Autism/down syndrome/intellectual disability
A 6-year-old child with autism is nonverbal and makes limited eye contact. What should the nurse do initially to promote social interaction? 1. Encourage the child to sing songs with the nurse. 2. Engage in parallel play while sitting next to the child. 3. Provide opportunities for the child to play with other children. 4. Use therapeutic holding when the child does not respond to verbal interactions.
Engage in parallel play while sitting next to the child. Entering the child's world in a nonthreatening way helps promote trust and eventual interaction with the nurse. Using therapeutic holding may be necessary when a child initiates self-mutilating behaviors. Engaging in parallel play with the child or providing opportunities for the child to play with other children is unrealistic at this time; playing with others is a long-term objective.
A mother of a 6-year-old boy with the diagnosis of attention deficit-hyperactivity disorder (ADHD) tells the nurse that when she is reading storybooks to her son, about halfway through the story he becomes distracted, fidgets, and stops paying attention. What should the nurse suggest to the mother? 1. "Talk with a louder voice." 2. "Shorten the rest of the story." 3. "Encourage your son to pay attention." 4. "Use therapeutic holding for the rest of the story."
2. "Shorten the rest of the story." Shortening the story nonjudgmentally limits the activity while supporting the child's self-esteem; the child with ADHD cannot control his inattention and hyperactivity. The mother should select activities that are more interactive or interesting for the child to engage his attention. The child does not have a hearing problem, and speaking louder will not change the behavior. Inattention and hyperactivity cannot be controlled; encouraging the child to pay attention may precipitate feelings of doubt, shame, or guilt and reinforce low self-esteem. Using therapeutic holding for the rest of the story is unnecessary in this situation; therapeutic holding is used when a child is out of control and at risk for self-harm or violence toward others; it reassures the child that the adult is in control and promotes feelings of security and comfort.
Methylphenidate is prescribed to treat a 7-year-old child's attention deficit-hyperactivity disorder (ADHD). The nurse understands that methylphenidate is used in the treatment of this disorder in children because it has what effect? 1. Diuretic effect 2. Synergistic effect 3. Paradoxical effect 4. Hypotensive effect
3. Paradoxical effect Methylphenidate, a stimulant, has an opposite effect on hyperactive children; the reason for this action is as yet totally unexplained. Although methylphenidate has a hypotensive effect, this is not why it is given to hyperactive children. Methylphenidate does not induce diuretic or synergistic effects.
A 3-year-old client has been admitted to the pediatric unit for dehydration resulting from nausea and vomiting. The parents tell the nurse the child has autism and resists being held, acts as if deaf, frequently mimics words or phrases, and is not toilet trained. What is most important for the nurse to do when planning care for this child? 1. Provide a structured routine for the child to follow while in the hospital 2. Involve the parents in the plan of care and encourage their being with the child as much as possible 3. Place the child in a semiprivate room near the nurses' station where activities can be seen and heard 4. Assign different personnel to the child until it is determined which staff members the child relates to best, and then use them to enhance the nurse-child relationship
2. Involve the parents in the plan of care and encourage their being with the child as much as possible The parents should stay with the child during hospitalization to preserve stability and consistency for the child. Although providing a structured routine is important, it is not the priority. Ensuring parental support is the priority. Decreased stimulation is essential; using a private room and avoiding extraneous auditory and visual distraction may decrease the disruptiveness of hospitalization. Assigning different personnel will increase the irritability and frustration of the child; consistency and stability are essential for the child's well-being, and the same staff members should be assigned to care for the child.
A nurse is caring for a group of children with the diagnosis of autism. Which signs and symptoms are associated with this disorder? Select all that apply. 1. Lack of appetite 2. Depressed mood 3. Repetitive activities 4. Self-injurious behaviors 5. Lack of communication with others
3. Repetitive activities 4. Self-injurious behaviors 5. Lack of communication with others Perseveration (repetition of a behavior pattern) is commonly demonstrated by children with autism; this behavior provides comfort. Self-stimulation through injurious behavior is associated with autism. Children with autism have difficulty communicating or do not communicate at all with others. There may be unusual eating habits and food preferences, but lack of appetite is not associated with autism. Mood disorders are usually not associated with autism.
A nurse is caring for a child with autism. Which intervention is most appropriate in an attempt to promote socialization for this child? 1. Encouraging participation in group activities 2. Providing minimal environmental stimulation 3. Holding and cuddling the child for short periods 4. Imitating and participating in the child's activities
4. Imitating and participating in the child's activities The nurse should begin by attempting to enter the world where the child's attention is currently focused; this is a way of establishing human contact, because the child's usual contacts are inanimate objects. Children with autism have deficits in social development, and relationships are difficult to establish. Autistic children are generally unable to participate in group activities. Providing minimal environmental stimulation will have no effect on the nurse's ability to reach the child; rather, it will reinforce withdrawal. Autistic children generally cannot tolerate body contact and will become rigid when anyone attempts to initiate it.
What is the prognosis for a normal productive life for a child with autism? 1. Dependent on an early diagnosis 2. Often related to the child's overall temperament 3. Ensured as long as the child attends a school tailored to meet needs 4. Unlikely because of interference with so many parameters of function
4. Unlikely because of interference with so many parameters of function Research studies have shown that the prognosis for normal productive function in autistic people is guarded, particularly if there are delays in language development. Accurate diagnosis and early interventions have not been shown to promote a normal, productive life; however, early intervention may help individuals maximize their abilities. Although temperament may affect the child's response to treatment, it does not affect prognosis to any extent. Stating that success is ensured as long as the child attends a school tailored to meet needs is false reassurance and is not helpful.
