Care of Children and Adolescents With Psychiatric Disorders - PowerPoint PPT Presentation

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Care of Children and Adolescents With Psychiatric Disorders

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Title: Care of Children and Adolescents With Psychiatric Disorders


1
Care of Children and Adolescents With Psychiatric
Disorders
  • Chapter 26

2
Psychiatric Disorders Diagnosed in Childhood or
Adolescence
  • Mental retardation
  • Learning disorders
  • Motor skills disorders
  • Communication disorders
  • Pervasive developmental disorders
  • Attention-deficit and disruptive disorders
  • Feeding and eating disorders of infancy or early
    childhood
  • Tic disorders
  • Elimination disorders
  • Others

3
Epidemiology
  • 5-9 of children between ages of 9-17 have
    serious emotional disturbance with severed
    functional impairments
  • 4-6 -- seriously emotionally disturbed with
    some functional impairment

4
Developmental Disorders
  • Significant delay in one or more lines of
    development
  • Mental retardation
  • Below average intelligence (Table 29.2)
  • No one cause
  • Dx through clinical assessment, history, and
    tests
  • Nursing management determined by the needs of the
    child

5
Developmental Disorders Pervasive
Developmental Disorders
  • Group of disorders marked by severe developmental
    disturbance
  • May or may not be mentally retarded
  • Uneven pattern of intellectual strengths and
    weaknesses
  • Developmental delay -- development outside the
    norm
  • socialization
  • communication
  • peculiar mannerisms
  • idiosyncratic interests

6
Pervasive Developmental Disorders Autistic
Disorder
  • Early onset before 30 months
  • Disturbance in social relations
  • Clinical symptoms
  • Marked impairment of development in social
    interaction and communication
  • Delayed and deviant language, or concrete
    thinking
  • Pronoun reversals and abnormal intonation
  • Stereotypic behavior
  • repetitive rocking
  • hand flapping
  • insistence on sameness
  • self-injurious behavior

7
Autistic Disorder
  • 2-10/ 10,000
  • More boys than girls
  • Girls more severe with poorer outcomes
  • 1/2 have mental retardation
  • 1/4 have seizure disorder
  • Cause unknown
  • genetic
  • ?first timesaver insult
  • increased platelet serotonin, excessive
    dopaminergic activity, alteration in opioids

8
Autistic Disorder Pharmacologic Interventions
  • Antipsychotics -- behavior
  • Methylphenidate -- inattention, impulsivity, and
    overactivity
  • Opioid antagonist -- naltrexone for activity
    level and attention
  • Clonidine -- reduces hyperactivity,
    self-stimulation, and irritability
  • SSRIs -- compulsive behavior, withdrawal,
    irritability
  • Lithium -- mood
  • Beta-blockers -- reduce anxiety
  • Buspirone and trazodone -- reduce agitation

9
Aspergers Disorder
  • Severe and sustained impairment in social
    interaction and restricted, repetitive patterns
  • Not associated with MR
  • Normal intelligence, good verbal skills, low
    performance
  • Profound social deficits
  • inappropriate initiation of social interactions
  • inability to respond to social cue
  • concrete in interpretation of language
  • stereotypic behavior

10
Aspergers Disorder
  • More common in boys
  • Runs in families, recurrence in fathers
  • Estimated 1-3/1,000
  • Recently recognized

11
Nursing Management Pervasive Developmental
DisordersBiologic Domain
  • Assessment
  • Physical health and neurologic status
  • Eating and sleep patterns
  • Co-morbid disorder
  • Current medication
  • Nursing Diagnosis
  • Self-care deficits
  • Impaired verbal communication
  • Disturbed sensory perceptions
  • Disturbed sleep pattern
  • Altered growth and development
  • Disturbed thought processes

12
Pervasive Developmental Disorders Biologic
Interventions
  • Teaching self-care skills
  • adapting to childs age
  • list of activities posted on bedroom
  • drawings for nonverbal children
  • Physical safety
  • Medications

13
Nursing Management Pervasive Developmental
DisordersPsychological Domain
  • Assessment
  • (direct observation)
  • Intellectual ability
  • Linguistic competence
  • Adaptive functioning
  • Nursing Diagnosis
  • Anxiety
  • Disturbed thought process

14
Pervasive Developmental Disorders Psychological
Interventions
  • Need specific behavioral interventions that are
    based on careful evaluation
  • Management of repetitive behaviors
  • depends on consequences of specific behavior
  • may be ignored (ie, rocking)
  • redirecting, using positive reinforcement (ie,
    head banging)

15
Nursing Management Pervasive Developmental
DisordersSocial Domain
  • Assessment
  • Review of childs capacity for self-care,
    self-injury, and aggression
  • Impact of developmental delays on family
  • Ability to live within family
  • Functioning in school
  • Nursing Diagnosis
  • Impaired social interaction
  • Social isolation
  • Ineffective role performance
  • Caregiver role strain
  • Interrupted family processes

