MH 5

Overview of Child & Adolescent Mental Health and Eating Disorders

  • Childhood Mental Disorders
      - No single cause for childhood mental disorders.
      - Influenced by various factors:
        - Genetics: Family history may contribute to the susceptibility of mental disorders in children.
        - Psychosocial Factors: Issues such as family dysfunction and poverty play a crucial role.
        - Biological Factors: Includes the neurological and physiological aspects of the child.
        - Sleep Issues: Sleep plays an essential role in a child's mental health.

Sleep Needs by Age

  • Toddlers: Require approximately 11+ hours/day of sleep.

  • School-age Children (6–13): Require about 9–11 hours/day.

Sleep Disorders

  • Sleepwalking: A disorder where a person walks or performs other complex behaviors while asleep.

  • Night Terrors: Episodes of intense fear during sleep, typically not remembered.

  • Nightmares: Disturbing dreams that can cause distress.
      - Note: Important to understand differences among these disorders for examinations.

Intellectual Disability (ID)

  • Definition: A disability characterized by significant limitations in intellectual functioning and adaptive behavior.

  • Onset: Must occur before age 18.

  • Causes Include:
      - Fetal Alcohol Syndrome: Caused by alcohol exposure in the womb, leading to developmental issues.
      - Down Syndrome: A genetic disorder causing developmental and intellectual delays.
      - Birth Injuries: Physical injuries sustained during birth can lead to ID.
      - Abuse (Shaken Baby Syndrome): Physical abuse resulting in brain damage.
      - 30–40% of ID cases have an unknown cause.

Nursing Care for Intellectual Disabilities

  • Promote independence in daily living activities.

  • Maintain safety in the environment.

  • Support the development of life skills to enhance quality of life.

Learning Disorders

  • Definition: Characterized by normal intelligence but significant deficits in learning and performance in one or more academic areas.

  • Affects areas such as:
      - Reading: Example: Dyslexia - difficulty in reading due to problems identifying speech sounds.
      - Math: Inability to perform mathematical tasks effectively.
      - Writing: Challenges in written expression and organizing thoughts on paper.

  • Consequences:
      - Low Self-Esteem: Often leads to a negative self-image due to academic struggles.
      - Poor Social Skills: Difficulty in making and maintaining friendships.

Tic Disorders & Tourette’s Syndrome

  • Defined by sudden repetitive movements or vocalizations.
      - Worsens with Stress: Symptoms may exacerbate in stressful situations.

  • Tourette's Syndrome:
      - Characterized by multiple motor and vocal tics lasting over 1 year.

Communication Disorders

  • Defined as challenges in the following areas:
      - Speech: Difficulty in articulating words.
      - Language Understanding: Challenges in comprehending language constructs.
      - Pronunciation: Issues with correctly generating sound patterns.

  • Types include:
      - Expressive: Problems conveying thoughts through speech.
      - Receptive: Difficulties in understanding spoken language.
      - Mixed: Combinations of both expressive and receptive issues.

Autism Spectrum Disorder (ASD)

  • Key Features:
      - Impeded Social Interaction: Difficulties in engaging socially with others.
      - Impaired Communication: Challenges in verbal and non-verbal communication skills.
      - Repetitive Behaviors: Engaging in certain behaviors or routines repeatedly.

  • Characteristics:
      - Poor Eye Contact: Minimal engagement visually when interacting with others.
      - Lack of Interest in Relationships: Difficulty forming friendships or social bonds.
      - No Imaginative Play: Limited ability to engage in pretend or imaginative scenarios.
      - Repetitive Movements: Such as rocking back and forth or flapping hands.
      - Echolalia: Repetition of words or phrases spoken by others; may indicate processing deficits.
      - Strict Routines: Adherence to specific routines or schedules.

Attention-Deficit/Hyperactivity Disorder (ADHD)

  • Core Symptoms:
      - Inattention: Difficulty in maintaining focus on tasks or activities.
      - Impulsivity: Hasty actions without forethought.
      - Hyperactivity: Excessive movement or restlessness.

