Child And Adolescent Slideshow Transcript
Slide 1: Unit 11 Child and Adolescent Disorders PDD ADHD Eating Disorders
Slide 2: Pervasive Developmental Disorders Three areas of functioning are affected: 1. Reciprocal social interaction impaired 2. Increased stereotypical behavior 3. Mental retardation in the majority of cases
Slide 3: Categories of PDD Childhood Degenerative Disorders: often due to CNS insult, losses in all areas after age 2 Asperger’s: Rec. later than autism, cognition and language OK, but low social function, lots of repetitive behavior, autistic bx. Rett’s: affects females, increasing deficits as grow. Lose hand coordination, language loss, mental retardation Autism: see next slide
Slide 4: Autism: Example of PDD Aversion to physical contact, even as infant Little eye contact Low verbal skills Mood abnormalities Repetitive motor behaviors—rocking, banging, unusual solitary play
Slide 5: Nursing Diagnoses (some) Growth and Development, delayed Injury, risk for Risk for self abuse Impaired social interaction Impaired communication Self care deficit Caregiver role strain
Slide 6: Downs Syndrome: mild to moderate mental retardation Caused by trisomy 21, not inherited. 1/600 births affected. Older moms more likely Shortened life span, often get dementia in 40s/50s. Physical features: Epicanthal slant eyes, flat nose, short stature, low set ears, short hands, and a single palmar crease.
Slide 7: ADHD: Attention Deficit Hyperactive Disorder: 3 symptoms Inattention: affects listening, finishing tasks, losing things, careless errors, distractible Impulsivity: affects turn taking, blurting out answers, intrusive, interruptive Hyperactivity: squirmy, fidgety, climbs, no quiet play, motor mouth, never ceasing energy
Slide 8: Framing the Assessment in ADHD Probably somewhat overdiagnosed currently, lack of structure and parental skill. Diagnosis should be by specialist. All assessment findings must be compared to age appropriate behavior. Only real deviations from this mark ADHD. Examples. Must see Significant impairment in social, academic and /or occupational function. Must emerge prior to age 7 (can be dx later though).
Slide 9: Intervening in ADHD (31-3) Signal/gestures Therapeutic holding Move closer Teach “counting” Redirection Clear limits clear consequences Clarify situation Avoid bargaining Restructure work for success Set a routine and stick to it Remove disruptive child
Slide 10: Ritalin: Drug of choice in ADHD CNS Stimulant, schedule II, potential for abuse by non ill individuals. Kids sell. Increases catecholamines to different parts of the brain, focusing attention better. SE: (a few) low growth, low appetite, sleeplessness, rebound effect, timing CONTRAINDICATED: glaucoma, HTN, Tourette’s, Seizure d/o. Interacts with MAOIs
Slide 11: Conduct Disorder: like Antisocial personality disorder, but as seen in children Aggression toward others, property destruction, deceit, theft, serious rule violation Core sense of unlovability Insecure parental attachment, family problems Difficult child pattern RX: like Antisocial Personality DO
Slide 12: Eating Disorders Anorexia Nervosa Bulimia Nervosa Compulsive Overeating—Binge Eating Disorder
Slide 13: Physiologic Aspects/Causes Tied to major mood disorders (depression, anxiety, OCD) with low norepinephrine, low serotonin, increased cortisol. Linked to physiologic release of endogenous opiods (eg B endorphins) Starvation, binging, exercise trigger release “Starvation dependence” Gives an addictive twist to all of these disorders, that often affects treatment
Slide 14: Anorexia Nervosa Demographics: white, 12022 yo middle and upper income women in industrialized countries
Slide 15: Physical Assessment Findings in Anorexia Nervosa 80% wt for ht Bradycardia, hypotension Amenorrhea Fatigue, weakness Lanugo Low T3, T4 Jaundice, dry skin Low K+, low Na+ Dehydration Pancytopenia, Low bone density anemia Peripheral edema Abnormal ECG and cold extremities
Slide 16: Psychosocial Assessment Findings Refusal to eat, purging All or nothing thinking Intense fear of getting As wt decreases, fat thinking is less rational Body Image distortion Often hx of sexual abuse Denial—focus on food Developmental delay and control over it with enmeshed family serves as a defense over other issues OCD traits, perfectionism
Slide 17: Behaviors used to keep wt down Rules set about Diet pills, herbs eating Self induced Manipulation vomiting Counting Lies Exercises Self punishment laxatives
Slide 18: Anorexia Nervosa Treatment Reverse starvation (first). Involves possible refeeding under supervision, NG feeding, TPN. Also prevention of physical sequelae by restricting activity and watching to prevent vomiting, etc. Moniter physical status-cardiac, liver, labs, renal, suicide.
Slide 19: Nursing Therapeutics Begins right away, but continues past initial refeeding issues. Prevent sabotage. Therapeutic alliance critical Contract and/or level system valuable Teach gentle eating Meds: when physically able— antidepressant, occasionally others
Slide 20: Issues faced by the ED pt Self esteem Family relationships Body Image Sexuality Thinking disorder Main thing will center around meeting the developmental challenge of separation and individuation
Slide 21: Bulimia Nervosa Demographics: similar to anorexia but with later average age of onset. 2-28% American women.
Slide 22: Physical Symptoms of Bulimia Wt for ht may be Peripheral edema close to WNL Esophageal dilation Amenorrhea and ulceration ECG changes Scars on fingers, Cardiomyopathy hands Parotid Gland Low K+ swelling, hoarse voice Dental erosion
Slide 23: Psychosocial Bulimia Symptoms Body image issues Rigid controlling family with low Repeated episodes client autonomy of binging and purging Separation individuation issues More distressed and less denial than with Sexual abuse, Anorexia sexuality issues Anger suppression
Slide 24: Bulimia Nervosa Treatment Not Grossly Different than for Anorexia Nervosa Instead of the starvation issue, deal with the electrolyte imbalances and sequelae of binging and purging All therapeutic issues apply. Benefit is that the denial system is less intense
Slide 25: Binge Eating Disorder Demographics: 46% of obese participants in wt loss programs have it 30 to 45% of the American population is overweight
Slide 26: Binge Eating Disorder: symptoms Obesity: BMI kg/m2 of at least 30 or wt that is 120% of ideal. Pattern of binge eating without purging. Review sequelae of obesity Self esteem disturbance, body image distortion, and sexuality issues Addictive nature of these illnesses
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