SensoryPerception Alterations Genetic Alterations by dfhdhdhdhjr

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									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!!
Questions??

								
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