Caring for the Child with a Psychosocial or Cognitive Condition

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Chapter 23

• Caring for the Child with a Psychosocial or
  Cognitive Condition

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Developmental Psychopathology

• Multiple fields of study with the goal to provide
  understanding between psychopathology and normal
  adaptation
• Combines developmental, biological, and social
  theories to track deviations from developmental
  norms

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Definitions

• Vulnerability (a predispositional factor that
  makes a disordered state possible)
• Resilience (children show positive adaptation
  despite significant life adversity)

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Culture, Diversity, and Health Disparities

• Culture
• External and acquired
• Complex set of beliefs and attributes passed on
  within a group
• Ethnicity
• Shared similar cultural characteristics
• Race
• Physical characteristics

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Health Care Disparities

• Vast information that health care disparities in
  racial and ethnic minorities are widespread
• Barriers mistrust, fear, and discrimination

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Barriers to Child andAdolescent Mental Health

• The stigma of mental illness
• Childhood is a sacred happy time free of
  problems
• Child going through a stage that will pass

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Issues for Children

• Not getting screened on a timely basis
• Having a sense of shame
• Being unable to receive adequate mental health or
  psychosocial treatment because of lack of
  resources

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Psychopathology in Children
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Anxiety Disorders

• Separation anxiety disorder (SAD)
• Generalized anxiety disorder (GAD)
• Specific phobia
• Panic disorder
• Social phobia
• Selective mutism
• Posttraumatic stress disorder
• Obsessive-compulsive disorder (OCD)

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Anxiety

• Signs and symptoms
• Does not abate or gets worse
• with time
• No response to reassurance or
• closeness with a safe person
• Interferes with functioning
• Somatic complaints
• Persistent worry, unfounded
• fears, separation difficulties,
• sleep problems/obsessions or
• compulsions
• Resist school and play time

• Nursing care
• Recognize clinically significant symptoms
• Refer to a mental health professional
• Provide health teaching
• Protect from influx of information
• Use Coping Cat, Cat or FRIENDS programs

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Posttraumatic Stress Disorder

• Signs and symptoms
• Re-experiencing the trauma
• Dissociative experiences
• Anxiousness
• Nursing care
• Educate parents about the symptoms
• Refer to a mental health professional
• Be aware of resources
• Administer pharmacotherapy

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Mood Disorders

• Depression
• Bipolar disorder (BPD)
• Suicide
• Schizophrenia
• Autism spectrum disorders

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Depression

• Signs and symptoms
• Persistent sad or irritable mood
• Loss of interest in activities once enjoyed
• Significant change in appetite or body weight
• Difficulty sleeping or oversleeping
• Physical agitation or slowing
• Fatigue or loss of energy
• Feelings of worthlessness or excessive guilt
• Nursing care
• Ensure safety
• Develop a trusting relationship
• Refer for evaluation and treatment

14
Bipolar Disorder

• Signs and symptoms
• Combination of major depression and mania
• Nursing care
• Teach the family and the child
• Model therapeutic parenting techniques

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Suicide

• Signs and symptoms
• Depression or other mental illness
• Alienation or withdrawal from friendships or
  relationships
• Personality changes
• Decline in schoolwork
• Giving away personal possessions that were once
  prized
• Preoccupation with death in writing or drawings
• References to dying
• Access to a method of suicide

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Suicide

• Nursing care
• Recognize children or adolescents who might be
  suicidal
• Be aware of the signs of suicide ideation and
  risk factors
• Refer to a mental health professional
• Identify family strengths
• Talk to family about measures that can be
  implemented
• Discuss the option of cognitive behavior therapy
  (CBT)
• Give medications
• Raise awareness about programs

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Schizophrenia

• Signs and symptoms
• Hallucinations, delusions
• Disorganized speech and behavior
• Flattening affect
• Nursing care
• Use pharmacological agents
• Discuss psychoeducation
• Discuss the option of psychotherapy
• Provide therapeutic communication

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Autism Spectrum Disorders

• Pervasive developmental disorder
• Autistic disorder
• Aspergers disorder
• Retts disorder
• Childhood disintegrative disorder
• Pervasive developmental disorder not otherwise
  specified

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Autism Spectrum Disorders

• Signs and symptoms (three cluster categories)
• Impairment in social reciprocity
• Communication impairment
• Restrictive and repetitive behaviors, interests,
  or activities

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Autism Spectrum Disorders

• Nursing care
• Promote awareness of the need for early
  intervention
• Promote early language development
• Encourage social competence
• Use A.L.A.R.M
• Stay aware of the childs physical boundaries and
  reluctance to be touched

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Psychosocial and Cognitive Disorders
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Reactive Attachment Disorder

• Signs and symptoms
• Children usually endured neglect/maltreatment
• Difficulties attaching or bonding
• Nursing care
• Develop trust
• Support and education
• Child parent psychotherapy

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Failure to Thrive

• Signs and symptoms
• Tracking the growth rate
• Physical examination and evaluation
• Underlying cause
• Weights below the third percentile on
  standardized growth charts
• Nursing care
• Complete a comprehensive health history
• Perform a physical examination
• Educate regarding feeding practices
• Offer support for caregivers and families
• Report abuse or neglect

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Attention Deficit Hyperactivity Disorder

• Signs and symptoms
• Hyperactivity
• Impulsivity
• Distractibility
• Inattention

