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NURS 503 > Developmental disabilities and peds MH > Flashcards

Developmental disabilities and peds MH Flashcards

1
Q

What is the significance of testing for an ASO titer when diagnosing developmental disorders?

A

Can be helpful in diagnosing OCD

  • Blood test to measure antibodies against streptolysin O (substance produced by group A streptococcus bacteria)
  • Rules out PANS/PANDAS (associated with strep infection)
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2
Q

True/false: Persistent anxiety at high levels can cause maladaptive behaviors

A

True - warrants diagnosis and treatment

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3
Q

Symptoms suggestive of an anxious response

A
  • Tachycardia
  • Tachypnea
  • HTN
  • GI distress
  • Tremor
  • Sweating
  • Enhanced vigilance and reactivity
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4
Q

Common pediatric anxiety disorder examples

A
  • Separation anxiety
  • Generalized anxiety
  • Social anxiety
  • OCD
  • Agoraphobia
  • PTSD
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5
Q

What three anxiety disorders are considered the pediatric anxiety disorder triad?

A

Happens in the same individual, have similar life courses and treatments

  • SAD
  • GAD
  • Social anxiety
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6
Q

What is important to assess for in pediatric patients who present with anxiety?

A

Watch out for evidence of physical trauma

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7
Q

At what age does separation anxiety disorder normally present in pediatric patients?

A

Normal development phenomenon from 7 months old through preschool

  • Manifests from 5-16 years (mean age 9 years)
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8
Q

Clinical findings associated with separation anxiety?

A
  • Excessive anxiety r/t separation
  • Unrealistic worry about harm to self or loved ones
  • Nightmares about separation
  • Physical complaints in anticipation of separation
  • Social withdrawal during separations
  • Environmental stress
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9
Q

Separation anxiety puts children at risk for what two disorders later in life?

A

Panic disorder and depression

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10
Q

Is pharmacology useful in managing separation anxiety?

A

Pharmacology is NOT helpful

  • Best treated as family system or relationship based problem (psychotherapy)
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11
Q

What is generalized anxiety disorder?

A

Cognitive and obsessive in nature

  • Cause excessive anxiety, worry, apprehension generalized to a number of events or activities
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12
Q

Generalized anxiety disorder clinical findings

A
  • Worry about future events and/or preoccupation about past behavior
  • Poor sleep
  • Unexplained fatigue
  • Irritability
  • Difficulty concentrating
  • Somatic complaints
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13
Q

What medications should NOT be prescribed to pediatric patients with GAD?

A

Benzodiazepines

  • Should be treated with SSRIs (sertraline, fluoxetine), SNRIs (venlafaxine, duloxetine), buspirone
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14
Q

True/false: Preschoolers benefit from play therapy for GAD management

A

True

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15
Q

How long do symptoms need to be present in order to be diagnosed with PTSD?

A

One month or longer

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16
Q

Pediatric PTSD management

A
  • Referral to pediatric behavioral health specialist
  • Psychotherapy
  • Medications
    • Beta blockers (propranolol) for tachycardia and hyperpnea
    • SSRIs for anxiety and depression
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17
Q

What are three categories of depression?

A
  • Major depressive disorder
  • Dysthymic disorder
  • Adjustment disorder with depressed mood
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18
Q

What is major depressive disorder?

A

Depressed or irritable mood or markedly diminished interest and pleasure in almost all of usual activities for at least 2 weeks

  • No precipitating event necessary
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19
Q

What is dysthymic disorder?

A

Depressed or irritable mood for the majority of days in the past 2 years that is less intense but more chronic than MDD

20
Q

What is adjustment disorder?

A

Occurs within 3 months after major life stressor

  • Episode is mild and brief
21
Q

Clinical findings of depression in infants

A

May not respond to extra efforts to soothe or engage them

22
Q

Clinical findings of depression in young children

A
  • FTT
  • Speech and motor delays
  • Repetitive self soothing behavior
  • Withdrawal from social interactions
  • Poor attachment
  • Loss of developmental skills
23
Q

Clinical findings of depression in toddlers and preschoolers

A
  • Lack energy
  • Too eager to peals others
  • Clingy
  • Whiney
  • Developmentally inappropriate problems with separation
24
Q

Clinical findings of depression in school aged children

A
  • Decreased mood
  • Impaired concentration
  • Inattention
  • Irritability
  • Fluctuating mood
  • Temper tantrums
  • Social withdrawals
  • Somatic complaints
  • Agitation
  • Separation anxiety
  • Behavioral problems
25
Q

What essential diagnostic labs should be ordered for patients with new symptoms of depression?

