Ch 26 CHILD AND ADOLESCENT

Question 1

Examines the family as whole vs. cause and effect relationships - happens to one family members impacts other members of the family; families viewed as a whole
The family is able to create a balance between change and stability
A change in one family member affects all family members - not just case of fixing the child and taking no responsibility of where came from and environment; with children and adolescents their “family” is affected when they are struggling so must consider that
A family system is part of a larger suprasystem and is composed of many subsystems

Answer 1

Gen systems theory

Question 2

All systems have fixed constraints from the environment, as well as choices that made about how the system will use its resources
The family is viewed as whole boundaries which are affected by the external environment
The family as a whole is greater than the sum of its parts

Answer 2

Examines the family as whole vs. cause and effect relationships - happens to one family members impacts other members of the family; families viewed as a whole

Question 3

Many children and adolescents grow up threatened by hardships that put them at risk for emotional or physical illness
Sig factor: support - helps them get over in a healthy way
Resiliency is developed through successful transition through a previous crisis, often with guidance and support
Children and youth with a high degree of resilience often have certain things in common: able come through in + ways

Answer 3

Resiliency

Question 4

More available resources than non-adapting children
Good parenting or mentoring figure
Neurologically less vulnerable to stress
More available resources than non-adapting children
Good parenting or mentoring figure
Neurologically less vulnerable to stress

Answer 4

Children and youth with a high degree of resilience often have certain things in common: able come through in + ways

Question 5

below is 1 unique to children; present depression differently
Disruptive Mood Dysregulation Disorder (DMDD)

Answer 5

Depressive disorder:

Question 6

Severe recurrent temper outbursts manifested verbally and/or behaviorally that is out of proportion (temper outburst - very intense - respond beyond what would expect) in intensity or duration to the situation or provocation (DSM-5) - beyond considered “norm”
Inconsistent with developmental level - where at developmentally
Average 3 or more times/week
Present for more than 12 months
The dx. should not be made before age 6 or after 18

Answer 6

Disruptive Mood Dysregulation Disorder (DMDD)

Question 7

remember it is on a spectrum - depends on symp of child; put everything together when creating this diagnosis
Common behaviors/symp seen at age appropriate - not cookie cutter

Answer 7

Gen manifestation of autism:

Question 8

Unresponsive to Caregiver
Resists Cuddling
Relates to Objects—Not People
Lack of Speech Development (mute to echolalia [repeating words heard])
Solitary, Repetitive Play Habits - play with things vs people
Hearing or Touch often Acute/Sleeping difficulties - hear/sensitive to things other people are not
Absence of self-image—Inability to identify body parts
Desire of Sameness—A routine - out routine; disregulates them; same article of clothes (often stripes)

Answer 8

Common behaviors/symp seen at age appropriate - not cookie cutter

Question 9

Center around child achieving full potential in cognitive and social skills - reach highest level; bottom line goal
Protection from harm - SAFETY; impulsive
Behavior Modification - catch them doing something right and reward that
Play Therapy:

Answer 9

Interventions: autism

Question 10

to develop trust, means to express feelings, time to have a positive experience with adult, opportunity to explore Fantasy vs Reality, creativity
Not just for autism; used for variety of ways; nonthreatening to kids and learn about home environment
Helps develop trusting feelings with adult and develop + feelings when with adult
Lot that comes out esp about home life
Share many things with you

Answer 10

Play Therapy:

Question 11

Variety therapies for variety children
Develops Trust, increase Communication, increase Socialization, increase decision-making, self-control (limits), Problem Solving
Can learn emotions and how feeling
Opportunity to explore Fantasy vs. Reality, Creativity - interaction with adult that is healthy, + and good role-modeling; explore with adult in safe enviornment
A means to express feelings: anger, fear, love, anxiety, sadness in safe enviornment
A positive experience with an Adult

Answer 11

Play therapy: Benefits:

Question 12

ADHD
Oppositional Defiant
Conduct Disorder:

Answer 12

Behavioral disorders

Question 13

(may have or may not have hyperactivity)
Typ Sxs. may develop around age 3, but not dx. until school age - probs real prob when have concentrate and have to sit down and be quiet then get message bad kids - are not - just distracted/bored; observed in variety of settings and diff interactions to know dealing with
More frequent in males

Answer 13

ADHD

Question 14

Pattern of negativistic, defiant, disobedient towards authority figures
Symp seen early age
You say yes they say no; you say up they say down
They don’t see themselves as defiant—just responding to unrealistic demands/rule is really stupid so why follow it - that is thinking pattern
Usually evident before age 8
More verbal

Answer 14

Oppositional Defiant

Question 15

persistent pattern in which the basic rights of others and societal norms are violated
Kids tend to be ones to set fires; cruel to animals
Often as grow end up in court sys and identify as having anti-social personalities
Childhood disorder; more destructive; more violence; may have anti-social personalities
More violent, harm
Males tend to fight, vandalism
Females: lying, school truancy, running away

Answer 15

Conduct Disorder:

Question 16

Acceptance of responsibility for own behavior: IMP: how talk to people - big approach
Protect from themself and others from harm
Increase ability to trust - need develop; need gain trust with them is helpful
Increase ability to control impulses - set boundaries
Positive role models
Provide support and education to caregivers that following their types of things: accept responsibility and control emotions, set boundaries and follow those: parents/caregivers admit and say creating probs for all of us; but edu that one issue affects all - they are part of the solution

Answer 16

Gen interventions behavioral disorders - conduct disorders and oppositional defiant, etc

Question 17

Most common in oldest child from small families-upper socioeconomic-overprotected environment
Separation Anxiety disorder
PTSD:
Phobias:

