NR 546 Week 7 Case Study - child and adolescent (Verified)

The client is a 6-year-old male accompanied by his mother and 10-year-old brother. Client’s Chief Complaints: “My son is getting in trouble at school. He has endless energy, he can’t sit still. When he plays, he is too rough with other kids.” History of Present Illness The mother presents with the client due to academic and behavioral concerns. The mother presents a school report that states that he cannot stay seated, frequently calls out in class, is disorganized, cannot complete his assignments, and has been known to be disrespectful to adults. According to his mother, he is very impatient, distractable and impulsive Past psychiatric history: . At age 4, the child was in a Head Start Program, and it was noted that he was demonstrating extreme hyperactivity, poor impulse control, and difficulty sustaining focus. Peer interactions were marked by aggression such as kicking and biting others. When told “no,” he would have extreme temper tantrums, where he would cry, scream, and destroy property. Such behaviors resulted in being permanently expelled from the program. At age 5, he was evaluated and diagnosed with ADHD, combined type. Medication was not prescribed at that time due to age. Physical Examination: Physical Examination (Obtained by Pediatrician 2 Days Earlier) Height 48″, weight: 65 lb, BMI: 23.9 Vital signs: B/P, 100/60; P, 78; R, 16; T, 98.4 General: Well-nourished 7-year-old male HEENT: PERRLA, EOMI, vision is 20/20, and hearing acuity is unremarkable. Neck: No masses Pulmonary: No wheezing, rhonchi, or rales Cardiac: S1, S2 Abdomen: No distension, bowel sounds × 4 quadrants, no masses or hernias Lymph nodes: No swelling Extremities: 2+ pulses bilaterally Skin: No lesions or edema Neuro: CN II-XII intact 1.23 CCK Past Medical History: healthy Perinatal history: full term pregnancy, uneventful. NSVD. Breastfed x 5 months. Developmental: mother reports client demonstrates age-appropriate gross and fine motor skills. He is able to dress and undress, can tie his shoes, colors within the lines; he can balance on one foot, catch a tennis ball, and ride a bicycle with training wheels. Family History  Father is alive and well.  Mother is alive, has anxiety  One brother age 10, alive and well Social History  Lives with parents and brother  1 st grader at local public school  does not have any friends Trauma history: no reports of trauma Review of Systems  appetite good, weight stable  sleeps 5-7 hours at night, difficulty falling asleep Allergies: NKDA Mental status exam: Appearance: well-nourished 6-year-old male who appears stated age. He is casually attired in a striped collared shirt, jeans, and sneakers, appropriate for age and weather. Hygiene and grooming are good. Alertness and Orientation: fully oriented to person‚ place‚ time‚ and situation, Alert Behavior: He separates easily from his mother and brother to come with interviewer. When he enters the office, he sits down in the chair, puts his hands on the desk and states, “Let’s get to work.” Initially, he stays seated with good posture, but after several minutes, he becomes hyperactive and cannot stay seated. Boundaries are poor, and he often grabs objects off the desk. He frequently interrupts.