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102 Cards in this Set
- Front
- Back
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What percentage of children have an emotional problem and what percent get care for that problem?
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12-22% of children have an emotional problem and only a fraction get help.
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What are some theories about why children have emotional problems?
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Genetic
Biochemical Temperament Social and environmental factors Cultural and ethnic factors Resiliency |
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At an early age what sort of things can be identified to see if a child has a emotional disorder?
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Verbal threats or social isolation
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What are 6 risk that can be identified that could lead to emotional problems in children?
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poverty, minority status, homelessness, severe caregiver conflicts or divorce, caregiver's mental status, substance abuse, chronic illness or disability of caregiver.
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How do some children have many of the risk factors and still are mentally healthy? (5 resilient characteristics)
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temperament- adaptable, form other nurturing relationships, distance self from family chaos, good social intelligence, ability to problem solve,
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What is important to keep in mind when doing an assessment of children and adolescents?
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need to know what is developmentally appropriate
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During the interview process what does the nurse need to do mostly?
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listen and observe
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What other assessment data is important to assess for in children?
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important to assess maturation age vs chronological age, illness, medical and family history.
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What is autism?
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Impairment in verbal and nonverbal communication, social interactions, imaginary thinking and non normal development, it is very rare and more common in males
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What is known about the etiology of autism?
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Cause is unknown, is abnormal brain function in left hemisphere.
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What are the symptoms associated with autism?
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abnormal speech patterns, unable to carry a conversation, LACK OF EMPATHY, oblivious of feelings of others, lack sense of attachment, need a routine
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What type of activities are important to encourage with autistic kids?
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social skills, emotional responses, language development, ADL's self concept, self control,
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What does ADD stand for?
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Attention deficit disorder
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What is ADD?
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persistent pattern of inattention, with or without hyperactivity, developmentally inappropriate
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What are symptoms seen for a child at the preschool age who has ADD?
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excessive gross motor activity
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What are symptoms seen for a child at the school age who has ADD?
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fidgety, restlessness, talkativeness, impulsive, difficulty completing task,
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What are some other symptoms for ADD?
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low frustration tolerance, temper outburst, poor school performance, difficulty with peers and low self esteem,
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what is the etiology for ADD? what drug is given to correct the problem?
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reduce blood flow in striatal region of the brain
methylphenidate (Ritalin) improves blood flow and improves behavior |
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What interventions are focused on for all disruptive behavioral disorders?
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keep safe, developing trusting relationships, self-control, cognitive skills, self esteem, education and support for parents and care givers.
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What are two other interventions that are used in combination to treat disruptive behavioral disorders?
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Behavior Modification directed at inappropriate behaviors
Medication Ritalin – methylphenidate Dexedrine – dextroamphetamine Cylert - pemoline |
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What is conductive disorder?
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violates rights of others and rules of society, this is the largest category of mental disorders for children, more common in boys,
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What are types of misconduct that boys will display that have a conduct disorder?
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aggressive - threatens or causes harm to others, destruction of property, lying or theft, serious violation of rights
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What are symptoms of conductive disorder?
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little empathy or concern, no guilt or remorse, low self esteem, suicidal ideation, use of substances, anxiety and depression
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What are some predisposing factors for conductive disorder in kids?
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ADHD, parental rejection, inconsistent parenting, early institutional living, frequent shift of parent figure, absent parents and antisocial and drug dependent families,
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What is oppositional defiant disorder?
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negative, hostile, and defiant disorder, no serious violation of rights, may only be in home, before 8 and male,
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What are things that are assessed with anxiety disorder?
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problem signs, health history, schoo and social phobia, developmental hx, psychiatric hx, physical assessment, mental status exam
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What are the important nursing interventions for kids with anxiety disorders?
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keep safe, help client progress developmentally, self-esteem, work through traumatic events,
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What are the 4 types of anxiety in kids?
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separation anxiety, social phobia, obsessive compulsive disorder, PTSD
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What are the 3 most common mood disorders in kids?
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major depression, dysthymic, bipolar, these are often masked
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How is mania portrayed in kids?
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as anger and aggression
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what is tourette's disorder?
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motor and verbal tics
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What is the chemical in the brain associated with activating the pleasure center of the brain?
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dopamine
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Why is meth and cocaine so addicting?
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speeds up the dopamine receptors in the brain
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What percent of americans abuse ETOH and have ETOHism?
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38%
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What are some facts about the epidemiology of substance abuse in america?
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2/3 adults consume ETOH daily, cost of ETOHism and abuse is >100 billion a year
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What is the most abused substance?
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ETOH
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what are some co-occurring disorders with ETOH?
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Cognitive D/O's, ADD, BPD, anxiety disorder, depression, and multiple medical disorder
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What is the difference between abuse and dependence of substances?
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abuse - people can not fulfill major role obligations and have interpersonal problems,
dependence - have tolerance, unable to cut down or control use |
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What is addiction?
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loss of control of substance consumption, substance use despite associated problems, tendency to relapse
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What is true about all addictions?
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The addiction eventually will control the person instead of the person controlling it
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What are some addictive behaviors?
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unrestrained search for gratification, initially behavior was pleasurable, behavior now controls life, life is out of control
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ETOH acts on what neurotransmitter and what drug is it similar to?
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Gaba and similar to the benzo class of drugs
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What is tolerance?
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need for more to get the desired effect
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what is cross-tolerance?
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similar response to drugs in same calss e.g. ETOH and benzo's
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what is withdrawal?
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physical and psychiatric symptoms, ETOH is the most dangerous and benzo's too.
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polydrug abuse?
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more than one substance
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dual diagnosis?
