Nursing care of the child with an alteration in behavior, cognition, or development Flashcards
Exam 4 (Final)
Factors Influencing Children’s Behavior
Biologic or genetic characteristics.
Nutrition.
Physical health.
Developmental ability.
Environmental and family interactions.
The child’s individual temperament.
The parents’ or caregiver’s responses to the child’s behavior.
Common Screening Tools include:
Autism
Anxiety
Common Screening Tools include:
Autism: What screenings tests are included?
Checklist for Autism in Toddlers (CHAT)
Modified Checklist for Autism in Toddlers (M-CHAT)
Social Communication Questionnaire (SCQ)
Pervasive Developmental Disorders Screening Test-II (PDDST-II)
Common Screening Tools include:
Anxiety: What screenings tests are included?
Beck Anxiety Inventory for Youth
Multidimensional Anxiety Scale for Children (MASC),
Preschool Anxiety Scale
Spence Children’s Anxiety Scale (SACS)
Common Medications In Mental Health
Psychostimulants
Antianxiety
Antimanic
Selective serotonin reuptake inhibitors
Atypical depressants
Nonstimulant norepinephrine reuptake inhibitors
Alpha-Agonist antihypertensive agents
Antipsychotic agents
Atypical antipsychotics
Tricyclic antidepressants
Common Medications In Mental Health
Examples of Psychostimulants
(methylphenidate, dextroamphetamines)
Common Medications In Mental Health
Examples of Antianxiety meds
(buspirone)
Common Medications In Mental Health
Examples of Antimanic meds
(lithium)
Common Medications In Mental Health
Examples of Selective serotonin reuptake inhibitors meds
(fluoxetine)
Common Medications In Mental Health
Examples of Atypical depressants meds
(trazodone)
Common Medications In Mental Health
Examples of Nonstimulant norepinephrine reuptake inhibitors meds
(atomoxetine)
Common Medications In Mental Health
Examples of alpha-Agonist antihypertensive agents meds
(clonidine)
Common Medications In Mental Health
Examples of Antipsychotic agents?
(thioridazine)
Common Medications In Mental Health
Examples of Atypical antipsychotics?
(risperidone)
Common Medications In Mental Health
Examples of Tricyclic antidepressants?
(amitriptyline)
Types of therapy:
Behavioral therapy
Play therapy
Cognitive behavioral therapy
Dialectical behavioral therapy
Family therapy
Group therapy
Mileu therapy
Individual therapy
Hypnosis
Types of therapy:
Behavioral therapy- what is it?
Uses stimulus and response conditioning to manage or alter behavior
Types of therapy: Play therapy
What is it designed to do?
Designed to change emotional status
Types of therapy: Play therapy
What does it encourage the child to do?
Encourages the child to act out feelings of sadness, fear, hostility or anger.
Types of therapy: Cognitive behavioral therapy
What does it teach children?
Teaches children to change reactions so that automatic negative thought patterns are replaced with alternative ones
Types of therapy: Dialectical behavioral therapy
What occurs in this?
Group and individual sessions to treat chronic, suicidal thoughts in borderline personality disorder.
Types of therapy: Dialectical behavioral therapy
What do individuals learn?
Individuals learn responsibility for their problems and better deal with negative emotions.
Types of therapy: Family therapy
What is it? What does it help with?
Exploration of the child’s emotional issue and its effect on family members.
Helps the family to focus in more constructive ways
Types of therapy: Group therapy
Where may it be conducted?
May be conducted at school, hospital, treatment facility or neighborhood center.
Types of therapy: Group therapy
What occurs during this? What does this take advantage of ?
Feelings are expressed and participants gain hope, feel a part of something, and benefit from role modeling.
Types of therapy: Milieu therapy
What is this therapy designed to promote?
A specially structured setting designed to promote the child’s adaptive and social skills.
Types of therapy: Individual therapy
What occurs in this?
The child and therapist work together to resolve the conflicts, emotions or behavior problems.
Types of therapy: Milieu therapy
This environment is for those at risk of…
A safe and supportive environment for those at risk for self harm or those who are very ill or very aggressive
Types of therapy: Individual therapy
What is central to this type of therapy?
