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Child & Adolescent Psychotherapy: Midterm Exam, Maternal Mental Health, & Medication, Assignments of Nursing

Computer Systems Institute (CSI)Nursing

A comprehensive overview of key concepts in child and adolescent psychotherapy, maternal mental health, and medication considerations. It explores developmental considerations in therapy, the importance of family involvement, and the role of systems in child development. The document also delves into piaget's stages of cognitive development, highlighting the importance of tailoring educational approaches to different developmental stages. Additionally, it examines ethical considerations in the treatment of children and adolescents, including privacy, informed consent, and mandatory reporting. The document concludes with a discussion of maternal mental health, including the prevalence of postpartum depression and ethical considerations in prescribing medication during the perinatal period.

Typology: Assignments

2024/2025

Available from 02/07/2025

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NR606 Midterm Exam (Latest Update)

Questions and Answers (100% Verified

Elaborations)

Steps for Obtaining Informed Consent

-Assess pt ability to understand medical info, tx options, to make a voluntary decision.

-Present relevant info with accuracy and sensitivity:

• diagnosis

• nature & purpose of tx options

• benefits, risks, burdens of all tx options, including forgoing tx

-Document informed consent conversation in the medical record, including all consent forms.

Underlying assumptions for child and adolescent psychotherapy

Developmental considerations

Family involvement

Systems involvement

Resiliency

Underlying assumptions for child and adolescent psychotherapy: Developmental considerations

-developmental level will impact how they:

• reason

• approach relationships

• regulate emotion and behavior

• communicate

-Developmental considerations

Partial preview of the text

Download Child & Adolescent Psychotherapy: Midterm Exam, Maternal Mental Health, & Medication and more Assignments Nursing in PDF only on Docsity!

NR606 Midterm Exam (Latest Update)

Questions and Answers (100% Verified

Elaborations)

Steps for Obtaining Informed Consent

Assess pt ability to understand medical info, tx options, to make a voluntary decision.
Present relevant info with accuracy and sensitivity:
diagnosis
nature & purpose of tx options
benefits, risks, burdens of all tx options, including forgoing tx
Document informed consent conversation in the medical record, including all consent forms. Underlying assumptions for child and adolescent psychotherapy Developmental considerations Family involvement Systems involvement Resiliency Underlying assumptions for child and adolescent psychotherapy: Developmental considerations
developmental level will impact how they:
reason
approach relationships
regulate emotion and behavior
communicate
Developmental considerations

inform the diagnostic process
guide tx planning Underlying assumptions for child and adolescent psychotherapy: Family involvement
Family involvement in tx & decision-making
a norm in child and adolescent psychotherapy
invite parents to share the hx of the child or adolescent's chief complaint & prior tx, medical & developmental hx, & behavioral info privately with the therapist ahead of the session
avoid feelings of criticism or discouragement
collaborate with parent or caregiver as a tx partner Underlying assumptions for child and adolescent psychotherapy: Systems involvement
Therapists must consider the systems that surround children & adolescents & promote their development
family
school
peers
the community
Therapy can help promote the child/adolescent's socioemotional competence
help develop a community support system Underlying assumptions for child and adolescent psychotherapy: Resiliency
therapist work to promote resiliency in children & adolescents
using strength-based orientation
supports:
functioning

Referral
Guidance to tx provides those identified as needing more extensive tx with access to specialty care Medication-Assisted Treatment (MAT) Treatment for opioid use disorder combining the use of medications (methadone, buprenorphine, or naltrexone) with counseling and behavioral therapies. Mental health and youth
13% of children ages 8-15 experience a mental health condition
50% of children ages 8-15 experiencing a mental health condition do not receive tx
13 - 20% of children living in the U.S. (1 out of 5 children) experience a mental health condition in a given year
17% of high school students seriously consider suicide
1/2 of all lifetime cases of mental illness begin by age 14 Barriers to Mental Health Treatment in Children and Adolescents
lack of sufficient information or access to services
stigmas or negative perceptions towards mental health services
many drop out before receiving effective treatment, often due to:
poverty
language barriers
living in communities with scarce resources
stressors such as ➣problems in the family ➣violence in the community

