and perinatal asphyxia have also been implicated. Postnatal factors include cerebral palsy, epilepsy, and other central nervous system abnormalities resulting from trauma, infections, or other neurological disorders.

Psychosocial

• Environmental Influences Disorganized or chaotic environments or a disruption in family equilibrium may predispose some individuals to ADHD. A high degree of psychosocial stress, maternal mental disorder, paternal criminality, low socioeconomic status, and foster care have been implicated.

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Nursing Care Plans Attention Deficit Hyperactivity Disorder (ADHD)

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common childhood disorders and can continue through adolescence and adulthood. Attention-deficit hyperactivity disorder (ADHD) is characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequent and severe than is typically observed in individuals at a comparable level of development (APA, 2000). The patient with attention deficit hyperactivity disorder has difficulty focusing his attention, engaging in quiet passive activities, or both. Some patients have an attention deficit without hyperactivity; they're less likely to be diagnosed and receive treatment. Although attention deficit hyperactivity disorder is present at birth, diagnosis before age 4 or 5 is difficult unless the child exhibits severe symptoms. Some patients, however, aren't diagnosed until they reach adulthood. Males are three times more likely to be affected than females. The presence of other psychiatric disorders also needs to be determined, this disorder occurs in roughly 3% to 5% of school-age children.

Causes for Attention Deficit Hyperactivity Disorder (ADHD)

Attention deficit hyperactivity disorder is thought to be a physiologic brain disorder with a familial tendency. Some studies indicate that it may result from altered neurotransmitter levels in the brain. Scientists are not sure what causes ADHD, although many studies suggest that genes play a large role. Like many other illnesses, ADHD probably results from a combination of factors. In addition to genetics, researchers are looking at possible environmental factors, and are studying how brain injuries, nutrition, and the social environment might contribute to ADHD

Predisposing Factors Attention Deficit Hyperactivity Disorder (ADHD)

Complications for Attention Deficit Hyperactivity Disorder (ADHD)

Emotional and social complications can result from the child's impulsive behavior, inattentiveness, and disorganization in school. Hyperactivity can also lead to poor nutrition.

Assessment Nursing Care Plans Attention Deficit Hyperactivity Disorder (ADHD)

The patient is usually characterized as a fidgeted and a daydreamer. He may also be described as inattentive and lazy. The parents may state that their child is intelligent but that his school or work performance is sporadic. They may also report that he has a tendency to jump quickly from one partly completed project, thought, or task to another. If the child is younger, the parents may note that he has difficulty waiting in line, remaining in his seat, waiting his turn, or concentrating on one activity long enough to complete it.  An older child or an adult may be described as impulsive and easily distracted by irrelevant thoughts, sights, or sounds. He may also be characterized as emotionally labile, inattentive, or prone to daydreaming. His disorganization becomes apparent when, for example, he has difficulty meeting deadlines and keeping track of school or work tools and materials.

• Difficulties in performing age-appropriate tasks
• Highly distractible
• Extremely limited attention span
• Shifts from one uncompleted activity to another
• Impulsivity, or deficit in inhibitory control, is common
• Difficulty forming satisfactory interpersonal relationships
• Disruptive and intrusive behaviors inhibit acceptable social interaction
• Difficulty complying with social norms
• Some children with ADHD are very aggressive or oppositional. Others exhibit more regressive and immature behaviors.
• Low frustration tolerance and outbursts of temper are common.
• Boundless energy, exhibiting excessive levels of activity, restlessness, and fidgeting
• Often described as “perpetual motion machines,” continuously running, jumping, wiggling, or squirming
• They experience a greater than average number of accidents, from minor mishaps to more serious incidents that may lead to physical injury or the destruction of property.

Predisposing Factors Attention Deficit Hyperactivity Disorder (ADHD)
Common Nursing Diagnoses and Interventions for Attention Deficit Hyperactivity Disorder (ADHD)

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Nursing outcomes, interventions, and Patient teaching for Anorexia Nervosa

Anorexia nervosa is a clinical syndrome in which the person has a morbid fear of obesity. It is characterized by the individual’s gross distortion of body image, preoccupation with food, and refusal to eat. The disorder occurs predominantly in females

Goals/Objectives Nursing Care Plans for Anorexia Nervosa
Short-Term Goal
Client will gain weight (amount to be established by client, nurse, and dietitian) pounds per week
Long-Term Goal
By discharge from treatment, client will exhibit no signs or symptoms of malnutrition.

Key outcomes Nursing Care Plans for Anorexia Nervosa
The patient will:

• Engage in appropriate physical activities.
• Verbalize strategies to reduce anxiety.
• Express positive feelings about self.
• Resume a normal bowel elimination pattern.
• Demonstrate skills appropriate for age.
• Acknowledge change in body image.
• Maintain body temperature within the normal range.
• Achieve target weight.
• Demonstrate ability to practice two new coping behaviors.
• Participate in decision-making about care.
• Comply with the treatment regimen.
• Interact with family or friends.
• Fluid balance will remain stable, with intake equal to or greater than output.

