Child And Adolescent

Slide 1: Unit 11 Child and Adolescent Disorders PDD ADHD Eating Disorders

Slide 2: Pervasive Developmental Disorders Three areas of functioning are affected:  1. Reciprocal social interaction impaired  2. Increased stereotypical behavior  3. Mental retardation in the majority of  cases

Slide 3: Categories of PDD Childhood Degenerative Disorders: often due  to CNS insult, losses in all areas after age 2 Asperger’s: Rec. later than autism, cognition  and language OK, but low social function, lots of repetitive behavior, autistic bx. Rett’s: affects females, increasing deficits as  grow. Lose hand coordination, language loss, mental retardation Autism: see next slide 

Slide 4: Autism: Example of PDD Aversion to physical contact, even as  infant Little eye contact  Low verbal skills  Mood abnormalities  Repetitive motor behaviors—rocking,  banging, unusual solitary play

Slide 5: Nursing Diagnoses (some) Growth and Development, delayed  Injury, risk for  Risk for self abuse  Impaired social interaction  Impaired communication  Self care deficit  Caregiver role strain 

Slide 6: Downs Syndrome: mild to moderate mental retardation Caused by trisomy 21, not inherited. 1/600  births affected. Older moms more likely Shortened life span, often get dementia in  40s/50s. Physical features: Epicanthal slant eyes, flat  nose, short stature, low set ears, short hands, and a single palmar crease.

Slide 7: ADHD: Attention Deficit Hyperactive Disorder: 3 symptoms Inattention: affects listening, finishing  tasks, losing things, careless errors, distractible Impulsivity: affects turn taking, blurting  out answers, intrusive, interruptive Hyperactivity: squirmy, fidgety, climbs,  no quiet play, motor mouth, never ceasing energy

Slide 8: Framing the Assessment in ADHD Probably somewhat overdiagnosed currently,  lack of structure and parental skill. Diagnosis should be by specialist.  All assessment findings must be compared to  age appropriate behavior. Only real deviations from this mark ADHD. Examples. Must see Significant impairment in social,  academic and /or occupational function. Must emerge prior to age 7 (can be dx later  though).

Slide 9: Intervening in ADHD (31-3) Signal/gestures Therapeutic holding   Move closer Teach “counting”   Redirection Clear limits clear   consequences Clarify situation  Avoid bargaining Restructure work for   success Set a routine and  stick to it Remove disruptive  child

Slide 10: Ritalin: Drug of choice in ADHD CNS Stimulant, schedule II, potential for  abuse by non ill individuals. Kids sell. Increases catecholamines to different parts of  the brain, focusing attention better. SE: (a few) low growth, low appetite,  sleeplessness, rebound effect, timing CONTRAINDICATED: glaucoma, HTN,  Tourette’s, Seizure d/o. Interacts with MAOIs

Slide 11: Conduct Disorder: like Antisocial personality disorder, but as seen in children Aggression toward others, property  destruction, deceit, theft, serious rule violation Core sense of unlovability  Insecure parental attachment, family  problems Difficult child pattern  RX: like Antisocial Personality DO 

Slide 12: Eating Disorders Anorexia Nervosa  Bulimia Nervosa  Compulsive Overeating—Binge Eating  Disorder

Slide 13: Physiologic Aspects/Causes Tied to major mood disorders (depression,  anxiety, OCD) with low norepinephrine, low serotonin, increased cortisol. Linked to physiologic release of endogenous  opiods (eg B endorphins) Starvation, binging, exercise trigger release “Starvation dependence” Gives an addictive twist to all of these disorders, that often affects treatment

Slide 14: Anorexia Nervosa Demographics: white, 12022 yo middle  and upper income women in industrialized countries

Slide 15: Physical Assessment Findings in Anorexia Nervosa 80% wt for ht Bradycardia,   hypotension Amenorrhea  Fatigue, weakness Lanugo   Low T3, T4 Jaundice, dry skin   Low K+, low Na+ Dehydration   Pancytopenia, Low bone density   anemia Peripheral edema  Abnormal ECG and cold extremities 

Slide 16: Psychosocial Assessment Findings Refusal to eat, purging All or nothing thinking   Intense fear of getting As wt decreases,   fat thinking is less rational Body Image distortion Often hx of sexual abuse   Denial—focus on food Developmental delay   and control over it with enmeshed family serves as a defense over other issues OCD traits,  perfectionism

Slide 17: Behaviors used to keep wt down Rules set about Diet pills, herbs   eating Self induced  Manipulation vomiting  Counting  Lies  Exercises  Self punishment  laxatives 

Slide 18: Anorexia Nervosa Treatment Reverse starvation (first). Involves possible refeeding under supervision, NG feeding, TPN. Also prevention of physical sequelae by restricting activity and watching to prevent vomiting, etc. Moniter physical status-cardiac, liver, labs, renal, suicide.

Slide 19: Nursing Therapeutics Begins right away, but continues past initial refeeding issues. Prevent sabotage. Therapeutic alliance critical Contract and/or level system valuable Teach gentle eating Meds: when physically able— antidepressant, occasionally others

Slide 20: Issues faced by the ED pt Self esteem  Family relationships  Body Image  Sexuality  Thinking disorder  Main thing will center around meeting  the developmental challenge of separation and individuation

Slide 21: Bulimia Nervosa Demographics: similar to anorexia but  with later average age of onset. 2-28% American women.

Slide 22: Physical Symptoms of Bulimia Wt for ht may be Peripheral edema   close to WNL Esophageal dilation  Amenorrhea  and ulceration ECG changes  Scars on fingers,  Cardiomyopathy  hands Parotid Gland  Low K+  swelling, hoarse voice Dental erosion 

Slide 23: Psychosocial Bulimia Symptoms Body image issues Rigid controlling   family with low Repeated episodes  client autonomy of binging and purging Separation  individuation issues More distressed and  less denial than with Sexual abuse,  Anorexia sexuality issues Anger suppression 

Slide 24: Bulimia Nervosa Treatment Not Grossly Different than for Anorexia  Nervosa Instead of the starvation issue, deal  with the electrolyte imbalances and sequelae of binging and purging All therapeutic issues apply. Benefit is  that the denial system is less intense

Slide 25: Binge Eating Disorder Demographics: 46% of obese  participants in wt loss programs have it 30 to 45% of the American population  is overweight

Slide 26: Binge Eating Disorder: symptoms Obesity: BMI kg/m2 of at least 30 or wt  that is 120% of ideal. Pattern of binge eating without purging.  Review sequelae of obesity  Self esteem disturbance, body image  distortion, and sexuality issues Addictive nature of these illnesses 