Studied by 3 people
Looks like no one added any tags here yet for you.
INTELLECTUAL DISABILITY
Called mentally retarded before
Intellectual Disability
a condition characterized by significant limitations in both intellectual functioning and adaptive behavior, which includes social and practical skills.
Intellectual functioning is below average
Concurrent deficits in adaptive functioning in conceptual, social, and practical domains
Intellectual Disability is Commonly defined based on two criteria:
IQ of 70 to 75 or lower with onset during the
developmental period
in Intellectual disability, the IQ
of ____ to ___ or lower with onset during the
developmental period
Conceptual
Social
Practical
What are then 3 domains of intellectual disability
Denial
What is the number 1 problem of parents with a child with intellectual disability
• Mild
• Moderate
• Severe
• Profound
CLASSIFICATION OF INTELLECTUAL DISABILITY
• IQ: between 50 and 70
• Exhibits difficulties in acquisition of academic skills during preschool age
• Socially: less mature, limited understanding of risk, poorer affect regulation than their similarly aged peers
• As adults: can usually achieve adequate social and vocational skill for minimum self-support and independent living
• Needs guidance and assistance with complex daily living tasks
MILD INTELLECTUAL DISABILITY Manifestations
between 50 -70
What is the IQ of mild intellectual disability?
Correct Answer: C. Difficulties in acquiring academic skills.
Rationale: The information provided states that individuals with mild intellectual disability "exhibit difficulties in acquisition of academic skills during preschool age." This directly indicates challenges in learning foundational academic skills. Options A, B, and D are contrary to the provided information.
A 6-year-old child with a diagnosis of mild intellectual disability is starting kindergarten. Which of the following is the MOST likely academic challenge this child will experience?
A. Advanced mathematical concepts
B. Rapid acquisition of reading skills
C. Difficulties in acquiring academic skills
D. Exceptional performance in standardized tests
Correct Answer: C. Social immaturity and limited understanding of risk.
Rationale: The provided information specifies that individuals with mild intellectual disability are "less mature, [have] limited understanding of risk, [and] poorer affect regulation than their similarly aged peers." This directly points to social immaturity and risk assessment deficits. Options A, B, and D contradict this information.
A 10-year-old child with mild intellectual disability is observed interacting with peers. Which of the following social characteristics is MOST consistent with their diagnosis?
A. Highly developed social problem-solving skills
B. Age-appropriate emotional maturity
C. Social immaturity and limited understanding of risk
D. Superior ability to regulate emotions
Correct Answer: C. Guidance and assistance with complex daily living tasks.
Rationale: The provided information states that individuals with mild intellectual disability "needs guidance and assistance with complex daily living tasks." Managing finances falls under complex daily living tasks, necessitating support. Options A and D are beyond the typical capabilities of this population, and option B minimizes the known need for support.
An adult with mild intellectual disability is learning to manage their finances. Which of the following is MOST likely to be required for successful completion of this task?
A. Independent and unsupervised financial decision-making
B. Minimal guidance and support
C. Guidance and assistance with complex daily living tasks
D. Advanced financial planning abilities
Language and preacademic skills
In moderate ID, __________________ develop slowly during preschool age,
typically peaking with academic skills at elementary level
poor interpretation of social cues when compared to peers of a similar age
A 12-year-old child with moderate intellectual disability is interacting with peers. What do you expect of their social approach?
Correct Answer: C. Extended periods of teaching and caregiver support.
Rationale: The provided information states that "simple ADLs can be learned through extended periods of teaching and caregiver support." This highlights the necessity of prolonged teaching and assistance. Options A, B, and D are not supported by the given information.
An 18-year-old adult with moderate intellectual disability is being taught basic daily living skills. Which of the following is MOST critical for successful learning?
A. Short-term, intensive teaching sessions
B. Minimal caregiver support
C. Extended periods of teaching and caregiver support
D. Independent learning without assistance
Severe ID, IQ ranges from 20-34
A 12-year-old child with severe intellectual disability has an IQ score of 28. what spectrum of ID does this belong?
Correct Answer: B. Limited understanding of language and academic skills.
Rationale: The provided information states that individuals with severe intellectual disability have a "limited understanding of language and academic skills." This directly indicates significant limitations in these areas. Options A, C, and D are not supported by the provided information.
