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NURS 503 > Developmental disabilities and peds MH > Flashcards

Developmental disabilities and peds MH Flashcards

(46 cards)

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1
Q

What is the significance of testing for an ASO titer when diagnosing developmental disorders?

A

Can be helpful in diagnosing OCD

  • Blood test to measure antibodies against streptolysin O (substance produced by group A streptococcus bacteria)
  • Rules out PANS/PANDAS (associated with strep infection)
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2
Q

True/false: Persistent anxiety at high levels can cause maladaptive behaviors

A

True - warrants diagnosis and treatment

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3
Q

Symptoms suggestive of an anxious response

A
  • Tachycardia
  • Tachypnea
  • HTN
  • GI distress
  • Tremor
  • Sweating
  • Enhanced vigilance and reactivity
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4
Q

Common pediatric anxiety disorder examples

A
  • Separation anxiety
  • Generalized anxiety
  • Social anxiety
  • OCD
  • Agoraphobia
  • PTSD
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5
Q

What three anxiety disorders are considered the pediatric anxiety disorder triad?

A

Happens in the same individual, have similar life courses and treatments

  • SAD
  • GAD
  • Social anxiety
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6
Q

What is important to assess for in pediatric patients who present with anxiety?

A

Watch out for evidence of physical trauma

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7
Q

At what age does separation anxiety disorder normally present in pediatric patients?

A

Normal development phenomenon from 7 months old through preschool

  • Manifests from 5-16 years (mean age 9 years)
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8
Q

Clinical findings associated with separation anxiety?

A
  • Excessive anxiety r/t separation
  • Unrealistic worry about harm to self or loved ones
  • Nightmares about separation
  • Physical complaints in anticipation of separation
  • Social withdrawal during separations
  • Environmental stress
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9
Q

Separation anxiety puts children at risk for what two disorders later in life?

A

Panic disorder and depression

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10
Q

Is pharmacology useful in managing separation anxiety?

A

Pharmacology is NOT helpful

  • Best treated as family system or relationship based problem (psychotherapy)
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11
Q

What is generalized anxiety disorder?

A

Cognitive and obsessive in nature

  • Cause excessive anxiety, worry, apprehension generalized to a number of events or activities
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12
Q

Generalized anxiety disorder clinical findings

A
  • Worry about future events and/or preoccupation about past behavior
  • Poor sleep
  • Unexplained fatigue
  • Irritability
  • Difficulty concentrating
  • Somatic complaints
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13
Q

What medications should NOT be prescribed to pediatric patients with GAD?

A

Benzodiazepines

  • Should be treated with SSRIs (sertraline, fluoxetine), SNRIs (venlafaxine, duloxetine), buspirone
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14
Q

True/false: Preschoolers benefit from play therapy for GAD management

A

True

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15
Q

How long do symptoms need to be present in order to be diagnosed with PTSD?

A

One month or longer

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16
Q

Pediatric PTSD management

A
  • Referral to pediatric behavioral health specialist
  • Psychotherapy
  • Medications
    • Beta blockers (propranolol) for tachycardia and hyperpnea
    • SSRIs for anxiety and depression
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17
Q

What are three categories of depression?

A
  • Major depressive disorder
  • Dysthymic disorder
  • Adjustment disorder with depressed mood
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18
Q

What is major depressive disorder?

A

Depressed or irritable mood or markedly diminished interest and pleasure in almost all of usual activities for at least 2 weeks

  • No precipitating event necessary
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19
Q

What is dysthymic disorder?

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A

Depressed or irritable mood for the majority of days in the past 2 years that is less intense but more chronic than MDD

20
Q

What is adjustment disorder?

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A

Occurs within 3 months after major life stressor

  • Episode is mild and brief
21
Q

Clinical findings of depression in infants

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A

May not respond to extra efforts to soothe or engage them

22
Q

Clinical findings of depression in young children

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A
  • FTT
  • Speech and motor delays
  • Repetitive self soothing behavior
  • Withdrawal from social interactions
  • Poor attachment
  • Loss of developmental skills
23
Q

Clinical findings of depression in toddlers and preschoolers

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A
  • Lack energy
  • Too eager to peals others
  • Clingy
  • Whiney
  • Developmentally inappropriate problems with separation
24
Q

