Child & Adolescent Disorders Flashcards
Eating disorder s/s serve a _________ going beyond weight loss, comfort, addiction, or feel special control.
purpose
Examples of s/s of eating disorders?
Comfort
Numbing
Cry for help
Self-punishment
Avoidance of intimacy
Eating Disorders are NOT
Vanity (self-love or self-absorption)
Diets
Obsession with Food
Obsession with Exercise
Fun
Easy to treat
Discriminatory – they affect all cultures and socioeconomic levels
Disordered Eating
Problematic eating patterns that are not practiced at a high enough frequency or severity to merit theformal diagnosis of an eating disorder.
- serious in nature
Path from Disordered Eating to Eating Disorder
No Disordered Eating Thoughts & Behaviors
Some Thoughts and behaviors (need to fit into something)
FrequentThoughts & Behaviors
Eating Disorder
Severe Eating Disorder
What percentage of people will progress to an eating disorder?
40
Influential factors of Eating Disorders
genetics
comorbid (anxiety, depression, ADD/ADHD, PTSD, OCD (anorexia), Addiction (Binge), Borderline
Wt loss as a child due to illness
Premature, gestation age
Trauma (changes, college, events)
ACEs
Media
Sports pressure
Peers and family
An enmeshed family allows individual members
little or no autonomy or personal boundaries.
- feel what the family feels and strong discouraged from own feelings
The peak onset of eating disorders occurs during
13-18 y/o adolescents
What are types of DSM-5 Eating Disorders?
Pica
Rumination Disorder
Anorexia Nervosa (AN)
Bulimia Nervosa (BN)
Binge-Eating Disorder (BED)
Avoidant/Restrictive Food Intake Disorder (ARFID)
Other Specified Feeding or Eating Disorder (OSFED)
Pica
Eating inedible things or craving and chewing substances that have no nutritional value
In Pica, what do they usually eat
Ice
Clay
Dirt
Paper
Paint
Hair
Pica can lead to
lead poisoning
Rumination Disorder
Regurgitating and re-swallowing food.
May start with GERD (gastroesophageal reflux disease).
comfort
Anorexia Nervosa Risk Factors
female
early childhood picky eating
Perfectionism, anxiety, OCD
Competitive athletics (ballet, gymnastics)
High Academic Achievers
Conforming and conscientious
Why are men less affected than women against anorexia?
testosterone protective effect
What has the Highest death rate of any psychiatric disorder?
Anorexia Nervosa
30-40% due to complications
Anorexia Nervosa reasoning
Maintain a sense of control (the family controls everything else)
-mood and behavior change
achievement though losing weight
Anorexia Nervosa patients have a high level of
distrust paranoia
Body dysmorphia
- believes others are lying
Anorexia Nervosa is the restriction of
energy (food) intake r/t requirement
Anorexia Nervosa leads to
significant low body weight
Anorexia Nervosa patient’s reasoning
intense fear of gaining weight or fat
- persistent interference with weight gain
Body dysmorphia - disturbance of body experience
Persistent lack of seriousness of low weight
What is body checking and who uses it?
how often they are weighting
measuring their food
walking by a mirror often
Pinching stomach
Anorexic patients frequently look at these spaces as trophies.
Collar bones
hip bones
thigh gap
Anorexia nervosa types
Restricting
Binge/Purge
Restricting Anorexia
Weight loss primarily achieved through fasting/dieting/excessive exercise
Binge and Purge Anoxeia
energy restriction with purging episodes
The insula in the brain receives stimuli and results in our making a decision. For people with anorexia nervosa, making a decision can be
overwhelming
- what to wear
- protein
Anorexic patients has lost
hunger cues
Why should you not tell an anorexic patient to eat when they are hungry?
because they do not have those hunger cues
Medical Complications of Anorexia
-Cardiovascular
Bradycardia & hypotension
Mitral valve prolapse (common)
Sudden death due to arrhythmias
Refeeding syndrome
regain wt too quickly
ECHO changes
Medical Complications of Anorexia
- Dermatologic
Dry Skin, Alopecia, Lanugo hair
Medical Complications of Anorexia
- GI
Constipation
Refeeding Pancreatitis – regain wt too quickly
Delayed gastric emptying
Dysphagia
Hepatitis
Medical Complications of Anorexia
- Pulmonary
Aspiration pneumonia
Respiratory failure
Spontaneous pneumothorax
Emphysema (malnutrition)
With self-induced starvation, the body will respond to preserve itself by
lowering heart and temp
Arrhythmias occur due to the what in Anorexia
low K and Mg
Why is lanugo hair grown back on Anorexia patients?
severe malnutrition
compensation to loss of body fat and hypothermia
Medical Complications of Anorexia
- Endocrine/Metabolism
Amenorrhea
Infertility
Osteoporosis
Thyroid Abnormalities
Hypercortisolemia
Hypoglycemia
Neurogenic diabetes insipidus
Arrested growth
Medical Complications of Anorexia
- Hematologic
Pancytopenia due to starvation
Decreased sedimentation rate
Medical Complications of Anorexia
- Neuro/Eyes
Cerebral atrophy
Lagophthalmos
- eyelids don’t close
Amenorrhea results from low
FSH and LH
DESPITE LOW ESTROGEN
-revert to pre-pubertal state
Bulimia Nervosa more common in
older adolescent girls
Bulimia patients are what type of weight
average or slightly above
What are the differences between anorexia nd bulemia?
Bulimia
- average slightly above NOT underweaight
- outgoing
- self destructive behavior
- aware of problem and want help
Bulimia personality
outgoing, impulsive
- prone to act out (self-destructive)
Which eating disorder wants help and is aware of problems?
Bulimia
Bulimia is characterized as
recurrent binge eating followed by purge
(1x per week for 3 months)
Binge eating is eating
large amount of food in short time (2hours)
with a sense of lack of control
Purging is
an attempt to rid the body of unwanted food by:
- Vomiting
- Laxatives and/or diuretics
- Fasting for days (following a binge)
- Excessive exercise (more common in men)
Bulimia patients find food as __________ but
soothing; feel guilt after
What is the cycle of Bulimia?
Binge
fear of fat gain
loss of fear
Guilt
Purge
Repeat
Medical Complications of Bulimia
- Cardiovascular
Arrhythmias
Diet pill toxicity: palpitations, hypertension
Cardiomyopathy
Medical Complications of Bulimia
- GI
Esophageal rupture
GERD
Constipation d/t laxative use
Cathartic colon
Dental erosion
Parotid gland swelling
Medical Complications of Bulimia
- Metabolic (FATALITY CASES
Hypokalemia
Dehydration
Nephropathy
Metabolic alkalosis
Hyperphospatemia
Medical Complications of Bulimia
- Endocrine
Irregular menses
Mineralocorticoid excess
Medical Complications of Bulimia
- Pulmonary
Aspiration pneumonia
Cathartic colon
chronic use of laxatives (greater than 3 times per week for at least 1 year).
