[Exam 4] Chapter 50 – An Alteration in Behavior, Cognition, or Development Flashcards
What are some behavior management techniques?
Set limits with child, holding them responsible
Do not aruge, bargian, negotiate about limits
Provide consistent caregivers and estbalish daily routine.
Learning Disabilities: Those with dyslexia struggle with what
reading, writing, and spelling
Learning Disabilities: Those with dysalculia struggle with what
mathematics and computation
Learning Disabilities: Children with dyspraxis sturggle with what
manual dexterity and coordination
Learning Disabilities: Children with dysgraphia sturggle with what
difficulty producing the written word (composition, spelling, writing)
Learning Disabilities - Therapeutic Mx: This may involve what
Remedial or compensatory approaches or may use interventiosn directred toward social-emotional problems.
Learning Disabilities - Therapeutic Mx: Social-emotional problems may result from what
frustration or low self-esteem realted to capabilities.
Learning Disabilities - Nursing Assess: RF include?
Learning disability, problems during pregnancy, drug use, or low birthweight.
Learning Disabilities - Nursing Assess: When should child be referred for learning disability?
Cannot speak in sentences by 30 months.
No understandable speech 50% of time by 3 years.
CAnnot sit for short story by 3-5 years
Cannot tie shoes or hop by 5-6 years.
Learning Disabilities - Nursing Assess: what is the IDEA act?
Offers protectionf rom discrimination adn the right to assitance in the school or workplace.
Intellectual Disability: What is this
Refers to a functional state where significant limitations in intellectual status and adaptive behavior before 18 years of age.
Intellectual Disability - Patho: Some potential causes of this?
Prenatal errors in CNS. Or insult or damage to brain during prenatal or postnatal period.
Intellectual Disability - Patho: Motor problems may occur like what?
Hyper/hypotonia, tremor, ataxia, or clumsiness or visual motor problems.
Intellectual Disability - Therapeutic Mx: Primary goal?
Provide appropriate educational experiences that allow chld to achieve level of functioning and self-sufficiency needed for existence in home/comunity.
Intellectual Disability - Therapeutic Mx: Classifications for MIld?
IQ between 50-80. Require academic support and immaure social skills. Independent in ADLs
Intellectual Disability - Therapeutic Mx: Classifications for Moderate?
Between 35-55 IQ. Complex taks sneed help. Social cues impaired. ADLS with moderate support
Intellectual Disability - Therapeutic Mx: SEvere classification?
IQ b/w 20-40. Little understanding of writitng. Needs healthy interactions and requires help with ADLs
Intellectual Disability - Therapeutic Mx: What is profound classification?
IQ < 20. May understand gestures. Dependent on support for ADLs
Intellectual Disability - Nurse Assess; What should be done at each healthcare visit?
Perform developmental screening. Get health hx. Document when developmental milestones achieved.
Intellectual Disability - Nurse Assess; Risk factors would include what
pre/postterm birth, low birthweight, birth injur, and infections.
Intellectual Disability - Nurse Assess; What diagnostic tests may be performed?
CT or MRI to evaluate brain structure.
Thyroid function tests rule out thyroid problems.
Intellectual Disability - Nurse Assess; Most sensitive early indicator of this?
Delayed language development
Intellectual Disability - Nurse Mx: What is important for nurse to do?
Follow home routine in hospital. Follow through with supports that child uses.
Autism Spectrum Disorder: When is this first noticed?
In infancy as developmental delays or between age 12-36 months when child regresses or losses previously acquired skills
Autism Spectrum Disorder - Patho: How do they act?
Have impaired social interactions and communication as well as stereotypic behaviors. Fail to develop interpersonal relationships
Autism Spectrum Disorder - Therapeutic Mx: What is this
For child to reach optimal functioning within limitations of each disorder. Treatment is individualized, with behavior and communication therapies important.
Autism Spectrum Disorder - Therapeutic Mx: What do they respond highly to?
