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Ch 23

Mr. D's Psychiatric Disorders

It is difficult to determine whether a child's behavior indicates emotional problems
DSM-IV criteria for diagnosing childhood disorders: 1 Not age appropriate. 2 Deviate from cultural norms. 3 Create deficits or impairments in adaptive functioning.
An emotional problem exists if it is manifested by behavior
Nursing Interventions for children with intellectual disability. Identify areas of deficit. Create a safe environment. Staff consistency. Info from family.
Mild IQ range 50-70
Mild Self-Care Capable of independent living, with assistance during times of stress.
Mild Cognitive 6th grade. Vocational skills for minimum self-support.
Moderate IQ range 35-49
Moderate Self-Care Can perform some activities independently. Requires supervision.
Moderate Cognitive 2nd grade. May be able to contribute to own support in sheltered workshop.
Severe IQ range 20-34
Severe Self-Care May be trained in elementary hygiene skills. Requires complete supervision.
Severe Cognitive Unable to benefit from academic or vocational training. Systematic habit training.
Profound IQ range < 20
Profound Self-Care No capacity for independent functioning. Requires constant aid and supervision.
Profound Cognitive Unable to profit from academic or vocational training. May respond to minimal training in self-help if 1 on 1.
Intellectual disability is an adaptive functioning problem
Intellectual disability is not necessarily a psychiatric problem
IEP Individual Education Plan
Academic Setting of IEP addresses the specific need of the student
IEP is used produced and used by parents, teachers, student's psychologist, resource specialist, and administrators.
Children with psychiatric disorders will also have: Substance abuse issues. Personality disorders.
There is no medical cure for autism
Autism rate in boys 1/42
Boys are __ times more likely to get autism than girls. 4
Autism rate in children (including boys and girls) 1/88
_____ is the fastest growing serious developmentally disability in the US. Autism
Muscular dystrophy rate in population 1/100,000
Muscular Dystrophy funding $162,000,000
Etiology of autism Unknown
Early signs of autism: Not responding to name by 12 months. No interest/pointing by 14 months. No pretend games by 18 months. Loss of speech.
Higher than normal risk for autism. Boys. Siblings of those with autism. People with other developmental disorders.
People with autism disorder(Classical) usually have significant delays in: language, social skills, communication, unusual behaviors and interest, intellectual disability (Low IQ)
Asperger Syndrome Milder symptoms than autism. They may have social challenges and unusual behaviors and interests.
Asperger syndrome people typically do not have problems in: Language and Intellect
Atypical disorder Pervasive Development Disorder
Pervasive Development Disorder People who meet some of the criteria for autistic disorder or Asperger syndrome, but not all may be diagnosed with PDD. (Consistency is key)
Autism interventions 1 on 1, Protect from self-harm, Limit # of caregivers, + reinforcemnt for eye contact, provide children with familar objects, Assess child to recognize seperateness from others during self-care activities.
ADHD Attention Deficit Hyperactive Disorder
ADHD is characterized by: Inattention. Hyperactivity. Impulsive behavior.
ADHD predisposing factors: Biological genetics, increased NE levels, increased dopamine levels, anatomical influences, prenatal/perinatal/postnatal exposure to stress/smoking/alcohol
ADHD predisposing factors: Environmental lead, diet, psychosocial
ADHD outcomes No physical harm. Interacts with others appropriately. Verbalizes positive aspects about self. Fewer demanding behaviors. Cooperates with staff.
Interventions for ADHD focus on Risk for injury (impulsive behavior). Impaired social interaction (constant talking). Low self-esteem (aware of stigma).
Tic Sudden brief movement or sound.
Age for Tourette's disorder in children 2-12 years old.
Average age for Tourette's disorder 7 years old.
