Studied by 6 peopleTags & Description
What are the developmental considerations for assessing a child for healthcare and psych-related reasons?
Children need simple phrases (more concrete)
Direct questions, rather than open-ended, may be used
May not be able to provide accurate timeline
May use play therapy
What are some strategies to build rapport with children?
Relate to common interests
Speak slowly and clearly
Remain Calm, Warm
Play therapy (Soccer example)
What are some strategies to build rapport with adolescent?
Be Transparent
Educate and go deeper into what their healthcare will look like
Give a broad reviews of what the parents will know to the patient
What are some strategies to build rapport with parents?
Be non-judgmental
Be the mediator
What is the safety question that you will ask children at every developmental level at assessment?
"Have you ever hurt yourself?"
What is the safety question that you will ask children from middle school age and older at assessment?
"Have you thought about hurting yourself?"
"How would you hurt yourself?"
"What do you think would happened?"
What info must be shared with the child's parents from assessment?
intent to commit suicide or to hurt others
What are some risk factors for childhood mental disorders?
Poverty and homelessness
Child abuse and neglect (Witnessing violence)
Substance abuse in families
What are some protective factors for childhood mental disorders?
Supportive social networks
Normal social development
What are some characteristics of preschool aged children's perception of death and grief?
May not get that death is permanent
More concerned with the reaction of others around them during a family grieving event
What are some characteristics of school aged children's perception of death and grief?
Many have difficulty expressing feelings
What are some characteristics of adolescents aged children's perception of death and grief?
Fears expression emotion
What are common issues in childhood psychosocial developments?
Divorces, separation, and remarriage
Sibling relationships (adverse)
Bullying
Physical illness
Risky Behaviors
What are some unhealthy behaviors that should be assessed for in children during an exam? (RUSTS)
Running away
Unprotected sex
Self injurious behavior
Truancy or delinquency
Smoking, alcohol or drug use
What are some interventions for child-healthcare?
Early intervention programs
Psychoeducation programs
Social skills training
Support groups
Bibliotherapy
What are the common mental disorders diagnosed in childhood and adolescence? (MEANS)
Mood disorders
Eating Disorders
Anxiety disorders (attachment disorder)
Neurodevelopmental disorders
Substance use disorders
ASD consists of persistent deficits in social communication and interaction across which contexts?
Social-emotional reciprocity
Nonverbal communicative behaviors used for social interactions
Developing, maintaining and understanding relationships
What are the manifestations of restricted, repetitive patterns of behaviors, interest, or activities common in ASD?
Repetitive motor movements, use of objects or speech
Sameness, inflexible adherence to routines, ritualized patterns
Highly restricted, fixated interest
Hyper/hyporeactivity to sensation
How many manifestations of behaviors patterns common with ASD are need to diagnose?
At least 2
What is the earliest an ASD diagnosis made?
18 months
General ASD screening for children is recommended at ages
9, 18, and 30 months
What is a common medical co-morbidity of ASD?
Seizure disorder
What are the mental status social behavior assessments of autism in an infant?
Poor eye contact
Lack of smile
What are the mental status social behavior assessments of autism in an child?
Social awkwardness or
Inappropriateness
Lack of empathy
What are the mental status social behavior assessments of autism in an adolescent?
Inability to respond to others feelings
(Major obstacle in developing friendships)
A nursing assessment of children with ASD or suspected ASD include what?
Physical assessment
Psychosocial assessment
What are the psychosocial assessments used for ASD/suspected ASD child patients?
Mood/Depression
Communication
Behavior
Flexibility or adherence to routine
What are the nursing interventions for ASD?
Child and family collaborative care
Address physical health needs
Encourage positive social interaction
Ensure predictability
Behavioral interventions
Support family
What is the top nursing goal for ASD?
Decrease self-injurious behavior
What are some non-med interventions for decreasing self-injurious behavior in ASD patients?
Redirect harmful behavior
Use positive reinforcement
Use protective headgear if needed
What are some medical interventions for decreasing self-injurious behavior in ASD patients?
Antipsychotics
SSRIs
What are the inattention symptoms of ADHD? (FLAMED) (9 tings)
Forgetful
Lack of attention/Loses materials necessary for tasks
Avoids tasks of sustained attention
Mind seems preoccupied
Easily distracted
Difficulty sustaining attention / following instructions / organizing tasks
What are the hyperactivity and impulsivity symptoms of ADHD?
Fidgets
Difficulty remaining seated
Runs or climbs inappropriately
Unable to engage in quiet play
Acts as if "driven by a motor"
Talks excessively
Blurts out answer before question has been completed
Difficulty waiting turn
Interrupts or intrudes on others
How many inattentive and hyperactivity and impulsivity symptoms are needed for a ADHD diagnoses?
