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Care of the Child with a Mental or Cognitive Disorder
Chapter 32Chapter 32
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 2Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of Cognitive FunctionDisorders of Cognitive Function
• Cognitive Impairment Formerly referred to as mental retardation The most common developmental disability, affecting
up to 3% of the population Defined as significantly subaverage general
intellectual functioning existing concurrently with deficits in adaptive behavior and manifested during the developmental period
Slide 3Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of Cognitive FunctionDisorders of Cognitive Function
• Cognitive Impairment (continued) Four Categories
• Mild: IQ of 50 or 55 to 70
• Moderate: IQ of 35 or 40 to 50 or 55
• Severe: IQ of 20 or 25 to 35 or 40
• Profound: IQ below 20 to 25
Slide 4Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of Cognitive FunctionDisorders of Cognitive Function
• Cognitive Impairment (continued) Etiology/pathophysiology
• Down syndrome
• Perinatal infections Cytomegalovirus, rubella, syphilis
• Perinatal anoxia
• Maternal drug or alcohol abuse
• Metabolic disorders Phenylketonuria, lead poisoning, hypothyroidism, and
prematurity
Slide 5Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of Cognitive FunctionDisorders of Cognitive Function
• Cognitive Impairment (continued) Clinical manifestations
• They vary according to the child’s age and degree of impairment.
• Children may fail to achieve developmental milestones at appropriate ages.
• In general, children may manifest delays in motor, social, cognitive, and language skills.
Slide 6Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of Cognitive FunctionDisorders of Cognitive Function
• Cognitive Impairment (continued) Diagnostic tests
• Neurologic examination
• CT scan
• Serum metabolic screening
• Developmental screening tests (Denver II)
• Standardized intellectual tests
• Chromosomal analysis
• Genetic screening
Slide 7Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of Cognitive FunctionDisorders of Cognitive Function
• Cognitive Impairment (continued) Nursing interventions
• Interventions are focused on promoting optimal development and providing the family with support, education, and referrals.
• Parents should be encouraged to enroll the child in an early intervention program.
• Each task that is taught should be broken into small, specific steps.
• Parents should be encouraged to emphasize the normal needs of all children: love, social interaction, and play.
Slide 8Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of Cognitive FunctionDisorders of Cognitive Function
• Cognitive Impairment (continued) Patient/family teaching
• It is essential to provide parents with information on normal developmental milestones, stimulation techniques, safety, normal speech development, sexual development, and the role of positive self-esteem in motivating children to accomplish goals within their limitations.
Prognosis• Cognitive impairment is a chronic condition.
Slide 9Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of Cognitive FunctionDisorders of Cognitive Function
• Down Syndrome Etiology/pathophysiology
• An extra chromosome on the 21st pair, trisomy 21.
• The risk of having a child with Down syndrome increases with aging maternal age, especially for women over 35 years of age.
Slide 10Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of Cognitive FunctionDisorders of Cognitive Function
• Down Syndrome (continued) Clinical manifestations
• Small, rounded skull with a flat occiput
• Upward-slanting eyes
• Broad, flat nose; low-set ears
• Protruding tongue
• Short, thick neck
• Hypotonic extremities
• Mottled skin
• Simian crease on the palmar side of the hand
• Intellectual impairment
Slide 11Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of Cognitive FunctionDisorders of Cognitive Function
• Down Syndrome (continued) Diagnostic tests
• Chromosomal analysis Medical management
• Routine medical care
• Corrective surgery for heart defects
• Auditory and vision screening
• Thyroid function tests
Slide 12Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of Cognitive FunctionDisorders of Cognitive Function
• Down Syndrome (continued) Nursing interventions
• Primary nursing goals include supporting the family at the time of diagnosis and referring the child and family to agencies that provide support and services.
Prognosis• Life expectancy has improved in recent years but
remains lower than that for the general population.
• Over 80% survive to age 30 years and beyond.
Slide 13Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Figure 32-1Figure 32-1
Down syndrome in infant.
