Exam 3: neurodevelopmental disorders Flashcards
(24 cards)
mental health promotion in childhood
-common problems: death and grieving, separation and divorce, sibling relationships. bullying, physical illness, adolescent risk-taking behaviors.
-common interventions: prevention, early intervention programs, psychoeducational programs, social skills support, bibliotherapy
-atraumatic approach always!
-assessment typically includes child, parents/family, HCP- all parties
-consider developmental age of patient- at and play may be therapeutic for patient
assessment of mental health disorders in children and adolescents
-use more specific, fewer open-ended questions
-children need simple phrases
-collaboration of information with adult
-use of artistic and play media
-possible problems with accurate sequencing of events
-mental status exam: developmental assessment-maturation (developmental delays), psychosocial development, language
-key elements are risk and safety: questions about thoughts or actions to hurt self or others, screen for use and abuse of substances
-if patient admits to thoughts of harm to self or others, parents MUST BE INFORMED.
intellectual disability
characterized by significant limitations in both intellectual function and in adaptive behavior that covers many everyday social and practical skills.
-diagnostic criteria and clinical course: significantly below average intelligence accompanied by impaired adaptive functioning and developmental delays; skills affected in adaptive behavior: conceptual, social, practical
-results from variety of causes, most common related to genetic syndromes
nursing care of children with intellectual disability
-assess developmental history and support systems
-interventions to promote optimal level of functioning, eventual independent functioning in a normal social environment
-continuum of care!
autism spectrum disorder
neurodevelopmental delays with or without intellectual disability
-autism and asperberg syndrome- no longer separate disorders, now considered an autism spectrum disorder differentiated by language or intellectual impairment, many overlapping symptoms and difficult to differentiate
-may have age-appropriate language and intelligence
characteristics:
-severe and sustained impairment in social interaction
-restricted, repetitive patterns of behavior, interests, and activities
-social deficits
-stereotypic behaviors like rocking and hand flapping
-highly restricted areas of interest, like train schedules, fans, air conditioners, or dogs
-genetic and epigenetic factors, greater in boys than girls, seizures often occur
nursing care for autism spectrum disorder
-experiences to support child’s development, and structured based on IQ and adaptive functioning
-mental health assessment
-physical: sleep, appetite, activity, medication history, physical health assessment
-psychosocial: communication, behaviors (relating to others, repetitive behaviors and restricted interests), flexibility or adherence to routine
PHYSICAL SAFETY IS A PRIORITY!
-treatment outcomes need to be individualized
-determining need for predictability and stability in routine
-ask family about triggers/warning signs for agitation
interventions: TREAT SYMPTOMS AND SPREAD AWARENESS
self-care skills, activities, safety, no meds effective at changing core social and language deficits of autism, some atypical antipsychotics are approved for treatment or irritability associated with autism.
focus on building on strengths, use positive reinforcement, promote interaction, ensure predictability and safety, behavioral interventions, support family, evaluation and treatment outcomes
Attention-deficient hyperactivity disorder
persistent pattern of inattention, hyperactivity, easily distracted, and impulsiveness
-usually diagnosed in children and persists into adulthood
-most common diagnosed disorder in school-aged children
-boys more than girls
-risk factors: family history of ADHD (genetics), substance use during pregnancy, exposures to environmental toxins like lead during pregnancy or at young age, low birth weight, and brain injuries.
-dysregulation dorsolateral prefrontal cortex, serotonin and dopamine dysregulation
-family stress, marital discord, parental substance use, poverty, overcrowded living conditions, family dysfunction
-hyperactivity in boys, and inattentive girls or combined
teamwork and care for ADHD
-family response: challenging, partner with school system, calm home structure, resist overreacting emotionally, focus on child, provide consistency in discipline
-SAFETY, injuries, depression, suicide risk
-physical assessment: developmental history, medical history, eating, sleeping, activity patterns
-psychosocial assessment: school performance, behavior at home, comorbid psychiatric disorders, classroom behavior, school performance, teaching rating, standardized instruments
GOLD STANDARD MEDS= stimulants!
stimulants
low doses help to calm nerve signals in the brain. decreases impulsivity and improve executive functioning to help stay on task. involves neurotransmission of dopamine and norepinephrine.
