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N353: Practice of Nursing II > Module 3 - Pediatric Mental Health > Flashcards

Module 3 - Pediatric Mental Health Flashcards

(100 cards)

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1
Q

Many __ ___ can lead to or resemble mental health disorders

A

learning disabilities

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2
Q

Many disorders occur ___ making diagnosis difficult

A

concurrently

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3
Q

What are some etiologies for mental health disorders in children?

A

Physiologic

Chronic Physical Illness or Disability

Family Dynamics

Environment

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4
Q

What are some examples of physiologic etiologies for mental health disorders?

A

Genetics

Structural Brain Abnormalities

Prenatal Influences

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5
Q

What are some examples of Family Dynamic etiologies for mental health disorders?

A

Child abuse

Dysfunctional Family System

Poor Role Modeling

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6
Q

What are some examples of environmental etiologies for mental health disorders?

A

Poverty

Homelessness

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7
Q

What are some treatment options for mental health disorders in children?

A

Cognitive, Behavioral, Group, Family, Play, Art, Music Therapy

Quiet Room

Time Out

Seclusion and/or Restraint

Psychopharmacology

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8
Q

What kind of therapy is most commonly used for mental health disorders in children?

A

Behavioral Therapy - if you start teaching and learning new behaviors early you can change them

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9
Q

Early Intervention

A

A federally mandated program implemented at the state level via LHD

Testing and Services are provided for free to try and prevent further developmental delay (if its already noted)

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10
Q

Many outcomes can be significantly improved if …

A

treatment is started early ! do not wait !

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11
Q

What sort of management can be done to treat mental health issues in children?

A

Community Based Treatment (Primary, Secondary, Tertiary)

Hospital Based Treatment

Specialized Units for Children and Adolescents

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12
Q

Primary Prevention Community based Treatment for Mental health in children

A

prenatal care

teaching about risk factors

parenting skills classes

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13
Q

Secondary Prevention Community based Treatment for Mental Health in children

A

Early detection and testing

school and community nurses, NPs, and teachers

Pediatricians

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14
Q

Tertiary Prevention Community based Treatment for Mental Health in Children

A

minimizes effect of disorder via individual, family, group therapy and behavioral modification

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15
Q

What Assessments should be done by the nurse for a child’s mental health status?

A

H&P - History and Physical (look at stressors and significant data)

PMH

FH

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16
Q

What are some examples of things to investigate in child PMH

A

prenatal and birth history

injuries

mood issues

medications

suicide and self injury

mood and actions at home

mood and action with friends

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17
Q

What are some examples of things to investigate in child FH

A

note strengths and weaknesses of family system

who do they live with

educational level

willingness to learn/participate in services

abuse issues? - Alcohol, physical, emotional

depression/anxiety issues?

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18
Q

What is important to do when assessing a child’s mental health status?

A

Become a detective - take things in visually like appearance, behavior, and developmental stage, but also ask open ended questions and learn during play

Try to get the family and the child to open up a little to learn about home life and family situations

Observe behaviors

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19
Q

Important Mental Health Disorders in Pediatrics

A

Developmental Disorders / Learning Disabilities

Pervasive Development Disorders (Autism)

ADD/ADHD/Behavioral Disorders

Mood Disorders

Anxiety Disorders

Intellectual Disabilities

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20
Q

What forms can developmental and learning disabilities take

A

Sensory Integration (Sensory issues)

Auditory Processing Difficulties (trouble hearing words or understanding)

Visual processing difficulties

Dyslexia

Speech/Language Delays etc

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21
Q

With developmental and learning disabilities, it is important to know what?

A

that they exist and can be misdiagnosed as other more common disorders

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22
Q

Pervasive Developmental Disorders (PDD)

A

GROUP of conditions that involve DELAYS in development of many basic skills

It is an umbrella term / group of conditions

Essentially, autism spectrum

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23
Q

PDD is more common in what gender?