TO highly structured educational environments.
Autism Spectrum Disorder - Therapeutic Mx: Why may stimulants and antipsychotics be used?
Stimulants: Contorl hyperactivity
Antipsychotics: For those with repetitive and aggressive behaviors.
Autism Spectrum Disorder - Nursing Assess: What is a concerening sign at 18 months?
Failure to point at objects and to gaze at an objective jointly with another.
Autism Spectrum Disorder - Nursing Assess: How will they speak
They may be mute, utter only sounds, or repeat words or phrases over and over.
Autism Spectrum Disorder - Nursing Assess: What may an infant resist doing?
May resist cuddling, lack keye conact, be indifferent to touch, and have little change in facial expression
Autism Spectrum Disorder - Nursing Assess: How will toddlers act
may show hyperactivity, aggression, temper tantrums, or self-injury behaviors.
Autism Spectrum Disorder - Nursing Assess: What screening tool is used?
Modified Checklist for Autism in Toddlers-Revised (M-CHAT-R).
Autism Spectrum Disorder - Nursing Mx: Stress the importance of what to parents?
Rigid, unchaging routines as children here act out when their routine changes
ADHD: What is this characterized by?
Inattention, impulsivity, distractibility and hyperactivity
ADHD: Three types of this?
Hyperactive-impulsive, inattentive, and combined.
ADHD: Oftene have a comorbidity like what
Oppositional defiant disorder, conduct disorder, anxiety disorder, depression, and less severe developmental disorder
ADHD - Patho: What is thought to cause this?
Alteration in dopamine and norepinephrine neurotransmitter system. Begin before 7.
ADHD - Therapeutic Mx: This begins with what?
Use os psychostimulants, nonstimulant norepinephrine reuptake inhibitors
Tourette Syndrome: What is this?
Multiple motor tics and one or more vocal tics occuring either simultaneously or at differetnt imes.
Tourette Syndrome: What are tics
sudden rapid recurrent stereotypical movements and sounds which child appears to have no control.
Tourette Syndrome - Nursing Mx: Inform that they become more noticeable when?
During severe times of stress and less pronounced when teh child is focused on anactivity such as wating tv or reading.
Eating Disorders: This incldues what
pica, rumination, anorexia nervosa and bulimia.
Eating Disorders: What is rumination
A eating disorder ininfants where baby regurgitates partially digested food or formula and expels or swallows it.
Eating Disorders: What is anorexia nervosa?
Dramatic weight loss as a result of decreased food intake, and sharply increased in exercise
Eating Disorders: What is bulimia?
Normal food intake , followed by binge-eating and then purging. Remaisn at normal weight.
Eating Disorders: What may be used to treat this?
Inpatient or outpatient setting. Atypical antipsychotics or antidepressants may be used
Eating Disorders - Nursing Assess: What is refeeding syndrome?
(Cardiovascular, Hematologic, and Neuroogic Complications) that may occur in severely malnourished adolescent with anorexia if rapid nutritional replacement is given. Give refeedings slowly.
Eating Disorders - Nursing Assess: Weight gain per week should be aimed at what?
0.5 - 2 lbs per week.
Eating Disorders - Nursing Assess: What can parents use to documenet this?
Keep a journal of everything that is going on
Mood Disorders: This incldues what
depressive disorder and bipolar disorder.
Mood Disorders: What plays a role in mood?
Norepinephrine and Dopamine. Norepinephrine important for energy and alertness, while dopamine important for pleasure and motivtion
Mood Disorders - Therapeutic Mx: Usually benefit from what
Psychotherapy. Helps child deal with psychosocial consequences on their behavior
Mood Disorders - Therapeutic Mx: What medications may be used for depression and bipolar disorde
Depression: Antidepressants
Bipolar: Mood stabilizer or atypical antipsychotics
Anxiety Disorders: How is this down in infants, toddlers, preschoolers, school-age and adolescents?
Infants: Fear loud noises, being startled.
