Nursing Care for Child with Psychiatric Disorders · Nursing Care for Child with Psychiatric Disorders . Mental Retardation/ Intellectual Disability ... Mental retardation is a developmental

Jiraporn Rakkarn, MNS, RN Division of Mental Health and Psychiatric Nursing

College of Nursing and Health, Suan Sunandha Rajabhat University

Nursing Care for Child with

Psychiatric Disorders

Mental Retardation/ Intellectual Disability

Autistic Disorders

Attention Deficit Hyperactivity Disorders: ADHD

Conduct Disorders: CD

Contents

College of Nursing and Health, Suan Sunandha Rajabhat University Jiraporn Rakkarn

Content


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Mental Retardation (Intellectual Disability)

Definition


DSM-IV Mental retardation

DSM-V Intellectual Disability

Definition

DSM-IV

Mental retardation is a developmental condition that is characterized by significantly lower than average level of general intellectual functioning.

Failure to develop cognitive abilities and achieve an intelligence level that would be appropriate for their age group.


Definition


DSM-V

Intellectual Disability is a disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social, and practical domains. (APA, 2013)

Mental Retardation Diagnostic Criteria

1. Intellectual functioning significantly below average. IQs of about 70 or lower

2. Impairments or deficits for that age group in functioning in at least two of the following areas:


Mental Retardation Diagnostic Criteria


Communication

Self-care

Home living

Social and interpersonal skills

Functional academic skills

Use of community resources

Self-direction

Leisure

Work

Health and safety

3. Onset before age 18

Severity Level


Level

IQ

Mild

50-70

Moderate

35-49

Severe

20-34

Profound

< 20

Severity Level


Cause


Unknown Genetic factor - Down syndrome - Tuberous sclerosis - PKU

Environment - Low socio-economic status - Inadequate caretakers - Child abuse

Postnatal - Meningitis - Encephalitis - Accidents - Poisoning

Prenatal - Rubella - Syphilis - Herpes simplex - HIV - Alcohol - Amphetamine Perinatal

- Prematurity - Birth asphyxia - Hyperbilirubinemia

Cause

Treatment


Physical illness & Mental illness

Counseling: Individual & Family

Certificate of disability

Education

Assessment


Physical development

Language development

Social development

Self-care ability

Intellectual ability

Education

Impulse control

Nursing Diagnosis


Delayed growth and development related to cognitive or perceptual impairment

Self-care deficit related to cognitive or perceptual impairment

Ineffective relationship related to developmental delay

Impaired verbal communication related to developmental delay

Ineffective coping related to learning disability

NANDA Nursing Diagnosis (Ackley & Ladwig, 2014)

Nursing Intervention


Family counseling & Family psychoeducation: Disease, Health care

Promotion of developmental

Environment

Therapeutic relationship

Physical therapy

Activity therapy

Speech therapy

Rehabilitation: Education, Occupational


Autistic Disorders

Definition


Autism Disorders or autism is marked impairment in reciprocal social interaction and verbal and nonverbal communication with a restrictive and repetitive activities and interest. (Tanguay, 2010 cited in Boyd, 2012: 681)

Cause


Biological factors genetic/familial factors

Brain

neurotransmitter: Serotonin Endorphins Dopamine Sulfate

Immunology factor

Gestational/Perinatal/Postnatal

Psychological factors Parenting raising


1 2 3

Impairment in social

interaction

Verbal and Non-verbal

communication

Restricted, repetitive and

stereotypic behaviors and

interests

Clinical



“ไม่สบตา ไม่พาที ไม่ช้ีน้ิว”

Diagnostic Criteria


A. A total of six (or more) items from (1) (2) and (3) with at least

two from (1) and one each from (2) (3)

(1) Social interaction Impaired nonverbal behavior

Lack of peer relationships

Lack of spontaneous social engagement

Lack of social and emotional reciprocity

Diagnostic Criteria


(2) Communication Absence or delay of spoken language

Pragmatic difficulties

Stereotyped or idiosyncratic language

Lack of imaginative or imitative play

(3) Behavior & Interests Abnormally restricted interests

Inflexible routines and rituals

Motor mannerisms

Preoccupation with parts of objects

Diagnostic Criteria


B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years:

(1) Social interaction

(2) Language as used in social communication

(3) Symbolic or imaginative play

C. The disturbance is not better accounted for by Rett’s Disorder or Childhood Disintegrative Disorder

Treatment


Developmental therapy: Behavior, Speech, Education

Medication: Antipsychotic Drugs, Antidepressant Drugs, Antianxiety Drugs, Anticonvulsant Drugs, Vitamin B6

Assessment


Developmental delays, uneven development, or loss of acquired abilities.

The parent-child relationship for evidence of bonding, anxiety, tension, and fit of temperaments.

