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Sensory/Perception Alterations Genetic Alterations

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Sensory/Perception Alterations Genetic Alterations NUR 264 Pediatrics Angela Jackson, RN, MSN Attention Deficit Hyperactivity Disorder Attention Deficit Disorder ... – PowerPoint PPT presentation

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Title: Sensory/Perception Alterations Genetic Alterations


1
Sensory/Perception Alterations Genetic Alterations
  • NUR 264
  • Pediatrics
  • Angela Jackson, RN, MSN

2
Attention Deficit Hyperactivity Disorder
Attention Deficit Disorder (ADHD/ADD)
  • ADHD Persistent pattern of inattention,
    hyperactivity and impulsivity
  • Behavioral problem, not a learning disability
  • ADD same symptoms as ADHD but without the
    hyperactivity appear sluggish, anxious, shy,
    unmotivated, have school problems treatment
    same as ADHD

3
ADHD/ADD Epidemiology
  • ADHD is the most common, significant behavioral
    syndrome in childhood, with an overall prevalence
    of 4-6 of elementary school-aged children
  • Male to female ration is about 61
  • Age of onset before age 7, present in at least 2
    settings for longer than 6 months
  • 50-80 continue through adolescence
  • 2/3 carry symptoms into adulthood

4
ADHD/ADD Clinical manifestations
  • Box 17-9 on page 537.
  • Inattention
  • Hyperactivity
  • Impulsivity

5
ADHD/ADD Treatment
  • Behavioral Therapy behavior modification,
    rewards, positive reinforcements, ignore
    behavior, remove from situation, quite time,
    effective discipline techniques, problem-solving
    training, loving support
  • Psychotherapy increase self-esteem, work through
    situations, coping strategies, play therapy
  • Special diets removing foods that contain
    additives and sugar

6
ADHD/ADD Treatment
  • Special physical exercise improve coordination,
    increase ability to handle situations, increase
    self-esteem
  • Work with teachers provide structured classroom,
    decrease stimulation, teach organization skills,
    provide written instructions
  • Work with parents teach organizational skills,
    anger control techniques, improve communication
    skills

7
ADHD/ADD Treatment
  • Medications
  • CNS stimulant drugs
  • Ritalin, Cylert, Focalin, Concerta
  • Dexedrine watch for development of tics
  • Adderall
  • Side effects insomnia, reduced appetite and
    weight loss, abdominal pain, headache, dizziness,
    increased heart rate and BP

8
ADHD/ADD Treatment
  • Non-stimulant drugs
  • Antidepressants
  • Antianxiety Buspar
  • Alpha-2 adrenergic agonists Clonodine, Tinex
  • Antipsychotics Phenothiazines, Haldol, Lithium
  • Selective norepinephrine reuptake inhibitor
    Strattera
  • Side effects abdominal pain, vomiting, decreased
    appetite, headache, cough, increased heart rate
    and BP

9
Autism
  • Developmental disorder of brain function
  • Characterized by impaired reciprocal social
    interactions, impaired verbal and nonverbal
    communication, lack of imaginative activity and a
    markedly restricted range of activities and
    interests

10
Autism Etiology
  • Unknown in most cases
  • May have multiple biologic causes immunizations,
    toxins, viruses, food, drugs
  • Genetic 10-20 risk of recurrence in families
  • Three to four times more frequent in boys

11
Autism Clinical Manifestations
  • Abnormalities in language and thinking skills
  • Repetitive behavior (rocking, hand flapping)
  • Abnormal responses to sensations, people, events,
    objects, no fear of danger
  • Self-abusive behavior (head-banging)
  • Do not participate in social play with others

12
Autism Clinical Manifestations
  • Mental retardation (75) or exceptional skills
  • Do not deal well with change in routine
  • Increased activity levels with short attention
    span
  • Usually a disturbance of communication, both
    expressive and receptive, first brings the
    autistic child to attention

13
Autism Clinical Manifestations
  • Language is nonexistent or immature,
    characterized by echolalia, pronoun reversals
    (using you to refer to himself and I to refer
    to refer to the listener), unintelligible jargon
  • Seizures occur in 15-35 of autistic children

14
Autism Treatment
  • No cure
  • Highly structured and intensive behavior
    modification programs
  • Positive reinforcement
  • Family support

15
Autism Nursing Considerations
  • Introduce slowly to new situations
  • Use brief and concrete communication
  • Make one request at a time
  • Maintain usual routine
  • Decrease stimulation (private room)
  • Maintain a safe environment with close
    supervision
  • Minimal touch or holding
  • Teach parents coping skills

