NR 606 midterm Questions and Answers

NR 606 midterm Questions and Answers Children in the pre-operational stage think _____ and use what to represent objects? symbolically, use words or pictures in which stage of piaget's model does thinking become more logical and organized about events and children can reason inductively concrete operational (age 7-11) which stage is defined by the ability to reason abstractly and consider hypothetical problems as well as moral, ethical, social, and political issues? formal operations (12+) Can a parent access information if the provider has concerns about parental abuse or neglect? the provider can decide whether or not to treat the parent as a personal representative If the parent is not the child's personal representative under HIPPA, do they have access to the health records? depending on state laws- if the state has a law against it then no, if the state does permit the provider to share health information then the provider is able to A challenge to prescribing psychoactive medications in the perinatal period is the paucity of evidence regarding the true risks for the pregnant client and developing fetus If a pregnant client is stable on their current medication regimen what should the PMHNP keep in mind keep them on current med rather than switching When should the PMHNP refer the patient to a perinatal psychiatrist when the patient is on a high-risk medication for pregnancy most common adverse effect associated with SSRIs and SNRIs neonatal withdrawal syndrome symptoms of neonatal withdrawal syndrome Symptoms include tremors, high-pitched crying, and disturbed sleep increase the risk of atrial septal defects. paroextine symptoms of newborn toxicity r/t benzodiazepine use during pregnancy Symptoms include sedation, floppy muscle tone, and potential breathing issues at birth bipolar medications that are considered teratogenic and should be avoided during pregnancy. valproic acid and carbamazepine Atypical antipsychotics that increase risk of gestational diabetes and large for gestational age infants olanzapine and quetiapine has also been found to increase the risk of musculoskeletal malformations in infants olanzapine the most used antipsychotics during pregnancy risperidone and quetiapine medications that are safe for breast feeding SSRIs, benzos, valproic acid, quetiapine medications that are safe for bottle feeding lithium, lamotrigine, clozapine smoking- related pregnancy complications ectopic pregnancy, placental abruption, placenta previa, fetal mortality, and stillbirth, as well as preterm birth and low birth weight infants Smoking-related effects on neonates include sudden infant death syndrome and birth malformations such as oral clefts and neural tube defects smoking effects on infants, children, and adolescents include asthma, cognitive impairment, lower respiratory illness, attention deficit hyperactivity disorder (ADHD), and central nervous system tumors Health problems associated with alcohol use disorder include increased risk for miscarriage, stillbirth, congenital anomalies, low birth weight, small for gestational age, and preterm delivery risk of using cannabis during the perinatal period including preterm labor, low birth weight and small for gestational age deliveries, and adverse effects on fetal and adolescent brain growth, executive functioning skills, behavioral problems, and academic achievement Cocaine use during pregnancy is linked with poor pregnancy-related outcomes including premature rupture of membranes, placental abruption, preterm birth, low birth weight, and small for gestational age deliveries, as well as long-term effects in children and adolescents including lower short-term memory, child and adolescent delinquent behavior, earlier age of sexual activity, and substance use complications of opioid use during the perinatal period eclampsia, heart attack or heart failure, and sepsis. Infants experience significant adverse effects, including neonatal abstinence syndrome, third trimester bleeding and mortality, postnatal growth deficiency, microcephaly, neurobehavioral problems, and sudden infant death syndrome includes policies, regulations, or laws that intentionally or unintentionally lead to discrimination structural stigma an example of structural stigma MAT encompasses the attitudes, beliefs, and behaviors of groups or individuals which form a stereotype that creates an emotional reaction or prejudice and results in discrimination. public stigma refers to the shame individuals internalize about negative stereotypes, may prevent themselves from seeking help self-stigma only validated behavioral health screening instrument designed specifically for pregnant women. It screens for alcohol, tobacco, marijuana, and illicit drug use. In addition, validated screening questions for depression and domestic violence can be included. The 4Ps Plus validated for use with adults to generate a risk level for each substance class. It can be self-administered or conducted via clinician interview and combines screening and brief assessment of past 90-day problematic use into one tool Tobacco, Alcohol, Prescription medication, and other Substance