The purging aspect can create what in the mouth
ulcers
-loss of tooth enamel with dental erosion
-Russell’s sign
- parotid gland swelling
Parotid gland swelling for
salvation if in chronic use will swell up
Russell’s sign
Callous on the back of knuckles from sticking fingers in the mouth
Binge Eating Disorder
recurrent episodes of binge eating (once a week for 3 months (Only Binge not purge)
+ 3 or more of these:
- more rapidly
-uncomfortably full
- when not physically hungry
- alone due to embarrassment
- disgusted, depressed, or guilty after
- NOT include compensatory (exercise) behaviors or relieve guilt
The goal of tx for binge eating is
interrupt and reduce eating binges and achieve healthy habits
T/F: Binge eating disorder only occurs in obesity.
False, linked to non-obese too
Avoidant/Restrictive Food Intake Disorder (ARFID)
restrict food intake causing weight loss
-failure to meet nutritional/energy needs
ARFID is associated with 1+ of
- Significant weight loss
- Significant nutritional deficiency
- Dependence on enteral feeding or oral nutritional supplements
- Marked interference with psychosocial functioning
Does ARFID disturb the body or shape experience?
no, not with any concurrent condition
ARFID is a disturbance of feeding behavior where an individual eats
very little and or avoids certain foods
AFRID
results in failure to grow and develop as expected and/or significant weight loss.
ARFID present with
nutritional deficiencies
- lack of interest related to senses of the food (picky eaters)
ARFID is more common in
younger males long illness prioir to 12
Other Specified Feeding or Eating Disorder (OSFED) include
Atypical AN
BN of low frequency
BED of low frequency
Purging Disorder
Night Eating Syndrome
Night eating syndrome
eating large amounts after awakening from sleep
- low melatonin levels
Influential factors from family on OSFED
chronic dieting, enmeshed family
enmeshed family- does not promote personal boundaries and family controls everything
Eating Disorders not listed in DSM-5
Food Addiction
Drunkorexia
Pregorexia
Post-Bariatric Surgery Transitions
Diabulimia
Orthoxia Nervosa
Food Addiction
pleasure from the anticipation of eating, the availability of foods, or the actual eating of foods.
- Uncontrollable cravings surrounding highly palatable food or excessive eating
- Foodie is not an addiction
Drunkorexia
Self-imposed starvation or bingeeating/purging combined with alcohol abuse
- result in alcohol intoxication and electrolyteimbalance.
Pregorexia
Attempting to remain slim through their pregnancy in order to drop the weight quickly following childbirth.
Post-Bariatric Surgery Transitions
eating avoidance following surgery (grazing, nibbling, picking) and fear of gaining weight
Diabulimia
Type 1 diabetes who reduce their insulin to lose weight
Orthorexia Nervosa
Obsession with the “healthfulness” of foods and this interferes with daily life
Extreme rigidity surrounding food content and food preparation
Identity and spirituality are rooted in food
Religiously on vegan or med diet
Restaurants anxiety not seen how it is made
Tx Team of Eating Disorders
Medical Professionalwith eating disorder pts
Mental Health Professional
Registered Dietitian/Nutritionist
Not all work well with eating disorders
Levels of Care for Eating Disorders
Outpatient (OP) prefer
Intensive Outpatient (IOP)
Partial Hospitalization (PHP)
Residential Treatment (RTC)
Inpatient Hospitalization (IP) for medical complications mainly
Nutrition Therapy used to
Treat malnutrition and restore dietary stability
May require IV therapy or tube feedings
Avoid refeeding syndrome in which replacement is **given
too rapidly (preventable)
Goal is to gain weight how much per week?
.5-1 lb per week
How to refeed
- correct electrolytes
- circulatory vol
Never administer rapid IV fluids (because of sodium)
Daily labs to monitor electrolytes for first 1-2 weeks when caloric intake increased (Phosphorous, Potassium, and Magnesium)
Start 1400-1600 kcal/day and increase by 300-400 kcal every 3-4 days until goal weight
Daily labs are taken for refeeding for
increase of Phosphorus, K, Mg
Start with how many calories a day for refeeding
1400-1600
How many calories do you increase the refeeding by every 3-4 days until the goal wt is met?
300-400
Refeeding Syndrome causes what to shift
- Potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding (either enterally or parentally).
Tx Mgmt for
Psychotherapy and psycoedu
Dialectical behavior therapy (DBT)
Cognitive behavioral therapy (CBT)
Antidepressant medications
Anticonvulsant medications
Antipsychotic medications
What is imperative for successful treatment of an eating disorder?
psychotherapy and education with focus on reduction of distorted body image and dysfunctional eating habits.
Dialectical Behavior Therapy
emotional regulation, distress tolerance and effectiveness in relationships.
It combines acceptance skills for stressful circumstances that can’t be immediately changed and change skills to better manage emotions or relationship issues.
-accept negative emotions
food journal
Cognitive Behavior Therapy
Addresses altered perceptions through understanding the relationship between thoughts, feelings and behaviors.
Is a key method of treatment, focusing on recognizing and coping with binge eating triggers and challenging and changing cognitive distortions (e.g., body weight and shape).
Cognitive Behavior Therapy Ex)
Food journaling
What they ate and drank and how they feel about it
Behavioral contracts
An agreement that the patient makes with others to change a maladaptive behavior
It is a written contract that places the responsibility for weight gain or other behavioral change on the patient
What treatment would not work for Anorexia?
Medications
Pharmacotherpay is used with
behavioral
SSRI’s
Selective Serotonin Reuptake Inhibitor’s
SSRI is used in
Bulimia and depression, and suicidal idelations
SSRI drugs
fluoxetine (Prozac)
sertraline (Zoloft)
citalopram (Celexa)
escitalopram (Lexapro)
SSRI side effects
Headache, dry mouth, weight gain, nervousness and sexual dysfunction
Tricyclic Antidepressants types
desipramine, imipramine, amitriptyline, monoamine oxidase inhibitors and buspirone
Tricyclic Antidepressants as used in
bulimia
SNRI
Selective Norepinephrine Reuptake Inhibitors
SNRI is tx on
binge eating
SNRI types
venlafaxine (Effexor)
duloxetine (Cymbalta)
Anticonvulsants decrease
binge eating episodes
Anticonvulsants types
topiramate (Topamax)
zonisamide (Zonegran
Antipsychotics REDUCE
distorted thinking
Antipsychotics type
olanzapine (Zyprexa)**
Inpatient Nursing Interventions for eating disorders
Weigh patient (blind)
Supervise meals during and 2 hours after
Seek staff when feel the need to vomit
Monitor vital signs, fluid intake and output
Encourage food journaling
Nursing Care Management for Eating disorders
Supportive yet firm
Structured environment
Consistency
Avoid manipulation
Continuity
Encouraging the patient by providing education and activities that strengthen self-esteem
- off weight and move on
Avoid these communications withan eating disorder person
Don’t make any comments about their appearance
“You look beautiful”
“Why don’t you just eat?”
