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184 Cards in this Set
- Front
- Back
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what are some psychiatric disorders diagnosed in childhood or adolescents
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Mental retardation
Learning disorders Motor skills disorders Communication disorders Pervasive developmental disorders Attention deficit and disruptive behavior disorders Feeding and eating disorders of infancy or early childhood Tic disorders Elimination disorders Other disorders |
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what are some developmental disorders
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Mental retardation
Pervasive developmental disorders Specific developmental disorders |
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what is a common feature of specific developmental disorders
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significant delay in one or more lines of development
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what is mental retardation
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Significantly below-average intelligence accompanied by impaired adaptive functioning
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what are the types of mental retardation
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Mild
Moderate Severe Profound |
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how is mental retardation diagnosed
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through clinical assessment of behaviors, history, and performance on standardized tests
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what is the nursing assessment for mental retardation
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Current adaptive skills
Intellectual status Social functioning Compared with normal growth and development |
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what are the nursing diagnosis for mental retardation
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Ineffective coping
Delayed growth and development Interrupted family processes |
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what are the nursing interventions for mental retardation
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Promoting coping skills
Patient education Parent education |
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what are pervasive developmental disorders
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Autistic disorder
Asperger’s disorder |
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what is aspergers disorder
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May or may not be mentally retarded
Uneven pattern of intellectual strengths and weaknesses |
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what are the lifelong patterns of asperger's
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Being rigid in style
Intolerant of change Behavioral outbursts in response to environmental demands or changes in routine |
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when is the onset of autism
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Early onset: before 30 months
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what is autism
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Disturbance in social relations
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what are the manifestations of autism
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Marked impairment of development in social interaction and communication
Delayed and deviant language, or concrete thinking Pronoun reversals and abnormal intonation Stereotypic behavior |
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what are some stereotypical behaviors of autism
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Repetitive rocking
Hand flapping Insistence on sameness Self-injurious behavior |
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what is the cause of autism
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Cause unknown
Genetics Perinatal insult Increased platelet serotonin, excessive dopaminergic activity, alteration in opioids |
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what are the meds or autism
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Antipsychotics: behavior
Methylphenidate (Ritalin): inattention, impulsivity, and overactivity Opioid antagonist: naltrexone for activity level and attention Clonidine: reduces hyperactivity, self-stimulation, and irritability Buspirone and trazodone: reduce agitation |
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what is aspergers
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Severe and sustained impairment in social interaction and restricted, repetitive patterns of behavior, interests, and activities
-not associated with mental retardation |
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what are the social deficits of aspergers
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Severe and sustained impairment in social interaction and restricted, repetitive patterns of behavior, interests, and activities
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what is the biological domain of the nursing assessment for pervasive developmental disorders
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Physical health and neurologic status
Eating and sleep patterns Co-morbid disorders (seizures in autism/depression in Asperger’s) Current medication |
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what are the nursing diagnosis for the biological domain for pervasive disorders
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Self-care deficits
Impaired verbal communication Disturbed sensory perceptions Delayed growth and development Disturbed sleep pattern |
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what are the nursing interventions for the biological domain of pervasive disorders
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Teaching self-care skills
Adapted to child’s adaptive skills and language limitations List of activities posted in bedroom Drawings for nonverbal children Medications |
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what is the nursing assessment for the psychological domain of pervasive disorders
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Intellectual ability
Communication skills Adaptive functioning |
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what are the nursing diagnosis for the psychological domain of pervasive disorders
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Anxiety
Disturbed thought process |
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what are the nursing interventions for the psychological domain of pervasive disorders
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Need specific behavioral interventions that are based on careful evaluation
Management of repetitive behaviors Depends on consequences of specific behavior May be ignored (i.e., rocking) Redirecting, using positive reinforcement (i.e., head banging) Environmental alterations Protective headgear |
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what is the nursing assessment for the social domain of pervasive disorders
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Review of child’s capacity for self-care, self-injury, and aggression
Impact of developmental delays on family |
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what are the nursing diagnosis for the social domain of pervasive disorders
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Social isolation
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what are the nursing interventions for the social domain of pervasive disorders
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Promoting interaction
Ensuring predictability and safety Managing behavior Supporting family |