Physical and emotional signs of possible abuse. Be aware that children with behavioral and developmental problems are at risk for abuse

Knowledge about community programs providing support services for parents and children, including parent education, counseling, and after-school programs

(Halter, 2014: 192)

Nursing Diagnosis



Impaired verbal communication related to speech and language delays

Impaired social interaction related to inability to relate to others

Risk for self-directed or other-directed violence related to lack of impulse control

Risk for delayed development related to autism



Safety

Developmental therapy

Family counseling

Play therapy

Behavior therapy

Family therapy

Milieu therapy

Nutritional therapy

Psychoeducation


Attention Deficit Hyperactivity Disorder: ADHD

วิทยาลยัพยาบาลและสขุภาพ มหาวิทยาลยัราชภฏัสวนสนัุนทา อาจารยจิ์ราพร รกัการ

Definition


DSM-V

ADHD as a persistent pattern or inattention and/or hyperactivity-impulsivity that interferes with functioning or development, has symptoms presenting in two or more setting.

Negatively impacts directly on social, academic or occupational.

Several symptoms must have been present before age 12 years. (APA, 2013)


1 2 3

Cause

Genetic factors

Biological factors

Social & environment

factors


- Fidget and squirm when seat - Doesn’t stay seated - Get up frequently to walk or run around

- Disorganization - Lack of focus - Difficulty giving attention to details

- Impatience - Having a hard time waiting to talk or react - Blurt out answers before someone finishes asking them a question

Hyperactivity Inattention Impulsivity

Clinical Characteristics


Diagnostic Criteria


A. Six (or more) of the following symptoms at least 6 months

(1) Inattention Fails to give close attention to details

Has difficulty sustaining attention in tasks or play activities

Does not seem to listen

Fails to finish

Has difficulty organizing tasks and activities

Avoids sustained effort

Loses things necessary for tasks or activities

Easily distracted by extraneous stimuli

Forgetful in daily activities

Diagnostic Criteria


(2) Hyperactivity/Impulsivity Fidgets with hands or feet or squirms in seat

Leaves seat in classroom

Runs or climbs

Unable to play or engage in leisure activities quietly

Motor excess

Talk excessively

Blurts out answers before a question has been completed

Has difficulty awaiting their turn

Interrupts or intrudes on others

Diagnostic Criteria


B. Present before age 7 years

C. Present in two or more setting

D. The symptoms interfere the quality of social, academic, or occupational

E. The symptoms do not occur exclusively during the course of developmental disorder, schizophrenia, or other psychotic disorder

Treatment


Family intervention: Psychoeducation,

Parent management training

School intervention

Medication: Methylphenidate (RitalinR, RubifenR)

Assessment


Level of physical activity

Attention span

Talkativeness

Frustration tolerance

Impulse control

Ability to follow directions and complete tasks

Developmental variance in these behaviors

Assessment


Social skills

Friendship history

Problem-solving skills

School performance

Academic failure and poor peer relationships lead to

low self- esteem, depression

Associated comorbidities: Anxiety & Depression

Nursing Diagnosis



Ineffective impulse control related to disorder of development

Impaired social interaction related to impulsive behavior

Chronic low self-esteem related to difficult in participating in expected

activities

Risk for self-directed or other-directed violence related to lack of

impulse control

Disable family coping related to significant person with chronically

unexpressed feelings of guilt, anxiety, and despair



Family counseling

Safety

Environment

Behavior therapy


Counseling

Psychoeducation


Conduct Disorders: CD

Definition


The main features of conduct disorder are repetitive and persistent patterns of behavior in which the rights of others or social rules are consistently violated.

(APA, 2002)

Children with this disorder are aggressive, deceptive, and destructive with these symptoms begin the primary reason for psychiatric referral.

(O’Brien, Kennedy and Ballard, 2013: 284)

Cause


Biological factors Genetic

Neurotransmitter: Dopamine

Hormones: testosterone androstenedione

Environment factors Low Economic

Parental Drugs abuse

Child Abuse

Homelessness

Diagnostic Criteria


A. Three of the following present within last 12 months and at least one within last 6 months

(1) Aggression to people and animal Bullies, threatens, or intimidates to others

Initiates physical fights

Used a weapon that can cause serious physical harm to others

Cruel to people

Cruel to animals

Stolen while confronting a victim

Forced someone into sexual activity

Diagnostic Criteria


(2) Destruction of property/Deceitfulness of theft Engaged in fire setting

Destroyed other’s property

Broken into someone else’s house, building, or car

Lies to obtain goods or favors to avoid obligations

Stolen items of nontrivial value without confronting a victim

(3) Serious violations of rules Stays out at night despite parental prohibitions, beginning before age 13 years

Run away from home overnight at least twice while living in parental

Truant from school, beginning before age 13 years

Diagnostic Criteria


B. The disturbance in behavior causes clinically significant impairment in social, academic or occupational function

C. If the individual is age 18 years or older, criteria are not met for antisocial personality disorder.

Treatment


Behavior therapy

Family therapy

Medication: Antipsychotic drugs, Lithium, Anticonvulsant drugs

Assessment


The seriousness of the disruptive behavior; determine when it started and what has been done to manage it.

