Pediatrics Exam 3 exam

What is DSM-5 used for

diagnosing mental health disorders

what is Pediatric Symptoms Checklist (PSC-17) used for

generalized psychosocial screen, ADHD, anxiety

What is patient health questionnaire used for (PHQ-A)

depressive symptoms and sucidality

What is GAD-7 used for

generalized anxiety disorder

What is Screen for Child Anxiety Related disorders (SCARED) used for

separation, social, GAD, panic, school avoidance

what is CRAFT-2 used for

substance abuse

Sucidality Screenings

Ages and Stages questionnaire (ASQ)

Columbia Sucidality Severity Screens (C-SSRS)

Why are LGBTQ at higher risk for mental health discrimination

-greater risk for discrimination

-greater risk of ACE

what are reasons mental disorders develop in children

• developmental disorders

• behavioral dysregulation

• somatic complaints

• academic difficulties

Mental health interview component

• grooming and hygiene

• rhythmic movement

• motor behaviors

• affect

• speech

• self concept

receptive language

the ability to recieve and understand what you are saying to them.

Prevalence of mental health disorders

1/6

Main factors of youth mental health crisis

-social media influence

-school pressures

-socioeconomic stressors

-biological factora

-pandemics impact

Anxiety symptoms and assessment

• worry

• irritability

• physical complaints like stomach aches, headaches and nausea

anxiety causes in children

-inconsistent caregiving environment

-family history

-temperment

Treatment approaches for anxiety in children

-CBT (first line)

what type of medications would be used for severe cases of anxiety

SSRI’s

Ongoing management for anxiety

-family involvement

-relapse prevention

-building resilience through supportive relationships

***play therapy can be helpful.

Scared questionnaire is for what

-anxiety

first line treatment for anxiety

Cognitive Behavioral Therapy where the child’s maladaptive thought patterns are evaluated and coping strategies are developed.

Post-traumatic stress disorder symptoms in younger children

regression, new behavioral problems, separation anxiety, reenactment of trauma through play

PTSD symptoms in older children

intrusive memories, nightmares, avoidance and hyperarousal

Assessment for PTSD

trauma informed interviews that prioritize emotional safety and confidentiality

treatments for PTSD

CBT and EMDR

long term support for PSTD

-stable caregivers

-school accommodations.

Eating disorders in younger children present as

-feeding refusal

-sensory aversions

-anxiety around eating

prevalence of anorexia or bulimia in males

10-15%

Eating disorder signs

• feeding refusal

• sensory aversions

• growth delays

• electrolyte imbalances

Nursing care for eating disorders

-crucial education

-monitoring physical health

-engaging families

Pica

involves eating non-food items, leading to nutritional and developmental issues

Anorexia nervosa

restrictive intake

weight loss

medical instability

Bulimia

-binge eating with purging (vomiting, laxative or overexercise)

Avoidant Restrictive Food intake (ARFID)

limited intake of food due to sensory sensitivity or fear of adverse consequences.

Treatments for eating disorders

-behavioral therapy

-nutrition therapy

-pharmalogical intervention

3 key features of anorexia

1.) self induced starvation

2.) relentless drive to thiness

3.) signs related to starvation

Risk factors for anorexia

family history, female, puberty/adolesence

BMI of an anorexia nervosa patient

>17.5 kg/m2 or 85%

anorexia common behaviors

-limiting food intake

-excessive exercise

-enemas

-laxatives

-purging

why are overachievers at risk for anorexia

it gives them a sense of control

stressors of anorexia

trauma, abuse, assault and social pressure

Are bulimia patients usually aware of their abnormal eating issues

yes

signs of bulimia

-eroded teeth due to gastric fluid via vomiting

-russel sign: scar or calluses on the dorsal side of the hand from contact with teeth after inducing vomit.

-esophageal tears

mania in children bipolar disorders

impulsivity, reduced need of sleep and emotional lability

treatment for bipolar mood disorder in children

psychotherapy, education, pharmacy (antidepressants or mood stabilizers)

PICA nursing implication

check for anemia

depression signs and symptoms in children

-irritability and behavioral change instead of typical sadness

-academic decline and somatic complaints

links to tic disorders

-ADHD

-OCD

Tourettes syndrome

sudden, repetetive motor tics that emerge in childhood

Schizophrenia signs and symptoms

-hallucinations

-delusions

-disorganized behavior

links to elimination disorders

• stress

• constipation

• delayed toilet training

what role does the nurse play in tic disorders, schizophrenia patients, and elimination disorders

reduces stigma and works with family.

substance abuse disorders

increased absenteeism, declining grades, diagnosis of hepatitis, STI, and HIV

Are nicotine, alcohol or weed deemed socially acceptable

yes, but has great addictions risks

Treatment for substance abuse

yes, but has great addiction risks

How do we screen for substance abuse disorder?