“You look great”
Avoid conversations about weight, calories, and exercise
Avoid statements that insist on them doing something, e.g., to stop exercise or to eat
Autism Spectrum Disorder
Ranges from mild to severe that all fall under the same label
A group that might have difficulty dressing themselves
A mid-level group
A high-end, fully verbal group
ASD manifests when
early childhood 18-36 months of age
- increased awareness and screening
High-Functioning Autism
intellectually gifted “savants”
- excel in areas like music, art, memory, math, skills
Autism Patho
no link between the MMR and thimerosal-containing vaccines
- antidepressant us in 2-3rd trimester
-the link between hereditary, genetic, medical, neuroinflammation, damage to cellular tissue, and environmental factors
Autism s/s
deficits in:
Social Interaction
Communication-common
Behavior
Social Differences in Autism
NO
eye contact
response to facial expressions
- can’t perceive other’s feelings
- doesn’t show empathy for others
pointing to show parents
look at objects the parent points to
bring objects to show interest
inappropriate facial expressions
- no/uninterested in friends
Autistic patients have what type of play
lack of social play
do not use imagination to play
uninterested in making friends
Autistic children have what type of affect?
flat expression
With Autistic children, how do they interpret other people’s feelings?
lack awareness of other’s feelings
Autistic communication impairments
absent to delayed speech
regression of language or social milestones
If the child is showing delayed or regression is noted,
hearing and speech evaluated
Communication differences between Autistics
Echolalia
Responds to sounds (meow/horn) but not their name
Mix pronouns (“He went to the store”)
Disinterest in communication
- no toys in pretend play
grunt/hum not talk
Good rote memory
Echolalia
repeats over and over what others say without understanding the meaning
- parroting/echoing
In Autistic children, what is a good rote memory?
memorization of info based on repetition
Classic Autistic Behavioral differences
rocks
spins
sways
twirl finger
walk on toes for a long time
flap hands
Summary of Behavior Differences for Autistic
Classic “rocking” - stimming
- repetitive mvmt or sound
Routines
Diff with change
No imitates actions
Parts of toys
No appearance of pain
very sensitive to sense (smell, sound, light, texture, touch
vision from unusual angles
intense temper tantrums
Classic Autistic behavior is also known
stereotypic behavior
stimming
- repetitive mvmt or sounds
Autistic Behaviors need what type of structure
routines. order, and rituals
- difficult to change; change could cause distress
Autistic Behaviors imitate ________ but not
words; actions of others
Autistic Behaviors r/t objects
constantly preoccupied with attachment to objects
With autistic patients, any environmental chnage produces
marked stress
- can produce self-injury behaviors (+ repetitive)
What is the priority for an Autistic child?
safe environment for a child
Autist children don’t imitate the
actions of others
When Autistic child has a toy, they play with
parts of toys NOT the whole toy
With the children’s disorders, which child is more likely to have pain, but does not show it?
ADHD
ASD
COD
ODD
ASD (Autism Spectrum Disorder)
Autistic children may have _________ _________ _______ or show aggression
intense temper tantrums
What other comorbid conditions could an Autistic child have?
Intellectual disabilities
Feeding disorders
Asthma
Sleep Disorders
GI disorders (constipation)
seizure, bipolar, or anxiety
What are the 2 screening tools used for Autistic?
Modified Checklist for Autism in Toddlers (M-CHAT)
Ages and Stages Questionaire
The AAP recommends screening at
Well visits
- 9 months (Development)
- 18 months (Develop and M-CHAT)
- 24-30 months (Develop and MCHAT)
What is the golden standard for diagnosing ASD?
Autism Diagnostic Observation Schedule (ADOS)
ASD Therapy is what type of behavior modification program?
- slow and with the flow
- slow highly structured
- intensive and highly structured
- fast-paced
highly structured and intensive
With ASD, behavior modification program, what would the nurses use?
positive reinforcement and punishments
increases social awareness
communicate skills
decreases unacceptable behaviors
set realistic goals with clear rules
small success structures
Applied Behavior Analysis (ABA) Therapy
teach, reinforce, and maintain new skills and desired behaviors
- communication, social
- reading and school
- motor skills
- hygiene and grooming
ABA method extinguished what type of behaviors for Autism?
problematic
- self-injury
- aggression
ABA Therapy requires a minimum of how long per week?
25 hours
- expensive
What other therapy besides ABA, cold be a less expensive option?
counseling
local and state departments of mental health and developmental disabilities
- ECI
-IEP
- Special education
ECI
Early Childhood Intervention
birth to 3 years
IEP
Individual Education Programs
Preschool (3-5) programs for children with disabilities
Special Ed = 5-21 y/o
Special Education from IEP can last from
5-21 y/o
If the child is in preschool or older and the parents suspect that they might be on the spectrum, they should
contact the school and ask for an evaluation
- does show signs then qualify for special ed
If the school suspects the presence of a disability,
they must do a full evaluation paid for by the school
ECI offers
speech, OT, and PT
- delays impacting development
You should refer to which therapy when a Dx of Autism is
suspected
What are some calming activities for ASD children?
walk
lifting jobs
trampoline jumping
stress ball
velcro
gum/lollipops
brush hair
weighted blankets
Calming Activities are used for Autistic children experiencing
overstimulated activities
Who is an Autistic savant discussed in class and on the PowerPoint?
Temple Grandin
- Brains are wired different
- education of autism and humane treatment of livestock
What are all of the therapies an Autistic person can utilize to help them in this lifelong disorder?
ABA (BEHAVIOR MODIFICATION)
ECI and IEP
Calming Interventions
Massage
Hippotherapy
Specific routine diet
What diet and supplements should an ASD patient have?
Gluten-free/Casein-free
High-fat and low-carb (ketogenic)
- Vitamin and Omega-3 supplementation
A GF/CF diet does not contain and needs supplements for
No milk/butter or carbs (breads)
- supplement with Ca, fiber, Vit A/D/B complex
Calories High
An ASD GF/CF diet consists of
chicken, fish, meat
fruits, veggies
potatoes, rice, infant rice cereal
Hippotherapy is used for
Autism by PT, OT, and Speech Pathologists
What medications would be used for an ASD patient?
Risperidone - irritable
Aripiprazole - irritable
Melatonin - sleep
Risperidone and Aripiprazole are what type of medications
anti-psychotic
Risperidone and Aripiprazole are used for what treatment of ASD
irritability Tx
- aggressive behavior
- deliberate self-injury
- temper tantrums
What is used for sleep issues in ASD
Melatonin (low dose)
Melatonin is a
hormone secreted from pineal gland in a 24 hour circadian rhythm
- regulates normal wake/sleep cycle
- sleep promtion
What is a non-pharmacological way of helping ASD patients sleep?
weighted blankets
What nursing interventions are used in ASD?