A

Male

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24
Q

Children with PDD are …

A

confused in their thinking and generally have problems understanding the world around them

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25
PDD exists as a spectrum of...
autism that goes from mild autism to Asperger's Syndrome
26
PDD is a very large...
umbrella term for many things
27
Autism
A range of complex neurodevelopment disorders
28
What is Autism characterized by (generally)?
1. Social impairments 2. Communication Difficulties 3. (sometimes) Receptive Patterns of Behavior (rocking, twirling, self abuse behavior)
29
S/S Of Autism
can engage in rigid, repetitive, machine like movement/obsessive behavior Impaired social interaction Unresponsive to people unable to respond to social/emotional cues (cant pick up on a situation) aversion to touch and extreme stimuli at risk for self injury (hitting head, scratching, etc) A pattern of restricted interests, activity and behaviors
30
Autistic Disorder
impaired social, communicative, and behavioral development It is a complex disorder of brain development
31
When do Autism symptoms tend to emerge?
Between 2-3 years but can be evident from early toddler stage
32
Asperger's Syndrome
Mild end of the autism spectrum Social skills and interactions impaired, but high intellectual functioning
33
How does Asperger's Syndrome differ from regular autism?
LATER ONSET MILD END Similar social interaction and repetitive behavior problems - but often called eccentric or loner NO Language delay Speech may be monotone, poor "give and take" in a conversation Egocentric
34
Egocentric
low empathy for others possessed by Asperger's Syndrome
35
Nursing Interventions for Children with Autism
Gradual and Gentle Interaction (Create a safe and stable environment) Enhance communication (learn triggers or what they like) Coach on socialization - collaborative activities Help parents decrease feelings of blame, provide education and resources Use Childs established routine and decrease stimuli while hospitalized (learn from parent what works, communication cutes, self injury habits) Use diversion for acting out and increased anxiety (appropriate activities) Provide child with familiar objects Change is often challenging MEDICATIONS may be needed for aggression Know the childs cues!!!
36
Autism Prevalence and the Vaccine Debate
10 epidemiologic population based studies concluded there is no evidence of a causal association between vaccines and autism No evidence to date that children with neurodevelopmental disabilities, including autism, in the US have increased mercury concentrations or environmental exposures
37
Examples of Attention Deficit and Disruptive Behavior Disorders
ADHD CD ODD
38
ADHD
Attention Deficit - Hyperactivity Disorder (ADHD) Disorder that makes it difficult for children to control their behavior Can be both attention deficit and hyperactivity (or more one than the other)
39
ADHD goes beyond the normal...
hyperactive child, this is inappropriate attention or impulsiveness consistently
40
What is one of the most common chronic conditions of childhood? How many children does it impact?
ADHD - 4 to 12% of School Aged Children
41
Due to how common ADHD is, what often happens?
Other things are often misdiagnosed as ADHD
42
Characteristics of ADHD
Inappropriate degrees of inattention, impulsiveness, and/or hyperactivity Trouble paying attention to details Making careless mistakes Trouble concentrating on one activity at a time Talking constantly even at inappropriate times Running around in a disruptive manner Fidgeting and Squirming Having trouble waiting turn Being easily distracted Impulsively blurting out answers Misplacing school assignments Seeming not to listen, even when directly addressed
43
When does ADHD onset begin and how long must it last for a diagnosis?
before age 7, last at least 6 months Stress can cause ADHD like symptoms so we need to watch and make sure
44
ADHD has a high incidence of what?
COMORBIDITY (this can lead to a lot of issues) ex: ODD, Anxiety disorders, mood disorders, developmental learning disorders like dyslexia
45
What is the focus of therapy for ADHD
MANIPULATE ENVIRONMENT TO DECREASE STIMULI (#1) Minimize hyperactivity and impulsivity Increase attention span Prevent potential future problems (ex: substance abuse, conduct disorders, etc) Assist family to establish regular scheduled times for eating, sleeping, homework, etc Provide emotional support Promote self-esteem, rewards for positive behavior
46
Why is one type of ADHD meds stimulants?
Stimulants cause an increase in dopamine levels that actually boost attention ability - it is a NT associated with motivation, pleasure, attention, and movement Therefore, it can boost concentration and focus while reducing hyperactive and impulsive behaviors
47
When should ADHD meds be given?
In the morning to help get through the day (and may need a second dose for evening and homework time)
48
