w5 - 20 questions Flashcards
Stimulants side effects
- ___creased appetite
- h/a
- stomach aches, diarrhea
- trouble falling asleep, insomnia
- jittery, restless
- social withdrawal
- nervous
- overstimulation
- tachycardia or bradycardia or both?
- HTN or hypotension?
- Dry mouth, bad taste
2 things to address s/e =
Stimulants side effects
- Decreased appetite
- h/a
- stomach aches, diarrhea
- trouble falling asleep, insomnia
- jittery, restless
- social withdrawal
- nervous
- overstimulation
- both - tachycardia or bradycardia
- HTN
- Dry mouth, bad taste
adjust dose amount or time of day admin
clinical manifestations: _________
- Neurological symptoms (e.g. paralysis,
tremors, non-epileptic seizures, or vision
problems) that are inconsistent with or
cannot be explained by medical tests.
- Symptoms often triggered by stress or
trauma.
Impacts:
- Sudden disability leading to impaired
mobility and independence.
- Emotional distress due to the sudden
onset of symptoms and from a lack of a
clear medical explanation.
- Social and occupational disruptions due
to the disability.
Conversion Disorder
(Functional
Neurological
Symptom
Disorder)
Pharmacological Treatment for ADHD: ____________
- Improve attention and focus
- Decrease hyperactivity
- Begin at low dose, not weight dependent
Stimulants
_________________ A lack of concern or emotional response despite having a serious medical illness or physical symptoms related to a health condition.
This condition is most often associated with ________ disorder
Labelle’ Indifference
conversion
somatic Symptom Disorder (SSD) vs Illness Anxiety Disorder (IAD)
______ - the focus is on the distress caused by actual physical symptoms
_____ - the focus is on the fear, worry and anxiety about the possibility of being seriously ill, despite minimal or no symptoms
SSD - the focus is on the distress caused by actual physical symptoms
IAD - the focus is on the fear, worry and anxiety about the possibility of being seriously ill, despite minimal or no symptoms
clinical manifestations: _________
- Intense fear and/or worry with having or
acquiring a serious illness, despite having
few or no actual physical symptoms.
- Constant checking for signs of illness,
checking their bodies for signs, seeking
reassurance from doctors despite normal
results or avoidance of medical situations.
- Hyperfocus on health-related information
(e.g., medical websites).
impact:
- Persistent fear and/or worry leading to
significant distress and disruption in
daily activities.
- Avoidance of certain activities or
places for fear of illness.
- Can lead to doctor shopping, high
health related costs or avoiding
healthcare altogether.
Illness Anxiety
Disorder (IAD)
Nursing Interventions to Consider:
* Establish a therapeutic relationship; build trust, empathize with the individual.
* Reduce health dependency: Collaborate with healthcare team and coordinate appointments; help the individual develop a structured plan for follow-up appointments and encourage involvement in both medical and psychiatric care to address both physiological and psychological needs.
* Provide education on the disorder.
* Encourage realistic expectations, set reasonable therapeutic goals, and encourage use of coping skills or techniques; teach coping strategies (Relaxation, Meditation, Biofeedback, etc.)
* Assist with medication management.
0
clinical manifestations: _________
- psychological factors (e.g. stress) or mental
health issues (e.g., anxiety, depression) that
worsen a physical medical condition (e.g.,
chronic pain, asthma, heart disease).
impacts:
- Poor health outcomes due to the
interaction between psychological and
physical symptoms.
- Difficulty managing multiple health
concerns at once.