Trust is central
Types of therapy: Individual therapy
What is the structure of this therapy based on?
Structure based on the child’s development level
Types of therapy: Hypnosis
What occur in this?
Deep relaxation with suggestibility remarks
Behavior Management Techniques:
What should you hold children responsible for?
Set limits and hold child responsible for behavior.
Behavior Management Techniques:
What should not be done?
Do not argue, bargain, or negotiate about the limits set.
Behavior Management Techniques:
How should you act?
Use a low-pitched voice and remain calm.
Ignore inappropriate behaviors.
Praise the child’s self-control efforts.
Behavior Management Techniques:
What should be done when needed?
Use restraints only when necessary.
Redirect the child’s attention when needed.
Behavior Management Techniques:
What should be done about caregivers?
Provide consistent caregivers and establish a daily routine.
Fetal Alcohol Syndrome:
What does this result from?
Results from in utero alcohol exposure.
Fetal Alcohol Syndrome:
What are typical facial features?
Typical facial features include
low nasal bridge with short upturned nose,
flattened midface,
long philtrum with narrow upper lip.
Fetal Alcohol Syndrome:
How are children coordination and skeletal systems?
Poor coordination, skeletal abnormalities.
Fetal Alcohol Syndrome:
What can occur in infants?
Microcephaly.
Failure to thrive.
Hearing loss.
Warning Signs of Autism
Lack of eye contact.
Not babbling by 12 months.
Not pointing or using gestures by 12 months.
No single words by 16 months.
No two-word utterances by 24 months.
Losing language or social skills at any age
Types of Learning Disabilities
Dyslexia:
Dyscalculia:
Dyspraxia:
Dysgraphia:
Others
Types of Learning Disabilities
Dyslexia:
difficulty with reading, writing, and spelling.
Types of Learning Disabilities
Dyscalculia:
problems with mathematics and computation.
Types of Learning Disabilities
Dyspraxia:
problems with manual dexterity and coordination.
Criteria for Diagnosis of Intellectual Disability
What are their deviations in?
Deviations in IQ of two or more standard deviations (IQ of less than 70 to 75).
Types of Learning Disabilities
Dysgraphia:
have difficulty producing the written word (composition, spelling, and writing).
Criteria for Diagnosis of Intellectual Disability
What coexists?
Coexisting deficits in at least two adaptive skills:
Criteria for Diagnosis of Intellectual Disability
Coexisting deficits in at least two adaptive skills: including?
communication, community use, functional academics, health and safety, home living, leisure, self-care, self-direction, social skills, and work.
Criteria for Diagnosis of Intellectual Disability
When does disability occur?
Disability occurring before the age of 18 years.
Categories of Intellectual Disability
Mild Intellectual Disability IQ?
IQ 50 to 70
Categories of Intellectual Disability
Moderate Intellectual Disability IQ?
Moderate: IQ 35 to 50
Categories of Intellectual Disability
Severe Intellectual Disability IQ?
Severe: IQ 20 to 35
Categories of Intellectual Disability
Profound Intellectual Disability IQ?
Profound: IQ less than 20
Three Subtypes of ADHD
Hyperactive–impulsive (ADHD)
Inattentive (ADD)
Combined
Three Subtypes of ADHD:
How could they be dealt with?
Cognitive behavioral therapy + meds
Types of Eating Disorders
Anorexia nervosa
Bulimia
Pica
Rumination
Types of Eating Disorders
Bulimia
process of binging and purging
Types of Eating Disorders
Bulimia- what are consequences of this?
esophagitis
ruining the enamel of teeth
Types of Eating Disorders
Pica- what is it?
Eating stuff that’s not food
Types of Eating Disorders
Rumination- what is it?
When you just chew food but don’t swallow it
Complications of Anorexia Nervosa and Bulimia
Fluid and electrolyte imbalance.
Decreased blood volume.
Cardiac arrhythmias.
Esophagitis.
Rupture of the esophagus or stomach.
Tooth loss.
