chapter 22 caring for the child with a psychosocial or cognitive condition

Prevention

*Pay attention to any signs of anxiety. *Children & adolescents likely respond to someone who takes the time to listen & care. *The nurse helps parents about how & when to protect children from information that might be overwhelming.

Education

*Teaching related to healthy coping and communication. *Relaxation and deep breathing *Problem-solving techniques.

VULNERABILITY & RESILIENCE are multifaceted and affected by

+ GENETICS + TEMPERAMENT + ENVIRONMENT + TIMING

K2= TYPE OF MARIJUANA= USED TO AVAILABLE ON THE COUNTER= LEAD THE KID TO THE PICU AND HAVE PERMANENT EFFECT FOR THE REST OF THEIR LIVES PEDIATRIC COMMON DRUG USES

- ALCOHOL - MARIJUANA - K2 - OPIATES - INHALANTS - PRESCRIPTION DRUGS - STIMULANTS(METH, RITALIN) - FLAKKA, "BATH SALTS"

nursing care for anxiety

- COPING CAT PROGRAM = 7 to 13 w anxiety disorders - CAT PROGRAMS= adolescent These programs help children develop skills to cope with anxiety and provide techniques to decrease fears through systemic exposure to the feared object. - FRIEND PROGRAM= parents + their children with anxiety disorders. It uses cognitive behavioral techniques to help children and their families cope with anxiety. Feeling worried? Relax and feel good Inner thoughts Explore plans Nice work so reward yourself Don't forget to practice Stay calm, you know how to cope.

alarm acronym for autism spectrum disorder

- Early signs of autism are often present before 18 months parents usually do have concerns that something is wrong parents generally do give accurate and qualify information when parents do not spontaneously raise concern, ask if they have any concerns - Act early know the differences between typical and atypical development learn to recognize red flags improve the quality of life for children and their families through early and appropriate intervention - Refer to the web for sources related to early intervention of autism or a local school program to an autism specialist, or team specialists, immediately for a definitive diagnosis to audiology to rule out a hearing impairment to local community resources for help and family support - Monitor schedule a follow up appointment to discuss concerns more thoroughly look for other features known to be associated with autism educate the parents and provide them with up to date information advocate for families with local early intervention programs, schools, respite care agencies, and insurance companies continue surveillance and watch for additional or late signs of autism and other developmental disorders

NURSING CARE

- First: Ensure safety -Understand how to deal w suicidal ideation or intent. - Determine presence of signs & symptoms - Develop trusting relationship = THEY FEEL THEY CAN TALK TO YOU ABOUT IT

1. CULTURE

- Is an external and acquired phenomenon - it is the complex set of beliefs and attributes passed on within a group - What is considered mental illness in one culture may not be in another.

Signs and Symptoms

- Persistent sad or irritable mood - Loss of interest in activities once enjoyed (ANHEDONIA) - Significant change in appetite or body weight/ difficulty sleeping of oversleeping - Fatigue or loss of energy - Feelings of worthlessness or excessive/inappropriate guilt - Decreased ability to think or concentrate or to make decisions/ example is a drop in grades or school performance - Recurrent thoughts of death or suicide with or without a suicide plan, and in younger children, consistent engagement in activities or play that involve themes of death and suicide.

PTSD PREVENTION

- Promoting resilience in at-risk families (prior to trauma)= IDENTIFY TRAUMATIC ADVANCE FOR KID SUCH AS ABUSE. -Teaching safety measures for potential risk factors/ environmental disasters. -Programs that ensure safety STRANGER/DANGER - Early research on pharmacological measures to prevent PTSD

EDUCATION/ DISCHARGE INSTRUCTIONS

- Psychotherapy and psychopharmacotherapy - help parents and families understand the immediate and ongoing impact that traumatic event may have

PTSD SIGNS & SYMPTOMS

- Re-experiencing trauma through flashbacks, nightmares, or physical sensations - Avoiding reminders of the anything or any place that triggers memories - Physiological symptoms of anxious arousal

PREVENTION

- Relaxation techniques - use firm restraint holds to control rages - Prioritize battles and let go of less important matters - Reduce stress at home & school - Use good listening and communication skills - Develop coping strategies beforehand - Engage the child's creativity through activities that express and channel gifts and strengths -Routines, structures, and freedom within limits

EDUCATION/DISCHARGE INSTRUCTIONS

- Talk with parents about suspected depression Suggest referral to counselor, pastor, chaplain, or spiritual director for evaluation and treatment.

eating disorders

- anorexia nervosa - binge eating and obesity

psychosocial or cognitive conditions in children

- anxiety - PTSD - mood disorder

reactive attachment disorder= relatively RARE condition characterized by significant difficulties in forming emotional attachments with others= due to experienced early life trauma or loss, making it difficult for them to form meaningful and vital connection= attachment difficulties can be recognized as early as infancy and definitely by the age of 5