- Impaired quality of life due to both
physical and psychological challenge
Psychological
Factors Affecting
Medical Condition
Risk factors: Childhood and neurodevelopmental disorders
Biological
- Genetic predisposition
- Neurobiological
Psychological
- Temperament
Environmental
- Abuse/trauma
- Low socioeconomic status
- Parenting
0
Neurodevelopmental disorders: Specific learning disorders
(Dyscalculia, Dysgraphia, Dyslexia)
_________– problems with reading
__________ – problems with math
__________ – problems with written expression
Specific learning disorders
Dyslexia – problems with reading
Dyscalculia – problems with math
Dysgraphia – problems with written expression
Non-stimulants side effects:
Clonidine
- dry mouth
- dizzy
- mild sedation
- constipation
- resolves after _______
buproprion
- dry mouth
- dizzy
- nausea
- appetite changes
- stomach pain
- h/a
- ringing in ears
- sore throat
- muscle pain
atomoxetine
- dry mouth
- dizzy
- n/v
- decreased appetite
- trouble sleeping
- !! monitor for ___
Non-stimulants side effects:
Clonidine
- dry mouth
- dizzy
- mild sedation
- constipation
- resolves after several doses
buproprion
- dry mouth
- dizzy
- nausea
- appetite changes
- stomach pain
- h/a
- ringing in ears
- sore throat
- muscle pain
atomoxetine
- dry mouth
- dizzy
- n/v
- decreased appetite
- trouble sleeping
- !! monitor for SI
Impulse control disorders (Oppositional defiant disorder, Intermittent explosive disorder, Conduct disorder)
Clinical features: __________
- Angry/irritable
- Argumentative defiant behavior
- Vindictive
- Swearing
- Mood liability
- Low frustration tolerance
- Interpersonal tolerance
- Aware of rules and others rights
Clinical features: __________
- Impulsive and unwarranted emotional outbursts
- Violence
- Destruction of property – pyromania and kleptomania
- Violation of basic rights of others
- Unmanageable
- Irritable, defiant
- Lacks empathy
- Only remorse at being caught
- Risk taking
- Animal cruelty
Clinical features: __________
- violation of right of others
- Aggression – people and animals
- Destruction of property
- Deceitfulness
- Violates rules
- Cant control aggressive impulses
Oppositional defiant disorder
Conduct disorder
Intermittent explosive disorder
Nursing process and clinical judgement model (for all d/o)
Nurses role
- Assessment
- Early identification
- Identify family needs
- Promote children’s rights
- Avoid seclusion/restraint
- Notify parents
Assessment techniques
- Ask Children info about internal symptoms (mood, sleep, SI)
- Ask Parents info about external symptoms (behavior, relationships)
- _______, concrete phrases
- Corroborate info with adult
- ask direct, yes/no questions or open ended questions?
- Play media
- Time line may not be accurate
- Treat with respect and preserve dignity
- Seek solutions, don’t blame
- Use “do this” or “don’t do this”?
- Instill hope for success
Assessment techniques
- Ask Children info about internal symptoms (mood, sleep, SI)
- Ask Parents info about external symptoms (behavior, relationships)
- Simple, concrete phrases
- Corroborate info with adult
- Direct, yes/no questions – not open ended
- Play media
- Time line may not be accurate
- Treat with respect and preserve dignity
- Seek solutions, don’t blame
- Use “do this” instead of “don’t do this”
- Instill hope for success
Manifestations: _________
- Deficits in social interactions and relationships
- Repetitive speech/behaviors
- Obsessive focus on certain objects
- Routines/rituals
- Hyper/hypo reactivity to sensory input
- Extreme resistance to change
- Appears in early childhood
Interventions
- Build on childs interests
- Predictable schedule
- Break down tasks into simple steps
- Actively engage child
- Highly structured activities
- Regular positive reinforcement of behavior
- Teach communication and social interaction skills
- Involve parents for treatment success
- Speech and language therapy
Autism spectrum disorder
Intellectual developmental disorder
Manifestations
Deficits in functioning:
- Intellectual
- Social
- Daily
Early identification and intervention ___creases quality of life
- Cognitive and social stimulation before age 5 ___creases level of function
- Motivational support determines adult productivity and independence
Intellectual developmental disorder
Manifestations
Deficits in functioning:
- Intellectual
- Social
- Daily
Early identification and intervention increases quality of life
- Cognitive and social stimulation before age 5 increases level of function
- Motivational support determines adult productivity and independence
stimulants:
Methylphenidate – daytrana
- Route – PO or patch?
