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Peds > mental health and cognition > Flashcards

mental health and cognition Flashcards

1
Q

describe mental health

A
  • mental health is foundational to a sense of personal well being, physical health, relationships and learning
  • it involves successful engagement in activities and relationships and the ability to adapt to and cope with change
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2
Q

describe cognition

A

cognition refers to the change in thought, intelligence, and language that occurs over time as brain maturation and life experiences interact to mutually influence childrens actions

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3
Q

describe brain development during pregnancy

A
  • the braindevelops early; critical development occurs by the fourth to sixth week of gestation
  • many women do not know they are pregnant at this time
  • during this time, the brain is not protected by the blood brain barrier and is at risk for injury from the fetal envirnment
  • maternal alcohol and drug ingestion, certain medications, and eexposure to environmental toxins can influene the devloping fetus’ brain
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4
Q

describe the development of the brain ad mental health throughout childhood

A
  • most of the brain structure is present at birth; during the first 5 years of life the brain continues to develop and mature as the hild gains fine and gross motor, social, and language skills
  • mental health and cognition in children is different from adults because developmental progression and abilities influence perceptions and reactions
  • childhood is a crucial period for development of mental health that provides for the social skills, emotional health, developmental progression and cognitive abilities that prepare youth for mental health and achieving maximum potential in adulthood
  • during childhood, the necessity for bonding and attchment to significant adults forms the cornerstone of the child’s healthy mental development
  • young children rely on adults for establishment of mental health
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5
Q

describe the incidence of mental health issues in children

A
  • one in five children and adolescents have a mental health disorder
  • 8 out of 10 lifetime mental disorders begin to manifest during childhood
  • less than 25% of children with mental health alterations receive mental health services to treat their impairment
  • increased risk for mnetal health disorders with children from low income families; children in the welfare system, and youth in the juvenile justice system
  • ages 10-21 years, mental health issues among the top two leading causes of hospitalization
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6
Q

do mental health issues originate from genetic or environmental dysfunctions?

A

both

  • some that are genetic include intellectual disability and childhood schizophrenia
  • often family and environmental factors influence characteristics and contribute to dysfunctions like anxiety, depression, and PTSD
  • these factors make prevention, diagnosis, and treatment very challenging
  • these issue can escalate to crisis and needs to be assessed frequently
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7
Q

describe assessment guidelines for mental health and cognition in chhildren

A
  • the assessment focuses on history, growth and developemtn, social skills, affect, appearance, behaviors and life events
  • kids with mental health issues usually dont meet developmental milestones, may have social skills and may have regression
  • important signs of disruption include repetitive actions, behvaioral instability, outbursts, and withdrawal
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8
Q

describe diagnostic testing for alterations in mental health and cognition

A
  • prents or teachers notice behavior changes and child is referred to mental health provider
  • evaluation includes observing behvaior, asking fam and teachers to complete behavioral questionnaires and a thorough review of history
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9
Q

describe the role of healthcare providers for alterations in mental health and cognition

A
  • play an important role in collaborating with schools to help a child with learning disorders or other disabilities get the special services they need
  • the AAP has created a repot that describes the role that healthcare providers can have in helping children with disabilities
  • these roles include identifying kids that may need early intervention, sharing relavent info with school and early intervention specialists, meeting with specialists and fam and school, and working to improve school functioning around kids with special needs
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10
Q

whats th primary treatment goal for alterations in mental health and cognition

A

assist the child and fam to achieve and maintain optimal level of functioning for child and fam through interventions desgined to reduce impact of stressors

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11
Q

what are the three treatment modes for alterations in mental health and cognition

A
  • individual therapy (child + therapist)
  • fam therapy (fam + therapist)
  • group therapy (child and children their age)
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12
Q

what are some therapeutic strategies for alterations in mental health and cognition and what do they do

A
  • play therapy: revelas problems through fantasy
  • art therapy: provides insight to issues and helps with healing
  • cognition therapy: teaches thinking patterns and how to change them and reactions
  • behavior modification: stimulus and response conditioning to alter undesirable behavior
  • visualization and guided imagery: using kids imagination and positive thinking
  • hypnosis
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13
Q

describe the etiology of autism spectrum disorders

A

unknown

proposed theories:
- genetic transmission, immune responses, environmental exposures and expose to drugs during pregnancy
- interaction of all theories with genetics is being investigated
- neurotransmitters: dopamine and serotonin are abnormal in some children

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14
Q

does the MMR vaccine cause autism?

