Blueprint for Exam 4
UNIT 9
Theory Content: neurocognitive
Overview :https://galen.screencasthost.com/watch/cZho2aVLFTw
Condition Presentation Interventions:
(notes) Assess, Monitor,
Medicate, Educate
ADHD Inattention, CBT, Positive
Impulsivity, Reinforcement
distractibility Rules, structure,
Questionnaire (dx rewards &
at least 2 settings) consequences,
Home and school ↓stimuli
(caffeine)
CBT/CAM
Meds: stimulants
vs non-stimulants
S:
methylphenidate–
anorexia,
insomnia (drug
free holidays)
Stimulants (drug
free holiday)
Non-stimulants –
don’t stop
abruptly
NS: atomoxetine–
↓appetite, abd
pain, ↑HR,
monitor SI (teens
AUTISM Impaired social Screening: ASQ & M-
Impaired social interaction; IQ interaction; IQ? CHAT(3LEVELS)
Rigid, inflexible, CBT/CAM,
repetitive, Conditioning &
aversions Therapy, oxytocin?
Music, Pet,
Rigid, inflexible, Equestrian
repetitive,
aversions
Red flag: no
phrases by 2, loss
of skill
,DOWN SYNDROME Facial Chromosome
(Trisomy 21) characteristics, analysis
short stature, Safety (helmets),
stubby digits Adequate
food/hydration
PT/OT/ST,
Assistance with
ADLs
ABUSE/ Deliberate Full body exam
MALTREATMENT infliction of injury (hidden signs)
Physical Fractures/bruises TEN4 Rule: Trunk,
Emotional Object-shaped Ear, Neck < 4 y/o
Sexual injuries Any bruising < 4
Stories don't months
match Mandated Reporting
ABUSIVE HEAD TRAUMA ↑Risk = Crying, Prevention – walk
(Shaken Baby Syndrome) special needs child away from crying
baby
Apnea, lethargy, ABCs, monitor LOC
irritability,
seizures
Attention Deficit Hyperactivity Disorder
o Pathophysiology/Etiology
The cause is unknown however the neurotransmitters dopamine (DA) and
norepinephrine (NE) are thought to be involved.
Diagnosis Based on the types of symptoms, three kinds
o Medical & (presentations) of ADHD can occur (CDC, 2020):
developmental histories o Combined Presentation: if enough symptoms of
o Physical exam both criteria inattention and hyperactivity-
o Vision & hearing impulsivity were present for the past 6 months
assessment o Predominantly Inattentive Presentation: if enough
o Detailed neurologic symptoms of inattention, but not hyperactivity-
evaluation. impulsivity, were present for the past 6 months
o Behavioral checklists o Predominantly Hyperactive-Impulsive
Presentation: if enough symptoms of
hyperactivity-impulsivity, but not inattention,
were present for the past 6 month
o Because symptoms can change over time, the
presentation may change over time as well
Nursing Care:
o ADHD is evaluated by using a variety of scales that ask the caregiver or teacher to
rate the child’s behavior (e.g., behavior occurs extremely often, often, sometimes,
rarely, or never).
, o A school nurse is trained to perform observations of the child while in class to
assist in the information gathering’s scales in combination with a clinical family
interview provide the examiner with valuable information to deter-mine a
diagnosis.
o A thorough clinical interview with the child is also important in determining the
appropriate diagnosis and treatment.
o The most effective treatment for ADHD is a combination of pharmacological and
psychosocial interventions.
o Using both modalities allows for the control or abatement of symptomatic behavior
by the medication while at the same time working on changing maladaptive
behavior patterns through therapy with the child and family.
o When recommending psychosocial intervention, clinicians must keep in mind the
developmental level of the child and family.
o Also, from a developmental psychopathology perspective, it is important to inform
the family that early intervention works best and that the child and family may
have periods of adaptive and maladaptive behavior.
Signs and symptoms of ADHD include:
Inattention
o Often fails to give close attention to details or makes careless mistakes in
schoolwork, work, or other activities
o Often has difficulty sustaining attention in tasks or play activities
o Often does not seem to listen when spoken to directly
o Often does not follow through on instructions and fails to nourish schoolwork,
chores, or duties in the workplace (not due to oppositional behavior or failure
to understand instructions)
o Often has difficulty organizing tasks and activities
o Often avoids, dislikes, or is reluctant to engage in tasks that require sustained
mental e ort (such as schoolwork or homework)
o Often loses things necessary for tasks or activities (e.g., toys, school
assignments, pencils, books, or tools)
o Is often easily distracted by extraneous stimuli
o Is often forgetful in daily activities
o Six (or more) of the following symptoms of hyperactivity-impulsivity have
persisted for at least 6 months toa degree that is maladaptive and inconsistent
with developmental level:
Hyperactivity
Often fidgets with hands or feet or squirms in seat
Often leaves seat in classroom or in other situations in which remaining
seated is expected
Often runs about or climbs excessively in situations in which it is
inappropriate (in adolescents or adults, may be limited to subjective feelings
of restlessness).