- May cause _________ – this is why it is typically worn on hip
- Worn for 9 hours
- does it continue to work for a few more hours after removal or no?
- Benefit – flexibility in amount of time worn = can control _______
Methylphenidate – methylin
- Comes in chewable tablet and _______
Methylphenidate –Ritalin (LA)
- Long acting
- Only LA that can be _________
Methylphenidate – concerta
- approved for kids over age ___
stimulants: Methylphenidate – daytrana
- Route – patch
- May causes permanent skin discoloration – worn on hip
- Worn for 9 hours
- YES - continues to work for a few more hours after removal
- Benefit – flexibility in amount of time worn = dose
Methylphenidate – methylin
- Comes in chewable tablet and oral solution
Methylphenidate –Ritalin (LA)
- Long acting
- Only LA that can be opened and sprinkled on food
Methylphenidate – concerta
- approved for kids over age 6
Impulse control disorders (Oppositional defiant disorder, Intermittent explosive disorder, Conduct disorder)
Treatment: ___________
- Meds to treat symptoms:
- Antidepressants
- Mood stabilizers
- Stimulants
- Antipsychotics
- Anticonvulsants
- Adrenergic
Treatment: _________
- Meds – divalproex sodium – used to control anger and aggression
- No FDA approved meds
Comorbidity: __________
- Dep/anxiety
- SUD
- Antisocial or borderline PD
Conduct disorder
Oppositional defiant disorder
Intermittent explosive disorder
________
Persistent pattern of inattention, hyperactivity, and impulsiveness that is pervasive and inappropriate for developmental level.
- In at least 2 settings
- Causing work, social, educational, etc. difficulties
- For at least 6 months before age 12
- 3 types – hyperactivity/impulsivity type, inattentive type, combined type
ADHD
clinical manifestations: _________
- Intentionally exaggerating or fabricating
physical or psychological symptoms for
external gain, such as avoiding work,
admission to a hospital or psychiatric
facility, receiving financial compensation, or
obtaining prescription medications.
impacts:
- Distrust and breakdown in
relationships, especially with healthcare
providers.
- Legal consequences if fraudulent
behavior is detected.
- Potential for unnecessary treatments or
accommodations based on false
information
Malingering
clinical manifestations: _________
- Intentionally pretending, lying about,
“faking” or producing physical or
psychological symptoms to assume the “sick
role” and gain things such as attention or
sympathy.
- May involve falsifying medical histories,
manipulating test results, or intentionally
harming oneself
impacts:
- Emotional distress stemming from the
need for attention or care.
- Trust issues in relationships and among
healthcare providers due to deceptive
behaviors.
- Risk of unnecessary medical treatments
and complications
Factitious Disorder (Imposed
on Self or Others)
Primary vs secondary Gain
____________ - A benefit that provides protection from (INTERNAL) anxiety or emotional symptoms and/or conflicts.
_____________ -Relieves the individual from (EXTERNAL) expected responsibilities.
examples of _______ gain = If an individual’s symptoms/ disease:
- increases the attention and sympathy they receive
- allows him/her to miss work
- admission to a hospital or psychiatric facility
- obtain financial assistance
- psychiatric disability, or other disability compensation
- receive prescription medication(s)
- avoids a jail sentence
**Remember: Primary gains produce __________ motivators, whereas secondary gains produce ________ motivators
Primary Gain- A benefit that provides protection from (INTERNAL) anxiety or emotional symptoms and/or conflicts.
Secondary Gain -Relieves the individual from (EXTERNAL) expected responsibilities.
examples of secondary gain.