• Nursing care
• Evaluate by using a rating scale
• Discuss pharmacological intervention (Ritalin)
• Discuss psychosocial Intervention (behavioral
  therapy, rewards, and positive versus negative
  reinforcement)

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Oppositional Defiant and Conduct Disorder

• Signs and symptoms
• Noncompliance, oppositional behavior and temper
  tantrums
• Overt/covert antisocial behavior
• Relational aggression
• Delinquency, substance abuse, high-risk sexual
  behavior
• Nursing care
• Encourage early assessment
• Educate the family about prevention/intervention
• Give medication

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Tic Disorders (Tourettes Syndrome)

• Signs and symptoms
• Chronic motor and phonic tics that vary in
  frequency, intensity, and complexity
• Nursing care
• Watch for signs that the child is being bullied
• Help others understand that the tics cannot be
  controlled
• Help family cope with the disorder
• Assess behavioral skills and promote stress
  management
• Give medications

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Maltreatment of Children

• Types of abuse
• Physical abuse (i.e., shaken baby syndrome)
• Child sexual abuse
• Emotional abuse
• Neglect
• Munchausen-by-proxy syndrome
• Electronic sexual luring

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Maltreatment of Children

• Signs and symptoms
• See Table 23-3

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Maltreatment of Children

• Nursing care
• Educate parents
• Help parents develop resources
• Give information regarding normal growth and
  development
• Discuss ways to discipline
• Educate children about personal boundaries
• Develop a safe and trusting relationship
• Report maltreatment

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Substance Use and Abuse

• Signs and symptoms
• Physical
• Emotional
• Family
• School
• Social problems

• Nursing care
• Use screening tools
• Find community resources
• Use family-based approach

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Eating Disorders

• Types
• Anorexia nervosa
• Bulimia nervosa
• Binge eating disorder
• Eating disorder not otherwise specified

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Eating Disorders

• Signs and symptoms
• Inordinate concern with body image and weight
• Hiding behaviors related to food and caloric
  intake
• Co-occurring mental health and family problems
• Lose up to 85 of body weight
• Amenorrhea, weakness, fatigue, general well-being
• Can be a life-threatening problem

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Eating Disorders

• Nursing care
• Communicate to the family that treatment involves
  contacting a physician
• Inform family that hospitalization may be
  required
• Administer antidepressant and atypical
  antipsychotic medications
• Support the adolescent and family
• Encourage dental care
• Refer for individual and family therapy

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Obesity

• Signs and symptoms
• BMI above the 95th percentile
• Nursing care
• Assess for risk factors
• Teach about improving activity level
• Teach that dieting is not suggested
• Educate family on healthy eating exercise

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Sleep Disorders

• Signs and symptoms
• Sleepwalking
• Difficulties getting to sleep or
• staying asleep
• Nightmares
• Excessive daytime sleepiness
• Irregularity of sleep routine

• Nursing care
• Listen carefully about sleeping issues
• Complete a physical assessment
• Assess of sleeping
• patterns
• Provide support
• Teach family about sleep hygiene

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Developmental Disabilities

• Three criteria
• IQ significantly below average (score of 70)
• Limitations in functions of daily life
• Onset before 18 years
• Four levels mild, moderate, severe, and profound

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Developmental Disabilities Nursing Care

• Provide open communication
• Promote good prenatal care
• Direct education toward building life skills
• Teach about community resources
• Discuss special education through the public
  school system

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Down Syndrome (DS)

• Signs and symptoms
• Poor muscle tone, slanting eyes
• Hyperflexibility, short, broad hands with a
  single crease across the palm of one or both
  hands
• Flat bridge of the nose, short/low-set ears
• Heart defects, gastrointestinal anomalies, visual
  and hearing problems
• Hypothyroidism

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Down Syndrome

• Nursing care
• Be sensitive to needs of parents
• Promote early intervention
• Ensure that care is geared toward physical,
  developmental, and emotional needs
• Coordinate programs
• Help families cope emotionally

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Fetal Alcohol Spectrum Disorder

• Signs and Symptoms
• Facial dysmorphic features
• Low birth weight, failure to thrive, microcephaly
• Developmental delays, hyperactive behavior,
  learning attention difficulties
• Nursing Care
• Develop prevention programs
• Provide information about the effects of alcohol

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Learning Disorders and Cognitive Impairment

• Types
• Reading disorder (dyslexia)
• Arithmetic disorder
• Writing disorder (dysgraphia)
• Graphomotor disorder (fine motor skills)
• Disorder of written expression
• Language disorder
• Signs and symptoms
• Found in Diagnostic Manual for Infancy and Early
  Childhood

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Learning Disorders and Cognitive Impairment

• Nursing care
• Promote early identification and treatment
• Communicate childs strengths
• Inform family about rights in public school
• Utilize IEP (individualized education plan)

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Elimination Disorders
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Enuresis

• Signs and symptoms
• Wetting clothing or the bed at least two times
  per week for at least three months
• Nursing care
• Understand parental attitudes on toilet training
  
• Discuss behavioral treatments
• Discuss pharmacologic treatments

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Encopresis

• Signs and symptoms
• Withholding the feces involuntarily due to
  constipation
• Nursing care
• Talk to parents about defecation pattern
• Evaluate dietary habits
• Talk about transitions that may be happening
• Help family understand healthy toilet training
• Refer family for counseling