ADHD/ADD:
its an actual disease, not the child or persons fault
ADHD/ADD main s/s:
inattention
impulsivity
hyperactivity
ADHD/ADD school age s/s:
poor grades, distraction/bored
fidgeting, interrupting alot
cannot follow rules
ADHD/ADD infant and toddler s/s:
infant: crying a lot, fussy, poor sleeping
toddler: can't sit down, acting out
ADHD/ADD adolescent s/s:
poor grades, skipping class
risky behavior-drugs, alcohol, fighting
ADHD/ADD adult s.s:
can't keep job, can't make deadlines
poor sleeping
self medicate with stimulants
poor relationships- forget things a lot
ADHD/ADD Etiology:
genetics- 1st degree relatives
altered serotonin/catecholamines
pre-natal influences-IUGR, toxins, smoking
low birth weight
frontal lobe metabolsim
males>females
socioeconomic influences
ADD/ADHD treatment:
no cure
safety! do not leave children alone, structure their day
Nutritional therapy: don't give sugar, caffeine
ADHD/ADD Meds:
Stimulants: Methylphenidate(Rytalin), Adderall, dyantra patch- these
need to be taken in the am & eat before
Antidepressants (SNRI): Strattera- need LFTS, and monitor suicide
Alpha Antagonist: clonidine, guandacine(tenex)
Modanifil: antiarcoleptic
**risk of sudden death with cardiovascular disease
Monitor for weight loss, sleep problems, and increase HR
**watch for abuse in these drugs- many ppl sell them- give to school
or give patch for preventing
ADHD/ADD behavioral therapy:
give them simple, clear instructions one at a time
fidget spinners, bouncing ball chair, sit them away from distractions
have children do homework in same place, same time, away from distractions
schedule things out
ADHD/ADD nursing care:
safety is priority!
provide supervision
give clear instructions
give positive reinforcement
establish daily schedule
ADHD/ADD Diagnosis:
DSM-5
it must be confirmed by parents and school
if school says they aren't that way at school then ask the parent if
anything has changed at school recently
Autism:
persuasive development disorder- identified between 18 months-3 years
Genetic link
No relation to MMR
Aspergers:
emotional/social problems- don't show emotion
same as autism without language or cognitive effect
SUPER smart people
Childhood disintegrative disorder (CDD):
marked regression after at least 2 years of normal growth and development
progress fine until 18mo then progressively declines cognitively and
developmentally, lifelong disorder
Autism s/s:
speech/language delay
not responsive to facial expression of others
poor eye contact/ looks through people
inability to share pleasure
repetitive hand, finger motion-head banging, hitting others
lack of pretend play, don't play with others
unusual reaction to sensory stimuli-sound, bright lights, touch
Autism treatment:
No cure-there is apps that help the children that can't speak
goal: reduce symptoms and promote learning & development
Speech,OT, PT, psychiatrist, behavioral therapy, nutritionist
if aggressive they can have antipsychotics- haloperidol
What should people with autism avoid:
gluten, casein protein
add vitamin B6
some keto diets help
0-6mo normal language milestone:
coos, turns to sounds, gazes at objects
7-12 mo old normal language milestones:
words appear, repeats syllables "mama
18 mo normal language milestones:
pointing, gestures, 20 words
2 years normal language milestones:
combining words
0-3mo normal developmental milestones:
social smiles, watches face intently
7mo normal developmental milestones:
responds to name, enjoys social play
1yr old normal developmental milestones:
initiate others, response to simple verbal requests
Rett Syndrome:
near developmental disorder
most are girls
normally early growth/develepment followed by a slowing of developing/regression
often exhibit autistic behavior
about 80% experience SEIZURES
Rett Syndrome s/s:
walking on toes, wide based gait
sleep problems, hands in mouth alot
wringing of the hands
breathing holding & swallowing air, apnea-worry about aspiration
hyperventilating
teeth grinding, difficulty chewing
SEIZURES-can cause death & cardiac issues
cognitive disabilities
Rett syndrome teaching point:
seizure meds need to given at same time everyday
Oppositional Defiant Disorder (ODD):
uncooperative, defiant, hostile behavior toward authority
dysfunction in social, academic, or work situations
still has good relationships socially, but does not listen to any
