Sensory/Perception Alterations

Genetic Alterations

NUR 264Pediatrics

Angela Jackson, RN, MSN

Attention Deficit Hyperactivity Disorder Attention Deficit Disorder

(ADHD/ADD)

ADHD: Persistent pattern of inattention, hyperactivity and impulsivityBehavioral problem, not a learning disabilityADD: same symptoms as ADHD but without the hyperactivity – appear sluggish, anxious, shy, unmotivated, have school problems – treatment same as ADHD

ADHD/ADD: EpidemiologyADHD is the most common, significant behavioral syndrome in childhood, with an overall prevalence of 4-6% of elementary school-aged childrenMale to female ration is about 6:1Age of onset before age 7, present in at least 2 settings for longer than 6 months50-80% continue through adolescence2/3 carry symptoms into adulthood

ADHD/ADD: Clinical manifestations

Box 17-9 on page 537.InattentionHyperactivityImpulsivity

ADHD/ADD: TreatmentBehavioral Therapy: behavior modification, rewards, positive reinforcements, ignore behavior, remove from situation, quite time, effective discipline techniques, problem-solving training, loving supportPsychotherapy: increase self-esteem, work through situations, coping strategies, play therapySpecial diets: removing foods that contain additives and sugar

ADHD/ADD: TreatmentSpecial physical exercise: improve coordination, increase ability to handle situations, increase self-esteemWork with teachers: provide structured classroom, decrease stimulation, teach organization skills, provide written instructionsWork with parents: teach organizational skills, anger control techniques, improve communication skills

ADHD/ADD: TreatmentMedications:

CNS stimulant drugs: Ritalin, Cylert, Focalin, ConcertaDexedrine: watch for development of ticsAdderallSide effects: insomnia, reduced appetite and weight loss, abdominal pain, headache, dizziness, increased heart rate and BP

ADHD/ADD: TreatmentNon-stimulant drugs:

AntidepressantsAntianxiety – BusparAlpha-2 adrenergic agonists – Clonodine, TinexAntipsychotics – Phenothiazines, Haldol, LithiumSelective norepinephrine reuptake inhibitor – StratteraSide effects: abdominal pain, vomiting, decreased appetite, headache, cough, increased heart rate and BP

AutismDevelopmental disorder of brain functionCharacterized by impaired reciprocal social interactions, impaired verbal and nonverbal communication, lack of imaginative activity and a markedly restricted range of activities and interests

Autism: EtiologyUnknown in most casesMay have multiple biologic causes: immunizations, toxins, viruses, food, drugsGenetic: 10-20% risk of recurrence in familiesThree to four times more frequent in boys

Autism: Clinical Manifestations

Abnormalities in language and thinking skillsRepetitive behavior (rocking, hand flapping)Abnormal responses to sensations, people, events, objects, no fear of dangerSelf-abusive behavior (head-banging)Do not participate in social play with others

Autism: Clinical Manifestations

Mental retardation (75%) or exceptional skillsDo not deal well with change in routineIncreased activity levels with short attention spanUsually 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 jargonSeizures occur in 15-35% of autistic children

Autism: TreatmentNo cureHighly structured and intensive behavior modification programsPositive reinforcementFamily support

Autism: Nursing Considerations

Introduce slowly to new situationsUse brief and concrete communicationMake one request at a timeMaintain usual routineDecrease stimulation (private room)Maintain a safe environment with close supervisionMinimal touch or holdingTeach parents coping skills

Fetal Alcohol Syndrome (FAS)

Specific cluster of physical and neurobehavioral birth defects associated with maternal alcohol abuse during pregnancyFAS represents the most severe end of possible damageFetal alcohol effects (FAE) represent less severe forms of damage

FAS: EtiologyOccurs in 0.5 per 1,000 live birthsIncreased incidence in Native Americans (1/250)The more alcohol consumed, the greater the risk for FAS

FAS: EtiologyDrinking patterns that produce very high blood alcohol levels, whether daily or weekly, pose the greatest riskFirst trimester exposure poses risks to structural development, third trimester exposure may impair CNS developmentUncommon in a first pregnancy. Effects of alcohol becomes more severe with each child bornChronic maternal alcohol use can deplete minerals and vitamins available to the fetus

FAS: Clinical Manifestations

Growth retardation: short stature, underweight, decreased adipose tissueCraniofacial abnormalities: microcephaly, small eyes with small palpebral fissures, wide flat nasal bridge, flat philtrumSensory integration difficulties

FAS: Clinical Manifestations

Learning and attention difficulties (low IQ)IrritabilityHyperactivityBehavioral disordersPoor social skillsPoor self-esteemPoor fine motor functionS/S alcohol withdrawal few days after birth

FAS: TreatmentReduction of environmental stimuli to help avoid over stimulationProvide good nutritionAnticonvulsant medicationsAppropriate referrals for early intervention and counseling

FAS: Nursing ManagementIncrease calorie intakeDaily weightSupportive treatment of health problemsMonitor and treat seizuresEarly intervention programs for disabilitiesFamily support

Eating Disorders: Anorexia Nervosa

Self-inflected starvation leads to emaciationIntense fear of becoming fat, body image disturbanceWeight decreased at least 25% less than original body weightNo known physical illness

Eating Disorders: Anorexia Nervosa

Nursing Management: Promote well-being by monitoring food intake, correct imbalances in fluid, electrolytes, nutritionMonitor weight gain (to 10% of IBW) by gradual gain – too quick gain can lead to cardiac overload and deathKind, nurturing but firm mannerInterventions to increase self-esteem and self-worthMedications: Antidepressants, hormones, antipsychotics, gastric motility enhancersPromote individual and family therapy

Eating Disorders: BulimiaRecurrent binge eating followed by inappropriate compensatory behaviors, such as self-induces vomiting, misuse of laxatives, diuretics, excessive exerciseMay eat 20,000 to 30,000 calories per day

Eating Disorders: BulimiaAwareness of abnormal eating patternFear of not being able to stop eating voluntarilyDepressed mood following eating binges

Eating Disorders: BulimiaNursing management:

Behavior modifications with individual, family and group therapyMonitor proper nutrition with dietary counseling, correct imbalances in fluid, electrolytes, nutritionMonitor weight gainInterventions to increase self-esteem and self-conceptMedications: antidepressants

Eating Disorders: ObesityIncrease in body weight resulting from excessive accumulation of body fat relative to lean body massWeighing 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 expenditureLess than 5% of childhood obesity is attributed to an underlying disease

Eating Disorders: ObesityNursing management:

Teach proper balanced nutritionMonitor weightDevelop exercise program child will participate in and parents will support

Eating Disorders: PicaPersistent eating of non-nutritive substances for at least 1 monthFood pica: coffee groundsNonfood picas: clay, soil, laundry starch, fecesAssociated with iron and zinc deficienciesMore common in autistic, mentally retarded, anemia, chronic renal failureInfants – plaster, paint, clothOlder children – bugs, rock, sandAdults – chalk, starch, paper

The End!!Questions??