Consistency of routine
Child’s communication style
Decrease stimulation
Safety precautions
Minimal holding, touch, eye contact
Parents stay with the child (support)
Intro new situations slowly and directly
Organize care with less interuptions
ADHD is
Attention Deficit Hyperactivity Disorder
ADHD refers to developmentally inappropriate degrees of
inattention
impulsiveness
hyperactivity
ADHD patients are at a greater risk for which complications?
ODD
CD
Depression
Anxiety
Developmental Disorders (delays and learning disability)
Tics (spasmodic contraction of muscles)
Sleep Apnea
ADHD is caused by
multifactorial
- genetic and environmental
- CNS problems ar key development moments
Dx of ADHD is done when s/s have persisted for
at least 6 months
- maladaptive behaviors
Maladaptive behaviors from ADHD include
stops them from adapting to new/difficult situations and inconsistent with their developmental levels
Maladaptive Behaviors are present in 2+ settings including
school
home
social setting
What are the 3 subtypes of ADHD?
Combined
Predominately inattentive
Predominately hyperactive-impulsive
What are the symptoms of inattention in ADHD?
- fail to give close attention to details
- difficulty with constant attention in tasks/play
- not listen
- not follow through with instructions or finish tasks
- difficult organizing tasks
- reluctant with sustained mental effort tasks
- loses things for tasks
- easily distracted
- forgetful daily
What are the symptoms of hyperactive in ADHD?
Hyperactive
- fidgets, leaves seat in class, excess inappropriate running/climb
- difficulty play quiet
- “on the go”
- excessive talking
What are the symptoms of impulsive in ADHD?
- blurts out answers before completing questions
- difficult waiting for turns
- interrupts others
The evaluation of ADHD includes who?
HCP
Pediatrician (developmental, neurologist)
Psychologist
Class teachers
An early dx of ADHD is needed to
prevent impaired emotional and psychological development
ADHD patients tend to engage in physically dangerous activities without
considering the possible consequences
Dx of ADHD includes using
medical hx from (maternal pregnancy and birth)
Vision and hearing exams for r/o
Neuro exam
Psychological Testing (projective testing and IQ/achievement)
Behavioral checklist and adaptive scales
Tx Mgmt of ADHD
family edu and counseling
Medication
proper classroom placement
environmental manipulation
Behavior and Psychotherapy
Behavioral Therapy for ADHD
- prevention of undesirable behaviors
Parents are educated on what in ADHD Behavioral Therapy
positive reinforcement
reward desired bahviors
providing age-appropriate consequences
Multimodel Tx includes
Pharmacotherapy
Behavioral intervention
ADHD coaching (manage inattention, hyperactivity, and impulsivity with self-awareness and strategies)
Pharmacologic Therapy choice of med is determined by
age
usually 5+ y/o
What medications should ADHD patients have?
Psychostimulants
Psychostimulants MOA
promote enhanced dopamine and norepinephrine functioning
Psychostimulants drug names
methylphenidate hydrochloride
- Concerta,
- Metadate,
- Ritalin - Drug of first choice
dextroamphetamine sulfate
- (Dexedrine)
lisdexamfetamine
- Vyvanse - 2nd
Dextroamphetamine-amphetamine
- Adderall XR
Which psychostimulant is the first drug of choice?
methylphenidate hydrochloride
Ritalin
What is the Methylphenidate HCl extended-release capsule called?
JORNAY PM
JORNAY PM is the first only only ADHD stimulant
dosed in the evening
- due to ER delivered in the morning and throughout the day
lisdexamfetamine (Vyvanse) is given as the 2nd choice when
symptoms and impairment are not reduced sufficiently after Ritalin is adequate
Psychostimulants are not based on Kg, what are they based on
initial small dose and work up gradually until desired response is achieved
Side effects of Psychostimulant Medications
loss of appetite (wt loss)
abd pain
growth suppression
sleepless
HA
crying and irritable
HTN
Non-stimulant Medication for ADHD
Selective norepinephrine reuptake inhibitors
Selective norepinephrine reuptake inhibitors drug type
atomoxetine (Strattera)
What are the side effects of atomoxetine (Strattera)?
suicidal thinking
You should contact your doctor if the child experiences what on atomoxetine (Strattera)?
mood changes or depression
atomoxetine (Strattera) is based on what
child’s wt not on resolution of symptoms
Adjunct Therapy for ADHD
Selective Adrenergic agonists
Tricyclic antidepressants
Tricyclic antidepressant drug types
nortriptyline (Pamelor)
imipramine (Tofranil)
desipramine (Norpramin)
Tricyclic antidepressant side effects
increase of dental caries
The environment of an ADHD patient should be
organized charts
- list all things to do before leaving school
family and teacher reinforcement
highly-structured environment
follow up and feedback with school personnel
decrease distractions while doing HW
- quiet and consistent study area
Model positive behaviors and problem-solving
Where should the ADHD child be placed in the classroom?
an orderly and predictable environment
- clear and consistent rules
- reduce assignments and HW
- additional time
- verbal and written instructions
- breaks
Teaching of Nursing Care Mgmt
Avoid caffeine as it decreases the efficacy of stimulant meds
take with or after meals if low appetite
Serving frequent, small meals and “on the go” snacks
Take meds earlier if you have sleeplessness
Children with ADHD are at a higher risk for what due to their impulsivity and decreased judgment of dangerous situations?
accidents and unintentional injuries
- ODD and CD
ODD is a
recurrent pattern of
- Negativity/irritable mood
- Disobedience/hostility/stubbornness
- Argument
- Explosive angry outbursts
- Low frustration tolerance/unwillingness to compromise
- Blaming others
- Becoming easily annoyed/annoying others
- revenge (vindictiveness)
With ODD, they see themselves
as normal not defiant
- response to unreasonable demand
OOD is frequently associated with
anxiety
mood disorders
ADHD
learning disabilities
Treatment of ODD
Parental mgmt training (response after)
psychotherapy (individual and family) to improve communication
- Anger mgmt
Stimulant med
Antidepressants
In psychotherapy for ODD, what is discussed?
id trigger situations
control negative situations and cope effectively with conflict
cog behavior therapy
social skills training
What stimulant medications are used only as treatment for ODD and ADHD together?
methylphenidate
dextroamphetamine
What antidepressant medication is used in ODD?
fluoxetine
sertraline
Antidepressant medication should only be used when
behavior mgmt achieved limited results
-hostile behaviors are ongoing
When ODD is untreated it can lead to
Conduct Disorder
Conduct Disorder under 10 y/o will lead to
Antisocial disorder/behavior
Conduct Disorder is characterized as
Aggression against people/animals
Bullying/fights
Vandalism
Lying
Shoplifting
Truancy (school and runs away from home)
- interferes with school performance
- expelled or trouble with law
Fire setting
What is the hallmark sign of Conduct Disorder?