(From Hockenberry-Eaton, M.J., Wilson, D., Winkelstein, M.L., Kline, M.D. [2003]. Wong’s nursing care of infants and children. [7th ed.]. St. Louis: Mosby.)
Slide 14Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of Cognitive FunctionDisorders of Cognitive Function
• Autism Etiology/pathophysiology
• Complex developmental disorder of brain function accompanied by a broad range and severity of intellectual and behavioral deficits.
• Multiple biologic causes
• Strong evidence for a genetic basis
Slide 15Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of Cognitive FunctionDisorders of Cognitive Function
• Autism (continued) Clinical manifestations and diagnostic tests
• There is inability to maintain eye contact.
• Body contact is avoided at a very early age.
• Child has limited functional play and may interact with toys in an unusual manner.
• Constipation is common.
• There are deficits in social development.
• A majority have some degree of mental retardation, but some may excel in particular areas, such as art, music, memory, or mathematics.
Slide 16Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of Cognitive FunctionDisorders of Cognitive Function
• Autism (continued) Nursing interventions
• Therapeutic intervention is a specialized area involving professionals with advanced training.
• During hospitalization Parents are essential to planning care. Decrease stimulation. Minimize holding and eye contact. Care must be taken when performing procedures. Introduce new situations slowly.
Slide 17Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of Cognitive FunctionDisorders of Cognitive Function
• Autism (continued) Prognosis
• This is usually a severely disabling condition.
• Some children improve with acquisition of language skills and communication.
• Some ultimately achieve independence, but most require lifelong adult supervision.
• Prognosis is most favorable for children with communicative speech development by age 6 years and an IQ above 50 at the time of diagnosis.
Slide 18Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Child MaltreatmentChild Maltreatment
• Child Neglect Physical
• Failure of a parent or caretaker to supply a child with adequate food, clothing, shelter, education, or health care although financially able to do so or offered financial or other means to do so
Emotional• Failure by a parent or caretaker to meet a child’s needs
for emotional nurturance, affection, and attention
Slide 19Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Child MaltreatmentChild Maltreatment
• Child Abuse Physical
• The intentional, nonaccidental infliction of physical injury upon a child by a parent or guardian
Emotional • The intentional attempt by a parent or caretaker to
impair or destroy the mental or emotional state of a child
Slide 20Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Child MaltreatmentChild Maltreatment
• Child Abuse (continued) Sexual
• Commission of a sexual offense by an older person against a child who is dependent or developmentally immature for the purpose of the perpetrator’s own sexual stimulation or gratification
Slide 21Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Child MaltreatmentChild Maltreatment
• Etiology Parental factors
• Parent’s culture
• Socialization history and history of having been an abused child
• Parent’s age and developmental level
• Attitudes toward the child and child rearing
• Knowledge of normal child behavior and development
• Parent’s psychologic state
Slide 22Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Child MaltreatmentChild Maltreatment
• Etiology (continued) Child’s factors
• Temperament
• Age
• Exceptional physical needs
• Disabilities
• Health or behavior problems These factors may increase the potential for
maltreatment by a parent or caretaker.
Slide 23Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Child MaltreatmentChild Maltreatment
• Etiology (continued) Situational factors
• Marital problems
• Financial difficulties
• Drug and/or alcohol abuse
• Lack of social support or the inability of the parent or caretaker to ask for support
• Poor social network
• Poor relationships with extended families
Slide 24Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Child MaltreatmentChild Maltreatment
• Clinical Manifestations Children who have been abused or neglected may
manifest certain physical and/or behavioral indicators that suggest maltreatment (see Table 3-1 in the text).
Slide 25Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Child MaltreatmentChild Maltreatment
• Nursing Interventions Identify a child who is being maltreated. The nurse often is the first person to see the child and
parent. The presence of a behavioral or physical indicator of
maltreatment should serve to prompt further investigation.
Special attention should be paid to injuries that are unexplained or inconsistent with the parent’s or caretaker’s explanation of how the injury occurred.