6 and 6
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What are popular co-occuring disorders in children with ADHD?
DMDD
Learing Disabilites
MDD
Anxiety
OCD
Tic Disorders
ASD
What are some physical assessments for ADHD?
Restlessness
Sleep disturbances
Daily food intake
Caffeinated product use (Hyperactivity)
Impulsivity
Inattention
Behavior issues
What are some psychosocial assessments for ADHD?
School performance
Functioning at home and/or discipline issues
Family functioning and life events
What are the top safety goals for kids with ADHD?
Reduce risk for injury
Monitor risk for abuse of stimulants
What is the medication management for ADHD?
Stimulants
Non-stimulants
What are the MOA of stimulants?
Enhances dopamine and NE activity
improves attention/focus and decreases hyperactivity/impulsivity
What are the side effects of stimulants? (CADING)
Cardiac complications
Appetite suppression
Dry mouth
Insomnia
Nausea
Growth effects
What is the non-stimulant medication for ADHD?
Norepinephrine uptake inhibitor (amoxetine)
Alpha 2 receptor agonists (guanfacine and clonidine)
What are the side effects of amoxetine?
Somnolence
Headaches
Irritability
Moodiness
GI symptoms
What are the side effects of guanfacine and clonidine?
Fatigue
Sedation
Somnolence
What is an abnormal process of aging?
Learning + Cognition decrease
What are the most common mental health problems in older persons? (DAD)
Depression
Anxiety Disorders
Dementia
What are some of the risk factors for mental disorders in older adults?
-Chronic Illness
-Alcohol and substance abuse
-Polypharmacy
-Bereavement and loss
-Poverty
-Lack of social support
-Elder mistreatment
What are some of the protective factors for mental disorders in older adults?
-The marriage effect
-Education and income
-Resilience and positive outlook
-Healthy lifestyle
-Nutrition
-Physical activity
What are some strategies for promoting mental wellness in older adults? (CREM CLASS)
-Cognitive engagement
-Reduce stigma
-Early recognition
-Monitor medications and polypharmacy
-Community services
-Lifestyle support
-Avoid premature institutionalization
-Social support
-Self care enhancement and spiritual support
What does a physical assessment of an older adult look like in a mental health assessment?
-Present and past health status
-Physical examination (lab values, neuro test, chronic illness)
-Nutrition and eating (change in appetite could be ...)
-Substance use
-Elimination
-Sleep
-Pain
-Pharmacological Assessment
Physical assessment: Nutrition and Eating looks for:
Type, amount, and frequency of food eaten
Changes in appetite
GI symptoms of current medication
Which med side-effect could cause dysphagia?
TD
Which med class could cause xerostomia?
anticholinergic meds
Changes in appetite may be a symptom of which mental disorders?
Depression, psychosis, dementia
Physical assessment: Elimination looks for:
constipation d/t anticholinergic meds
assess fluid intake
Why do you need to assess fluid intake in elderly adults, especially in those with urinary incontinence?
Because many older adults drink fewer fluids to manage urinary incontinence
Physical assessment: Sleep looks for:
assess for sleep patterns
Insomnia could indicate depression stress or loneliness
Sleep walking could be an early sign on alzheimer's dementia
Physical assessment: Pharmacological Assessment looks for:
The use of
-Duplicate meds
-Interacting meds
-Drugs used to treat adverse drug interactions
Which drugs are associated with dementia in older adults?
opiates and synthetic narcotics
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Which drugs are associated with psychosis in older adults?
digitalis, L-Dopa, reserpine, corticosteroids, barbiturates, isoniazid
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Which drugs are associated with Anxiety in older adults?
decongestants, bronchodilators, anticholinergics
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Which drugs are associated with depression in older adults?
beta-blockers, chemotherapy drugs, sedative hypnotics
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For the use of medication in older adults, what are some good considerations?
Start low and go slow d/t
-Increase in relative body fat
-natural decline in kidney function
-Larger drug stores + lower drug clearance = increase drug conc. compared to younger adults with the same medication dose
What is a useful stepwise approach to prescribing meds in older adults (PRRANDS)
-Review (current Dx therapy)
-Discontinue (unnecessary Dx therapy)
-Adverse drug events (consideration for any new symptom)
-Nonpharm approaches (consideration)
-Reduce (dose)
-Simplify (dosing schedule)
-Prescribe (beneficial therapy)
What is the Beers criteria?
It is a clinical tool developed to assist clinicians in improving medication safety in older adults.
What does a psychological assessment of an older adult look like in a mental health assessment?
-Response to mental health problems
-Depression vs Dementia
-MSE
-Behavioral changes
-Stress and Coping Patterns
-Risk Assessment
What is the most common mental illness in older adults?
