Chapter 17: Disorders of Infancy, Childhood, and Adolescence Copyright © 2012, 2007 Mosby, Inc., an...

Chapter 17:Chapter 17:

Disorders of Infancy, Disorders of Infancy, Childhood, and AdolescenceChildhood, and Adolescence

Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

22Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Mental RetardationMental Retardation

Problems in adaptive functioningProblems in adaptive functioning Mild (85%)Mild (85%)

Academic skills to grade 6Academic skills to grade 6 Minimum self-supportMinimum self-support

Moderate (10%)Moderate (10%) Academic skills to grade 3Academic skills to grade 3 Provide self-care hygieneProvide self-care hygiene

Severe (3% to 4%)Severe (3% to 4%) Rudimentary Rudimentary

communicationcommunication Simple skillsSimple skills

Profound (1% to 2%)Profound (1% to 2%) Sensory-motor Sensory-motor

problemsproblems


AutismAutism

Abnormalities of eating/sleepingAbnormalities of eating/sleeping Stereotyped behaviorsStereotyped behaviors Preoccupied with rituals/samenessPreoccupied with rituals/sameness Lack of emotional reciprocityLack of emotional reciprocity Inappropriate affectInappropriate affect Intellectual limitationsIntellectual limitations Absent/poor language skillsAbsent/poor language skills Perceptual problemsPerceptual problems Limited social skillsLimited social skills


Asperger’s DisorderAsperger’s Disorder

Sustained social impairmentSustained social impairment Restricted, repetitive behaviorsRestricted, repetitive behaviors No delays in development of language, No delays in development of language,

cognitive skillscognitive skills


Attention-Deficit/Attention-Deficit/Hyperactivity Disorder (ADHD)Hyperactivity Disorder (ADHD)

Genetic factors likelyGenetic factors likely Motor hyperactivityMotor hyperactivity Attention deficitAttention deficit NoisyNoisy ImpulsiveImpulsive LabileLabile Low self-esteemLow self-esteem Learning disorderLearning disorder Social problemsSocial problems


Developmental DisordersDevelopmental Disorders

LearningLearning CoordinationCoordination CommunicationCommunication


Separation Anxiety DisorderSeparation Anxiety Disorder

Somatic complaintsSomatic complaints Anxiety/fearAnxiety/fear NightmaresNightmares Social manifestationsSocial manifestations


Tourette’s DisorderTourette’s Disorder

Tic: Sudden rapid, recurrent, nonrhythmic, Tic: Sudden rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalizationstereotyped motor movement or vocalization Simple motor ticsSimple motor tics Complex motor ticsComplex motor tics Simple vocal ticsSimple vocal tics Complex vocal ticsComplex vocal tics

Self consciousness, shameSelf consciousness, shame Social discomfort, low self-esteemSocial discomfort, low self-esteem


Conduct DisorderConduct Disorder

Repetitive, persistent pattern of violating Repetitive, persistent pattern of violating rights of others (bully, threaten, intimidate, rights of others (bully, threaten, intimidate, fight, act cruelly, force sex)fight, act cruelly, force sex)

High-risk behaviorsHigh-risk behaviors Little empathyLittle empathy Misperceive others’ motives Misperceive others’ motives Learning impairmentsLearning impairments Impaired social figuresImpaired social figures


Oppositional Defiant DisorderOppositional Defiant Disorder

DefianceDefiance DisobedienceDisobedience Hostility toward authority figures Hostility toward authority figures


Other Problems Affecting Children Other Problems Affecting Children and Adolescentsand Adolescents

SuicideSuicide Youth violenceYouth violence Substance abuseSubstance abuse DepressionDepression Bipolar disorderBipolar disorder SchizophreniaSchizophrenia Anxiety disordersAnxiety disorders


AssessmentAssessment

Developmental stageDevelopmental stage Within context of family dynamicsWithin context of family dynamics Identified client?Identified client? Physical assessmentPhysical assessment Family lifeFamily life Activities of Daily Life (ADLs)Activities of Daily Life (ADLs)


Nursing DiagnosisNursing Diagnosis

Look carefully at:Look carefully at: Safety issuesSafety issues CommunicationCommunication RelationshipsRelationships Family issuesFamily issues


Outcome IdentificationOutcome Identification

Foci:Foci: Promotion of normal growth and developmentPromotion of normal growth and development Improving dysfunctionImproving dysfunction


PlanningPlanning

Involve client Involve client Involve familyInvolve family Involve treatment teamInvolve treatment team


ImplementationImplementation

Support client and family through change Support client and family through change processprocess

Provide role modelProvide role model Set consistent boundaries and limitsSet consistent boundaries and limits Expect testing behaviorsExpect testing behaviors Maintain safetyMaintain safety Provide therapeutic activityProvide therapeutic activity


Implementation, cont’d.Implementation, cont’d.

Behavior modificationBehavior modification Goal settingGoal setting

ADLsADLs Impulse controlImpulse control RelationshipsRelationships

Rewards for accomplishmentRewards for accomplishment Chart for preschool and school ageChart for preschool and school age Contracts for older children, teens; use increased Contracts for older children, teens; use increased

privilegesprivileges


Nursing InterventionsNursing Interventions

Maintain safe environment.Maintain safe environment. ContrabandContraband SuicidalitySuicidality Aggressive behaviorAggressive behavior

Communicate respect.Communicate respect. Promote boundaries, expectations.Promote boundaries, expectations.

Set fair limitsSet fair limits Increase self-confidence, self-esteem.Increase self-confidence, self-esteem.

Realistic praiseRealistic praise Maintain realistic, hopeful outlook.Maintain realistic, hopeful outlook.


Other Treatment ModalitiesOther Treatment Modalities

MedicationsMedications Activity therapiesActivity therapies

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