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.
Characterized by a focus on somatic (physical) symptoms, such as pain or fatigue, to the point of excessive concern, preoccupation, and fear. Patients’ suffering is authentic
Somatic Symptom Disorder
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.
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.
This includes family distress, abuse, inadequate parenting, and problems with attachment.
ACE's
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.
What are the 3 hallmarks of this obsessive compulsive personality 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.”
What are the some guidelines to follow when caring for a histrionic 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. 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
Characteristics of conduct disorder?
4. Often argues with authority figures or, for children and adolescents, with adults
5. Often actively defies or refuses to comply with requests from authority figures or with rules
6. Often deliberately annoys others
7. Often blames others for his or her mistakes or misbehavior
Early: Difficulty remembering recent conversations, names or events, apathy, and depression.
Middle: Impaired communication, disorientation, confusion, poor judgment, and behavioral changes.
Late: Difficulty speaking, swallowing, and walking
Alzheimer's Dementia.
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
a primary defense mechanism or coping style. It involves an inability to view both positive and negative aspects of others as part of a whole, which results in viewing someone as either a wonderful person or a horrible person.
Splitting
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.
They are somewhat expressionless and have a restricted range of emotional expression.
Schizoid PD
What is a guardianship?
a court-ordered relationship in which one party, the guardian, acts on behalf of an individual, the war