Depression
Which is worse in the AM? Depression or Dementia?
Depression
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Which condition is associated with the awareness of deficits? Depression or Dementia?
Depression
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Which condition is associated with the ability to complete ADLs? Depression or Dementia?
Depression
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What are all the MSE components to use for the psych assessment for older adults?
Mood and affect
Thought Processes
Cognition and Intellectual Performance
MSE for older adults (Mood and Affect)
Depression is common (late onset after 60)
What are the thought processes that characterize dementia?
Suspicious and delusional thoughts
i.e. People stealing my things, The house is not my house, My relative is an imposter
What are the five abnormalities that indicate underlying neuropathologic changes in older adults?
Changes in
-Consciousness
-Orientation
-Judgement
-Speech
-Language
What are normal changes in cognition for aging?
-Slowing of information processing
-Memory retrieval
What is another cognition assessment tool for older adults?
Mini-mental status exam
What behavioral changes are associated with psychiatric disorders in older adults?
-Irritability
-agitation
-apathy
-euphoria
What is apraxia?
Loss of the ability to execute or carry out learned (familiar) movements, despite having the desire and the physical ability to perform the movements
What does a risk assessment of older adults consist of?
-Depression or suicide attempt, Fam Hx
-Firearms (in house)
-Alcohol or substance abuse
-Stress and social isolation (Unusual), feels like a burden
-Chronic medical condition
-Suicide rates increase with age
What does a Social assessment of an older adult look like in a mental health assessment?
-Activity Level
-Functional Status
-Community resources use
-Spiritual Assessment
-Quality of Life
-Legal Status (elder abuse, advanced care directives)
What is a normal process of aging?
Physical Decline
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What are Neurocognitive disorders characterized by? Name deficits (LLEAPS)
Decline in cognitive functioning and acquired
included deficits in:
-Perceptual motor
-Attention
-Executive functioning
-learning + memory
-language
-social cog deficits
What is delirium?
a disorder of acute cognitive impairment caused by a medical condition (medical emergency, acute + reversible)
What is dementia?
-chronic cognitive impairments
-differentiated by underlying cause
-cortical or subcortical classification
Delirium symptoms
-Impaired consciousness
-Problems w/ attention/focus
-Memory, orientation and language problems
Risk factors for delirium
-advanced age
-Pre-existing dementia
-Functional dependence
-Endocrine and metabolic disorders
-Bone fracture
-Infx
-Medication s/e
-Changes in vital signs (including hypotension and hyper/hypothermia
-Electrolyte or metabolic imbalance
-Admission to a long-term care institution
-Postcardiotomy
-AIDS
-Pain
-Acute or chronic stress
-Substance use and alcohol withdrawal
What is a hallmark of delirium?
Rapid onset of global cognitive impairment
What is the mental status changes for delirium?
-Mental status tends to fluctuate
-Thought content often illogical
-Fluctuations in LOC
-Difficulty focusing and sustaining or shifting attention
-Severely impaired memory (immediate and recent)
-May be disoriented to time and place (rarely to person)
What is the behavior changes assoc with delirium?
Restless or agitated and/or lethargic and slow respond
What are the nursing's care actions to prevent or treat delirium?
-Admin meds judiciously (avoid high risk meds)
-Appropriately treat infx
-treat dehydration and electrolyte disturbances
-Pain control
-Maximize oxygen delivery
-Sensory aids (Provide)
-Bowel/bladder function (Regulate)
-Nutrition
What are the important nursing diagnosis for delirium?
-Risk for injury
-Acute confusion
(Place pts with sitter, send yo emergency room)
What is Alzheimer's disease?
-a type of cortical dementia
-Degenerative + Progressive
-Neuropsychiatric disorder that results in cognitive impairment, emotional and behavioral changes, physical and functional decline and death
early onset dementia
forms of dementia that begin before age 65
late onset dementia
forms of dementia that begin after age 65
What are the symptoms of mild stage AD?
-Loss of memory
-Language difficulties
-Mood swings
-Personality changes
-Diminished judgement
-Apathy
What are the symptoms of moderate stage AD?
-Inability to retain new info
-Behavioral, personality changes
-Increasing long-term mem loss
-Wandering, agitation, aggression, confusion
-Requires assistance w/ADL
What are the symptoms of severe stage AD?
-Gait and motor disturbances
-Bedridden
-Unable to perform ADL
-Incontinence
-Requires long-term care placement
What are all the cognitive domains that can decline in functioning in ppl with AD? (PLEASL)
-Perceptual-motor
-Language
-Executive function
-Attention
-Social cognition
-Learning and mem
What is aphasia?
loss of ability to understand or express speech, caused by brain damage.
What is agnosia?
Inability to use an object correctly
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