Aggressive behavior
-fight/bully/intimidate/assault/poor peer relations/violates rights of other and society
Conduct Disorder demonstrates a lack of
remorse or care for other’s feelings
Conduct Disorder is more commonly seen in
males under 18 years of age
Causes of Conduct Disorder
genetic
psychosocial (stress/conflict in family)
Contributing Factors of CD
parental rejection/neglect
difficult temperament
harsh discipline
abuse
no supervision
large family
delinquent friends
parent with mental illness
Treatment of Conduct Disorder
Prevention and early intervention
- Parent education
- special skills training
- family/individual therapy
Antipsychotics
Mood stabililizers
Gender Dysphoria Dx in children
A) incongruence btw expressed gender and assigned
> 6 months
W/ at least 6 of the criterion (1 MUST BE A1)
B) shows significant distress in social, school, or functioning
What are the 6 criteria in the dx criteria of gender dysphoria in children?
- strong desire/insistence to be another gender
- clothing not associated with their sex
- cross-gender roles in role play
- stereotypical toys/activities of the other gender
-playmates of other gender - reject toys/activities of assigned gender
- strong dislike of anatomy
- sex characteristics desire match expressed gender
Gender Dysphoria Dx Criteria in Adolescents
A) incongruent between assigned and expressed gender
> 6 months
> 2 of criteria (1 MUST be A1)
B) distress in social/work/functioning
Criteria for Adolescent Gender Dysphoria Dx
- incongruence between assigned and expressed gender and sex characteristics
- desire to rid of own sex characteristics
- desire of the other sex
- desire for other assigned roles
- the desire to be treated as other gender
- belief they have the typical feelings/reactions of other gender
Gender Dysphoria is the
disconnect between ID and BIOLOGICAL
- Genderbread PERSON
- Gender Unicorn
Associated Features of Gender Dysphoria
- hormone blockers (reversible - where is data?)
gives them time to decide - full-time living in the desired gender
- cross-sex hormone tx
- reassignment surgery to confirm gender
Males with reassignment will get what surgeries?
Penectomy
Vaginoplasty
Females with reassignment will get what surgeries?
Mastectomy
Phalloplasty
Childhood Depression is under
diagnosed and under treated
It is harder to detect childhood depression due to the children unable to
express their feelings and act out their problems instead of identifying them verbally
Children who cannot verbalize their feelings may exhibit _____________, manifesting as
Irritability
- Frustration
- Temper tantrums
- Behavioral problems
- Increased rejection sensitivity
Symptoms of depression may be confused with a “_______________ ________” which may lead to a delay in referral and treatment
developmental stage
Childhood Depression may be caused by
temporary and traumatic event (Acute)
- loss of parent (death/divorce)
- loss of pet/friend/family/place
more serious due to chronic illness and diability
It may difficult to diagnose depression if they have a medical disorder associated with a chronic illness with changes in
low appetite
sleep disruption
somatic
- pain, HA, weak, dizzy, faint, abd pain, diarrhea, constipation
fatigue
The behavior of a child with depression
sad face (predom)
solitary play/alone
disinterest in play
withdrawal from enjoyed activities/relations
low grades in school
lack of doing homework
low motor activity
tired
cry
dependent/cling or aggressive
substance abuse
What internal states reflect a child in depression?
statements of low self-esteem, hopelessness, guilt
suicidal ideations
What physiologic s/s refer to childhood depression?
constipation
c/o not feeling well
change in appetite = wt loss/gain
alter sleep (too much or not enough)
Treatment of Childhood Depression
high individualized
counseling
Psychotherapy - mild to moderate
family therapy
cog-behavior therapy (irrational thoughts/anxiety)
educate on social/life skills for coping
improve environment
If the family can not provide constant monitoring of the suicidal child then the child will be
Admitted to the hospital
What Medication Tx could be used for childhood depression?
Tricyclic antidepressants
SSRIs
For mild to moderate depression, then the treatment is
psychotherapy
For moderate to severe depression, what is used
pharmacologic tx
Tricyclic antidepressants
SSRIs
SSRI means
Selective serotonin reuptake inhibitors
SSRI drug types
fluoxetine (Prozac) – first choice in children ages 8 years & older
escitalopram (Lexapro)
sertraline (Zoloft)
What is the first drug of choice with 8+ y/o children for SSRIs
fluoxetine (Prozac)
Antidepressants must be at the therapeutic level by this time to be effective.
2-4 weeks
Antidepressants may cause this BLACK BOX WARNING for
suicidal tendencies and behaviors
Nursing Care Mgmt
brief psy screening
Referrals
Assess suicide risk
- presence of ideation
- plan for injury
- Hx of actual self-harm
Screening for depression or suicidal risk evaluated in adolescents with:
Declining school grades
Chronic melancholy (sadness)
Family dysfunction
Alcohol or drug use
LGBT orientation
History of abuse
Previous suicide attempts
Suicide is the leading cause of death in teens in this place.
3rd
Suicide
The deliberate act of self-injury with the intent that the injury results in death
Suicide Ideation
preoccupation with thoughts about committing suicide (may be a precursor to suicide)
Suicide attempt
Attempted to cause injury or death
What is a serious indicator for possible suicide completion in the future?
previous suicide attempt history
Causes of Depression
Environment
- Hx of maltreatment
- Bullying
- peer influence
- media
Psycho
- worthlessness/low self-esteem
- impulsive
- lonely
The most important cause of depression is the presence of
active psychiatric disorder
- Depression
- Bipolar disorder
- Psychosis
- Substance abuse
- Conduct disorder
Influencing factors of Depression
loss of parent
disruption of family
Hx of suicide/depression/abuse/emotional disturbance/conflict
Risk Factors of Depression
Jail
Isolation
loss of BF/GF
no future
available of firearms
Motivation of Suicide Ideation
fantasies
- relief from suffering
- gain comfort/sympathy
-revenge
- only release
Most adolescents don’t tell about their
suicidal thoughts
(not to adults but to peers)
- usually social isolation
Warning s/s of suicide
preoccupied with death themes
give valued possessions
take about own death
reckless/antisocial (drink/drugs/fight/vandalism/run away/sex promiscuity
repeat visits to ED for injury
sudden cheerfulness by deep depression
Adolescents who express suicidal feelings and have a specific plan should be
monitored at all times (no access to firearms, medications, belts, scarves, shoestrings, sharp objects, matches, or lighters
What nursing care can be provided to a parent of a depressed child?
Anticipatory guidance
- support child
- positive communication
creative outlets and coping
Behavior Contract
Assess Interactions
FAMILY COUNSELING
Suicide prevention programs
What is used to assess a depressed child about suicide?