- children who have not been afforded consistent and nurturing presence early in their lives become either anxiously attached or detached in relation to others - infants and children diagnosed with attachment disorders have usually endured neglect or maltreatment or have experienced severe trauma - vulnerable children are those within the foster care and international and domestic adoption system who have previously been abandoned or abused. ==> these are the children who have most clearly experienced early attachment - infants with mothers with significant postpartum depression or mental illness may not have had the opportunity to bond and attach healthily 1/ S/S marked disturbance in ability to relate socially manifesting either - emotional withdrawal or inhibition + inability to seek or accept warmth from others/ inability to show or respond to affection - marked disinhibition/ indiscriminant willingness to seek comfort even from strangers/ excessive trust of stranger (OVERLY trustful of strangers) - INFANTS WITH SERIOUS INSECURE ATTACHMENT MAY EXHIBIT SEVERE FEEDING DIFFICULTIES NOT RELATED TO A PHYSIOLOGICAL CAUSE 2/ DIAGNOSIS - the nurse can aid in parental report and observation about how child interacts around parents and strangers - have generally experienced early life trauma 3/ PREVENTION - because childhood and adolescent disorders are related to early trauma, prevention lies in educating parents and caretakers and providing them with mental health services prior to becoming parents - adoptive parents should be aware of the difficulties that may have been experienced by their children prior to adoption 4/ NURSING CARE - because attachment disorders in infants and children result from the lack of opportunity to experience a caring relationship ==> DEVELOP TRUST = FIRST STEP through meeting the child's BASIC NEEDS or responding to cries or tantrums or listlessness with patience and consistency is exceptionally important ==> PSYCHOTHERAPY 5/ EDUCATION/DISCHARGE INSTRUCTIONS - support - education about attachment and bonding - education about how to deal with child's difficulty making interpersonal connections - support group

MOOD DISORDERS

- depression - bipolar disorder - suicide - schizophrenia Sometimes more difficult to diagnose in children & adolescents because of developmental phases, the lack of language and cognitive skills to describe symptoms & experiences.

3. RACE

- describe categories of people, mostly based on physical characteristics - example: skin color, shape of nose

PREVENTION

- does the child have a plan? - is the plan possible? (is the mean to self-harm accessible)? - has the child attempted suicide before? If any of these factors are present, the nurse must refer the child and family to mental health professional who can assess the level of risk/ the child or adolescent may need immediate hospitalization to remain safe

tic disorder= sudden, painless, non-rhythmic behaviors that are either motor (related to movement or vocal and that appear out of context such as grimacing in class/ tics are temporary condition that resolve on their own/ for some children, the tics persist over time, becoming more complex and severe

- eye blinking, facial grimacing (simple motor tics) - hand gestures, jumping ( complex motor tics) - throat clearing, grunting (complex vocal tics) - meaningless changes in volume and pitch of speech - echolalia (repeating last heard sounds or words)

agoraphobia

- fear/ avoidance of certain places or situations/ FEAR OR LEAVING HOME OR OPEN PLACES

developmental disabilities

- fragile X syndrome - down syndrome - intellectual disabilities - autism spectrum disorder - fetal alcohol spectrum disorder

2. ETHNICTITY

- groups of people who share similar cultural characteristics: Common language, religion, food, and beliefs about health.

DIAGNOSIS

- have you thought about doing something to hurt yourself or take your life? - do you ever wish you were not alive? - what would you do if you were to hurt yourself?

down syndrome health-related issues

- heart defects - decreased immune function - GI anomalies - visual and hearing difficulties - speech difficulties - hypothyroidism - SLEEP APNEA IS ALSO A PROBLEM NOTED IN THESE CHILDREN

PTSD NURSING CARE

- mental health-care facility - educate parents about symptoms - help family & child by making referrals for appropriate services - provide secure home base

Developmental anxiety: Fear of strangers or in response to separation from caregivers

- occurs between 7 to 12 months - peaks between 9 to 18 months - decreases by age 2 1/2 - also a child may have an inherent anxious temperament and may be inhibited when encountering new situations, people or objects and may respond to these with fear and withdrawal

separation anxiety disorder

- overwhelming fear of becoming separated from or losing a caregiver

psychosocial and cognitive disorders

- reactive attachment disorder - ADHD - oppositional defiant - conduct disorder - Tourette's syndrome

learning disabilities and cognitive impairment/ NOT SPENDING A LOT OF TIME ON THESE

- reading - arithmetic - language disorders

Signs & symptoms

- symptoms of depression or other psychosocial or cognitive conditions - withdrawal from friendships - expression of hopelessness - isolative behavior - personality changes - decline in schoolwork - giving away personal possessions that were once prized - preoccupation with death in writing or playing - refers to dying or no longer being around - access to a method of suicide such as medications or weapons

education/ discharge instructions

- teach about healthy coping and communication/ DON'T RESCUE THEM WHENEVER THEY MAKE A MISTAKE BC IT WON'T HELP THEM DEVELOP COPING SKILLS/ LET THEM LEARN THE LESSON - teach relaxation and deep breathing/ ART, WRITING, MUSIC IS A BIG THING, SPORT, JOURNALING, OR TAKE A 5 MIN TIME OUT FROM THE SITUATION CAN HELP - teach about problem-solving techniques - psychopharmacology-what is the drug class of choice? SSRIs/ INCREASE RISK OF SUICIDE SO YOU NEED TO KEEP THAT IN MIND WHEN TREATING CHILDREN

maltreatment of children = abuse + neglect of a child less than 18 years of age by anyone who is in a caregiver or custodial role (a parent, foster caregiver, clergy, coach, or teacher)

