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Mental Health > Children and Teenagers > Flashcards

Children and Teenagers Flashcards

1
Q

What is involved in the Children with Disabilities Act?

A

Education and treatment is mandated. Includes therapeutic nursery schools, day treatment programs, and special education classes in public schools. Includes working with parents.

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2
Q

What characteristics does the resilient child or teen have?

A

Temperament that can adapt to changes in the environment. Ability to form nurturing relationships with other adults when a parent is not available. Ability to distance self from emotional chaos of parent or family. Social intelligence. Ability to use problem-solving skills.

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3
Q

What problems may CT’s be threatened by?

A

Poverty, neglect, natural disasters, physical or mental illness, homelessness, abuse, in general are known as high risk

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4
Q

Includes family living situation, peer and family relationships, school performance, substance use, any co-occuring conditions

A

Psychosocial assessment

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5
Q

Is similar to that of adults except that the developmental level is considered

A

Mental status assessment

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6
Q

Provides information about the child’s current maturational level that, when compared with the child’s chronological age, identifies developmental lags and deficits

A

Developmental assessment

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7
Q

Test designed for infants and children up to 6 years of age

A

Denver II Developmental Screening Test

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8
Q

What are some methods of collecting data about CT’s?

A

Interviewing, testing, observing, interacting. Histories from parents and caregivers. Questions about life at home and school. Free to describe current problems. Games,drawings, puppets, and free play used for children unable to respond to a direct approach. Important observations of interactions socially.

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9
Q

What’s involved in a mental health assessment?

A

What is the level of emotional and intellectual maturity? What are the pt’s particular strengths and weaknesses? What stresses and how they affect the pt at any particular stage in life?How did gender-specific challenges affect the expression of illness and the treatment?

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10
Q

What are some nursing diagnoses for CT’s?

A

Fear. Defensive and ineffective coping. Delayed growth and development: self-care deficit. Impaired verbal communication and social interaction deficits. Risk for: impaired child or parent attachment, injury, self-mutiliation, self- or other-directed violence.

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11
Q

Previously known as mental retardation. Can be mild, moderate, severe, or profound.

A

Intellectual developmental disorder (IDD).
Degree of disability will guide academic, vocational, and living conditions. Intelligence quotients (IQs) are no longer used to define level of impairment. Multiple causes.

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12
Q

Combined DSM-IV disorders of autistic disorder and Asperger’s syndrome.

A

Autism Spectrum Disorders (ASD).
Significant evidence supports genetic transmission. CDC estimates that 1 out of 80-240 children in the US has a disorder of this sort to some degree.

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13
Q

DSM-V criteria for ASD (autism) must demonstrate two of more of which of the following?

A

Stereotyped or repetitive speech, motor movements, echolalia, use of objects. Excessive adherence to routines, rituals, excessive resistance to change. Fixated interests that are abnormal in intensity. Hyporeactive or hyperactive to the sense of joy or unusual interest in sensory aspects of the environment.

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14
Q

What are some deficits seen in those with ASD?

A

Social and emotional reciprocity. Verbal and nonverbal communicative behaviors used for social interaction. Developing and maintaining relationships appropriate to the developmental level.

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15
Q

No medications are available to treat ASD directly. But can be used to help?

A

Risperidone if aggression, deliberate self-injury, temper tantrums.
Propranolol for social function and word fluency.
SSRIs for rigidity or compulsive rituals

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16
Q

Interventions for ASD?

A

Referral for early intervention. Structured environment, give plenty of notice before changing routines. Short, concise, developmentally appropriate comm. Role model social skills. Encourage verbal comm. Limit self-stimulating and ritualistic behaviors by providing alternative play activities.

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17
Q

What are some hoped-for long-term outcomes for those with ASD?

A

Attain an increased interest in reciprocal interactions. Provide for the development of psychomotor/social skills, self-concepts, self-control including impulse control. Facilitate the appropriate expression of emotions and develop of cognitive skills.

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18
Q

Which disorder shows symptoms of inattention, hyperactivity, and impulsivity? Thought to be caused by a sluggish frontal lobe

A

Attention Deficit Hyperactivity Disorder (ADHD).

Affect 5-10% of children and adolescents. Is difficult to diagnose before the age of 4 years.

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19
Q

ADHD symptoms of inattention?

A

Doesn’t seem to listen, has trouble finishing hw/chores, often loses things, easily distracted by outside stimuli, difficulty organizing papers/tasks, fails to meet deadlines, has trouble following instructions.

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20
Q

ADHD symptoms of hyperactivity and impulsivity?

A

Unable to sit still, runs and climbs inappropriately, can’t sit still to eat meals, watch movies. Talks excessively, does things without thinking, blurts out answers/interrupts, difficulty waiting their turn.

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21
Q

What are some things to do when dealing with a child with ADHD?

A

Calm, firm, respectful. Obtain attention before giving directions, short/clear explanations. Set clear limits on behaviors and be consistent. Assist parents in develop a reward system. plan physical activities. Safe environment.

22
Q

What are some interventions for those with ADHD?

A

Special ed program that addresses academic difficulties. Psychotherapy and play therapy to determine emotional problems that develop as a result of the disorder.

23
Q

Psychostimulants/CNS stimulants for ADHD?

A 
methylphenidate
 (Ritalin, Concerta), dexmethlyphenidate (Focalin)
dextroamphetamine/amphetamine 
(Adderall)
lisdexamfetamine (Vyvanse)
24
Q

What are therapeutic effects of psychostimulants?