A
  • CBC
  • EBV titers
  • Vitamin D
  • TSH
  • Hcg
  • UA
  • Drug screen
26
Q

Depression management

  • Non pharmacologic therapy
A
  • Determine suicidal risks and intervene
  • Referral to community resources and behavioral health specialist
  • Follow up in three months if symptoms are stable
27
Q

Depression management

  • Pharmacologic therapy
A

CBT + SSRIs (avoid paroxetine)

  • Start antidepressants low and increase dose slowly
  • Can take 4-6 weeks to see max response
28
Q

What medications should be avoided in pediatric patients when treating depression?

A
  • TCAs - avoid in young children (risk of harm)
  • Paroxetine - avoid in children and adolescents (suicide risk)
  • Atypical antidepressants can cause metabolic disorders
29
Q

Signs and symptoms of serotonin syndrome

A
  • Mental status changes
  • Agitation
  • Autonomic instability (HR, BP, sweating)
  • Neuromuscular changes (poor muscle coordination, twitching, rigidity)
30
Q

What is bipolar disorder?

A

Unusual shifts in mood, energy, functioning

  • May begin with manic, depressive, or mixed set of manic and depressive symptoms
31
Q

Signs of a manic episode in bipolar disorder

A
  • Irritable mood and grandiosity
  • Elevated mood
  • Decreased sleep
  • Racing thoughts
  • Poor judgement
  • Flight of ideas
  • Hyper sexuality
32
Q

What essential labs should be collected for symptomatic patients with bipolar disorder?

A
  • CBC
  • CMP
  • TSH
  • Toxicology screen
33
Q

Bipolar disorder management considerations

A
  • Promote patient safety (highest risk of suicide)
  • Referral to behavioral health provider
  • Mood stabilizers (lithium) alone or in combination with anti seizure medications (valproate) + atypical antipsychotics (risperidone)
34
Q

What two medications are NOT effective in patients with bipolar?

A

Antidepressants and stimulants

35
Q

ADHD clinical findings

A
  • Inability to sustain attention, curb activity level, or inhibit impulsivity
  • Concerns r/t memory, emotional control, organization, planning
  • Inhibiting thoughts or actions
  • Difficulty with peers, following rules and regulations
36
Q

Important diagnostic/screening tools needed to diagnose ADHD

A
  • Screen for iron deficiency, lead, thyroid dysfunction
  • Screening tools
    • Vanderbilt ADHD Scales
    • ADHD rating scale IV
    • Conner Parent and Teacher rating scales
    • Child attention profile
37
Q

ADHD management

  • Non pharmacologic therapy
A
  • Family education and support
  • Behavior management alone
    • For children < 6 years old and/or have mild symptoms
    • First line therapy
38
Q

ADHD management

  • Pharmacologic therapy
A
  • Stimulants → methylphenidate (Ritalin)
  • Amphetamine (adderall, focalin, vyvanse)
  • SNRI (strattera)
  • Alpha adrenergic agonist (guanfacine, clonidine)
39
Q

If a provider is going to start a patient with ADHD on a stimulant, what will it be important to screen for prior to therapy?

A

CV disease risk

  • Collect family history
  • Check if they are obese, have DM, dyslipidemia
  • History of stroke, MI, TIA
40
Q

What is the only stimulant for ADHD therapy that is approved for children <3 years old?

A

Amphetamine (adderrall)

  • Therapy can cause patients to develop a tic, but most go away within 1 year
  • Give more snacks for nutrition
41
Q

What SNRI drug is approved for children >6 years old for ADHD treatment?

A

Strattera/atomoxetine - non controlled substance approved for children >6 years old

  • Takes up to 6 weeks of regular use to notice effects
42
Q

True/false: Patients with anorexia and bulimia are often underweight

A

False

  • Anorexia = underweight
  • Bulimia = average weight or overweight
43
Q

Clinical findings for patients with eating disorders

A
  • Menstrual irregularities
  • Body dysmorphism
  • Preoccupation with food
  • History of dieting
  • Guilt about eating
  • Lies about eating or having eaten
  • Social isolation
  • GI symptoms
  • Syncope
  • Substance abuse
  • Family history of chaos and abuse
44
Q

Physical exam findings in patients with eating disorders

A
  • Altered growth
  • Parotid gland enlargement
  • Fluid retention
  • Thin body type
  • Hypotension
  • Dental erosion
  • Thin hair, lanugo
  • Muscle atrophy
  • Lethargy
45
Q

How much weight should a patient with an eating disorder gain per week while refeeding?

A

Weight gain during refeeding should be 1.1 pound/week

  • Monitor for refeeding syndrome → confusion, irritability, organ dysfunction, seizure
46
Q

Clinical findings suggestive of Down syndrome

A
  • Short stature
  • Brachycephaly - flat head
  • Midface hypoplasia with flat nasal bridge
  • Brushfield spots
  • Epicanthal folds with up slanting palpebral fissures
  • small mouth with protruding tongue
  • Myopia, cataracts
  • Small ears, narrow canal
  • Extra skin at nape of neck
  • Single palmer crease
  • Clinodactyly - abnormally bent or curved finger

NURS 503 (10 decks)

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