Understanding ADHD, Co-Morbidities, and Interventions, Exams of Nursing

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What ADHD symptoms are lack of attention to detail, careless mistakes, not listening, losing things diverting attention, forgetfulness Ans✔- Selective attention What ADHD symptoms are poor problem solving, trouble completing a task, disorganization, trouble sustaining mental effort Ans✔- Lack of sustained attention What ADHD symptoms are excessive talking, blurting things out, not waiting ones turn, interrupting Ans✔- Impulsivity What ADHD symptoms are fidgeting, leaving ones seat, running, climbing, trouble playing quietly Ans✔- Hyperactivity What ADHD symptom is common in childhood Ans✔- hyperactivity Effects of maturation ADHD- young kids may experience Ans✔- DD, bx less mature than peers Effects of maturation ADHD- teens Ans✔- poor academic performance, trouble driving, trouble in social situations, risky sexual bx, SUD Effects of maturation ADHD- Adult Ans✔- Issues with EF, attention, working memory, that cause issues with day to day fnx and performance at work and in relationships Dx criteria for ADHD How many s/s How long How many settings Ans✔- Pattern of 6 s/s that interfere with fnx/development, NR 606 Final Exam 2024 Graded A;Chamberlain 6 months or longer Present in 2 or more settings How to combat anorexia with stimulant use Ans✔- Take medication with breakfast to decrease anorexia or associated weight loss When patients with ADHD have co morbid MH issues, what do you tx first Ans✔- ADHD (stimulants first line) Treating ADHD s/s first will give a clearer picture of the comorbidities Work up for starting stimulant Ans✔- ECG- if personal/first relative fmly hx Check bp/wgt/hgt What co morbidity should the PMHNP assess for before starting a stimulant Ans✔- BPD, CNS stimulant can cause psychotic or manic s/s in pt's with no prior hx or may exacerbate bx disturbances and thought d/o in pt's with pre-exisiting psychosis Stimulants can exacerbate what comorbid dx Ans✔- anxiety and SUD Increased irritability or insomnia can be tx with what Ans✔- low dose non stim Abrupt withdrawal from stimulants can cause what Ans✔- irritability and rebound s/s What to do with tx for ADHD if the pt is argumentative or oppositional Ans✔- Combo therapy with stim and non stim Recommendations for parent training in behavior management for ADHD as a first-line Intervention - What do the parents learn Ans✔- Recommended for child under 6 - Parents learn positive communication and reinforcement, structure, and discipline Benefits of early interventions for FAS Ans✔- Helps patient develop basic skills like walking, talking, interacting with others. It is a combo of pharm and nonpharm Pharmacology for FAS Ans✔- SSRI, alpha 2 agonist, anticonvulsant, stimulants, atypical antipsychotic PMHNP role in identifying early with diagnosis for disabilities education act Ans✔- A federal law to ensure kids with disabilities receive free appropriate education -IDEA Receive individualized special education services to address needs, receive preparation for employment and independent living, protected by law, federal agency, state/local/educational service agencies receive support Ans✔- IDEA- individuals with disabilities education act Risk factors for developing eating disorders Ans✔- -Fmly hx, close relative with an eating disorder -Weight stigma in the culture or family -Trauma (Physical or sexual abuse) -Hx of being bullied about weight or physical appearance -Biopsychological involving Se and Da Lab values for PICA Ans✔- CBC and zinc- iron deficiency anemia may cause pica) and a Lead level Lab alues for anorexia Ans✔- CBC- anmeia, thrombocytopenia, low WBC common in anorexia due to marrow response to starvation Lab values for bulimia Ans✔- Urea and electrolytes- dehydration, hypokalemia, hypochloremia, hyponatremia, metabolic alkalosis, hypomagnesemia, hypophosphatenmia Restrictive eating patterns, extremely low body weight intense fear of gaining weight, excessive exercise to control it. Ans✔- Anorexia Recurrent episodes of eating unusually large amounts of food paired with feeling a lack of control over eating, binge eating alone or in secrecy about eating or eating when not hungry Ans✔- Binge eating Recurrent episodes of eating unusually large amounts of food paired with a feeling of lack of control of eating behaviors. To compensate for overeating, individuals with bulimia nervosa engage in behaviors to prevent weight gain, including self-induced vomiting, excessive use of laxatives or diuretics, excessive exercise, fasting, or a combination of these behaviors - At least once a week for 3 months