➣unstable housing ➣unemployment ➣food insecurity

Cost
scheduling conflicts
long waitlists for services
high staff turnover Prescribing Considerations for Children and Adolescents
physiologic factors impact pediatric med selection & dosing
Children, more rapid metabolism than adults, may require larger dose of med per unit of body weight
Around puberty, pharmacokinetic properties reach adult parameters
dosing after puberty may need to be decreased
Developmental considerations
attuned to signs of adverse effects, younger children may not be able to communicate complaints Kassia, a 5-year-old, is prescribed a stimulant medication for ADHD (Attention Deficit Hyperactivity Disorders) for the first time. Consider Piaget's stages, match the developmentally-appropriate education statements with the correct client: "It's kind of like you've got a great bike. The brakes just need some fixing. The medication is like fixing the brakes." "This medication can help you ignore distractions so you can complete tasks. They can also help with self-control, which ma "Do you know how it's sometimes hard for you to sit still and pay attention at school? This medicine will help you."

"This medication can help you ignore distractions so you can complete tasks. They can also help with self-control, which may help you get along better with your friends and parents. Do you have any concerns about taking the medication?" Rationale: Tamika is in the Formal Operational stage. This stage typically occurs at age 12 and up. Adolescents and young adults begin to reason abstractly and can consider hypothetical problems. They begin to think more about moral, philosophical, ethical, social, and political issues. Addressing Parental Concerns: Collaborative Treatment Plans

tx plans for children typically made in collaboration with parents or guardians
Collaboration between the PMHNP, clients, and families when creating the treatment plan is key to ensuring the plan meets the client's needs and is comfortable and manageable for the family Ethical Considerations in the Treatment of Children and Adolescents Privacy and HIPAA Informed Consent Mandatory Reporting Ethical Considerations in the Treatment of Children and Adolescents: Privacy and HIPAA
parents have right to req access to a minor's mental health record, including symptoms, diagnosis, tx plan
circumstances may limit that right ➣see HIPAA fact sheet Ethical Considerations in the Treatment of Children and Adolescents: Informed Consent
Parents may decide whether to allow tx child is unable to provide true informed consent

children may not be able to give legal consent, should be included in discussions about med & tx whenever possible
encourage tx adherence Ethical Considerations in the Treatment of Children and Adolescents: Mandatory Reporting
PMHNPs mandated reporters in most states
required to report suspicions about abuse or neglect to the appropriate authorities
federal & state statutes include stipulations related to mandatory reporting
PMHNPs responsible for following all relevant statutes in their state of practice most common complication during the perinatal period? Mental health problems maternal mental health
Up to 1 in 5 women will suffer from a maternal mental health disorder like postpartum depression
<15% of women receive tx
1 in 7 will experience depression during pregnancy
Up to 50% of women living in poverty will suffer from a maternal mental health disorder
Maternal mental health disorders impact the whole family, not just moms
More than 600,000 women will suffer from a maternal mental health disorder in the U.S. ever year
Anxiety & depression have risen 37% in teen girls. This will increase the number of women suffering postpartum depression in the future
Rates of depression are more than doubled in Black moms due to cumulative effects of stress called weathering Ethical Considerations in Maternal Mental Health Tx

Increased renal blood flow & GFR may speed the excretion Prescribing Considerations in Maternal Mental Health Tx: Lack of Evidence
psychoactive medications in the perinatal period
paucity of evidence regarding the true risks for the pregnant client and developing fetus ➣limited as pregnant women and newborns are frequently excluded from medication research Prescribing Considerations in Maternal Mental Health Tx: Switching Medications During Pregnancy
switching meds during pregnancy can create a high risk for destabilization of mental illness
puts both the client and fetus at risk for stress & trauma
increases the absolute # of substances to which the fetus is exposed ➣may increase risk for adverse outcomes
If stable on current med regimen, typically better to continue current regimen Allie is a 26-year-old who has been receiving treatment for bipolar I disorder for 3 years. Her symptoms have been in remission with lithium 500 mg twice daily. She also completed 12 weeks of interpersonal and social rhythm therapy (IPSRT) upon diagnosis and used the life charting methodology to track her symptoms. She calls her PMHNP and states "I just found out I'm pregnant. My partner and I were not expecting this, but we are excited! I am worried about what lithium will do to my baby. Sh schedule an appointment for Allie and her husband to discuss a treatment plan as soon as possible ask Allie to continue taking lithium at the current dose for now recommend that Allie begin tracking her mood, sleep schedule, and other symptoms Rationale: Rationale: The PMHNP should schedule an appointment as soon as possible to discuss Allie's treatment plan during her pregnancy. Discontinuation of medications for pregnancy is associated with a relapse rate of 80-100% for clients who take mood stabilizers; therefore, the client should not abruptly

