(Class 12 & 13) (26.7% of final exam) Older adult mental health and Pediatric and adolescent mental health

What are the developmental considerations for assessing a child for healthcare and psych-related reasons?

Children need simple phrases (more concrete)

Direct questions, rather than open-ended, may be used

May not be able to provide accurate timeline

May use play therapy

What are some strategies to build rapport with children?

Relate to common interests

Speak slowly and clearly

Remain Calm, Warm

Play therapy (Soccer example)

What are some strategies to build rapport with adolescent?

Be Transparent

Educate and go deeper into what their healthcare will look like

Give a broad reviews of what the parents will know to the patient

What are some strategies to build rapport with parents?

Be non-judgmental

Be the mediator

What is the safety question that you will ask children at every developmental level at assessment?

"Have you ever hurt yourself?"

What is the safety question that you will ask children from middle school age and older at assessment?

"Have you thought about hurting yourself?"

"How would you hurt yourself?"

"What do you think would happened?"

What info must be shared with the child's parents from assessment?

intent to commit suicide or to hurt others

What are some risk factors for childhood mental disorders?

Poverty and homelessness

Child abuse and neglect (Witnessing violence)

Substance abuse in families

What are some protective factors for childhood mental disorders?

Supportive social networks

Normal social development

What are some characteristics of preschool aged children's perception of death and grief?

May not get that death is permanent

More concerned with the reaction of others around them during a family grieving event

What are some characteristics of school aged children's perception of death and grief?

Many have difficulty expressing feelings

What are some characteristics of adolescents aged children's perception of death and grief?

Fears expression emotion

What are common issues in childhood psychosocial developments?

Divorces, separation, and remarriage

Sibling relationships (adverse)

Bullying

Physical illness

Risky Behaviors

What are some unhealthy behaviors that should be assessed for in children during an exam? (RUSTS)

Running away

Unprotected sex

Self injurious behavior

Truancy or delinquency

Smoking, alcohol or drug use

What are some interventions for child-healthcare?

Early intervention programs

Psychoeducation programs

Social skills training

Support groups

Bibliotherapy

What are the common mental disorders diagnosed in childhood and adolescence? (MEANS)

Mood disorders

Eating Disorders

Anxiety disorders (attachment disorder)

Neurodevelopmental disorders

Substance use disorders

ASD consists of persistent deficits in social communication and interaction across which contexts?

Social-emotional reciprocity

Nonverbal communicative behaviors used for social interactions

Developing, maintaining and understanding relationships

What are the manifestations of restricted, repetitive patterns of behaviors, interest, or activities common in ASD?

Repetitive motor movements, use of objects or speech

Sameness, inflexible adherence to routines, ritualized patterns

Highly restricted, fixated interest

Hyper/hyporeactivity to sensation

How many manifestations of behaviors patterns common with ASD are need to diagnose?

At least 2

What is the earliest an ASD diagnosis made?

18 months

General ASD screening for children is recommended at ages

9, 18, and 30 months

What is a common medical co-morbidity of ASD?

Seizure disorder

What are the mental status social behavior assessments of autism in an infant?

Poor eye contact

Lack of smile

What are the mental status social behavior assessments of autism in an child?

Social awkwardness or

Inappropriateness

Lack of empathy

What are the mental status social behavior assessments of autism in an adolescent?

Inability to respond to others feelings

(Major obstacle in developing friendships)

A nursing assessment of children with ASD or suspected ASD include what?

Physical assessment

Psychosocial assessment

What are the psychosocial assessments used for ASD/suspected ASD child patients?

Mood/Depression

Communication

Behavior

Flexibility or adherence to routine

What are the nursing interventions for ASD?

Child and family collaborative care

Address physical health needs

Encourage positive social interaction

Ensure predictability

Behavioral interventions

Support family

What is the top nursing goal for ASD?

Decrease self-injurious behavior

What are some non-med interventions for decreasing self-injurious behavior in ASD patients?

Redirect harmful behavior

Use positive reinforcement

Use protective headgear if needed

What are some medical interventions for decreasing self-injurious behavior in ASD patients?

Antipsychotics

SSRIs

What are the inattention symptoms of ADHD? (FLAMED) (9 tings)

Forgetful

Lack of attention/Loses materials necessary for tasks

Avoids tasks of sustained attention

Mind seems preoccupied

Easily distracted

Difficulty sustaining attention / following instructions / organizing tasks

What are the hyperactivity and impulsivity symptoms of ADHD?

Fidgets

Difficulty remaining seated

Runs or climbs inappropriately

Unable to engage in quiet play

Acts as if "driven by a motor"

Talks excessively

Blurts out answer before question has been completed

Difficulty waiting turn

Interrupts or intrudes on others

How many inattentive and hyperactivity and impulsivity symptoms are needed for a ADHD diagnoses?

6 and 6

3 MULTIPLE CHOICE OPTIONS

What are popular co-occuring disorders in children with ADHD?

