Disorders of Children and Adolescents – Flashcards
Unlock all answers in this set
Unlock answersquestion
What are some characteristics of ADHD?
answer
Inattention Hyperactive - Impulsive At least 6 symptoms Symptoms before age 7 Symptoms present in 2 or more settings Significant impairment in social, academic or occupational functioning. 7-9% prevalence rate
question
What are some signs of inattention in the client with ADHD?
answer
careless mistakes, lack of attention to detail difficulty sustaining attention in tasks or play activities easily distracted by extraneous stimuli often forgetful in daily activities often does not seem to listen when spoken to directly avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort often has difficulty organizing tasks and activities often loses things necessary for tasks or activities
question
What are some signs of hyperactivity in the client with ADHD?
answer
fidgets w/hands or feet or squirms in seat leaves seat in classroom or in other situations runs about or climbs excessively difficulty playing or engaging in leisure activities quietly "on the go" or acts as if "driven by a motor" talks excessively blurts out answers trouble awaiting turn interrupts or intrudes on others
question
What are areas of concern for the client with ADHD?
answer
success in school and interpersonal relationships frequent negative responses from parents, teachers, peers safety - labeled "bad, stupid, dumb" known risk factor for antisocial behavior, substance abuse, low academic and occupational success in adulthood developmentally behind peer group
question
What are some appropriate nursing diagnoses related to the client with ADHD?
answer
risk for injury r/t impulsive and accident prone behavior impaired social interaction r/t intrusive or immature behavior low self-esteem r/t negative feedback noncompliance r/t low frustration tolerance and short attention span
question
What is the goal for the client with ADHD who has the nursing diagnosis of risk for injury?
answer
Goal: client will be free of injury
question
What are appropriate interventions for the client with ADHD who has the nursing diagnosis of risk for injury?
answer
provide safe environment identify behaviors that put child at risk and institute consequences for these behaviors provide adequate supervision or assistance w/activities
question
What is the goal of the ADHD client who has the nursing diagnosis of Impaired Social interaction r/t intrusive and immature behavior?
answer
Client will observe limits set on intrusive behavior and will demonstrate ability to interact appropriately with others.
question
What are some interventions for the client with nursing diagnosis impaired social interaction r/t intrusive and immature behavior?
answer
Develop 1:1 trusting relationship w/ child Discuss acceptable and unacceptable behaviors and consequences of unacceptable behaviors Provide group situations for child to practice appropriate behaviors.
question
What is an appropriate goal for the client with ADHD who has been diagnosed as low self esteem r/t negative feedback?
answer
Client will demonstrate increased feelings of self worth by verbalizing positive statements about self and exhibiting fewer demanding behaviors.
question
What are some interventions for the client with nursing diagnosis low self esteem r/t negative feedback?
answer
establish realistic goals plan activities that provide opportunities for success convey positive regard offer recognition of successful endeavors and positive reinforcement of attempts made give immediate positive feedback for acceptable behavior
question
What is an appropriate goal for the client with nursing diagnosis noncompliance r/t low frustration tolerance and short attention span?
answer
Client will be able to complete assigned tasks independently or with minimum of assistance.
question
What are some appropriate interventions for the client with nursing diagnosis noncompliance r/t low frustration tolerance and short attention span?
answer
Provide environment free of distractions provide assistance on a one-to-one basis Give simple, concrete instruction Ask client to repeat instructions to you Establish step-by-step tasks w/reward for each task completed Gradually decrease amount of assistance given
question
What are some other interventions for the client with ADHD?
answer
routine schedule/structure simple instructions, one at a time behavioral techniques build self-esteem, support quick rewards use visual cues calm, quiet, limit stimulation Medication
question
What is the order of treatment for medications for the client with ADHD?
answer
psychostimulants (CNS stimulants) an alternate psychostimulant pemoline w/liver function tests q 2 wks an antidepressant an alternate antidepressant clonidine (Catapres)
question
What are the desired outcomes of pharmacological treatment for the client with ADHD?
answer
increased: attention, accuracy, concentration, learning, memory, on-task behavior decreased: daydreaming, defiance, distractibility, hyperability
question
What are some examples of psychostimulants?
answer
methylphenidate (Ritalin, Concerta) dextroamphetamine (Dexadrine) dexmethylphenidate (Focalin) mixed amphetamine salts (Adderall) pemoline (Cylert) Lisdexamfetamine dimeesylate (LDX, Vyvanse)
question
What are some important nursing and family teaching considerations?
answer
Drugs w/ short-half lives will have to be given mid-day Monitor appetite, weight and sleep Monitor for side effects Monitor BP and P
question
What are the desired outcomes of CNS stimulants/psychostimulants?