Answer 17

Anxiety disorders

Question 18

Rooted in unresolved dependent ties-strong fears abandonment
May come from overprotective fam that have this when away from fam

Answer 18

Separation Anxiety disorder

Question 19

May develop in children of any age
Younger children do not relive traumatic event, but develop nightmares with monsters, threats to self with self-harm
May not show same type symp
Younger child internalizes and older children tend to externalize the anxiety - act out

Answer 19

PTSD:

Question 20

Peak during the transition times (esp school: going to school for the first time, middle school, etc.) - watch and give support to kids
Occur more often in girls

Answer 20

Phobias:

Question 21

Experience real high-stress events before age 18 much increase in emotional issues as get into adulthood and physical effects: cardiac, resp
Deals with traumatic events kids have and how impacts their live ongoing; basic 10 questions - agencies can add more; 4+ sets up for long-term potential impact physically (heart disease, resp probs) and emotionally; traumatic childhood events; idea what may be impacting them ongoing

Answer 21

ACE study

Question 22

Tx. usually provided on an outpatient basis unless impacting daily life
Protect from panic level - not reach this
Cognitive therapy focuses on underlying fear - more + approach
Behavior Modification used to reinforce self-control
Help to increase self-esteem and feelings of competence - ask identify + things about self

Answer 22

Interventions anxiety with kids

Question 23

For optimal outcomes-involve families/main people in life; cannot always happen because resistance in family/others
Younger children: utilize play therapy
Grade-school: combine play and talk - more verbalizing but combined is powerful; how feel
Older children: talk therapy - helpful; also do well if play game with them
Medications are used for all ages

Answer 23

Overall interventions/children

Question 24

Set boundaries - imp with them - want them often because want know how far they can - bring in parent/caregiver - need them identify why imp as well; be consistent
Desired behavior is rewarded - behavior modification
Promote self-Responsibility
Important to:

Answer 24

Overall intervention/adolescents

Question 25

Find some common ground - what have in common (simple); great to start
Show inability to be manipulated - stand firm in boundaries and set boundaries
Be a role model to how appropriately express emotions
Intervene before explosive behavior
Avoid power struggles - can be troubling
Use community resources - know these and get to right people - adolescents and PCP

Answer 25

Important to:

Question 26

Two antipsychotic medications approved by the FDA are:
They are targeted for the following symptoms:
Dosage is based on the weight of the child and the clinical response. Meds and dosage either end developmental age have to be careful with dosage

Answer 26

Psychopharm: Autism Spectrum Disorder (ASD)

Question 27

Risperidone (Risperdal)
Aripiprazole (Abilify)

Answer 27

Two antipsychotic medications approved by the FDA are:

Question 28

Aggression - goal is to reduce aggression
Deliberate self-injury - banging heads, hit thigh
Temper tantrums
Quickly changing moods

Answer 28

They are targeted for the following symptoms:

Question 29

Drowsiness
Increased appetite
Nasal congestion
Fatigue
Constipation
Drooling
Dizziness
Weight gain (less with Abilify) - worry about DM

Answer 29

Common side effects of antipsychotic Risperidone (Risperdal) and Aripiprazole (Abilify) are:ASD Psychopharm:

Question 30

Neuroleptic malignant syndrome
Tardive dyskinesia (not usually in kids)
Hyperglycemia
Extrapyramidal symptoms
Diabetes

Answer 30

Things to consider: Caution must be given to less common but more serious possible side effects of risperidone and aripiprazole.

Question 31

CNS Stimulants
Make sure to Inform parents that over-the-counter (OTC) medications should be avoided while the child is receiving stimulant medication. - need drug edu and what to avoid
Some OTC medications, particularly common cold and hay fever preparations, contain sympathomimetic agents that can compound the effects of the stimulant and create a drug interaction that could be toxic to the child

Answer 31

ADHD

Question 32

Usually stimulants
Cautious of AE
Side effects: insomnia, anorexia, weight loss (attractive to many woman), tachycardia, decrease in rate of growth and development (especially with Ritalin - grandfather of med; if taken off will catch up; do drug holiday to give chance to catch up on growth)
Warning:
A periodic drug “holiday” is necessary to determine medication effectiveness and need for continuation
Sometimes give meds for BP meds - use with children; helps calm them down

Answer 32

CNS Stimulants

Question 33

Careful monitoring of cardiovascular functioning during treatment
Psychiatric symptoms may worsen

Answer 33

Warning:

Question 34

An adolescent, diagnosed with attention-deficit/ hyperactivity disorder (ADHD), is having difficulty maintaining concentration in the inpatient milieu. Which nursing intervention would help improve the client’s task performance?
A.Mandate that the client remains in his room until all homework is complete.
B.Remove privileges if homework has not been completed within a 2-hour period.
C.Encourage dividing tasks into smaller, attainable steps and reward successful completion.
D.Seek a physician’s order to discontinue the stimulant methylphenidate (Ritalin).

Answer 34

Correct answer: C
A client with a short attention span can be over-whelmed with large tasks. Rewards for task completion are more successful than punishments for task completion failure. Positive reinforcements increase self-esteem and provide incentives for future positive behaviors - reinforce child being good than trying to make them focus on the bad: behavior modification

Question 35

2.Which is a potential adverse effect from the prolonged use of methylphenidate (Ritalin)?
A.Psychosis
B.A decreased intelligence quotient (IQ)
C.Weight gain
D.A decrease in rate of growth and development

Answer 35

Correct answer: D
A temporary decrease in the rate of growth and development may be a side effect of Ritalin therapy