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Case 13: 8-Year-Old Girl Who Was Naughty – NURS 6630

In this case, the study involves an 8-year-old girl who was presented to a pediatrician by her 26-year-old mother. The reasons for hospital visit were due to fever and sore throat. On medical assessment, the patient indicated signs of being negative, defiant and disobedient though she denied both. Besides, the medical diagnosis reveals an Attention deficit hyperactivity disorder (ADHD) inattentive type with a comorbid Oppositional Defiant Disorder (ODD). However, on follow-up visits, it was established that the mother’s behavior was similar to her daughter’s as she is disorganized and her response to the ADHD rating scale significantly revealed a mental health condition (Voris, 2016). As such, the intervention was focused on both the child and the mother. In the case of the child, high doses of stimulants were administered, but it was established to cause insomnia to the child and did not adequately manage the oppositional symptoms. To this effect, the patient was also given guanfacine XR, a 2A selective noradrenergic agonist, to improve oppositional symptoms and to stabilize the patient (Cardinal, 2012). For the subsequent analysis, the practicing nurse in the health facility will take the roles of a physician and conduct a clinical interview for the patient. Moreover, the nurse practitioner will also recommend suitable therapies to respond to the patient’s oppositional symptoms.

Patient Clinical Interview Question

As per the clinical case study, the patient manifest disturbances of activity both at home and in school. Her conditions revealed a diagnosis of a combined type of ADHD as evidenced by her character. It was therefore imperative by the charge nurse to establish the reasons behind her behavior and make a diagnosis using comorbidities manifested by the patient (Rolon-Aroyo, Arnold, Harvey, & Marshall, 2016). However, this could be ascertained by asking the following questions to the patient:

What do you hate most in life?
Are you easily angered or irritated at school and home?
How do you cope with frustration and emotional pain in daily life?

These questions indulge the patient to assess for the possibility of anxiety and mood disorder, which might predispose her to ODD. Particularly, the first question helps a nurse to assess the way the child views rules, authority and convey expectations in life. Based on this perspective, the nurse will be able to find out the patient’s reaction to rules, and this will determine her medication adherence. For the second question, the nurse will ascertain patterns of defiance, disobedience, and negativisms to make a diagnosis of ADHD with comorbid condition of ODD (Rolon-Aroyo, Arnold, Harvey, & Marshall, 2016). The third question intends to ascertain the child’s behavior in response to disappointing situations.

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