**Remember: Primary gains produce internal motivators, whereas secondary gains produce external motivators
Key Take Aways on Treatments:
- Interprofessional collaborative care is often needed, especially for _______ disorder and psychological factors affecting medical conditions.
- Psychoeducation is important in all these disorders. This helps individuals understand the connection between their ________ symptoms and ________ states.
- _________ Therapy: The primary and most effective treatment approach for these disorders; specifically, to address the relationship between irrational thinking and emotional and behavioral distress; helps the individual reframe thoughts about their health and reduce anxiety.
- Mindfulness-Based Therapy and Stress Reduction Techniques
- Pharmacotherapy: (Typically antidepressants and anxiolytics); While medications are not the primary intervention for somatic disorders, they can be used to relieve the specific symptoms of these conditions. They are more commonly used when people have co-occurring mental
health conditions like _______ and _________.
Key Take Aways on Treatments:
- Interprofessional collaborative care is often needed, especially for conversion disorder and psychological factors affecting medical conditions.
- Psychoeducation is important in all these disorders. This helps individuals understand the connection between their physical symptoms and psychological states.
- Cognitive-Behavioral Therapy (CBT): The primary and most effective treatment approach for these disorders; specifically, to address the relationship between irrational thinking and emotional and behavioral distress; helps the individual reframe thoughts about their health and reduce anxiety.
- Mindfulness-Based Therapy and Stress Reduction Techniques
- Pharmacotherapy: (Typically antidepressants and anxiolytics); While medications are not the primary intervention for somatic disorders, they can be used to relieve the specific symptoms of these conditions. They are more commonly used when people have co-occurring mental
health conditions like anxiety and depression.
stimulants: Dextroamphetamine/amphetamine
- Approved for kids over age ____
- Can capsule can be opened and sprinkled on apple sauce if child cant swallow pill?
stimulants: Dextroamphetamine/amphetamine
- Approved for kids over age 6
- yes - Capsule can be opened and sprinkled on apple sauce if child cant swallow pill
ADHD 3 types (hyperactivity/impulsivity type, inattentive type, combined type)
_________ type
- Fidgets
- Leaves seat before excused
- Runs/climbs excessively or at inappropriate times
- Difficulty playing quietly (ex: board games)
- Always on the move
- Often talks excessively/non stop
- Speaks before thinking, blurts out answer
- Interrupts others, butts into conversations
- Problems with waiting for turn
___________ type
- Does pay attention to details, repeated careless mistakes
- Cant keep attention on task
- Cant follow through with task completion
- Trouble organizing activities
- Avoids doing tasks that involve mental effort
- Loses things, Distracted, forgetful
- Easily bored
- Disorganized
________ type
- Has behaviors from both types above
hyperactivity/impulsivity type
hyperactivity behaviors
- Fidgets
- Leaves seat before excused
- Runs/climbs excessively or at inappropriate times
- Difficulty playing quietly (ex: board games)
- Always on the move
- Often talks excessively/non stop
Impulsivity behaviors
- Speaks before thinking, blurts out answer
- Interrupts others, butts into conversations
- Problems with waiting for turn
inattentive type
- Does pay attention to details, repeated careless mistakes
- Cant keep attention on task
- Cant follow through with task completion
- Trouble organizing activities
- Avoids doing tasks that involve mental effort
- Loses things, Distracted, forgetful
- Easily bored
- Disorganized
combined type
- Has behaviors from hyper/impulsive and inattentive
class of meds: _____________
- Dextroamphetamine
- amphetamine
- Methylphenidate – daytrana, metadate CD, Ritalin (LA), concerta, Ritalin SR, methylin ER, metadate ER
stimulants (for ADHD)
treatment for Tic disorders
- Behavioral
- Relaxation
