Week 7: Early childhood Part 2

Question 1

true or false: disorders in children are often noticed first by a parent or well child check up

Answer 1

true

Question 2

is nursing care directed at
parent support
appropriate referral to services/supports/allied health or other clinicians
effective communication and documentation

Answer 2

yessss of course munch

Question 3

what is an asd and what is it defined as?

Answer 3

asd = autism spectrum disorder and is defined as a complex neurodevelopment disorder with unknown etiology

Question 4

what is this describing? Characterized by deficits in social interactions and communication, unusual behaviours (e.g. Fixed interests, inflexibility, repetitive behaviours and/or unusual sensory responses).

Answer 4

autism spectrum disorder

Question 5

what is one of the hallmarks of asd?

Answer 5

failure of social interaction
communication development

Question 6

true of false regarding asd: Common core deficits are noted primarily in social interactions. (e.g., abnormal eye contact, decreased response to own name, decreased imitation)

Answer 6

true

Question 7

what is autism regression?

Answer 7

normal development followed by sudden regression frequently displayed in expressive language.

Question 8

what are some nursing care management for asd?

Answer 8

Providing a structured routine for the child is critical
If hospitalized, parents are essential to planning care and, ideally, should be present as much as possible.

Question 9

should a nurse be doing this with a patient diagnosed with asd? Decreasing stimulation by using a private room, avoiding extraneous auditory and visual distractions, and encouraging the parents to bring in possessions the child is attached to may lessen the disruptiveness of hospitalization.

Answer 9

TRUE

Question 10

true or false regarding ASD:
Children with ASD must be introduced quickly to new situations, with visits with staff caregivers kept short whenever possible.

Answer 10

false; slowly

Question 11

what are some next steps for a diagnosis of ASD?

Answer 11

Any child who does not display language skills such as babbling or gesturing by 12 months old, single words by 16 months old, and two-word phrases by 24 months old is recommended for hearing and language evaluation.

Assessment of communication by a registered speech and language pathologist

Mental health providers assess family dynamics, ability to cope, how dynamics can contribute to symptom aggravation and evaluate for co-existing disorders (e.g ADHD)

Physician for any underlying medical issue and,

Occupational therapists (OT) assess for tactile sensitivities and challenges in daily living (e.g dressing, eating and bathing)

Question 12

what is Tourette syndrome?

Answer 12

A complex TIC disorder characterized by multiform, involuntary motor and vocal tics. (Tourette Syndrome Foundation of Canada, 2006).

Question 13

is Tourette syndrome acute or chronic?

Answer 13

chronic

Question 14

does genetic play a role in Tourettes?

Answer 14

yes it is generally transferred

Question 15

is tourettes neurological or neurochemical?

Answer 15

it can be either or

Question 16

how nursing care and management affects Tourettes?

Answer 16

no diagnostic test
criteria: presence of more than 2 motor tics and 1 or more phonic tics
ex. Limb jerking, frowning, abdominal tensing, lip pouting. Sucking sounds, barking, coughing or grunting

Nurse’s role is to document parents’ description of child’s behaviour including type of tic(s), duration in months, times per day demonstrated and any other symptoms are present

“Automatic Suppression”

Question 17

what are some next steps with a child that has Tourettes?

Answer 17

family support
normal intelligence
Tics are worst during puberty and lessen over time

Tourette Syndrome is chronic but not degenerative
Referrals – neuro, OT, SLP
Treatments – meds., cognitive behavioural therapy, psychotherapy

Question 18

select all that is true regarding Obsessive compulsive disorder
- 50% diagnosed in childhood adolescence
2/3 of children who have TS also have OCD
Includes “rituals” or “compulsions” e.g step back and forth three time before crossing a doorway and “obsessions” e.g unwanted, intrusive thoughts

Answer 18

all true!!

Question 19

what are some of the characteristics of obsessive compulsive disorder?

Answer 19

Checking, counting, hand washing, symmetry or exactness, collecting and “looping” or “being stuck”
Can make children appear defensive, negative or “needy”

Question 20

what are some nursing care and management with OCD?

Answer 20

Families of pediatric patients with OCD may have high levels of anxiety. Can create a vicious cycle and exacerbate the child’s condition.

Nursing role is to perform history and physical including:
* Parents account of concerning behaviour
* Any other co-morbidities including TS, ASD or mental health disorder in families and child
* Developmental delays observable or noted by caregivers or teachers

Question 21

what are some patterns of adversity? what are the risk factors?

Answer 21

• Neglect (34%)
• Exposure to intimate
  partner violence (34%)
• Physical abuse (20%)
• Emotional maltreatment (9%)
• Sexual abuse (3%)

risk factors:
* Sociocultural Factors
* Characteristics of the
Child
* Characteristics of the Abuser
* Household Stressors

Question 22

true or false: Childhood stressors, ranging from day-to-day maltreatment of traumatic events, that increase the risk of wide-ranging, negative health and social consequences over the life course

Answer 22

true

Question 23

what is neglect?

Answer 23

Can lead to physical and chemical disruptions in the brain that can last a lifetime

Associated with wider range of damage than active abuse but receives less public attention, policy or practice

Question 24

true of false: Neglect can disrupt emotions, cognition and behaviour

Answer 24

true

Question 25

what are some risk of neglect?

Answer 25

significant risk of emotional and interpersonal difficulties
and risk for learning difficulties, poor school achievement

Question 26

true or false regrading neglect:
Intervention needs to be appropriate and timely to reverse or reduce the negative consequences

Merely removing a child from neglect does not guarantee positive outcomes

Therapeutic intervention and highly supportive care is needed to mitigate adverse effects and assist with recovery

Children in these environments need to have their safety, control and predictability restored

Answer 26

all true

Question 27

what is adverse childhood experiences?

Answer 27

No single factor contributes, but rather the presence of multiple variables increases chances

Question 28

what are the outcomes of adverse childhood experiences ?

Answer 28

Exposure effect: the degree of intensity and duration of a stressor is
related to the intensity of the response

Toxic stress response: persistently elevated physiological arousal caused by strong, recurring, and/or unabated adversity

Question 29

how can you prevent ACEs?

Answer 29

starts with education
identification of at risk families
vigorous enforcement of existing child abuse laws
reporting of abuse is MANDATORY in all provinces and territories