Boyd 8e

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UNIT VII • Care of Children and Adolescents

Taking Action: Nursing Interventions Priorities of nursing care for children or adolescents who are depressed are similar to those for adults. Treatment goals include improving the mood and restoring sleep, appetite, and self-care. Interventions for responses to mood disorders in children and adolescents are also sim ilar to those for adults. The psychiatric nurse develops a therapeutic relationship with the child and provides par ent education and support. Developing sensitivity to the influence of environmental events on the child is import ant for the nurse, parents, and teachers (Box 37.13). Medication Interventions Children and adolescents may be treated with medica tion. Antidepressant medications are used for depres sion and mood antipsychotics for bipolar disorder. The controversy surrounding the use of SSRIs in children reminds us that all treatments involve a risk–benefit equation. Given the modest benefit of the SSRIs and the Mrs. S has just returned with her son Jared to the child psychiatric inpatient services facility after an overnight pass. She reports that the visit did not go well because of Jared’s anger and defiance. She remarked that this behavior was distressingly similar to his behavior before the hospitalization. She expressed additional concern because of the upcoming discharge from the hospital. After saying goodbye to Jared, she pulled the nurse aside and stated that she had decided to file for divorce. Mrs. S indicated that she had not told her husband or the family therapist. When asked whether Jared knew about her decision, Mrs. S suddenly realized that he may have overheard her discussing the matter with her sister on the telephone during this home visit. How should the nurse approach this situation? CHOICE Possible Outcomes Discuss her hypothesis about Jared’s behavior and his uncertainty Mother can see relationship between Jared’s behav ior and her plan for divorce. Mother ignores the nurse. Mother is interested but does not see the connection. Ignore the statement Child and family did not learn about the connection between Jared’s behavior and the events at home. Encourage Jared’s mother to sort out her issues. The focus is then on mother’s issues. Analysis The best response is focusing on the possible relationship between Jared’s recent behavioral deterioration and his uncertainty about his family’s future. If the nurse ignores the statement or focuses on the mother’s interpretation of Jared’s behavior, the mother is less likely to appreciate the connection between her pending divorce and Jared’s behavior. The nurse should also emphasize the impor tance of discussing the matter in family therapy. BOX 37.13 Questions, Choices, and Outcomes

potential for side effects, these medications merit careful monitoring in children and adolescents. Patient monitor ing should focus on evidence of benefit and side effects, including sleep issues, hyperactivity, sudden changes in mood or behavior, suicidal ideation, or self-injurious behavior. Spiritual Interventions Nurses should keep in mind the role of religion and spir ituality in their patients’ lives. Integrating religious and spiritual practices—for example, forgiveness, gratitude, compassion, and acceptance—into a plan of care may be effective in adolescents with depression and anxiety. These practices may also contribute to the development of pos itive identity; provide opportunities for strength, support, and social connectedness; and facilitate positive coping mechanisms. Additionally, religious beliefs and spiritual practices can strengthen family bonds and serve as inspi ration and comfort in times of difficulty, trauma, or loss (Aggarwal et al., 2023; Camino-Gaztambide et al., 2022). CHILDHOOD SCHIZOPHRENIA Childhood (early-onset) schizophrenia is diagnosed by the same criteria as those used in adults (see Chapter 24). Difficulty in diagnosing a psychiatric disorder in children has led to years of debate and controversy regarding whether childhood schizophrenia differs from the adult type or is merely an early manifestation of the same disorder. For many years, it was believed that autism rep resented the childhood form of schizophrenia. However, today autism and childhood schizophrenia are differ entiated. As currently defined, childhood schizophrenia (onset before the age of 13 years) is very rare, but preva lence increases sharply during adolescence, especially in young males (Sunshine & McClellan, 2022). Childhood schizophrenia is usually characterized by poorer premorbid functioning than late-onset schizophre nia. Common premorbid difficulties include social, cogni tive, linguistic, attentional, motor, and perceptual delays. Taken together, these findings suggest that early-onset schizophrenia is a more severe form of the disorder. Nursing care for children with schizophrenia follows an approach similar to that for ASD. Antipsychotic med ications are not generally approved for use in children, although the newer atypical antipsychotic medications appear to have a lower risk for neurologic effects; other side effects such as weight gain also warrant careful monitoring. Development of an individualized care plan for chil dren with schizophrenia begins with a nursing assessment to identify functional issues specific to the child. Similarly, the recognition that childhood schizophrenia is a chronic and severe condition should guide the identification of outcomes. Goals should be realistic; the nurse should pay special attention to the child’s support systems. Parent

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