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Mental Health Nursing > Exam 3 > Flashcards

Exam 3 Flashcards

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1
Q

what characteristics do resilient children or adolescents have?

A

temperament that can adapt to changes in the environment; ability to form nurturing relationships with other adults when a parent is not avialable; social intelligence - can read people (expressions and faces and figure out how things are going in a situation and what you need to do); ability to use problem-solving skills

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2
Q

what is the prevalence of children or adolescents having a major psychiatric disorder?

A

one in five children have one

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3
Q

how many young people with a mental problem are not receiving the help that they need

A

an estimated 2/3 of all young people

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4
Q

what percent of 21 year olds that have mental disorders have had a previous disorder?

A

75%

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5
Q

what barriers to treatment of children and adolescent behaviors is there a lack of?

A

clarity about why, when, and how of screening; coordination of funding and eligibility systems; resources; mental health providers; adequate reimbursement

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6
Q

what does genetics have to do with children and adolescent mental disorders?

A

often times their parents are diagnosed with a problem as well

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7
Q

what does temperament have to do with children and adolescent mental disorders?

A

some children can adapt and some can’t, whether or not they have a mental disorder often has to do with how well they can adapt

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8
Q

what do biochemical factors have to do with children and adolescents?

A

some of them as the same as adults; often have to do with serotonin, norepinephrine, and dopamine

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9
Q

what types of environments increase the chances for the development of mental disorders in children and adolescents?

A

low socioeconomic status; large families; marital issues; abuse; parental criminality; maternal psychiatric disorders; foster care placement

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10
Q

how is the mental status assessment of a child or adolescent different from that of an adult?

A

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

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11
Q

what does the developmental assessment provide information on?

A

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

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12
Q

what ages is the denver II designed for?

A

infants and children up to 6 years of age

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13
Q

what are methods of collecting data on children and adolescents with mental disorders?

A

interviewing, testing, observing, and interacting; histories from parents and caregivers (teachers are really important); questions answered about life at home and school; free to describe current problems; games, drawings, puppets and free play unable to respond to a direct approach; important observations of interactions among, child, adolescent, caregiver, and siblings

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14
Q

what questions should you ask about the mental health assessment of children and adolescents?

A

what is the level of emotional and intellectual maturity?; what are the child or adolescents particular strengths?; what particular strengths and weaknesses are present?; what stresses does the child encounter?; how do stressors affect young people at different stages of development?

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15
Q

what was the intellectual development disorder formerly known as?

A

mental retardation

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16
Q

what can causes of IDD be?

A

heredity, alterations in early embryonic development, pregnancy or perinatal problems, other factors such as trauma or poisoning

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17
Q

what does intellectual disability include deficits in?

A

reasoning, problem solving, planning, abstract thinking, judgement, academic learning, and learning from experience

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18
Q

what deficits in general mental abilities occur with IDD?

A

deficits in daily activities such as communication, functioning at school or work, personal independance, and impairment in cognitive functioning

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19
Q

what is the median age for the earliest diagnosis for autistic spectrum disorder?

A

4.5-5.5 years of age

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20
Q

what must someone demonstrate in order to be diagnosed with autistic spectrum disorder?

A

two or more of the following: stereotyped or repetitive speech, motor movement, and echolalia (the repetitive use of objects); excessive adherence to routines, rituals, or excessive resistance to change; fixated interests that are abnormal in intensity; hyporeactive or hyperreactive rate to the sense of joy or unusually interest and sensory aspects of the environment

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21
Q

what deficits do people with ASD have?

A

social and emotional reciprocity; verbal and nonverbal communicative behaviors used for social isolation; developing and maintaining relationships, appropriate to the developmental level

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22
Q

what things should you assess for in children with ASD?

A

developmental spurts and lags, uneven development, or loss of previously acquired abilities; quality of relationship between child and parent (evidence of bonding, anxiety, tension, and difficulty of fit between parent, child, and caregiver temperaments); co-occurring conditions; child’s strengths; at risk for abuse

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23
Q

are there medications available to treat ASD?

A

no

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24
Q

what is risperidone used to treat in children with ASD?

A

the symptoms of aggression, deliberate self injury, and/or temper tantrums, but propranolol is preferred because it has lower side effects; SSRIs may also be used but cautiously

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25
Q

what are some goals for long-term outcomes of ASD?

