Chapter 33 Peds Part 1
Anorexia Nervosa
(anorexia, "want of appetite," and nervosa, "nervous") is a form of self-starvation seen mostly in adolescent girls.
Anorexia Nervosa Treatment and nursing care
A brief period of hospitalization may be necessary to correct electrolyte imbalance, establish a minimum restoration of nutrients, and stabilize the patient's weight. It also provides a time-out from a dysfunctional home environment.
dysfunctional family
A family that provides a negative environment that discourages the growth and development of family members.
Anorexia Nervosa Manifestations
Adolescents who wish to be fashion models or actresses or who participate in sports, dance, or gymnastics activities may be at risk
Anorexia Nervosa
Affluent families may be at high risk when the concept of being thinner rules and the focus is on diet and exercise.
Anorexia Nervosa Manifestations
Although eating less, individual is preoccupied with food and its preparation. Hunger is denied. The patient complains of bloating and abdominal pain after ingesting small amounts of food.
The disorder is classified under "Binge eating disorder" and is characterized by:
Amenorrhea
Expressive language
An inability to express ideas
The disorder is classified under "Binge eating disorder" and is characterized by:
An intense fear of gaining weight
Intellectual disability onset
Before the age of 18 year olds It may include an IQ below of 70 at least 2 standard deviations below age-appropriate norms of development.
Anorexia Nervosa Treatment and nursing care
CBT- congenital behavior therapy helps develop adaptive patterns of behavior. Authoritarian food policing is avoided, and parents must be educated to help the adolescent gain his or her own self-control toward a healthier lifestyle.
Obsessive-compulsive disorders in children Tx
Cognitive behavioral therapy (CBT) combined with medication provides the best results.
Orientation:
Confusing left and right
Motor coordination:
Copying forms, printing, writing
intellectual disability
Describes impairment of general mental ability that in turn impairs functioning r/t everyday tasks
Information processing:
Differentiating words that look or sound alike
Behavioral problem:
Difficulty in concentrating; impatience
Receptive language
Difficulty in listening and understanding
Dysgraphia
Disability in spelling and writing
Learning disabilities include
Dyslexia, dysgraphia, and dyscalculia
The disorder is classified under "Binge eating disorder" and is characterized by:
Excess influence of body weight on self-evaluation
The disorder is classified under "Binge eating disorder" and is characterized by:
Failure to maintain the minimum normal weight for age and height (less than 85% of expected weight)
Anorexia Nervosa
Families of these young people are often dysfunctional. They may exhibit such abnormal behaviors as overprotectiveness, rigidity, lack of privacy, and inability to resolve conflicts.
Obsessive-compulsive disorders in children Cause
Family conflicts arise to compound the problem;
Recreation Therapy
Field of study that uses recreation to assist people with disabilities or long-term illnesses to improve quality of live, prevent advancing disability, and help maintain mental health.
Obsessive-compulsive disorders in children Tx
For behavior therapy to be successful, however, the child must be motivated and capable of following directions. Parent and sibling involvement and support are essential.
Anorexia Nervosa
For young people with the disorder, their own emerging sexuality is very threatening.
Obsessive-compulsive disorders in children Another cause
Group A beta-hemolytic streptococcal infections may trigger an autoimmune response that
A recommended communication strategy parents can use is
HELP - they should offer hope; demonstrate empathy and loyalty; and participate with the family to have a consistent plan of care
Aspergers Syndrome
High function autism May be more socially awkward Specific interest in certain topics
Dyslexia and dysgraphia may be apparent and are considered to be comorbidities. Some symptoms include:
Hyperactivity (at least two of the following): Climbs on furniture, fidgets, is always "on the go," cannot stay seated, does things in a loud and noisy way
Dyslexia and dysgraphia may be apparent and are considered to be comorbidities. Some symptoms include:
Impulsivity (at least three of the following): Is disruptive with other children, talks out in class, is extremely excitable, cannot wait turn, is overly talkative, requires a lot of supervision
Autism spectrum disorders
In early childhood there is evidence of little pretend play, the use of rigid rules in play, or a preference for solitary play.
Anorexia Nervosa Treatment and nursing care
In the early stages, dissatisfaction with body image, amenorrhea, and social isolation are suspect.
Dyslexia and dysgraphia may be apparent and are considered to be comorbidities. Some symptoms include:
Inattention (at least three of the following): Is easily distracted, needs a calm atmosphere in which to work, fails to complete work, does not appear to listen, has difficulty concentrating unless instruction is one-to-one, needs information repeated
Anorexia Nervosa Manifestations
Mealtime becomes a family battleground. The body image becomes increasingly disturbed and there is a lack of self-identity.
