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N353: Practice of Nursing II > Module 3 - Pediatric Mental Health > Flashcards

Module 3 - Pediatric Mental Health Flashcards

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1
Q

Many __ ___ can lead to or resemble mental health disorders

A

learning disabilities

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2
Q

Many disorders occur ___ making diagnosis difficult

A

concurrently

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3
Q

What are some etiologies for mental health disorders in children?

A

Physiologic

Chronic Physical Illness or Disability

Family Dynamics

Environment

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4
Q

What are some examples of physiologic etiologies for mental health disorders?

A

Genetics

Structural Brain Abnormalities

Prenatal Influences

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5
Q

What are some examples of Family Dynamic etiologies for mental health disorders?

A

Child abuse

Dysfunctional Family System

Poor Role Modeling

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6
Q

What are some examples of environmental etiologies for mental health disorders?

A

Poverty

Homelessness

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7
Q

What are some treatment options for mental health disorders in children?

A

Cognitive, Behavioral, Group, Family, Play, Art, Music Therapy

Quiet Room

Time Out

Seclusion and/or Restraint

Psychopharmacology

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8
Q

What kind of therapy is most commonly used for mental health disorders in children?

A

Behavioral Therapy - if you start teaching and learning new behaviors early you can change them

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9
Q

Early Intervention

A

A federally mandated program implemented at the state level via LHD

Testing and Services are provided for free to try and prevent further developmental delay (if its already noted)

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10
Q

Many outcomes can be significantly improved if …

A

treatment is started early ! do not wait !

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11
Q

What sort of management can be done to treat mental health issues in children?

A

Community Based Treatment (Primary, Secondary, Tertiary)

Hospital Based Treatment

Specialized Units for Children and Adolescents

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12
Q

Primary Prevention Community based Treatment for Mental health in children

A

prenatal care

teaching about risk factors

parenting skills classes

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13
Q

Secondary Prevention Community based Treatment for Mental Health in children

A

Early detection and testing

school and community nurses, NPs, and teachers

Pediatricians

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14
Q

Tertiary Prevention Community based Treatment for Mental Health in Children

A

minimizes effect of disorder via individual, family, group therapy and behavioral modification

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15
Q

What Assessments should be done by the nurse for a child’s mental health status?

A

H&P - History and Physical (look at stressors and significant data)

PMH

FH

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16
Q

What are some examples of things to investigate in child PMH

A

prenatal and birth history

injuries

mood issues

medications

suicide and self injury

mood and actions at home

mood and action with friends

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17
Q

What are some examples of things to investigate in child FH

A

note strengths and weaknesses of family system

who do they live with

educational level

willingness to learn/participate in services

abuse issues? - Alcohol, physical, emotional

depression/anxiety issues?

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18
Q

What is important to do when assessing a child’s mental health status?

A

Become a detective - take things in visually like appearance, behavior, and developmental stage, but also ask open ended questions and learn during play

Try to get the family and the child to open up a little to learn about home life and family situations

Observe behaviors

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19
Q

Important Mental Health Disorders in Pediatrics

A

Developmental Disorders / Learning Disabilities

Pervasive Development Disorders (Autism)

ADD/ADHD/Behavioral Disorders

Mood Disorders

Anxiety Disorders

Intellectual Disabilities

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20
Q

What forms can developmental and learning disabilities take

A

Sensory Integration (Sensory issues)

Auditory Processing Difficulties (trouble hearing words or understanding)

Visual processing difficulties

Dyslexia

Speech/Language Delays etc

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21
Q

With developmental and learning disabilities, it is important to know what?

A

that they exist and can be misdiagnosed as other more common disorders

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22
Q

Pervasive Developmental Disorders (PDD)

A

GROUP of conditions that involve DELAYS in development of many basic skills

It is an umbrella term / group of conditions

Essentially, autism spectrum

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23
Q

PDD is more common in what gender?

A

Male

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24
Q

Children with PDD are …

A

confused in their thinking and generally have problems understanding the world around them

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25
Q

PDD exists as a spectrum of…

A

autism that goes from mild autism to Asperger’s Syndrome

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26
Q

PDD is a very large…

A

umbrella term for many things

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27
Q

Autism

A

A range of complex neurodevelopment disorders

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28
Q

What is Autism characterized by (generally)?

A
  1. Social impairments
  2. Communication Difficulties
  3. (sometimes) Receptive Patterns of Behavior (rocking, twirling, self abuse behavior)
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29
Q

S/S Of Autism

A

can engage in rigid, repetitive, machine like movement/obsessive behavior

Impaired social interaction

Unresponsive to people

unable to respond to social/emotional cues (cant pick up on a situation)

aversion to touch and extreme stimuli

at risk for self injury (hitting head, scratching, etc)

A pattern of restricted interests, activity and behaviors

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30
Q

Autistic Disorder

A

impaired social, communicative, and behavioral development

It is a complex disorder of brain development

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31
Q

When do Autism symptoms tend to emerge?