16
Fetal Alcohol Syndrome (FAS)
  • Specific cluster of physical and neurobehavioral
    birth defects associated with maternal alcohol
    abuse during pregnancy
  • FAS represents the most severe end of possible
    damage
  • Fetal alcohol effects (FAE) represent less severe
    forms of damage

17
FAS Etiology
  • Occurs in 0.5 per 1,000 live births
  • Increased incidence in Native Americans (1/250)
  • The more alcohol consumed, the greater the risk
    for FAS

18
FAS Etiology
  • Drinking patterns that produce very high blood
    alcohol levels, whether daily or weekly, pose the
    greatest risk
  • First trimester exposure poses risks to
    structural development, third trimester exposure
    may impair CNS development
  • Uncommon in a first pregnancy. Effects of
    alcohol becomes more severe with each child born
  • Chronic maternal alcohol use can deplete minerals
    and vitamins available to the fetus

19
FAS Clinical Manifestations
  • Growth retardation short stature, underweight,
    decreased adipose tissue
  • Craniofacial abnormalities microcephaly, small
    eyes with small palpebral fissures, wide flat
    nasal bridge, flat philtrum
  • Sensory integration difficulties

20
FAS Clinical Manifestations
  • Learning and attention difficulties (low IQ)
  • Irritability
  • Hyperactivity
  • Behavioral disorders
  • Poor social skills
  • Poor self-esteem
  • Poor fine motor function
  • S/S alcohol withdrawal few days after birth

21
FAS Treatment
  • Reduction of environmental stimuli to help avoid
    over stimulation
  • Provide good nutrition
  • Anticonvulsant medications
  • Appropriate referrals for early intervention and
    counseling

22
FAS Nursing Management
  • Increase calorie intake
  • Daily weight
  • Supportive treatment of health problems
  • Monitor and treat seizures
  • Early intervention programs for disabilities
  • Family support

23
Eating Disorders Anorexia Nervosa
  • Self-inflected starvation leads to emaciation
  • Intense fear of becoming fat, body image
    disturbance
  • Weight decreased at least 25 less than original
    body weight
  • No known physical illness

24
Eating Disorders Anorexia Nervosa
  • Nursing Management Promote well-being by
    monitoring food intake, correct imbalances in
    fluid, electrolytes, nutrition
  • Monitor weight gain (to 10 of IBW) by gradual
    gain too quick gain can lead to cardiac
    overload and death
  • Kind, nurturing but firm manner
  • Interventions to increase self-esteem and
    self-worth
  • Medications Antidepressants, hormones,
    antipsychotics, gastric motility enhancers
  • Promote individual and family therapy

25
Eating Disorders Bulimia
  • Recurrent binge eating followed by inappropriate
    compensatory behaviors, such as self-induces
    vomiting, misuse of laxatives, diuretics,
    excessive exercise
  • May eat 20,000 to 30,000 calories per day

26
Eating Disorders Bulimia
  • Awareness of abnormal eating pattern
  • Fear of not being able to stop eating voluntarily
  • Depressed mood following eating binges

27
Eating Disorders Bulimia
  • Nursing management
  • Behavior modifications with individual, family
    and group therapy
  • Monitor proper nutrition with dietary counseling,
    correct imbalances in fluid, electrolytes,
    nutrition
  • Monitor weight gain
  • Interventions to increase self-esteem and
    self-concept
  • Medications antidepressants

28
Eating Disorders Obesity
  • Increase in body weight resulting from excessive
    accumulation of body fat relative to lean body
    mass
  • Weighing more than average for height and body
    build (greater than 120 of ideal body weight for
    height and age)
  • Caloric intake consistently exceeds caloric
    requirements and expenditure
  • Less than 5 of childhood obesity is attributed
    to an underlying disease

29
Eating Disorders Obesity
  • Nursing management
  • Teach proper balanced nutrition
  • Monitor weight
  • Develop exercise program child will participate
    in and parents will support

30
Eating Disorders Pica
  • Persistent eating of non-nutritive substances for
    at least 1 month
  • Food pica coffee grounds
  • Nonfood picas clay, soil, laundry starch, feces
  • Associated with iron and zinc deficiencies
  • More common in autistic, mentally retarded,
    anemia, chronic renal failure
  • Infants plaster, paint, cloth
  • Older children bugs, rock, sand
  • Adults chalk, starch, paper

31
The End!!
  • Questions??
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