Anorexia Nervosa Treatment and nursing care
Medications such as serotonin reuptake inhibitors (SSRIs) (e.g., fluoxetine) are often prescribed to manage symptoms of depression.
Autism spectrum disorders Red flags to report include:
No babbling or pointing by 12 months No two-word spontaneous phrases by 24 months Loss of social skills or language previously attained
Autism spectrum disorders
Parents need to be educated concerning normal growth and development so they can recognize deviations and seek early interventions.
Obsessive-compulsive disorders in children
Poor school performance is related to compulsive repetitive behavior rather than a deficit in intelligence.
Memory:
Remembering personal information or spelling
Rhetts syndromw
Repetitive hand movements found between 6-18 months X chromosome Occurs in females
Attention deficit/hyperactivity disorder (ADHD)
Some children who are "labeled" in school develop low self-esteem and antisocial behavior.
Attention deficit/hyperactivity disorder (ADHD)
The childhood criteria for the diagnosis of ADHD include at least six symptoms; adulthood criteria require five symptoms for diagnosis: Receptive language Expressive language Information processing Memory Motor coordination Orientation Behavioral problem
Autism spectrum disorders favorable prognosis.
The development of meaningful language by 5 years of age
Anorexia Nervosa Treatment and nursing care
The nurse plays an important role in ensuring that the atmosphere is relaxed, supportive, and nonpunitive.
Anorexia Nervosa Manifestations
The young person remains egocentric and unable to complete normal adolescent tasks.
Anorexia Nervosa Treatment and nursing care
Therapies include individual and family psychotherapy and a bio-psycho-social model of behavior therapy
Anorexia Nervosa
There is often a power struggle between child and parent. Children may feel that the only thing they can control in their environment is what they put into their mouth.
Autism spectrum disorders
There is often little empathy for others.
Anorexia Nervosa
These adolescents characteristically have average to superior intelligence and are overachievers who expect to be perfect in all areas.
Anorexia Nervosa
Young people - They experience anxiety and guilt over an imagined or a real fear of intimacy. They have low self-esteem, are obedient, and are nonassertive and shy.
Anorexia Nervosa Treatment and nursing care
a lack of recognition is one of the biggest obstacles to treatment.
Obsessive-compulsive disorders in children
a recurrent, persistent, repetitive thought invades the conscious mind (obsession), and a ritual movement or activity assumes inordinate importance (compulsion).
An area of specific focus in neurodevelopmental function is
academic skill development, such as learning disabilities.
Autism spectrum disorders
are a group of neurodevelopmental disorders characterized by difficulties in social interaction and communication, repetitive behaviors, and stereotyped interests and activities
Dyslexia is often seen in children with
attention deficit/hyperactivity disorder (ADHD), but it is not part of the pathology of ADHD
Prolonged ritualistic behavior should
be referred for follow-up care.
Obsessive-compulsive disorders in children
behavior may start as early as 4 years of age but may not be noticed as interfering with daily functioning until 10 years of age or older.
dyslexia use of a calculator and computer and providing a distraction-free classroom environment
can provide successful learning experiences.
Autism spectrum disorders
cause is thought to be related to factors such as close spacing of pregnancies, advanced parental age, prematurity, prenatal environment, and multiple genetic factors.
Obsessive-compulsive disorders in children
cause may be genetic, and abnormalities of the basal ganglia of the brain have been noted.
Attention deficit/hyperactivity disorder (ADHD)
child often underachieves in school, has problems with interpersonal relationships, and has low self-esteem.
The nurse assesses the level of
development, social skills, affect, eye contact, face and body expressions, appearance, and behavior.
Autism spectrum disorders
diagnosis can be made as early as 1 to 2 years of age and is well established by 18 years of age
Dyscalculia
disability in math
Abuse in early infant development can cause
disruption in the brain's regulatory system that results in problems in information processing, memory, and self-regulation
The U.S. Food and Drug Administration (FDA)-approved medications prescribed for ADHD include
dopaminergic agonists, such as Ritalin, Concerta, Focalin, Dexedrine, Adderall, and atomoxetine.
Anorexia Nervosa Manifestations
dry skin, amenorrhea, lanugo hair over the back and extremities, cold intolerance, low blood pressure, abdominal pain, and constipation.
