Alteration in Cognition, Behavior, or Dev Flashcards
Factor’s Influencing Children’s Behavior
- biologic or genetics
- nutrition
- physical health
- developmental ability
- environment/family
- temperament
- family’s response to behavior
What are some techniques for evaluation?
- clinical features
- brain imaging
- blood or urine toxicology
- screening tools
Behavior Management Techniques
- set limits and hold responsible for behavior
- do NOT argue, bargain, or negotiate
- consistent caregivers/daily routine
- remain calm
- ignore inappropriate behavior
- praise self control
- use restraints only when necessary
Psychostimulants
Methylphenidate TID
- long acting preparations are given once daily in AM
- decreased appetite; abdominal pain
Antianxiety
Buspirone
- monitor for depression, confusion, agitation
- may cause drowsiness
Antimanic
Lithium
- monitor closely
- polyuria, polydipsia
- tremors, diarrhea
SSRI
fluoxetine, paroxetine, sertraline
- monitor for BP increases
- insomnia
- GI distress
- irritability
- headache
Atypical Antidepressant
Trazadone
- monitor BP for postural hypotension
- observe for sedation and drowsiness
- avoid alcohol
- administer w/ meals or snacks
A-Agonist
Clonidine
- strongly sedating
- monitor BP and pulse
Tricyclic Antidepressants
Amitriptyline
- monitor ECG for arrhythmias
- monitor for anticholinergic effects
- weight loss
- check blood levels
Antipsychotics
Thioridazine, Chlorpromazine, Haloperidol
- monitor for anticholinergic effects, drowsiness, dystonia, dizziness
- drowsiness
- evaluate for orthostatic HTN, tachycardia
- observe for tardive dyskinesia
Assessments for a Child w/ Cognitive or Mental Health Disorder
- health history
- past medical history
- history of neurologic injury or disease and family history of mental health disorder
- developmental history
What are some behaviors related to mental health disorders?
hallucinations aggression, impulsivity distractibility intolerance to frustration lack of sense of humor inhibition poor attention span potential cognitive or learning disability unusual motor activity
What is the most sensitive early indicator of an intellectual disability?
delayed language development
Dyslexia
difficulty w/ reading, writing, and spelling
Dyscalculia
difficulty w/ math and calculations
Dyspraxia
problems w/ manual dexterity and coordination q
Dysgraphia
difficulty producing the written word
Sensory Processing Disorder
may be mistaken for a learning disability, but it is not and should be treated differently
What is the criteria for being diagnosed w/ an Intellectual Disability?
- deviations in IQ of two or more standard deviations
- coexisting deficits in at least 2 adaptive skills
- disability occurring before the age of 18
Mild Intellectual Disability
IQ 50-70
Moderate Intellectual Disability
IQ 35-50
Severe Intellectual Disability
IQ 20-35
Profound Intellectual Disability
IQ less than 20
What are the warning signs of autism?
- not babbling by 12 months
- not pointing or using gestures by 12 months
- no single words by 16 months
- no 2 word utterances by 24 months
- losing language or social skills at any age
What are some possible etiologies of autism?
- genetic makeup
- brain abnormalities
- altered chemistry
- virus
- toxic chemicals
Autism Screening Tools
- Checklist for Autism in Toddlers (CHAT)
- Modified Checklist for Autism in Toddlers (M-CHAT)
- Social Communications Questionnaire (SCQ)
- Pervasive Developmental Disorders Screening Test II (PDDST-II)
What to look for when assessing an Autistic Child?
-lack of eye contact
-failure to look at objects
-failure to point to himself
-failure to let his or her needs known
-perseverative play activities
-hand flapping
spinning
Nursing Interventions for Autism
- provide emotional support
- professional guidance and education
- assess fit b/t developmental needs and treatment plan
- help parent’s overcome barriers
- stress importance of rigid, unchanging routines
- assess need for respite care
- provide positive feedback
What is ADHD characterized by?
inattention, impulsivity, distractibility, and hyperactivity
What are the 3 subtypes of ADHD?
- hyperactive-impulsive
- inattentive
- combined
Tourette Syndrome
multiple motor tics and one or more vocal tics occurring either simultaneously or at different times
What are 2 comorbid conditions that occur 60% of the time w/ Tourette’s?
ADHD
Obsessive compulsive disorder
When do tics become more noticeable for a child w/ Tourette’s?
during times of stress
What are the 4 types of eating disorders?
- pica
- rumination
- anorexia nervosa
- bulimia
Pica
- 2-3 years old
- ingests a nonnutritive material such as clay, paint, or sand for at least 1 month
Rumination
infants which regurgitate partially digested food/formula and then expel or swallow it
Anorexia Nervosa
dramatic weight loss as a result of decreased food intake and sharply increased physical exercise
Bulimia
cycle of normal food intake, followed by binge-eating and then purging
Complications of Anorexia Nervosa and Bulimia
- fluid and electrolyte imbalance
- decreased blood volume
- cardiac arrhythmias
- esophagitis
- rupture of esophagus or stomach
- tooth loss
- menstrual problems
- mortality rate as high as 18%
Mood Disorders
- depressive disorders
- bipolar disorder
- anxiety disorder
- mood control
Teaching Topics for Mood Disorders
- mood disorders are biologic conditions not personality flaws
- teach how to administer antidepressant meds and monitor for adverse effects
- encourage for following through w/ therapies
- support family
- refer to local support resources
What are some disorders that may be seen w/ depression?
- suicide
- anxiety disorders
- substance abuse
- eating disorders
- self harm
- disruptive behavioral disorders
Risk Factors for Suicide
- previous suicide attempt
- change in school performance, sleep, or appetite
- loss of interest in formerly favorite school or other activities
- feelings of hopelessness or depression
- statements about thoughts of suicide
Types of Anxiety Disorders
- generalized anxiety disorder
- social phobia
- selective mutism
- separation anxiety
- obsessive compulsive disorder
- posttraumatic stress disorder
Generalized Anxiety Disorder
unrealistic concerns over past behavior, future events, personal competence
Social Phobia
persistent fear of speaking or eating in front of others, using public bathrooms, or speaking to authority
Selective Mutism
persistent failure to speak
Separation Anxiety
close to parents; worry focuses on separation
Obsessive Compulsive Disorder
compulsions performed to reduce anxiety about obsessions
Compulsions
repetitive behavior such as cleaning, washing, checking something
Obsessions
unwanted and intrusive thoughts
PTSD
an anxiety disorder that occurs after a traumatic event
Types of Abuse/Violence Leading to Mental Illness
- child maltreatment
- Munchausen syndrome
- Substance abuse
Munchausen Syndrome
type of child abuse in which the parent creates a physical/psychological illness, symptoms, or impairment in the child
Warning Signs of Munchausen Syndrome
- child w/ 1 or more illnesses that don’t respond to treatment or follow a puzzling course; similar history in siblings
- symptoms that don’t make sense or that disappear when the perpetrator is removed
- physical & lab findings that don’t fit w/ reported history
- repeated hospitalizations failing to produce a diagnosis, transfers to other hospitals
- parent who refuses to accept that the diagnosis is not medical
