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Children or Adolescence, oct 9.pptx - PowerPoint Presentation

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    Children or Adolescence, oct 9.pptx - PowerPoint Presentation Children or Adolescence, oct 9.pptx - PowerPoint Presentation Presentation Transcript

    • Chapter 25
      Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence
    • MentalRetardation
      Mental retardation is defined as deficits in general intellectual functioning and adaptive functioning.
    • Mental Retardation (cont.)
      Predisposing Factors
      Five major predisposing factors
      Hereditary factors
      Early changes in embryonic development
      Pregnancy and perinatal factors
      General medical conditions acquired in infancy or childhood
      Environmental influences and other mental disorders
    • Mental Retardation: Application of the Nursing Process
      Assessment
      The extent of severity of mental retardation is identified by the client’s IQ level.
      Four levels have been delineated:
      * Mild (50 to 70)
      * Moderate (
      * Severe
      * Profound (lower than 20)
    • Autistic Disorder
      Autistic disorder is characterized by a withdrawal of the child into the self and into a fantasy world of his or her own creation.
    • Autistic Disorder (cont.)
      The affected child has markedly abnormal or impaired development in social interaction and communication and a markedly restricted repertoire of activity and interests.
    • Autistic Disorder (cont.)
      Predisposing Factors
      Biological factors
      Neurological implications
      Genetics
      Perinatal influences
    • Autistic Disorder: Application of the Nursing Process (cont.)
      Diagnosis/Outcome Identification
      Risk for self-mutilation related to neurological alterations
      Impaired social interaction related to inability to trust and neurological alterations
    • Autistic Disorder: Application of the Nursing Process (cont.)
      Diagnosis/Outcome Identification (cont.)
      Impaired verbal communication related to withdrawal into the self, inadequate sensory stimulation, and neurological alterations
      Disturbed personal identity related to inadequate sensory stimulation; neurological alterations
    • Autistic Disorder: Application of the Nursing Process (cont.)
      Outcomes (cont.)
      The client (cont.):
      Is able to communicate so that he or she can be understood by at least one staff member
      Demonstrates behaviors that indicate he or she has begun the separation/individuation process
    • Attention Deficit/Hyperactivity Disorder(ADHD)
      The essential feature of ADHD is a persistent pattern of inattention and/or hyperactivity-impulsivity
      more frequent and
      severe than typically
      observed at a comparable
      level of development.
    • ADHD (cont.)
      Predisposing Factors
      Biological influences
      Genetics
      Biochemical theory
      Anatomical influences
      Prenatal, perinatal, and
      postnatal factors
    • ADHD (cont.)
      Predisposing Factors (cont.)
      Environmental Influences
      Environmental presence of lead
      Dietary factors
      Psychosocial influences
    • ADHD: Application of the Nursing Process
      Assessment
      A major portion of the hyperactive child’s problems relate to difficulties in performing age-appropriate tasks
      Highly distractible
      Extremely limited attention span
      Impulsivity
    • ADHD: Application of the Nursing Process (cont.)
      Assessment
      Difficulty forming satisfactory interpersonal relationships
      Demonstrates behaviors that inhibit acceptable social interaction
      Disruptive and intrusive in group endeavors
      “Perpetual motion machines”
      Accident-prone
    • ADHD: Application of the Nursing Process (cont.)
      Diagnosis/Outcome Identification
      Risk for injury related to impulsive and accident-prone behavior and the inability to perceive self-harm
      Impaired social interaction related to intrusive and immature behavior
    • ADHD: Psychopharmacological Intervention
      CNS stimulants
      In children with ADHD, the effects include increased attention span, control of hyperactive behavior, and improvement in learning ability.
      Examples include Dexedrine, Ritalin, Cylert, Adderall
    • ADHD: Psychopharmacological Intervention (cont)
      Selective norepinephrine reuptake inhibitor: atomoxetine (Strattera)
      Approved by FDA in 2002 for treatment of ADHD
      Mechanism of action in ADHD is unknown
    • ADHD: Psychopharmacological Intervention (cont.)
      Antidepressants
      Some antidepressant drugs have been used with some success in treatment of ADHD.
      Examplesinclude
      Bupropion (Wellbutrin)
      Desipramine (Norpramin)
      Nortriptyline (Pamelor)
      Imipramine (Tofranil)
    • ADHD: Psychopharmacological Intervention (cont.)
      Nursing Implications (cont.)
      To reduce adverse effect of anorexia, medication may be administered immediately after meals.
      To prevent insomnia, administer last dose at least 6 hours before bedtime.
      Administer sustained-release forms in the morning.
    • ADHD: Psychopharmacological Intervention (cont.)
      Nursing Implications (cont.)
      The client should be weighed regularly (at least weekly) during hospitalization and at home while on therapy with CNS stimulants because of the potential for anorexia and weight loss and for the temporary interruption of growth and development.
    • ADHD: Psychopharmacological Intervention (cont.)
      Nursing Implications (cont.)
      In children with behavior disorders, a drug “holiday” should be attempted periodically under direction of the physician to determine effectiveness of the medication and need for continuation.
    • ADHD: Psychopharmacological Intervention (cont.)
      Nursing Implications (cont.)
      Inform parents that over-the-counter (OTC) medications should be avoided while the child is receiving stimulant medication.
    • ADHD: Psychopharmacological Intervention (cont.)
      Nursing Implications (cont.)