  • Signs Include:
      - Easily distracted by insignificant stimuli.
      - Poor organizational skills leading to unfinished tasks.
      - Fidgeting: Inability to remain still; often tapping hands or feet.
      - Excessive Talking: Inappropriate or excessive verbal communication.
      - Difficulty Waiting Turns: Problems in situations requiring patience.

Medications for ADHD

  • Stimulants: Common medications include Ritalin and Adderall.

  • Clonidine: Often prescribed to help with symptoms.

  • Antidepressants: Can be used for co-occurring mood disorders.

  • Atomoxetine (Strattera): A non-stimulant option.

Side Effects of ADHD Medications

  • Insomnia: Difficulty sleeping due to medication side effects.

  • Decreased Appetite: Some medications can lead to less desire to eat.

  • Mood Changes: Variability in mood or emotional state.

  • Growth Delay: Potential impact on a child’s physical growth and development.

Nursing Interventions for ADHD

  • Clear, Consistent Communication: Establishes a reliable interaction pattern.

  • Positive Reinforcement: Encouragement for desired behaviors.

  • Encourage Expression of Feelings: Creating a safe environment for emotional sharing.

Oppositional Defiant Disorder (ODD)

  • Characteristics:
      - Defined by a pattern of defiant and hostile behavior towards authority figures.

  • Key Signs:
      - Stubbornness: Oppositional behavior that is persistent over time.
      - Mood Swings: Frequent changes in emotional state.
      - Low Frustration Tolerance: Difficulty managing feelings of frustration, leading to anger or aggression.

Conduct Disorder

  • Definition: A severe behavioral disorder involving significant violations of societal norms or laws.

  • Features Include:
      - Aggression: Harmful behavior directed towards people or animals.
      - Destruction of Property: Intentional damage to property.
      - Violation of Rights: Disregard for the basic rights of others.

  • Risks: Possible development into antisocial personality disorder in adulthood.

Nursing Interventions for Conduct Disorder

  • Provide a Safe Environment: Establishing a secure space for treatment.

  • Set Clear Rules: Expectations and consequences must be established outright.

  • Reinforce Positive Behavior: Encouragement of good behavior through rewards.

  • Focus on Strengths: Enhance self-esteem through positive strengths.

Asperger’s Disorder

  • Definition: A milder form of autism with preserved intellectual functioning.

  • Characteristics:
      - Individuals often have specific talents or areas of strength but struggle with social interactions.

Elimination Disorders

  • Enuresis: Bedwetting that occurs after the age of 5.

  • Encopresis: Fecal incontinence that occurs after the age of 4.

  • Treatment Options:
      - Routine Training: Establishing regular schedules for elimination.
      - Behavioral Therapy: Techniques aimed at reinforcing positive behaviors.

Nursing Process for Children

  • Assessment:
      - Evaluate behavior (indicators of hyperactivity or impulsivity).
      - Observe mood fluctuations.
      - Assess cognition through learning ability.
      - Review social interactions and relationships.

  • Nursing Diagnoses: Common diagnoses may include:
      - Risk for Violence: Monitoring and preventing risk behaviors.
      - Impaired Social Interaction: Addressing social deficits in interactions.
      - Ineffective Coping: Evaluating strategies used to handle stress or frustration.

Nursing Interventions

  • Utilize Simple Instructions: Communicate in a straightforward manner to aid understanding.

  • One Task at a Time: Reduce cognitive overload by focusing on one activity.

  • Reduce Stimulation: Minimize distractions in the environment where possible.

  • Set Clear Limits: Establish boundaries for behavior and expectations.

  • Teach Coping and Social Skills: Enhance interpersonal skills and coping strategies.