Is often “on the go” or often acts as if “driven by a motor”
Often talks excessively
Impulsivity
, • Often blurts out answers before questions have been completed
• Often has difficulty awaiting turn
• Often interrupts or intrudes on others (e.g., butts into conversations or games
Therapeutic Management
Three-pronged approach
1 Pharmacologic therapy: Psychostimulants
Goal: pt family might be on the meds during the Erik off on the weekends or Meds
during the school year and off over the breakers summer or winter.
Methylphenidate
o Therapeutic: central nervous system stimulants
o Treatment of ADHD (adjunct).
o Therapeutic Effects: Increased attention span in ADHD. Increased
motor activity, mental alertness, and diminished fatigue in
narcoleptic patients.
o Adverse Reactions/Side Effects
CNS: hyperactivity, insomnia, restlessness, tremor,
dizziness, headache, irritability.
EENT: blurred vision.
CV: hypertension, palpitations, tachycardia, hypotension.
GI: anorexia, constipation, cramps, diarrhea, dry mouth,
metallic taste, nausea, vomiting.
Derm: rashes.
Neuro: akathisia, dyskinesia.
Misc: fever, hypersensitivity reactions, physical
dependence, psychological dependence, suppression of
weight gain (children), tolerance.
Dextroamphetamine
o Generic name: dextroamphetamine sulfate
o not recommended for children younger than 3 years of age
o During or within 14 days following the administration of
monoamine oxidase inhibitors (hypertensive crises may result.
Amphetamine
Lisdexamfetamine
o Prescribed dose based on resolution of symptoms & not child’s
weight
2. Behavioral therapy:
o Prevention of undesired behavior/parenting skills
o Counseling
o Peer group work
o Family therapy
3. Environmental Manipulation:
o Environment modified to allow child to be successful.
UNIT 9
Theory Content: neurocognitive
Overview :https://galen.screencasthost.com/watch/cZho2aVLFTw
Condition Presentation Interventions:
(notes) Assess, Monitor,
Medicate, Educate
ADHD Inattention, CBT, Positive
Impulsivity, Reinforcement
distractibility Rules, structure,
Questionnaire (dx rewards &
at least 2 settings) consequences,
Home and school ↓stimuli
(caffeine)
CBT/CAM
Meds: stimulants
vs non-stimulants
S:
methylphenidate–
anorexia,
insomnia (drug
free holidays)
Stimulants (drug
free holiday)
Non-stimulants –
don’t stop
abruptly
NS: atomoxetine–
↓appetite, abd
pain, ↑HR,
monitor SI (teens
AUTISM Impaired social Screening: ASQ & M-
Impaired social interaction; IQ interaction; IQ? CHAT(3LEVELS)
Rigid, inflexible, CBT/CAM,
repetitive, Conditioning &
aversions Therapy, oxytocin?
Music, Pet,
Rigid, inflexible, Equestrian
repetitive,
aversions
Red flag: no
phrases by 2, loss
of skill
,DOWN SYNDROME Facial Chromosome
(Trisomy 21) characteristics, analysis
short stature, Safety (helmets),
stubby digits Adequate
food/hydration
PT/OT/ST,
Assistance with
ADLs
ABUSE/ Deliberate Full body exam
MALTREATMENT infliction of injury (hidden signs)
Physical Fractures/bruises TEN4 Rule: Trunk,
Emotional Object-shaped Ear, Neck < 4 y/o
Sexual injuries Any bruising < 4
Stories don't months
match Mandated Reporting
ABUSIVE HEAD TRAUMA ↑Risk = Crying, Prevention – walk
(Shaken Baby Syndrome) special needs child away from crying
baby
Apnea, lethargy, ABCs, monitor LOC
irritability,
seizures
Attention Deficit Hyperactivity Disorder
o Pathophysiology/Etiology
The cause is unknown however the neurotransmitters dopamine (DA) and
norepinephrine (NE) are thought to be involved.