SLAP
What is SLAP
Specificity - feel suicidal/plan
Lethality - methods
Accessibility - means of suicide
Proximity - time and when
What should the teacher teach the peers of adolescents about suicide?
detect any changes
SPEAK UP
tell someone if their friend is suicidal
Behavioral Contracts
-expressed suicidal intent
-agreement that they will not attempt suicide during an agreed-upon period and that they will call the 24-hour crisis line immediately if they feel they cannot keep their contract
- A 6-year-old boy is being admitted to the hospital with acute appendicitis. Which of the following statements by the mother during the admission process would suggest the child may need to be evaluated for oppositional defiant disorder (ODD) in order to plan appropriately for his care while hospitalized?
A. “He can have a bad temper and has a temper tantrum about once a month.”
B. “He loves participating in sports but sometimes gets upset with himself if he doesn’t do well.”
C. “I am concerned he will become aggressive when the nurses try to take care of him.”
D. “The only person he gets angry with is his little brother when he bothers his things.”
C. “I am concerned he will become aggressive when the nurses try to take care of him.”
Vindictiveness is one of the three categories used to diagnose ODD and is often manifested as physical aggression. Children older than 5 years of age with ODD have disruptive behaviors such as temper tantrums at least once a week, the anger and disruptive behavior is directed at someone other than a sibling and they may have difficulty with the authority figures associated with sports teams rather than their own performance.
- An 8-year-old girl admitted to an acute care pediatric unit has been defiant and angry to clinicians caring for her. Which of the following items noted on the admission history is a risk factor for oppositional defiant disorder?
A. Father was diagnosed with attention deficit hyperactivity disorder (ADHD).
B. Mother had pre-eclampsia during pregnancy with this child.
C. She is the fifth of 10 children in the family.
D. She was diagnosed with a seizure disorder when she was 5.
A. Father was diagnosed with attention deficit hyperactivity disorder (ADHD).
Oppositional defiant disorder (ODD) is a complex disorder with multiple theories of the causes and risk factors that may contribute to the development of the disorder in children. Research has suggested there is an increase in ODD in children with a parent that has been diagnosed with ADHD or ODD. The other answer options are not considered risk factors or causes of ODD.
- What event during hospitalization of a 12-year-old boy with oppositional defiant disorder (ODD) might be a trigger resulting in negative behavior?
A. Explain on admission that the unit has a zero-tolerance policy for aggressive behavior.
B. Quietly discuss with the boy and his mother the rules of the unit.
C. Tell the child he has to take a bath but can do it in the morning or evening.
D. Tell the child it is time to get out of bed for physical therapy.
D. Tell the child it is time to get out of bed for physical therapy.
ODD may respond negatively to feeling a loss of control; for example, being told it is time for physical therapy as he may feel he has no control and is simply being told what he must do. A better approach might be, “It is time for physical therapy. Would you like to wear your blue slippers or the brown ones?” The other examples are all methods of providing consistent staff interaction with the patient and his mother while still allowing him some choices.
- What would be the first treatment option for children with oppositional defiant behavior (ODD) without other mental health conditions?
A. Psychiatric hospitalization.
B. Behavior modification and skill set training.
C. Mood stabilizer medications such as valproic acid.
D. Educating parents on methods for stricter enforcement of rules.
B. Behavior modification and skill set training.
Behavioral interventions are the first choice of treatment and management of oppositional defiant disorder (ODD). Psychiatric hospitalization would be reserved for the child that is a danger to himself or herself or others. Medications are typically not effective in the treatment of ODD and are reserved for use in children who have other mental health conditions in addition to ODD. Parental management training (PMT) focuses on teaching the parents positive reinforcement methods, not how to be stricter.
- The mother of a child with oppositional defiant disorder (ODD) that is being discharged home with outpatient therapy for ODD asks the clinician to explain cognitive behavioral therapy (CBT). Which of the following is the best explanation of this type of therapy?
A. Focuses on improving the child’s academic performance.
B. Teaches parents how to implement strict household rules.
C. Teaches parents positive reinforcement methods.
D. Works with the child to identify more desirable patterns of responses.
D. Works with the child to identify more desirable patterns of responses.
Cognitive behavioral therapy (CBT) works to identify maladaptive patterns of thinking and/or behavior and suggests more desirable patterns of response for substitution.
- Diagnosis of oppositional defiant disorder (ODD) is based on behaviors in three categories: vindictiveness, angry/irritable mood and ___________.
A. Argumentative/defiant
B. Depression
C. Hostile/violent
D. Hyperactivity
A. Argumentative/defiant
Behaviors associated with the diagnosis of oppositional defiant disorder are grouped into three categories: vindictiveness, angry/irritable mood and argumentative/defiant. A child with ODD often has some or all of the traits associated with these three categories.
- A clinician on a pediatric acute care unit has been notified of an admission from the Emergency Department. The child is being admitted for cardiac arrhythmia, but the ED also reports that he has oppositional defiant disorder (ODD) with a history of physical aggression toward authority figures. What is the first intervention the clinician should implement?
A. Contact the provider for a restraint order to use as needed for aggression.
B. Create a whiteboard with a list of expectations for behavior.
C. Remove all items the child could hurt himself or herself or others with.
D. Request an order for clonidine to treat aggression.
C. Remove all items the child could hurt himself or herself or others with.
The first intervention should be to ensure the safety of the child and staff members by removing all items that could result in injury. Listing behavior expectations on a whiteboard may be indicated after ensuring his safety, but the other options would only be indicated after behavior-management strategies have been attempted. Restraints should be ordered on an as-needed basis.
- What is the first step in developing a plan of care for a child with oppositional defiant disorder (ODD)?
A. Assessment by a qualified mental health professional.
B. Consult with the provider for medication management.
C. Implement behavior-management strategies.
D. Implement suicide precautions.
A. Assessment by a qualified mental health professional.
The first intervention should be to ensure the safety of the child and staff members by removing all items that could result in injury. Listing behavior expectations on a whiteboard may be indicated after ensuring his safety, but the other options would only be indicated after behavior-management strategies have been attempted. Restraints should be ordered on an as-needed basis.
- Which of the following is most likely to be a trigger for inappropriate behavior in a 7-year-old boy with oppositional defiant disorder?
A. Classmates invite him to play baseball during school recess.
B. Teacher asks him to be the class leader for the day.
C. He is told he must clean his room either before or after dinner.
D. His basketball coach tells him to stop pushing the other players.
D. His basketball coach tells him to stop pushing the other players.
Many children with ODD come from homes where parenting is inconsistent. This may pose a problem in other areas of life where rules must be enforced by authority figures to maintain safety and order, such as the classroom, sports team settings and extracurricular activities. Being told to stop pushing by the basketball coach could possibly trigger an increase in inappropriate behavior.
- Jesse is a 12-year-old who has been in the hospital with pneumonia but had a previous diagnosis of oppositional defiant disorder for which he has never received therapy. He had some exacerbation of ODD behaviors while in the hospital, and discharge planning includes at-home therapy for ODD. What should the clinician expect to be the first intervention recommended for Jesse’s treatment of ODD at discharge.
