Sensory/Perception Alterations Genetic Alterations

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Sensory/Perception AlterationsGenetic Alterations

• NUR 264
• Pediatrics
• Angela Jackson, RN, MSN

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Attention Deficit Hyperactivity Disorder
Attention Deficit Disorder (ADHD/ADD)

• ADHD Persistent pattern of inattention,
  hyperactivity and impulsivity
• Behavioral problem, not a learning disability
• ADD same symptoms as ADHD but without the
  hyperactivity appear sluggish, anxious, shy,
  unmotivated, have school problems treatment
  same as ADHD

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ADHD/ADD Epidemiology

• ADHD is the most common, significant behavioral
  syndrome in childhood, with an overall prevalence
  of 4-6 of elementary school-aged children
• Male to female ration is about 61
• Age of onset before age 7, present in at least 2
  settings for longer than 6 months
• 50-80 continue through adolescence
• 2/3 carry symptoms into adulthood

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ADHD/ADD Clinical manifestations

• Box 17-9 on page 537.
• Inattention
• Hyperactivity
• Impulsivity

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ADHD/ADD Treatment

• Behavioral Therapy behavior modification,
  rewards, positive reinforcements, ignore
  behavior, remove from situation, quite time,
  effective discipline techniques, problem-solving
  training, loving support
• Psychotherapy increase self-esteem, work through
  situations, coping strategies, play therapy
• Special diets removing foods that contain
  additives and sugar

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ADHD/ADD Treatment

• Special physical exercise improve coordination,
  increase ability to handle situations, increase
  self-esteem
• Work with teachers provide structured classroom,
  decrease stimulation, teach organization skills,
  provide written instructions
• Work with parents teach organizational skills,
  anger control techniques, improve communication
  skills

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ADHD/ADD Treatment

• Medications
• CNS stimulant drugs
• Ritalin, Cylert, Focalin, Concerta
• Dexedrine watch for development of tics
• Adderall
• Side effects insomnia, reduced appetite and
  weight loss, abdominal pain, headache, dizziness,
  increased heart rate and BP

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ADHD/ADD Treatment

• Non-stimulant drugs
• Antidepressants
• Antianxiety Buspar
• Alpha-2 adrenergic agonists Clonodine, Tinex
• Antipsychotics Phenothiazines, Haldol, Lithium
• Selective norepinephrine reuptake inhibitor
  Strattera
• Side effects abdominal pain, vomiting, decreased
  appetite, headache, cough, increased heart rate
  and BP

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Autism

• Developmental disorder of brain function
• Characterized by impaired reciprocal social
  interactions, impaired verbal and nonverbal
  communication, lack of imaginative activity and a
  markedly restricted range of activities and
  interests

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Autism Etiology

• Unknown in most cases
• May have multiple biologic causes immunizations,
  toxins, viruses, food, drugs
• Genetic 10-20 risk of recurrence in families
• Three to four times more frequent in boys

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Autism Clinical Manifestations

• Abnormalities in language and thinking skills
• Repetitive behavior (rocking, hand flapping)
• Abnormal responses to sensations, people, events,
  objects, no fear of danger
• Self-abusive behavior (head-banging)
• Do not participate in social play with others

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Autism Clinical Manifestations

• Mental retardation (75) or exceptional skills
• Do not deal well with change in routine
• Increased activity levels with short attention
  span
• Usually a disturbance of communication, both
  expressive and receptive, first brings the
  autistic child to attention

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Autism Clinical Manifestations

• Language is nonexistent or immature,
  characterized by echolalia, pronoun reversals
  (using you to refer to himself and I to refer
  to refer to the listener), unintelligible jargon
• Seizures occur in 15-35 of autistic children

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Autism Treatment

• No cure
• Highly structured and intensive behavior
  modification programs
• Positive reinforcement
• Family support

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Autism Nursing Considerations

• Introduce slowly to new situations
• Use brief and concrete communication
• Make one request at a time
• Maintain usual routine
• Decrease stimulation (private room)
• Maintain a safe environment with close
  supervision
• Minimal touch or holding
• Teach parents coping skills

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Fetal Alcohol Syndrome (FAS)