When considering the academic abilities of a child with severe intellectual disability, which of the following is MOST accurate?
A. Advanced understanding of complex academic concepts
B. Limited understanding of language and academic skills
C. Age-appropriate academic achievement
D. Rapid acquisition of academic knowledge
Correct Answer: C. Minimal acquisition of communicative speech.
Rationale: The provided information states that individuals with severe intellectual disability have "minimal acquisition of communicative speech." This directly supports the correct answer. Options A, B, and D are contrary to the information given.
A 5-year-old child with severe intellectual disability is being assessed for language development. Which of the following findings is MOST consistent with this diagnosis?
A. Severe sentence formation
B. Age-appropriate vocabulary acquisition
C. Minimal acquisition of communicative speech
D. Fluent conversational skills
Correct Answer: C. Requirement of parental support in all ADLs.
Rationale: The provided information states that individuals with severe intellectual disability "require parental support in all ADLs." This directly indicates the need for complete assistance with daily living tasks. Options A, B, and D contradict this information.
A 10-year-old child with severe intellectual disability is participating in a daily living skills assessment. Which of the following is MOST likely to be observed?
A. Independent performance of all ADLs
B. Performance of complex ADLs
C. Requirement of parental support in all ADLs
D. Occasional need for assistance with ADLs
Rationale:
C. Mild Intellectual Disability is the correct answer. The student's IQ score (50-70 range), difficulties in academic acquisition, social immaturity, and poorer affect regulation align with the characteristics of mild intellectual disability.
A. Severe Intellectual Disability: Individuals with severe intellectual disability typically have IQ scores below 35-40 and require extensive support in all areas of life.
B. Moderate Intellectual Disability: Individuals with moderate intellectual disability typically have IQ scores between 35-40 and 50-55 and experience significant delays in development.
D. Autism Spectrum Disorder: While autism spectrum disorder can present with social interaction difficulties and learning challenges, the specific IQ range and the primary focus on academic and social delays point more directly to mild intellectual disability. It is possible for someone to have both, but based on the information provided, the mild intellectual disability is the most accurate answer.
A school nurse is reviewing the educational and developmental history of an 8-year-old student. The student exhibits delays in reading and math skills, struggles with social interactions, and demonstrates less mature emotional responses compared to peers. The student's IQ score is assessed to be 60. Based on these findings, which of the following is the most likely diagnosis?
A. Severe Intellectual Disability
B. Moderate Intellectual Disability
C. Mild Intellectual Disability
D. Autism Spectrum Disorder
Correct Answer: B. Providing constant supervision to ensure safety.
Rationale: The provided information states that "constant supervision is mandatory to ensure safety." This directly highlights the critical need for continuous monitoring. Options A, C, and D are unsafe and contradict the given information.
A child with severe intellectual disability is observed during playtime. Which of the following safety considerations is MOST important?
A. Encouraging independent exploration without supervision
B. Providing constant supervision to ensure safety
C. Allowing unsupervised interaction with peers
D. Minimal monitoring during activities
Correct Answer: B. Implementing a consistent, highly structured environment with predictable routines.
Rationale: Given the "minimal capacity for sensorimotor functioning" and the need for a "highly structured environment," a predictable routine minimizes cognitive overload and enhances the client's ability to process limited sensory input. Options A and D are too complex and potentially overwhelming. Option C, while seemingly logical, could lead to sensory deprivation.
A client with profound intellectual disability exhibits limited responsiveness to sensory stimuli. Which of the following nursing interventions is MOST crucial for promoting optimal sensorimotor functioning in this client?
A. Providing complex, multi-sensory experiences to stimulate neural pathways.
B. Implementing a consistent, highly structured environment with predictable routines.
C. Minimizing sensory input to avoid overwhelming the client's limited processing capacity.
D. Focusing on advanced motor skill development through repetitive exercises.
Correct Answer: B. Providing total assistance with ADLs while maintaining the client's safety.
Rationale: The information states that the client is "dependent on others for ADLs, help, and supervision for safety" and that "very limited self-care is possible." Therefore, the priority is to provide total assistance while ensuring safety. Options A, C, and D are not realistic given the client's profound limitations.