A. Child-focused play therapy
B. Parent management training (PMT)
C. Stimulant medication
D. Antidepressant medication
B. Parent management training (PMT)
Numerous controlled studies support parental management training (PMT) as producing large, positive treatment effects that are both effective across settings and long lasting. Stimulant medication (methylphenidate, dextroamphetamine) should only be used as a treatment for ODD and ADHD together. Antidepressant medication (fluoxetine, sertraline) should only be used when behavior management interventions have achieved limited results and hostile and aggressive behaviors are ongoing.
- Which of the following behaviors or comments correlate with the signs and symptoms of anorexia nervosa? Select all that apply.
A. “I think I am lactose intolerant and last year I decided to stop eating meat, sugar, and butter.”
B. Anna reports restricting and counting calories.
C. Anna’s mother indicated she has been exercising excessively.
D. Daily laxative use
E. Weight 46.8 kg; height 173 cm
A,B,C,D, E
All are correct. Each of these behaviors, findings, and comments are indicative of anorexia nervosa. Patients with anorexia nervosa have medically significant voluntary weight loss by dieting, over-exercising, and/or laxative/diuretic abuse with a duration of greater than or equal to three months
- Another important component of successful treatment of an eating disorder is psychotherapy. Psychotherapy helps to assist in reduction of distorted body image and dysfunctional eating habits. What components of psychotherapy are beneficial? Select all that are appropriate.
A. Acceptance skills for stressful circumstances that can’t be immediately changed.
B. Change skills to better manage emotions or relationship issues.
C. Emotional regulation, distress tolerance, and effectiveness in relationships
D. Involvement of family
E. Skills-based, problem-focused and time-limited interventions
All are correct!
Each of these are important components of psychotherapy. Psychotherapy includes dialectical behavioral therapy and cognitive behavioral therapy within the individual and group setting. In addition, families are vital during the recovery and maintenance stages of eating disorders and they play an important role in managing and disrupting eating disorder thoughts and behaviors.
- Which of the following best describes an eating disorder?
A. A choice individuals make regarding the types of food they eat.
B. A type of mental illness that involves emotional and behavioral problems revolving around weight and food.
C. Eating disorders are a condition in which individuals become severely malnourished and underweight.
D. Eating disorders only affect females.
B is correct. Eating disorders are a group of conditions that can cause serious physical, behavioral and emotional problems. It is a type of mental illness that involves issues about weight and food.
- Bradley, a 5-year-old male, presents to Urgent Care with his mother, who reports her son has lost weight and shows little interest in food. Mom describes Bradley as a picky eater but is concerned that he is too skinny. What would be a potential diagnosis for Bradley?
A. Anorexia nervosa
B. Avoidant/restrictive food intake disorder
C. Binge eating disorder.
D. Bulimia nervosa
B is correct. Avoidant/restrictive food intake disorder (ARFID) is a disturbance of feeding behavior not explained by lack of food, cultural norms, or a diagnosed psychiatric or medical disorder explaining the weight loss or lack of weight gain. Patients often present with lack of interest in food or abnormal rejection of food due to its sensory properties.
- Some complications of eating disorders are reversible with weight restoration and cessation of eating disorder behaviors. However, other complications are not reversible. Which complication is not fully reversible?
A. Bradycardia
B. Orthostatic hypotension
C. Osteoporosis
D. Starvation hepatitis
C is correct. Failure to achieve peak bone mass during adolescence may have long-lasting implications. Bone density loss and osteoporosis may not be fully reversible even with restoration to normal weight.
- Jaqueline has been brought to the eating disorder clinic by her parents, who are very worried about her health. Upon talking with Jaqueline about her eating habits and reviewing her medical information you determine that she has been diagnosed with anorexia nervosa. Which of the following eating patterns best describes anorexia nervosa?
A. Behavior of eating large amounts of food during a short period of time, then trying to rid of the extra calories through abusing laxatives.
B. Eating large amounts of food, even when not hungry, in a short amount of time, which leads to feelings of guilt or depression.
C. Eating only foods of a certain type of texture and consistency.
D. Substantial weight loss by dieting, over-exercising or laxative/diuretic abuse
D is correct. Anorexia nervosa is defined as substantial and medically significant voluntary weight loss by dieting, over-exercising, or laxative/diuretic abuse.
- Joshua is beginning treatment for bulimia nervosa. Psychotherapy and psychoeducation is imperative for successful treatment of an eating disorder through reduction of distorted body image and dysfunctional eating habits. Psychotherapy treatment includes dialectical behavioral therapy and cognitive behavioral therapy. What does cognitive behavioral therapy entail?
A. Addresses altered perceptions through understanding the relationship between thoughts, feelings and behaviors.
B. Helps reduce feelings of fear through exposure.
C. Systematic and planned performance of body movements or exercises, which aims to improve and restore physical function.
D. Teaches skills such as emotional regulation, distress tolerance and effectiveness in relationships.
A is correct. Cognitive behavioral therapy addresses altered perceptions through understanding the relationship between thoughts, feelings and behaviors. In addition, it is a skills-based, problem-focused and time-limited intervention.
- Tamara is a junior in high school and has struggled with her weight for the past few years. She has tried diets but they don’t seem to work and she has tried eating smaller portions but that just seems to make her hungrier. Tamara ends up consuming large amounts of food because she is so hungry and feels like she can’t stop eating. Tamara is very athletic, lettering in both softball and track. She just wishes she could control her weight. What eating disorder might Tamara be diagnosed as having?
A. Anorexia nervosa
B. Avoidant/restrictive food intake disorder
C. Binge eating disorder.
D. Bulimia nervosa
C is correct. Tamara has a binge eating disorder. The most prevalent eating disorder, binge eating involves the consumption of large amounts of food accompanied by a lack of control overeating and no compensatory mechanisms after the binge.
Tamara is receiving treatment for binge eating disorder. Which of the following would be a treatment goal for her?
A. Cessation of purging behavior
B. Correct nutrient deficiencies.
C. Normalize eating behavior.
D. Weight gain of 1 to 2 kg/week
C is correct. Treatment goals for binge eating disorder include normalizing eating behavior and maintaining an appropriate weight for age and height. In addition, it is important to teach body cues for satiety and to understand how to choose portion sizes.
- A nurse is performing an admission assessment of a client who has bulimia nervosa with purging behavior. Which of the following is an expected finding? Select all that apply.
A. Amenorrhea
B. Hypokalemia
C. Mottling of the skin
D. Slightly elevated body weight
E. Presence of lanugo on the face
B,D
Amenorrhea is an expected finding of anorexia nervosa rather than bulimia nervosa.
B. CORRECT: Hypokalemia is an expected finding of purging-type bulimia nervosa.
C. Mottling of the skin is an expected finding of anorexia nervosa rather than bulimia nervosa.
D. CORRECT: Most clients who have bulimia nervosa maintain a weight within a normal range or slightly higher.
E. Lanugo is an expected finding of anorexia nervosa rather than bulimia nervosa.
- A nurse on an acute care unit is planning care for a client who has anorexia nervosa with binge-eating and purging behavior. Which of the following nursing actions should the nurse include in the client’s plan of care?