DMDD

Learing Disabilites

MDD

Anxiety

OCD

Tic Disorders

ASD

What are some physical assessments for ADHD?

Restlessness

Sleep disturbances

Daily food intake

Caffeinated product use (Hyperactivity)

Impulsivity

Inattention

Behavior issues

What are some psychosocial assessments for ADHD?

School performance

Functioning at home and/or discipline issues

Family functioning and life events

What are the top safety goals for kids with ADHD?

Reduce risk for injury

Monitor risk for abuse of stimulants

What is the medication management for ADHD?

Stimulants

Non-stimulants

What are the MOA of stimulants?

Enhances dopamine and NE activity

improves attention/focus and decreases hyperactivity/impulsivity

What are the side effects of stimulants? (CADING)

Cardiac complications

Appetite suppression

Dry mouth

Insomnia

Nausea

Growth effects

What is the non-stimulant medication for ADHD?

Norepinephrine uptake inhibitor (amoxetine)

Alpha 2 receptor agonists (guanfacine and clonidine)

What are the side effects of amoxetine?

Somnolence

Headaches

Irritability

Moodiness

GI symptoms

What are the side effects of guanfacine and clonidine?

Fatigue

Sedation

Somnolence

What is an abnormal process of aging?

Learning + Cognition decrease

What are the most common mental health problems in older persons? (DAD)

Depression

Anxiety Disorders

Dementia

What are some of the risk factors for mental disorders in older adults?

-Chronic Illness

-Alcohol and substance abuse

-Polypharmacy

-Bereavement and loss

-Poverty

-Lack of social support

-Elder mistreatment

What are some of the protective factors for mental disorders in older adults?

-The marriage effect

-Education and income

-Resilience and positive outlook

-Healthy lifestyle

-Nutrition

-Physical activity

What are some strategies for promoting mental wellness in older adults? (CREM CLASS)

-Cognitive engagement

-Reduce stigma

-Early recognition

-Monitor medications and polypharmacy

-Community services

-Lifestyle support

-Avoid premature institutionalization

-Social support

-Self care enhancement and spiritual support

What does a physical assessment of an older adult look like in a mental health assessment?

-Present and past health status

-Physical examination (lab values, neuro test, chronic illness)

-Nutrition and eating (change in appetite could be ...)

-Substance use

-Elimination

-Sleep

-Pain

-Pharmacological Assessment

Physical assessment: Nutrition and Eating looks for:

Type, amount, and frequency of food eaten

Changes in appetite

GI symptoms of current medication

Which med side-effect could cause dysphagia?

TD

Which med class could cause xerostomia?

anticholinergic meds

Changes in appetite may be a symptom of which mental disorders?

Depression, psychosis, dementia

Physical assessment: Elimination looks for:

constipation d/t anticholinergic meds

assess fluid intake

Why do you need to assess fluid intake in elderly adults, especially in those with urinary incontinence?

Because many older adults drink fewer fluids to manage urinary incontinence

Physical assessment: Sleep looks for:

assess for sleep patterns

Insomnia could indicate depression stress or loneliness

Sleep walking could be an early sign on alzheimer's dementia

Physical assessment: Pharmacological Assessment looks for:

The use of

-Duplicate meds

-Interacting meds

-Drugs used to treat adverse drug interactions

Which drugs are associated with dementia in older adults?

opiates and synthetic narcotics

3 MULTIPLE CHOICE OPTIONS

Which drugs are associated with psychosis in older adults?

digitalis, L-Dopa, reserpine, corticosteroids, barbiturates, isoniazid

3 MULTIPLE CHOICE OPTIONS

Which drugs are associated with Anxiety in older adults?

decongestants, bronchodilators, anticholinergics

3 MULTIPLE CHOICE OPTIONS

Which drugs are associated with depression in older adults?

beta-blockers, chemotherapy drugs, sedative hypnotics

3 MULTIPLE CHOICE OPTIONS

For the use of medication in older adults, what are some good considerations?

Start low and go slow d/t

-Increase in relative body fat

-natural decline in kidney function

-Larger drug stores + lower drug clearance = increase drug conc. compared to younger adults with the same medication dose

What is a useful stepwise approach to prescribing meds in older adults (PRRANDS)

-Review (current Dx therapy)

-Discontinue (unnecessary Dx therapy)

-Adverse drug events (consideration for any new symptom)

-Nonpharm approaches (consideration)

-Reduce (dose)

-Simplify (dosing schedule)

-Prescribe (beneficial therapy)

What is the Beers criteria?

It is a clinical tool developed to assist clinicians in improving medication safety in older adults.

What does a psychological assessment of an older adult look like in a mental health assessment?

-Response to mental health problems

-Depression vs Dementia

-MSE

-Behavioral changes

-Stress and Coping Patterns

-Risk Assessment

What is the most common mental illness in older adults?

