Peds Unit 4 - Cognitive Impairment & Psychosocial Complications

The school nurse is planning a vaping prevention program for middle school students. Which is most likely to be effective in preventing this population from vaping?

A talk on the importance of not vaping given by a local high school basketball star.

What teaching points of the nurse include when educating the parents of a child diagnosed with schizophrenia? Select all that apply. .

Acute severe episodes require hospitalization. Delusions, hallucinations, and social withdrawal are common symptoms. It may take 4 to 6 weeks for the anti-psychotic meds to begin working. Treatment will include individual psychotherapy, family therapy, and various psychotropic medications

A parent is concerned about her 8-year-old child's recent behavior and calls the nurse for advice. According to the parent, her child is constantly crying, is not sleeping well, has withdrawn from activities, and does not want to attend school. Which would the nurse explore in more detail with the parents?

Bullying

Mathematics and computation problems

Dyscalculia

Difficulty with writing, spelling, and composition; forming letters or writing within a prescribed space

Dysgraphia

Difficulty with writing, reading, or spelling. Words mixed up

Dyslexia

Problems with manual dexterity and coordination

Dyspraxia

Nursing management of learning disabilities

Early detection Referral to school or testing resource Plan for learning needs Establish goals Promote self-esteem

Which assessment finding by the nurse is most diagnostic of Tourette's syndrome?

Eye blinking, head jerking, and clearing the throat for 1 ½ years

Abnormal gene on X chromosome characterized by increased head circumference, long, wide protruding ears, long narrow face, and strabismus

Fragile X Syndrome

Autism is associated with what other conditions?

Fragile X syndrome Metabolic disorders Fetal rubella syndrome H.Influenza meningitis

What are the goals of interventions for Autism?

Promoting developmental skills Reducing repetitive behavior Eliminating negative behavior such as head banging or temper tantrums Supporting the family

What is the priority focus of a long-term treatment plan for an adolescent with an eating disorder?

Restructuring perception of body image

Rare. Severe. Primarily affects girls. Norm development until 6 to 18 month. Social and intellectual difficulties

Rett Syndrome

Nursing Management for Pervasive Developmental Disorders

Stabilize environmental stimuli Provide supportive care Enhance communication Maintain safe environment Provide anticipatory guidance

Down syndrome children are at risk for what?

cardiac defects leukemia hearing loss thyroid disease gastrointestinal & dermatological disorders

Expected outcomes depends on what?

child's needs developmental level

Common in childhood. Affect about 5% of children. Brain cannot receive or process information normally. Can involve reading, writing, math, or understanding oral information. IQ is usually normal

learning disability

what may trigger withdrawn, self-abusive, or violent behaviors in a child with Autism?

often unable to tolerate change in routine

In a child with autism you often see a fixed, unchanging response to what?

stimuli Self-stimulation (repetition of pleasing stimulus)

A nurse is assessing a child for possible obsessive-compulsive disorder. Which response by the nurse would be most helpful in obtaining information from the child?

"Is there anything that you do over and over again and can't resist doing?"

A 15-year-old girl has been evaluated and diagnosed with major depression. The advanced practice mental health nurse has prescribed paroxetine, a selective serotonin reuptake inhibitor. The mother of the girl refuses to let her take the medication because she has read about several suicides of teenagers who have been on this medication. Which response by the nurse would be most appropriate in addressing the mother's concerns?

"Let's sit down and talk about your concerns."

Which child should the nurse identify as exhibiting a delay in meeting developmental milestones?

A five-year-old child who is unable to button their shirt

Which adolescent would the nurse identify as being the highest risk to commit suicide?

A male who has guns at home and just broke up with his long-term girlfriend.

Inner epicanthal folds. Wide, flat nasal bridge. Protruding tongue. Simian line. Wide gap between first/second toes. Short, broad neck Hypotonic

Down syndrome

Common syndromes associated with Intellectual Disabilities?

Down syndrome Fragile X syndrome Fetal alcohol syndrome

The nurse recognizes which manifestation as a sign/symptom of oppositional defiant disorder?

Argumentative

The mother of a nine-year-old child is suspected of having Munchausen syndrome by proxy. Which nursing intervention is best when assessing the child and family in the pediatrician's office?