Clinical findings of depression in school aged children

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A
  • Decreased mood
  • Impaired concentration
  • Inattention
  • Irritability
  • Fluctuating mood
  • Temper tantrums
  • Social withdrawals
  • Somatic complaints
  • Agitation
  • Separation anxiety
  • Behavioral problems
25
What essential diagnostic labs should be ordered for patients with new symptoms of depression?
* CBC * EBV titers * Vitamin D * TSH * Hcg * UA * Drug screen
26
Depression management * Non pharmacologic therapy
* **Determine suicidal risks and intervene** * Referral to community resources and behavioral health specialist * Follow up in three months if symptoms are stable
27
Depression management * Pharmacologic therapy
CBT + SSRIs (avoid paroxetine) * Start antidepressants low and increase dose slowly * Can take 4-6 weeks to see max response
28
What medications should be avoided in pediatric patients when treating depression?
* TCAs - avoid in young children (risk of harm) * Paroxetine - avoid in children and adolescents (suicide risk) * Atypical antidepressants can cause metabolic disorders
29
Signs and symptoms of serotonin syndrome
* Mental status changes * Agitation * Autonomic instability (HR, BP, sweating) * Neuromuscular changes (poor muscle coordination, twitching, rigidity)
30
What is bipolar disorder?
Unusual shifts in mood, energy, functioning * May begin with manic, depressive, or mixed set of manic and depressive symptoms
31
Signs of a manic episode in bipolar disorder
* Irritable mood and grandiosity * Elevated mood * Decreased sleep * Racing thoughts * Poor judgement * Flight of ideas * Hyper sexuality
32
What essential labs should be collected for symptomatic patients with bipolar disorder?
* CBC * CMP * TSH * Toxicology screen
33
Bipolar disorder management considerations
* Promote patient safety (highest risk of suicide) * Referral to behavioral health provider * Mood stabilizers (lithium) alone or in combination with anti seizure medications (valproate) + atypical antipsychotics (risperidone)
34
What two medications are NOT effective in patients with bipolar?
Antidepressants and stimulants
35
ADHD clinical findings
* Inability to sustain attention, curb activity level, or inhibit impulsivity * Concerns r/t memory, emotional control, organization, planning * Inhibiting thoughts or actions * Difficulty with peers, following rules and regulations
36
Important diagnostic/screening tools needed to diagnose ADHD
* Screen for iron deficiency, lead, thyroid dysfunction * Screening tools * Vanderbilt ADHD Scales * ADHD rating scale IV * Conner Parent and Teacher rating scales * Child attention profile
37
ADHD management * Non pharmacologic therapy
* Family education and support * Behavior management alone * For children \< 6 years old and/or have mild symptoms * **First line therapy**
38
ADHD management * Pharmacologic therapy
* Stimulants → methylphenidate (Ritalin) * Amphetamine (adderall, focalin, vyvanse) * SNRI (strattera) * Alpha adrenergic agonist (guanfacine, clonidine)
39
If a provider is going to start a patient with ADHD on a stimulant, what will it be important to screen for prior to therapy?
CV disease risk * Collect family history * Check if they are obese, have DM, dyslipidemia * History of stroke, MI, TIA
40
What is the only stimulant for ADHD therapy that is approved for children \<3 years old?
Amphetamine (adderrall) * Therapy can cause patients to develop a tic, but most go away within 1 year * Give more snacks for nutrition
41
What SNRI drug is approved for children \>6 years old for ADHD treatment?
Strattera/atomoxetine - non controlled substance approved for children \>6 years old * Takes up to 6 weeks of regular use to notice effects
42
True/false: Patients with anorexia and bulimia are often underweight
False * Anorexia = underweight * Bulimia = average weight or overweight
43
Clinical findings for patients with eating disorders
* Menstrual irregularities * Body dysmorphism * Preoccupation with food * History of dieting * Guilt about eating * Lies about eating or having eaten * Social isolation * GI symptoms * Syncope * Substance abuse * Family history of chaos and abuse
44
Physical exam findings in patients with eating disorders
* Altered growth * Parotid gland enlargement * Fluid retention * Thin body type * Hypotension * Dental erosion * Thin hair, lanugo * Muscle atrophy * Lethargy
45
How much weight should a patient with an eating disorder gain per week while refeeding?
Weight gain during refeeding should be 1.1 pound/week * Monitor for refeeding syndrome → confusion, irritability, organ dysfunction, seizure
46
Clinical findings suggestive of Down syndrome
* Short stature * Brachycephaly - flat head * Midface hypoplasia with flat nasal bridge * Brushfield spots * Epicanthal folds with up slanting palpebral fissures * small mouth with protruding tongue * Myopia, cataracts * Small ears, narrow canal * Extra skin at nape of neck * Single palmer crease * Clinodactyly - abnormally bent or curved finger

NURS 503 (10 decks)

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