Childhood & Neurodevelopment Disorders
Usual attitude, mood or behavior that a child uses to cope (present in infancy)
Temperament
What is depersonalization disorder and how does it manifest?
A feeling of detachment from one's body or mental processes
Depersonalization is characterized by a sense of unreality or self-estrangement.
What is somatoform disorder?
Soma is the Greek word for “body,” and somatization is the expression of psychological stress through physical symptoms.
Clients generally demonstrate ineffective coping such as anxiety, loneliness, and risk of suicide
The mother of a 6-year-old child expresses concern over the child’s frequent temper outbursts. He deals with any frustration by bullying and hitting and seldom shows any remorse for his actions. The nurse who gathers this data will note that the child’s behaviors are most consistent with which diagnosis?
Conduct disorder
A family member reports that the client had been oriented and able to carry on a logical conversation last evening, but this morning is confused and disoriented. The nurse can suspect that the client is displaying symptoms associated with which cognitive disorder?
Delirium
Delirium is characterized by a disturbance of consciousness, a change in cognition (such as impaired attention span), and a fluctuating level of consciousness that develop over a short period of time.
When working with a client who may have made a covert reference to suicide, the nurse should base the response on what statement?
Asking the client directly if they are thinking of attempting suicide.
Covert references should be made overt. Talking openly about suicide leads to a decrease in isolation and can increase problem-solving alternatives for living. People who attempt suicide, even those who regret the failure of their attempt, are often extremely receptive to talking about their suicide crisis.
All personality disorders (PD) share characteristics of inflexibility and difficulties in interpersonal relationships that impair social or occupational functioning. Which PD is characterized by feelings of entitlement and lacks empathy but in reality suffer from weak self-esteem and are hypersensitive to criticism?
NARCISSISTIC PERSONALITY DISORDER
Early identification of risk factors & treatments for depression are key measures for suicided prevention:
What are the Key Measures
1. Diagnosable psychiatric illness (psychosis, anxiety, substance use & previous suicide attempts
2. Psychological alteration (personality, emotional reactivity & impulsiveness)
3. Stressful life events.
Other risk factors include access to weapons, access to large doses of medications & chronic or terminal illness
A child diagnosed with autism will demonstrate impaired development in which area?
Symptoms associated with autism spectrum disorders include significant deficits in social relatedness, including communication, nonverbal behavior, and age-appropriate interaction. Other behaviors include stereotypical repetitive speech, obsessive focus on specific objects, over adherence to routines or rituals, hyper- or hypo-reactivity to sensory input, and extreme resistance to change.
Empathic listening is therapeutic because it focuses on what form of action?
Lessening feelings of isolation
Empathic listening can be healing because it can help minimize feelings of isolation.
A woman suddenly finds she cannot see but seems unconcerned about her symptom and tells her husband, “Don’t worry, dear. Things will all work out.” Her attitude is an example of what process?
La belle indifference
La belle indifference is an attitude of unconcern about a symptom that is unconsciously used to lower anxiety.
Identify ways to communicate with a potentially hostile patient
Use nonthreatening body posture
Use a flat neutral tone of voice when correcting behavior
Speak matter-of-fact in easy to understand words.
Consistently set limits
Avoid personal terms such as "I" or "you" when setting limits
The nurse caring for a client diagnosed with Alzheimer’s disease can anticipate that the family will need information about which medication therapy?
Acetylcholinesterase inhibitors
Memory deficit is thought to be related to a lack of acetylcholine at the synaptic level. Acetylcholinesterase inhibitor drugs prevent the chemical that destroys acetylcholine from acting, thus leaving more available acetylcholine.
A client with a history of repeated suicidal attempts refuses to participate in a no-suicide contract. What intensity of nursing observation should be instituted?
Constant 24-hour, one-to-one observation at arm’s length
- A client who will not enter into a no-suicide contract should be placed on the highest level of suicide watch since the client is unable to commit to seeking help to resist suicidal ideations.
Obsessive-Compulsive personality disorder is characterized by limited emotional expression, stubbornness, perseverance and indecisiveness. What are the 3 hallmarks of this disorder?
1.Preoccupation with orderliness
2. Preoccupation with perfectionism
3. Preoccupation with control
What are the protective factors in the elderly to help mitigate suicide risk?
1. Spiritual beliefs
2. Married or have a partner
3. Personal resilience
4. Perception of social/family support
5. Children/other family members (in contact)
Identify the 2 types of tic disorders
Persistent motor or vocal disorder - single or multiple motor or vocal tics but not both for more than 1 year
Tourette's disorder -Multiple motor tics and at least one vocal tic for more than 1 year
Symptoms of an adjustment disorder can include which characteristics?
Depression
Guilt
Anger
Social withdrawal
The primary difference between unconscious and conscious somatic disorders are?
Unconscious not under the patients voluntary control
Somatic symptoms (headache, N/V, sweating, GI etc.)
Conscious disorders have a symptomatology that is actually controlled by the client.
Factitious disorders & malingering in contrast to other somatic disorders, are under conscious control.
Identify 3 important nursing interventions when caring for a patient with impulse control disorder.
1. Promote a climate of safety for the patient and others
2. Establish rapport
3. Set limits and expectations
What are the two Cognitive and Perceptual Disturbances?
- Illusions: errors in perception of sensory stimuli
The stimulus is a real object in the environment but the individual misinterprets it and often become the object of the patients projected fear
- Hallucinations: false sensory stimuli.
Visual hallucinations are common in delirium yet tactile hallucinations may also be present. Auditory hallucinations occur more often (schizophrenia).
When a colleague committed suicide, the nurse stated, “I do not understand why she would take her own life.” This is an expression of which feeling?
