Transcript Sensory/Perception Alterations Genetic Alterations

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, problemsolving 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 selfinduces 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 selfconcept
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??