Test 3 Mental Health of Child and Adolescent Flashcards
Biggest concern we have as nurses regarding mental health problems
The need to eradicate the stigma against mental health
____% of those in the juvenile justice system have diagnosable mental health problems
70% have mental health problems in the juvenile justice system
Alcohol abuse starts as early as age?
Starts as early as age 8
___% of children in the welfare system have diagnosable mental health problems
50% of children in the welfare system have diagnosable mental health problems
Autosomal dominant framework
Mental health problems, such as alcohol abuse, run in families
Environmental framework for mental health
Example: mother who drinks could predispose child to mental health problems
Erikson in child development
Maturationist approach to development. Individuals who mature at a certain rate and surmount the developmental task at that level are able to successfully challenge the next step. If they don’t, they’re development is interrupted and challenged, and this can pose a problem for them in the coming years.
Ecological systems in child development
environment, psychosocial development, and physical development. It is the total environment that says whether or no the child will develop safely and successfully.
- Ability to withstand stress
- Characteristics include, “good natured”, confident, sense of humor, realistic, flexible, self assured,secure.
- Demonstrate capacity to “counce back” and master stress
*Definition of ?*
Resilience
___% of children who are exposed to a powerful stressor do not experience lasting developmental damage
80% exposed to stressor don’t experience lasting developmental changes
- Clear thinking
- Skill in verbal language
- Understanding own emotions and also those of others
- Making friends
- Getting along with others
- Even temperament
- Responsive caregiving
- Self esteem
- Fostered competence
- Supportive adults in the environment
*All of these things are meant to ?*
Meant to foster resilience
- Social relatedness impairment
- communication impairment
- restricted repertiore of behaviors (childs ability to be flexible in situations is not seen. Only one or two responses to all situations)
Autism
Types of developmental disorders (4)
- Mental Retardation
- Pervasive Developmental Disorders
- Specific Developmental Disorders
- Tic Disorder
True or False: As autistic children grow, they can have unusual abilities for a person of their developmental level , also called cevant abilities
True
True or False: Autistic children speak later than other kids of their developmental stage, and also talk about themselves using their name
True
How is autism diagnosed?
- There is no specific tool, assessment is used over time to diagnose.
- Child doesn’t respond to his or her name, doesn’t make eye contact, wants specific order, unusual rituals, all centered around soothing the self
PANDAS
- Psychiatric and Neurological disorders associated with strep
- Some symptoms can be alleviated using medicines “off label”
- Self harming: anti-depressants, anti-anxiety
Autism
- Mild end of the autism spectrum
- intellect is intact
- Matked by social awkwardness
Asperger’s Disorder
CHAT
Checklist for Autism in Toddlers
- focus on symptom management
- Early detection (CHAT)
- Behavioral intervention
- Language therapies
- Occupational therapies
- Pharmacotherapy
- Social skills training
Nursing care for Asperger’s
Pharmacotherapy for Aspergers
- Medicine to stabalize mood, decrease depression, and deal with anxiety
3 Disruptive behavior disorders
- Attention Deficit Hyperactivity Disorder
- Conduct Disorder
- Oppositional Defiant Disorder
- 3 Types
- Inattentive
- Hyperactive-Impulse
- Combined: inattention and hyperactivity
Attention Deficit/Hyperactivity Disorder
-Enduring pattern of disobedience, argumentativeness, explosive angry outbursts, low frustration tolerance, and a tendency to blame others for quarrels or accidents
Oppositional Defiant Disorder
Use stimulating medications for this because of the “sleepy brain”
ADHD
Ritalin: short acting
Best drug for ADHD, used multiple times a day
Cognitive behavioral component to ADHD therapy
Cause and reaction problem solving component (learning strategy)
Oppositional defiant disorder is comorbid with?
Comorbid with ADHD and anxiety
- Risk factors include: Physical and sexual abuse, inconsistent or inadequate parenting, lived in institutional setting during early childhood
Conduct Disorder
Characterized by serious violations of social standards such as aggression, vandalism, cruelty to animals, stealing, lying, and truancy
Conduct Disorder
Rapid, jerky movements of the eyes, face, neck and shoulders or slow purposeful movements
motor tics
Throat clearing, grunting, repetitive noises, words, phrases
Phonic tics
Types of Tic Disorders (3)
- Motor Tics
- Phonic Tics
- Tourette’s Disorder
Ways to deal with conduct disorder as a nurse
Implement some structure strategies and support for the involved family
A combination of motor and phonic tics on a spectrum from barely discernable to extremely debilitating
Tourette’s Disorder
Diagnosis of Tourette’s
Comes when symptoms are visible for at least a year
Treatment for Tics
Antipsychotics, as well as behavioral therapy
Child soiling themselves with feces in a child 4 years or older. Not the result of pre-existing medical problem
Encopresis
Enuresis
Inability to control urination/ daytime wetting
- A subset of children who develop OCD and/or tic disorder following a strep. infection
- Autoimmune disorder
- Criteria
- Presence of OCD/tic
- Pediatric onset (3y/o - puberty)
- Varying severity
- Association with A Beta-hemolytic streptococcal infection
- Association with neurological abnormalities (motor activity)
Psychiatric and Neurologic Symptoms Associated with Strep (PANDAS)
Treated with an antibiotic
PANDAS
Precipitating factors for depression in adolescents include
- Low self-esteem
- difficult relationships
- academic difficulties
- parental depression
- bereavement
Why increase in suicide with adolescents on antidepressants
Treatment starting to work enough, that they have the energy to complete the suicide plan. Paired with impulsivity of the adolescent.
If you can do one intervention in mental health nursing care, what do you want to do?
Establish a therapeutic alliance
_______ experience higher co morbidity of depression with anxiety, conduct disorders, and substance abuse than adults experience
adolescents
- Often seen as part of bipolar disorder
- elevated mood
- increased engergy/strength
- little need for sleep
- restlessness
- diregard for safety
- rapid speech
- increased irritability
Mania
Ways to investigate suicide in the adolescent. How would you phrase it?
- I know you’re feeling very depressed, tell me about any plans you have to harm yourself/ I need to know if you’re thinking about killing yourself
- I need to know your plan/ Tell me about your plan
- consistently below or above caloric needs to maintain a healthy weight
- eating is accompanied by anxiety or guilt
- eating happens in the absence of hunger and appetite is never satisfied
- results in physiologic imabalances and complications to health
Eating Disorders
Treatment for Mania
- Mood stabilizers, anti-convulsants
- often don’t see lithium in adolescents because of small therapeutic range, lack of compliance, and it’s renally toxic