A

Between 2-3 years but can be evident from early toddler stage

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32
Q

Asperger’s Syndrome

A

Mild end of the autism spectrum

Social skills and interactions impaired, but high intellectual functioning

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33
Q

How does Asperger’s Syndrome differ from regular autism?

A

LATER ONSET

MILD END

Similar social interaction and repetitive behavior problems - but often called eccentric or loner

NO Language delay

Speech may be monotone, poor “give and take” in a conversation

Egocentric

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34
Q

Egocentric

A

low empathy for others

possessed by Asperger’s Syndrome

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35
Q

Nursing Interventions for Children with Autism

A

Gradual and Gentle Interaction (Create a safe and stable environment)

Enhance communication (learn triggers or what they like)

Coach on socialization - collaborative activities

Help parents decrease feelings of blame, provide education and resources

Use Childs established routine and decrease stimuli while hospitalized (learn from parent what works, communication cutes, self injury habits)

Use diversion for acting out and increased anxiety (appropriate activities)

Provide child with familiar objects

Change is often challenging

MEDICATIONS may be needed for aggression

Know the childs cues!!!

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36
Q

Autism Prevalence and the Vaccine Debate

A

10 epidemiologic population based studies concluded there is no evidence of a causal association between vaccines and autism

No evidence to date that children with neurodevelopmental disabilities, including autism, in the US have increased mercury concentrations or environmental exposures

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37
Q

Examples of Attention Deficit and Disruptive Behavior Disorders

A

ADHD

CD

ODD

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38
Q

ADHD

A

Attention Deficit - Hyperactivity Disorder (ADHD)

Disorder that makes it difficult for children to control their behavior

Can be both attention deficit and hyperactivity (or more one than the other)

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39
Q

ADHD goes beyond the normal…

A

hyperactive child, this is inappropriate attention or impulsiveness consistently

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40
Q

What is one of the most common chronic conditions of childhood? How many children does it impact?

A

ADHD - 4 to 12% of School Aged Children

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41
Q

Due to how common ADHD is, what often happens?

A

Other things are often misdiagnosed as ADHD

42
Q

Characteristics of ADHD

A

Inappropriate degrees of inattention, impulsiveness, and/or hyperactivity

Trouble paying attention to details

Making careless mistakes

Trouble concentrating on one activity at a time

Talking constantly even at inappropriate times

Running around in a disruptive manner

Fidgeting and Squirming

Having trouble waiting turn

Being easily distracted

Impulsively blurting out answers

Misplacing school assignments

Seeming not to listen, even when directly addressed

43
Q

When does ADHD onset begin and how long must it last for a diagnosis?

A

before age 7, last at least 6 months

Stress can cause ADHD like symptoms so we need to watch and make sure

44
Q

ADHD has a high incidence of what?

A

COMORBIDITY (this can lead to a lot of issues)

ex: ODD, Anxiety disorders, mood disorders, developmental learning disorders like dyslexia

45
Q

What is the focus of therapy for ADHD

A

MANIPULATE ENVIRONMENT TO DECREASE STIMULI (#1)

Minimize hyperactivity and impulsivity

Increase attention span

Prevent potential future problems (ex: substance abuse, conduct disorders, etc)

Assist family to establish regular scheduled times for eating, sleeping, homework, etc

Provide emotional support

Promote self-esteem, rewards for positive behavior

46
Q

Why is one type of ADHD meds stimulants?

A

Stimulants cause an increase in dopamine levels that actually boost attention ability - it is a NT associated with motivation, pleasure, attention, and movement

Therefore, it can boost concentration and focus while reducing hyperactive and impulsive behaviors

47
Q

When should ADHD meds be given?

A

In the morning to help get through the day (and may need a second dose for evening and homework time)

48
Q

Side Effects of using Stimulants for ADHD medications

A

Difficulty Sleeping

Loss of appetite (big one) - we need to make sure they are growing well height and weight wise so give them suggestions for nutrition dense food options

Tachycardia

Tics (Rare)

Upset Stomach

49
Q

Examples of Stimulant ADHD Meds

A

Adderall

Concerta

Ritalin

50
Q

Why can non-stimulants be used as ADHD medication?

A

It boosts the levels of norepinephrine and has some anti depressant features

51
Q

Non-stimulant ADHD meds lack which side effect?

A

Tic side effects

52
Q

What is more effective, Stimulant or Non-stimulant ADHD meds?