cease taking lithium (Ortega et al., 2023). Clients with a diagnosis of bipolar disorder may benefit from tracking the symptoms of their illness, especially during stressful times. Although reassurance is appropriate, the PMHNP should not minimize the potential risks of continuing medication by telling the client that no harm will come to the baby. Discontinuation of medications for pregnancy is associated with a relapse rate of ___________% for clients who take mood stabilizers 80 - 100% Informed consent: pregnancy

must initiate discussion with pt regarding informed consent for tx
whether new symptoms during pregnancy or already established with care
risks of continuing current meds and the risks of stopping them
help pt process their risk factors & tx hx to make an informed decision
if must remain on high-risk medications such as valproic acid should be thoroughly evaluated by the multidisciplinary team including a perinatal psychiatrist
Documentation should note whether the woman plans to continue with treatment or discontinue the medication Kenya is a 36-year-old who has been taking fluoxetine for three years for major depressive disorder. Her symptoms are currently in remission, and she just found out that she is 7 weeks pregnant. She calls the PMHNP to discuss whether she should continue her medication during pregnancy. After the discussion, Kenya indicates that she will remain on her medication. Which of the following should be included in the discussion and documentation of the call with Kenya? Select all that apply. rare adve rare adverse effect of persistent pulmonary hypertension in the neonate

increases with higher doses
risks and benefits carefully considered, Consider the gestational age of the embryo and fetus
AVOID DURING PREGNANCY
valproic acid and carbamazepine are considered teratogenic Pregnancy Safety Considerations for Common Mental Health Treatment: Meds for Psychosis
atypical antipsychotic medications, particularly olanzapine and quetiapine
increased risk of gestational diabetes ➣D/Cing may not decrease the risk
increased risk of large for gestational age infants
Olanzapine increase the risk of musculoskeletal malformations in infants
Risperidone & quetiapine are the most used antipsychotics during pregnancy
Neither cause malformations
Antipsychotic meds may cause neonatal withdrawal symptoms
close monitoring of newborn several days after delivery Johnita has been taking sertraline 100 mg daily for 4 years for major depressive disorder. Her symptoms have fluctuated over the past year. She is 10 weeks pregnant. Which of the following is the most appropriate recommendation for Johnita? continue sertraline 100 mg daily decrease sertraline to 50 mg daily increase sertraline to 150 mg daily discontinue sertraline

continue sertraline 100 mg daily Rationale: Sertraline is considered a safe medication during pregnancy. The client's symptoms have fluctuated on her current medication dose; therefore, decreasing the dose may cause a relapse of symptoms. Alexandra has been taking lithium 1200 mg orally in two divided doses of 600 mg each for bipolar I disorder. She has been in remission of symptoms for 14 months. She is 7 weeks pregnant. Which of the following is the most appropriate recommendation for Alexandra? obtain serum lithium levels before tapering the lithium dose decrease dose to 600 mg daily decrease dose to 900 mg daily discontinue lithium and switch to lamotrigine obtain serum lithium levels before tapering the lithium dose Rationale: Lithium exposure during the first trimester has a small but statistically significant risk of cardiac malformations; the risk increases with higher dosages of the medication. Obtaining serum lithium levels before tapering the dose is indicated since Alexandra has bipolar I disorder and is stable. The development of the heart begins as early as the third week of gestation with the 4-chamber fetal heart formed by gestational week 7. By the time Alexandra is weaned the risk has passed as the heart is already formed. Although lamotrigine is considered safe during pregnancy, it may not be appropriate for clients who have experienced mania in the past. Saoirse takes aripiprazole 30 mg daily for a diagnosis of schizophrenia. She has taken the medication throughout her pregnancy and is now 34 weeks pregnant. She is concerned about the risks of neonatal withdrawal syndrome once her child is delivered. Which of the following is the most appropriate recommendation for Saoirse?