answer
increased attention, accuracy, concentration, memory, learning, coordination, on-task behavior
question
What are some common side effects of CNS stimulants/psychostimulants?
answer
appetite suppression abdominal pain and upset headaches dysphoria sleep problems irritability
question
What patient/family teaching should be given when the patient has been prescribed a CNS stimulant/psychostimulant?
answer
Administer immediately after meals to avoid anorexia watch weight administer last dose at least 6 hours before bedtime report signs of liver involvement report new or worsening psychiatric symptoms check w/ health care provider before using OTC meds do not withdraw abruptly
question
What should not be taken concurrently with Ritalin?
answer
antihistamines
question
What is important about the administration of Dexadrine and Adderall?
answer
Should avoid citrus within an hour of taking
question
What is an associated risk of pemoline?
answer
hepatitis (LFTs should be performed q 2 weeks)
question
Why is pemoline prescribed?
answer
up to 1/3 of patients do not respond to first line meds
question
What is important patient teaching in regards to the administration of pemoline?
answer
signs and symptoms of hepatitis: stomach pain, GI distress, darker urine, light colored stools
question
What are some types of alternate medications used to treat ADHD?
answer
Antidepressants - tricyclics, Wellbutrin Atomoxetine Beta Andrenergic Agonists
question
What are some characteristics of oppositional defiant disorder?
answer
negativistic, hostile, defiant behavior often loses temper often argues w/adults often actively defies or refuses to comply w/requests deliberately annoys others often blames others for his mistakes often angry or resentful spiteful, revengeful
question
What are some appropriate nursing diagnoses for the client with oppositional defiant disorder?
answer
noncompliance w therapy r/t negative temperament, denial of problems, underlying hostility defensive coping r/t low self-esteem, family influences, established behavior patterns low self-esteem r/t lack of positive feedback impaired social interaction r/t negative temperament, underlying hostility, manipulation of others
question
What is the goal for the client diagnoses with noncompliance with therapy r/t negative temperament, denial of problems, underlying hostility?
answer
Client will participate in and cooperate during therapeutic activities Interventions: structured therapeutic activities, use reward systems for compliance and consequences for noncompliance, convey acceptance of the client separate from undesirable behaviors
question
What is the goal for the client with the nursing diagnosis defensive coping r/t low self-esteem, family influences and established behavior patterns?
answer
Client will accept responsibility for own behaviors and interact with others without becoming defensive Interventions: help child recognize that feelings of inadequacy provoke defensive behaviors, provide immediate nonthreatening feedback for passive aggressive behavior, help identify situations that provoke defensiveness, provide immediate positve feedback for acceptable behaviors
question
What is the goal for the client with the nursing diagnosis low self-esteem r/t lack of positive feedback?
answer
Child will demonstrate increased feelings of self worth by verbalizing positive statements about self and exhibiting fewer negative behaviors.
question
What are some appropriate interventions for the client with nursing diagnosis low self esteem r/t positive feedback?
answer
ensure that goals are realistic plan activities that provide opportunities for success convey acceptance and positive regard set limits on unacceptable behavior help client understand the use of unacceptable behavior in order to try to increase own self-esteem
question
What is the goal for the client with nursing diagnosis impaired social interaction r/t negative temperament, underlying hostility and manipulation of others?
answer
Client will be able to interact with staff and peers using age-appropriate acceptable behaviors. Interventions: develop trusting relationship with child. Discuss with child passive-aggressive behavior and how these behaviors are perceived by others. Describe which behaviors are not acceptable and role-play more adaptive responses. Give positive feedback for acceptable behaviors.
question
What are the characteristics of conduct disorder?
answer
pattern of behavior in which basic rights of others or major societal norms or rules are violated: aggression to people and animals, destruction of property, deceitfulness or theft, serious violations of rules
question
What are some appropriate nursing diagnoses for the client with conduct disorder?
answer
risk for other direct violence r/t temperament, peer rejection, negative parental role models, dysfunctional family dynamics impaired social interaction r/t negative parental role models, impaired peer relationships defensive coping r/t low self esteem, dysfunctional family low self-esteem r/t lack of positive feedback and unsatisfactory parent/child relationships
question
What is the goal for the client with nursing diagnosis risk for other direct violence r/t temperament, peer rejection, negative parental role models, dysfunctional family dynamics?
answer
Client will not harm others or others property Interventions: frequent observation of behavior, offer physical outlets for anger/frustration, encourage appropriate expression of anger, role modeling, medication
question
What is the goal for the client with nursing diagnosis impaired social interaction r/t negative parental role models, impaired peer relationships?
answer
Client will be able to interact with staff and peers using age-appropriate acceptable behavior.
question
What is the goal for the client with nursing diagnosis defensive coping r/t low self esteem, dysfunctional family system?