Slide 26Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Child MaltreatmentChild Maltreatment
• Nursing Interventions (continued) All states have regulations for the mandatory reporting
of child maltreatment when a health professional has reason to suspect that a child has been abused or neglected.
During the prenatal period, families at risk for abuse can be identified and referred for intervention.
Reinforcement of positive caretaking behaviors is an effective way of affirming positive parenting practices.
Slide 27Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
School Avoidance (School Phobia, School Refusal)School Avoidance (School Phobia, School Refusal)
• Occurs when a physically healthy child repeatedly stays home from school or is sent home from school for physical symptoms of an emotional origin.
• Etiology/pathophysiology Cause may be related to anxiety or worry about
academic progress, peer conflicts, or marital discord in the home.
Separation anxiety is also common among these children even after the age when this should be mastered (3 to 4 years).
Parents may be too lenient, place little value on education, or be unconcerned about the ramifications of missing school.
Slide 28Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
• Clinical Manifestations Children who are of the anxious type tend to have
physiologic symptoms of anxiety, including• Headache
• Recurrent abdominal pain
• Vomiting, diarrhea
• Insomnia
• Pallor
• Palpitations
• Hyperventilation
School Avoidance (School Phobia, School Refusal)School Avoidance (School Phobia, School Refusal)
Slide 29Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
• Clinical Manifestations (continued) May exaggerate or fabricate symptoms
• Sore throat
• Leg pain
• Coughing tics
• Chest pain
• Fatigue No organic cause can be found. The child usually sounds very sick but appears to
be well.
School Avoidance (School Phobia, School Refusal)School Avoidance (School Phobia, School Refusal)
Slide 30Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
• Medical Management/Nursing Interventions Assist in convincing parents that their child is healthy;
explain the diagnosis. Assist in returning the child to regular school
attendance. Assure parents that this occurs in “normal” children
and is stress-related and not a psychiatric disorder. Encourage parents to be firm if the child refuses to go
to school; reassure child that there is nothing physically wrong with him or her.
School Avoidance (School Phobia, School Refusal)School Avoidance (School Phobia, School Refusal)
Slide 31Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Learning DisabilitiesLearning Disabilities
• Etiology/Pathophysiology Cause is multifactorial; often a specific cause cannot
be identified. It may be the result of various physiologic and/or
environmental factors such as intrauterine exposure to drugs or infection, birth trauma, lead poisoning, seizures, malnutrition, and exposure to toxic substances, such as alcohol and lead.
Hearing or vision impairments may lead to learning problems.
Genetic syndromes such as fragile X syndrome or Prader-Willi syndrome may be associated.
Slide 32Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Learning DisabilitiesLearning Disabilities
• Clinical Manifestations Problems with speech, behavior, and/or motor
coordination Failure to master basic, grade-appropriate academic
skills in one or more subject areas A progressive decline in school performance Delayed acquisition of language milestones, deficient
social skills, avoidance behavior, low frustration tolerance, disorganization, and somnolence
Slide 33Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Learning DisabilitiesLearning Disabilities
• Diagnostic Tests Thorough history and physical examination may
provide specific indications to obtain• Lead level
• EEG
• Chromosomal studies
• Hearing and vision screenings
• Intelligence and achievement testing
• Neuropsychological testing
Slide 34Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Learning DisabilitiesLearning Disabilities
• Medial Management/Nursing Interventions Provide educational referrals. Educate parents about the special education process. Therapeutic manipulation of the educational setting:
suggest special arrangements in a regular classroom; alternative classroom placement, tutoring, and remediation assistance.
• Prognosis With early identification, appropriate referrals, and
proper educational interventions, the negative consequences of school failure may be avoided; child can usually function optimally within his or her limitations.