A

attain an increased interest in reciprocal interactions; provide for the development of psychomotor skills; facilitate appropriate expression of emotions and development of cognitive skills; foster the development of social skills, self-concept, and self control (including impulse control)

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26
Q

what percentage of children are affected by ADD and ADHD?

A

3-10% of children and adolescents

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27
Q

what are the three cardinal signs of ADHD and ADD?

A

intattention, hyperactivity, impulsivity

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28
Q

what are some predisposing factors for ADD and ADHD?

A

family history and perinatal or prenatal influences

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29
Q

what do brain scans of children with ADD or ADHD reveal?

A

underdeveloped or inactive frontal lobes - a lot of their behavior is the brain trying to stay awake and stay functional

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30
Q

what type of ADD or ADHD is more common in females?

A

the ‘inattentive type’ the day dreamers

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31
Q

what are interventions for the child with ADD and ADHD?

A

behavior modification and pharmacological agents that address inattention and hyperactive impulsive behaviors; special education programs that address academic difficulties; psychotherapy and play therapy to determine emotional problems

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32
Q

what is the most widely used medication to treat ADD and ADHD?

A

methylphenidate (Ritalin) which is available orally, the transdermal form is Daytrana

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33
Q

what is concerta?

A

an extended-release Ritalin that allows for once-daily dosing

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34
Q

what is Adderall?

A

a combination of dextroamphetamine and amphetamine that also calms and comes in an extended release form

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35
Q

what are some side effects of pharmacological interventions for ADD and ADHD?

A

decreased appetite, decreased sleep, increased VS

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36
Q

what should you monitor for the child taking medications to treat ADD or ADHD?

A

monitor weight, appetite, sleep and vital signs

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37
Q

what medication treats aggression and insomnia in the child with ADD or ADHD?

A

guafacine HCl

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38
Q

what are tics?

A

stereotyped, rapid, and involuntary recurring motor movements that include excessive blinking, facial grimacing, shoulder shrugging, and head turning. wax and wane over time

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39
Q

what is the average onset of tourette disorder?

A

may appear by age 2, but has an average onset between 6 and 7

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40
Q

how long is tourette disorder?

A

usually lifelong with periods of remission

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41
Q

what part of the body does tourette disorder usually affect?

A

usually the head, but can also affect the torso and limbs

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42
Q

what is coprolalia?

A

the uttering of obscenities that is present in less than 10% of cases

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43
Q

how common is Tourette’s disorder?

A

affects 4-5 persons in 10,000 and is more common in males

44
Q

what things should you assess for in someone with Tourette’s disorder?

A

symptoms include obsessions, compulsions, hyperactivity, distractibility, and impulsivity; low self-esteem is common, feeling ashamed, self-conscious, and rejected by peers; fear of tics in public situations limits activities; CNS stimulants increase the severity of tics; children with co-existing ADHD must have their medications monitored carefully because they are treated with stimulants

45
Q

what is the focus of treatment for Tourette’s disorder?

A

helping the child, family, and school understand and cope with tic behavior

46
Q

what are the most effective drugs used to treat Tourette’s disorder?

A

clonidine HCl and guanfacine HCl

47
Q

what disorders are common with Tourette’s disorder?

A

OCD, disruptive, impulsive, and conduct disorders

48
Q

what is ODD characterized by?

A

angry mood and headstrong behavior that is persistent and frequent - they are the mouthy kids

49
Q

what should you assess with ODD?

A

quality of child-parent-caregiver relationship (bonding anxiety, tension, and difficulty of fit between the parent and child’s temperaments can contribute to these problems); parent or caregiver’s understanding of growth and development and parenting skills (lack of knowledge contributes to the development of these problems); lags or deficits in cognitive, psychosocial, and moral development result in disruptive behaviors

50
Q

when does childhood onset of conduct disorder occur mainly?

A

occurs mainly in male children before the age of 10 years

51
Q

what are the symptoms of childhood-onset conduct disorder?

A

physically aggressive, has poor relationships, shows little concern for others, and lacks guilt and remorse

52
Q

what should you assess with conduct disorder?

A

seriousness of disruptive behavior; possible hospitalization or residential placement; levels of anxiety, aggression, hostility, and impulse control; and assess the moral development of the ability to understand the effects of hurtful behaviors on others, to empathize with others, and to feel remorse

53
Q

what should you do during the interview of a child or adolescent with conduct disorder

A

have support available in case hostility escalates, and position self in a safe spot

54
Q

what things should you do for a child or adolescent with conduct disorder?