Safe for Bottle Feeding

Lithium
Lamotrigine
Clozapine Substance Use Disorders During the Perinatal Period
Perinatal SUDs are an urgent public health crisis
increasing across all groups of childbearing people ➣rates rising rural or low-income communities & those with Medicaid coverage for maternity care
greatest risk for life-threatening outcomes of SUDs is among people of color.
hallmark symptoms of SUDs: behavioral, physical, and psychological dependence
most used substance in the perinatal period is tobacco, followed by alcohol, cannabis, and other illicit drugs
use of prescription & illicit opioids also increasing
In US: 70, 000 maternal overdose deaths in 2018, 69% were related to opioid use Health Risks Associated with SUDs: Tobacco No tobacco product is considered safe for use during the perinatal period
Smoking-related pregnancy complications:
ectopic pregnancy
placental abruption
placenta previa
fetal mortality
stillbirth
preterm birth

low birth weight infants
Smoking-related effects on neonates:
sudden infant death syndrome
birth malformations ➣oral clefts ➣neural tube defects
Smoking-related effects on infants, children, and adolescents:
asthma
cognitive impairment
lower respiratory illness
ADHD
central nervous system tumors Health Risks Associated with SUDs: Alcohol
Drinking while pregnant costs the US $5.5 billion
CDC: no safe time to drink during pregnancy, no safe quantity of alcohol to consume while pregnant or trying to get pregnant
1st trimester exposure correlates with the most significant alcohol-related birth outcomes
increased risk for miscarriage, stillbirth, congenital anomalies, low birth weight, small for gestational age, and preterm delivery
Lifelong effects of AUD on children:
fetal alcohol spectrum disorders (FASDs)
neurodevelopmental & CNS deficits
speech & language challenges
cognitive & behavioral deficits
impaired executive functioning

preterm labor
low birth weight
small for gestational age deliveries
adverse effects on fetal and adolescent brain growth
adverse effects on executive functioning skills
behavioral problems
adverse effects on academic achievement
All forms of cannabis have adverse effects, even medical marijuana Marijuana Possible Effects on Your Fetus
Disruption of brain development before birth
Smaller size at birth; higher risk of still birth
Higher chance of being born too early, especially when a woman uses both marijuana and cigarettes during pregnancy
Harm from second-hand marijuana smoke: Behavioral problems in childhood and trouble paying attention in school Marijuana Possible Effects on You
Permanent lung injury from smoking marijuana
Dizziness, putting you at risk for falls
Impaired judgment, putting you at risk of injury
Lower levels of oxygen in the body, which can lead to breathing problems Health Risks Associated with SUDs: Cocaine
majority of women addicted to cocaine are of childbearing age
linked with poor pregnancy-related outcomes:

premature rupture of membranes
placental abruption
preterm birth
low birth weight
small for gestational age deliveries, as well
long-term effects in children and adolescents:
lower short-term memory
child and adolescent delinquent behavior
earlier age of sexual activity
substance use Health Risks Associated with SUDs: Opioids
epidemic in the U. S.
Opioid use disorder (OUD) during pregnancy, including heroin & prescription opioids, increases risk of maternal life-threatening health problems & death by 50%
greater risk of eclampsia, heart attack or heart failure, & sepsis
Infants experience significant adverse effects:
neonatal abstinence syndrome (NAS)
increased risk of toxemia
low birth weight
respiratory complications
third trimester bleeding and mortality
postnatal growth deficiency
microcephaly
neurobehavioral problems
sudden infant death syndrome (SIDS)
4x as many infants were born with neonatal abstinence syndrome (NAS) in 2014 than in 1999

Child & Adolescent Psychotherapy: Midterm Exam, Maternal Mental Health, & Medication, Assignments of Nursing

Related documents

Partial preview of the text

Download Child & Adolescent Psychotherapy: Midterm Exam, Maternal Mental Health, & Medication and more Assignments Nursing in PDF only on Docsity!

NR606 Midterm Exam (Latest Update)

Questions and Answers (100% Verified

Elaborations)