Child Nursing Care III: Emotional Conditions

Child Needing Nursing Care III: Emotional and Behavioral Conditions

• This lesson covers safe, effective care for children and families experiencing emotional/behavioral conditions.
• Pediatric nursing recognizes differences between childhood and adulthood development, even if some disorders are shared.
• Childhood depression may manifest as agitation or somatic symptoms; adolescent depression might involve antisocial behavior, aggression, withdrawal, or substance use.
• Early intervention is often more effective than later intervention.

Nursing Role and Treatment Settings

• Nurses play a crucial role in interacting with families and assessing child-parent relationships.
• The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) is used for mental disorder diagnoses.
• Age-appropriate tools like Research and Diagnostic Criteria – Preschool Age (RDC-PA) and Zero to Three Diagnostic Classifications are used for infants and young children.
• Intellectual disabilities involve impairments in general mental ability, affecting daily tasks (e.g., language, reasoning).
• Therapies for infants/toddlers focus on parent-child relationships and positive reinforcement.

Treatment Types and Settings

• Treatment settings often include child guidance clinics with a multidisciplinary team (psychiatrist, psychologist, social worker, pediatrician, nurse).
• Therapy types include individual, family, or group therapy; behavior modification; milieu therapy (physical/social environment); and creating emotionally safe environments.
• Therapy goals aim to improve family functioning.
• Common behaviors (e.g., finger sucking, nail biting) can reflect anxiety stemming from family dysfunction.

Common Organic Behavioral Disorders in Children

• Learning Disabilities: Affect acquiring, retaining, comprehending, and organizing information (e.g., dysgraphia, dyslexia, dyscalculia).
• Suspected Causes: Perinatal factors (low birth weight, prenatal exposure to drugs/alcohol), genetics, abuse.
• Dyslexia: Difficulty reading, identifying speech sounds, and letter/word relationships. Often comorbid (cooccurring) with ADHD.
• Autism Spectrum Disorders (ASD): Characterized by difficulties in social interaction, communication, repetitive behaviors, and stereotyped interests. Early diagnosis possible, usually well established by age 18.
• Obsessive-Compulsive Disorder (OCD): Recurrent, persistent thoughts (obsessions) and ritualistic behaviors (compulsions). Usually does not impair cognitive function or relationships.
• Attention-Deficit/Hyperactivity Disorder (ADHD): Developmentally inappropriate levels of activity, impulsivity, and inattention, starting before age 7 and lasting more than 6 months.
• Symptoms (ADHD): Inattention (e.g., making mistakes, easily distracted), Impulsivity (e.g., interrupting, talking out of turn), and Hyperactivity (e.g., fidgeting, difficulty staying seated).
• ADHD Therapy: Multiple approaches including family counseling, medication (e.g., stimulants), classroom placement, environmental modification, and sometimes psychotherapy.
• Eating Disorders: Anorexia nervosa (self-starvation), Bulimia (binge eating followed by purging). These often stem from low self-esteem and issues with body image.
  • Treatments include hospitalization, psychotherapy, behavior therapy.

Common Environmental/Biochemical Disorders in Children

• Mood Disorders (Depression): Difficulty expressing feelings, acting out problems, manifested in various behaviors (e.g., withdrawal, school problems, changes in appetite/sleep).
  • Treatment involves a multidisciplinary approach with cognitive behavioral therapy (CBT), medication (antidepressants).
• Suicide: Deliberate self-injury with intent to die. Suicide is the third leading cause of death in adolescents. Risk factors include parental loss, family disruption, abuse, neglect, and dysfunctional families.
  • Warning signs include social withdrawal, decreased school performance, giving away possessions, talking about death, flat affect, or sudden mood change. Immediate action is necessary.
• Substance Abuse: Experimentation, controlled use, abuse, and dependence (psychological and physical). Includes substances like alcohol, drugs, and tobacco.
  • Treatment focuses on education and support for families and individuals.
• Children of Alcoholics: Face emotional and physical neglect, experiencing family unpredictability and confusion. They may develop coping strategies such as flight, fight, being the perfect child, or trying to be a family savior.

Minimizing Impact of Behavioral Disorders

• Multidisciplinary interventions and referrals are implemented after identifying the problem source.
• The Developmental Troubleshooters Eclectic Checklist for Kids and Teenagers (D-TECKT) is used to direct care.

Effects on Growth and Development

• The duration and intensity of stressful events, along with coping skills, affect developmental progress. A family-centered approach to care is key.

Effects on Siblings

• Siblings often experience emotional scars or protective coping mechanisms due to a brother or sister's emotional or behavioral condition. Sibling rivalry is a normal developmental process.

Case Study: Christopher (Autism)

• Factors influencing reactions include unfamiliar surroundings and the pace of same-day surgery units.
• Key information to elicit from Christopher's mother includes his coping strategies for changes in schedule, surroundings, and interactions.
• Strategies for interacting with Christopher include slow approach, asking permission before touching, letting him handle equipment.

Summary of the Lesson

• This lesson reviews the nurse's role and treatment settings, common behavioral disorders, and environmental/biochemical disorders in children. It also includes a case study and discussion.

This quiz focuses on safe and effective nursing care for children experiencing emotional and behavioral conditions. It includes important aspects of pediatric nursing, developmental differences, and the role of nurses in assessing child-parent relationships. Key tools and early intervention strategies are also covered.