A client with profound intellectual disability requires assistance with all activities of daily living (ADLs). Which of the following nursing priorities is MOST essential when providing care for this client?
A. Encouraging independent self-care to the greatest extent possible.
B. Providing total assistance with ADLs while maintaining the client's safety.
C. Implementing complex communication strategies to promote verbal expression.
D. Focusing on advanced cognitive skill development through structured learning sessions.
Correct Answer: C. Implementing interventions that maximize the client's limited sensorimotor abilities within a structured environment.
Rationale: Given the "minimal capacity for sensorimotor functioning" and the need for a "highly structured environment," interventions should focus on maximizing these limited abilities. Options A, B, and D are not realistic or appropriate given the client's profound limitations.
When developing a care plan for a client with profound intellectual disability, which of the following is the MOST critical consideration?
A. Focusing on achieving developmental milestones typical of early childhood.
B. Prioritizing the acquisition of complex academic skills.
C. Implementing interventions that maximize the client's limited sensorimotor abilities within a structured environment.
D. Designing interventions that promote rapid advancement in language and communication skills.
B. Moderate Intellectual Disability is the correct answer. The IQ range (35-49), delayed language and pre-academic skills, difficulty with social cues, and the need for significant support in ADLs are all characteristic of moderate intellectual disability.
A. Mild Intellectual Disability: Individuals with mild intellectual disability typically have IQ scores between 50 and 70 and can achieve greater independence in daily living and vocational skills.
C. Severe Intellectual Disability: Individuals with severe intellectual disability have lower IQ scores and require more extensive support in all areas of life.
D. Profound Intellectual Disability: Individuals with profound intellectual disability have the lowest IQ scores and require constant care and supervision.
A case manager is reviewing the developmental history of a 15-year-old client. The client's records indicate an IQ score of 45. During childhood, the client experienced significant delays in language and pre-academic skill development, with academic skills peaking at the elementary level. The client struggles to interpret social cues and requires extensive teaching and caregiver support to perform simple activities of daily living. Which of the following levels of intellectual disability is most consistent with these findings?
A. Mild Intellectual Disability
B. Moderate Intellectual Disability
C. Severe Intellectual Disability
D. Profound Intellectual Disability
• IQ: between 20 and 34
• Limited understanding of language and academic skills
• Minimal acquisitions of communicative speech
• Require parental support in all ADL’s
• Constant supervision is mandatory to ensure safety
SEVERE INTELLECTUAL DISABILITY
C. Severe Intellectual Disability is the correct answer. The IQ range (20-34), limited language and academic skills, minimal communicative speech, and the need for constant supervision are all indicative of severe intellectual disability.
A. Mild Intellectual Disability: Individuals with mild intellectual disability have higher IQ scores and greater independence.
B. Moderate Intellectual Disability: Individuals with moderate intellectual disability have higher IQ scores and greater language abilities than those described in the question.
D. Profound Intellectual Disability: While those with profound intellectual disability also need constant care, they typically have IQ scores below 20 and demonstrate even more significant limitations in all areas.
Question:
A nurse is reviewing the developmental assessment of a 10-year-old child. The child has an IQ score of 30, exhibits limited understanding of language and academic skills, and has minimal acquisition of communicative speech. The child requires parental support for all activities of daily living and constant supervision to ensure safety. Based on these findings, which of the following levels of intellectual disability is most accurate?
A. Mild Intellectual Disability
B. Moderate Intellectual Disability
C. Severe Intellectual Disability
D. Profound Intellectual Disability
• IQ: less than 20
• Minimal capacity for sensorimotor functioning
• Nonverbal and non-symbolic in communication
• Needs a highly structured environment
• Very limited self-care is possible
• Dependent on other for ADL’s, help, and supervision for safety
PROFOUND INTELLECTUAL DISABILITY
D. Profound Intellectual Disability is the correct answer. The IQ score below 20, minimal sensorimotor functioning, nonverbal communication, and complete dependence on caregivers are all characteristic of profound intellectual disability.
A. Mild Intellectual Disability: Individuals with mild intellectual disability have higher IQ scores and greater independence.
B. Moderate Intellectual Disability: Individuals with moderate intellectual disability have higher IQ scores and greater language abilities than those described in the question.