A

Increased attention in ADHD, increased goal directed behavior, decreased impulsiveness, hyperactivity and restlessness.

25
Q

What are the most common side effects of psychostimulants?

A

Insomnia, restlessness, anorexia, emotional lability

26
Q

What are the most serious potential adverse reactions to psychostimulants?

A

Dizziness, confusion, hallucinations, delusions, palpatationsg, hypotension, dysrhythmias.

27
Q

What are the most important nursing considerations for psychostimulants?

A

Monitor HR, BP, height and weight regularly. Monitor for behavioral changes.

28
Q

What are some special notes for psychostimulants?

A

Avoid fruit juices when taking Adderall, do not chew, limit caffeine intake, highly adductor/potential for abuse. May take drug holiday, may take daily dosing in the morning.

29
Q

Stereotyped, rapid, involuntary recurring motor moments that include excessive blinking, facial grimacing, shoulder shrugging, and head turning.

A

Tourette’s disorder
Tics wax nd wane over time and are usually in response to stress, fatigue, excitement, and anxiety.
The most serious of tic disorders.

30
Q

What are symptoms of Tourette’s?

A

Obsessions, compulsions, hyperactivity, distractibility, impulsivity.
Fear of tic in public limits activities.
Low self-esteem is common, feeling ashamed, self-conscious, and rejected by peers.

31
Q

What are some treatments for Tourette’s?

A

Focus of the treatment is helping the child, family, and school understand cope with behaviors. Clonidine HCl and guanfacine HCl are the most effective drugs.
CNS stimulants increase the severity of tics.

32
Q

Angry mood, defiant and headstrong behaviors. Almost all children show symptoms found in this disorder.

A

Oppositional Defiant Disorder (ODD)

For ODD to be diagnosed, the behaviors need to occur “more persistently and frequently”

33
Q

Rights of others and societal rules are violated. Occurs in all settings. Forerunner of antisocial personality disorder. Aggressive, destructive, deceitful with serious rule violations and lack of remorse or empathy.

A

Conduct Disorder
Child onset vs teen onset
Leads to academic failure and juvenile delinquency

34
Q

What should be assessed for ODD and conduct disorder alone with the seriousness of disruptive behavior and possible hospitalization or residential placement?

A

Co-occuring anxiety, aggression, hostility, and impulse control. Assess moral development: the ability to understand the effects of hurtful behavior on others, to empathize with others, and to feel remorse.

35
Q

What meds can be used to treat aggressive behaviors?

A

Antipsychotics, lithium, anticonvulsants, antidepressants, beta blockers (clonidine)

36
Q

What therapies can be used to treat aggressive behaviors?

A

Cognitive behavioral therapy, problem solving techniques, conflict resolution, empathy training, social interaction skills

37
Q

Most common mental disorders of childhood and teens. Characteristics are the same as adults except may manifest as somatic complaints.

A

Anxiety disorders.
May be so serious the child is unable to function normally at home or at school.
Separation anxiety, PTSD

38
Q

What are risk factors for depressive disorders?

A

Family history, physical or sexual abuse or neglect, homelessness, disputes among parents, conflicts with peers or family and rejection by peers or family. Bullying, as an aggressor or victim. Learning disabilities. Chronic illness.

39
Q

What are interventions that can apply to all children?

A

Plan activities that are geared to child’s abilities to maximize success. Offer positive recognition and feedback when a child succeeds. Focus on strengths, not just problems.

40
Q

What are interventions for families?

A

Evaluate the quality of child-parent/caregiver relationship. Parent/caregiver’s understanding of growth and development, parenting skills. Discuss realistic behavioral goals. Discuss the support systems. Support parents’ efforts to remain hopeful.

41
Q

Examples of therapeutic modalities?

A

Dramatic play therapy, movement, dance, music, recreation, drawing, family therapy, bibliotherapy, plays group, behavior modification, games, time out, therapeutic holding, removal and restraint

42
Q

Nonstimulants/antihypertensives for ADHD?

A

Non-stimulants:
clonidine hydrochloride
guanfacine

43
Q

What are the therapeutic effects of nonstimulants?

A

Decreased BP, improvement in ADHS symptoms, increased social interactions

44
Q

What are the common potential side effects and adverse reactions for nonstimulants?

A

Drowsiness, dry mouth, weight gain

Hypotension

45
Q

What are the most important nursing considerations for nonstimulants?

A

Use with caution in children with cardiac history. Withdrawal phenomenon (rebound hypertension)

46
Q

What are special notes for nonstimulants?

A

Used as mono therapy or in conjunction with psychostimulants for the treatment of ADHD

47
Q

What is the therapeutic class for the nonstimulant atomoxetine (Strattera)? Therapeutic effects?

A

SSRI. Increased attention in ADHD, increased goal directed behavior, decreased impulsiveness, hyperactivity, restlessness.

48
Q

Side effects and adverse reactions for nonstimulant atomoxetine?

A

Side effects are GI reactions, reduced appetite, dizziness, somnolence, mood swings, trouble sleeping.
Adverse are suicidal thought in children, hepatotoxicity.

49
Q

Nursing considerations for nonstimulant atomoxetine?

A

Monitor for SI, use with caution in children with cardiac history (Decrease HR and BP)

50
Q

Special notes or nonstimulant atomoxetine?

A

Assess for s/s of liver toxicity (jaundice, LFT, RUQ, tenderness), monitor behavior for s/s of SI

Mental Health (11 decks)

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