Side Effects of using Stimulants for ADHD medications
Difficulty Sleeping Loss of appetite (big one) - we need to make sure they are growing well height and weight wise so give them suggestions for nutrition dense food options Tachycardia Tics (Rare) Upset Stomach
49
Examples of Stimulant ADHD Meds
Adderall Concerta Ritalin
50
Why can non-stimulants be used as ADHD medication?
It boosts the levels of norepinephrine and has some anti depressant features
51
Non-stimulant ADHD meds lack which side effect?
Tic side effects
52
What is more effective, Stimulant or Non-stimulant ADHD meds?
Stimulant Non-stim does not always work as well so you may need several types of meds and dosages until you get the right one that works for them
53
Side Effects of Non-stimulant ADHD meds?
Sleepiness Headache Mood Swings Nausea Loss of Appetite
54
Oppositional Defiant Disorder (ODD)
While all children are defiant at times, especially toddlers saying no and early adolescents, this is much more so and is a pattern of uncooperative, defiant, and hostile behavior
55
What is ODD a combination of?
Internal Depression/Anxiety along with externalizing aggression/temper tantrums
56
What are some treatments for ODD
Therapy Social Skill Training Parenting Classes Medications (We want to work on managing this with a combination of things, and do so quickly because this could spiral out of control; we need strict action = consequences laid down)
57
Signs and Symptoms of ODD
Frequent temper tantrums Excessive arguing with adults Often questioning rules Active defiance and refusal to comply with adult requests and rules Deliberate attempts to annoy or upset people Blaming others for his/her mistakes or misbehaviors Often being touchy or easily annoyed by others Frequent anger and resentment Mean and hateful talking when upset Spiteful attitude and revenge seeking
58
Conduct Disorder
Much worse than ODD Great difficulty following the rules, often viewed as "bad" rather than mentally ill These are the kids on the edge of even more serious aggression or criminal acts
59
Those with Conduct Disorders are likely to have what if they are not treated?
ongoing and increasingly serious problems if they go untreated
60
Signs and Symptoms of Conduct Disorders
Lying, Aggression, Even criminal acts No remorse Aggression to people and animals - bullies, threatens, starts fights, cruel to animals Destruction of Property - fire starting, vandalism Deceitfulness, Lying, or Stealing - money, shoplifting, breaking into house or car, lying to avoid obligations or get something Serious violations of the rules - running away, truant, staying out past parents limits
61
What are the 2 subtypes of Conduct Disorders?
1. Childhood Onset 2. Adolescent Onset
62
What are some treatments for Conduct Disorders?
Intense behavioral and psycho therapy - the tx of choice for CD Positive reinforcement Arrange organized, supervised activity HAVE TO SET STRICT BOUNDARIES AND CONSISTENT CONSEQUENCES Pharmaceuticals - Anti depressants, mood stabilizers
63
Tourette's Syndrome
INVOLUNTARY motor movements and/or vocalizations (TICS) - consistent and uncontrollable! Tics could be motor or verbal It is a neurobiological disorder
64
What are some signs/symptoms of Tourette's Syndrome
TICS Snorts Throat Clearing Facial Twitching Arm Jerking Kicking May show sudden rage - frustration Verbal tics Co-morbidities - like depression
65
What alters the frequency and intensity of Tourette's syndrome?
It can be up or down between people Also, symptoms may worsen with anxiety
66
Are kids with TICS always diagnosed with Tourette's?
No, some kids have tics that are not true Tourette's and it will go away with a stressor's leaving - true Tourette's is consistent and remains
67
Anxiety Disorders
Generalized Anxiety Disorder Panic Disorder Phobias Separation Anxiety Disorder Obsessive Compulsive Disorder Post Traumatic Stress Disorders
68
Generalized Anxiety Disorders
tend to being in childhood and continue into adolescence - anxiety is a normal part of development but if we fail to move beyond fear that is when problems begin This lasts at least 3 months
69
What behaviors might generalized anxiety include
Bedwetting Sucking Thumb Regression (for at least 3 months)
70
Separation Anxiety Disorder
Fear of being separated from the person to whom the child is most attached It is an abnormally excessive or age inappropriate fear (toddlers and infants have this normally, but a 5 year old should be able to be dropped off without significant distress)
71
What can untreated separation anxiety lead to?
other generalized anxiety disorders or relationship difficulty later
72
What are some symptoms of Separation Anxiety Disorder
Refusal to attend school Somatic complaints Severe anxiety regarding separation Worry about harm coming to significant caretaker Clinging Crying Tantrums
73
Nursing Interventions for Separation Anxiety Disorder