- the most common forms of abuse are physical, sexual, emotional abuse, and neglect - CHILD PHYSICAL ABUSE= injury inflicted by beating, pushing, kicking, pinching, burning, or choking - CHILD SEXUAL ABUSE= any sexually related act, usually between a child and an adult (related or not) - CHILD EMOTIONAL ABUSE= any behavior, attitude, or failure to act that disrupts children's socioemotional development and mental health /ex/ SHAMING OR HUMILIATING/ YOU ARE WORTHLESS and INTIMIDATING (threatening and frightening) - CHILD NEGLECT= involves failures to provide emotional and physical care as well as opportunity for education - MUNCHAUSEN-BY-PROXY SYNDROME= a person, usually the mother, deliberately makes the child sick/ SHE LIKES TO GET ATTENTION SEEKING EX/ GIVING SOMETHING IN THE FOOD THAT THE CHILD IS ALERGIC TO - ELECTRONIC SEXUAL LURING= enticing children via the internet

DIAGNOSIS

- thorough history and physical exam/ including family history--why? Bipolar disorder tends to run in families. Children with a parent or sibling who has bipolar disorder are much more likely to develop the illness, compared with children who do not have a family history of the disorder. - identification of significant mood swings - not usually diagnosed in children because children are naturally growing and changing, and developmental considerations must always be kept in mind when determining whether a behavior is a "symptom" or merely a reflection of youth/ Bipolar disorder in children is especially difficult to distinguish from ADHD, since they share a number of symptoms — impulsiveness, distractibility, and hyperactivity.

panic disorder

- usually begins in adolescence (may start earlier) S&S: - palpitations - sweating - shaking - nausea - dizziness - fear of dying - tingling sensation - chills or hot flushes

social anxiety disorder

-Children avoid social situations/ SUCH AS PUBLIC SPEAKING

EDUCATION/DISCHARGE

-SAFETY!!! - remove harmful objects from home - keep medications in locked cabinet - teach family to watch for child's response/reaction to medications/ instruct the family that it may take 2 to 3 weeks before the medications become effective - instruct family to contact health-car professional if symptoms escalate and become uncontrollable. - STRUCTURE IN THE HOME IS IMPORTANT.

barriers to child & adolescent mental health

1. The stigma of mental illness is a major barrier to accessing mental health services for children & their families 2. Health-care community & the public are skeptical about whether young children experience mental health disorders, such as depression or anxiety: There is a belief that childhood is a happy time free of problems 3. health care provider also "minimize" or "dismiss" caregivers' concerns: Parents may be told that the child is going through a stage that will pass, when there are truly concerns (signs of autism spectrum disorder).

barriers to child & adolescent mental health may lead to other issues

1. not getting screened on a timely basis for disordered behaviors and emotional difficulties can be attenuated or resolved if early intervention is sought in a timely fashion 2. having a sense of shame for the family if a child or adolescent is eventually diagnosed with a mental illness that may have been prevented or attenuated earlier 3. Inability to receive adequate treatment because lack of resources

oppositional defiant and conduct disorder/ antisocial behavior is at the core of disordered behavior that can often explode in to clinical disorders= ODD and CD= due to psychosocial factors that may be associated with the development of CD and ODD in children and adolescents

1/ OPPOSITIONAL DEFIANT DISORDER - FREQUENT TEMPER TANTRUMS - EXCESSIVE ARGUING WITH ADULTS - OFTEN QUESTIONING OF RULES - active defiance and refusal to comply with adult requests and rules - deliberate attempts to annoy or upset people - blaming others for his or her mistakes or misbehavior - often being touchy or easily annoyed by others - frequent anger and resentment - mean and hateful talking when upset - spiteful attitude and revenge seeking CONDUCT DISORDER - BREAKING RULES WITHOUT OBVIOUS REASON - CRUEL OR AGGRESSIVE (HARMING ANIMALS, FIGHTING, BULLYING, USING DANGEROUS WEAPONS, FORCING SEXUAL ACTIVITY, AND STEALING)/ LACK OF REMORSE - FAILURE TO ATTEND SCHOOL - heavy drinking, or illicit drug use - intentionally setting fires - vandalizing or destroying property 2/ DIAGNOSIS - behavioral criteria present 3/ NURSING CARE - medications for ODD or CD = stimulants for ADHD symptoms, ANTIPSYCHOTICS for behavior regulation, mood stabilizers for regulation high and low mood presentations, and antianxiety agents - teach coping skills - encourage family to take care of personal needs because these disorders can cause the stress on the whole family/ it may be exhausting for parents to cope with the defiant behaviors/ siblings may be put at risk simply spending time with the misbehaved child 4/ EDUCATION/DISCHARGE INSTRUCTIONS - educate about medications, community resources, and psychotherapy

anorexia nervosa, bulimia, and binge eating ==> ANOREXIA NERVOSA CAN BECOME A LIFE THREATENING PROBLEM OR CAUSE DEATH BECAUSE OF SEVERE WEIGHT LOSS THAT CAN RESULT IN ELECTROLYTE IMBALANCE AND HEMODYNAMIC INSTABILITY