Eating Disorders

  • Anorexia Nervosa
      - Definition: Characterized by the refusal to maintain a healthy body weight despite being underweight.
        - Intense fear of gaining weight and distorted body perception.
      - Key Signs Include:
        - Weight below 85% of expected weight.
        - Amenorrhea: Absence of menstrual cycles.
        - Engagement in extreme dieting practices.
        - Excessive exercise habits.
        - Preoccupation with food-related topics.
      - Symptoms:
        - Bradycardia: Slower than normal heart rate.
        - Hypotension: Low blood pressure.
        - Cold Intolerance: Increased sensitivity to cold temperatures.
        - Dry Skin: Lack of hydration and nutrition can affect skin health.
        - Presence of Lanugo: Fine hair growth as a response to malnutrition.
        - Electrolyte Imbalance: Critical imbalances in body fluids and salts.
      - Complications:
        - Risk of Cardiac Arrhythmias: Irregular heartbeats that can lead to serious health issues.
        - Mortality Rate: Between 10-20% of individuals may succumb to the disorder.

  • Bulimia Nervosa
      - Definition: Characterized by episodes of binge eating followed by purging behaviors.
      - Signs Include:
        - Patients may be of normal weight despite the disorder.
        - Engaging in secretive eating behaviors.
        - Purging: Inducing vomiting after meals.
        - Symptoms of Tooth Decay: Resulting from frequent vomiting.
        - Potential for Electrolyte Imbalance due to purging practices.
        - Experiences of Guilt/Shame related to eating behaviors.

  • Other Eating Disorders:
      - Binge Eating Disorder: Similar to bulimia but without purging.
      - Purging Disorder: Engaging in purging without bingeing.
      - Pica: Eating non-food items, which can be dangerous.

Risk Factors for Eating Disorders

  • Genetics: Family history of eating disorders can increase risk.

  • Low Self-Esteem: Negative self-image may contribute to development.

  • Family Pressure: Influences from family dynamics about body image and weight.

  • Psychological Issues: Includes needs for control or perfectionism.

Assessment for Eating Disorders

  • Questions to Ask: Focus on daily habits concerning eating and exercise:
      - Dietary habits and restrictions.
      - Individual’s weight goals and perceptions.
      - Use of laxatives or diuretics for weight control.
      - Frequency and type of exercise.
      - Menstrual History: Impacts can be significant for females.

  • Physical Assessment:
      - Monitor weight and calculate BMI (Body Mass Index).
      - Check vital signs for stability.
      - Assess skin, hair, and teeth for signs of neglect or malnutrition.
      - Order lab tests including:
        - Electrolytes: To detect imbalances.
        - CBC (Complete Blood Count): To monitor overall health.
        - EKG: To assess heart function and potential issues related to electrolyte imbalances.

Nursing Interventions for Eating Disorders

  • Priority: Correcting nutrition and electrolyte imbalances is the primary focus.
      - Monitor meals closely to prevent purging behaviors.
      - Restrict bathroom access immediately after meals to diminish purging opportunities.
      - Weigh patients daily—ensure consistency in timing and scale used for accuracy.
      - Build rapport and trust with patients to encourage openness.
      - Implement a firm and consistent approach to behavioral management.
      - Continuously monitoring for signs of suicidal ideation.

Teaching for Eating Disorders

  • Educate on the dangers of purging or laxative overuse and encourage healthy choices.

  • Reinforce development of Healthy Coping Strategies: Provide alternatives to maladaptive coping.

  • Work towards improving Body Image perception: Foster a positive self-image and self-acceptance.

Expected Outcomes for Patients with Eating Disorders

  • Aim for a gradual weight gain of approximately 1 lb/week.

  • Improve eating behaviors to reflect healthier patterns.

  • Enhance self-esteem in conjunction with nutritional rehabilitation.

  • Aim for reduced distorted thinking concerning body image and self-worth.

Key NCLEX Takeaways

  • Ensure Safety and Nutrition as top priorities in patient management.

  • Know the Differences between Anorexia Nervosa and Bulimia Nervosa: Recognize symptoms and treatment variations.

  • Stay vigilant for Electrolyte Imbalances: Carry out appropriate checks and balances in care.

  • Maintain Supervision after Meals to prevent purging.

  • Conduct Daily Weights under the same conditions (same time, same scale).

  • Focus on empowering control, coping mechanisms, and positive body image throughout therapy.