development and functional ability
explain the 3 interrelated concepts of development
growth - physical growth is a quantitative change
differentiation - process by which initially formed cells and structures become specialized
maturation - individual is fully developed in personal, behavioral, or adultlike physical characteristics
explain ASD and what we use to diagnose
- appear in the first 3 years of life
- affects social and communication skills
- DSM5 criteria : social-emotional reciprocity, nonverbal communicative behaviors, deficits in developing and maintaining relationships
- symptoms must be present in early developmental period, they together limit and impair everyday functioning and are not better explained by intellectual disability
explain what ADHD is and what ADHD-PI is
how is this diagnosed ?
adhd - inappropriate degree of inattention, impulsiveness, and hyperactivity
adhd-pi - further classified as primarily inattentive type (was ADD)
diagnosis : must be present in at least 2 settings and occur before age 12
what are the classes of medications we use for ADHD ?
amphetamines, CNS stimulants, SNRIs, and central acting alpha-2 adrenergic agonists
what is functional ability ?
cognitive, social, physical, and emotional ability to carry on normal activities of life
explain the symptoms of ASD
- deficits in social and relationship building skills
- repetitive patterns
- obsessive focus on specific objects
- routines or rituals
- resistant to change
explain the assessment and diagnosis part of the nursing process with ADHD
assessment : physical activity, attention span, talkitiveness, frustration tolerance, impulse control, ability to follow directions/complete tasks, social skills, comorbidities, learning disorders, and sleeping/eating patterns
diagnosis : overactive/ disruptive behaviors, difficulty with attention, behavior negatively impacts relationship development, conflict with others, noncompliant, not follow age appropriate norms, inappropriate ways to meet needs
Explain amphetamines
class - stimulant
med - adderall (amphetamine/dextroamphetamine)
AE - insomnia, nervousness, weight loss / suppressed growth, HTN, tachy, depression if stopped abruptly
PE/NC - take before 4pm, monitor Height and weight, "drug holidays", dont stop abrupt, largest meal when appetite is largest, contraindicated with substance abuse and cardiac disease, avoid caffeine
discuss childhood mental health and what it can do to development
- disrupts the normal pattern of development
- barriers to assessing, diagnosing, and treating
- lack of services and premature termination of Tx
explain the assessment and diagnosis part of the nursing process
assessment : developmental delays, communication skills, parent-child relationship, physical and emotional signs of abuse, comorbidities (should be completed prior), need for community programs
diagnosis : severe impairments in social interactions and communication skills, intellectual disability, inability to bond with peers, behavioral problems
explain the outcome and implementation parts of the nursing process with adhd
outcomes should target hyperactivity, impulse control, freedom from injury, improved social relationships, development of self, and positive coping skills
implementation should include different types of therapy, managing disruptive behaviors, and psychosocial interventions,
explain CNS stimulants
med - Methylphenidate (concerta, ritalin, daytrana) ; PO or Transdermal
AE - insomnia, nervousness, weight loss and suppressed growth, HTN, tachy, depression when stopped abrupt
PE/NC - before 4pm, monitor height and weight, "drug holidays" dont stop abrupt, allow larger meal when most hungry, not for substance abuse or cardiac disease Hx, avoid caffeine
explain the risk factors of impaired development (with MH) as well as the general assessment of a child with a potential MH issue
bio- genetic and nerobiological
cognitive - temperament and resilence
environment - adverse childhood experiences
cultural - ethnicity, worldview, religion, and socioeconomics
general assessment includes data collection, mental status exams, and developmental assessments
explain the outcomes, implementations, and evaluations in the nursing process
outcomes : social interaction skills, communication skills, and family normalization
implementation : early intervention programs, behavior management, and family support
evaluation : level 1 = requires support, level 2 = substantial support, level 3 = very substantial support
with ADHD, ADHD-PI, and ADHD hyperactive-impulsive type or combo type, what are our focuses ?
adhd - symptom patterns and severity
adhd-pi - academic performance, ADLs, social relationships, and personal perception
HIT/combo - academic performance, social skills, relationships, impulse control, and behavioral response
explain SNRIs
med - atomoxetine (strattera)
AE - GI upset, urinary retention, dizzy, fatigue/insomnia, liver injury, increased SI in depressed patients
PE/NC - 6 weeks, good for those who have increased anxiety with stimulants/ substance use disorder
explain some of the interventions / treatments for these patients in childhood MH
interventions : rewards, therapies (play, biblio, art, music, family, and journaling)
treatments : pharmacotherapy (multimodal approach), CBT, group therapy
explain the pharmacotherapy and psychological therapies for ASD
pharm - used to improve relatedness and decrease anxiety, agitation, and compulsive behaviors
psych - applied behavior analysis, early intensive behavioral interventions, early start denver model
what treatments will we see with ADHD
biologic - meds to increase attention and task directed behavior as well as meds for aggressive behaviors
psychological therapies - parent training in behavior therapy and CBT
explain Centrally acting alpha-2 adrenergic agonists
med - Guafacine (intuniv), clonidine (catapress, kapvay)
AE - drowsy, dizzy, dry mouth, htn, rebound HTN crisis if stopped abruptly
PE/NC - @ bed to reduce drowsiness, dry mouth will dimish, dont stop abruptly
FUN FACT - can also be used for HTN and used through a transdermal patch for this !