A

no

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15
Q

what are some characteristics of ASDs

A
  • socialization impairments
  • communication issues
  • behvaior may be rigid and obsessive
  • difficulty with eye and body contact
  • language delay can be an early sign
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16
Q

when is diagnosis of ASD usually confirmed?

A

age 2 to 3 years

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17
Q

describe the assessment for ASD

A
  • assessment done at each health care visit
  • if at risk, administer age-appropriate ASD screening tool
  • if not at risk, ASD screening done at 18-24mo
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18
Q

what diagnostics are used for ASD

A

rule our other causes: CT/MRI, lead screening, meabolic studies, DNA analysis, EEG

diagnosis is based on criteria in DSM-V:
- persistent deficits in social communication and social interactions
- restrictive, repetitive actions or behavior interests
- severity depends on symptoms
- may be seen in early developmental periods

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19
Q

describe clinical therapy for ASD

A
  • early intervention maximizes potential: improves developmental skills and behaviors and establishes parental support
  • therapy focuses on behavior management to reward appropriate behavior, foster positive or adaptive coping skills and effective communication
  • speech therapy to enhance communication
  • occupational therapy for social skills and improving fine motor and sensory integration
  • meds to treat associated disorders
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20
Q

describe nursing management for ASD

A

environmental stimuli:
- sounds may be perceived as louder, frightening, overwhelming
- orient to new environment more extensively
- favorite objects from home

provide supportive care:
- ask about home routine and maintain
- parent participation in ADL

enhance communication:
- chort, direct sentences
- teach to developmental level
- visual cues: picture, computers, and visual aids to enhance communication

maintain safety
family support and education

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21
Q

describe ADHD

A
  • ADHD is characterized by dveelopmentally inappropriate behvaiors involving attention
  • ADHD is ADD with impulsivity and hyperactivity
  • most common mental health alteration in children
  • boys more common then girls
  • often continues into adulthood
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22
Q

describe the etiology of ADHD

A
  • causes difficult to identify
  • known associations with high lead or mercury levels and prenatal exposure to alcohol or tobacco
  • genetic factors: single gene not identified
  • genetic predisposition intects with environment: family stress, poverty, poor nutrition may be contributers
  • can have low catecholamines, lowering the threshold for stimuli input
  • marked by delays in brain regarding self regulation
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23
Q

what are some clinical manifestations of ADHD

A
  • symptoms range from mild to severe
  • decreased attention span
  • impulsiveness
  • increased motor activity
  • difficulty completeing tasks
  • fidgets constantly
  • loud and disruptive
  • sleep disturbances common
  • may have learning disabilities, motor disorders, and aggressive behaviors
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24
Q

describe diagnosis of ADHD

A
  • diagnosis made after children brought in for evaluation due to behvaiors that interfere with daily function of parents or teachers
  • any child 4-18 with academic probs, behavior difficulties, inattention, hyperactivity, or impulsivity should be evaluated for ADHD (AAP)
  • history, physical exam to rule out medical cause and questionairres for parents and teachers to complete
  • DSM-V diagnostic criteria established diagnosis
25
Q

describe clincial therapy for ADHD

A
  • treatment is long term
  • environmental changes
  • behvaior therapy
  • promote self esteem
  • emotional support for parents and child
26
Q

describe environmental changes for ADHD

A
  • decrease stimulation
  • small classroom placement
  • consistent limits and expectations
  • structured routine
27
Q

describe behavior therapy for ADHD

A
  • behavior modification: reward positive behvaior/consequences for unacceptable behavior
  • prent training on behavioral techniques: increasing parenting skills and decreases conduct problems
28
Q

describe med therapy for ADHD

A
  • stimulant and nonstimulant med to increase attentionspan and decreasr distractibility
  • stimulant: methyphenidate and amphetamines

common side effects:
- anorexia: give at mealtime; monitor weight and height; high calorie diet recommended
- insomnia: administer early in the day
- cardiac exam prior to initiation and periodically: monitor BP and tachycardia
- potential for abuse: education with fam and child

