Medications
What type of medication raises the levels of norepinephrine, serotonin, and dopamine into the central nervous system?
CNS stimulants
What are complications of CNS stimulants?
Insomnia
Weight loss/reduced appetite
Cardiovascular effects
Withdrawal reaction
Psychotic manifestations
Clinical manifestations of separation anxiety disorder
Excessive anxiety when child separated from home/parents
Can progress into school phobia
Depression is common
Anxiety can develop after a specific stressor
Can progress to panic disorder
Nursing interventions for anxiety disorders
Provide emotional support that is accepting of regression
Offer protection during panic levels
Provide for needs
Implement methods to increase patient self-esteem and feelings of achievement
What are nursing considerations for CNS stimulants?
Take the last dose before 4pm
Monitor heigh and weight
Take before or after meals
Avoid abrupt cessation
Contraindications/Precautions for SSRIs in children/adolescents
Paroxetine can increase suicidal ideation
Prozac (fluoxetine) can cause irritability
Abrupt withdrawal of medication can lead to discontinuation syndrome-dose should be tapered
Serotonin Syndrome
Weight changes
Clinical manifestations of oppositional defiant disorder
Negativity
Disobedience
Hostility
Defiant behaviors towards authority figures
Stubbornness/Argumentativeness
Limit testing
Unwillingness to compromise
Don't see themselves as defiant
Can develop into CONDUCT DISORDER
Exhibit low self-esteem
Nursing interventions for disruptive, impulse control and conduct disorders and ADHD
Use a calm, firm, respectful approach
Use modeling to show acceptable behavior
Obtain child's attention before giving directions and provide short explanations
Plan physical activities
Set clear limits
Assist child in developing effective coping mechanisms
What is the first line treatment for ADHD? First line treatment for depression?
Stimulants
SSRI's (fluoxetine, sertraline, escitalopram)
Atypical antipsychotics can cause:
Diabetes mellitus
Weight gain
Hypercholesteremia
Orthostatic hypotension
Clinical manifestations of disruptive mood dysregulation disorder
Recurrent and severe temper outbursts
Temper 3 or more times per week and observable by others
Onset between 6 and 18
Manifestations are not due to another mental disorder
What are atypical antipsychotics used for in children?
Pervasive development disorders, including Autism spectrum disorder
Conduct disorder
OCD
Relief of psychotic manifestations
What other medications can be used to treat ADHD besides stimulants?
alpha-2 agonists
(Clonidine, Guanfacine)
SNRI atomoxetine
What are side effects of TCAs?
Anticholinergic effects
Weight gain
Sedation
Toxicity
Decreased seizure threshold
Clinical manifestations of intermittent explosive disorder
Patients 18 YEARS AND OLDER
Verbal and physical aggression
Aggressive overreaction to normal events followed by shame and regret
Prevents client's ability to have healthy relationship or normal job
What is a nursing intervention for autism spectrum disorder?
Provide for a structured environment
Use short, concise and developmentally appropriate communication
Role model social skills
Encourage verbal communication
Provide alternative play activities to limit self-stimulating and ritualistic behaviors
Give plenty of notice before changing routines
What are therapeutic uses for TCA's in children?
Depression
Autism spectrum disorder
ADHD
Panic disorder, separation anxiety disorder
OCD
What are interactions with CNS stimulants?
MAOIs
Caffeine
Phenytoin, warfarin and phenobarbital
OTC cold and decongestant medications
Clinical manifestations of ADHD
Inattention
Hyperactivity
Impulsivity
Must present prior to 12
Present in more than 1 setting
Risk for injury due to inattentive and impulsive behavior
What is guanfacine used for? What do you avoid with Guanfacine?
Autism spectrum disorder, ADHD
High fat foods