A

Stimulant

Non-stim does not always work as well so you may need several types of meds and dosages until you get the right one that works for them

53
Q

Side Effects of Non-stimulant ADHD meds?

A

Sleepiness

Headache

Mood Swings

Nausea

Loss of Appetite

54
Q

Oppositional Defiant Disorder (ODD)

A

While all children are defiant at times, especially toddlers saying no and early adolescents, this is much more so and is a pattern of uncooperative, defiant, and hostile behavior

55
Q

What is ODD a combination of?

A

Internal Depression/Anxiety along with externalizing aggression/temper tantrums

56
Q

What are some treatments for ODD

A

Therapy

Social Skill Training

Parenting Classes

Medications

(We want to work on managing this with a combination of things, and do so quickly because this could spiral out of control; we need strict action = consequences laid down)

57
Q

Signs and Symptoms of ODD

A

Frequent temper tantrums

Excessive arguing with adults

Often questioning rules

Active defiance and refusal to comply with adult requests and rules

Deliberate attempts to annoy or upset people

Blaming others for his/her mistakes or misbehaviors

Often being touchy or easily annoyed by others

Frequent anger and resentment

Mean and hateful talking when upset

Spiteful attitude and revenge seeking

58
Q

Conduct Disorder

A

Much worse than ODD

Great difficulty following the rules, often viewed as “bad” rather than mentally ill

These are the kids on the edge of even more serious aggression or criminal acts

59
Q

Those with Conduct Disorders are likely to have what if they are not treated?

A

ongoing and increasingly serious problems if they go untreated

60
Q

Signs and Symptoms of Conduct Disorders

A

Lying, Aggression, Even criminal acts

No remorse

Aggression to people and animals - bullies, threatens, starts fights, cruel to animals

Destruction of Property - fire starting, vandalism

Deceitfulness, Lying, or Stealing - money, shoplifting, breaking into house or car, lying to avoid obligations or get something

Serious violations of the rules - running away, truant, staying out past parents limits

61
Q

What are the 2 subtypes of Conduct Disorders?

A
  1. Childhood Onset
  2. Adolescent Onset
62
Q

What are some treatments for Conduct Disorders?

A

Intense behavioral and psycho therapy - the tx of choice for CD

Positive reinforcement

Arrange organized, supervised activity

HAVE TO SET STRICT BOUNDARIES AND CONSISTENT CONSEQUENCES

Pharmaceuticals - Anti depressants, mood stabilizers

63
Q

Tourette’s Syndrome

A

INVOLUNTARY motor movements and/or vocalizations (TICS) - consistent and uncontrollable!

Tics could be motor or verbal

It is a neurobiological disorder

64
Q

What are some signs/symptoms of Tourette’s Syndrome

A

TICS

Snorts

Throat Clearing

Facial Twitching

Arm Jerking

Kicking

May show sudden rage - frustration

Verbal tics

Co-morbidities - like depression

65
Q

What alters the frequency and intensity of Tourette’s syndrome?

A

It can be up or down between people

Also, symptoms may worsen with anxiety

66
Q

Are kids with TICS always diagnosed with Tourette’s?

A

No, some kids have tics that are not true Tourette’s and it will go away with a stressor’s leaving - true Tourette’s is consistent and remains

67
Q

Anxiety Disorders

A

Generalized Anxiety Disorder

Panic Disorder

Phobias

Separation Anxiety Disorder

Obsessive Compulsive Disorder

Post Traumatic Stress Disorders

68
Q

Generalized Anxiety Disorders

A

tend to being in childhood and continue into adolescence - anxiety is a normal part of development but if we fail to move beyond fear that is when problems begin

This lasts at least 3 months

69
Q

What behaviors might generalized anxiety include

A

Bedwetting

Sucking Thumb

Regression

(for at least 3 months)

70
Q

Separation Anxiety Disorder

A

Fear of being separated from the person to whom the child is most attached

It is an abnormally excessive or age inappropriate fear (toddlers and infants have this normally, but a 5 year old should be able to be dropped off without significant distress)

71
Q

What can untreated separation anxiety lead to?

A

other generalized anxiety disorders or relationship difficulty later

72
Q

What are some symptoms of Separation Anxiety Disorder

A

Refusal to attend school

Somatic complaints

Severe anxiety regarding separation

Worry about harm coming to significant caretaker

Clinging

Crying

Tantrums

73
Q

Nursing Interventions for Separation Anxiety Disorder

A

Maintain a calm manner

Teach parents about consistency in expectations

Therapy - family and/or child

Education and resources for the parents

Medications MAY be needed (but they might just need better coping skills)

Ex: Get the kid back in school ASAP and keep a routine!!

74
Q

Obsessive Compulsive Disorder

A

Ritualistic behaviors (similar to those displayed in adults) that are highly specific and a high anxiety issue for children

75
Q

What some signs or symptoms of OCD in a child?