Boys are _____ likely to get Tourette's disorder than girls. more
Boys are ______ times more likely than girls to get Tourette's disorder. 3-4
Tourette's Disorder is characterized by tics
Motor tics are ____ common than Verbal tics. more
Simple motor tics: eye blinking, head jerking, sticking tongue in and out
Complex motor tics: touching nose, touching people, touching objects, smelling objects, obscene gestures, arm flapping, hoping, jumping
Simple verbal tics: hiccups, yelling, throat clearing, barking
Complex verbal tics: change in tone of voice, repeating words, echoalia, vulgar obscene expletives
Stress, tiredness, and excitement will ______ tics. increase
Some tics can evolve or disappear
Tics ______ during teenage years. increase
Possible cause of tics genes, increased levels of dopamine, increased levels of serotonin,
Tourette's disorder treatment: Discuss behaviors that are not acceptable. Develop a trusting relationship with the client. Redirect violent behavior with physical outlets for frustration. Medication
Tourette's disorder Meds Psychotropics (typical): Haldol, causes EPS. Ritalin and adderall.
Conduct disorder is a precursor to ________ personality disorder. Antisocial
Conduct disorder behaviors: Aggression to people and animals. Destruction of property. Theft. Serious rule violations. Deceit.
Conduct disorder predisposing factors: Traumatics life experience. Child abuse. Genetic.
General medical conditions acquired during infancy or childhood account for about __% of cases of mental retardation. (infections, poisonings, physical trauma) 5%
Between ___% and ___% of cases of mental retardation are attributed to deprivation of nurturance and social, linguistic, and other stimulation, and to severe mental disorders, such as autistic disorder. 15%-20%
Nsg Dx of Impaired Social Interaction. S & Sx: Intrusive and immature behavior.
Nsg Dx of Impaired Social Interaction. Nsg Ax: Develop a trusting relationship. Discuss acceptable and unacceptable behaviors. Consequences for unacceptable behavior. Provide group situations for client.
Nsg Dx of Impaired Social Interaction. Outcomes: Develop trusting relationship with nurse. Interact with peers appropriately.
Nsg Dx of Low Self-Esteem. S & Sx: Denies responsibility. Blames others. Ridicules others.
Nsg Dx of Low Self-Esteem. Nsg Ax: Ensure goals are realistic. Plan activities that provide opportunities for success. Convey unconditional acceptance and positive regard. + reinforcement for acheivements.
Nsg Dx of Low Self-Esteem. Outcomes: Verbalizes + statements about self. Fewer demanding behaviors.
ODD Oppositional defiant disorder
ODD is characterised by a pattern of negativistic, defiant, disobedient, and hostile behavior toward authority figures
ODD typically begins by ___ yrs old. 8 yrs old
Etiology of ODD: Parental problems in discipling, structuring, and limit setting. Parental unavailability (seperation, evening work hours)
In an effort to help the child with mild to moderate mental retardation develop satisfying relationships with others, which nsg intervention is most appropriate? Set limits on behavior that is socially inappropriate.
The child with autistic disorder has difficulty with trust. With this in mind, which of the following nursing actions would be most appropriate? Assign the same staff person as often as possible to promote feelings of security and trust.
Which of the following nursing diagnoses would be considered the priority in planning care for the child with autistic disorder? Risk for self-mutilation evidenced by banging head against the wall.
Which of the following activities would be most appropriate for the child with ADHD? Volleyball
Which of the following groups are most commonly used for drug management of the child with ADHD? CNS stimulants. (methylphenidate [Ritalin])
The child with ADHD has a nursing diagnosis of impaired social interaction. Which of the following are the most appropriate intervention for this child? Set limits with consequences on inappropriate behaviors. Provide rewards for appropriate behaviors. Provide group situations for the child.
The Nsg History and assessment of an adolescent with a conduct disorder might reveal all of the following behaviors except: Feelings of the guilt associated with the exploitation of others.
Certain family dynamics often predispose adolescents to the development of conduct disorder. Which of the following patterns is thought to be contributing factor? Parents who are alcohol dependent.
Which of the following is least likely to predispose a child to Tourette's disorder? Absence of parental bonding.
Which of the following medications is used to treat Tourette's disorder? Haloperidol (Haldol)
Created by: Sanctus Verus