1/ RISK FACTORS - family genetics - rigidity, ritualism in home - stressful life event - hormonal and physiological changes associated with puberty - "picky" eater in childhood - participation is sports that focus on the pursuit of thinness 2/ SIGNS AND SYMPTOMS - inordinate concern and gross distortion of body image and body weight - preoccupation with food - hide behaviors related to food and caloric intake from others - depression - anxiety - family discord/ conflict avoidance - WEIGHT LOSS UP TO to 85% of ideal body weight OR WEIGHT < 85% OF EXPECTED WEIGHT - consuming caloric intake but then purging by vomiting - vigorous physical activity - amenorrhea - weakness - fatigue 3/ DIAGNOSTIC OF ANOREXIA NERVOSA - weight < 85% of expected weight - distorted body image - absence of three consecutive menstrual cycles 4/ DIAGNOSTIC CRITERIA FOR BULIMIA NERVOSA - lack of control over eating - recurrent inappropriate compensatory behavior to prevent weight gain such as VOMITING/ LAXATIVE - cycle of binge eating occur at least twice a week for 3 months - BULIMIA CAN BE NORMAL WEIGHT OR OVER WEIGHT 5/ NURSING CARE - provide a highly structured environment - involve client in decision making and participation in care plan - assist client in setting realistic weight goals - promote cognitive reframing HELP THEM WITH THE BODY IMAGE DISTORTION THAT THEY HAVE/ YOU DO NOT GIVE ANOREXIA THEIR WEIGHT BECAUSE IT GIVES THEM MORE ANXIETY AND THEY ARE GOING TO FREAK OUT AND THAT WILL AFFECT THE TREATMENT PLAN EVEN IF THEY GAIN 1/2 POUND/ assist patient in changing negative perception to positive one - monitor patient's weight, vitals, intake/output, caloric intake, and exercise 6/ EDUCATION/DISCHARGE INSTRUCTIONS - instruct family about team approach and that treatment can take a long time

ADHD/ they can have ADHD with or without hyperactivity - a child can have ADHD without hyperactivity typically has symptoms of distractibility while ADHD without hyperactivity garners much less attention than ADHD with hyperactivity - children with ADHD can have comorbid conditions such as depression, anxiety, oppositional defiant disorder, and learning disabilities

1/ S/S - INATTENTION/ fail to give close attention to details or make careless mistakes in schoolwork, work or other activities/difficulty sustaining attention in tasks or play activities/not seem to listen when spoken to directly/ not follow through on instructions and fails to finish homework, chores, or duties in the work place/ difficulty organizing tasks and activities/ often avoid, dislikes, or reluctant to engage in tasks that require sustained mental effort such as schoolwork or homework/ often lose things necessary for tasks or activities such as toys, school assignments, pencils, books, or tools/ often easily distracted by extraneous stimuli/ forgetful in daily activities - HYPERACTIVITY/ fidgets with hands or feet or squirms in seat/ often leaves seat in classroom or i other situations in which remaining seated is expected/ often runs about or climbs excessively in situations in which it is inappropriate/ is often "on the go" or often acts as if "driven by a motor"/ often talks excessively - IMPULSIVITY/ often blurts out answers before questions have been completed/ often has difficulty awaiting turn/ often interrupts or intrudes on others such as butts into conversations or games 2/ DIAGNOSIS - evaluation by physician and others - the child must first meet the diagnostic criteria outlined in the DSM-V 3/ NURSING CARE - observe and gather information - combination of pharmacological and psychosocial interventions - assess the developmental level of the child and family - refer to the feature medications: ADHD= pharmacological and psychosocial interventions/ VERY EFFECTIVE TREATMENT IF YOU COMBINE THESE TOGETHER/ NOT EFFECTIVE ALONE - early intervention works best and that the child and family may have periods of adaptive and maladaptive behavior 4/ EDUCATION/DISCHARGE INSTRUCTION - educate the family about behavior techniques for helping the child focus and maintain appropriate behaviors/ GET THE CHILDREN A PLANNER CAN BE EFFECTIVE WITH SCHOOL - educate parents about pharmacological interventions/ STIMULANT= METHYLPHENIDATE AND DEXTROAMPHETAMINE/ IT SUPPRESSES APPETITE SO WE NEED TO ASSESS FOR BMI= HEIGHT AND WEIGHT - CHILDREN OFTEN RESPOND TO THERAPEUTIC APPROACHES = behavioral therapy, REWARD STICKER CHARTS, AND POSITIVE VERUS NEGATIVE REINFORCEMENT ( used as often as possible when child demonstrates acceptable behavior

obesity= hypertension, diabetes, shortness of breath, and increased risk for cardiovascular disease obesity = be teased or bullied by peers, leading to difficulties with self esteem and social development