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what are the types of specific developmental disorder
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communication disorder
learning disorder |
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what is a learning disorder
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discrepancy between actual achievement and expected achievement
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what are the types of learning disorders
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Verbal (reading and spelling)
Nonverbal (mathematics |
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what are the types of communication disorders
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Speech
Language |
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what is the assessment for specific developmental disorders
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Evidence of disorder
Ability to communicate Child’s perception of disability Observation for impaired learning and communication Past and current interventions |
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what are the diagnosis for specific developmental disorders
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Impaired verbal communication
Social isolation |
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what are the interventions for specific developmental disorders
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Foster social and communication skills
Refer for speech and language therapy |
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what are the types of disruptive behavior disorders
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Attention deficit/hyperactivity disorder
Oppositional defiant disorder Conduct disorder |
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what is conduct disorder marked by
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significant problems of conduct
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what is ADHD
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Persistent pattern of inattention, hyperactivity, and impulsiveness that is pervasive and inappropriate for developmental level
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what are the types of ADHD
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Hyperactive type
Inattentive type Combined type |
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what are the causes of ADHD
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Biologic factors(heredity is most common identifiable factor)
Genetics Frontal lobe functioning Psychosocial influences Family stress and marital discord Poverty Overcrowded living conditions Family dysfunction |
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what is the nursing assessment for the biological domain of ADHD
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Collection of data through direct observation, observing child and parent, and teacher ratings
Developmental history Medical history Eating, sleeping, and activity patterns |
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what are the nursing diagnosis for the biological domain of ADHD
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Self-care deficit
Risk for imbalanced nutrition Risk for injury Disturbed sleep pattern |
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what are the nursing interventions for the biological domain of ADHD
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Planning within the context of the family, treatment setting, and school
Medication management Stimulants |
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what is the nursing assessment for the psychological domain of ADHD
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Hyperactivity
Impulsivity Inattention Discipline issues |
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what are the nursing diagnosis for the psychological domain of ADHD
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Anxiety
Defensive coping |
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what are the nursing interventions for the psychological domain of ADHD
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Behavioral interventions
Cognitive behavioral techniques Child will respond positively to rewards and not to punishment Establish/maintain predictable environment with decreased stimuli Promote attention by maintaining a calm environment with few stimuli Establish eye contact before giving directions; ask to repeat what was heard Encourage child to do homework in a quiet place Encourage one assignment at a time |
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what is the nursing assessment for the social domain of ADHD
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Review the family situation
Assess school performance |
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what are the nursing diagnosis for the social domain of ADHD
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Impaired social interaction
Ineffective role performance Compromised family coping |
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what are the nursing interventions for the social domain of ADHD
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Family treatment
School programming Specific remediation for co-morbid deficits in learning or language |
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what is oppositional defiant disorder
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Disobedience
Argumentativeness Angry outbursts Low frustration tolerance Tendency to blame others |
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what is conduct disorder
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Serious violations of social norms
Aggressive behavior Destruction of property Cruelty to animals |
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what is the nursing assessment for the biological domain of oppositional defiant disorder
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Physical injury
Sexual promiscuity Co-morbid conditions |
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what are the nursing diagnosis for the biological domain of oppositional defiant disorder
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Risk for other-directed violence
Risk for self-directed violence Impaired verbal communication |
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what are the nursing interventions for the biological domain of oppositional defiant disorder
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Remediation programs
Medications Antipsychotics Anticonvulsants Antimanics |
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what is the nursing assessment for the psychological domain of oppositional defiant disorder
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Inconsistencies, distortions, and misrepresentations of truth
Use of defense mechanisms |
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what are the nursing diagnosis for the psychological domain of oppositional defiant disorder
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Ineffective coping
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what are the nursing interventions for the psychological domain of oppositional defiant disorder
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Increase personal responsibility for behavior
Increase use of problem-solving skills Decrease rule violations Social skills training Problem-solving therapy |
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what is the nursing assessment for the social domain of oppositional defiant disorder
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Marital conflict
Parental substance abuse Parental antisocial behavio |
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what are the nursing diagnosis for the social domain of oppositional defiant disorder