A

Repeatedly perform routines or think thoughts over and over until they become a ritual

Cant control the deep need to the ritual again and again

The anxiety and rituals get in the way of daily life

76
Q

What is commonly used to treat OCD in children?

A

Medications - to calm and focus the child

Sometimes therapy to learn coping skills, letting go, and lower anxiety

77
Q

When is COD more common in children?

A

more so in littler kids than older ones.

78
Q

What are 2 important mood disorders in children?

A

Suicide

Depression

79
Q

Mood Disorders are often associated with what in children?

A

Behavioral Issues

Social Skill Deficits

Family Dysfunction

poor achievement

80
Q

Mood disorders were recognized as occurring in children…

A

only recently! It is not just in teenagers, grade schoolers too!

81
Q

S/S of Depression in Children

A

Poor school grades

Withdrawal from activities previously enjoyed

Sleep and appetite disturbances

Somatic complaints

Decreased energy

Difficulty concentrating

Low self esteem

Feelings of hopelessness

82
Q

Warning signs of Suicide in Teens

A

Sudden withdrawal

Violent behaviors

Drug and alcohol use

Unusual neglect of personal appearance

Truancy

running away

excessive fatigue

poor response to praise

talks about suicide

gives away possessions

83
Q

How do children under 12 committing suicide differ from it occurring in teens?

A

MAY DO SO IMPULSIVELY (less thought) - so it ends up being often recorded as an accident

Tend not to give warning signs as adolescents and adults do

Careful monitoring for an treatment of depression is critical

84
Q

Many child suicides are recorded as …

A

accidents

85
Q

Because of the differences between how children deal with suicide to others, what is highly important to do?

A

Careful monitoring for and treatment of depression critical

86
Q

Nursing Interventions for Mood Disorders

A

BE SUPPORTIVE

Medications when needed

Monitor for Side Effects of Meds

Provide Community Resources, Education

Promote Self-Esteem

Maintain Hopefulness

Provide a safe environment

Use Suicide Precautions

Change approach based on the mood disorder or the effect of certain medications. - Be gentle with them

87
Q

Fetal Alcohol Syndrome (FAS)

A

Completely preventable syndrome of cognitive problems and physical abnormalities

Caused by drinking while the child is developing in the womb

88
Q

What sort of delays and issues can occur d/t FAS

A

Developmental Delays

Behavioral Disorders

Intellectual Disabilities

89
Q

What are some characteristic physical abnormalities in FAS children?

A

Wide eye placement

Small thin upper lip

Flat nasal bridge

Upturned nose

“Classic Look”

90
Q

Anorexia Nervosa

A

Distorted body image d/t fear of obesity, thus leading to dramatic weight loss

They strain to keep a “perfect” body - high expectation type of image

91
Q

What group is anorexia nervosa most common in?

A

Females aged 12-18 years old

92
Q

What are some signs and symptoms of Anorexia Nervosa?

A

Fear of Obesity

Dramatic Weight loss

Distorted body image

anemia

amenorrhea (body just stops everything)

dry brittle hair

nails

laxative and enema use frequently

electrolyte imbalance

High expectation of body type image

93
Q

What is a highly useful treatment for Anorexia Nervosa?

A

Behavior Modification Model - meet a goal and get a reward/privilege

94
Q

Bulemia

A

Distorted body image with much of the characteristics of anorexia, but involves binge eating and then vomiting

95
Q

Signs and Symptoms of Bulemia?

A

Many anorexia s/s

Binge eating (high calorie food in short time) followed by induced vomiting

Could be normal weight or even overweight

Electrolyte imbalances

Body slows itself (like with many eating disorders) - body slows itself down (constipation, bradycardia, low BP)

96
Q

What are some interventions for eating disorders?

A

Behavioral modification therapy (rewarded for corrected behavior; ex: gains weight each week = add privileges)

Family therapy

Monitor clinical status - weight, intake, vital signs - so we can get them into a proper facility

97
Q

PICA

A

Ingestion of non nutritional substances (ex: clay, chalk, plants, paint chips, hair…)

It is a nervous anxiety issue for them that soothes them, but they need therapy

98
Q

How long does PICA need to occur for diagnoses?

A

For at least one montyh

99
Q

Treatment for PICA?

A

Feeding Therapist, Psychologist, etc

They might use PICA as a soothing behavior, but they need therapy

100
Q

What is the overall goal for pediatric mental health?

A

SUPPORT AND UDNERSTANDING

(remember that is a patient has these issues, it frames how you set the goals, go forward, reevaluate goals more often, meet their needs, etc)

N353: Practice of Nursing II (14 decks)

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