1/ S/S - a BMI-for-age between the 5th and less than the 85th percentile is considered a healthy weight - a BMI-for-age between the 85th and less than the 95% percentile is considered overweight - a BMI-for-age greater or equal to 95% is considered obese 2/ DIAGNOSIS - diagnosis of obesity is based on an excess of fat in proportion to lean body mass BMI= weight (kg)/ height (in meters) squared 3/ NURSING CARE - nursing care measures are geared toward helping the child and family recognize the problem and help the child to return to a healthier state - address potential health risks - offer education and support - help family to change lifestyle habits/ the change of lifestyle habits of the family become much easier to do when the entire family engages in new healthy habits together- set goals with family's input 4/ EDUCATION/ DISCHARGE INSTRUCTIONS - inquire about family's perception and weight - conduct comprehensive individual and family history such as a hx of diabetes, dyslipidemia, or cardiovascular disease - perform thorough physical assessment - teach child and family about value of 24 hour recall/ MEANING WHAT DID YOU EAT IN THE LAST 24 HOUR AND HAVE THE REFLECTION ON WHAT THEY ATE - discuss an activity inventory to determine the amount of time spent in playing video games, watching tv, and other activities within 24 hours period - suggest fun family activities such as walking, playing catch, going to the zoo , or park

fetal alcohol spectrum disorder=result of the teratogenic effects of alcohol= drinking while being pregnant

1/ S/S - abnormal facial features - growth problems - hyperactive behavior - learning and attention difficulties - developmental delays - poor motor skills 2/ DIAGNOSIS - comprehensive history - physical characteristics at birth 3/ NURSING CARE - early intervention and referral can help the child and family function optimally - early education such as birth to three service as an infant and in special education as a preschooler can help her learn adaptive skills to use throughout life - help parents work with child, learning about limitations and strengths 4/ EDUCATION/DISCHARGE INSTRUCTIONS - women of childbearing age can be informed of the preventability of FAS disorder through abstinence - teach parents to cope with behaviors - provide resources to help parents to deal with child's limitations

reading (dyslexia), arithmetic, language disorders

1/ S/S - academic achievement significantly less than would be expected for child's age, education, and level of intelligence - significant interference with academic performance or activities that require reading, math, or writing skills 2/ DIAGNOSIS - diagnosis is made through comprehensive assessment involving interviews and observations 3/ NURSING CARE - communicate to family that child's strengths are incorporated as part of assessment, early prevention, and intervention - inform parents about child's rights and entitlements in the public school sector - often children who enter public education with a learning challenge or disability will have an IEP (individualized education plan) 4/ EDUCATION/DISCHARGE INSTRUCTION - teach parents about how to capitalize on child's strengths - school nurses are useful in providing education and support

encopresis= passage of feces into inappropriate places and locations repeatedly such as on the wall, clothing, or furniture= encopresis is primary in children who have not become consistently continent by age 5 or secondary in children who have been continent and then become incontinent for a period of time/ the child may present with wither constipation with fecal incontinence because of overflow of feces, or without constipation

1/ S/S - constipation - pain and straining with defecation - anxiety about defecating in a specific place - anal fissure - fecal retention 2/ DIAGNOSIS - placement of feces into inappropriate place - occurs in child at least 4 years old or older 3/ NURSING CARE - talk to parents about the child's defecation patterns during a medical appointment - take thorough history of bowel habits and toilet training - monitor occurrence of constipation - evaluate child's dietary habits 4/ EDUCATION/ DISCHARGE INSTRUCTIONS - recommend high-fiber diet to prevent constipation - talk to parents to determine any life transitions that may be occurring in child's life

autism spectrum disorder= limitations in social relatedness, verbal and nonverbal communication, and the range of interests and behaviors/ JUST BECAUSE THEY HAVE THESE IMPAIRMENT AND THEY DON'T HAVE INTELLIGENCE. ACTUALLY THEY ARE INTELLIGENCE

1/ S/S - persistent qualitative impairment in social reciprocity - impaired communication/ USING NO LANGUAGES, OR USING DEVIANT SPEECH WITH ERRORS IN TONES, PROSODY, PITCH, GRAMMAR, OR PRAGMATICS (TAKING TURNS) - restrictive or repetitive behaviors SUCH AS HEAD BANGING, interests, or activities 2/DIAGNOSIS http://www.firstsigns.org/delays_disorders/other_disorders.htm 3/ NURSING CARE - awareness of need for early intervention BC OF THE SUBSTANTIAL CORTICAL PLASTICITY (THE ABILITY OF TISSUES TO GROW DURING EARLY BRAIN DEVELOPMENT)= nonmedical treatment = address social competence = EARLY LANGUAGE DEVELOPMENT (poor functional communication skills also contribute significantly to the problematic behaviors that some autistic children display such as POOR FRUSTRATION TOLERANCE AND AGGRESSION TOWARD SELF OR OTHERS = teach parents about SOCIAL SKILLS TRAINING to help the child with opportunity to learn and practice appropriate social relatedness = facilitate coping with this disorder = stay aware of child's physical boundaries and reluctance to be touched by others/ THESE KIDS DON'T LIKE TO BE CUDDLE BY A PARENT SO WE NEED TO RESPECT THOSE PHYSICAL BOUNDARIES 4/ EDUCATION/DISCHARGE INSTRUCTION - ALARM ACRONYM

sleep disorder= more susceptible to stress-induced disorder COMMON CAUSES OF SLEEP PROBLEMS IN CHILDREN - nightmares - sleep terrors - sleepwalking - episodes of insomnia - irregular sleep routine - caffeine intake - sleep apnea - restless leg syndrome