Use (TAPS) Tool assess substance use disorder risks among adolescents 12-17 years old. NIDAMED's Screening Tools for Adolescent Substance Use when is inpatient treatment recommended for alcohol use disorder in pregnant women? for clients at risk for moderate, severe, or complicated alcohol withdrawal as indicated by a score of more than 10 on the CIWA meds for tobacco use disorder that are safe in pregnancy nicotine replacement therapy (NRT), bupropion, or a combination why use IR over ER in pregnancy an help minimize infant exposure during pregnancy and breastfeeding. OUD meds that are safe during pregnancy methadone and buprenorphine OUD meds that are safe during breastfeeding methadone, buprenorphine, and naltrexone neurological condition characterized by persistent, uncontrollable worrying that causes emotional distress + symptoms on most days, for a period of at least six months. GAD mood disorder characterized by depressive symptoms that last longer than two weeks + 5 or more of the following: irritable mood, diminished interest in activities, significant weight or appetite changes, fatigue, feelings of worthlessness, sleep disturbances, and the diminished ability to concentrate MDD Untreated MMHDs can have long-term negative impact on mother including Have poor nutrition Use substances such as alcohol, tobacco, or drugs Experience physical, emotional, or sexual abuse Be less responsive to baby's cues Have fewer positive interactions with baby Experience breastfeeding challenges Question their competence as mothers Untreated MMHDs can have long-term negative impact on the child including Low birth weight or small head size Pre-term birth Longer stay in the NICU Excessive crying Impaired parent-child interactions Social-emotional, cognitive, language, motor, and adaptive behavior development Adverse Childhood Experience Risk Factors for MMHDs Smoking Lack of social support Poor relationship quality Pregnancy complications Personal or family history of depression History of physical or sexual abuse Unintended pregnancy Life stress Chronic physical conditions Prior pregnancy with fetal/infant loss History of mental illness pathophysiology of the baby blues The abrupt change in hormones that occurs when the placenta is delivered may contribute to the development of symptoms and may be exacerbated by fatigue, pain, overstimulation, lack of support, or insecurity baby blues symptoms Poor concentration Moody Feeling sad Fatigue Easily angered Insomnia Anxiety Crying without reason Poor concentration baby blues causes Drastic hormonal changes Fatigue after giving birth and breastfeeding Sudden changes in routine caring for baby Lack of support from partner or family Transition to being a mother the most common maternal mood disorder depression when can the specifier "with peripartum onset" be applied can be applied to depressive disorders if the onset of mood symptoms occurs during pregnancy or in the four weeks following childbirth. criteria for perinatal psychosis as a "brief psychotic disorder with peripartum onset" when symptoms present suddenly during pregnancy or within the first 4 weeks after birth and last at least one day but no more than one month. who has the highest risk of a postpartum psychotic episode preexisting bipolar disorder Current recommendations from the American College of Obstetricians and Gynecologists (ACOG) include screening how often? at least once during the perinatal period using a validated instrument, increasing the frequency of visits when symptoms are identified, and referring clients for appropriate pharmacotherapy and psychotherapy treatments The American Academy of Pediatrics (AAP) recommends incorporating the Edinburgh Postnatal Depression Scale (EPDS) how often into infants' 1, 2, 4, and 6-month well check visits using a cutoff score of 10 as an indicator that maternal depression may be present what must be ruled out before starting SSRIs for perinatal depression bipolar II Medications for perinatal bipolar disorder lithium, lamotrigine First line therapy for perinatal PTSD first line= psychotherapy SSRIs may be used for comorbid depression screening tool used for bipolar disorder MDQ Screening tool used for depression PHQ-9 tool used to monitor symptoms of bipolar disorder after diagnosis young mania rating scale tool used to assess clients who present with symptoms of psychosis brief psychiatric rating scale how can maternal depression and anxiety can impact fetal development in utero increase the risk for preterm birth and low birth weight, and lead to an insecure attachment between the mother and infant as well as suboptimal breastfeeding practices Diagnostic criteria for GAD in children and teens only one physical or cognitive symptom is required for diagnosis whereas three symptoms are required for adult diagnosis Screen for Child Anxiety Related Disorders (SCARED) tool Child Version enables providers to screen for several types of anxiety disorders, including generalized anxiety, panic disorder, separation anxiety, and social anxiety. A total score of ___ or more points on the SCARED scale indicates a potential anxiety disorder 25 To meet diagnostic criteria for