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Compromised family coping
Impaired social interaction |
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what are the nursing interventions for the social domain of oppositional defiant disorder
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Clarify parental expectations
Parent management training Family therapy |
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what are disorders of mood and anxiety
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Anxiety disorders
Separation anxiety disorder Obsessive-compulsive disorder Major depressive disorder |
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what is separation anxiety disorder
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Suffer great distress when faced with ordinary separations from major attachment figures
School phobia |
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what is the treatment for separation anxiety
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Return to school as soon as possible
Individual psychotherapy Behavior therapy Flooding and desensitization Antidepressants |
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what is OCD
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Intrusive thoughts and/or ritualized behaviors
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what is the onset of OCD
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reported onset in childhood
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what is the treatment of OCD
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Medications
Behavior therapy: exposure and response prevention Cognitive behavioral therapy |
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what are the assessment findings for major depressive disorder
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Less spontaneous expression of sadness and worthlessness
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what are the interventions for major depressive disorder
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Antidepressants
Psychotherapy |
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what is the assessment for tic and tourette disorders
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History of disorder
Current level of symptoms Effects of symptoms on child and family |
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what are the nursing diagnosis for tic and tourette disorders
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Ineffective coping
Impaired social interaction Anxiety Compromised family coping |
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what are the interventions for tic and tourette disorders
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Counseling and education for patient
Individual psychotherapy Education for parents Consultation for schools |
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how is childhood schizophrenia diagnosed
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Diagnosed by same criteria as in adults
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what is different about the onset of schizophrenia in children then adults
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Poorer pre-morbid functioning than adult onset
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what is the treatment for childhood schizophrenia
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Nursing care similar to PDD
Antipsychotics Parent education |
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what are elimination disorders
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Enuresis
Encopresis |
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what is enuresis
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Involuntary excretion of urination after an age of attainment of bladder control
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what are the interventions for enuresis
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Limit fluid intake in evening
Pharmacologic interventions Behavioral interventions: pad, buzzer |
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what is encopresis
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Soiling clothing with feces or depositing feces in inappropriate places
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what are the interventions for encopresis
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Education and behavioral interventions
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how is the assessment process for mental health disorders in children different then adults
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Children need simple phrases (more concrete)
Corroborate information with adult Direct questions, rather than open-ended May use play media May not be able to provide accurate time |
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what is done in the comprehensive evaluation
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Biopsychosocial history
Mental status examination Additional testing as needed Records of school performance and medical–physical history Information from other agencies |
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what is the primary tool of data collection
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Clinical interview
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what does data collection depend on
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developmental level of each child
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what should you establish in the interview
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treatment alliance
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what should you assess in the clinical interview
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Assess interactions between child and parent
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how should you interview the child and the parent
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Interview parent and child separately- each may give accurate information about different things.
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what are some considerations for pre-school children
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have difficulty putting feelings into words, thinking concretely
Use play; conduct assessment in play room |
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what are some considerations for school aged children
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: able to use constructs, provide longer explanations
Establish rapport through competitive games |
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what are some considerations for adolescents
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are egocentric; have increased self-consciousness, fear of being shamed
Let them know what information will be shared with parents; direct, candid approach |
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what are the attachment theories
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Infants tend to bond to one primary parental figure, usually the mother
Fathers’ emotional support tends to enhance the quality of mother–child relationships and facilitates positive adjustment by children Child–mother attachment associated with perceived self-worth and physical appearance Child–father attachment associated with child-perceived school competence |
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what is easy temperament
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positive mood, regular patterns, positive approaches, low emotional intensity
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what is difficult temperament
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irregular patterns, negative responses to new stimuli, slow adaptation, negative mood and high emotional intensity
