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Care of the Child with Cognitive or Mental Health Problems

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Title: Care of the Child with Cognitive or Mental Health Problems


1
Care of the Child with Cognitive or Mental Health
Problems
  • Presented by
  • Chris Hicks

2
Assessment Interview
  • Observational Data
  • General Appearance
  • Motor Behaviors
  • Speech Language
  • Affect
  • Thought Process
  • Ability to Relate to Evaluator
  • Behaviors Displayed During the Interview

3
  • Interactional Data
  • Interpersonal Relationships
  • Self-concept Image
  • Conscience

4
At Risk Children
  • Trauma or Neglect
  • Difficult Temperament
  • Attachment Problems
  • Experience of Major Losses
  • Negative Sibling Relationships
  • Medical Problems Illnesses

5
  • Exposure to High Risk Activities
  • Poverty Homelessness
  • Parental Substance Abuse

6
Nursing Diagnoses
  • Response of Children Families to the Condition
  • Anxiety
  • Self-esteem Disturbance
  • Powerlessness
  • Decisional Conflict
  • Ineffective Family Coping

7
  • Related to the Condition
  • Risk for violence
  • Altered thought processes
  • Sleep pattern disturbance
  • Social isolation

8
DSM-IV R
  • Diagnostic Statistical Manual 4th Edition
    Revised
  • Purpose
  • Classifications

9
Lecture Focus
  • Developmental Disorders
  • Mental Retardation
  • Autistic Disorder
  • Disruptive Behavior Disorders
  • Attention Deficit/Hyperactivity Disorder
  • Conduct Disorder

10
  • Anxiety Disorders
  • Separation Anxiety
  • Eating Disorders
  • Anorexia Nervosa
  • Bulimia Nervosa
  • Psychiatric Disorders
  • Childhood Depression
  • Childhood Schizophrenia

11
Psychiatric Care of Children
  • Historical Background
  • Principles
  • Therapies

12
Developmental Delay
  • Areas of Developmental Delay
  • Attention
  • Cognition
  • Language
  • Affect
  • Social/Moral Behavior

13
Cognitive Impairment
  • Criteria
  • Intelligence Quotient
  • Deficits in Adaptive Functioning
  • Classification
  • Mild
  • Moderate
  • Severe
  • Profound

14
  • Assessment
  • Interview
  • History Taking
  • Behavioral Observation
  • Physical Observation
  • Testing Tools
  • IQ Testing
  • Denver Developmental Screening Tool

15
  • Intervention Management
  • Health Maintenance Needs
  • Illness
  • Self-Care Activities
  • Social Relationships
  • Play
  • Education

16
  • Issues
  • Need for Family Counseling
  • Understanding the Diagnosis
  • Family Teaching
  • Institutional v. Home Care
  • Daily Care
  • Caretaker Stress
  • Program Choices
  • Preparation for Adulthood

17
  • Hospitalized Child with Cognitive Impairment

18
Infantile Autism
  • Definition-An absorption in fantasy to the
    complete exclusion of reality understood only
    by the individual

19
  • Characteristics
  • Social Isolation
  • Nonresponsive to Touch
  • No eye contact
  • No social interaction
  • Stereotyped Behaviors
  • Repetitive Motion
  • Circular Motion
  • Bizarre Behavior

20
  • Resistance to Change
  • Intense Reactions
  • Craves Consistency
  • Insensitivity to Pain
  • Impaired Communication
  • Echolalia
  • Nominal Aphasia
  • Neologisms
  • Labile Mood

21
  • Intervention Management
  • Behavior Modification
  • Support for Family
  • Referrals
  • Programs/Day Care

22
Attention Deficit/Hyperactivity Disorders
  • Assessment
  • History--Typical Day
  • Description of Hyperactivity
  • Excess Movement
  • Disorganized
  • Repetitive Activities
  • Variability
  • Impulsiveness

23
  • Communication Difficulties
  • Concepts
  • Use of Conjunctions/Prepositions
  • Reading
  • IQ Testing

24
  • Intervention Management
  • Environment
  • Medication
  • Diet
  • Family Support