Menstrual problems.
Complications of Anorexia Nervosa and Bulimia:
What is the mortality rate?
Mortality rate may be as high as 18%.
Depression: Comorbid Disorders
Suicide
Anxiety disorders
Substance abuse
Eating disorders
Self-harm
Disruptive behavioral disorders
Types of Anxiety Disorders
Generalized anxiety disorder (GAD)
Social phobia
Selective mutism
Separation anxiety
Obsessive-compulsive disorder (OCD)
Posttraumatic stress disorder (PTSD)
Types of Abuse/Violence Leading to Mental Illness in Children
Child maltreatment
Munchausen syndrome by proxy
Substance abuse
Types of Abuse/Violence Leading to Mental Illness in Children
Child maltreatment includes
Physical abuse
Sexual abuse
Neglect
Warning Signs of Munchausen Syndrome by Proxy
What occurs in child?
Child with one or more illnesses that do not respond to treatment or that follow a puzzling course; a similar history in sibling.
Warning Signs of Munchausen Syndrome by Proxy
How are symptoms?
Symptoms that do not make sense or that disappear when the perpetrator is removed or not present; the symptoms are witnessed only by the caregiver.
Warning Signs of Munchausen Syndrome by Proxy
How are physical and lab findings?
Physical and laboratory findings that do not fit with the reported history.
Warning Signs of Munchausen Syndrome by Proxy
What repeatedly occurs?
Repeated hospitalizations failing to produce a medical diagnosis, transfers to other hospitals, discharges AMA.
Warning Signs of Munchausen Syndrome by Proxy
How is the parent?
Parent who refuse to accept that the diagnosis is not medical.
Assessments for a Child With a Cognitive or Mental Health Disorder:
What information is collected?
Health history
Family history of any mental health disorders
Past medical history
History of neurologic injury or disease
Developmental history
Assessments for a Child With a Cognitive or Mental Health Disorder:
When health history is taken, what should be noted?
Health history, noting the child’s prenatal and birth history.
Assessments for a Child With a Cognitive or Mental Health Disorder:
When past health history is taken, what should be included?
Past medical history (including previously diagnosed cognitive or mental health disorders).
Assessments for a Child With a Cognitive or Mental Health Disorder:
When Developmental history is taken, what should be noted?
Developmental history, noting age of attainment (or loss) of milestones.
Behaviors Related to Mental Health Disorders
Hallucinations
Aggression, impulsivity
Distractibility
Intolerance to frustration
Lack of sense of humor or fun
Inhibition
Poor attention span
Potential cognitive or learning disabilities
Unusual motor activities
Changes in behavior or activity level
Nursing Interventions for Families of Children With Autism;
What should be provided?
Provide emotional support.
Provide professional guidance and education about the disorder.
Provide positive feedback to parents for their perseverance in working with their child.
Nursing Interventions for Families of Children With Autism;
What should be assessed?
Assess the fit between the child’s developmental needs and the treatment plan.
Assess the parents’ need for respite care and make referrals.
Nursing Interventions for Families of Children With Autism;
What should you help parents with?
Help parents overcome barriers to obtain appropriate education, developmental, and behavioral treatment programs.
Nursing Interventions for Families of Children With Autism;
What should you stress the importance of?
Stress the importance of rigid, unchanging routines.
Teaching Topics and Psychosocial Interventions: Mood Disorders
What are mood disorders?
Mood disorders are biologic conditions, not personality flaws.
Teaching Topics and Psychosocial Interventions: Mood Disorders
What should be done with antidepressants?
Administer antidepressant medication safely and monitor for adverse effects.
Teaching Topics and Psychosocial Interventions: Mood Disorders
What should you encourage?
Encourage and praise the child’s and family’s efforts at following through with cognitive and behavioral therapies.
Teaching Topics and Psychosocial Interventions: Mood Disorders
What should you do for parents throughout the process?
Support the family throughout the process, as sometimes treatment may be lengthy.
Teaching Topics and Psychosocial Interventions: Mood Disorders
What should you do refer families to?
Refer the family to local support resources.