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what is slow to warm up temperament
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negative, mildly emotional response to new situations, but adaptation evolves
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what is the risk assessment for children
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Ask straightforward questions
Have you thought about hurting yourself? Have you ever acted on these thoughts? How would you hurt yourself? What do you think would happen? Have you ever hurt yourself? |
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what must be done if the child has suicide thoughts or thoughts to harm others
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it must be shared with parents
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what is the nursing assessment for the social domain of children with mental health disorders
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Family relationship
School and peer adjustment Community Religious and spiritual assessment Functional status Stresses and coping behaviors Evaluation of childhood sexual abuse |
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what is the onset of anorexia
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early adolescence typically between 14 and 16 years
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what is anorexia
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Chronic condition with relapses characterized by significant weight loss
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what is often seen in anorexia
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Often continue to be preoccupied with food
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what is the outcome of anorexia
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Poor outcome related to initial lower minimum weight, presence of purging, and later age of onset
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what is the diagnostic criteria for anorexia
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Refusal to maintain body weight
Intense fear of gaining weight Disturbance in body image Perfectionism Weight loss of 25 pounds and absence of menses for at least 3 consecutive months or periods Restricting and/or purging |
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what is body image
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discrepancy between self-perception and others
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what is the drive for thinness
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an intense physical and emotional process that overrides all physiologic body cues, such as hunger and weakness
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what is Impaired interoceptive awareness
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sensory response to emotional and visceral cues, such as hunger
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what is anorexia co-morbid with
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depression and anxiety disorders
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what are the biologic theories for anorexia
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Neuropathologic theories
Genetic theories Biochemical theories |
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what are the causes of anorexia
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biologic theories
psychological theories social theories |
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what are the psychological theories of anorexia
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Interference with separation, individuation and autonomy
Families rigid, enmeshed, over-protective |
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what are the risk factors for anorexia
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Biologic
Psychological Sociocultural Family Concurrent disorders Sexual abuse |
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what are the goals of interdisciplinary treatments for anorexia
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Initiating nutritional rehabilitation
Resolving conflicts around body image disturbance Increasing effective coping Addressing underlying conflicts Assisting family with healthy functioning and communication |
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what are the treatment modalities for anorexia
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Hospitalization usually necessary
Intensive therapies |
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what is the pharmocological treatment of anorexia
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use of SSRIs controversial
Target symptoms of obsessiveness, ritualistic behaviors, and perfectionism |
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what are priority cares in anorexia
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Mortality and substance abuse
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what are dermatological complications of eating disorders
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Dry skin
Lanugo-like hair Alopecia Brittle nails Pale skin Cyanosis |
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what are cardiac complications of eating disorders
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Low heart rate 30-40 beats per minute common
Low BP Decrease in heart size CHF MI Arrhythmias Death |
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what are respiratory complications of eating disorders
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Decrease in breaths per minute
Decrease in respiratory muscle tone |
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what are GI complications of eating disorders
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Delayed gastric emptying
Bloating Constipation Abdominal pain Gas Diarrhea |
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what are musculoskeletal complications of eating disorders
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Loss of muscle mass
Loss of fat Osteoporosis Pathologic fractures |
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what are hematologic complications of eating disorders
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Leukopenia
Anemia Thrombocytopenia Hypercholesterolemia Hypercarotonemia |
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what are neuropsychiatric complications of eating disorders
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Abnormal taste sensation
Apathetic depression Mild organic mental sx Sleep disturbances |
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what is the nursing management of eating disorders
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Therapeutic relationship
Use firm, accepting, and patient approach Provide a rationale for all interventions Avoid power struggles over eating |
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what is the nursing assessment of the biological domain of eating disorders
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Evaluation of systems-lots of labs, EKG, thorough physical assessment
Careful history (patient and family)-include how long any sx have gone on- fasting, avoiding meals, overexercising, etc. Most are restrictors, but some purge- want to know about that as well, as body systems can be affected. Determine weight with BMI (less than 85% of ideal |
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what are the nursing diagnosis of the biological domain of eating disorders
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Imbalanced nutrition: less than body requirements
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what are the nursing interventions of the biological domain of eating disorders
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Refeeding