      Some OTC medications, particularly common cold and hay fever preparations, contain sympathomimetic agents that can compound the effects of the stimulant and create a drug interaction that could be toxic to the child.
    • Conduct Disorders
      With conduct disorder, there is a repetitive and persistent pattern of behavior in which the basic rights of others or
      major age-appropriate
      societal norms or rules
      are violated.
    • Conduct Disorders (cont.)
      Two subtypes
      Childhood-onset type
      Adolescent-onset type
    • Conduct Disorders (cont.)
      Predisposing Factors
      Biological influences
      Genetics
      Temperament
      Biochemical factors
    • Conduct Disorders (cont.)
      Predisposing Factors (cont.)
      Psychosocial Influences
      Peer relationships
    • Conduct Disorders (cont.)
      Predisposing Factors (cont.)
      Family Influences
      Parental rejection
      Inconsistent
      management with
      harsh discipline
      Early institutional
      living
      Frequent shifting
      of parental figures
    • Conduct Disorders (cont.)
      Predisposing Factors (cont.)
      Large family size
      Absent father
      Parents with antisocial
      personality disorder,
      alcohol dependence, or both
      Association with a delinquent subgroup
    • Conduct Disorders (cont.)
      Predisposing Factors (cont.)
      Marital conflict and divorce
      Inadequate communication patterns
      Parental permissiveness
    • Conduct Disorders: Application of the Nursing Process
      Assessment
      Classic characteristic of conduct disorder is the use of physical aggression in the violation of the rights of others.
      Stealing, lying, and truancy are common problems.
    • Conduct Disorders: Application of the Nursing Process (cont.)
      Assessment (cont.)
      The child lacks feelings of guilt or remorse.
      Use of tobacco, alcohol, or nonprescription drugs as well as participation in sexual activities occurs earlier than the peer group’s expected age norm.
    • Oppositional Defiant Disorder
      Oppositional defiant disorder is characterized by a pattern of negativistic, defiant, disobedient, and hostile behavior toward authority figures that occurs more frequently than is typically observed in people of comparable age and developmental level.
    • Oppositional Defiant Disorder (cont.)
      Predisposing Factors
      Biological influences
      Family influences
      Parental problems in disciplining, structuring, and limit-setting
      Identification by the child with an impulse-disordered parent who sets a role model for oppositional
      and defiant interactions with
      other people
      Parental unavailability
    • Oppositional Defiant Disorder: Application of the Nursing Process (cont.)
      Assessment (cont.)
      Usually these children do not see themselves as being oppositional but view the problem as arising from other people they believe are making unreasonable demands on them.
    • Tourette’s Disorder
      The essential feature of Tourette’s disorder is the presence of multiple motor tics and one or more vocal tics.
      Tics may appear simultaneously or at different periods during the illness.
      Presence of tics causes
      marked distress.
    • Tourette’s Disorder (cont.)
      Predisposing Factors
      Biological factors
      Genetics
      Biochemical factors
      Structural factors
      Environmental factors
    • Tourette’s Disorder: Application of the Nursing Process
      Assessment
      Tics may involve the head, torso, and upper and lower limbs.
      Signs may begin with a single motor tic, most commonly eye blinking, or with multiple symptoms
      Palilalia-involuntary repetition of words or phrases
      Echolalia-repetition of words spoken by others
    • Tourette’s Disorder: Application of the Nursing Process (cont.)
      Diagnosis/Outcome Identification
      Risk for self-directed or other-directed violence related to low tolerance for frustration
      Impaired social interaction related
      to impulsiveness and to oppositional and aggressive behavior
    • Tourette’s Disorder: Application of the Nursing Process (cont.)
      Diagnosis/Outcome Identification (cont.)
      Low self-esteem related to shame associated with tic behaviors
    • Tourette’s Disorder: Psychopharmacological Intervention (cont.)
      Medications used to treat Tourette’s disorder include:
      Haloperidol (Haldol)
      Pimozide (Orap) antipsychotic
      Clonidine (Catapres)
      Atypical antipsychotics
    • Separation Anxiety Disorder
      The essential feature of separation anxiety disorder is excessive anxiety concerning separation from the home or from those to whom the person is attached.
    • Separation Anxiety Disorder (cont.)
      The anxiety exceeds that expected for the person’s developmental level and it interferes with social, academic, occupational, or other
      areas of functioning.
    • Separation Anxiety Disorder (cont.)
      Predisposing Factors
      Biological Influences
      Genetics
      Temperament
      Environmental Influences
      Stressful life events
      Family Influences
    • Separation Anxiety Disorder: Application of the Nursing Process
      Assessment
      In most cases, the child has difficulty separating from the mother.
      Anticipation of separation
      may result in tantrums, crying, screaming, complaints of physical problems, and clinging behaviors.
    • Separation Anxiety Disorder: Application of the Nursing Process (cont.)
      Assessment (cont.)
      Reluctance or refusal to attend school is especially common in adolescence.
      Younger children may “shadow.”
      Worrying is common.
      Specific phobias are not uncommon.
    • Separation Anxiety Disorder: Application of the Nursing Process (cont.)
      Outcomes
      The client:
      Is able to maintain anxiety at manageable level
      Demonstrates adaptive coping strategies for dealing with anxiety when separation from attachment figure is anticipated
    • Separation Anxiety Disorder: Application of the Nursing Process (cont.)
      Outcomes (cont.)
      The client (cont.):
      Interacts appropriately with others and spends time away from attachment figure to do so