The levels of anxiety, aggression, anger, and hostility

The ability to control impulses

Moral development for the ability to understand the effect of hurtful behavior on others, to empathize with others, and to feel remorse or guilt

Negative thoughts

Nursing Diagnosis



Ineffective impulse control

Ineffective coping

Ineffective relationship

Impaired social interaction

Risk for other-directed violence




Family counseling

Family psychoeducation

Behavior therapy

Positive & Negative reinforcement

Relaxation technique

Self-awareness

ฉววีรรณ สตัยธรรม, แผ จนัทรส์ุข และศุกรใ์จ เจรญิสุข. (2556). การพยาบาลจติเวชและสุขภาพจติ (ฉบบัปรบัปรงุ) เล่มที ่2. กรงุเทพมหานคร: ธนาเพรส.

ทวศีกัดิ ์สริริตัน์เรขา. (2556). ออทสิตกิ. สบืคน้เมือ่ 15 กนัยายน 2559, จาก http://www.dmh.go.th/downloadportal/Morbidity/Autistic.pdf

มนสัว ีจ าปาเทศ และศุกรใ์จ เจรญิสุข. (2556). การพยาบาลจติเวชเดก็ (Child Psychiatric Nursing). ใน ฉววีรรณ สตัยธรรม, แผ จนัทรส์ุข และ

ศุกรใ์จ เจรญิสุข (บรรณาธกิาร), การพยาบาลจติเวชและสุขภาพจติ (ฉบบัปรบัปรงุ) เล่มที ่2 (หน้า 179-211). กรงุเทพมหานคร: ธนาเพรส.

มาโนช หล่อตระกูล และปราโมทย ์สุคนิชย.์ (2555). จติเวชศาสตร ์รามาธบิด.ี (พมิพค์รัง้ที ่3). กรงุเทพมหานคร: ภาควชิาจติเวชศาสตร ์คณะแพทยศาสตร ์

โรงพยาบาลรามาธบิด ีมหาวทิยาลยัมหดิล.

ศริไิชย หงษ์สงวนศร.ี (2555). ความผดิปกตทิางจติเวชเดก็และวยัรุ่น. ใน มาโนช หล่อตระกูล และปราโมทย ์สุคนิชย ์(บรรณาธกิาร), จติเวชศาสตร ์รามาธบิด ี

(หน้า 433-439). (พมิพค์รัง้ที ่3). กรงุเทพมหานคร: ภาควชิาจติเวชศาสตร ์คณะแพทยศาสตร ์โรงพยาบาลรามาธบิด ีมหาวทิยาลยัมหดิล.

สุวรรณ ีพุทธศิร.ี (2555). Attention Deficit and Disruptive Behavior Disorder. ใน มาโนช หล่อตระกูล และปราโมทย ์สุคนิชย ์(บรรณาธกิาร), จติเวชศาสตร ์

รามาธบิด ี(หน้า 461-468). (พมิพค์รัง้ที ่3). กรงุเทพมหานคร: ภาควชิาจติเวชศาสตร ์คณะแพทยศาสตรโ์รงพยาบาลรามาธบิด ี มหาวทิยาลยัมหดิล.

Ackley, B. J. & Ladwig, G. B. (2014). Nursing Diagnosis Handbook: An Evidence-Base Guide to Planning Care. (10th ed.). Maryland Heights, MO: Elsevier Mosby.

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. (5th ed). Washington DC: American Psychiatric Association.

Boyd, M. A. (2012). Psychiatric Nursing: Contemporary Practice. (5th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

Halter, M. J. (2014). Varcarolis’ Foundations of Psychiatric Mental Health Nursing: A Clinical Approach. (7th ed.). St. Louis, MS: Elsevier Saunders.

O’Brien, P. G., Kennedy, W. Z., & Ballard K. A. (2013). Psychiatric Mental Health Nursing. (2nd ed). Burlington, MA: Jones & Bartlett Learning.

Stuart, G. W. (2013). Principles and Practice of Psychiatric Nursing. St. Louis, MS: Elsevier Saunders.

Varcarolis, E. M. (2013). Essentials of Psychiatric Mental Health Nursing. St. Louis, MS: Elsevier Saunders.

Videbeck, S. L. (2014). Psychiatric-Mental Health Nursing. (6th ed). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Reference


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Nursing Care for Child with Psychiatric Disorders · Nursing Care for Child with Psychiatric Disorders . Mental Retardation/ Intellectual Disability ... Mental retardation is a developmental