1/ S/S - difficulty falling asleep at night - difficulty returning to sleep after waking up during the night - waking up frequently during the night - light sleep/ not deep sleep - sleepiness and low energy during the day - day time irritability - snoring or periods of sleep apnea 2/ DIAGNOSIS - physical examination - assess sleep pattern and quality of sleep 3/ NURSING CARE - listen - provide information on healthy sleep habits - the nurse educates parents about about healthy sleep hygiene, management or respiratory disorders, pediatric depression, anxiety, and developmental and mental health diagnoses 4/ EDUCATION/DISCHARGE INSTRUCTIONS - encourage follow-up care - support group - WHAT ARE SOME SLEEP HYGIENE TECHNIQUES THE NURSE CAN PROVIDE PATIENTS? + SLEEPING IN A DARK ROOM WITH NO TV OR ELECTRONICS/ PAGE 861

maltreatment of children

1/ S/S of physical, sexual, emotional abuse, neglect, and munchausen by proxy 2/ DIAGNOSIS - family history, physical examination and developmental assessment SUCH AS REGRESSION OR SOMETIMES THE CHILD WILL ACT OLDER THAN THEIR AGE - X-rays - serum chemistry lab tests to determine any infection, drug induction, or toxicity 3/ NURSING CARE - utilize primary and secondary preventive strategies - report abuse/ ALWAYS BC IT IS MANDATORY 4/ EDUCATION/ DISCHARGE INSTRUCTIONS - provide parents with information regarding "normal" stages of growth and development/ ESPECIALLY TEENS MOM OR TEENS DAD - family education about what to expect from parenthood - instruct parents on how to cope with difficult times related to raising a child - help parents develop resources for support, such as babysitters, family members, and community resources/ THINGS THAT PARENTS CAN TAKE A BREAK

tourette's syndrome= included in a spectrum of tic disorder= transient and chronic tics= inherited neuropsychiatric disorder with an onset in childhood TS= multiple physical (motor) tics + at least one vocal (phonic) tic

1/ S/S/ children with TS often exhibit symptoms of other disorders, similar to OCD, autism, ADHD. children with coexisting disorders are more likely to suffer depression, low self-esteem, negative peer acceptance, and poor school performance than those with tics alone - eye blinking - neck jerking - abdominal tensing - touching 2/ DIAGNOSIS - the child may have both multiple motor and one or more vocal tics present at some time but not necessarily concurrently OR AT THE SAME TIME - tics occur several times a day - tics occur almost every day or intermittently throughout a period of more than 1 year - the onset of tics is before age 18 years - the disturbance is not caused by the direct physiological effects of a substance or a general medical condition 3/ NURSING CARE - recognize impact of disorder on child's functioning and social relationships/ the nurse can help family members and teachers understand that the child can not control the tics - active listening - professional counseling 4/ EDUCATION/DISCHARGE INSTRUCTIONS - teach parents to be aware of stress this syndrome can create - the nurse can help the parents watch for signs that the child is being bullied by peers or siblings - instruct family to watch for signs of coexisting disorder such as ADHD or OCD - STIMULANTS USE FOR KID WITH TOURETTE'S SYNDROME CAN EXACERBATE THE SYMPTOMS/ KID DIAGNOSE WITH TICS ALSO GET DIAGNOSED WITH ADHD

fragile X syndrome

1/ SIGNS AND SYMPTOMS - PHYSICAL FEATURES/ large head, elongated face, prominent ears, chin, and forehead - DEVELOPMENTAL DELAYS/ not reaching milestones in line with children in the same age group - LEARNING DISABILITIES/ difficulty learning new skills; poor intellectual development - SOCIAL/ BEHAVIORAL DIFFICULTIES/ poor communication, self-abuse, no eye contact, difficulty paying attention 2/ DIAGNOSIS - DNA testing 3/ NURSING CARE (no known cure for FXS) - access and utilize early intervention services - provide information about growth and development and anticipatory guidance to raise the child according to his or her developmental level 4/ EDUCATION/DISCHARGE INSTRUCTIONS - provide information related to FXS and potential sequalae - provide education about medication

substance use and abuse

1/ SIGNS AND SYMPTOMS - PHYSICAL/ fatigue, repeated health complaints, red and glazed eyes, and a lasting cough - EMOTIONAL/ personality change, sudden mood changes, irritability, irresponsible behavior, low self-esteem, poor judgement, depression, and a general lack of interest/ APATHETIC MEANING THEY DON'T CARE - FAMILY/ stating arguments, breaking rules, or withdrawing from the family - school - social problems 2/ DIAGNOSIS - based on the physical, emotional, and social factors exhibited by the child - a thorough family history 3/ NURSING CARE - screening tools to assess drug and alcohol use - refer to table 22-4/ the CRAFT and CAGE tools use SIMPLE ACRONYMS to assist in the evaluation of drinking or drug use 4/ EDUCATION/DISCHARGE INSTRUCTIONS - be alert to early signs of substance use - observe for changes in mood or odd behavior - help the family find community resources

schizophrenia ==> the disorder begins in late adolescence or early adulthood, but it is possible for children as young as 5 or 6 to exhibit signs