16
Pervasive Developmental Disorders Social
Interventions
  • Foster nonverbal social interactions
  • getting mail, passing out snacks, taking turns
  • Milieu management
  • consistent, structured environment with
    predictable routines
  • Integration of medical, psychiatric social
    agencies
  • Residential care
  • Family interventions
  • support
  • education
  • counseling

17
Specific Developmental Disorders
  • Learning disorders -- discrepancy between actual
    achievement and expected achievement
  • Verbal (reading and spelling)
  • Nonverbal (mathematics)
  • Communication disorders
  • Speech
  • Language

18
Nursing ManagementSpecific Developmental Disorder
  • Assessment
  • evidence of disorder
  • ability to communicate
  • childs perception of disability
  • Nursing Diagnosis
  • Impaired verbal communication
  • Low self-esteem
  • Social isolation
  • Interventions
  • Building self-esteem
  • Connect families with educational resources
  • Use strategies for increasing communication --
    taking turns, facing the listener

19
Disruptive Behavior Disorders
  • Externalizing disorders
  • Attention Deficit Hyperactivity Disorder
  • Oppositional Defiant Disorder
  • Conduct Disorder
  • Attention Deficit/Hyperactivity Disorder
  • persistent inattention
  • hyperactivity
  • impulsiveness

20
ADHD
  • Common psychiatric disorder
  • 6 of school age children
  • Boys more affects (3-8X more)
  • Many continue to have problems with attention and
    impulsiveness into adulthood
  • Multiple etiological factors (not food)

21
ADHD Etiology
  • Biologic
  • Genetics
  • Frontal lobe functioning
  • Striatum (caudate and putamen) involvement
  • Psychosocial Influences
  • Family stress
  • marital discord
  • poverty
  • Overcrowded living conditions
  • Overall family dysfunction

22
Nursing ManagementAttention Deficit
Hyperactivity DisorderBiologic Domain
  • Assessment
  • Collection of data through direct observation
  • Restlessness
  • Sleep
  • Daily food intake
  • Caffeinated products
  • Several assessment tools (see Ch. 11)
  • Nursing Diagnosis
  • Self-care deficit
  • Risk for imbalanced nutrition
  • Risk for injury
  • Disturbed sleep

23
Nursing ManagementAttention Deficit
Hyperactivity DisorderBiologic Interventions
  • Planning within the context of the family,
    treatment setting, and school
  • Medication management
  • Stimulants methylphenidate
  • Short-acting, peak 2 hours, effective for 4

24
Nursing ManagementAttention Deficit
Hyperactivity DisorderPsychological Domain
  • Assessment
  • Hyperactivity
  • lmpulsivity
  • Inattention
  • Discipline issues
  • Nursing Diagnosis
  • Anxiety
  • Defensive coping
  • Low self-esteem

25
Nursing ManagementAttention Deficit
Hyperactivity DisorderPsychological Interventions
  • Cognitive behavioral techniques
  • Set clear limits with clear consequences
  • Establish-maintain predictable environment with
    decrease stimuli
  • Establish eye contact before giving directions
    ask to repeat what was heard
  • Encourage child to do homework
  • Encourage one assignment at a time

26
Nursing ManagementAttention Deficit
Hyperactivity DisorderSocial Domain
  • Assessment
  • Family environment
  • School environment
  • Nursing Diagnosis
  • Impaired social interaction
  • Ineffective role performance
  • Compromised family coping

27
Nursing ManagementAttention Deficit
Hyperactivity DisorderSocial Interventions
  • Family treatment
  • School programming
  • Specific remediation for child

28
Other Disruptive Behavior Disorders
  • Oppositional Defiant Disorder
  • Disobedience, argumentative
  • Trouble making friends
  • Conduct Disorder
  • Serious violations of social norms

29
Separation Anxiety Disorder
  • School phobia
  • 4 of school age children
  • Runs in family
  • May emerge after a change
  • May need medication -- antidepressants
  • Treatment
  • psychotherapy
  • behavior therapy
  • flooding vs desensitization

30
Obsessive Compulsive Disorder
  • May have onset in childhood
  • Treatment similar to adults

31
Depression
  • 1-5 of school age children (adolescents higher)
  • Similar to adult treatment
  • Associated with suicide

32
Childhood Schizophrenia
  • Rare -- 2 per 100,000
  • Poorer pre-morbid functioning than adult onset
  • Nursing care follow PDD

33
Elimination Disorders
  • Enuresis
  • involuntary excretion of urination after an age
    of attainment of bladder control
  • most common in boys
  • etiology unknown
  • limit fluid intake in evening
  • behavioral treatment -- pad, buzzer
  • Encopresis
  • soiling clothing with feces or depositing feces
    in inappropriate places
  • more common in boys
  • usually not a result of physical problems
  • education and behavioral interventions

34
National Institute of Mental Health
http//intramural.nimh.nih.gov/chp/adhd/
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