Disbelief
Denial and the minimization of suicidal ideation or gestures is a defense against experiencing the feelings aroused by a suicidal person. Denial can be seen in such statements as “I cannot understand why anyone would want to take his own life.”
Histrionic personality disorder are excitable and dramatic yet are often high functioning. What are the some guidelines to follow when caring for this type of patient?
1.Nursing care should reflect an understanding that seductive behavior is a response to distress
2. Keep communication and interactions professional
3. Patients may exaggerate symptoms and have difficulty in functioning
4. Encourage and model the use of concrete and descriptive rather than vague and impressionistic language
5. Assist the patient to clarify feelings because they often have difficulty identifying them
6. Teach and role model assertiveness
7. Assess for suicidal Ideation
An elderly patient who is newly confused, falling, disrobing and fighting with staff. What is the nursing priority?
Assess for Delirium.
Questions to consider:
- Has the patient taken any new medications?
- Does the patient pay their own bills?
- Does the patient cook for themselves?
Characteristics of a resilient child
Adaptable temperament
Ability to form nurturing relationships with surrogate parental figures
Ability to distance themselves from emotional chaos
Good social intelligence
Ability to perceive a future
Problem-solving skills
What information should the nurse give to the family of a client who has had a dissociative episode?
Dissociation is a method for coping with severe stress. Additionally, dissociative symptoms are not under the person's conscious control.
Childhood physical, sexual, or emotional abuse and other traumatic events are associated with adults experiencing dissociative symptoms. None of the other options are true.
Nursing assessment for patients with Somatic Symptom Disorders
1. Assess for nature, location, onset, characteristics and duration of symptoms
2. Explore past history of adverse childhood events
3. Identify symptoms of anxiety, depression & past trauma
4. Determine current quality of life, social support & coping skills.
5. Identify any secondary gains
6. Explore the patients cognitive style & ability to communicate feelings/needs
7. Assess current psychosocial and biological needs
8. Screen for misuse of prescribed medications and or substance use
What is Expressed Emotion?
Refers to the qualitative amount of emotion displayed, usually in the context of family interaction
High Expressed Emotion is a major cause of aggressive responses from patients with impulse control disorders
Low Expressed Emotion (used by medical staff) calmly communicates in a way that reduces confrontation and decreases the need for seclusion
The term “perceptual disturbance” refers to difficulty in which area of function?
Processing information about one’s internal and external environment
Perceptual distortion refers to impaired ability to process intellectual, sensory, and emotional data in a logical, meaningful way.
What suicide protective factors has the greatest impact on a client’s safety (making it less likely to consider, attempt or die by suicide)?
- Effective mental healthcare
- Strong connections to individuals family, community and social institutions
- Problem-solving and conflict resolution skills
- Contact with providers
- Having Children
When admitted for treatment either in an inpatient or outpatient treatment facility, what is the primary goal for Borderline Personality Disorder
- Management of the patients affect in a group context
- Consistency and team approach in the delivery of care (weekly staff meetings should occur to minimize splitting)
Community meetings, coping skills groups and socializing groups provide a patient with BPD an opportunity to interact with peers & staff to discuss goals and learn problem-solving skills.
What are some key concepts to teach the patient & family about polypharmacy or drug safety?
- Learn about your medicines
- Keep track of side effects or possible drug interactions and notify your provider immediately
- Have a "medicine check-up" as least once a year
Attention-deficit/hyperactivity disorders are evidenced by?
Inattentiveness
Hyperactivity
Impulsivity that are developmentally inappropriate
Treated with stimulant medications and behavioral therapies
Trauma interventions for a child with PTSD
- Establish trust and safety
- Use developmentally appropriate language to explore feelings
- Teach relaxation techniques before trauma exploration
Help identify and cope with feelings through the use of art & play to promote expression
Involve the parents or caregivers in 1:1 unless they are the cause of trauma
Educate child & parents about the grief process and response to the trauma
Assist parents in resolving their own emotional distress about the trauma.
Coordinate with social work for protection as needed.
Which disorder is characterized by the client’s misinterpretation of physical sensations or feelings?
Illness anxiety disorder
Previously known as hypochondriasis, illness anxiety disorder results in the misinterpretation of physical sensations as evidence of a serious illness. Illness anxiety can be quite obsessive, because thoughts about illness may be intrusive and difficult to dismiss, even when the patient recognizes that his or her fears are unrealistic.
What are techniques for managing disruptive behaviors?
Behavioral contract
Counseling
Modeling
Role playing
Planned ignoring
Physical distance and touch control
Redirection positive feedback
Clarification as intervention
Restructuring
Limit Setting
Simple restitution
Physical Restraint
An older client diagnosed with early stage Alzheimer’s disease will have greatest difficulty with?
Memory Lapses -- Initially, recent memory is impaired, and remote memory remains intact.
Examples: Difficulty retrieving correct words or names previously known
A client on one-to-one supervision at arm’s length indicates a need to go to the bathroom but reports, “I cannot ‘go’ with you standing there.” How should the nurse respond to the client’s concern?
"For your safety I can be no more than an arm’s length away.”
- This level of suicide watch does not make adjustments based on client preference. The explanation and the reason (your safety) reinforces the basic need for client safety.
identify Interventions for the following:
1. Manipulative Behavior
2. Aggressive Behavior
3. Impulsive Behavior
1. Limit setting -establish parameters of desirable & acceptable patient behavior (Box 24.1)
2. Facilitate the expression of anger in an adaptive nonviolent manner (Box 24.2)
3. Assist the patient to mediate impulsive behavior through application of problem-solving strategies to social and interpersonal situations (Box 24.3)
What is the Patient Self-Determination Act?
Guidelines and philosophy of care that call for patients to be free from unnecessary use of drugs and physical restraints.