1/ SIGNS AND SYMPTOMS - hallucinations - delusions - disorganized speech and behavior - decreased or "flattening" of affect 2/ DIAGNOSIS - based on a mental health interview that includes a comprehensive developmental and family history - rate to diagnose in children/ adolescents but can occur 3/ NURSING CARE - pharmacological agents - psychoeducation and psychotherapy - national alliance for the mentally ill - THIS CAN BE A BIG STRESS IN THE FAMILY/ PROVIDE SUPPORT 4/ EDUCATION/DISCHARGE INSTRUCTIONS - remind patients about importance of medications (antipsychotic) - reinforce ongoing psychotherapy (aimed at increasing level of functioning) and support/ to obtain the best outcome, the adolescent and family should always stay in treatment - acute treatment for active psychosis (hallucinations, delusions, fearfulness, and acting out)

down syndrome= MOST COMMON AND READILY IDENTIFIABLE CHROMOSOMAL ABNORMALITY ASSOCIATED WITH DEVELOPMENT DISABILITIES

1/ SIGNS AND SYMPTOMS - poor muscle tone - slanting eyes with folds of skin at the inner corner (epicanthal folds) - hyperflexibility - short, broad hands with a single crease across the palms of one or both hands - broad feet with increased space between the first and second toes - flat bridge of the nose - short, low-wt ears - short neck with extra folds of skin - small head - RESPIRATORY ISSUE CAN BE MORE SERIOUS IN DOWN SYNDROME KID= BC THEY DON'T HAVE A NORMAL ANANOMY= NC/ PATIENT AIRWAY 2/ DIAGNOSIS - chromosomal blood test shortly after birth 3/ NURSING CARE - be sensitive to the needs of the parents - help parents cope - provide resources - promote early intervention 4/ EDUCATION/ DISCHARGE INSTRUCTIONS - educate parents and families about the resources

intellectual disabilities= due to PKU and the use of alcohol or drugs during pregnancy, prematurity, low birth weight, lack of oxygenation, environmental toxins, illnesses, and malnutrition, or after birth (whooping cough, chickenpox, measles, haemophilus influenzae, or exposure to environmental toxin) can contribute/ poverty increase the risk factors

1/S/S - an IQ below average (average score is 100) - limitation in functions of daily life such as communication, social situations, or school activities - onset before the age of 18 four levels - mild= IQ 55-69= live independently - moderate= IQ 40-54= semi-independently - severe= IQ 25-39= requires institutionalization or very close monitoring - profound= IQ below 25= total care 2/ DIAGNOSIS - based on determination of intellectual (IQ, reasoning, learning, problem solving) - based on delays in reaching developmental milestones or inability to perform developmental tasks 3/ NURSING CARE - ongoing communication with family about child's specific disability, treatment measures, and medications - tell families about genetic counseling - promote good prenatal care/ THE MOST PREVENTABLE FORMS OF DEVELOPMENTAL DISABILITIES ARE RELATED TO PRENATAL NUTRITION AND ABSTINENCE FROM ALCOHOL - encourage immunization - teach parents about enforcing safe practices WHEN BIKE-RIDING OR PLAYING MAY HELP PREVENT DEVELOPMENTAL DISABILITIES 4/ EDUCATION/DISCHARGE INSTRUCTIONS - help family find educational resources - encourage family to use physical therapy, speech and language therapy - teach family about community resources

BIPOLAR DISEASE

Also known as manic-depression, is a mood disorder that is evidenced by significant mood swings. BIPOLAR: Is a combination of major depression and mania

PTSD

Anxiety disorder that occurs in response to a real or perceived or actual threat to one's life or safety. *The response may persist for weeks, months, or years and is accompanied by panic symptoms.

DIAGNOSIS

Based on the exhibited depressive symptoms

PTSD DIAGNOSIS

Based on the exhibited symptoms

A mother brings her 13-year-old daughter in to their primary care provider's office. The mother reports the 13-year-old has quit the basketball team, isolates self to room, and has gone from straight A's to failing a class. Which of the following questions is priority for the provider to ask? a/ "Is someone bullying you at school?" b/ "Are you using any drugs or alcohol?" c/ "Are you having thoughts of harming yourself?" d/ "Why did you quit the basketball team?"

C

VULNERABILITY

Characteristics that may predispose a child to a disorder. - Vulnerability risk factors: + Genetics + Temperaments + Environment + Exposure to threat of mental health

RESILIENCE

Child's capacity to utilize adaptive & positive resources (internal and external) to cope with adversity = THEIR ABILITY TO COPE AND COPING ABILITY

generalized anxiety disorder

Children worries excessively about everything including relationships, social acceptance, and pleasing others

ANXIETY DIAGNOSIS

Complete physical, psychosocial, and family history helps reveal GENETIC, BIOLOGICAL and familial contributors to anxiety.

