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Pediatric disorders order 14

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Mental Health Fall '12

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Pediatric disorders order 14

  1. 1. Renee Franquiz RN, MSN
  2. 2.  Catergories of Mental Health Issues  Growth &Developmental - Stages and Norms ▪ Aspergers, Autism, MR  Behavioral Disorders ▪ ADHD, Opposition/Defiance, Conduct, Separation Anxiety  Clinical Disorders ▪ BiPolar, Depression, Suicide Diagnosis  Ability to communicate; Wide range of “normal” Pathologic  Not age Appropriate  Deviates from Cultural Norms  Impairs Adaptive Functioning
  3. 3.  Overview  Dx - Autism Spectrum DSM-IV Criteria  Effects 2:10,000 with higher  Two of the following incidence in males (4:1 ▪ Impaired Non Verbal Communication ratio) ▪ Failure to develop peer relationships  Autism Spectrum – No ▪ Lack interests in other people cognitive or language ▪ Lack of social/emotional reciprocity impairment  One of the following  Suspicions in pre-school years ▪ Preoccupation with a restricted interest  Socially “awkward” to an that is abnormal in intensity extreme ▪ Inflexible adherence to routines or  Difficulty continues into rituals adulthood ▪ Repetitive motor mannerisms  Etiology – unknown; ▪ Persistent preoccupation with parts of genetic d/t familial an object tendency
  4. 4. MEDICAL MANAGEMENT NURSING INTERVENTIONS Social Skills Training  Collaborative Care  role play social situations  Team member role as a nurse Cognitive/Behavior w/medical management Therapy  Talk Therapy  Independent Nursing Care Medications  Where else and how else  Co-morbidities might you come in contact with these children and their Physical Therapy families? Family Coping  Support groups
  5. 5.  Developmental disorder of brain function which effects:  Communication – language delay, echolacia  Social Interaction- lack of reciprocity, responsiveness, relationships  Repetitive Behaviors – head banging, clapping, rocking, rituals and routines Manifests b/t 24-48 mos age; 6:1000 with 4x males Cause is unknown; evidence supports multiple causes  Biologic – Abnormal brain structure, Brain Hypoplasia, Seratonin  Genetic – Twins, familial  Environment – Thimerosal; intranatal exposures; Food Additives/Dyes
  6. 6.  DSM-IV Criteria page 382 in Textbook Impaired Verbal Communication  Establishment of trust  Able to communicate needs and desires Impaired Social Interaction  Establishment of trust  Engagement in social interaction Risk for Harm to Self  No Harm to self  Engage in alternate behaviors
  7. 7.  Est’b of therapeutic relationship – trust Limit Number of caretakers/Decrease stimuli Provide w/familiar or security objects Maintain a routine/Avoid abrupt changes Anticipate Needs Positive praise and reinforcement for desired behavior Protect from Self-Harm  Distract  Devices Ongoing Behavior Management Therapy  Social Training  Verbal Skills Parent Support  Autism Society of America
  8. 8.  Definition  Deficit in general intellectual functioning as measured by IQ  DSM-IV Criteria on page 377 in Textbook Etiology (Biologic and or Social)  Hereditary– Genetic, Chromosomal, Metabolic D/O  Perinatal Exposure– Infections, Ingestions  Acquired– Infection, Safety/TBI, Child Abuse, Sx, Social deprivation/neglect
  9. 9.  Mild - IQ 50 – 75  Slower to talk and perform adls; mental age of 8- 12 year old; likely to achieve skills for self- maintenance with support Moderate – IQ 36 -49  Noticable delays, simple speech, mental age of 3-7 years; simple tasks with supervision; not capable of self-maintenance Severe – IQ 20 – 35  Marked delay, limited communication; mental age of a 1-3 years; requires continuous supervision Profound – IQ below 20  Minimal purposeful actions; infantile
  10. 10.  Risk for Injury  No physical harm Self Care Deficit  Self Care needs fulfilled Impaired Communication  Means of communication established Impaired Social Interaction  Interacts with others Impaired Growth and Development  Maximize developmental capacity
  11. 11.  Physical Needs  Provide for ADLs  Encourage Self-Care Safety  Create a safe environment  Protect from self harm – devices Establish means/ method for communication Early intervention/special education programs to maximize potential Support families and help in setting realistic goals Counsel adolescent/family on sexual maturity and responsibility, marriage, childbearing and vocation
  12. 12. OVERVIEW ETIOLOGY Key Symptoms  Biologic  Inattentiveness  Genetic – familial  Hyperactive-Impulsive  Biochemical – alterations in Difficult to Dx before age 4 dopamine, serotonin, norepi Issues emerge with school  Anatomical variations – lobe size More common in boys  Intrauterine exposure – Substances Majority persist as adults  CNS disorders – sz, infection Subtypes  Combined  Environmental  Inattentive type  Lead  Hyperactive-Impulsive type  Food Additives , dyes, sugars
  13. 13.  DSM-IV Criteria on page 387 in textbook Inattentive  Unable to listen; Inattentive; forgetful  Disorganized; Poor follow through  Procrastinates; Loses things Hyperactive  Restless; Excessive motor actvitiy  Difficulty with quiet activities  Talks excessively Impulsive  Interrupts  Blurts out  Difficulty waiting turns
  14. 14.  Risk For Injury  No physical harm Impaired Social Interaction  Interacts with others Low self-esteem  Positive self regard Noncompliance  Participates in therapeutic activities
  15. 15.  Protect from injury/provide safe environments for physical activity Set boundaries; identify unacceptable behaviors and consequences Provide structure and routines – feenback systems Convey acceptance and provide opportunities for success Limit distractions in the environment Empower child to manage own behavior Medication Therapy