CRAFT:2.1 +N

brief motivational interviews

screen watch for co-occurring depression/trauma

what is required for self-harm behavior

-thorough exam is required

significant sign of suicide is

withdrawal from peer activities or previously enjoyed events

prevalence of suicide

doubled in the recent decades

suicidal ideation

refers to thinking, planning or considering suicide

risk factors for successful suicide

-male more successful

-spring in fall are common seasons

-3pm and midnight

-linked to depression

-gun is #1 methods

-LGBTQ higher at risk

why is sleep important

bad sleep can worsen conditions

IEP/504 plans

gives accommodation in schools

what group requires complex care coordination

foster care patients

what is something we should document during interviews for screening

who was present

crisis number for self harm

988

nursing implications to confidentiality

-clarify limitations when it comes to self-harm or harming others

-minor laws may vary by state

Assessing GI

-fontanelles (sunken = dehydration)

-growth parameters

-weight loss (rare in children)

-appetite

-GI assessment: abdominal contour, bowel sounds, tenderness and distension

-appetite

who do we assess for gas patterns

x-ray

what is manometry is for

rectal or esophageal pressure (inserts a ballon down for resistance)

why are infants and younger children at a higher risk for fluid and electrolyte imbalance

-greater proportion of body water

- higher metabolic rate

-kidneys do not concentrate urine well which leads to more loss of water

-infants have greater surface area to body mass

what is the most important thing a nurse take care of when it comes to GI

HYDRATION

what is the difference between CBC and CMP

CMP includes liver function.

CBC gives overall electrolyte function.

Barium study

radio opaque contrast medium that the patient can swallow, allow us to take serial x-ray and watch how the barium moves through the GI

how are electrolytes lost

vomiting and diarrhea

cause of emesis

bacterial or viral gastroenteritis, increased iCS, obstruction, cannabaid hyperemesis

main concern for emesis

fluid and electrolyte imbalance

Interventions for fluid and electrolyte imbalance

-clear fluids for maintenance

-oral rehydration

dehydration causes

diarrhea, vomiting, poor intake

types of dehydration is based on

sodium levels

warning signs for dehydration

dry mouth

no tears

decreased urine

what diet would you recommend for dehydrated patient

-water or diluted juices (not high in sugar)

-lean protein, fruits, vegetables and complex carbs

-No BRAT diet

-increase breastfeeding

what med would we consider in a dehydrated patient

antiemetic

symptoms of diarrhea

-2-10 loose stools/day

-fever

-anorexia

-irritability

Nursing management of diarrhea

• infection control (provide education)

• manage fever

• >24 hour stool culture to determine causative organism

Characteristics of stool in diarrhea

• green

• effortless or explosive

• less that 7 (acidic)

• sweet or foul smelling

• positive or overt occult test

Signs and symptoms of severe diarrhea

• 103-104 fever

• weak pulse

• weak respirations

• depressed fontanelle

• sunken eyes

• poor skin turgor

what labs would be elevated in severe diarrhea

-hematocrit

-hemoglobin

-serum protein

what should the nurse monitor for with severe diarrhea

weight loss and metabolic acidosis

what percentage of weight loss indicates mild diarrhea

2.5-5%

what percentage of weight loss indicated severe diarrhea

5-15%

what percentage of weight loss indicated immediate treatment of diarrhea

anything over 10%

acute gastroenteritis

viral or bacterial infection causing inflammation of the stomach and intestines

symptoms of gastroenteritis

diarrhea, vomiting, fever and dehydration

causative agents of food borne illness

-salmonella

-listeriosis

-Shigellosis

-Staphylococcal food poisoning

nursing interventions for gastroenteritis

hand hygiene and oral rehydration

signs and symptoms of GERD in children

• spitting up

• irritability

• arching

• poor weight gain

• recurrent pneumonia (from aspiration)

risk factors of GERD for babies

-preterm

-low birth weight

Nursing intervention for GERD

-keep infant upright after feedings (20-30 minutes)

-smaller , more frequent feeds

-most disappear by 6 months

-avoid fatty/acidic foods

-sleep with upper body elevated

-parent education for signs of aspiration and feeding techniques

what comorbidities but children at risk for GERD

cerebral palsy, Down syndrome, cystic fibrosis and obesity have a higher incidence, esophageal abnormalities

what GI disorders do we vaccinate for

rotovirus

hepatitis A