Mod 4: Neurodevelopmental & Disruptive Disorders Flashcards
Developmental norms
Characteristics of good mental health:
1. Ability to interpret reality and have correct perception of surrounding environment
2. Positive self concert
3. Ability to cope with stress and anxiety in age appropriate way
4. Mastery of developmental tasks
5. Ability to express oneself spontaneously and creatively
6. Ability to develop and maintain satisfying relationships
7. Resiliency
What is Intellectual Disability
Less than expected intellectual functioning and adaptive behavior (social and daily functioning)
Manifestations of Intellectual Disability
-Disorder with onset during developmental period (before 18 yrs)
-Deficit in intellectual, social, and daily functioning (performing ADLs)
Levels of Intellectual Disability
- Mild: 85% of cases, they can learn to read, write, and perform math skills at a 3rd-6th grade level
- Moderate: they usually are able to learn to read and write at a basic level
-Requires assistance working or living independently - Severe: Can’t read or write but can perform some basic living skills
- Profound: They can communicate verbally or non verbally to some degree
Interventions for Intellectual Disability
Promote health and wellness
Create long term therapeutic relationship
Increased nonverbal communication
Advocate
Diagnosis: DSM 5
what is ADHD
Inability to control behaviors requiring sustained attention
Manifestations of ADHD
- Inattention: wanders off, lacks persistence, disorganized
- Hyperactivity: moves constantly, fiiting, can’t sit still, running/climbing inappropriately
- Impulsivity: acts immediately in response to timuli, can’t wait for their turn, interrupting others, acting without consideration of consequences
Inattentive and impulsive → risk of injury
Diagnosis of ADHD
Behaviors must be present prior to age 12 and in more than 1 setting
Expected findings of ADHD
- Anxiety or stress levels will interfere with normal growth and development
- Anxiety or stress levels so severe the child will unable to fx normally at home, in school, and other areas of life
Interventions for ADHD
- Advocate for best interests
- Educating parents and schools
- Screening for ADHD in schools
- Early screening increases identifying # of children with learning and behavioral difficulties increasing chances of successful treatment
- Establish resources for support and treatment options
- Use cognitive behavioral therapy
- Diagnosis: ADHD-FX
Medications for ADHD
- Methylphenidate (stimulant)
- Amoxetine (SNRI)
- Guanfacine (alpha 2 adrenergic agonists)
Manifestations of a Learning Disability
- Dyslexia: Difficulty reading
- Dysgraphia: Difficulty writing
- Dyscalculia: Difficulty performing calculations
Cognitive:
-Spelling the same word various ways
-Inability to adapt to dif learning settings
-Works slow and difficulty with instruction
Behavioral:
-Dissatisfaction with school, teachers, hw
-Avoiding school
-Feeling inadequate
-Bullied at school
interventions for Learning Disability
Promote health and wellness
Create long term therapeutic relationship
Increased nonverbal communication
Advocate
What is Autism spectrum disorder
Deficits in social interaction, communication, behavior patterns, and interests
-Ex: Rocking back and forth, doesnt speak yet, can’t maintain eye contact, repetitive actions, strict routine
Levels of Autism
Level 1: Require some support
-Awkward or anti social
-Change is hard, loves routine
-Fidgets and is seen as quirky or annoying
-Called lazy or insecure
Level 2: Require more support
-Most can tell they have a disability
-Doesn’t engage socially or handle change well
-Noticeable repetitive behaviors
Level 3: Require the most support
-Everyone can tell they have a disability
-Doesn’t communicate
-Any change is impossible
-Repetitive behavior helps them stay calm
-Major developmental delays
interventions for autism
1: Initiate referrals (physical, occupational, and speech therapy)for early screening and intervention to obtain the best results
-Early screening prior to age of 2 can improve outcomes bc of increased neuroplasticity
-prevent overstimulation –> place in private room away from nurses station
-Identify desired behaviors and reward them
-Role-model social skills
-Role-play situations that involve conflict and resolution strategies
-Provide alternative play activities
-Detemrine emotional and situational triggers
-Give plenty of notice before changing routines
-Use speech therapy
-ASD common comorbidity is Epilepsy and ADHD
-Stress is difficult to handle → be patient
-Can understand what people say even if it doesn’t look like they are listening
-Help them with communication
Medications for autism
SSRI and antipsychotic meds (risperidone, olanzapine, quetiapine, aripiprazole)
RN Interventions for disruptive, impulse control, conduct disorders and ADHD:
-Use modeling to show acceptable behavior
-Get child’s attention before giving directions
-Short and clear explanations
-Set clear limits on unacceptable behaviors and be consistent
-Plan physical activities → child can use energy and be successful
-Assist parents to develop a reward system using methods
-Support parents to remain hopeful
-Administer antipsychotics, mood stabilizers, anticonvulsants, antidepressants
What is Tourette’s
-most severe TIC disorder
-Hereditary
diagnose of tourette’s
-Must occur before 18 years and not be caused by another medical condition/adverse effect of meds
-Exhibits at least 2 motor tics and at least 1 vocal tic for at least 12 consecutive months that occur several times during the day
manifestations of tourette’s
-First symptoms are often motor tics that occur in the head and neck area.
-Tics often worse during times of stress/exciting, tend to improve when a person is calm or focused on an activity.
treatment for tourettes
Haloperidol (FGA)
-Tics do not require treatment
but essential to educate the individual and others about TS and provide appropriate support across all settings (e.g., school, work, and home).