Strict monitoring and recording of intake Weight-increasing protocols (usually a behavioral plan with positive and negative reinforcements) Structured, healthy sleep routine Exercise is generally not permitted during refeeding Any exercise needs to be monitored Mirtazapine (Remeron) is sometimes used because it has a tendency to quickly add weight |
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what is the nursing assessment of the biological domain of psychological disorders
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Body distortion
Fear of weight gain Unrealistic expectations and thinking Ritualistic behaviors Difficulty expressing negative feelings Inability to experience visceral cues and emotions |
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what are the nursing diagnosis of the psychological domain of eating disorders
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Anxiety
Disturbed body image |
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how should you do refeeding
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Calorie calculation
25-35 kcl x current weight Increase calories by 200-300 kcl every 2-3 days (1-2 lb gain/week) Fluid intake of at least 1500cc/day Daily weights |
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what is refeeding syndrome
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Greatest risk of cardiac complication is within the 1st two weeks of refeeding
The myocardium is less able to withstand the stress of increased metabolic demands because left ventricular mass and contractility have been reduced hypophosphatemia electrolyte imbalance |
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what does Hypophosphatemia cause
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decreased cardiac stroke volume
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what are the nursing interventions for the psychological domain of eating disorders
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Understanding feelings
Restructuring responses to challenge cognitive distortion Movement and dance therapy Imagery and relaxation Interpersonal therapy Focus on role transitions, control, and ineffective feelings Change distortions about food and interactions with others Patient education Clarify misinformation about food |
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what is the nursing assessment for the social domain of eating disorders
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School attendance
Family interaction |
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what are the nursing diagnosis for the social domain of eating disorders
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Ineffective coping
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what are the nursing interventions for the social domain of eating disorders
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Facilitate transition to school
Family therapy Family education |
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what is the continuum of care for anorexia
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Hospitalization
Emergency care Family assessment and intervention Outpatient treatment |
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how do you prevent anorxeria
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McKnight Risk Factor Survey
National eating disorder awareness and advocacy groups Strategies for parents and schoolteachers |
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what is bulimia
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Recurrent episodes of binge eating
Generally not life-threatening |
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who is bulimia present in
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Present as overwhelmed and overly committed individuals who have difficulty setting limits and establishing boundaries
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what is the treatment for bulimia
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Treatment is outpatient therapy
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what is binge eating
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Rapid, episodic, impulsive, and uncontrollable ingestion of large amounts of food over a short period of time (1 to 2 hours)
Eating followed by guilt, remorse, and severe dieting |
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what is dietary restraint
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Restricting intake is believed to explain the relationship between dieting and binge behavior
Restraining intake is predictive of overeating |
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what are the metabolic complications of bulimia
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Electrolyte abnormalities
Particularly hypokalemia and hypomagnesemia Elevated BUN |
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what are GI complications of bulimia
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Salivary gland enlargement
Pancreatic inflammation with elevated serum amylase Esophageal irritation Gastric erosion |
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what are dental complications of bulimia
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Erosion of dental enamel
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what are neuropsychiatric complications of bulimia
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Seizures
Mild neuropathies Fatigue Weakness Mild organic mental sx |
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what are the lab abnormalities of bulimia
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RBCs—low
Hgb and Hct elevated due to hemoconcentration WBCs—low Na, K, Cl—low in purging, diuretic, or laxative use Serum glucose—low |
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what is the clinical course of bulimia
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Few outward signs
Binge and purge in secret Treatment often delayed for years Treatment initiated when control of eating is lost or when someone else insists on treatment. |
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what is restricting bulimia
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Similar to anorexia nervosa
Restricting is followed by binge eating, which is then followed by another period of restricting |
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what is purging bulimia
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Recurrent episodes of binge eating and compensatory purging in the form of vomiting or using laxatives, diuretics, or emetics, fasting or overexercising
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how long must restricting and purging episodes last
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These episodes must occur at least twice a week for a period of at least 3 months
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what is the onset of bulimia
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Onset is between 18-24 years (older than anorexia nervosa)
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what are the co-morbid conditions of bulimia
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substance abuse and dependence, depression, and OCD
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what are the biological theories of bulimia
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Neuropathologic
Genetic and familial predispositions Biochemical |
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what are the psychological and social theories of bulimia
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Cognitive theory
Family |
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what are the goals of bulimia treatment
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Stabilizing and normalizing eating
