NUR244 TOPIC 7 TO 9

🧠 1. Determinants of Child & Adolescent Mental Health

NUR244 LECTURE 7

Risk Factors

  • Child factors: genetics, brain damage, low intelligence, poor social skills, low self-esteem.

  • Parent/family: insecure attachment, harsh/inconsistent discipline, poor supervision, conflict, parental mental illness.

  • School: bullying, lack of support, poor academic resources.

  • Societal: discrimination, low socioeconomic status.

Protective Factors

  • Child: good health, positive temperament, high intelligence, strong coping/self-efficacy.

  • Family: secure attachment, positive parenting, consistent discipline, emotional warmth.

  • School: supportive culture, effective supervision.

  • Society: promotion of children’s rights and inclusion.

💭 2. Common Mental Health Disorders in Children

NUR244 LECTURE 7

Disorder

Key Features

Nursing Focus

ADHD

Inattention, impulsivity, hyperactivity; affects learning/social skills.

Support parents with behaviour management; coordinate with paediatricians; encourage structured routines.

Autism Spectrum Disorder (ASD)

Social communication deficits, repetitive behaviours.

Minimise hospital stressors, listen to parents, ensure familiar routines, provide accurate info.

Conduct Disorder (CD) & Oppositional Defiant Disorder (ODD)

Repetitive violation of rules/rights of others, argumentative, angry.

Individualised therapy, positive reinforcement, family involvement.

Anxiety Disorders

Generalised, phobias, separation anxiety.

Behavioural, CBT, family therapy, reassurance, routine maintenance.

Depression

Sadness, hopelessness, withdrawal, low energy.

Early detection, PHQ-A screening, referral, supportive environment.

Eating Disorders

Body image distortion, restrictive/binge eating.

Family therapy, nutritional monitoring, early referral.

Self-Harm

Intentional harm without suicidal intent.

Identify triggers, provide safe environment, involve mental health team.

Common Disorders

1. ADHD (Attention Deficit Hyperactivity Disorder)

  • Core features: inattention, hyperactivity, impulsivity.

  • Comorbidities: learning difficulties, anxiety.

  • Impacts: low academic performance, poor social skills, family stress.

  • Nursing Interventions:

    • Support structured routines and predictable environments.

    • Collaborate with family and teachers for behaviour management plans.

    • Monitor effects of medication (e.g. stimulants).

    • Promote positive reinforcement and frequent feedback.

2. Autism Spectrum Disorder (ASD)

  • Features: deficits in social communication, restricted interests/repetitive behaviours.

  • Comorbidities: anxiety, depression, sensory sensitivities.

  • Nursing Care:

    • Provide calm, familiar environments to reduce sensory overload.

    • Engage parents—listen to their expertise.

    • Use visual aids and predictable routines.

    • Avoid sudden changes; prepare child for procedures.

3. Conduct Disorder (CD) & Oppositional Defiant Disorder (ODD)

  • CD: persistent violation of rules and others’ rights (aggression, deceit, theft).

  • ODD: defiance, argumentative behaviour, loss of temper, anger.

  • Nursing Interventions:

    • Encourage individualised therapy (behavioural, family-based).

    • Avoid punitive responses; focus on positive reinforcement.

    • Educate parents on consistent limit-setting and communication.

4. Anxiety Disorders

  • Types: generalized anxiety, phobias, separation anxiety disorder (specific to children).

  • Manifestations: excessive fear, somatic complaints (stomach aches, headaches), school refusal.

  • Therapy: CBT, relaxation, gradual exposure, family support.

  • Nursing Role: create safe space, model calm behaviour, encourage coping skills, maintain routines.

5. Depression

  • Features: sadness, loss of interest, irritability, changes in sleep/appetite, poor concentration, guilt.

  • Causes: genetic vulnerability, chronic stress, family dysfunction.

  • Consequences: self-harm risk, poor academic and social functioning.

  • Nursing Role: early screening (PHQ-A), empathetic listening, promote social connectedness, involve mental health specialists.

6. Eating Disorders

  • Anorexia Nervosa (AN): restriction, fear of weight gain, body image distortion; high mortality.

  • Bulimia Nervosa (BN): binge–purge cycles, self-esteem tied to body image.

  • Nursing Role:

    • Monitor vitals and nutrition.

    • Encourage family therapy and counselling.

    • Support positive body image and coping.

7. Self-Harm

  • Definition: intentional self-injury without intent to die.

  • Common forms: cutting, burning, hitting, scratching, poisoning.

  • Risk factors: trauma, bullying, low mood, poor coping, identity confusion.

  • Nursing Role: ensure safety, non-judgmental listening, assess suicide risk, coordinate referral and follow-up.

3⃣ Screening Tools for Paediatric Mental Health

(from Tutorial 7)

A. Mental State Examination (MSE)

Systematic assessment of current psychological functioning:

  1. Appearance – grooming, hygiene, dress, behaviour.

  2. Behaviour – eye contact, agitation, withdrawal, motor activity.

  3. Mood/Affect – range, congruence, appropriateness.

  4. Speech – rate, tone, volume, coherence.

  5. Thoughts – content (delusions, self-harm), process (logical or disorganised).

  6. Perception – hallucinations, dissociation.

  7. Cognition – orientation, memory, concentration.

  8. Insight/Judgement – awareness of illness, ability to make safe decisions.

2. PHQ-A (Modified PHQ-9 for Adolescents)

  • Screens for depression.

  • ≥10 = probable Major Depressive Disorder (MDD).