C. Severe Intellectual Disability: While those with severe intellectual disability also need constant care, they typically have higher IQ scores and demonstrate greater abilities than those described.
A nurse is assessing a 5-year-old child with significant developmental delays. The child has an IQ score of 18, demonstrates minimal sensorimotor functioning, and communicates nonverbally and non-symbolically. The child requires a highly structured environment and is completely dependent on caregivers for all activities of daily living and safety. Which of the following levels of intellectual disability is most consistent with these findings?
A. Mild Intellectual Disability
B. Moderate Intellectual Disability
C. Severe Intellectual Disability
D. Profound Intellectual Disability
● Chromosomal abnormalities
● Infection in utero
● Anoxia at birth
● Fetal alcohol spectrum disorder
● Inherited metabolic disorders
● Head trauma, lead poisoning, or hypothyroidism
● Brain malformations
● Very low birth weight
● Autism spectrum disorder
COMMON CAUSES OF INTELLECTUAL DISABILITY
Remove potential hazards such as sharp objects, toxic substances, and tripping hazards.
Use safety gates, corner protectors, and non-slip mats as appropriate.
Ensure adequate lighting in the child’s living and play areas to reduce falls.
Consistent, nurturing environment
HOME AND FAMILY ENVIRONMENT INTERVENTIONS
Risk for injury
Self Care deficit
Impaired verbal communication
Nursing diagnoses for Intellectual disability
False: Treat the child according to his or her intellectual age, not the chronologic age.
T/F: Children with intellectual disability, must be treated according to their age rather than intellectual age
✓ Same health maintenance supervision as all other children
✓ Treat the child according to his or her intellectual age, not the chronologic age
HEALTH MAINTENANCE NEEDS
✓ Increase risk to develop a degree of depression by school age
✓ Pain scale with faces; Talking picture boards
✓ Carefully observe the child for symptoms such as tugging an ear, refusing to swallow food, rapid breathing, or limping
ILLNESS interventions for ID
✓ Learn the maximum amount of self-care possible to develop mastery of skills
✓ Mastered self-care activities need continued review and reinforcement.
SELF-CARE ACTIVITIES
Oh we use wong baker faces
What pain scale do we use in children
✓ Break a task down into separate small steps
✓ Demonstrate the skill to be learned
✓ Reduce the number of extra stimuli present
✓ Introduce motivators for learning
✓ Keep things simple
✓ Be patient and flexible with the child and the task at hand
GUIDELINES FOR TEACHING THE CHILD
Rationale:
C. Social deficits, communication issues, and restricted behaviors. is the correct answer. The child's avoidance of eye contact, limited speech, lack of social interest, and repetitive hand-flapping directly correspond to these three core characteristics of ASD.
A. Cognitive delays, motor impairments, and emotional lability: While these can co-occur with ASD, they are not the core defining features.
B. Anxiety, depression, and obsessive-compulsive behaviors: These are often comorbid conditions with ASD, but not the defining triad.
D. Attention deficits, hyperactivity, and impulsivity: These are characteristic of ADHD, not ASD, although they can sometimes co-occur.
A parent brings their 3-year-old child to a developmental clinic. The parent reports that the child avoids eye contact, rarely speaks, and engages in repetitive hand-flapping. During the assessment, the nurse observes the child showing little interest in interacting with toys or other people. Which of the following best describes the core characteristics of Autism Spectrum Disorder (ASD) that are being exhibited by this child?
A. Cognitive delays, motor impairments, and emotional lability.
B. Anxiety, depression, and obsessive-compulsive behaviors.
C. Social deficits, communication issues, and restricted behaviors.
D. Attention deficits, hyperactivity, and impulsivity.
Ø Social deficits
Ø Communications issues
Ø Restricted behaviors
AUTISM SPECTRUM DISORDER is marked by difficulties in three main areas
Autistic disorder, Asperger disorder, Childhood disintegrative disorder, Pervasive developmental disorder not otherwise specified: 1
The lists the former diagnostic categories under the broader umbrella of ASD
● No known single cause.
● Genetic and environmental factors might play a role.
● No link between vaccines and autism spectrum
disorder
● Risk factors: Sex (male), family history, extremely
preterm babies, parent’s ages
Causes and risk factors for Autism
study pls
Rationale:
B. Delay in language development and lack of social interest. is the correct answer. These are the primary findings presented in the scenario and are core indicators of autism spectrum disorder.