• Specific cluster of physical and neurobehavioral
  birth defects associated with maternal alcohol
  abuse during pregnancy
• FAS represents the most severe end of possible
  damage
• Fetal alcohol effects (FAE) represent less severe
  forms of damage

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FAS Etiology

• Occurs in 0.5 per 1,000 live births
• Increased incidence in Native Americans (1/250)
• The more alcohol consumed, the greater the risk
  for FAS

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FAS Etiology

• Drinking patterns that produce very high blood
  alcohol levels, whether daily or weekly, pose the
  greatest risk
• First trimester exposure poses risks to
  structural development, third trimester exposure
  may impair CNS development
• Uncommon in a first pregnancy. Effects of
  alcohol becomes more severe with each child born
• Chronic maternal alcohol use can deplete minerals
  and vitamins available to the fetus

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FAS Clinical Manifestations

• Growth retardation short stature, underweight,
  decreased adipose tissue
• Craniofacial abnormalities microcephaly, small
  eyes with small palpebral fissures, wide flat
  nasal bridge, flat philtrum
• Sensory integration difficulties

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FAS Clinical Manifestations

• Learning and attention difficulties (low IQ)
• Irritability
• Hyperactivity
• Behavioral disorders
• Poor social skills
• Poor self-esteem
• Poor fine motor function
• S/S alcohol withdrawal few days after birth

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FAS Treatment

• Reduction of environmental stimuli to help avoid
  over stimulation
• Provide good nutrition
• Anticonvulsant medications
• Appropriate referrals for early intervention and
  counseling

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FAS Nursing Management

• Increase calorie intake
• Daily weight
• Supportive treatment of health problems
• Monitor and treat seizures
• Early intervention programs for disabilities
• Family support

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Eating Disorders Anorexia Nervosa

• Self-inflected starvation leads to emaciation
• Intense fear of becoming fat, body image
  disturbance
• Weight decreased at least 25 less than original
  body weight
• No known physical illness

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Eating Disorders Anorexia Nervosa

• Nursing Management Promote well-being by
  monitoring food intake, correct imbalances in
  fluid, electrolytes, nutrition
• Monitor weight gain (to 10 of IBW) by gradual
  gain too quick gain can lead to cardiac
  overload and death
• Kind, nurturing but firm manner
• Interventions to increase self-esteem and
  self-worth
• Medications Antidepressants, hormones,
  antipsychotics, gastric motility enhancers
• Promote individual and family therapy

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Eating Disorders Bulimia

• Recurrent binge eating followed by inappropriate
  compensatory behaviors, such as self-induces
  vomiting, misuse of laxatives, diuretics,
  excessive exercise
• May eat 20,000 to 30,000 calories per day

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Eating Disorders Bulimia

• Awareness of abnormal eating pattern
• Fear of not being able to stop eating voluntarily
• Depressed mood following eating binges

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Eating Disorders Bulimia

• Nursing management
• Behavior modifications with individual, family
  and group therapy
• Monitor proper nutrition with dietary counseling,
  correct imbalances in fluid, electrolytes,
  nutrition
• Monitor weight gain
• Interventions to increase self-esteem and
  self-concept
• Medications antidepressants

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Eating Disorders Obesity

• Increase in body weight resulting from excessive
  accumulation of body fat relative to lean body
  mass
• Weighing more than average for height and body
  build (greater than 120 of ideal body weight for
  height and age)
• Caloric intake consistently exceeds caloric
  requirements and expenditure
• Less than 5 of childhood obesity is attributed
  to an underlying disease

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Eating Disorders Obesity

• Nursing management
• Teach proper balanced nutrition
• Monitor weight
• Develop exercise program child will participate
  in and parents will support

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Eating Disorders Pica

• Persistent eating of non-nutritive substances for
  at least 1 month
• Food pica coffee grounds
• Nonfood picas clay, soil, laundry starch, feces
• Associated with iron and zinc deficiencies
• More common in autistic, mentally retarded,
  anemia, chronic renal failure
• Infants plaster, paint, cloth
• Older children bugs, rock, sand
• Adults chalk, starch, paper

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The End!!

• Questions??