  16. 16.  Dextramphetamin - Dexedrine Methamphetamine - Desoxyn Combo – Adderall Methylphenidate – Ritalin Dexmethylphenidate – Focalin  Anorexia, Insomnia, Weight Loss, Decreased Growth Atomoxetine – Strattera  Same as above, increase BP/Pulse, sexual Dysfunction Bupropion – Wellbutrin  CNS stimulation, anorexia, weight loss
  17. 17.  Administer after meal(s); monitor growth and weight Administer in AM, or 6 hours before bedtime Use cautiously in clients with CV D/O Monitor LFTs Monitor for new psychotic D/O Monitor OTC that may contain similar components Medication “holiday” to assess behaviors off therapy
  18. 18. OVERVIEW ETIOLOGY Patterns of behavior that  Biologic violate the rights of others  Genetics Physical Aggression if  Biochemical – Serotonin, Nor- Common epi, Testosterone – inconclusive Most common reason for  Temperament – “difficult” psychiatric referral Strong willed Higher Incidence Males  Psychosocial Child Onset – less than 10 y,  Peer socialization aggression, disturbed  Family relationships ▪ Marital discord, changing parent Adolescent Onset – After figures, absent fathers 10y, less aggressive, better ▪ Harsh discipline, permissiveness relationships ▪ Parenteral rejection; Parent MH D/O, early institutionalization
  19. 19.  DSM-IV Criteria on page 395 in textbook Physical Aggression - “Tough Guy”  People and Animals  Initiates; Weapons  Rape Destruction of Property  Fire Setting Lying/Stealing – Lacks Remorse Rules Violations  Curfew Issues  Runaway  School Truancy – ability exceeds achievement
  20. 20.  Risk for other directed violence  No harm to others Impaired Social Interactions  Interacts in socially appropriate ways Defensive Coping  Accepts feedback and responsibility Low Self-Esteem  Positive self regard; discontinuation of exploitation
  21. 21.  Highly Resistant to Treatment – Requires intensive , persistent , long term services Family Therapy  Parenting Skills Training  Communication Behavior Therapy  Improved Decision Making/Problem Solving  Anger Management  Impulse Control  Relationship Building  Substance Use/Abuse Medications – manage behaviors (Sedation agents; Impulsiveness; Mood Stabilizers) Prognosis - refractory
  22. 22. OVERVIEW ETIOLOGY Negative, disobedient,  Biologic defiance towards authority  Genetics Stubborn, argumentative,  Biochemical – Serotonin, Nor- temper epi, Testosterone – Interferes with social, inconclusive school, and work  Temperament – “difficult” Do not violate rights of Strong willed others  Family  Parenting Limitations Behaviors emerges in  Impulsed Disordered Parent – childhood Serves as a Role Model Higher incidence in males  Absent Parent
  23. 23.  DSM-IV Criteria on page 398 in Textbook Passive Aggressive – Negative, stubborn, disobedient, testing, uncooperative, argumentative Attitude directed toward parent(s) Project blame on others Poor relationships (limited friends), school performance
  24. 24.  Impaired Social Interactions  Interacts is socially appropriate ways Defensive Coping  Verbalize responsibilities for behaviors  Demonstrate effective Coping Low Self Esteem  Positive self regard Noncompliance  Participation in Therapeutic Activities
  25. 25.  Family Therapy  Parenting Skills Training ▪ Avoid Power Struggles ▪ Set reasonable expectations - Structure ▪ Impose limits ▪ Follow Through – Consequences - Rewards Behavior Therapy  Improved Decision Making/Problem Solving  Anger Management  Social Skills Building
  26. 26. OVERVIEW ETIOLOGY Excessive anxiety when  Biologic separating or anticipating  Genetics separation from home or  Temperament – Shy, cautious parents  Environment May be triggered by a  Traumatic Event trauma event; Most  Maternal Over Attachment common on starting school  Overprotective Family Higher incidence in  Parent Role Model Fears females May progress to panic D/O
  27. 27.  Separation reluctance Tantrums, crying, screaming, clinging Reluctance to attend school Follow parent around the house Inability to sleep away from home Worry, nightmares – during separation harm will come to self or parent Phobias – fear of dark, ghosts, dogs
  28. 28.  DSM-IV Criteria on page 405 in textbook Anxiety  Uses adaptive activity to manage anxiety  Feels safe  Demonstrates trust Ineffective Coping  Demonstrate adaptive coping Impaired Social Interaction  Spend time with others
  29. 29.  Establish calm atmosphere Reassure client of safety Explore fears and worries Establish gradual separation goals – desensitize Identify alternative adaptive coping Alternate parenting techniques Anti-anxiety medications – severe cases
  30. 30.  Suicide Overview  Rates rise during adolescence  3rd leading cause death 15-24 years old  Greater risk due to impulsive behaviors;Risk Taking  Most common methods is firearm (49%)  Trigger more often relationship issues
  31. 31.  Assessment  Similar tools, methods and findings  Desire to hurt self with a plan and the means  Report – minors who seek health care for mental health are considered emancipated Dx  Risk For Suicide  Hoplessness Interventions  Physical Safety/Treat Co-Morbidities  Suicide Precautions  Therapy/Support
  32. 32.  Overview  Approximately 4%-5% of children experience depression  Etiology – usually a feeling of loss ▪ Genetic Predisposition ▪ Relationship Difficulties, Family Distruption, school Changes Behaviors  May vary or similar to adults  Morbid Thoughts; Excessive Worry, Sadness  Changes in School Performance and Relationships  Sleeping and Eating Disturbances  Self Harm - slashing Management  Similar to adults  +/- Hospitalization  AntiDepressants and Psychotherapy

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