kind of authority- police, teachers, principles, parents
typically develops into antisocial personality disorder if not treated
ODD s/s:
angry outburst, argue with adults
refusal to comply with requests/rules
blaming others for mistakes/behavior
seeking revenge
ODD risk factors:
parent with mood disorder/substance abuse problem
history of absent parents or neglect
harsh or inconsistent discipline
lack of supervision
peer rejection
exposure to violence or traumatic event
parents with troubled marriage/divorce
poor relationship with parents
history of emotional or physical abuse
ODD nursing care:
reinforce positives
take time out
pick your battles
set age appropriate limits
be consistent
psychotherapy/family therapy
Conduct Disorder:
persistent antisocial behavior of children & adolescents that
impairs ability to function in social, academic, or occupational areas
associated with early sexual activity, drinking, smoking, use of
illegal drugs, and other reckless or risky behaviors
if they are before age 10-the more severe they will be
they do not have cognitive issues-they just have poor behavior
Conduct disorder 4 main symptoms:
aggression to people/animals
destruction of property-arson, grafitti
decietfulness/theft
violation of rules
Conduct Disorder Classifications:
Mild: lying, truancy, breaking curfew
Moderate: vandalism, theft
Severe: rape, cruelty to animals, use of weapons, burglary, robberies
Conduct Disorder Treatment:
JAIL does NOT help these people-makes it worse
individualized
difficult to treat
family therapy
problem solving skills
parenteral training
behavioral therapy
Conduct Disorder Meds:
antidepressants, halidol
Conduct disorder risk factors:
early maternal rejection, neglect
parental mental illness or substance abuse
absent father, adopted children
inconsistent discipline
abuse or violence
low academic achievement
poor peer relationships
low self esteem, poverty
early institutional living
low economic status
Conduct disorder nursing care:
set limits on behaviors- inform them of rules & consequences
State expected behaviors- be consistent
Promote compliance with treatment
Positive reinforcement
Assist with coping- journaling, finger painting
Provide patient and family education
Why is it so hard to treat people with conduct disorder?
they don't want help and they don't have family support
treatment has worked when they start taking ownership and stop
committing crimes
Separation Anxiety symptoms:
tantrums, crying
clinging on separation, anxious
fear of sleeping alone or away from home
somatic complants- headache, stomach ache, dizziness
avoids school
Separation anxiety etiology:
genetics
parenting styles
shy or fearful
traumatic incidence at school- ask before sending back to school if
something happened
symptoms absent on the weekends or holidays
can be precursor for panic attacks
Separation anxiety treatment:
return to school gradually
enlist assistance at school with nurse or counselor
Separation anxiety nursing care:
provide emotional support- give them something special of parents to
take to school
serve as a mediator between school and family
assure children's safety
help parents/children set goals
Tourettes Disorder s.s:
both motor and vocal tics-to ensure dx
coprolalia, echolalia, palilalia
may get worse over time
significant impairment of academic, social, or work environment
Tourettes Disorder etiology:
tends to run in families
abnormal dopamine transmission
Tourettes Treatment:
atypical antipsychotic such as Risperidone(risperidol) or olanzapine(zyprexa)
side effects of meds: no alcohol with risperidone
can cause:
tardive dyskinesia
agranulocytosis-need WBC
NMS- high fever, HTN, CBK labs
acute dystonia
anticholinergic effects-super dry-promote adequate rehydration and nutrition
Tourettes Nursing Care:
family support
promote rest, and decrease stress
positive reinforcement
local support groups
parenting skills workshop
do NOT rush these people when they are speaking to you
Bulimia:
recurrent pinge/purges- may hide evidence from family/friends
they typically have normal BMI or slightly over
they use laxatives ad syrup of lipecac-makes you throw up and causes
lethal arrhythmia
Bulimia S/s:
serious cardiac effects- "bulimia heart attack"
electrolyte imbalances- Mg and K+
GI erosion or rupture- worry about airway!
