pediatric neuro disorders

temperament

behavior used to cope w the environment, begins in infancy

resilience

ability to adapt well in the face of adversity, trauma, tragedy, threats or stress

assessment data

history of present illness, developmental history, dev assessment, neuro assessment, med hx, fam hx, mse

intellectual dev disorder

a neurodevelopmental condition that has limitations in intellectual functioning and adaptive behavior, affecting their ability to learn, communicate, and live independently.

• Deficients in intellectual functioning, social functioning, and daily functioning

our goal as nurses for IDD

to support independence and help the pt and support caregiver

outcomes for IDD

appropriate use of verbal language, engage in simple social interactions for short periods of time without frustration, accept assistance and feedback without frustration, refrain from impulsivity towards self or others when frustrated, and families and caregivers acknowledge the existence of impairment and its potential to alter family routines.

interventions/eval for IDD

Individualized and realistic treatment plans with family and patient guided care, cont, involvement of the family or caregiver, long term planning as the child transitions to adulthood, timely and efficient services,and communication with all care providers

autism spectrum disorders

neurobiological and developmental disability that affects how individuals communicate, interact socially, and behave, with symptoms typically appearing in early childhood.

• deficient in social interactions and communication

ASD assessment

1. modified checklist for autism in toddlers (M-CHAT-R/F)

   1. Low (0–2): no follow-up

   2. Medium (3–7): follow-up

   3. High (8–20): refer immediately

outcomes for ASD

 improved communication skills and improved emotional regulation. Also increased socialization and cooperation. Finally, family and caregiver education, training, and support.

ASD interventions/eval

1. set realistic goals for each individual, early intervention programs, IEP, coordination of appointments with multiple providers of care, behavior management, psychological therapies, and meds to help reduce anxiety, compulsive behaviors, and agitation. 

ADHD

1. inappropriate degrees of inattention, impulsiveness, and/or hyperactivity. 

   1. Symptoms must be present in two settings 

   2. There are three types: Inattentive, hyperactive, and combination. 

ADHD outcomes

1. development of self identity and self esteem, freedom from injury, improved social relationships, positive coping skills, and increased family functioning. 

ADHD interventions/eval

safety promotion, identification of symptom patterns and severity, IEP plans, recognize ineffective coping strategies and assist with developing positive strategies, family therapy and education, psychological therapies, pharmacotherapy, and long term planning. 

time out

1. Not a timed punishment, it's a voluntary redirection of behavior and the patient can leave once their emotions are regulated. 

   1.  Intended to promote self reflection and self control, may involve going to a designated area or sitting on the periphery of an activity until self control is regained, less restrictive than the quiet room or seclusion, and loses effectiveness when used too often.

quiet room

1. area of decreased stimulation for regaining and maintaining control. 

   1. Feelings rooms are carpeted and supplied with soft objects that can be punched and thrown. 

   2. Sensory room control items for relaxation and meditation.  

seclusion

1. involuntary, no set time, as soon as they are calm and dangerous. 

   1. Monitor vital signs and range of motion every 15 minutes

   2. Document every 15 minutes with info such as behaviors leading up to the therapeutic hold, seclusion, or restraint, the time the individual was placed in and the time the individual was released from seclusion/restraint, the location of the individual, and additional information per facility protocol.

restriction

same as seclusion except its last resort when nothing else works.  

stimulants

Take in AM after breakfast, stimulants are 1st line, don’t take if not needed and the effect can wear off over time.

1. Methylphenidate or Ritalin and S/S: insomnia, appetite suppression, headache, abdominal pain, mood swings, and can increase anxiety or anger/irritability. 

2. Amphetamine/dextroamphetamine or Adderall and S/S: insomnia, appetite suppression, headache, abdominal pain, mood swings, and can increase anxiety or anger/irritability. 

3. Lisdexamfetamine dimestylate or Vyvanse and S/S: GI issues, insomnia, and increased HR and RR. 

Not as harsh side effects as adderall.

non stimulants

1. Atomextine or Strattera and S/S: GI upset, dizziness, insomnia, and mood swings. 

   1. An SNRI; can take up to 6 weeks to work and caution is used if you have depression or anxiety.

sedatives

1. Guanfacine or Tenex/Intunive and S/S: sedation, hypotension, and fatigue. 

Clonidine or Hapvay/Catapres and S/S: sedation, hypotension, and fatigue.