- DBS
- Medications =
- antipsychotics
- clonidine (HTN med)
- klonopin (benzo)
- fluoxetine and sertraline (SSRI)
- When anxiety increases, tics __crease
treatment for Tic disorders
- Behavioral
- Relaxation
- Medications – antipsychotics, clonidine, klonopin, fluoxetine, and sertraline
- DBS
- When anxiety increases, tics increase
Neurodevelopmental disorders: Motor disorders (Developmental coordination d/o, Tic d/o, Stereotypic movement d/o)
_____________
- Impairments in motor skill development
- Coordination is below the child’s developmental age
_____________
- Repetitive, purposeless movements for 4 or more weeks
________
Tourette’s d/o persistent = more than 1 yr
Tourette’s d/o provisional = less than 1 yr
- sudden non rhythmic and rapid motor movements or vocalizations
Motor disorders
Developmental coordination disorders
- Impairments in motor skill development
- Coordination is below the child’s developmental age
Stereotypic movement disorder
- Repetitive, purposeless movements for 4 or more weeks
Tic disorders (Tourette’s d/o, persistent = more than 1 yr, provisional = less than 1 yr)
- sudden non rhythmic and rapid motor movements or vocalizations
- When anxiety increases, tics increase
Pharmacological Treatment for ADHD: Non-stimulants
Atomoxetine – SNRI
- not used as often as _______
- ____ therapeutic response
- kids over 6 year
- helpful for ADHD + anxiety
Bupropion – NDRI
Clonidine
- alone or combo with stimulant
- helpful for ADHD + ____
Guanfacine
Imipramine - TCA
Pharmacological Treatment for ADHD: Non-stimulants
Atomoxetine – SNRI
- not used as often as stimulants
- slow therapeutic response
- kids over 6 year
- helpful for ADHD + anxiety
Bupropion – NDRI
Clonidine
- alone or combo with stimulant
- helpful for ADHD + tics
Guanfacine
Imipramine - TCA
Manifestations: Childhood and neurodevelopmental disorders
- All behavior has meaning
- Address the ______ behind the behavior
- Children want to behave and please those who they care about
- Difficulty communicating their needs
- All behavior has meaning
- Address the issue behind the behavior
- Children want to behave and please those who they care about
- Difficulty communicating their needs
clinical manifestations: _________
- Actual, persistent, and distressing physical symptoms (pain, fatigue, digestive issues, etc.) that cause significant anxiety.
- Often without a clear medical cause.
- Preoccupation with health, with excessive time and energy devoted to symptoms
individual impact:
- chronic anxiety and worry about health, interfering with daily life.
- Frequent doctor visits and unnecessary medical tests, leading to a high emotional and financial burden.
- Impaired social and occupational functioning due to health concerns
somatic Symptom
Disorder (SSD)
Childhood and neurodevelopmental disorders:
Resiliency
- Adapt to change/adversity
- Inner strength
- Healthy coping strategies
- Function amid strong emotions
- Reach out for help
- From nurturing relationships with other adults when parent is unavailable
Protective factors (promote mental health by increasing ______)
- Positive self image
- Family cohesion and absence of discord
- Positive relationship with parent(s)
- Positive early family experiences
- Support
- Academic achievement
- Positive peer relationships
- Temperament
Resiliency
- Adapt to change/adversity
- Inner strength
- Healthy coping strategies
- Function amid strong emotions
- Reach out for help
- From nurturing relationships with other adults when parent is unavailable
Protective factors (promote mental health by increasing resilience)
- Positive self image
- Family cohesion and absence of discord
- Positive relationship with parent(s)
- Positive early family experiences
- Support
- Academic achievement
- Positive peer relationships
- Temperament
Factitious disorder vs malingering
_________ symptom presentations are motivated by external incentives (secondary gain)
_________ symptom presentations are motivated by internal incentives (primary gain), such as seeking nurturance and sympathy for being ill;
- this has also been referred to as the need to “assume the sick role”
malingering symptom presentations are motivated by external incentives (secondary gain)