29
Q

describe depression

A
  • psychological distress that can range from mild to severe
  • many children referred to child guidance centers/mental health professionals due to behavior problems or poor school performance suffer from depression
30
Q

describe the etiology of depression

A

multiple theories to explain cause of depression
- biologic: physiologic theory focuses on decreases in indolamine, serotonin, norepi, and dopamine; MRI demonstrates brain changes
- learned helplessness
- cognitive distortion
- social skills deficit
- family dysfunction
- parental depression is strong predictor of childhood depression
- other conditions are associated with depression: ADHD, anxiety, bipolar disease, substance abuse

31
Q

what are some clinical manifestations of depression

A
  • poor school performance
  • withdrawal from social activities
  • sleep disturbances: too much or too little
  • appetite decreased or increased
  • headaches/stomach aches
  • decreased energy
  • difficulty concentrating and making decisions
  • low self esteem
  • feeling of hopelessness
  • vary according to developmental level
32
Q

describe diagnosis of depression

A
  • all children should be screened beginning at 11 yrs
  • variety of mental health assessment tools available
33
Q

describe clinical therapy for depression

A
  • individual, fam, and group therapy in combination with psychotropic meds
  • therapy and medication is the most effective treatment
  • antidepressants, most commonly SSRIs, block reuptake of serotonin in the synapse increasing serotonin levels
  • fluoxetine (prozac): only antidepressant approved for children
  • reports of increased suicidal ideation and other behavioral changes in children on antidepressants (first 2-4wks)
  • close observation very important
34
Q

whats a side effects of starting SSRIs and why

A

diarrhea

lots of serotonin hosued in the gut

it eventually resolves

35
Q

describe nursing management of depression

A
  • encourage open expression of feelings
  • encourage self care
  • meds as ordered
  • assist in identifying friends and support systems
  • assist in teaching positive coping strategies
  • help in identification of areas of interest
  • encourage interaction with peers and staff
  • offer nutritious food and provide exercise
  • education with child and family regarding home safety
36
Q

describe the incidence of suicide

A
  • second leading cause of death in 10-24year olds
  • suicide attempts are often labeled as accidents
  • difficult for parents to understand that a child or adolescent would want to end their life
37
Q

what are some risk factors for suicide

A
  • depression: most common precursor
  • pregnancy, drug use or abuse, friend or fam member who committed suicide
  • school issues, problems with significant other
  • sexual preferences or gender identification issues
  • lonliness, withdrawal, anxiety, low self esteem
  • chronic illness, chronic family problems
  • history of previous attempts
38
Q

what are some protective factors for suicide

A
  • emotional wellbeing
  • satisfactory school performance
  • participation in activities
  • parent/family connectedness
  • frequent discussions in the family of important issues
  • availability of school counseling and school policies limiting bullying
39
Q

describe clinical treatment for suicide

A
  • suicide attempt of suicidal ideation: admission to hospital
  • individual, family, group therapy
  • a no suicide contract
  • treat co-morbidities with therapy and medications
40
Q

describe nursing management in the hospital for suicide

A
  • monitor for risk for self harm
  • 1:1 nursing
  • education with fam
41
Q

describe management in the community for suicide

A
  • follow up psychiatric care
  • prevention for all children and adolescents. beginning at 11 yrs, depression screening should occur at all health visits
42
Q

should all threats of suicide be taken seriously?