25
Conduct Disorders
  • Most common psychiatric diagnosis of children
    adolescents
  • Characteristics
  • Repetitive persistent pattern of violations of
    personal rights or societal rules
  • Stealing, fighting, destruction of property, fire
    setting, early sexual behavior

26
  • Have few meaningful peer relationships
  • Egocentric
  • Able to manipulate others
  • No feelings of guilt or remorse

27
  • Intervention Management
  • Modification of Home Environment
  • Training in Social Skills
  • Training in Problem-solving Skills
  • Parental Training
  • Structured Day Care
  • Behavioral Therapy
  • Medications

28
Separation Anxiety
  • Description--Older child shows excessive anxiety
    about separation or possible separation from
    caretaker
  • Characteristics
  • Acute distress
  • Nightmares
  • Refusal
  • Physical Illness

29
  • Intervention Management
  • Counseling
  • Family Therapy
  • Medications

30
Eating Disorders
  • Effects 8-20 of the Population
  • 95 of effected population is Female
  • Mortality Rate is 22
  • Age of Development of Disorder
  • Anorexia 13-17 years old
  • Bulimia 17-23 years old

31
  • Often begins at a developmental task stage such
    as
  • Beginning of Puberty
  • Starting or Finishing High School
  • Starting College
  • Beginning to be Self-supportive
  • Marrying

32
Anorexia v. Bulimia
  • Anorexia--Lose weight by dramatically decreasing
    food intake sharply increasing the amount of
    physical exercise. Decrease in body weight.
  • Bulimia--Develop cycles of binge eating followed
    by purging. The severity of the disorder
    determined by the frequency of the cycles.
    Normal or near normal body weight

33
Criteria of Anorexia Nervosa
  • Refusal to maintain body weight
  • Intense fear of gaining weight or becoming fat
    even tho underweight
  • Disturbance in which ones body weight, size, or
    shape is experienced
  • In female patients an absence of 3 consecutive
    menstrual cycles

34
Types of Anorexia Nervosa
  • Restricting
  • Binge eating/purging

35
Feelings of Anorexia Patients
  • Needs to please others
  • Self-worth comes from others approval
  • Overcompliant wants to meet others expectations
  • To control themselves the environment they
    develop rigid rules
  • Feel that they need to make the absolute correct
    decisions

36
  • Feel controlled by others not eating may be an
    attempt to assert themselves gain some control
    within the family
  • Avoidance of food provides a feeling of control
    sense of pleasure when weight is lost
  • When weight is gained they feel extreme anxiety
    severe guilt

37
  • Distorted thinking
  • Severely distorted body image
  • Misperception of internal physical sensations

38
Physical Changes of the Child with Anorexia
  • Electrolyte imbalance
  • Decrease in blood volume
  • Increase in BUN
  • GI complications
  • Tooth problems
  • Amenorrhea

39
Goals
  • Keep patient in best possible physical condition
  • Weight restoration
  • Establish healthy eating patterns
  • Identify issues assist in dealing with them
  • Education

40
Intervention Management
  • Monitoring for medical emergencies suicide
    potential
  • Contract with patients for amount of food to be
    eaten per day a target weight is established
  • One-to-one support

41
  • Assist in identifying situations that precede a
    binge explore alternative coping behaviors
  • Identify secondary gains
  • Assist patient in becoming a self (separate from
    family)

42
Childhood Depression
  • 0.3 preschoolers - 14 adolescents
  • Note there is dramatic increase in adolescent
    suicide

43
  • Criteria--5 or more of the following symptoms
    lasting more than 2 weeks
  • Loss of interest or pleasure
  • Significant weight loss or gain
  • Depressed mood
  • Insomnia
  • Psychomotor agitation
  • Feelings of worthliness

44
  • Inappropriate guilt
  • Diminished concentration
  • Recurrent thoughts of death
  • Suicidal ideation

45
  • Intervention Management
  • Counseling
  • Medications
  • Assessment for Suicide Risk

46
Childhood Schizophrenia
  • Under 12 years old

47
  • Characteristics
  • Hallucinations
  • Flat affect
  • Catatonia

48
  • Intervention Management
  • Hospitalization
  • Therapy
  • Medications
  • Long-Term Follow-up Care
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