dental erosions-tooth enamel damage
broken blood vessels in eyes
abrasions on knuckles
seizures bc lyme problems
Bulimia Treatment:
CBT
antidepressants
teach family about warning signs
Anorexia Nervosa:
self imposed fasting/restricting
obsessive need for control-want to control something
compulsive exercise, perfectionist, 90-95% female
common ages 14-18, increase risk of death
Anorexia Nervosa S.s:
wasted appearance, thinning hair
lungago, dry skin/brittle nails
heart rate low, BP low
constipation, amenorrhea
electrolyte imbalance- K+, Ca, Mg-can be lethal
heart failure, osteoporosis, joint swelling
lethargy, always cold
unusual eating patterns-eating ice, calorie counting, cutting food
in tiny pieces
Anorexia Nervosa Abnormal Labs:
decrease plts and H&H
abnormal thyroid
increase BUN(pre renal failure)
decrease WBC
decrease calcium
estrogen level decrease- reason for no period
Anorexia Nervosa Nursing:
Restore nutritional status- multivitamins, increase fiber, decrease
sodium, increase calories
Rehydrate
Maintain reasonable weight- weight them backwards, weigh checks
Re-establish normal eating-1500 calories/day then add 200 daily
1 on 1 supervision while eating-UAPs can do
allow them to pick food from pre approved menu
small frequent meals often
Anorexia Nervosa Treatment:
CBT
Group therapy can be good or bad-ensure their ready
Family therapy
Pharmaceutical: antidepressants(helps weight gain)
amitriptyline-elavil
cyproheptadine-periactin
fluxotine-prozac
Binge eating disorders:
loss of control over food consumption-cant control it
often over weight and obese
Binge eating s.s:
eating large amounts of food over long periods of time- often in a
"daze" while eating
eating when not hungry
eating in secret and hiding food
eating rapidly
Binge eating treat:
CBT
weight loss program
stimulants
address psychological problem first before surgery
Trisomy 21:
extra chromosome 21, most common chromosomal disorder
increase risk in moms over 35
Trisomy 21 symptoms:
Inner epicanthal folds
Small flat nose, Small low set ears
Short broad neck,
Short stature
Transverse plantar crease
Conductive hearing loss
Congenital heart defects
Septal defects
Hypotonicity, Hypothyroidism
Impaired immune function, Frequent URI
Hirschsprung's disease
Trisomy 21 treatment:
evaluate hearing/vision
corrective surgery as needed
they need echo, hearing and vision test at birth
80% survive into 60s
Trisomy 21 nursing care:
assist with parental diagnosis- AFP, CVSm amino
refer to genetic counselor
support at birth
echocardiogram
support groups
PKU:
autosomal recessive- lacks enzyme to convert phenylalanine to tyrosine
1 in 15,000 births
usually asymptomatic at birth
heel test done at birth and 2 weeks later- early recognition is key!
PKU s/s:
cognitive delay/delay in development
behavioral/emotional and social problems
psychiatric disorders, neuro problems
fair skin and blue eyes bc melanin
hyperactivity, musty odor on breath
poor bone strength
microcephaly
PKU nursing care:
screen 48hrs after birth and 2 weeks later
low phenylalanine formula: PHENEX, breast milk
avoid high protein foods and diet coke
they can have veggies, fruit, cereal
diet it rigid and strict- need dietician
need extra vitamins
PKU treatment:
early diagnosis
guthrie blood test at birth and 2 weeks later
avoid high protein and diet coke
PKU formula with essential protein
Fragile X syndrome:
abnormal gene on lower end of longer of the X chromosomes in affected
males and carrier females
Fragile X s/s:
Prognathism (long face and strong jaw)
Large protruding ears
Mild to severe cognitive delay/insufficiency
Speech delay
Hyperactivity
Autistic behaviors
Fragile X nursing care:
provide support
national fragile X foundation
genetic counseling
Fragile X treatment:
serotonin agents to control temper
carbamazepine
fluxetine
CNS stimulant for ADHD
clonidine