C/A Tourettet's Flashcards
What are the characteristics of Tourette’s disorder?
characterized by the presence of multiple motor tics and one or more verbal tics which may appear simultaneously or at different periods during the illness
What are biochemical predisposing factors related to Tourette’s?
abnormalities in the level of dopamine, creatine, and norepinephrine
what two symptoms are most consistent with Tourette’s?
palilalia: repeating one’s own words or phrases
echolalia: repeating what others say
NCP for risk for self-directed or other-directed violence and nursing interventions
STG: patient seeks out staff or support person at any time if thought of harming self or others are present
LTG: patient does not harm self or others
INTERVENTIONS: observe patient behavior in routines activities and interactions and indicate rise in agitation, monitor for self-destructive behaviors or impulses and stay with patient if those occur, provide hand coverings and other restraints to prevent patient from self-mutilation behaviors, redirect violent behaviors with physical outlets for frustration
NCP for impaired social interaction
STG: patient develops one-to-one relationship with nurse within one week
LTG: patient is able to interact with staff and peers using age-appropriate behaviors
INTERVENTIONS: patient develops trusting relationship with nurse and conveys acceptance of behavior form unacceptable, discuss which behaviors are and are not acceptable, provide group situations for patient
NCP for low self-esteem and nursing care plan.
STG: patient verbalizes positive aspects of self not associated with tics
LTG: patient exhibits increasing self-esteem as evidence by verbal expression of positive aspects of self and future prospects
INTERVENTIONS: convey unconditional acceptance and positive regard, set limits on manipulative behaviors. help the patient understand that he/she uses manipulation to try to increase self-esteem, provide a specific time time if suppression around others occurs, ensure patient has regular one-to-one time with staff
What antipsychotics are used to suppress tics and vocal utterances?
haloperidol (no younger than 3) adverse effects of extrapyramidal symptoms, tardive dyskinesia, and neuroleptic malignant syndrome
pimozide (no younger than 12)
RISPERIDONE: most effective atypical antipsychotic for treatment of tics
what alpha agonists are used to help with the comorbities associated with Tourette’s?
clonidine: dry mouth, headache, fatigue, dizziness, postural hypotension, or sedation
Guanfacine: longer lasting and less sedating
*no preexisting cardiac problems or suspected problems
*Comorbid symptoms: ADHD, anxiety, and insomnia
what are some non pharmacological treatment options for children with Tourette’s?
comprehensive behavioral intervention for tics (CBIT), speech therapies, and deep brain stimulation
CBIT: evidence-based treatment to reduce the severity of tics as an intervention to teach individuals how to recognize and manage environmental factors that trigger or worsen tics
