Ch 24 Pediatrics Flashcards
an emotional problem exists if behavioral manifestations…
are NOT age appropriate
deviate from cultural norms
interfere with adaptive functioning
strong desire for sleep or sleeping for long periods of time
somnolence
impairment in intellectual performance and adaptive skills across multiple domains
intellectual development disorder (IDD)
onset of IDD
prior to 18 yo
measured by BOTH clinical assessment and a person’s performance on IQ tests
general intellectual functioning
person’s ability to adapt to requirements of activities of daily living and expectations of their age/cultural group
adaptive functioning
predisposing factors of IDD
disruptions in embryonic development (30%) sociocultural factors (15-20%) pregnancy and perinatal factors (10%) genetics (10%) general medical conditions (5%)
extent of severity of IDD may be measured by..
the client’s IQ level
what are the levels of IDD
4: mild, moderate, severe, profound
nursing diagnoses
risk for injury self care deficit impaired verbal communication impaired social interaction delayed growth/development anxiety defensive coping ineffective coping
what should a care plan for an IDD pt focus on
risk for injury, self care deficit, impaired verbal communication
withdrawal of child into self and into a fantasy world of his own creation
autism spectrum disorder (ASD)
who is ASD most common in
boys
1 in 88 children
onset is early childhood
chronic course
predisposing factors to ASD
neurological implications
physiological implications
genetics
perinatal influences
ASD is characterized by…
impairment in social interaction
impairment in communication an imaginative activity
restricted activities and interests
diagnoses of ASD
risk for self mutilation
impaired social interaction
impaired verbal communication
disturbed personal identity
FDA approved meds for ASD
Risperidone
Aripiprazole
what do ASD meds target
aggression, deliberate self injury, temper tantrums, quickly changing moods
dosage of ASD meds is based on…
weight of child and clinical response
side effects of Risperidone
drowsiness, increased appetite, nasal congestion, fatigue, constipation, drooling, dizziness, weight gain
side effects of Aripiprazole
sedation, fatigue, weight gain, vomiting, tremors, somnolence
essential feature of ADHD:
developmentally inappropriate degrees of…
inattention
impulsiveness
hyperactivity
types of clinical diagnosis of ADHD
combined type
predominately inattentive
predominately hyperactive
predisposing factors of ADHD
genetics, biochemical theory, anatomical influcence, prenatal/perinatal/postnatal, environmental, psychosocial influences
assessment of ADHD
difficulty in performing age appropriate tasks
highly distractable
extremely limited attentionspan
impulsive
difficulty forming relationships
behaviors inhibit acceptable social interactions
disruptive and intrusive
accident prone
low frustration tolerance/temper outbursts
these are prevalent with ADHD
comorbid psychiatric disorders
common comorbidities with ADHD
oppositional defiant disorder, conduct disorder, anxiety, depression, bipolar disorder, substance use disorder
these may be treated cocurrently with ADHD
anxiety and depression
these must be stabilized BEFORE ADHD treatment
substance use disorder and bipolar disorder
nursing diagnoses for ADHD
risk for injury
impaired social interaction
low self esteem
noncompliance with tasks
psychopharmacology for ADHD
CNS stimulants
ie/ dextroamphetamine, methamphetamine
* -phetamine
side effects of CNS stimulants
insomina, anorexia, weight loss, tachycardia, decrease in growth and developmental rate
children on ADHD drugs have….
increased risk of injury related hospital admissions
presence of multiple motor tics and one or more vocal tics
tourette’s disorder
prevalence of tourette’s disorder
more common in boys
onset is 2-6 yrs (6/7 yrs more common)
predisposing factors of tourette’s disorder
biological and environmental
simple motor tics
eye blinking, neck jerking, shoulder shrugging, facia grimacing,
complex motor tics
squatting, hopping, skipping, tapping, retracing steps
vocal tics
words/sounds, squeak, grunt, bark, sniff, short, cough, obscenities
what other symptoms of tourette’s disorder
palilalia and echolalia
diagnoses of tourette’s disorder
risk for self directed violence
impaired social interaction
low self esteem
pharmacological treatments for tourette’s are most effective when…
combined with other therapy (ie/behavioral, individual, family)
common meds for tourette’s
antipsychotics
alpha agonists
persistent pattern of angry mood and defiant behavior that occurs more frequently than is usually observed in comparable individuals
oppositional defiant disorder (ODD)
predisposing factors for ODD
biological
family influences: parental power struggle
what is ODD characterized by
passive aggressive behaviors** stubbornness, procrastination disobedience, negativism carelessness, testing limits resistance to directions running away school avoidance temper tantrums
how do children view themselves with ODD
children do not see themselves as oppositional, view problem arising from others and unreasonable demands of them
nursing diagnoses for ODD
noncompliance with therapy
defensive coping
low self esteem
impaired social relationships
persistent pattern of behavior in which the basic rights of others and major age appropriate societal norms and rules are violated
conduct disorder
what are the onsets of conduct disorder
childhood onset
adolescent onset
what is conduct disorder a precursor for
antisocial personality disorder
predisposing factors of conduct disorder
biological
peer relationships
family influences
conduct disorder is characterized by
use of physical aggression in violation of rights of others use of drugs and alcohol sexual permissiveness low self esteem lack of guilt projection
diagnoses of conduct disorder
risk for violence
impaired social interactions
defensive coping
low self esteem
essential feature is excessive anxiety concerning separation from those to whom the individual is attached
separation anxiety disorder
explain separation anxiety disorder
anxiety exceeds what is expected for the person’s developmental level and interferes with functioning
predisposing factors of separation anxiety
genetics, temperament, stressful life event, family influences
when is the onset of separation anxiety
preschool age
what does separation result in
tantrums, crying, screaming, clinging, complaints
separation anxiety is characterized by
reluctance to attend school worrying nightmares fear of sleeping away from home young children will shadow
diagnoses of separation anxiety
anxiety (severe)
ineffective coping
impaired social interaction
general therapeutic approaches
behavior, family, group, psychopharmacology