answer
Explore with client correlation between feelings of inadequacy and need for acceptance of others and how these feelings provoke defensive behaviors such as blaming others.
question
What are some interventions for the client with nursing diagnosis defensive coping r/t low self esteem, dysfunctional family system?
answer
Provide immediate, matter of fact, nonthreatening feedback for unacceptable behaviors Help identify situations that provoke defensiveness and practice role-play for more appropriate responses provide immediate positive feedback for acceptable behaviors
question
What is the goal for a client with nursing diagnosis low self esteem r/t lack of positive feedback and unsatisfactory parent/child relationships?
answer
Client will demonstrate increased feelings of self worth by verbalizing positive statements about self and exhibiting appropriate behavior
question
What is an appropriate nursing diagnosis for the client with Tourette Disorder?
answer
low self esteem r/t shame and embarrassment associated with tic behaviors
question
What is an appropriate goal for the client with Tourette's Disorder?
answer
Child will verbalize positive aspects about self Interventions: convey acceptance and positive regard, support therapies established to help manage tics, monitor effects and side effects of medication management.
question
What are some characteristics of Tourette's disorder?
answer
motor tics - involuntary movements ex. eye blinking vocal tics - involuntary vocalizations ex. throat clearing coprolalia - involuntary use of obscenities
question
What are some treatment options for the client with Tourette's disorder?
answer
supportive environments behavioral therapies medication
question
What are some characteristics of Asperger disorder?
answer
Qualitative impairment in social interaction: failure to develop peer relationships lack of social or emotional reciprocity restrictive/repetitive patterns of behaviors, interests preoccupation with patterns of interest persistent preoccupations with parts of objects no clinically significant language delay, delay in cognitive development, or development of age-appropriate skills (only delay in social, occupational areas of functioning)
question
What triad of impairments is characteristic of autistic disorder?
answer
Social isolation communication impairment strange repetitive behaviors
question
What are some appropriate nursing diagnoses for the client with autistic disorder?
answer
risk for self-mutilation r/t neurological alterations impaired social interaction r/t inability to trust, neurological alterations impaired verbal communication r/t withdrawal into self, inadequate sensory stimulation, neurological alterations
question
What are some characteristics of the client with autistic disorder?
answer
profound social isolation disturbance in motor behavior self mutilation tantrums for no reason obsessive interest in single toy or activity very intent on sameness/resist changes in routines slow/abnormal language development serious impairment in communication with others may be mute unintelligible sounds repeat words may not be able to name objects cannot use or understand abstract language
question
What are some interventions for the Autistic client with nursing diagnosis risk for self-mutilation r/t neurological alternations?
answer
1:1 if necessary observe for self mutilations offer diversion/replacement activities protect child when self-mutilative behaviors occur consult with parents/caregivers regarding effective management strategies in place.
question
What is the goal for the Autistic client with nursing diagnosis impaired social interaction r/t inability to trust or neurological alterations?
answer
Client will initiate social interactions with caregiver
question
What are some interventions for the Autistic client with nursing diagnosis impaired social interaction r/t inability to trust or neurological alterations?
answer
Assign a limited number of caregivers to the child convey warmth, acceptance and availability provide child with familiar objects, such as toys or blanket support attempts to interact with others give positive feedback for eye contact with something acceptable to the child - gradually replace with social reinforcement
question
What is the goal for the Autistic client with nursing diagnosis impaired verbal communication r/t withdrawal into self, inadequate sensory stimulation, neurological alterations?
answer
Client will establish a means of communicating needs and desires to others
question
What are some interventions for the Autistic client with nursing diagnosis impaired verbal communication r/t withdrawal into self, inadequate sensory stimulation, neurological alterations?
answer
maintain consistency in assignment of caregivers anticipate/fulfill child's need until communication can be established give positive reinforcement when eye contact is used to convey nonverbal expression
question
What are alternate interventions for the client with Autism?
answer
behavior modification: point systems, contracts group, play, expressive therapy family therapy milieu
question
What are some interventions for overactivity?
answer
get attention identify triggers remove from over-stimulating environment no caffeine routine simple explanations - one thing at a time
question
What are some interventions for managing anger?
answer
help identify triggers and ways to manage anger differently help learn how to get control before escalation help them relate more appropriate to others practice conflict resolution
question
What are some ways to teach clients about socialization?
answer
think before speaking recognize intrusive behavior/substitute appropriate behavior learn to check other's non-verbal reactions
question
What are some forms of expressive therapy?
answer
art, drama, dance, writing, group therapy
question
What type of therapy is the "vehicle" by which the child masters the environment and his own impulses and increases adaptive behavior?
answer
Play therapy
question
What type of therapy produces more lasting change?
answer
Family therapy - helps family understand illness, child development and teaches new ways of relating