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Substance abuse disorder with another psychiatric disorder.
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Synergistic Effect?
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Potentiated when taken together
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Co-dependence?
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Overresponsible for others; esp. in attemptin to control another’s drug use
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What does the screening tool CAGE stand for?
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Cut down on drug use, Agitated or angry, Guilty, Eye opener
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What are the 3 primary defense mechanisms for substance abuse?
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rationalization, projection and denial
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What is important to watch for when a pt is on CNS depressants?
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Suicide
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For every one person that commits suicide how many people are effected?
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40
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Is there a higher risk of suicide/homicide with a dual diagnosis (e.g. substance abuse and medical condition)?
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Yes
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What are some typical questions asked for some who is withdrawing from alcohol?
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When was their last drink?
How much did they drink? What did they drink? How long have they been drinking? Why do you want to stop drinking? |
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What are the 6 things to assess for with a chemically impaired person?
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1. Assess for severity of withdrawal
2. Assess for symptoms of O.D. 3. Assess for suicidal ideation 4. Assess physical complaints 5. Explore motivation for treatment 6. Assess knowledge of community resources. |
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What is the first thing to go when under the influence of a substance?
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Good Judgment
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What type of hallucinations can someone withdrawing from alcohol experience?
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They may have visual or tactile hallucinations
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When is someone at risk form grand mal seizures during their withdrawal?
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7 - 48 hrs after last drink
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When does withdrawal start?
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hours after last drink
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What does DT stand for?
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Delirium Tremens
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What is the cardinal sign of DT?
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Elevated temperature
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What are some signs of DT?
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tachycardia, hypertension, disorentation, hallucinations, alterations in LOC, paranoid delusions and elevated temperature,
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What is the risk of death from DT's?
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20%
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What is the treatment for someone withdrawing from a CNS depressant?
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Titrate with a similar drug start with IV and then switch to PO this will minimize withdrawal sx
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What is the importance of hanging a banana bag with someone who is withdrawing from a CNS depressant?
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it will raise the seizure threshold and prevent wet brain
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What are the two typical drugs used to withdraw someone from a CNS depressant?
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Librium or valium
if they begin to experience delirium increase the dose |
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What is the drug of choice for decreasing cravings for alcohol?
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Campral
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What is a synthetic opiate typically used in treatment for heroin addiction?
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methadone or Subutex
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What is a nursing goal for a pt who is affected by substance abuse?
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for the pt to take responsibilities for their treatment
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What is abstinence?
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It is not a cure just not using the substance
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Is there a cure for substance abuse?
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No! living in recovery
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eating disorder in the middle ages
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saints starving themselves for purity
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eating disorder in the 1800's
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France and England records of women using self-starvation to control weight
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In what decade did anorexia become dx?
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1960
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In what decade did bulimia become dx?
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1970s
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What percentage of people have an eating disorder also have major depression?
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50%
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What percentage of people that have a personality disorder also have an eating disorder?
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40%
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What percentage of monozygotic twins, if one has an eating disorder that the other one will have an eating disorder?
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56%
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What is anorexia?
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Intense fear of gaining weight, refusing to eat
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Is anorexia life threatening?
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Yes
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What is an important intervention with a person who has an eating disorder?
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to get person beyond just the idea of weight and food, getting them to think about other things,
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Name two support groups for an eating disorder?
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National Eating Disorders Association
National Institute of Mental Health |
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Are there any medications to treat anorexia?
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No but can treat depression with SSRI's
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What neurotransmitter is released when someone is binging?
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serotonin
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What are the types of binging?
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Binge eating or exercising
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What is bulimia?
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binge eating, followed by methods to compensate for large intake of calories (vomiting)
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Is a person who has bulimia over weight?
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No, their weight is normal
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What are some interventions for a person who has bulimia?
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sessions that address the feeling associated with the cycle, behavior modification techniques to stop binging and purging?
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What type of medication is someone with bulimia on?
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Long term antidepressant fluoxetine
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what is binge eating disorder and signs of it?
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compulsive overeating disorder
s/x - not associated with hunger, eat large amounts quickly, eat alone and is depressed about eating, |
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What medication can be given to decrease binges and there severity?
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SSRI - sertaline
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Define Crisis:
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Change or loss that threatens our equilibrium
or a stressful situation event |
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define crisis intervention
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assisting those in crisis cope
this is not rescuing them or doing it for them |
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What are the three types of intervention?
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maturation (developmental), situational (anything that happens in life), adventitious (things not in your control major flood)
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What are the 4 phases of crisis according to caplan?
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1: Self-concept is threatened and respond with anxiety.
2. Continued anxiety. 3. Anxiety can become severe—panic. Flight . . . 4. If not solved . . . personality disorganization. |
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What can long term anxiety give you?
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GAS (general adaptation syndrome)
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according to freud what is anxiety
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Ego is threatened so we responded to anxiety, greater use of defense mechanisms, like denial,
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What are the 4 factors that determine a clients response to crisis intervention?
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1. Perception of the event.
2. Past experience in coping with stress. 3. Established coping strategies. 4. Availability of support. |
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What are the 9 goals for treatment in a crisis intervention?
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1. remain free from harm.
2. i.d. the specific problem. 3. verbalize feelings related to the event. 4. analyze the event and verbalize perceptions. 5. i.d. and seek support. 6. explore alternatives for coping. 7. participate in choosing a plan of action. 8. experience less anxiety. 9. verbalize increased self-esteem. |
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What are the two main goals for the nurse during a crisis intervention?
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pt safety and reduction of anxiety
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What is critical incident debriefing?
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used to debrief after a critical incident e.g. natural disaster, suicide, take-down
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