A

protect from harm, and provide for needs; provide immediate nonthreatening feedback for unacceptable behaviors; provide immediate positive feedback for acceptable behaviors; increase the ability to control impulses using role play; foster identification with positive role models; foster the development of realistic self-identity; provide education and guidance for parents and care givers

55
Q

what is the most common mental disorder in childhood and adolescents? what is the prevalence?

A

anxiety disorders are the most common. they affect 13% of youth age 9-17

56
Q

how might anxiety in children be displayed?

A

in more somatic complaints like headaches and stomach aches

57
Q

what things may anxiety disorders develop into in adulthood?

A

agoraphobia, GAD, panic disorders, specific phobias, and a social phobia

58
Q

what is separation anxiety?

A

an anxiety particular to children in which they experience extreme anxiety when separated or anticipating separation from familial surroundings; the panic is overwhelming and excessive

59
Q

if not treated what can separation anxiety lead to later in life?

A

panic disorder with agoraphobia

60
Q

what things should you assess in a child with anxiety?

A

quality of child-parent-caregiver relationship; recent stressors and severity; parents or caregivers understanding of developmental norms, parenting skills, handling of problematic behaviors; whether or not regression has occurred; assess child’s previous and current ability to separate from parent or caregiver; separation and individualization process may not be completed or the child may have regressed; assess for presence of anxiety problems in the parent or caregiver

61
Q

what should be the first option of treatment for a child or adolescent with an anxiety disorder?

A

therapy and counseling

62
Q

when are medications used to treat a child or adolescent with an anxiety disorder?

A

only when psychotherapy is unsuccessful and anxiety levels are incapacitating

63
Q

what medications are the most effective for anxiety disorders in children and adolescents?

A

SSRIs

64
Q

what things should you do for a child or adolescent with an anxiety disorder?

A

foster developmental competencies and coping skills; protect from panic levels of anxiety; accept regression and give emotional support; offer positive reinforcement for small victories, don’t use negative reinforcement because this may increase anxiety

65
Q

how may a child with PTSD react differently than an adult

A

they may show behaviors indicative of internalized anxiety rather than reliving the traumatic event

66
Q

how do preschool age children demonstrate PTSD?

A

they generally internalize behaviors that may exhibit sleep difficulties, night mares or terrors, reliving trauma in repetitive play of the event, increase in specific fears, irritability, angry outbursts, temper tantrums, separation anxiety, somatic complaints

67
Q

how do school age children demonstrate PTSD?

A

generally externalize PTSD and exhibit sleep difficulties somatic complaints, irritability/increased fighting, impaired academic performance, repetitive playing out to traumatic event, feeling jumpy, belief that life will be short, “omen formation”, feelings of detachment/estrangement from others

68
Q

when is the typical onset of somatic symptom disorder?

A

usually before age 30

69
Q

what are common complaints of somatic symptom disorder?

A

long list of somatic complaints, pain, dysphagia, GI issues (big connection between IBS and anxiety), SOA, palpitation, have fainting spells with no reason for the fainting

70
Q

why do people with somatic complaints have unnecessary health care costs?

A

because they demand tests that don’t really need to be run and they go “dr. shopping” until they get a dr that will tell them what they want to hear

71
Q

what is thought to be an underlying factor in somatic symptom disorders?

A

anxiety and depression

72
Q

what is the diagnosis when they can’t find any cause for somatic pain in patients?

A

somatic symptom disorder with pain

73
Q

what usually happens if you treat the underlying psych problems in somatic symptom disorder?

A

the somatic complaints will go away, but they often refuse psych treatment

74
Q

what are secondary gains that people get from somatic symptom disorder?

A

attention and freedom from daily responsibilities

75
Q

are people with somatic symptom disorder faking their symptoms?

A

no, we don’t see them, but they are real to them. it might just be psych pain that is manifesting itself physically

76
Q

disorder that includes extreme concern and preoccupation with having a devastating disease. they might not have a physical illness, but they are preoccupied with it even when they have been tested and nothing has come up

A

illness anxiety disorder (hypochondiasis)

77
Q

what are common symptoms of conversion disorder?

A

paralysis, blindness, movement and gait disorders, numbnress, paresthesias, loss of vision or hearing, or episodes resembling epilepsy

78
Q

what are the ways in which people with conversion disorder show their concern?

A

they are either not concerned at all or are extremely concerned with it (la belle indifference vs distress)

79
Q

who is conversion disorder more common in?