Ask to speak to the child separate from the family

Mild disorder. Norm to high intellectual development and language development. Social and emotional symptoms. Requires rigid scheduling. Difficulty with relationships

Asperger Disorder

Difficulty using and understanding language; relating to people, objects and events. Unusual play with toys and other objects. Difficulty with changes in routine or familiar surroundings. Repetitive body movements or behavior patterns

Autism

A 9-year-old with anxiety disorder is experiencing a panic attack in the waiting room of the pediatrician's office. What is the first action the nurse should take?

Calmly move the child to a quiet comfortable area.

Which risk factor should the nurse be aware of when caring for an infant with down syndrome?

Cardiac defect

What is the focus of care for a patient with a cognitive impairment?

Care is based on the child's cognitive level.

Late outcomes

Child's communication skills Child's self-care skills Utilization of community and educational resources

A child with autism is hospitalized with asthma. What would be an important consideration in the nurse's plan of care?

Child's routine, habits, and preferences are maintained.

Rare. Severe. Primarily affects boys. Normal development up to 3 to 4 years. Loss of motor, language and social skills. Seizures, loss of bowel/bladder control

Childhood Disintegrative Disorder

Education - 3-21years. Free, appropriate and in least restrictive environment. Included with non-disabled peers

Disabilities Education Act

The nurse is evaluating a 16-year-old with bipolar disorder. Which finding indicates the patient is responding therapeutically to the medication regimen?

Demonstrated less labile moods and better sleep patterns.

Significant limitation in intellectual functioning and adaptive behavior. Begins before age 18. IQ is usually less than 70. IQ is not as important as functional assessment. (Motor movement, Language, Adaptive behavior. Achieve developmental milestones slowly. i.e Developmentally disabled, mentally handicapped, mentally deficient, mentally challenged

Intellectual Disabilities

What are some behavioral characteristics of child with Fragile X Syndrome?

Mild to severe CI Speech delay Short attention span, hyperactivity Autistic like behaviors

What are some absolute Indicators for Immediate evaluation for Autism?

No babbling or pointing or other gesture(e.g., waving bye-bye) by 12 months No single words by 16 months No spontaneous 2-word (not echolalic) phrases by 24 months Any loss of language or social skills at any age

Early Behavioral Signs for Developmental Disorders

Non-responsiveness to contact Poor eye contact during feeding Diminished spontaneous activity Decreased alertness to voice or movement Irritability Slow feeding

Experiences that Encourage Development

Parent-child transactions - Developmentally sensitive caregiver-child interactions; Structured environment; Learning built on previous learning Family-orchestrated child experience- Developmentally appropriate toys and materials; Positive contacts with other adults and children

Which intervention should the nurse include in the plan of care for a child who is diagnosed with an intellectual disability? Select all that apply.

Participating in the individualized education program (IEP) process, maintaining a safe environment for the patient provide emotional support to the family.

Begin in early childhood, usually apparent by age 3. Affect 12% to 16% of children. Rigid, obsessive behavior. Impaired social interactions and communication. Restricted interests / activities

Pervasive Developmental Disorders or Autism Spectrum Disorders.

What is the goal of therapeutic management for a child diagnosed with attention deficit/hyperactivity disorder?

Reduce the frequency and intensity of unsocialized behaviors

While wearing a 12-month-old in the clinic, the nurse notes six nickel-sized bruises on the child's buttocks. The bruises range in color from purple to greenish-yellow. The nurse also notes a looped cord mark on the child's thigh. What is the priority action for the nurse to take in the situation?

Report suspected child abuse to the appropriate authority.

Medical treatment for child with Fragile X Syndrome

Serotonin CNS stimulants

A 2-year-old was admitted to the hospital in critical condition after ingesting about 20 children's chewable vitamins with iron 2 days ago. The mother said, "since it was his vitamins, I didn't think it was a poison." Which is the most appropriate nursing intervention in this situation?

Teach the mother about the dangers of iron poisoning

A nurse is evaluating a three-year-old with a developmental delay. Which assessment finding would indicate that this child might have a type of autism spectrum disorder? .

The child uses echolalia

Early outcomes

Understanding of child's diagnosis Specific physical and developmental needs of the child