Ch. 33 - Children and Adolescents Flashcards Preview

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Flashcards in Ch. 33 - Children and Adolescents Deck (33):

What are risk factors for disorders of children and adoleswcents?

1. low birth wt
2. physical defects
3. family hx of mental issue or addictive d/o
4. poverty (poor prenatal care, poor infant nutrition, lack of stimulation and care)
5. separation from caregivers (children must be stimulated to develop)
6. abuse or neglect


There are varying levels of intellectual disability. How are they delineated?

By IQ level.

The labels are:
-mild (50-70)
-moderate (35-49)
-severe (20-34)
-profound (below 20)

Remember them easier (50,35,20,20)
-mild (50+)
-moderate (>35)
-severe (>20)
-profound (


A person with ____ intellectual disability is capable of independent living with some assistance in stressful situations. Can learn up to the 6th grade level and be social.

mild (50-70)


A person with ____ intellectual disability is capable of requires supervision. Can perform some things independently. Can learn through the 2nd grade level. some speech issues. Decent motor development

moderate (35-49)


A person with ____ intellectual disability may be trained in elementary hygiene. Requires supervision (not necessarily constant aid). Unable to benefit from academia. Can learn habits. Minimum speech ability - usually acts out to express needs. Poor psychomotor ability



A person with ____ intellectual disability requires constant aid and supervision. Limited, if any, speech. No social skills.. Psychomotor lacks.



"Old labels" such as Rett's, Asperger's, and pervasive developmental d/o are all included in the new label...

autism spectrum disorder (ASD)


Autistic Spectrum Disorder (ASD) is characterized by what?

1. impairment of social interaction (varying levels of affection, aggression, and tantrums)

2. impairment in communicationand imaginative activity (language may be immature)

3. Restricted activities and interests (fascination with objects)


Nursing diagnoses for ASD may include risk for self-mutilation related to neurological alterations; history of self-mutilative behaviors; hysterical reactions to the environment (even a slight change can cause tantrums) . What interventions can we use?

Protect - check to see if child has harmful behavior and address accordingly. Find out why the behavior occurs (anxiety etc) and do what you can to prevent it.

Routine - try not to introduce change in environment when possible. Caretakers should be consistent (hospitalized, use same nurses when possible)


What meds should we use for ASD?

Risperidone (Risperdal)
Aripiprazole (Abilify)

antipsych meds - think about an autistic child have an anxiety based tantrum.. .and calming them with these meds


T or F: Tourette Syndrome may be caused by abnormal levels of various neurotransmitters.

True. Abnormalties in levels of dopamine, serotonin, dynorphin, GABA, acetylcholine, and NE.

Makes sense when you think of the reaction of older adults with diseases related to increases in these...and the signs you see...


What are characteristics of tourette's syndrome?

-motor tics (can include copropraxia)
-vocal tics (an include coprolalia)
-palilalia (repeating own words)


what is copropraxia ?

obscene gestures

co pro praxia
co = could
pro = probably

copropraxia could probably cause problems for the person who has it...


what is coprolalia ?

obscene language

co pro lalia
co = could
pro = probably

coprolalia could probably cause problems for the person who has it...


What is the time frame that a person has s/s of tourette's before they will be diagnosed?

1 year


What meds can we use to treat tourette's?

Low Dose antipsych (haldol, pimozide (orap), clonidine as anti-HTN)


_______ _______ D/O is characterized by excessive fear or anxiety concerning separation from those to whom the invidividual is attached.

separation anxiety disorder

usually surfaces around age 5-6.

can be a precursor to adult panic d/o
interferes with social academic, occupational, or other areas of functioning.


What are the three hallmark signs of ADHD?



What are the two MUST BE PRESENTS to be diagnosed with ADHD?

-present for 6 months
-present in 2 or more settings (causing an impairment of functioning)


T or F: ADHD can be predictive of depression and suicide in adolescence.



T or F: Low maternal dopamine can increase risk of ADHD in offspring.

False. Low 5HT (serotonin can)


There are three subtypes of ADHD. All will have impulsivity for 6 months. List them...

1. Predominantly inattentive
2. Predominantly hyperactive
3. Combined type


What is the diagnotic criteria for "Predominantly inattentive type...

6+ symptoms of inattention
less than 6 symptoms of hyperactivity

(all subtypes must have impulsivity for 6 months)


What is the diagnotic criteria for "Predominantly hyperactive" type...

6+ symptoms of hyperactivity
less than 6 symptoms of inattention

(all subtypes must have impulsivity for 6 months)


What is the diagnostic criteria for "Combined" type...

6+ Hyperactive
6+ Inattention
6+ Impulsivity
for 6 months


Children/adolescents are underdiagnosed as bipolar and overdiagnosed as ADHD. How can we determine what the true problem is?

methylphenidate (Ritalin). Give Ritalin. If it doesn't work, the person is bipolar.


What should you avoid when administering methylphenidate (Ritalin)?

-taking the med within six hours of sleep
-handing it over to the kid to administer (might trade it with classmates or over do it)


How does methylphenidate (Ritalin) function in the cerebral cortex?

Dopamine in cerebral cortex is increased to the reticular activating system.


Besides methylphenidate (Ritalin), what other medication is commonly given to treat ADHD?

amphetamine/dextroamphetamine (Adderall)


Name the disorder in which the patient is hostile toward authority and uncooperative (more than usual for their developing age).

These kids are labile, have a low frustration tolerance, blame other, swear, argue, throw tantrums, are stubborn and can be vindictive/spiteful.

Oppositional Defiant D/O

Also passive aggressive, procrastination, limit testing, negativism, do not see self as opposition...view others as putting harsh demands on them.

All attitude and mood,


What are some probably causes of Oppositional Defiant DO?

-Various caregivers with inconsistent rules
-harsh upbringing (authoritarian parents)
-Depressed mothers
-Marital problems


This DO has the hallmark of aggression toward other people and animals. This person is a bully, intimidates and assaults others physically or sexually. Violates others right and society's rules. Destroy property, theft, crime and legal problems. (May become antisocial)

Conduct D/O


What are some are nursing interventions for Conduct DO?

1. Be clear with rules
2. Set limits
3. Appropriate expression of anger should be allowed

(So similar to antisocial)