Depression

Which is worse in the AM? Depression or Dementia?

Depression

1 MULTIPLE CHOICE OPTION

Which condition is associated with the awareness of deficits? Depression or Dementia?

Depression

1 MULTIPLE CHOICE OPTION

Which condition is associated with the ability to complete ADLs? Depression or Dementia?

Depression

1 MULTIPLE CHOICE OPTION

What are all the MSE components to use for the psych assessment for older adults?

Mood and affect

Thought Processes

Cognition and Intellectual Performance

MSE for older adults (Mood and Affect)

Depression is common (late onset after 60)

What are the thought processes that characterize dementia?

Suspicious and delusional thoughts

i.e. People stealing my things, The house is not my house, My relative is an imposter

What are the five abnormalities that indicate underlying neuropathologic changes in older adults?

Changes in

-Consciousness

-Orientation

-Judgement

-Speech

-Language

What are normal changes in cognition for aging?

-Slowing of information processing

-Memory retrieval

What is another cognition assessment tool for older adults?

Mini-mental status exam

What behavioral changes are associated with psychiatric disorders in older adults?

-Irritability

-agitation

-apathy

-euphoria

What is apraxia?

Loss of the ability to execute or carry out learned (familiar) movements, despite having the desire and the physical ability to perform the movements

What does a risk assessment of older adults consist of?

-Depression or suicide attempt, Fam Hx

-Firearms (in house)

-Alcohol or substance abuse

-Stress and social isolation (Unusual), feels like a burden

-Chronic medical condition

-Suicide rates increase with age

What does a Social assessment of an older adult look like in a mental health assessment?

-Activity Level

-Functional Status

-Community resources use

-Spiritual Assessment

-Quality of Life

-Legal Status (elder abuse, advanced care directives)

What is a normal process of aging?

Physical Decline

1 MULTIPLE CHOICE OPTION

What are Neurocognitive disorders characterized by? Name deficits (LLEAPS)

Decline in cognitive functioning and acquired

included deficits in:

-Perceptual motor

-Attention

-Executive functioning

-learning + memory

-language

-social cog deficits

What is delirium?

a disorder of acute cognitive impairment caused by a medical condition (medical emergency, acute + reversible)

What is dementia?

-chronic cognitive impairments

-differentiated by underlying cause

-cortical or subcortical classification

Delirium symptoms

-Impaired consciousness

-Problems w/ attention/focus

-Memory, orientation and language problems

Risk factors for delirium

-advanced age

-Pre-existing dementia

-Functional dependence

-Endocrine and metabolic disorders

-Bone fracture

-Infx

-Medication s/e

-Changes in vital signs (including hypotension and hyper/hypothermia

-Electrolyte or metabolic imbalance

-Admission to a long-term care institution

-Postcardiotomy

-AIDS

-Pain

-Acute or chronic stress

-Substance use and alcohol withdrawal

What is a hallmark of delirium?

Rapid onset of global cognitive impairment

What is the mental status changes for delirium?

-Mental status tends to fluctuate

-Thought content often illogical

-Fluctuations in LOC

-Difficulty focusing and sustaining or shifting attention

-Severely impaired memory (immediate and recent)

-May be disoriented to time and place (rarely to person)

What is the behavior changes assoc with delirium?

Restless or agitated and/or lethargic and slow respond

What are the nursing's care actions to prevent or treat delirium?

-Admin meds judiciously (avoid high risk meds)

-Appropriately treat infx

-treat dehydration and electrolyte disturbances

-Pain control

-Maximize oxygen delivery

-Sensory aids (Provide)

-Bowel/bladder function (Regulate)

-Nutrition

What are the important nursing diagnosis for delirium?

-Risk for injury

-Acute confusion

(Place pts with sitter, send yo emergency room)

What is Alzheimer's disease?

-a type of cortical dementia

-Degenerative + Progressive

-Neuropsychiatric disorder that results in cognitive impairment, emotional and behavioral changes, physical and functional decline and death

early onset dementia

forms of dementia that begin before age 65

late onset dementia

forms of dementia that begin after age 65

What are the symptoms of mild stage AD?

-Loss of memory

-Language difficulties

-Mood swings

-Personality changes

-Diminished judgement

-Apathy

What are the symptoms of moderate stage AD?

-Inability to retain new info

-Behavioral, personality changes

-Increasing long-term mem loss

-Wandering, agitation, aggression, confusion

-Requires assistance w/ADL

What are the symptoms of severe stage AD?

-Gait and motor disturbances

-Bedridden

-Unable to perform ADL

-Incontinence

-Requires long-term care placement

What are all the cognitive domains that can decline in functioning in ppl with AD? (PLEASL)

-Perceptual-motor

-Language

-Executive function

-Attention

-Social cognition

-Learning and mem

What is aphasia?

loss of ability to understand or express speech, caused by brain damage.

What is agnosia?

Inability to use an object correctly