INfant, Child and Adolescent Mental Health

Question 1

Define prenatal mental health

Answer 1

preconception until the infant is around. 24 months old
this area considers maternal and infant mental health understands that early intervention is important to maximise health outcomes for mother and infant

Question 2

What are the potential challenges a nurse may face when engaging with and assessing the health of a child

Answer 2

• communication issues due to developmental and/or chronological age
• parental resistance and/or consent
• access
• the restrictions, environmental restrictions, difficulty establishing a therapeutic relationship

Question 3

Why are maori at a higher risk of suicide than non-maori

Answer 3

• risk associated with the history of colonisation
• higher rates of mental illness and AOD use
• higher rates of family violence

Question 4

Anorexia Nervosa

Answer 4

Symptoms- restriction of energy intake with intention of weight reduction. intense fear of gaining weight, body dysmorphia
Impact- low mood, cognitive impairment, increased anxiety, pseudo sense of control, life threatening medical conditions

Question 5

Bulimia Nervosa

Answer 5

Symptoms- eating an excessive amount of food, larger than most people would eat, over a similar period of time; then purging oneself due to feelings of fear and/or disgust
Impact- low mood, anxiety, oesophageal ulceration, teeth decay, medical complication

Question 6

Binge eating disorder

Answer 6

Symptoms- recurrent episodes of binge eating, lack of self-control associated with distress after bingeing
Impact- marked psychological distress, significant psychiatric comorbidities

Question 7

Difference between men and women who experiences eating disorders

Answer 7

Men- generally pursue bulking up and looking slim, aim for muscular bodies through exercise excessively, bingeing, purging steroid use.
Women- generally want to look thinner so restrict, excessively exercise and purge

Question 8

Outline the physical effects/risk factors for people who experience an eating disorder

Answer 8

• gastrointestinal effects
• endocrine effects
• musculoskeletal effects
• dental and oral effects
• skin/integument effects
• renal dysfunction
• electrolyte abnormalities
• cardiovascular effects
• neurological effects and cognitive changes

Question 9

Outline requirement for a Physical assessment on someone with an eating disorder

Answer 9

• ECG
• Urinalysis
• Complete blood count
• Weight
• Height
• Vital signs
• metabolic status
• cardiovascular and peripheral vascular function

Question 10

Outline requirement for a Mental health assessment (including risk) assessment on someone with an eating disorder

Answer 10

• cognitive assessment
• MSE
• risk assessment - self (intentional and unintentional) risk of AWOL, alcohol and drugs use
• AOD assessment
• functional assessment

Question 11

Outline requirement for a body image assessment on someone with an eating disorder

Answer 11

• distortion
• dissatisfaction
• avoidance
• body checking

Question 12

Outline requirement for a nutritional and exercise assessment on someone with an eating disorder

Answer 12

• caffeine and smoking (appetite reduction),
• laxative use
• supplements
• weight measurement
• intak- avoidance of food groups
• excessive exercise
• water loading
• vomiting
• diuretic use

Question 13

Outline requirement for a eating disordered behaviour and rituals assessment on someone with an eating disorder

Answer 13

• refusing to eat
• cutting up food into small pieces
• removing oils and fats
• lack of variety
• fear of touching food
• cutting out food
• eating slow/ no enjoyment
• fidgeting and take measuring food
• leaving to purge

Question 14

Outline requirement for a family assessment on someone with an eating disorder

Answer 14

• confidentiality issues
• family support
• education
• no judgement

Question 15

What is re-feeding syndrome

Answer 15

potentially fatal in those who are malnourished. insulin and electrolytes altered rapidly and a severe drop in phosphates can lead to sudden death

Question 16

What other areas of health might you see re-feeding syndrome in?

Answer 16

• poverty
• older persons health
• dementia/ or delirium
• mental illness/ psychosis/ depression where functional needs aren’t met
• abuse
• prisoners of war
• anorexic patients

Question 17

What is infant mental health

Answer 17

infant mental health refers to how well a child develops socially and emotionally from birth to three. understanding infant mental health is key to preventing and treating mental health problems of very young children and their families

Question 18

Mothering myths

Answer 18

• a mother immediately wants. knows and lovers her baby
• maori and pacific mothers bond better with their babies because of more family support
• a mother should be able to give her full emotional self to her nany
• the birth of a baby bring contentment and happiness to a family

Question 19

maternal mental health

Answer 19

• the most risky time for women to become mentally unwell is postpartum
• 10-15% of women experience PND
• 10% pregnant women experience depression
• 15-20% women experience anxiety while pregnant or post nataly
• 1-2% women experience BPAD while pregnant or post nataly
• 0.5% of women experience post natal psychosis

Question 20

what can influence maternal mental health

Answer 20

• biology
• psychology, temperament and resilience
• social situation and supports
• previous pregnancy and birth experience
• trauma
• drug and alcohol use
• cultural perceptions

Question 21

bonding

Answer 21

• getting to know a baby and having the baby get to know a primary attachment figure
• encourages parent to meet their child’s needs and respond readily
• non verbal
• reading cues
• forming attachment
• can start utero
• not immediate or expected

Question 22

The maternal - infant dyad

Answer 22

“3 patients”

• synchronised
• needs protecting and promoting
• consider what the mother bring, what the infant brings and how this impacts on them as individuals and their relationship
• maternal sensitivity
• more valued in some cultures than others

Question 23

the first 3 years

Answer 23

• important to determine brain structure for life
• connectivity occurs- learned through responsive relationships, nurture, learning
• adaptation to environment
• attachments

Question 24

watch wait wonder

Answer 24

• infant led
• encourages free play
• seeks to understand emotional responses
• recommended for 0-4 years
  watch: what is the child doing? what are they wanting to do? what is the child communicating? how is the adult able to allow the child to lead?
  wait: i don’t need to rush in- lets give this some time and the space it needs
  wonder: mentalizing, what is going on for the child? how is this for the child? why do i react or respond the way i do?

Question 25

child mental health and development

Answer 25

Not diagnosed with haste, careful assessment, inclusive assessment including whanau and school

• problems in more than one setting
• changes in appetite
• social withdrawal or fear of things did not use to be fearful of
• returning of past behaviours from childhood e.g. bed wetting
• signs of being upset, such as sadness or tearfulness
• signs of destructive behaviour, such as head banging or suddenly getting hurt often

Question 26

Examples of childhood mental issues

Answer 26

• ADD and ADHD
• anxiety- PTSD, OCD, GAD ect
• depression
• BPAD
• eating disorders

Question 27

Nursing considerations for working with those with eating disorders

Answer 27

• cardiac complications (including heart failure)
• starvation (refeeding syndrome)
• electrolyte imbalances
• dental hygiene and dental implications
• weight gain/ loss
• amenorrhea
• osteoporosis
• dehydration
• low body temperature and lanugo
• muscle wasting
• inflammation of oesophagus and peptic ulcer (which can rupture)
• cognitive impairment
• family impacts and relationships
• mental health