A

yeppers

43
Q

describe PTSD

A
  • occurs following a life threatening event that is experience or witnessed
  • symptoms of distress continue for more than 1 month and impair function
  • relive event frequently in thoughts and dreams
  • child has feelings of fear, terror, and helplessness
  • child feels detached and alone
44
Q

who diagnoses PTSD

A

mental health specialist

45
Q

describe clinical therapy for PTSD

A

CBT
- focuses on thoughts and behaviors leading to an understanding of negative thoughts and increasing activities that provide pleasure
- child anf fam and group therapy
- meds for anxiety/depression

46
Q

describe nursing management of PTSD

A
  • teach relaxation techniques
  • enhance coping skills
  • include parents in treatment plan
  • involve school personnel
  • administer meds if prescribed
47
Q

describe learning disabilities

A
  • common problem of children
  • involve neurologic conditions; brain cant receive or process information in the normal manner
  • often in one or two types of learning
  • difficulty reading, writing, spelling
  • diagnosed with cognitive and developmental testing
  • multidisciplinary team works with familt after diagnosis
48
Q

describe intellectual disability

A
  • significant limitation in intellectual functioning and adaptive behavior
  • intellectual diasbility characterized by TQ below 70
  • significant impairments in adaptive functioning (ability of individual to meet expected standards of cultural group)
  • functional assesment is considered a more accurte identification of the child’s performance and needs than IQ
  • delays in motor movement, language, and adaptive behavior
49
Q

describe the etiology of intellectual disability

A
  • prenatal errors in development of CNS
  • prenatal and postnatal changes in the infant’s biologic environment
  • external forces leading to CNS damage
  • in each instance, the precipitating factor causes a change in the form, function, and adaptation of the CNS
  • examples include, trisomy 21, fetal alc syndrome, fragile X syndrome, genetic conditions, birth defects,serious head injuries, stroke, infections
50
Q

describe down syndrome

A
  • prenatal condition
  • trisomy 21 - three chromosomes instead of 2
  • intellectual disability
  • advanced maternal age has been identified as a significant risk factor
  • first indicatot can occur with maternal blood test durng pregnancy
51
Q

what are some characteristics of down syndrome

A
  • micorcephaly
  • flat foehead
  • wide short neck
  • epicanthal eye folds
  • flat nose
  • small low set ears
  • protruding tongue
  • short broad hands
  • single transverse crease that corsses palm of hand
  • hypotonia, cardiac defects, hearing loss, leukemia
52
Q

describe fetal alcohol syndrome

A
  • alcohol is a leading preventable cause of intellectual diasbility in the US
  • FAS ranges from mild to severe
  • happens only when mom drinks when pregnant
  • 100% preventable
53
Q

what are some characteristics of fetal alcohol syndrome

A
  • poor coordination
  • failure to thrive, premature birth
  • skeletal and joint abnormality
  • hearing loss
  • tremors and irritability
  • hyperactivity, motor probs, ADHD
  • cognitive issues, comprehension issues and language delays
  • increased incidence of cleft lip and palate
  • cardiac defects and renal anomalies
  • low nasal bridge
  • microcephaly
  • epicanthal folds
  • flat midface
  • small eye openings
  • underdeveloped jaw
54
Q

will physical features always be present with fetal alcohol syndrome?

A

nope

55
Q

describe clinical therapy for intellectual disability

A
  • multidisciplinary team
  • goal is to maximize potential for development
  • early intervention to improve the degree of adaptive function
  • special education programs (IEP)
  • education regarding community resources
56
Q

describe diagnosing intellectual disability

A
  • comprehensive history
  • lab tests: chromosomes, enzymes, lead
  • evaluation of child’s physical characteristics, developmental level, IQ and adaptive functioning
  • developmental screening
57
Q

describe nursing management of intellectual disability in the hospital setting

A
  • ask parents the developmental age of their child
  • allow developmental age to guide interaction, teaching, expectations
  • mild to moderate delay: safety issues and ADLs
  • severe delay (unable to provide self care): skin care, oral hygiene, positioning Q2
58
Q

when does confidentiality not apply

A

when a child or adolescent shares info about having tried to hurt themselves or plans to hurt themselves

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