A. Nominal aphasia, C. Labile mood and D. Excellent long term memory are all possible findings but are not the most prominent in the given scenario.
A nurse is observing a 4-year-old child during a developmental assessment. The child demonstrates limited verbal communication, avoids eye contact, and shows no interest in interacting with other children. Which of the following assessment findings is most consistent with these observations?
A. Nominal aphasia
B. Delay in language development and lack of social interest.
C. Labile mood.
D. Excellent long-term memory.
Rationale:
C. Echolalia. is the correct answer. Echolalia is the repetition of words or phrases, which directly matches the parent's report.
A, B and D do not describe the repetition of spoken words.
A parent reports that their child frequently repeats phrases heard from television shows and conversations. The nurse documents this behavior as:
A. Nominal aphasia.
B. Abnormal speech melody.
C. Echolalia.
D. Repetitive hand movements.
Rationale:
C. Hand stims. is the correct answer. Repetitive hand movements and body rocking are described as "hand stims" in the provided information, often occurring when the child is upset or excited.
A, B and D do not describe this type of physical action.
A nurse is interacting with a child who suddenly begins to rock back and forth and flap their hands. The nurse understands this behavior is likely a form of:
A. Nominal aphasia.
B. Labile mood.
C. Hand stims.
D. Abnormal speech melody.
Rationale:
B. Intense reactions to minor changes in the environment. is the correct answer. This aligns with the provided assessment finding of children with ASD having heightened sensitivity to environmental changes.
A, C and D, while possible findings, are not the most direct answer to the question.
A child with autism spectrum disorder becomes extremely agitated when their usual routine is disrupted. The nurse recognizes this behavior as:
A. Aggressive actions.
B. Intense reactions to minor changes in the environment.
C. Labile mood.
D. Lack of social interest.
Rationale:
C. Abnormal speech melody. is the correct answer. The described behavior matches the assessment finding of "abnormal speech melody."
A, B, and D do not describe this type of vocal pattern.
During an assessment, a nurse notices a child consistently using a questioning tone when making declarative statements. This is best described as:
A. Echolalia.
B. Nominal aphasia.
C. Abnormal speech melody.
D. Repetitive play.
NOMINAL APHASIA
being unable to name things
ABNORMAL SPEECH MELODY
questioning speech
ECHOLALIA
tend to repeat phrases from other people
Rationale:
C. Using a matter-of-fact approach and focusing on safety. is the correct answer. The provided information specifically states to use a matter-of-fact approach and avoid criticism or sympathy when self-mutilation occurs.
A, B, and D are contrary to the recommended approach.
A child with autism spectrum disorder (ASD) begins to exhibit self-injurious behavior. Which of the following nursing interventions is most appropriate?
A. Expressing sympathy and attempting to comfort the child.
B. Criticizing the behavior and implementing a strict punishment.
C. Using a matter-of-fact approach and focusing on safety.
D. Ignoring the behavior to avoid reinforcing it.
Rationale:
B. Ensuring safety at all times. is the correct answer. The provided information emphasizes safety as a primary concern.
A, C, and D are not consistent with the information given.
A nurse is developing a care plan for a child with ASD. Which of the following is a priority nursing intervention?
A. Encouraging social interaction with multiple children at once.
B. Ensuring safety at all times.
C. Promoting a highly stimulating environment.
D. Allowing the child to dictate all routines.
Rationale:
B. Assessing which self-care activities the child can complete independently. is the correct answer. The provided information specifically states to assess what self-care activities the child completes for himself.
A, C, and D are not consistent with the recommendations.
A nurse is working with a child with ASD who struggles with self-care activities. Which of the following nursing interventions is most appropriate?
A. Completing all self-care tasks for the child.
B. Assessing which self-care activities the child can complete independently.
C. Avoiding any self-care activities to prevent frustration.
D. Introducing multiple new self-care tasks at once.
Rationale:
C. A non-punitive and consistent approach. is the correct answer. The provided information emphasizes consistency and a non-punitive approach.
A, B, and D are contrary to the recommended approach.