Diagnosis Based on the types of symptoms, three kinds
o Medical & (presentations) of ADHD can occur (CDC, 2020):
developmental histories o Combined Presentation: if enough symptoms of
o Physical exam both criteria inattention and hyperactivity-
o Vision & hearing impulsivity were present for the past 6 months
assessment o Predominantly Inattentive Presentation: if enough
o Detailed neurologic symptoms of inattention, but not hyperactivity-
evaluation. impulsivity, were present for the past 6 months
o Behavioral checklists o Predominantly Hyperactive-Impulsive
Presentation: if enough symptoms of
hyperactivity-impulsivity, but not inattention,
were present for the past 6 month
o Because symptoms can change over time, the
presentation may change over time as well
Nursing Care:
o ADHD is evaluated by using a variety of scales that ask the caregiver or teacher to
rate the child’s behavior (e.g., behavior occurs extremely often, often, sometimes,
rarely, or never).
, o A school nurse is trained to perform observations of the child while in class to
assist in the information gathering’s scales in combination with a clinical family
interview provide the examiner with valuable information to deter-mine a
diagnosis.
o A thorough clinical interview with the child is also important in determining the
appropriate diagnosis and treatment.
o The most effective treatment for ADHD is a combination of pharmacological and
psychosocial interventions.
o Using both modalities allows for the control or abatement of symptomatic behavior
by the medication while at the same time working on changing maladaptive
behavior patterns through therapy with the child and family.
o When recommending psychosocial intervention, clinicians must keep in mind the
developmental level of the child and family.
o Also, from a developmental psychopathology perspective, it is important to inform
the family that early intervention works best and that the child and family may
have periods of adaptive and maladaptive behavior.
Signs and symptoms of ADHD include:
Inattention
o Often fails to give close attention to details or makes careless mistakes in
schoolwork, work, or other activities
o Often has difficulty sustaining attention in tasks or play activities
o Often does not seem to listen when spoken to directly
o Often does not follow through on instructions and fails to nourish schoolwork,
chores, or duties in the workplace (not due to oppositional behavior or failure
to understand instructions)
o Often has difficulty organizing tasks and activities
o Often avoids, dislikes, or is reluctant to engage in tasks that require sustained
mental e ort (such as schoolwork or homework)
o Often loses things necessary for tasks or activities (e.g., toys, school
assignments, pencils, books, or tools)
o Is often easily distracted by extraneous stimuli
o Is often forgetful in daily activities
o Six (or more) of the following symptoms of hyperactivity-impulsivity have
persisted for at least 6 months toa degree that is maladaptive and inconsistent
with developmental level:
Hyperactivity
Often fidgets with hands or feet or squirms in seat
Often leaves seat in classroom or in other situations in which remaining
seated is expected
Often runs about or climbs excessively in situations in which it is
inappropriate (in adolescents or adults, may be limited to subjective feelings
of restlessness).
Is often “on the go” or often acts as if “driven by a motor”
Often talks excessively
Impulsivity
, • Often blurts out answers before questions have been completed
• Often has difficulty awaiting turn
• Often interrupts or intrudes on others (e.g., butts into conversations or games
Therapeutic Management
Three-pronged approach
1 Pharmacologic therapy: Psychostimulants
Goal: pt family might be on the meds during the Erik off on the weekends or Meds
during the school year and off over the breakers summer or winter.
Methylphenidate
o Therapeutic: central nervous system stimulants
o Treatment of ADHD (adjunct).
o Therapeutic Effects: Increased attention span in ADHD. Increased
motor activity, mental alertness, and diminished fatigue in
narcoleptic patients.
o Adverse Reactions/Side Effects
CNS: hyperactivity, insomnia, restlessness, tremor,
dizziness, headache, irritability.
EENT: blurred vision.
CV: hypertension, palpitations, tachycardia, hypotension.
GI: anorexia, constipation, cramps, diarrhea, dry mouth,
metallic taste, nausea, vomiting.
Derm: rashes.
Neuro: akathisia, dyskinesia.
Misc: fever, hypersensitivity reactions, physical
dependence, psychological dependence, suppression of
weight gain (children), tolerance.
Dextroamphetamine
o Generic name: dextroamphetamine sulfate
o not recommended for children younger than 3 years of age
o During or within 14 days following the administration of
monoamine oxidase inhibitors (hypertensive crises may result.
Amphetamine
Lisdexamfetamine
o Prescribed dose based on resolution of symptoms & not child’s
weight
2. Behavioral therapy:
o Prevention of undesired behavior/parenting skills
o Counseling
o Peer group work
o Family therapy
3. Environmental Manipulation:
o Environment modified to allow child to be successful.