factitious disorder symptom presentations are motivated by internal incentives (primary gain), such as seeking nurturance and sympathy for being ill;
- this has also been referred to as the need to “assume the sick role”
Pharmacological Treatment for ADHD: Stimulants
_____ acting stimulants
- Dextroamphetamine/amphetamine
- Methylphenidate – daytrana, metadate CD, Ritalin (LA), concerta
________ acting stimulants
- Dextroamphetamine
- Methylphenidate – Ritalin SR, methylin ER, metadate ER
______ acting stimulants
- Methylphenidate – Ritalin
- Dextroamphetamine
- Amphetamine sulfate
Long acting stimulants
- Dextroamphetamine/amphetamine
- Methylphenidate – daytrana, metadate CD, Ritalin (LA), concerta
Intermediate acting stimulants
- Dextroamphetamine
- Methylphenidate – Ritalin SR, methylin ER, metadate ER
Short acting stimulants
- Methylphenidate – Ritalin
- Dextroamphetamine
- Amphetamine sulfate
Interview process:
Preschool children – have difficulty putting feelings into words, thinking concretely
- Use ______
- Conduct assessment in playroom
School-aged children – able to use constructs and provide longer explanations
- Establish rapport through competitive ______
Adolescents – egocentric, increased self consciousness, fear of being shamed
- Let them know what information will be shared with parents
- Direct candid approach
Interview process
Preschool children – have difficulty putting feelings into words, thinking concretely
- Use play
- Conduct assessment in playroom
School-aged children – able to use constructs and provide longer explanations
- Establish rapport through competitive games
Adolescents – egocentric, increased self consciousness, fear of being shamed
- Let them know what information will be shared with parents
- Direct candid approach
Interventions: play therapy
- Older or younger children?
- “language” of child
- Helps express _______, build trust and relationship, and acts as a vehicle for change
- Can it be standardized?
Interventions: play therapy
- Younger children
- “language” of child
- Helps express feelings, build trust and relationship, and acts as a vehicle for change
- NO - Cant be standardized
Impulse control disorders
Nursing care
- Safety
- Rapport
- Set limits and expectations
- Follow through with consequences
- Structure and boundaries
- Sense of purpose
Interventions
- Family impact
- Safe environment - Talk separately to family
- Realistic behavior goals
- Role play with parents to teach behavior modification
- Support
- Education on meds
- Resources
- Advocate
0
Which childhood disorders occur most frequently (4)
Effects of childhood mental illness
- Long term mental d/o as ______
- Thwarted development
- Diminished productivity
- Conflict with family/friends
- Child welfare involvement
- Juvenile justice involvement
- Special ed
- Physical health impairments
- ADHD
- Mood d/o
- MDD
- Conduct d/o
Effects of childhood mental illness
- Long term mental d/o as adults
- Thwarted development
- Diminished productivity
- Conflict with family/friends
- Child welfare involvement
- Juvenile justice involvement
- Special ed
- Physical health impairments
Impulse control disorders (Oppositional defiant disorder, Intermittent explosive disorder, Conduct disorder)
Risk factors
- Genetics, family hx
- Neurobiological
- Environment, ACE
- Temperament
Risk factors
- Neurobiological
- Violence in family
Risk factors
- Abuse
- Inconsistent parenting with harsh discipline
- Lack of supervision
- Early age of institutional living
- Delinquent peers
- Parental SUD
- Biologic
Oppositional defiant disorder
Intermittent explosive disorder
Conduct disorder
Neurodevelopmental disorders: Communication disorders (language vs speech d/o)
_______ disorders
- Problems making sounds
________ disorders (expressive language d/o, social communication d/o)
- Problems understanding or using words appropriately
- May be evident by inability to follow directions
Speech disorders
- Problems making sounds
Language disorders (expressive language d/o, social communication d/o)
- Problems understanding or using words appropriately
- May be evident by inability to follow directions
