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Psych Final > Child and Adolescent Mental Health > Flashcards

Child and Adolescent Mental Health Flashcards

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1
Q

This is a disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social, and practical domains.

A

neurodevelopmental disorder

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2
Q

Heterogenous group of neurodevelopmental syndromes
Wide range of communication impairments and restricted, repetitive behaviors
Withdrawal of child into self and into a fantasy world of his or her own creation
Onset in early childhood
Often chronic course

A

autism spectrum disorder

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3
Q

predisposing factors for ASD

A

Neurological implications
Genetics
Prenatal and perinatal influences

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4
Q

possible symptoms along spectrum of ASD

A

Impairment in social interaction
Impairment in communication and imaginative activity
Restricted activities and interests
Varied functionality

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5
Q

possible nursing diagnosis for ASD

A

Risk for self-mutilation
Impaired social interaction
Impaired verbal communication

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6
Q

ASD nursing outcomes
the client:

A

Exhibits no evidence of self-harm
Interacts appropriately with at least one staff member
Demonstrates trust in at least one staff member
Is able to communicate so that he or she can be understood by at least one staff member
Demonstrates behaviors that indicate he or she has begun the separation/individuation process

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7
Q

ASD nursing planning/implementation

A

Protection of the child from self-harm
Improvement in social functioning
Improvement in verbal communication
Enhancement of personal identity

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8
Q

ASD nursing evaluation

A

Has the child been able to establish trust with at least one caregiver?
Have the nursing actions directed toward preventing mutilative behaviors or other injury been effective in protecting the client from self-harm?
Has the child attempted to interact with others? Has he or she received positive reinforcement for these efforts?
Has eye contact improved?
Has the child established a means of communicating his or her needs and desires to others? Have all self-care needs been met?
Does the child demonstrate an awareness of self as separate from others? Can he or she name own body parts and body parts of caregiver?

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9
Q

two medication FDA approved for ASD

A

Risperidone
Aripiprazole

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10
Q

targeted symptoms for medications treating ASD

A

Aggression
Deliberate self-injury
Temper tantrums
Quickly changing moods

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11
Q

Inattention and/or hyperactivity and impulsivity

A

Attention Deficit/Hyperactivity Disorder

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12
Q

excessive psychomotor activity

A

Hyperactivity

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13
Q

acting without reflection or thought of consequences

A

Impulsiveness

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14
Q

ADHD subtypes

A

Combined type (meeting the criteria for both inattention and hyperactivity/impulsivity)
Predominantly inattentive presentation
Predominantly hyperactive/impulsive presentation

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15
Q

ADHD predisposing factors

A

Genetics
Biochemical theory
Anatomical influences
Prenatal, perinatal, and postnatal factors

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16
Q

environmental influences on ADHD

A

Environmental lead
Dietary factors (food dyes and additives)

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17
Q

psychosocial influences on ADHD

A

Disorganized or chaotic family environments
Maternal mental disorder or paternal criminality
Low socioeconomic status
Unstable foster care

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18
Q

ADHD nursing assessment

A

Difficulty in performing age-appropriate tasks
Highly distractible
Extremely limited attention span
Impulsive
Difficulty forming satisfactory interpersonal relationships
Demonstrates behaviors that inhibit acceptable social interaction
Disruptive and intrusive in group endeavors
Excessive levels of activity, restlessness, and fidgeting
Accident prone
Low frustration tolerance and temper outbursts

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19
Q

ADHD comorbidities

A

Oppositional defiant disorder and conduct disorder: 50%
Anxiety: 30%
Depression: 30%
Bipolar disorder: 20%

Depression and anxiety may be treated concurrently with ADHD
Substance use disorder and bipolar disorder must be stabilized BEFORE beginning ADHD treatment

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20
Q

possible nursing diagnosis for ADHD

A

Risk for injury
Impaired social interaction
Low self-esteem
Noncompliance with task expectations

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21
Q

ADHD nursing outcomes
the client:

A

Has experienced no physical harm
Interacts with others appropriately
Verbalizes positive aspects about self
Demonstrates fewer demanding behaviors
Cooperates with staff in an effort to complete assigned tasks