Toddlers: Afraid of separation and dark
School-Age: Worry about injury and natural events
Adolescents: Anxious about school and social performance.
Anxiety Disorders: What is GAD
Characterized by unrealistic concerns over past behavior, future events and personal competence
Anxiety Disorders - Patho: What is thought to contribute to this?
Underactivation of serotonergic system and overactivaiton of the noradrenergic system.
Anxiety Disorders - Patho: Therapeutic Mx?
Pharmacologic agents and psychological therapites. Anxiolytics or antidepressants are most common
Anxiety Disorders - Patho: What history will they present with?
Social inhibition, panic, heart rracting .Young kids may over overreactivity, acting out. Older may have feelings of nervousness
Child Maltreatment: What jis this?
Physical abuse sexual abuse, emotional abuse and neglect.
Child Maltreatment: All history of childhood abuse is associated with what?
Development of depressive disorders, suicidal ideation and attempts, anxiety disorders, and alcohol and drug use
Child Maltreatment: Therapeutic Mx of this?
Physical treatment of injury, palliative care, and interventions to restore metnal wel-being.
Child Maltreatment: Labs to check for this?
Radiographic skeletal survey or bone scan
CT scan of head
Rectl, oral, vaginal specimens
Medical Child Abuse (Munchausen Syndrome by Proxy): Wht is this?
Type of child abuse in which parent creates a physical symptoms of illness or paimpairment in child
Medical Child Abuse (Munchausen Syndrome by Proxy): Therapeutic management of this?
Ensuring the safety and well-being of the child, as well as providing psychotherapy.
Medical Child Abuse (Munchausen Syndrome by Proxy): Warning signs of this?
Child with one or more illnesses do not respond to treatment
Symptoms do not make sense or disappear with perpetrator removed.
Substance Abuse: RF for this?
Family hx, current parental substance use, dysfunctional family relaitonship, concurrent mental health disorder
Substance Abuse: Document history of what
insomnia, appetite loss, excessive itching, sleepiness or extreme fatigue, and dry mouth.
Substance Abuse: What screening tool is recommended?
CRAFFt screening tool.
Substance Abuse: Labs?
Toxicology studies like urine screening.
The nurse is caring for a child with ADHD. Which behavior would the nurse not expect the child to display?
moody, morose behavior with pouting interruption and inability to take turns forgetfulness and easy distractibility excessive motor activities and fidgeting
Moody, morose behavior with pouting
An adolescent girl who has been receiving treatment for anorexia nervosa has failed to gain weight over the past week despite eating all of her meals and snacks. What is the priority nursing intervention?
Increase the teen’s daily caloric intake by at least 500 calories. Ensure that the teen’s entire fluid intake includes calories. Supervise the teen for 2 hours after all meals and snacks. Assess the teen’s anxiety level to determine need for medication.
Supervise the teen for 2 hours after all meals and snacks.
A 15-year-old girl has been making demands all day, exaggerating her every need. She is now crying, saying she has nothing to live for and threatening to kill herself. What is the priority nursing action?
Ignore her continued exaggerated and melodramatic behavior. Consult with the physician or nurse practitioner to increase her antidepressant dose. Leave the girl alone for a little while until she composes herself. Take the girl’s suicidal threat seriously and provide close supervision.
Take the girl’s suicidal threat seriously and provide close supervision.
When trying to manage aggressive or impulsive behaviors in children or adolescents, what is the best nursing intervention?
Train the child to be assertive. Provide consistency and limit setting. Allow the child to negotiate the rules. Encourage the child to express feelings.
Provide consistency and limit setting.
The nurse is caring for an adolescent who says, “I’m sick of this. I wish I weren’t alive anymore.” What is the best response by the nurse?
“I often feel sad and sick of things.” “Have you thought about hurting yourself?” “Are you trying to escape your problems?” “Do your parents know about this feeling?”
“Have you thought about hurting yourself?”