OCD, the obsessions and compulsions must be time-consuming (1 hour per day) and disrupt normal routines, functioning, or relationships. PANDAS pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections lab test to detect PANDAS Cunningham panel First-line treatment for mild to moderate OCD CBT which includes exposure and response prevention If symptoms persist after two or more trials of an SSRI or clomipramine and failure to respond to CBT, treatment may be augmented with an atypical antispcyhotic Body dysmorphic disorder (BDD) type of obsessive-compulsive disorder in which an individual becomes preoccupied with one or more perceived flaws in physical appearance that are not visible or appear slight to others screening tools for use with clients who may have BDD Body Dysmorphic Disorder Questionnaire (BDDQ) The BDD Yale-Brown Obsessive Compulsive Scale for Adolescents (BDD-YBOCS-A) scoring for BDD-YBOCS-A Scores range from 0-to 48. Scores above 20 indicate the presence of BDD. The higher the score, the more severe the disorder screening tool that provides different scoring thresholds to screen for mild, moderate, or moderately severe depression GLAD-PC SSRI acute phase of treatment goals Aim is to achieve a significant reduction or disappearance of symptoms for 8-12 weeks. SSRI continuation phase of treatment goals Aim is to consolidate treatment gains and prevent relapse for 6 to 12 months SSRI maintenance phase of treatment goals Aim is to prevent relapse by continuing treatment for those with recurrent, severe, or chronic depression. _______ is a possible late-onset side effect in clients who take antidepressant medication emotional disinhibition presentation differences of children vs adults with BiPD Children typically experience more rapidly cycling moods and mixed episodes characterized by symptoms of both mania and depression together validated tool used for dx BiPD Kiddie Schedule for Affective Disorders and Schizophrenia for School-Aged Children interview tool an evidence-based treatment that can help clients manage life with a mood disorder by promoting regularity in daily routines interpersonal and social rhythm therapy Early intervention for youth at genetic risk for developing BPT IRPT with Data-Informed Referral (IPSRT+DIR) before symptoms manifest shows promise in helping youth establish more regular sleep-wake cycles which may help decrease mood fluctuations the preferred drug for adolescents with bipolar disorder with mixed features Divalproex The hallmark clinical feature of DMDD chronic, persistent irritability and anger. DSM5 criteria of DMDD outbursts of temper 3 times per week, chronically irritable or anger that is observable to others, symptoms present 12 months, symptoms present in at least 2 out of 3 settings (home, school, peers), ages 6-18, onset before age 10 when can DMDD not be diagnosed if bipolar, intermittent explosive disorder, or oppositional defiant disorder are present screening tool for DMDD KSADS-PL therapies for DMDD CBT= first line computer-based interpretation bias training (IBT) to help children and adolescents more accurately interpret others' emotions medications for DMDD stimulant medications- decrease irritability Antidepressants- irritability and other mood problems Atypical antipsychotics- control severe outbursts of temper/ aggression which medication requires up to 30% increased dosage for clients who smoke concurrently olanzapine actors associated with an increased likelihood of developing ASD having a sibling with ASD, having older parents, having certain genetic conditions such as Fragile X syndrome or Down syndrome, or having a very low birth weight DSM-5 criteria for ASD includes ersistent deficits in communication and social interaction across multiple contexts and restrictive, repetitive patterns of behavior, interests, or activities. Symptoms must appear early in development and can cause clinically significant impairment in functioning. Early signs of ASD include avoiding eye contact showing little interest in peers or caretakers limited language abilities frustration with minor changes in routine repetitive behaviors The American Academy of Pediatrics recommends that all children be screened for ASD at which well-child visits? 18 month and 24 month general developmental screening tool. Parent-completed questionnaire; series of 19 age-specific questionnaires screening communication, gross motor, fine motor, problem-solving, and personal adaptive skills; results in a pass/fail score for domains. ages and stages questionnaires Standardized tool for screening of communication and symbolic abilities up to the 24-month level; the Infant Toddler Checklist is a 1-page, parent-completed screening tool communication and symbolic behavior scales This is a general developmental screening tool. Parent-interview form; screens for developmental and behavioral problems needing further evaluation; single response form used for all ages; may be useful as a surveillance tool. parents evaluation of developmental status Parent-completed questionnaire designed to identify children at risk for autism in the general population. modified checklist for autism in toddlers