22
Q

ADHD nursing planning/interventions

A

Ensuring that client remains free of injury
Encouraging appropriate interactions with others
Increasing feelings of self-worth
Fostering motivation for compliance with tasks

23
Q

ADHD nursing evaluation

A

Have the nursing actions directed at client safety been effective in protecting the child from injury?
Has the child been able to establish a trusting relationship with the primary caregiver?
Is the client responding to limits set on unacceptable behaviors?
Is the client able to interact appropriately with others?
Is the client able to verbalize positive statements about self?
Is the client able to complete tasks independently or with a minimum of assistance?
Can the client follow through after listening to simple instructions?

24
Q

CNS stimulants for ADHD med interventions

A

Dextroamphetamine, lisdexamfetamine, methylphenidate, dexmethylphenidate
Increase dopamine and norepinephrine levels
Side effects: Insomnia, anorexia, weight loss, tachycardia, decrease in rate of growth and development
Higher risk of injury-related hospital admissions

25
Q

Presence of vocal tics and multiple motor tics
Onset may be as early as age 2
Occurs most commonly around age 6 or 7
More common in boys than in girls
3 to 8 per 1,000 in school-age children

A

tourette’s disorder

26
Q

environmental predisposing factors for tourette’s

A

Maternal alcohol use during pregnancy
Low birth weight
Complications during childbirth
Infection

27
Q

tourette’s nursing assessment

A

Simple motor tics
Complex motor tics
Vocal tics
-Repeating certain words or phrases out of context
-Palilalia
-Echolalia

28
Q

possible nursing diagnosis for tourette’s

A

Risk for self-directed or other-directed violence
Impaired social interaction
Low self-esteem

29
Q

tourette’s nursing outcomes
the client:

A

Has not harmed self or others
Interacts with staff and peers in an appropriate manner
Demonstrates self-control by managing tic behavior
Follows rules without becoming defensive
Verbalizes positive aspects about self

30
Q

Tourette’s Nursing Planning/Implementation

A

Safety of client and others
Encouraging interpersonal interaction using appropriate behaviors
Promoting increased feelings of self-worth

31
Q

Tourette’s Nursing Evaluation

A

Has the client refrained from causing harm to self or others during times of increased tension?
Has the client developed adaptive coping strategies for dealing with frustration to prevent resorting to self-destruction or aggression to others?
Is the client able to interact appropriately with staff and peers?
Is the client able to suppress tic behaviors when he or she chooses?
Does the client verbalize positive aspects about self, particularly as they relate to his or her ability to manage the illness?

32
Q

Tourette’s Pharmacological Intervention

A

Pharmacological intervention most effective when combined with other behavioral therapy
Antipsychotics
-Haloperidol (Haldol) and pimozide
Alpha agonists (antihypertensives)
-Clonidine (Catapres) and guanfacine (Tenex; Intuniv)

33
Q

Persistent pattern of angry mood and defiant behavior
Interferes with social, educational, or vocational activities
Typically begins by 8 years of age and usually not later than early adolescence

A

oppositional defiant disorder

34
Q

common comorbidities for ODD

A

ADHD, anxiety, MDD, conduct disorder, and substance use

35
Q

pathology of ODD

A

developmental phase is prolonged

36
Q

ODD Predisposing Factors

A

Biological influences
-Role not determined
Family influences
-If power and control are issues for parents
-If parents exercise authority for their own needs
-Power struggle between the parents and the child

37
Q

ODD nursing assessment

A

Passive-aggressive behaviors
Stubbornness, procrastination
Disobedience, negativism
Carelessness, testing of limits
Resistance to directions
Unwillingness to cooperate
Running away
School avoidance and underachievement
Temper tantrums, fighting, and argumentativeness
Impaired interpersonal relationships

38
Q

possible nursing diagnoses for ODD

A

Noncompliance with therapy
Defensive coping
Low self-esteem
Impaired social interaction

39
Q

ODD nursing outcomes
the client:

A

Complies with treatment by participating in therapies without negativism
Accepts responsibility for his or her part in the problem
Takes direction from staff without becoming defensive
Does not manipulate other people
Verbalizes positive aspects about self
Interacts with others in an appropriate manner

40
Q

ODD nursing planning/implementation

A

Encouraging cooperation with therapy
Helping client accept responsibility for own behaviors
Promoting increased feelings of self-worth
Assisting in the development of socially appropriate behaviors in interactions with others

41
Q

ODD nursing evaluation

A

Is the client cooperating with schedule of therapeutic activities? Is level of participation adequate?
Is the client’s attitude toward therapy less negative?
Is the client accepting responsibility for problem behavior?
Is the client verbalizing the unacceptability of his or her passive-aggressive behavior?
Is he or she able to identify which behaviors are unacceptable and substitute more adaptive behaviors?
Is the client able to interact with staff and peers without defending behavior in an angry manner?

42
Q

Persistent pattern of behavior in which basic rights of others are violated
Major age-appropriate societal norms or rules are violated
-Childhood-onset type
-Adolescent-onset type

A

conduct disorder

43
Q

predisposing factors for conduct disorder

A

Biological influences
-Genetics
-Irritable temperament
-Biochemical factors
Psychosocial influences
-Peer relationships
–Poor academic performance and social maladaptation
–Affiliations with deviant peer group
Family influences
Parental rejection
Inconsistent management with harsh discipline
Early institutional living
Frequent shifting of parental figures
Large family size
Absent father
Parents with antisocial personality disorder, alcohol dependence
Marital conflict and divorce
Inadequate communication patterns
Parental permissiveness

44
Q

assessment for conduct disorder

A

Use of physical aggression in violation of rights of others
Use of drugs and alcohol
Sexual permissiveness
Low self-esteem manifested by a “tough-guy” image
Problems with inattentiveness, impulsiveness, and hyperactivity
Lack of feelings of guilt or remorse
Use of projection as a defense mechanism
Inability to control anger
Low academic achievement

45
Q

possible nursing diagnoses for conduct disorder

A

Risk for other-directed violence
Impaired social interaction
Defensive coping
Low self-esteem

46
Q

conduct disorder nursing outcomes
the client:

A

Has not harmed self or others
Interacts with others in a socially appropriate manner
Accepts direction without becoming defensive
Demonstrates evidence of increased self-esteem by discontinuing exploitative and demanding behaviors toward others

47
Q

Conduct Disorder Planning/Implementation

A

Ensuring safety of client and others
Assisting in the development of socially appropriate behaviors in interactions with others
Encouraging client to accept responsibility for own behaviors
Promoting increased feelings of self-worth

48
Q

Conduct Disorder Evaluation

A

Have the nursing actions directed toward managing the client’s aggressive behavior been effective?
Have interventions prevented harm to others or others’ property?
Is the client able to express anger in an appropriate manner?
Has the client developed more adaptive coping strategies to deal with anger and feelings of aggression?
Does the client demonstrate the ability to trust others? Is he or she able to interact with staff and peers in an appropriate manner?
Is the client able to accept responsibility for his or her own behavior? Is there less blaming of others?

49
Q

therapeutic approaches for conduct disorder

A

Behavior therapy
Disruptive behavior disorders
ADHD, ODD, and conduct disorder
Group Therapy
Parents should be involved in treatment process

50
Q

gender dysphoria shows distress with:

A

Gender identity
Depression related to desire to be opposite gender
Fear and anxiety related to others learning about their gender identity

51
Q

nurse role for gender dysphoria in children

A

emphasis is given to improvement in social interactions and enhancement of positive self-esteem

52
Q

treatment for gender dysphoria treatment should include:

A

Evaluation/management of concurrent mental health issues
Social support systems
Later childhood: nonjudgmental exploration of individual’s preferences
Behavior modification: assist with acceptance of self-image without discomfort/distress
Treatment is matter of personal choice
Address depression, anxiety, social isolation, anger, self-esteem, and parental conflict
Nursing role: educating families, identifying safe, supportive peer groups

Psych Final (2 decks)

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