When setting limits for a child with ASD, the nurse should prioritize:
A. Punitive measures.
B. Inconsistency to promote flexibility.
C. A non-punitive and consistent approach.
D. Ignoring challenging behaviors.
Rationale:
B. Assessing for the availability of family members and significant others who can assist with caregiving. is the correct answer. The provided information directly states this as a necessary assessment.
A, C, and D are not listed in the provided information.
A nurse is assessing the support system of a child with ASD. Which of the following is a critical component of this assessment?
A. Determining the child's favorite toys.
B. Assessing for the availability of family members and significant others who can assist with caregiving.
C. Evaluating the child's academic performance.
D. Documenting the child's dietary preferences.
✓ Speech therapy
✓ Occupational therapy
✓ Physical therapy
Core deficits: These therapies directly address the core challenges associated with autism, such as communication difficulties, social interaction challenges, and restricted/repetitive behaviors.
Therapies in autism may include
Rationale:
B. "Medications can be prescribed to manage specific symptoms, but there is no cure for ASD." is the correct answer. This accurately reflects the information provided: no specific medications cure ASD, but they can be used to manage troublesome symptoms.
A, C, and D are incorrect and contradict the given information.
A parent of a child recently diagnosed with Autism Spectrum Disorder (ASD) asks the nurse about medication options for their child. Which of the following is the most accurate response by the nurse?
A. "There are several medications specifically designed to cure ASD."
B. "Medications can be prescribed to manage specific symptoms, but there is no cure for ASD."
C. "Medications are not recommended for children with ASD."
D. "Medications are only effective in adults with ASD, not children."
ATTENTION DEFICIT HYPERACTIVITY DISORDER
One of the most common neurobiologic conditions in
childhood that can also persist into adulthood.
▪ Inattention – predominant behavior as they grow
▪ Impulsiveness
▪ Hyperactivity
Attention Deficit Hyperactivity disorder is characterized by three major behaviours?
Correct Answer: C
Rationale: Impulsiveness is a hallmark characteristic of ADHD, often manifesting as interrupting others, difficulty waiting, and acting without thinking.
A school nurse is observing a 7-year-old child who has been referred for an ADHD evaluation. Which of the following behaviors would be MOST consistent with a diagnosis of ADHD?
A. Sitting quietly reading a book for an extended period.
B. Completing a complex puzzle with focused attention.
C. Interrupting others frequently and having difficulty waiting their turn.
D. Following multi-step instructions carefully and accurately.
Rationale:
C. Attention and social interaction. is the correct answer. The provided information highlights that at age 4 and above, attention becomes a predominant behavior to assess. Given the parent's description of attention difficulties and limited social interest, this is the most relevant assessment area.
A. Motor skill development: While important, it's not the primary focus according to the provided statement.
B. Language acquisition: Also important, but attention is highlighted as the predominant behavior.
D. Emotional regulation: While related, the core idea is that attention is the key indicator.
A parent is concerned about their 4-year-old child's behavior. They describe the child as having difficulty focusing, being easily distracted, and showing limited interest in social interactions. The nurse understands that at this age, which of the following is a key indicator to assess when evaluating for potential developmental or behavioral concerns?
A. Motor skill development.
B. Language acquisition.
C. Attention and social interaction.
D. Emotional regulation.
Rationale:
C. Inattention. is the correct answer, based on the provided info. The "scatter" pattern on IQ tests is attributed to a lack of focus, which aligns with inattention in ADHD.
A, B, and D are characteristics of ADHD, but are not connected to the "scatter" pattern in the information provided.
A school nurse is assessing a child who exhibits a "scatter" pattern on IQ tests. The nurse understands this finding is likely related to which of the following characteristics commonly seen in ADHD?
A. Hyperactivity.
B. Impulsivity.
C. Inattention.
D. Emotional lability.
Rationale:
B. Potential motor coordination issues related to inattention. is the correct answer, based on the provided info. The context given is that the motor coordination problems are related to ADHD.
A, C, and D are not consistent with the information given.
During a neurological assessment of a child suspected of having ADHD, the nurse observes difficulty performing the finger-to-nose test and rapid hand movements. The nurse should interpret these findings as:
A. Typical motor coordination for a child with ADHD.
B. Potential motor coordination issues related to inattention.
C. Signs of emotional distress.
D. Indicators of normal development.
Rationale:
C. A potential neurological indicator related to inattention. is the correct answer, based on the provided info. The context given is that the mirroring is related to ADHD.