-Behavioral therapy can teach how to manage tics
type of treatment to help children with tics
behavioral therapy: helps manage their tics
reduces # or severity of tics
What does a stimulant med do?
block the reuptake of norepinephrine and dopamine in the synapse and increases these substances in the brain
Effects of stimulant meds for ADHD
calming effect and improve the ability to focus and concentrate for individuals diagnosed with ADHD
Stimulant meds for ADHD
methylphenidate
amphetamine
dextroamphetamine
lisdexamfetamine dimesylate
what is ODD
-Recurrent pattern of antisocial behaviors
-They do not view themselves as defiant, they think there is unreasonable demands
-Exhibit low self esteem, mood lability, low frustration
-Can develop into Conduct Disorder
Manifestations of ODD
Anger/irritable mood, argumentative/defiant behavior directed toward care giver, vindictiveness (holds a grudge or wants revenge), negativity, disobedience, hostility, unwilling to compromise, does not accept responsibility
Mild: symptoms only in 1 setting
Moderate: symptoms in 2 settings
Severe: symptoms in 3 or more settings
Therapy approach to managing ODD
-goal of treatment for ODD is to reduce the child’s impulsiveness, reduce their aggression, manage their anger, and improve their problem-solving abilities
-Cognitive behavioral therapy: Teaches clients how to correct cognitive errors in thinking
-Behavioral Management Training: parent management training, these programs teach and encourage skillful parent or caregiver responses to challenging child behaviors.
-Social skills training
-Psychosocial interventions include group therapy, anger management, and parent training
Manifestations of Distruptive mood dysregulation disorder
-temper outburst that do not correlate to the situation
-Temper outbursts are present 3 or more times per week in at least 2 settings
-Onset: 6-18 years old
-Manifestations not due to bipolar disorder
what is Intermittent Explosive Disorder (impulse control behavior disorder)
-Recurrent overreactive, violent, and aggressive behavior with the possibility of hurting people, property, or animals followed by feelings of shame and regret
-Prevents client to have healthy relationships adn employment
-Males>, diagnosed as early as 6 years old but usually between 13-21
Manifestatinos of Conduct Disorder (CD)
Persistent pattern of violating the rights of others or rules/norms of society:
Aggression to people and animals
Destruction of property
Deceitfulness or theft
Bullies, threatens, intimidates others
Suicidal ideation
Has cognitive fx disorders
Ran away from home
Lack of remorse or care for feelings of others
Contributing factors of Conduct disorder
Parental rejection and neglect
Harsh childhood discipline
Physical or sexual abuse
Lack of supervision
Frequent changing of caregivers
Large family size
Parent with history of physiological illness
Lack of male role model
Chaotic homelife
Treatment for conduct disorder
Med: mood stablizier (lithium)
Behavioral Management Training
Family therapy
Group therapy
Special ed classes
Multisystemic therapy (MST) - home based treatment good for family and client
Medication for conduct disorder
Target specific problem behaviors
SGA and FGA (risperidone, olanzapine, quetiapine, aripiprazole)
Tricyclic antidepressants
Antianxiety
Mood stabilizers
Antipsychotic
Childhood onset of conduct disorder
develops BEFORE age of 10 (males>)
Adult onset of conduct disorder
develops AFTER age of 10 (male:female equal)
Pharm action of Mood stabilizer (lithium carbonate)
lithium produces neurochemical changes in brain, blocks serotonin
Therapeutic use of mood stablizer
Treat bipolar and conduct disorders, controls espisodes of acute mania, helps to prevent the return of mania or depression, decreases incidence of suicide
Side effects of mood stablizer
-Nausea, diarrhea, abdominal pain
-Intervention: Administer meds with meals or milk
-Fine hand tremors
-Interventions: Administer beta blocker, adjust
dosage lower, report an increase in tremors →
LITHIUM TOXICITY
-Polyuria
-Interventions: use a potassium sparing diuretic
(spironolactone), maintain adequate fluid intake 1.5-
3 L/day
-Weight gain
-Renal toxicity
-Intervention: monitor I&O, adjust dosage, assess
baseline BUN/creatinine
-Goiter and hypothyroidism with long term treatment
-Intervention: Baseline T3/T4 levels prior to starting
treatment, administer levothyroxine
-Bradydysrhythmias, hypotension, e- imbalances
adverse effects of mood stabilizers
1 Lithium toxicity!
-Lithium: greater than 1.5 meq
-Common Manifestations: Diarrhea, n/v, thirst, polyuria, muscle weakness, fine hand tremors, slurred speech, lethargy
-Interventions: manifestations at low levels improve over time
Early indications:
Lithium: 1.5-2.0
Manifestations: mental confusion, sedation, poor coordination, coarse tremors, GI, n/v/d
Interventions: withhold med, notify provider
Advanced indications:
Lithium: 2.0-2.5 meq
Manifestations: Extreme polyuria of dilute urine, tinnitus, giddiness, jerking movements, blurred vision, ataxia, seizures, severe hypotension, stupor leading to coma, respiratory complications
Interventions: administer emetic or gastric lavage
Severe toxicity
Lithium: greater than 2.5
Manifestations: rapid progression of manifestations leading to coma or death
Intervention: hemodialysis
Nursing interventions for lithium toxicity
-Monitor plasma lithium levels during treatment every 2-3 days until stable
-Effects begin within 5-7 days
-Max benefit might not be seen for 2-3 weeks
-Adequate fluid and sodium intake cruical
what levels of neurotransmitters does people with adhd have
low dop and low norepi
what do you monitor methylphenidate?
monitor BP, height/weight
give no later than 6 pm –> restlessness
pharm action of mthylphenidate?
stimulates the sns –> speeds up cns –> elevated BP, wakefullness, increased or decreased pulse
lithium toxicity level
lithium greater than 1.5
