Module 14 Childhood MH student PDF Fall 2024

MODULE 14: CHILDHOOD MENTAL HEALTH DISORDERS ASHLEY H. BARNES, DNP, RN, CNE FALL 2024 NURS 1112  2 LEARNING OBJECTIVES 1. Perform an accurate development...

MODULE 14: CHILDHOOD MENTAL HEALTH DISORDERS ASHLEY H. BARNES, DNP, RN, CNE FALL 2024 NURS 1112  2 LEARNING OBJECTIVES 1. Perform an accurate developmental assessment of the child/adolescent client and family and differentiate between expected and abnormal findings. 2. Implement a plan of nursing care that is specific to the client’s disorder. 3. Communicate effectively with children/adolescents who are experiencing alterations in mental health. 4. Incorporate knowledge of psychotropic medications commonly prescribed to children/adolescents into plan of care. 5. Develop a plan for client/family education about diagnosis, medications, and community resources. 6. Manage care for the child/adolescent with mental illness who is in a medical- surgical or community setting. 7. Demonstrate self-awareness of potential transference/counter-transference issues associated with caring for children and adolescents with mental health needs. 8. Identify ethical and legal issues related to mental health treatment in children/adolescents (including medications, seclusion, restraints, differential diagnosis).  ATTENTION-DEFICIT/ HYPERACTIVITY DISORDER ADHD  4 ADHD: PATHO Genetics Neurotransmitter changes Increased Dopamine transporters🡪 less dopamine available Low serotonin and norepinephrine Brain anatomy changes Pre, peri, & post-natal factors Environmental factors  PRESENTATION TITLE 5 ASSESSMENT FINDINGS Low frustration tolerance Temper outbursts Labile Moods Poor school performance Peer rejection Low self-esteem  PRESENTATION TITLE 6 DIAGNOSIS Symptoms present in at least 2 settings for at least 6 months Diagnosed before age 12 DSM-5 Criteria on page 180 Nursing Diagnoses: Risk for impaired socialization Risk for injury Risk for low self-esteem Risk for sleep disturbances d/t medication administration Risk for imbalanced nutrition d/t medication administration  7 INTERVENTIONS Medications Stimulants Non-stimulants Table 11.2 page 183 Behavioral Training Parents before age 6 Parents and Child after age 6 Cognitive Behavioral Therapy Coping Skills Outpatient setting: monitoring growth (height and weight) OPPOSITIONAL DEFIANT DISORDER & CONDUCT DISORDER ODD  9 ODD/CONDUCT DISORDER: PATHO Genetics Neurobiological Physiological Cognitive Environmental Co-diagnoses ASSESSMENT FINDINGS 10 Intermittent Explosive ODD Conduct Disorder Disorder Key frequent and persistent Difference pattern of angry mood and defiant behavior that occurs more frequently than is repetitive and persistent pattern usually observed in individuals of behavior in which the basic Pattern of behavioral of comparable age and rights of others or major age- outbursts characterized by an developmental level and appropriate societal norms inability to control one’s interferes with social, or rules are violated aggressive impulses educational, occupational, or other important areas of *physical aggression is *aggression can be verbal, functioning common, towards individuals, physical, people, property, property, animals animals, or even self *behaviors align with normal developmental behaviors but more frequent and exaggerated  PRESENTATION TITLE 1 ODD Conduct Disorder Intermittent Explosive Disorder 1 Passive aggressive Lacks guilt or remorse Negativism Low self-esteem Feel emotions stronger, not Emotional dysregulation Callousness just rage Typically only towards Sexual behaviors Start with rage and cycle to parents/caregivers at first, Risk taking behaviors remorse but progresses Substance abuse  12 ADVERSE CHILDHOOD EXPERIENCES (ACES)  DIAGNOSIS Rule out other impulse control Nursing Diagnosis disorders, such as ADHD Connor’s Assessment & Risk for suicide Vanderbilt ADHD Diagnostic Impaired impulse control Teacher Rating Scale Risk for violence Risk for injury d/t risk taking behaviors Impaired social interaction Risk for nonadherence Low Self-esteem  PRESENTATION TITLE 14 INTERVENTIONS Don’t engage in power struggles with the client Boundaries, boundaries Box 21.1 No triangulation: everyone is on the same page CBT/DBT  PRESENTATION TITLE 15 MEDICATIONS No FDA approved medication; only used for off-label use Divaloprex sodium (mood stabilizer/anticonvulsant) Aripriprazole , risperidone (antipsychotics) EATING AND FEEDING DISORDERS PRESENTATION TITLE 17  PRESENTATION TITLE 18 ANOREXIA NERVOSA Intense fair of gaining weight PATHO: Genetics Neurohormonal: Tryptophan Changes in the brain Cognitive Environmental factors  PRESENTATION TITLE 19 ASSESSMENT Lanugo Mottled, cool skin Low blood pressure Low heart rate Low temperature Terror of gaining weight View of fat even when emaciated Pushing pieces of food around Rigorous exercise regimen  PRESENTATION TITLE 20 DIAGNOSIS BMI NURSING DIAGNOSES 17 or more: mild Impaired nutritional intake 16-17: moderate Impaired cardiac output 15-16: severe Electrolyte imbalance Less than 15: extreme Laboratory Impaired body image CMP Impaired coping Thyroid function Risk for powerlessness CBC EKG DEXA scan ESR and CPK  PRESENTATION TITLE 21 INTERVENTIONS Hospitalization for those severely malnourished Refeeding syndrome Weight restoration program; goal of 90% of ideal body weight Weighing 2-3 times per week; backwards on the scale Boundaries/restrictions: may need supervision in the bathroom Reforming relationships with family  PRESENTATION TITLE 22 BULIMIA NERVOSA PATHO: Genetics Neurobiological Serotonin & dopamine Brain changes Cognitive factors Environmental factors  PRESENTATION TITLE 23 ASSESSMENT May appear close to ideal Low self-esteem body weight Body dysphoria Enlarged parotid glands Depressive symptoms Dental erosion or cavities Social anxiety Esophagitis EKG Changes Electrolyte imbalance Muscle wasting  PRESENTATION TITLE 24 DIAGNOSIS CMP NURSING Glucose level DIAGNOSES Thyroid function level Impaired cardiac output CBC Electrolyte imbalance EKG Impaired body image Impaired coping Risk for powerlessness Risk for social isolation  PRESENTATION TITLE 25 INTERVENTIONS Hospitalization CBT Electrolyte replacement DBT Monitoring for esophageal Interpersonal therapy (IPT) tears and bleeding Acceptance and Restrictions/boundaries commitment therapy (ACT) Fluoxetine SSRIs: Sertaline, paroxetine, citalopram Tricylclic antidepressants:  PRESENTATION TITLE 26 BINGE-EATING DISORDER Episodes of increased intake that occur beyond the point of satiety and cause distress afterwords Tend to be overweight PATHO: Genetics Neurobiological Changes to orbitofrontal cortex Cognitive Environmental  PRESENTATION TITLE 27 ASSESSMENT Food portions are larger than normal Health problems: Diabetes Hypertension Cardiac disease  PRESENTATION TITLE 28 DIAGNOSIS Impaired nutritional intake, greater than body requirements Impaired body image Impaired coping Anxiety Chronic low self-esteem Risk for social isolation  PRESENTATION TITLE 29 INTERVENTIONS