A, B, and D are not consistent with the information given.
A child with suspected ADHD demonstrates "mirroring" during an assessment. The nurse recognizes this behavior as:
A. A sign of social anxiety.
B. A typical response to stress.
C. A potential neurological indicator related to inattention. D. A normal developmental stage.
● Cause is unknown.
● Risk factors include: sex (male), genetics, exposure to environmental risks
(e.g., lead) during pregnancy or at a young age, alcohol and tobacco use
during pregnancy, premature delivery, low birth weight
32
CAUSE & RISK FACTORS:
Symptoms persist for more than 6 months
Negatively impact social activities & academic performance:
Key diagnostic criterion for ADHD
§ Running or climbing in inappropriate
situations
§ Fidgeting with things
§ Squirming while seated
§ Inability to play or engage in activities quietly
§ Constantly on the go
§ Blurting out answers
§ Talking excessively
§ Interrupting or intruding on others
Symptoms of hyperactivity and
impulsivity:
Risk for Injury
Ineffective coping
Chronic low self esteem
Nursing diagnosis
Graphesthesia
ability to recognize the shape that was drawn on skin.
Stereognosis
ability to recognize the object by touch.
• Having a short attention span and being easily distracted
• Making careless mistakes
• Appearing forgetful or losing things
• Being unable to stick to tasks that are tedious or time consuming
• Appearing to be unable to listen to or carry out instructions
• Constantly changing activity or task
• Having difficulty organizing tasks
MAIN SIGNS OF INATTENTIVENESS
• Being unable to sit still constantly fidgeting
• Being unable to concentrate on tasks
• Excessive physical movement
• Excessive talking
• Being unable to wait their turn
• Acting without thinking
• Interrupting conversations
• Little or no sense of danger
MAIN SIGNS OF HYPERACTIVITY AND IMPULSIVENESS
• Avoid stimulating or distracting settings
• Implement scheduled routine every day
• Use simple and direct instructions
• Give positive reinforcements
• Encourage ventilation of feelings
• Encourage use of appropriate memory retraining techniques
• Encourage parents to be fair but firm and to set consistent limits to reduce arguments
• Help parents build, not hinder, their child’s self-esteem at every developmental stage possible
NURSING INTERVENTIONS & MANAGEMENT
1. Methylphenidate hydrochloride (Ritalin, Concerta, Daytrana), dexmethylphenidate (Focalin)
2. Dextroamphetamine (Dexedrine), dextroamphetamine
mixed salts (Adderall), lisdexamfetamine (Vyvanse
MEDICATIONS STIMULANT MEDICATIONS FOR ADHD
believed to work by increasing dopamine levels in the brain. It boosts concentration and focus while reducing hyperactive and impulsive behaviors
ACTION OF THE STIMULANT MEDICATIONS
1. Atomoxetine (Strattera)
2. Guanfacine, Intuniv
NON-STIMULANT MEDICATIONS FOR adhd
increases attention span and decreases impulsivity; doesn’t appear to be as effective as the stimulant medications for treating symptoms of hyperactivity
Action of Non stimulant medications
OPPOSITIONAL DEFIANT DISORDERS (ODD)
Consist of a pattern of irritability, defiant behaviors, and
vindictiveness that results in disturbed function in academic and social domains
ODD Develops most frequently in _______________or______________ and rarely later than early adolescence
ODD Develops most frequently in late preschool or early school age and rarely later than early adolescence
• No clear cause
• Possibly a combination of genetics and environmental factors
• RISK FACTORS: temperament, parenting issues, other family issues, and environment
CAUSE & RISK FACTORS of ODD
Ø Often and easily loses temper.
Ø Frequently touchy and easily annoyed by others.
Ø Often angry and resentful.
Ø Often argues with adults or people in authority.
Ø Often actively defies or refuses to follow adults' requests or
rules.
ØOften annoys or upsets people on purpose.
ØOften blames others for their own mistakes or misbehavior.
ØSays mean and hateful things when upset.
ØTries to hurt the feelings of others and seeks revenge
ØHas shown vindictive behavior at least twice in the past six months.
Assessment findings for ODD
ü Establish a trusting relationship with child and family by conveying your
acceptance.
