Sensory/Perception Alterations Genetic Alterations NUR 264 Pediatrics Angela Jackson, RN, MSN Attention Deficit Hyperactivity Disorder Attention Deficit Disorder (ADHD/ADD) ADHD: Persistent pattern of inattention, hyperactivity and impulsivity Behavioral problem, not a learning disability ADD: same symptoms as ADHD but without the hyperactivity – appear sluggish, anxious, shy, unmotivated, have school problems – treatment same as ADHD ADHD/ADD: Epidemiology ADHD is the most common, significant behavioral syndrome in childhood, with an overall prevalence of 4-6% of elementary school-aged children Male to female ration is about 6:1 Age of onset before age 7, present in at least 2 settings for longer than 6 months 50-80% continue through adolescence 2/3 carry symptoms into adulthood ADHD/ADD: Clinical manifestations Box 17-9 on page 537. Inattention Hyperactivity Impulsivity ADHD/ADD: Treatment Behavioral Therapy: behavior modification, rewards, positive reinforcements, ignore behavior, remove from situation, quite time, effective discipline techniques, problem- solving training, loving support Psychotherapy: increase self-esteem, work through situations, coping strategies, play therapy Special diets: removing foods that contain additives and sugar ADHD/ADD: Treatment Special physical exercise: improve coordination, increase ability to handle situations, increase self-esteem Work with teachers: provide structured classroom, decrease stimulation, teach organization skills, provide written instructions Work with parents: teach organizational skills, anger control techniques, improve communication skills ADHD/ADD: Treatment Medications: CNS stimulant drugs: Ritalin, Cylert, Focalin, Concerta Dexedrine: watch for development of tics Adderall Side effects: insomnia, reduced appetite and weight loss, abdominal pain, headache, dizziness, increased heart rate and BP ADHD/ADD: Treatment Non-stimulant drugs: Antidepressants Antianxiety – Buspar Alpha-2 adrenergic agonists – Clonodine, Tinex Antipsychotics – Phenothiazines, Haldol, Lithium Selective norepinephrine reuptake inhibitor – Strattera Side effects: abdominal pain, vomiting, decreased appetite, headache, cough, increased heart rate and BP Autism Developmental disorder of brain function Characterized by impaired reciprocal social interactions, impaired verbal and nonverbal communication, lack of imaginative activity and a markedly restricted range of activities and interests Autism: Etiology Unknown in most cases May have multiple biologic causes: immunizations, toxins, viruses, food, drugs Genetic: 10-20% risk of recurrence in families Three to four times more frequent in boys Autism: Clinical Manifestations Abnormalities in language and thinking skills Repetitive behavior (rocking, hand flapping) Abnormal responses to sensations, people, events, objects, no fear of danger Self-abusive behavior (head-banging) Do not participate in social play with others Autism: Clinical Manifestations Mental retardation (75%) or exceptional skills Do not deal well with change in routine Increased activity levels with short attention span Usually a disturbance of communication, both expressive and receptive, first brings the autistic child to attention Autism: Clinical Manifestations Language is nonexistent or immature, characterized by echolalia, pronoun reversals (using “you” to refer to himself and I to refer to refer to the listener), unintelligible jargon Seizures occur in 15-35% of autistic children Autism: Treatment No cure Highly structured and intensive behavior modification programs Positive reinforcement Family support Autism: Nursing Considerations Introduce slowly to new situations Use brief and concrete communication Make one request at a time Maintain usual routine Decrease stimulation (private room) Maintain a safe environment with close supervision Minimal touch or holding Teach parents coping skills Fetal Alcohol Syndrome (FAS) Specific cluster of physical and neurobehavioral birth defects associated with maternal alcohol abuse during pregnancy FAS represents the most severe end of possible damage Fetal alcohol effects (FAE) represent less severe forms of damage FAS: Etiology Occurs in 0.5 per 1,000 live births Increased incidence in Native Americans (1/250) The more alcohol consumed, the greater the risk for FAS FAS: Etiology Drinking patterns that produce very high blood alcohol levels, whether daily or weekly, pose the greatest risk First trimester exposure poses risks to structural development, third trimester exposure may impair CNS development Uncommon in a first pregnancy. Effects of alcohol becomes more severe with each child born Chronic maternal alcohol use can deplete minerals and vitamins available to the fetus FAS: Clinical Manifestations Growth retardation: short stature, underweight, decreased adipose tissue Craniofacial abnormalities: microcephaly, small eyes with small palpebral fissures, wide flat nasal bridge, flat philtrum Sensory integration difficulties FAS: Clinical Manifestations Learning and attention difficulties (low IQ) Irritability Hyperactivity Behavioral disorders Poor social skills Poor self-esteem Poor fine motor function S/S alcohol withdrawal few days after birth FAS: Treatment Reduction of environmental stimuli to help avoid over stimulation Provide good nutrition Anticonvulsant medications Appropriate referrals for early intervention and counseling FAS: Nursing Management Increase calorie intake Daily weight Supportive treatment of health problems Monitor and treat seizures Early intervention programs for disabilities Family support Eating Disorders: Anorexia Nervosa Self-inflected starvation leads to emaciation Intense fear of becoming fat, body image disturbance Weight decreased at least 25% less than original body weight No known physical illness Eating Disorders: Anorexia Nervosa Nursing Management: Promote well-being by monitoring food intake, correct imbalances in fluid, electrolytes, nutrition Monitor weight gain (to 10% of IBW) by gradual gain – too quick gain can lead to cardiac overload and death Kind, nurturing but firm manner Interventions to increase self-esteem and self-worth Medications: Antidepressants, hormones, antipsychotics, gastric motility enhancers Promote individual and family therapy Eating Disorders: Bulimia Recurrent binge eating followed by inappropriate compensatory behaviors, such as self- induces vomiting, misuse of laxatives, diuretics, excessive exercise May eat 20,000 to 30,000 calories per day Eating Disorders: Bulimia Awareness of abnormal eating pattern Fear of not being able to stop eating voluntarily Depressed mood following eating binges Eating Disorders: Bulimia Nursing management: Behavior modifications with individual, family and group therapy Monitor proper nutrition with dietary counseling, correct imbalances in fluid, electrolytes, nutrition Monitor weight gain Interventions to increase self-esteem and self- concept Medications: antidepressants Eating Disorders: Obesity Increase in body weight resulting from excessive accumulation of body fat relative to lean body mass Weighing more than average for height and body build (greater than 120% of ideal body weight for height and age) Caloric intake consistently exceeds caloric requirements and expenditure Less than 5% of childhood obesity is attributed to an underlying disease Eating Disorders: Obesity Nursing management: Teach proper balanced nutrition Monitor weight Develop exercise program child will participate in and parents will support Eating Disorders: Pica Persistent eating of non-nutritive substances for at least 1 month Food pica: coffee grounds Nonfood picas: clay, soil, laundry starch, feces Associated with iron and zinc deficiencies More common in autistic, mentally retarded, anemia, chronic renal failure Infants – plaster, paint, cloth Older children – bugs, rock, sand Adults – chalk, starch, paper The End!! 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