A

females, people in lower socioeconomic group, lower education levels, history of severe trauma

80
Q

how may genetic and familial factors play a role in somatic symptom disorder?

A

it may cause them to exhibit feelings more physically than emotionally and they may have a lower pain threshold

81
Q

how might learning and sociocultural factors play a role in somatic symptom disorder?

A

they may have had early experiences that play a role or they may be a little more sensitive to somatic experiences

82
Q

what does the interpersonal theory say about somatic symptom disorder?

A

they may have grew up in a rough environment with a lot of adversity and abuse; they may have a traumatic background

83
Q

what are some ways that people from African and Southern Asian cultures might demonstrate somatic symptoms?

A

burning hands and feet; worms in the head; ants under the skin

84
Q

how should you assess symptoms of patients with somatic symptom disorder?

A

OLDCARTS; how do they describe their symptoms (are they dramatic)

85
Q

do people with somatic symptom disorder have voluntary control over their symptoms?

A

no, they are not consciously trying to make it up and lie to you - you might see the connection to psych, but they don’t

86
Q

what things should you assess with a patient with somatic symptom disorder?

A

symptoms and unmet needs, voluntary control of symptoms, secondary gains, cognitive style, ability to communicate feelings and emotional needs, dependence on medications

87
Q

what are some basic level interventions for somatic symptom disorders?

A

promotion of self-care activities, health teaching and promotion (address lower education level), case management, pharmacological interventions (get at underlying anxiety and depression)

88
Q

what are some advanced level interventions for a patient with somatic symptom disorder?

A

psychotherapy

89
Q

when can you diagnose somatic symptom disorder?

A

only when you rule out all medical causes

90
Q

disorder in which the patinet deliberately fabricates symptoms of illness or self-injury without obvious gains. they want to assume ‘sick-role’

A

factitious disorder

91
Q

how far do people with facticious disorder go to have the symptoms that they want?

A

far enough that they could be inducing the symptoms theirselves, they may exaggerate symptoms or make some things up

92
Q

what is muchausen syndrome?

A

the most serious form of facticious disorder in which the patient is trying desperately to make themselves sick - they go so far that they may inject themselves with things to make them sick, contaminate lab orders, push for treatments

93
Q

why is muchausen syndrome so dangerous?

A

they could accidentally kill themselves in trying to make themselves sick

94
Q

what is mallingering?

A

consciously feigning an illness for obvious benefit

95
Q

what are dissociative disorders?

A

disturbances in the normally well-integrated continuum of consciousness, memory, identity, and perception - unconscious defense mechanism. this protects the individual from overwhelming anxiety.

96
Q

what is an altered mind-body connection?

A

a patient might become enraged and ‘lose their mind’ and then when they calm down, they have blacked out for that point of time

97
Q

what is depersonalization?

A

alteration in the perception of self, might think they are seeing themselves from a distance, reality testing intact, disturbing experiences of sense of deadness of body, seeing oneself from a distance, perceiving limbs to be larger or smaller than normal

98
Q

what is derealization?

A

experience of unreality of surrounding, reality testing remains intact

99
Q

what is dissociative amnesia?

A

the inability to recall important personal information often due to trauma or stress

100
Q

what is the difference between generalized and local amnesia?

A

with generalized they cannot remember anything, while with localized they only block out certain things around the stressor

101
Q

what is dissociative amnesia with fugue?

A

sudden unexpected travel away from the customary locale; inability to recall one’s identity and some or all of the past; during the fugue stat they tend to live simple, quiet lives; when former identity remembered, they become amnestic from time spent in the fugue state; don’t remember the time when they had the amnesia, but while they have the amnesia they don’t remember the time before that

102
Q

what occurs during dissociative identity disorder?

A

there is a presence of two or more distinct personality states (usually more than two); primary personality is not aware of the alters; alternate personalities take control of behavior; alters are often aware of each other and each alter thinks and behaves as a separate individual; stressors send them into these alters

103
Q

what biological factors may be affected with a dissociative disorder?

A

the limbic system plays a role and serotonin levels may be affected

104
Q

what are psychological factors that could cause dissociative disorder?

A

they are trying to avoid or suppress any kind of severe traumatic event; the more they try to suppress those memories, the more likely they are to dissociate

105
Q

what things do children and adolescents with a high degree of competency have in common?

A

more available resources than nonadapting children; average or better than average intellectual skills; good parenting or mentor figure; less vulnerable to stress

Mental Health Nursing (4 decks)

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