Maintain a calm manner Teach parents about consistency in expectations Therapy - family and/or child Education and resources for the parents Medications MAY be needed (but they might just need better coping skills) Ex: Get the kid back in school ASAP and keep a routine!!
74
Obsessive Compulsive Disorder
Ritualistic behaviors (similar to those displayed in adults) that are highly specific and a high anxiety issue for children
75
What some signs or symptoms of OCD in a child?
Repeatedly perform routines or think thoughts over and over until they become a ritual Cant control the deep need to the ritual again and again The anxiety and rituals get in the way of daily life
76
What is commonly used to treat OCD in children?
Medications - to calm and focus the child Sometimes therapy to learn coping skills, letting go, and lower anxiety
77
When is COD more common in children?
more so in littler kids than older ones.
78
What are 2 important mood disorders in children?
Suicide Depression
79
Mood Disorders are often associated with what in children?
Behavioral Issues Social Skill Deficits Family Dysfunction poor achievement
80
Mood disorders were recognized as occurring in children...
only recently! It is not just in teenagers, grade schoolers too!
81
S/S of Depression in Children
Poor school grades Withdrawal from activities previously enjoyed Sleep and appetite disturbances Somatic complaints Decreased energy Difficulty concentrating Low self esteem Feelings of hopelessness
82
Warning signs of Suicide in Teens
Sudden withdrawal Violent behaviors Drug and alcohol use Unusual neglect of personal appearance Truancy running away excessive fatigue poor response to praise talks about suicide gives away possessions
83
How do children under 12 committing suicide differ from it occurring in teens?
MAY DO SO IMPULSIVELY (less thought) - so it ends up being often recorded as an accident Tend not to give warning signs as adolescents and adults do Careful monitoring for an treatment of depression is critical
84
Many child suicides are recorded as ...
accidents
85
Because of the differences between how children deal with suicide to others, what is highly important to do?
Careful monitoring for and treatment of depression critical
86
Nursing Interventions for Mood Disorders
BE SUPPORTIVE Medications when needed Monitor for Side Effects of Meds Provide Community Resources, Education Promote Self-Esteem Maintain Hopefulness Provide a safe environment Use Suicide Precautions Change approach based on the mood disorder or the effect of certain medications. - Be gentle with them
87
Fetal Alcohol Syndrome (FAS)
Completely preventable syndrome of cognitive problems and physical abnormalities Caused by drinking while the child is developing in the womb
88
What sort of delays and issues can occur d/t FAS
Developmental Delays Behavioral Disorders Intellectual Disabilities
89
What are some characteristic physical abnormalities in FAS children?
Wide eye placement Small thin upper lip Flat nasal bridge Upturned nose "Classic Look"
90
Anorexia Nervosa
Distorted body image d/t fear of obesity, thus leading to dramatic weight loss They strain to keep a "perfect" body - high expectation type of image
91
What group is anorexia nervosa most common in?
Females aged 12-18 years old
92
What are some signs and symptoms of Anorexia Nervosa?
Fear of Obesity Dramatic Weight loss Distorted body image anemia amenorrhea (body just stops everything) dry brittle hair nails laxative and enema use frequently electrolyte imbalance High expectation of body type image
93
What is a highly useful treatment for Anorexia Nervosa?
Behavior Modification Model - meet a goal and get a reward/privilege
94
Bulemia
Distorted body image with much of the characteristics of anorexia, but involves binge eating and then vomiting
95
Signs and Symptoms of Bulemia?
Many anorexia s/s Binge eating (high calorie food in short time) followed by induced vomiting Could be normal weight or even overweight Electrolyte imbalances Body slows itself (like with many eating disorders) - body slows itself down (constipation, bradycardia, low BP)
96
What are some interventions for eating disorders?
Behavioral modification therapy (rewarded for corrected behavior; ex: gains weight each week = add privileges) Family therapy Monitor clinical status - weight, intake, vital signs - so we can get them into a proper facility
97
PICA
Ingestion of non nutritional substances (ex: clay, chalk, plants, paint chips, hair...) It is a nervous anxiety issue for them that soothes them, but they need therapy
98
How long does PICA need to occur for diagnoses?
For at least one montyh
99
Treatment for PICA?
Feeding Therapist, Psychologist, etc They might use PICA as a soothing behavior, but they need therapy
100
What is the overall goal for pediatric mental health?
SUPPORT AND UDNERSTANDING (remember that is a patient has these issues, it frames how you set the goals, go forward, reevaluate goals more often, meet their needs, etc)

N353: Practice of Nursing II (14 decks)

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