Anorexia Nervosa Manifestations
experience feelings of helplessness, lack of control, low self-esteem, and depression. Socialization with peers diminishes. Mealtime becomes a family battleground.
Obsessive-compulsive disorders in children medications
fluoxetine, sertraline and fluvoxamine.
Behavior modifications
focuses on modifying specific behaviors by means of stimulus and response conditioning.
Attention deficit/hyperactivity disorder (ADHD) increased risk
has been associated with a high fat and sugar prenatal diet, the prenatal environment; and maternal drug use.
Attention deficit/hyperactivity disorder (ADHD) Genetic Factors
has been identified involving disturbances in the dopamine system - this has been labeled the "dopamine hypothesis," and it is the basis for the development of the condition and the medications used to treat it
dyslexia Speech and occupational therapists are helpful
in designing interventions for the child, whose interests and strengths should be the basis for any approach.
Early childhood intervention programs are helpful
in preventing major problems that affect growth and development.
Autism spectrum disorders
include formerly separate conditions, such as autism, Asperger's syndrome, Rett's syndrome, and others
Attention deficit/hyperactivity disorder (ADHD)
includes inattention, increased distractibility, poor impulse control, and motor restlessness.
Autism spectrum disorders
involves providing well-structured home and school environments, behavior modification, and the use of specific drugs to manage specific behavioral problems. The goal of therapy is to maximize the child's ability to live independently.
Anorexia Nervosa Treatment and nursing care
is complex and involves several modalities.
Obsessive-compulsive disorders in children The nurse's role
is to assess normal growth and development and to understand that ritualistic behavior that is normal at 3 years of age is normally replaced by hobbies of collecting and special interests by 8 years of age.
Autism spectrum disorders The nurse's role
is to identify abnormal behavior as early as possible, refer for follow-up care, and monitor the side effects of prescribed medications.
If the health care provider discredits the parents' values,
it threatens the child's security and creates anxiety.
Early signs of dyslexia
may include difficulty in recognizing letters of the alphabet, difficulty in learning nursery rhymes, or confusing words that sound alike, resulting in a dislike for reading.
Autism spectrum disorders Permission should be asked
of the child before touching him or her, and sudden movements or loud noise should be avoided.
Attention deficit/hyperactivity disorder (ADHD)
often occurs with learning disabilities; learning disabilities are not part of ______, and the child usually has average or above-average intellectual ability.
Early childhood intervention programs For infants and toddlers, therapies focus on
parent-child relationships and principles of behavior modification, especially positive reinforcement and consistent responses.
The causes of neurodevelopmental dysfunction may include
perinatal influences, such as low birth weight; prenatal exposure to drugs or alcohol; genetic influences, such as anomalies that may be found on chromosomes 6 and 15; or brain abnormalities in the parietotemporal or occipital areas that result in the development of alternate pathways in the brain to develop reading ability
Early bonding and attachment are essential parts of developing
positive mental health.
Psychosomatic
refer to the dysfunctions of the body that seem to have an emotional or a mental root.
Attention deficit/hyperactivity disorder (ADHD)
refers to a developmentally inappropriate degree of gross motor activity, impulsivity, and inattention in the school and home settings that begins before age 7 years, lasts more than 6 months, and is not related to the existence of any other central nervous system illness.
Obsessive-compulsive disorders in children Pediatric acute onset neuropsychiatric syndrome (PANS)
refers to cases of acute-onset OCD related to streptococcal infections
milieu therapy
refers to the physical and social environment provided for the child.
Anorexia Nervosa Treatment and nursing care
requires the cooperation of the family to understand that the focus is on developing positive coping mechanisms rather than assigning criticism to the parent or child.
Attention deficit/hyperactivity disorder (ADHD) MRI has shown
revealed some abnormalities within the prefrontal cortex and ganglia of the brain.
Anorexia Nervosa Manifestations
severe weight loss.
Autism spectrum disorders The nurse's approach to the patient
should be slow paced, with few distractions. The child should be allowed to become familiar with the office, room, or equipment.
Bibliotherapy
the use of self-help books and other reading materials as a form of therapy, or reading a story about children in a situation similar to child situation
Art therapy, music therapy, and play therapy are particularly helpful for interacting with
younger children who have difficulty expressing themselves.
Strategies for managing the child with ADHD in the classroom:
• Seat the child in the front of the classroom to minimize distraction. • Whenever necessary remind the child to focus his or her attention. • Give clear instructions, and repeat them often. • Provide breaks between periods of work or study.