-medications: methylphenidate (CNS and respiratory stimulation with weak sympathomimetic activity), amphetamine, lisdexamphetamine
-common side effects: decreased appetite, nausea, stomachache, weight loss, sleep problems, transient headache, behavioral rebound, increased HR or BP, irritability or dysphoria, psychosis, euphoria, mania, severe depression, rarely exacerbation of tics
-counteract ADHD overactive brain- calms the mind, organizes dopamine and norepinephine
-CONTROLLED SUBSTANCE
for appetite suppression: small, more frequent meals, protein dense meals, snacks on the go, eat a good breakfast- medication is faa=st action, so eat a full breakfast, give med, and it should cover school day behaviors/activities
-monitor sleep disruption and educate parents!
non-stimulant medications for ADHD
blocks reuptake of norepinephrine, and can also help with anxiety symptoms (atomoxeine)
-moderate release of norepinephrine in various areas of the brain
-thought to work better for hyperactivity, impulsivity, and tics, than on cognitive impairment
-off label medications: buproprion may be used to boost mood and treat ADHD symptoms
atomoxetine
2nd line non-stimulant medication for ADHD
-selectively inhibits norephinephrine resulting in therapeutic effect of increased attention span- noradrenergic reuptake inhibitor
-SE: dizziness, fatigue, mood swings, insomnia, nausea, vomiting, constipation, weight loss, weight and growth loss, decreased appetite
-adverse reactions: suicidal ideation, hepatotoxicity, rhabdomyolysis, anaphylaxis
non-stimulant meds: guanfacine adverse effects are usually dose related and transient- do not gibe with high fat meals as it increases medication exposure, check BP regularly during treatment. medication must be tapered off slowly to avoid rebound, including nervousness and increased BP. side effects: sedation, dizziness, abdominal pain, nausea, dry mouth, constipation, dose related hypotension, fatigue, weakness
ADHD health interventions
-modifying nutrition
-promoting sleep
-administering and teaching about pharm agents: psychostimulants, atomoxetine, bupropion, TCA, alpha agonists
-behavioral programs: rewards for positive behaviors
-cognitive behavioral techniques
-clear limits with clear consequences
-predictable environment with decreased stimuli- one assignment at a time!
-calm environment with few stimuli, homework in a quiet place
-eye contact before giving directions, ask to repeat what was heard
-evaluation and treatment outcomes, continuum of care
oppositional defiant disorder
-disruptive behavior disorder
-persistent pattern of disobedience, argumentativeness, angry outbursts, low tolerance for frustration, and tendency to blame other for misfortunes
conduct disorder
-disruptive behavior disorder
-characterized by more serious violations of social norms, including aggressive behavior, destruction of property, and cruelty to animals
-high risk for physical injury, sexual promiscuity, pregnancy, STIs
-comorbidities: ADHD, learning disabilities, chemical dependency, depression, bipolar illness, GAD, depression
-establish safety, improve communication, enhance coping skills
tic disorders and tourette disorder
-motor tics= quick, jerky movements of the eyes, face, neck, and shoulders
-phonic tics= repetitive throat clearing, grunting, other noises or complex sounds such as words, parts of words, or possibly obscenities
tourette disorder
multiple motor and phonic tics
-onset: around age 7
-motor tics before phonic tics; waxing and waning and typically hollow patterns of stress
-boys affected three times more often than girls
-OCD frequently occurs
-assessment: history of disorder, current level of symptoms, effects of symptoms on child and family, overall development, activity level, capacity to concentrate
-interventions: counseling and education including individual psychotherapy and comprehensive behavior therapy, education for parents, consultation for schools, medication interventions including antipsychotics and alpha-adrenergic receptor agonists (aripiprazole and clonidine)
-important to assess how much tics interrupt daily life, look for periods of stress or triggers
separation anxiety disorder
fear and anxiety developmentally inappropriate: worry about harm to or permanent loss of major attachment figure; school phobia is common manifestation
-most common childhood anxiety disorder
-occurs at mean age of 7
-risk factors: parents with anxiety disorder, parental depression
obsessive-compulsive disorder
intrusive thoughts (obsessions), ritualized behaviors (compulsions), or both
-treatment: CBT, psychoeducation, cognitive training, exposure and response preventions, relapse prevention, SSRIs
-management: distinguish between normal and pathologic; interventions based on developmental needs; antidepressants and close monitoring (BBW!)
learning disability
discrepancy between actual achievement and expected achievement based on the person’s age and intellectual ability
-learning disorders are typically classified as verbal (reading or spelling) or nonverbal (mathematics)
communication disorder
involves speech or language impairments
-can adversely affect the child’s socialization and education
-nursing care: evidence of interference in daily life, determination of child’s ability or limitations to communicate during the interview, assessment of the child’s perception about their disability, observation for impaired learning and communication, past and current interventions for learning or communication deficit, continuum of care
mood disorders in children
-depression accounts for largest percentage
-females more commonly affected
-children more likely to show suffering through behavior rather than expression of feelings
-therapeutic relationship, education, and support!!
-antidepressants for depression- use of SSRIs requires frequent monitoring
-mood stabilizers or antipsychotics for bipolar disorders
childhood schizophrenia
-diagnosed by same criteria as in adults
-poorer premorbid functioning than later/adult onset
-nursing management is like that of ASD: antipsychotics for symptoms, parent education, long-term management
enuresis
bed wetting
-elimination disorders
-most common in boys
-etiology unknown
-limit fluid intake in evening
-desmopression
-bell and pad
encopresis
fecal soiling in clothing, fecal deposition in inappropriate places
-most common in boys
-education and behavioral interventions
-bowel management