  • Questions include mood, sleep, appetite, energy, concentration, guilt, and suicidal thoughts.

  • Positive Q9 (suicidal ideation) → urgent clinical follow-up.

HEEADSSS Psychosocial Assessment

Holistic youth screening covering:

  • H Home environment

  • E Education/Employment

  • E Eating/nutrition

  • A Activities/peer relationships

  • D Drugs/alcohol

  • S Sexuality

  • S Suicide/depression

  • S Safety (violence, risk behaviours)

4⃣ Importance of Positive Relationships, Experiences & Environments

(from Lecture 7)

🌱 Promoting Resilience

  • Resilience: ability to adapt positively to stress/change.

  • Develops through: secure attachments, supportive adults, safe environments, opportunities for mastery and belonging.

🌍 Key Frameworks

The Common Approach (ARACY)

  • Six domains: physical health, mental health, relationships, safety, learning, material well-being.

  • Encourages early, holistic conversations with families.

The Nest Action Agenda (ARACY)

  • Focus areas:

    • Being loved and safe

    • Positive participation

    • Positive culture and identity

  • Promotes protective environments and engagement in community life.

💬 Nursing Role

  • Build trusting relationships with children and families.

  • Empower families through education and inclusion.

  • Promote positive parenting (Triple P, Circle of Security).

  • Encourage play, self-expression and coping strategies.

5⃣ Burns in Paediatrics

(from Lecture 8 & Tutorial 8)

🔥 Initial Emergency Management

  1. Stop the burn process (remove source, cool with tepid water).

  2. Assess airway, breathing, circulation.

  3. Cover burn with clean dressing—no ice.

  4. Take history (time, cause, substance, first aid).

  5. Check immunisations (tetanus).

Fluid Resuscitation

  • Required for significant burns (> 8 % TBSA < 18 mo; > 10 % > 18 mo).

  • Formula:
    Volume (mL) = %TBSA × Weight (kg) × 2

  • Use Hartmann’s solution.

  • Give 50 % in first 8 hrs, 50 % next 16 hrs.

  • Monitor urine output to gauge adequacy.

Age-Adjusted TBSA Percentages

Age

Head

One Thigh

One Leg

0 yr

12 %

2 %

21 %

5 yr

8.1 %

4 %

18 %

10 yr

6.1 %

4.1 %

13 %

15 yr

5.1 %

4.5 %

12 %

Adult

3.5 %

4.5 %

10 %

Burn Fluid Types

  • Crystalloids: (e.g., Hartmann’s, Normal Saline) – expand intravascular volume.

  • Colloids: (e.g., Albumin, Gelatin) – stay in circulation longer, used for volume maintenance.

6⃣ End-of-Life (EoL) Care in Children & Families

(from Topic 9)

💗 Principles of Paediatric Palliative Care

  • Begins at diagnosis and continues throughout illness.

  • Focus on symptom control, emotional, social, spiritual support.

  • Multidisciplinary and family-centred.

  • Aims for comfort and quality of life, not just cure.

🧒 Understanding of Death by Age

Age

Understanding

Nursing Implications

0–2 yrs

No concept; sense of separation only.

Maintain routines, caregiver presence.

2–6 yrs

Think death reversible; magical thinking.

Simple explanations, reassure, use play.

6–11 yrs

Realises death is final but not universal.

Honest answers, include in rituals.

11 + yrs

Understands death as inevitable and irreversible.

Encourage open discussion, respect privacy, involve in decisions.

🗣 Communication Strategies

  • Honest, age-appropriate information.

  • Use drawings, books, and play for expression.

  • Encourage questions and emotional expression.

  • Allow pauses and silence.

  • Acknowledge emotions; maintain trust.

  • Support discussions about care choices, DNR, organ donation.

👪 Family and Sibling Support

  • Recognise grief, guilt, and anxiety.

  • Encourage rest, respite, and social support.

  • Offer sibling inclusion in care and explanations at their developmental level.

  • Provide bereavement follow-up after death.

⚰ At the Time of Death

  • Respect family’s spiritual/cultural practices.

  • Allow time for farewells.

  • Provide written information and ongoing contact.

  • Offer post-mortem or memorial options per wishes.

7⃣ Medication and IV Fluid Calculations

(from Tutorial 8)

💊 Basic Dosage Formula

[Required Dose = (Prescribed Dose / Stock Strength) × Stock Volume

Example: Paracetamol 1 g ordered; stock = 500 mg tabs → 2 tabs.

💧 Flow Rate (mL/hr)

[Rate (mL/hr) = . Volume (mL) divided by Time (hr).

If time in minutes:If time is in minutes:

Rate (mL/hr) = (Volume (mL) × 60) / Time (min)

💉 Drops per Minute

[Drops/min = (Volume (mL) × Drop Factor (drops/mL)) / Time (min)

⚗ Dilution Formula

[Current Conc. (mg/mL) × Current Vol. = Required Conc. (mg/mL) × Total Vol.

Example: Clindamycin 450 mg (600 mg/4 mL)
→ ( \frac{450 × 4}{600} = 3 mL ) drawn; dilute to 25 mL with 0.9 % NaCl.

✅ Quick Exam Checklist

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  • Determinants & protective factors – know examples.

  • Major mental disorders – causes, features, nursing care.

  • Screening tools – MSE, PHQ-A, HEEADSSS.

  • Positive relationships/resilience programs.

  • Burns – emergency care, fluid formula, TBSA table.

  • End-of-life care – communication by age, grief support.

  • Medication & IV calculations – practice formulas.

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