Nursing interventions Nursing Care Plans for Anorexia Nervosa:

• If client is unable or unwilling to maintain adequate oral intake, physician may order a liquid diet to be administered via nasogastric tube. Nursing care of the individual receiving tube feedings should be administered according to established hospital procedures.
• Sit with client during mealtimes for support and to observe amount ingested, Client should be observed for at least 1 hour following meals. This time may be used by client to discard food stashed from tray or to engage in self- induced vomiting.
• During hospitalization, regularly monitor vital signs, nutritional status, and intake and output. Weigh the patient daily
• Negotiate an adequate food intake with the patient. Be sure that she understands that she'll need to comply with this contract or lose privileges.
• Frequently offer small portions of food or drinks if the patient wants them. itself.
• Anticipate a weight gain of about 1 lb/week.
• If edema or bloating occurs after the patient has returned to normal eating behavior, reassure her that this phenomenon is temporary
• Encourage the patient to recognize and assert her feelings freely.
• If a patient receiving outpatient treatment must be hospitalized, maintain contact with her treatment team to facilitate a smooth return to the outpatient setting.

Patient teaching Nursing Care Plans for Anorexia Nervosa

• Emphasize to the patient how improved nutrition can reverse the effects of starvation and prevent complications.
• Teach the patient how to keep a food journal, including the types of food eaten, eating frequency, and feelings associated with eating and exercise.
• Advise the pateint's family to avoid discussing food with him.

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Nursing Care Plans for Hypertension

Hypertension Description is a persistent or intermittent elevation of systolic arterial blood pressure above 140 mm Hg or diastolic pressure above 90 mm Hg. Hypertension is a chronic disease, primary goals in Hypertension Nursing Care Plan is to reduce the blood pressure to less than 140/90.

Hypertension classified:

• Primary (essential) accounts for over 90% of cases and is often referred to as idiopathic, since the underlying cause is not known.
• Secondary hypertension results from a number of conditions that impair blood pressure regulation, and accounts for only 5% to 8% of all cases of hypertension
• Malignant hypertension, results from either type and can cause blood pressures as high as 240/150 mm Hg, possibly leading to coma and death.

Cause of Hypertension:

• Cause of primary hypertension is not known; however, associated with risk factors such as genetic predisposition, stress, obesity, and a high-sodium diet.
• Secondary hypertension results from disorders that impair blood pressure regulation, particularly renal, endocrine, vascular, and neurological disorders, hypertensive disease of pregnancy (toxemia) and use of estrogen-containing oral contraceptive
• Malignant hypertension is also not known, but it may be associated with dilation of cerebral arteries and generalized arteriolar fibrinoid necrosis, which increases intracerebral blood flow

Ethnic/Racial African Americans and elderly people are most prone to hypertension and its complications.

Physical Examination Hypertension Nursing Care Plan:

• Appear symptom-free in early stages, although flushing of the face may be present
• Fundoscopic examination of the retina may reveal hemorrhage
• Measure blood pressure in both arms three times 3 to 5 minutes apart while the patient is at rest in the sitting, standing, and lying positions.
• Hypertension should not be diagnosed on
• The basis of one reading unless it is greater than 210/120 mm hg.

Diagnostic Highlights Hypertension Nursing Care Plan

• Blood urea nitrogen
• Serum creatinine
• Total cholesterol
• Triglycerides
• Electrocardiogram

Because Hypertension is chronic disease and a major cause of stroke, cardiac disease, and renal failure, Hypertension nursing diagnosis on nursing care plan for Hypertension many associated with the Knowledge deficit about Diet, Disease process, Health behaviors, Medication, prescribed activity, Treatment regime and lifestyle

Primary Hypertension nursing diagnosis is knowledge deficit related to chronic disease management,

Possible nursing diagnosis which is commonly found in nursing care plan for Hypertension

• Fatigue
• Ineffective coping
• Ineffective tissue perfusion: Cardiopulmonary
• Noncompliance: Therapeutic regimen
• Risk for injury

Nursing outcomes Hypertension nursing care plan, Patients will:

• Identify appropriate food choices.
• Express that he has more energy.
• Demonstrate adaptive coping behaviors.
• Maintain adequate cardiac output and hemodynamic stability.
• Comply with his therapy regimen.
• Remain free from complications

 Patient Teaching and Home Healthcare Guide on Hypertension nursing care plan

• Teach the patient to use a self-monitoring blood pressure cuff and to record the reading at least twice a week.
• Tell the patient to take his blood pressure at the same hour each time, with out more than usually activity preceding the measurement.
• Tell the patient and family to keep a record of drugs used in the past.
• To encourage compliance with antihypertensive therapy, suggest establishing a daily routine for taking medication. Warn the patient that uncontrolled hypertension may cause stroke and heart attack. Tell him to report any adverse reactions to prescribed drugs. Advise him to avoid high-sodium antacids and over-the-counter cold and sinus medications containing harmful vasoconstrictors.
• Help the patient examine and modify his lifestyle behavior.
• Suggest stress-reduction groups, dietary changes, and an exercise program.
• Encourage a change in dietary habits. Help the obese patient plan a reducing diet.
• Tell to the patients to avoid high-sodium foods, table salt, and foods high in cholesterol and saturated fat.

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