A. Allow the client to select preferred meal times.
B. Establish consequences for purging behavior.
C. Provide the client with a high-fat diet at the start of treatment.
D. Implement one-to-one observation during and after meals.
D. Implement one-to-one observation during and after meals.
- A nurse is caring for a client who has bulimia nervosa and has stopped their purging behavior. The client tells the nurse that she is afraid she is going to gain weight. Which of the following response should the nurse make?
A. “Many of the clients are concerned about their weight. However, the dietician will ensure that you don’t get too many calories in your diet.”
B. Instead of worrying about your weight, try to focus on your other problems at this time.”
C. “I understand you have concerns about your weight, but first, let’s talk about your recent accomplishments.”
D. “You are not overweight, and the staff will ensure that you do not gain weight while you are in the hospital. We know that is important to you.”
C
This statement acknowledges the client’s concern and then focuses the conversation on the client’s accomplishments, which can promote self-esteem and self-image.
- A very thin individual describes herself as “positively obese”. She states that she “has to keep dieting.” Which statement by the nurse is the best response to this patient regarding her distorted body image?
A. “ I think it will be important for you to attend group to get some feedback about your weight from peers.”
B. “You really are quite thin. Trust me on this. I am a health professional.”
C. “What makes you think that you are obese?”
D. “I am concerned about your health. Let’s consider some ways to help you stay healthy.”
D
A significant symptom of anorexia nervosa is a distorted body image. This irrational belief (sometimes understood to be delusional) does not usually lessen with the use of logic or the opinion of others (A, B, and C.). In fact, these comments can sometimes lead to defensiveness on the part of the patient. Answer D focuses away from appearance and on health which the person may more readily accept.
- A nursing assistant is asked to provide continual observation for 2 hours following dinner for a patient admitted with a diagnosis of anorexia nervosa. The RN provides the following explanation for this intervention.
A. Patients with this disorder can get very sleepy and fall following a meal.
B. Patients with this disorder may vomit following a meal.
C. Patients with this disorder usually become combative following a meal.
D. Patients with this disorder sometimes need a companion after dinner.
B
A. Sleepiness following a meal is not a symptom of this illness.
B. Patients with this disorder may vomit after eating to prevent weight gain.
C. Combativeness following a meal is not a symptom of this illness.
D. Continuous observation is used for safety or to prevent harmful behaviors.
- Symptoms associated with a diagnosis of anorexia nervosa include: (Select SATA)
A. Extreme fear of gaining weight
B. A happy disposition when not eating
C. Excessive exercise
D. Slightly overweight appearance
E. Hiding laxative use
F. Self-harm behaviors like “cutting”
A, C, E, F
- A nurse is providing instruction to the teacher of a child who has attention deficit/hyperactivity disorder (ADHD). Which of the following classroom strategies should the nurse include in the teaching? Select all that apply.
A. Eliminate testing.
B. Allow for regular breaks.
C. Combine verbal instruction with visual cues.
D. Establish consistent classroom rules.
E. Increase stimuli in the environment.
B,C,D
- A nurse is assisting the parents of a school-age child who has oppositional defiant disorder in identifying strategies to promote positive behavior. Which of the following is an appropriate strategy for the nurses to recommend? Select all that apply.
A. Allow the child to choose consequences for negative behavior.
B. Use role-playing to act out unacceptable behavior.
C. Develop a reward system for acceptable behavior.
D. Encourage the child to participate in school sports.
E. Be consistent when addressing unacceptable behavior.
C,D,E
- A nurse is obtaining a health history from the parents of a 12-year-old client who has conduct disorder. Which of the following findings should the nurse expect? Select all that apply.
A. Bullying of others
B. Threats of suicide
C. Law-breaking activities
D. Narcissistic behavior
E. Flat affect
a,b,c
- A nurse in a pediatric clinic is caring for a preschool-age child who has a new diagnosis of ADHD. When teaching the parent about this disorder, which of the following statements should the nurse include in the teaching?
A. “Behaviors associated with ADHD are present prior to age 3.”
B. “This disorder is characterized by argumentativeness.”
C. “Below-average intellectual functioning is associated with ADHD.”
D. “Because of this disorder, your child is at increased risk for injury.”
D
- A nurse is assessing a 4-year-old child for indications of autism spectrum disorder. For which of the following manifestations should the nurse assess?
A. Impulsive behavior
B. Repetitive counting
C. Destructiveness
D. Somatic problems
B
- A nurse is caring for a child who has depression. Which of the following findings should the nurse expect? Select all that apply.
A. Preferring being with peers
B. Weight loss or gain
C. Report of low self-esteem
D. Sleeping more than usual
E. Hyperactivity
B,C,D
- A nurse is performing an admission assessment on an adolescent client who has depression. Which of the following manifestations should the nurse expect? Select all that apply.
A. Fear of being alone
B. Substance use
C. Weight gain or loss
D. Irritability
E. Aggressiveness
B,C,D,E
Agender
Asexual
person who experiences little or no sexual attraction to others.
Ally
supports the rights of LGBT people.
Bisexual
sexual orientation that describes a person who is emotionally and sexually attracted to people of their own gender and people of other genders.
Cisgender
person whose gender identity and assigned sex at birth correspond.
Gay
. A sexual orientation that describes a person who is emotionally and sexually attracted to people of their own gender (more commonly used to describe men).
Gender Binary
The idea that there are only two genders, male and female, and that a person must strictly fit into one category or another
Gender dysphoria
Distress experienced by some individuals whose gender identity does not correspond with their assigned sex at birth.
Gender fluid
Describes a person whose gender identity is not fixed.
Gender non-conforming
Describes a gender expression that differs from a given society’s norms for males and females.
Intersex
Group of rare conditions where the reproductive organs and genitals do not develop as expected.
Lesbian
sexual orientation that describes a woman who is emotionally and sexually attracted to other women.
Pangender
Describes a person whose gender identity is comprised of many genders.
Pansexual
A sexual orientation that describes a person who is emotionally and sexually attracted to people regardless of gender.
Queer
An umbrella term used by some to describe people who think of their sexual orientation or gender identity as outside societal norms.
Questioning
Describes and individual who is unsure about or is exploring their own sexual orientation and/or gender identity.
Transgender
Describes a person whose gender identity and assigned sex at birth do not correspond.
Transsexual
Sometimes used in medical literature or by some transgender people to describe those who have transitioned through medical interventions.
Two-Spirit
term that connects today’s experiences of LGBT Native American and American Indian people with the traditions of their cultures.
Misgendering
. When a person intentionally or accidentally uses the incorrect name or pronouns to refer to a person. Repeated or intentional misgendering is a form of bullying.