Restructuring dysfunctional thoughts and attitudes Teaching healthy boundary setting Resolving conflicts about separation-individuation |
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what is the Multifaceted approach
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Cognitive behavioral therapy (CBT)
Pharmacologic: SSRIs Nutrition counseling |
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what are the priority care issues of bulimia
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Co-morbid depression and suicide
Risk for self-mutilation Impulsive behavior (shoplifting, overspending, etc.) |
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what is the nursing assessment of the biological domain for bulimia
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Current eating patterns
Number of times a day of binging and purging, what is used Dietary restraint practices Sleep patterns Exercise habits |
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what are the nursing diagnosis of the biological domain for bulimia
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Imbalanced nutrition: less than body requirements
Disturbed sleep pattern |
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what are the nursing interventions of the biological domain for bulimia
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Strictly monitor food intake
Adequate fluid intake and exercise (abrupt cessation of laxatives will cause constipation) Bathroom visits should be supervised Encourage regular sleep patterns CBT Pharmacologic interventions SSRIs Monitoring and administration of medication |
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what is the nursing assessment of the psychological domain for bulimia
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Cognitive distortions
Knowledge deficits Body dissatisfaction Impulsivity |
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what are the nursing diagnosis of the psychological domain for bulimia
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Deficient knowledge
Disturbed thought processes Powerlessness |
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what are the nursing interventions of the psychological domain for bulimia
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CBT and IPT
Behavioral techniques Cue elimination Self-monitoring Psychoeducation Setting boundaries and healthy limits Developing assertiveness Learning nutritional concepts related to healthy eating Clarifying misconceptions about food Group therapy Concentrate on interpersonal issues Understand the binge–purge cycle |
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how do you prevent bulimia
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Requires effort on the part of teachers, school nurses, parents, and society as a whole
Educate school nurses and teachers in elementary schools Emphasize protective factors that mediate between risk factors and the development of an eating disorder |
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when are children more likely to be mentally healthy
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healthy if they have normal physical and psychosocial development
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what does easy temperament allow
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adaptation to change
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what does secure attachment prohibit
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fear of rejection
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what are some common childhood problems
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Death and grieving
Separation and divorce Sibling relationships Physical illness Adolescent risk-taking behaviors |
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how do pre-school children deal with death
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React more to others’ responses than to death itself
Need reassurance that they will be cared for Avoid euphemisms (e.g., “he went to sleep”) |
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how do school aged children deal with death
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Unable to express feelings in a grownup way
Express grief through somatic complaints, regression, behavior problems, withdrawal, hostility |
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how do adolescents deal with death
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Understand death as an abstract concept
May have a romantic idea of death If parent, may assume parental role |
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what does divorce cause
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changes in family structure
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what are children at risk for with divorce
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Children are at increased risk for emotional, behavioral, and academic problems
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what is the most difficult time after divorce
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First 2 or 3 years after marital breakup tend to be the most difficult
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what are protective factors for divorce
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Structured home and school environment
Education Regular and predictable visitations Reduction of conflict between parents Continuance of usual routines Limit-setting Family counseling |
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what do sibling relationships affect
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personality development
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what can positive sibling relationships be
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protective factors against the development of psychopathology
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Children with emotionally disturbed siblings are at increased risk for what
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emotional problems
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what influences families ability to cope with physical illness
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Perception of an event
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what is chronic physical illness linked to
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emotional/behavioral problems
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what are some common childhood reactions to physical illness
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Regression
Sleep and feeding difficulties Behavioral problems Somatic complaints Depression |
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what are some interventions for adolescent risk taking behaviors
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Intervene at peer level, educational programs
Alternative recreation activities Peer counseling |
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what are some risk factors for psychopathology
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Poverty and homelessness
Increased risk for physical health problems, mental health problems, and educational underachievement Child abuse and neglect Family stress, drug/alcohol abuse, unstable parent, lack of social support Out-of-home placement Coping styles may be detachment, rage, depression, antisocial behavior, low self-esteem, chronic dependency Substance-abusing families Poor school performance, emotional problems |
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what is resilience
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is phenomenon by which some children at risk for psychopathology yet attain good mental health, maintain hope, and achieve healthy outcomes- due to genetic and/or experiential circumstances
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