ü Provide clear behavioral guidelines, including consequences for disruptive and
manipulative behavior.
ü Use a consistent approach to discipline and following through with positive
reinforcement of appropriate behaviors.
ü Identify abusive communication. Encourage child to stop using them.
ü Teach child on constructive methods of releasing negative feelings to express
anger appropriately.
Ø Help the child accept responsibility for behavior rather than blaming others,
becoming defensive, and wanting revenge.
Ø Use role-playing so he can practice ways of handling stress and gain skill
and confidence in managing difficult situations.
Ø Teach parents age-appropriate activities and expectations for clients such
as reasonable curfews, household responsibilities, and acceptable behavior
at home
Nursing management for ODD
Conduct Disorders
Refers to a group of behavioral and emotional problems characterized by a disregard for others.ODD is sometimes a precursor.
Oppositional Defiant Disorder
_____ is sometimes the precursor of Conduct disorder
Conduct disorder
It's characterized by a persistent pattern of behavior that violates the rights of others and disregards societal norms or rules.
12 months, with at least one criterion present in the past 6 months)
Conduct disorder involves a repetitive and persistent pattern of behavior that lasts for a significant period typically at least
Aggressive conduct of CD
● Intimidating behavior
● Bullying
● Physical fights
● Cruelty to others or animals
● Using a weapon
● Forcing someone into sexual
activity, rape, or molestation
Destructive conduct
● Intentionally destroying
property (vandalism)
● Arson
Deceitfulness
● Lying
● Theft
● Shoplifting
● Delinquency
Violation of rules or ageappropriate
norms
● Not going to school (truancy)
● Running away
● Pranks
● Mischief
● Very early sexual activity
Ø Genetic predisposition
Ø Neurologic deficit correlates
Ø Sociologic factors related to poverty and cultural disadvantage
Ø Home environment
Cause and risk factors of CD
• Rejection
• Frustration
• Harsh and inconsistent discipline.
• Marital conflicts by parents
• Substance abuse problems
• Series of inconsistent caretaking by stepparents or foster parents or a history of
institutional living
Home environment may be characterized by:
Risk for violence (self directed or other directed)
Ineffective coping
Deficient kmowledge
NURSING
DIAGNOSES
Correct Answer: B. Providing a safe environment and protecting the client from self-harm.
Rationale: Safety is always the priority. Clients with Conduct Disorder may exhibit impulsive and aggressive behaviors that put themselves or others at risk
A 12-year-old client with Conduct Disorder is admitted to the psychiatric unit. Which of the following is the PRIORITY nursing intervention?
A. Developing a long-term behavioral contract.
B. Providing a safe environment and protecting the client from self-harm.
C. Establishing a trusting relationship through extensive one-on-one interactions.
D. Modifying the home environment through family therapy sessions.
Correct Answer: B Rationale: Establishing a trusting relationship is foundational for effective therapeutic intervention with a child who has Conduct Disorder. It allows for open communication and cooperation with the treatment plan.
A nurse is developing a plan of care for a child with Conduct Disorder. Which of the following is the PRIORITY nursing intervention?
A. Administering prescribed antipsychotic medications.
B. Establishing a trusting relationship with the child.
C. Modifying the child's school environment.
D. Focusing solely on the child's disruptive behaviors.
Correct Answer: B Rationale: Consistent behavioral guidelines and consequences provide structure and predictability, which are essential for managing manipulative behaviors in children with Conduct Disorder.
2. A child with Conduct Disorder is exhibiting manipulative behaviors. Which nursing intervention is MOST appropriate?
A. Ignoring the manipulative behaviors to avoid reinforcing them.
B. Providing clear behavioral guidelines with consistent consequences.
C. Restricting the child's access to social activities.
D. Discussing the child's manipulative behaviors with peers.
Correct Answer: A Rationale: The image explicitly states that therapy needs to be individualized and focused on modifying the home environment, highlighting the significant role of the family in the child's behavior.
What is the PRIMARY focus of therapy for a child with Conduct Disorder, as indicated in the image?
A. Individualized therapy focused on modifying the home environment.
B. Group therapy to improve social skills.
C. Play therapy to express emotions.
D. Cognitive therapy to address distorted thinking.