Ans✔- Bulimia Nervosa Persistent ingestion of nonfood items that do not contain nutritional value at least once a month. Clay paper soap hair soil chalk paint metal pebbles ice Ans✔- Pica Reduced intake of food volume or variety due to fear of aversive consequences of eating, lack of interest in food or eating or sensory sensitivity. Associated with nutritional, medical, or psychological impairment. Eating only a few foods that do not meet nutritional needs Ans✔- ARFID What dx criteria for AFRID Ans✔- Significant weight loss, nutritional deficiency, dependence of an E tube or nutritional supplements, impaired psychosocial functioning Pica tx Ans✔- Non contingent reinforcement, environmental enrichment, overcorrection What is the SCOFF tool used for Ans✔- eating disorders Content of SCOFF tool Ans✔- Sick: Eat until feeling sick Control: loss of control One: Have you recently lost one stone (14 pounds) in 3 mo Fat: Believe you're fat when others say you're too thin Food: Does food dominate your life Over 2 needs investigation What is one of the most successful tx for eating d/o in kids and teens Ans✔- Family based tx for eating d/o What are the 3 phases to family based tx for eating disorder Ans✔- Full parental control, gradual return of control, autonomy One's concept of oneself as male female or both that is not derived from an interconnection of biotraits, developmental influences, or environmental factors Ans✔- Gender identity At what age do kids become aware of the physical differences between boys and girls What age have kids established their gender identity Ans✔- 2 4 Social affirmations for gender Ans✔- Pronouns and gender expression like hairstyle or clothing A supportive family of gender dysmorphia increases Ans✔- Resilience for pt while a family that is resistant or discriminates cause significant distress Adolescent prevalence for alcohol Ans✔- 38.3% Adolescent prevalence for marijuana Ans✔- 24.6% Adolescent prevalence for tobacco Ans✔- 27.1% Adolescent prevalence for other drugs Ans✔- 9.2% CRAFFT tool content Ans✔- Car: Driven with someone high or drunk Relax: Use substances to relax/feel better about self Empowerment: Promotes self efficacy agency and dignity Cultural/Historical/Gender awareness: ACEs may bea. result of the following PTSD in kids manifestation include what kind of symptoms Ans✔- Dissociative (depersonalization derealization) Feeling detached from ones own body Ans✔- Depersonalization Feelings that ones surrounds are not reality Ans✔- Derealization 4 symptom categories of PTSD Ans✔- Intrusion, avoidance, negative cognitive mod/symptoms, arousal or reactivity What are the following symptoms categorized as for PTSD: Irritability and verbal or physical aggression Reckless or risk taking bx Hypervigilance Concentration difficulty Exaggerated startle response Sleep disturbances Ans✔- Arousal or reactivity What are the following symptoms categorized as for PTSD: Memory deficits surrounding traumatic event Exaggerated negative beliefs of self or environment Distorted cognitions and self blaming behaviors related to the cause/consequence of trauma Persistent negative emotions (guilt, anger, fear, shame) Feelings of detachment from others Persistent inability to experience positive emotions Social w/d in kids under 6 Ans✔- Negative cognitive mood symptoms What are the following symptoms categorized as for PTSD: Avoidance of distressing memories/thoguhts/feelings Avoidance of reminders like people, places, situations Ans✔- Avoidance What are the following symptoms categorized as for PTSD: Recurrent/intrusive memories of trauma, children engage in repetitive play expressing trauma themes Distressing dreams/nightmares Dissociative reactions or flashbacks Intense psychological/physiological reactions when exposed to cues the symbolize ore represent an aspect of trauma Ans✔- Intrusion When do s/s occur for PTSD Ans✔- Within the first 3 months and at least for 1 month the development of emotional or behavioral symptoms within 3 months of the onset of a new stressor, with significant impairment in social or occupational functioning but do not persist past 6 months after the initial stressor has resolved. Ans✔- Adjustment disorders The child's symptoms have been present for 2 months; Ans✔- Adjustment disorder is most likely PTSD symptoms must be present for how long? Ans✔- 1 month Adjustment disorder specifiers Ans✔- Depressed mood, anixety, mixed anxiety & depressed mood, disturbance of conduct, mixed disturbance of emotions and conduct What has no clear resolution such as physical disability or living in a community with high crime rates. ACEs are at risk Ans✔- persistent adjustment disorder