Signs & Symptoms

DEPRESSION: -Persistent sad/irritable mood -Worried, feeling empty -Loss of interest in activities once enjoyed -Change in eating and sleeping habits -Physical agitation or slowing Loss of energy -Feelings of worthlessness or inappropriate guilt -Difficulty concentrating -Recurrent thoughts of death or suicide

SUICIDE

Devastating consequence resulting from psychiatric difficulties. Suicide is the 3rd leading cause of death for youth between the ages of 10 and 24. - 46% firearm - 37% suffocation - 8% poisoning

4. DIVERSITY

Fundamental differences between cultures - nurse must be able to respect cultural values & diversity

CULTURE AND DIVERSITY

Have a significant influence on children's and families' cognitive and psychosocial health = make the treatment for mental illness more difficult

NURSING CARE

If a child is in an acutely manic state, the child is struggling against internal feelings and it not just being a bad child =>> psychotherapy and medication are indicated.

Signs & Symptoms

MANIA: - overly happy, irritable, silly, and elated - overly inflated self-esteem, grandiosity - increased energy, feels jumpy or wired - decreased need for sleep - increased talking - distractability - hyper-sexuality - increased goal-directed activity or physical agitation - disregard of risk - impulsive behavior such as spending sprees

depression

May be situational or related to environmental factors combined with genetic and biological factors. Five key features must be present and persistent for most days during a period of 2 weeks for the diagnosis of a major depressive disorder in children and adolescents.

NURSING CARE

Nurse is supportive of the child / adolescent & supportive of the medication regime. pharmacological treatments include medications to treat the underlying psychiatric difficulty.

ANXIETY

S&S: - anxiety that does not abate or gets worse with time - anxiety that pervades more than one aspect of child's life/ INTERFERE ABILITY OF A CHILD TO LIVE A NORMAL LIFE - significant distress or avoidance of feared situations - impaired functioning or development in response to the anxiety.

Education/Discharge instructions

SAFETY: - remove all potentially self-harmful or other harmful objects from the home - rid cupboards of poisons, lock medicines away - provide close/ constant supervision/ ALL NIGHT/ ALL DAY... - assist family in identifying strengths and resources available

Anxiety often presents in the form of somatic complaints like STOMACHACHES AND RESTLESSNESS

The pediatric nurse can recognize anxiety problems when a child persistently presents with symptoms that do not have a recognizable physical cause

Pharmacological intervention

Treat the symptoms first. SSRIS is used to decrease the avoidant behaviors and intrusive thoughts engendered by ptsd. SSRIS are helpful in treatment of depression and anxiety disorder

SEVERE ANXIETY

Will manifest into a somatic complaint like a stomach ache or suddenly get sick before school start.

A 16-year-old girl is admitted to the inpatient pediatric unit for dehydration related to anorexia. After being hospitalized for a day, the patient complains of palpitations and lightheadedness. Which of the following assessment findings is priority? a/ K+ 2.6 b/ RBC 4.2 c/ Hgb 15.1 d/ Sodium 135

a/

The nurse reviewed the upper arm blood pressure results for multiple children between the ages of 3 and 5 years. Which BP should the nurse evaluate as being an abnormal reading for this age group? a/ 96/42 b/ 101/57 c/ 112/66 d/ 115/68

a/ both number is abnormal

dyscalculia

arithmetic disorder

A 12-year-old child presents to the emergency department accompanied by his stepfather. The stepfather reports the patient "fell" and has bruising on his abdomen and upper arm. What is the nurse's next action? a/ Ask the stepfather if the patient falls often and why b/ Ask the stepfather to leave the room in order to complete assessment c/ Ask the child if the stepfather pushed him with the stepfather present d/ Contact law enforcement officers and hospital security

b/

The pediatric nurse working with at-risk children understands the term "resilience" to mean which of the following? a/ Child's characteristics that predispose him or her to a disorder b/ Ability of child to use resources to help cope with adversity c/ immune system functioning of the child to combat illness d/ Child's belief that his life and his health are in his control

b/

The nurse is preparing the 4-year-old child for surgery. Based on Erikson's developmental stages, which intervention is appropriate to include in preoperative teaching? a/ Allow the child to make a project related to surgery. b/ Have the child put a surgical mask on a doll. c/ Ask the child to describe feelings about the surgery. d/ Have the child listen to music without interruption.

b/ have the child put a surgical mask on a doll they are in stage

The 8-month-old who is developing appropriately, is hospitalizaed. The mother is holding the child, who is crying and trying to hide. Which normal developmental stage according to Erikson's theory, should the nurse consider when approaching the child? a/ Oral phase b/ Initiative versus guilt c/ Trust versus mistrust d/ Punishment versus obedience orientation

c/ birth to 1 year

language disorder

delays in or lack of ability to understand or express verbal communication

elimination disorders

encopresis

specific phobia

fear of specific object/situation such as spiders, storms/ SCARED OF HEIGHT

CRAFT AND CAGE =

if the adolescent answers no to all three opening questions, the provider only needs to ask the adolescent the first question--the CAR question/ if the adolescent answers yes to any one or more of the three opening questions, the provider asks all six CRAFT questions

dyslexia

reading disorder

mindful breathing

the nurse teaches slow breathing by telling the child to - consciously direct your attention to your breathing - breathe in slowly, paying attention as the air enters nose and mouth and fills your lungs - breath out slowly, paying attention as the air leaves your body - allow your mind to follow the breath in and out - imagine yourself in a rubber raft riding the gentle waves of your breath

dysgraphia

writing disorder