Slide 35Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Attention Deficit Hyperactivity DisorderAttention Deficit Hyperactivity Disorder
• Etiology/Pathophysiology Multifactorial Incidence in first-degree relatives of 25%. Theories of altered neurotransmitter profiles Possible environmental factors: low socioeconomic
status and parental psychopathology
Slide 36Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Attention Deficit Hyperactivity DisorderAttention Deficit Hyperactivity Disorder
• Clinical Manifestations May exhibit
• Decreased attention span
• Impulsivity
• Failure to follow instructions
• Hyperactivity; fidgeting
• Poor self-regulation
• Noncompliance
• Aggression
• Immaturity during play
• Failure to follow rules of play games
Slide 37Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Attention Deficit Hyperactivity DisorderAttention Deficit Hyperactivity Disorder
• Clinical Manifestations (continued) May exhibit
• Lack of turn-taking during play
• Easy distraction by extraneous stimuli
• Poor school performance; learning disabilities
• Antisocial behaviors: lying, cheating, stealing
• Excessive anxiety
• Sleep disturbances
• Poor peer relationships
• Limited fine motor skills
• Additional psychiatric diagnosis
Slide 38Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Attention Deficit Hyperactivity DisorderAttention Deficit Hyperactivity Disorder
• Diagnostic Tests Report of characteristic behaviors made by multiple
observers, over an extended period of time, and in various settings
Many rating scales available to assess ADHD
Slide 39Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Attention Deficit Hyperactivity DisorderAttention Deficit Hyperactivity Disorder
• Medical Management Behavioral counseling Educational intervention Pharmacotherapy
• Nursing Interventions Provide counseling. Educate parents on discipline and setting limits. Explain need for increased supervision. Assist in the development of the educational plan
where appropriate. Explain reasons for medications and risks.
Slide 40Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Other DisordersOther Disorders
• Anorexia and Bulimia Eating disorders with significant underlying
psychologic and emotional issues Primarily affect adolescents, but younger children may
be affected
• Substance Abuse Substance abuse usually points to significant
problems in the child, family, or both, warranting professional counseling.
In the adolescent, the incentives are usually experimental and recreational.
Slide 41Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Other DisordersOther Disorders
• Depression Depression is generally defined as a mood
disturbance with overall feelings of sadness, despair, worthlessness, or hopelessness.
Girls are more likely than boys to suffer from depression.
Etiology/pathophysiology• Causes have not been established.
• Risk factors can be genetic or environmental.
• Cognitive theories attribute depression to actual loss or perceived loss.
Slide 42Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Other DisordersOther Disorders
• Depression (continued) Clinical manifestations
• Infancy: crying, panic, followed by apathy, blank staring, and sad facial expressions
• School-aged: sad facial expressions, irritability, crying easily, accident-prone, social withdrawal, and eating and sleeping disturbances
• Adolescents: impulsiveness, somatization disorders, eating disorders, drug/alcohol use, antisocial behavior, withdrawal, fatigue, and suicidal ideation
Slide 43Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Other DisordersOther Disorders
• Depression (continued) Diagnostic tests
• Structured questionnaires or interviews Children’s Depression Scale Depression Self-Rating Scale
Medical management• Antidepressant medications
• Psychologic therapies
Slide 44Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Other DisordersOther Disorders
• Depression (continued) Nursing interventions
• Establish a trusting relationship with the child.
• Provide support to the child’s family, using open and honest communication
Patient/family teaching• Review the treatment plan with the family to help them
realize recovery may be a lengthy process.
Slide 45Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Other DisordersOther Disorders
• Depression (continued) Prognosis
• For the child and family motivated to develop better supports and relationship skills, the prognosis is good, but episodes may recur.
Slide 46Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Other DisordersOther Disorders
• Suicide Etiology/pathophysiology
• Suicide is not caused by a single factor but is the culmination of multiple factors.
Depression Loss of a loved one or relationship Social isolation Lack of attaining a sense of identity, leading to self-doubt
and low self-esteem
Slide 47Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Other DisordersOther Disorders
• Suicide (continued) Diagnostic tests
• Structured questionnaires or interviews Children’s Depression Scale Depression Self-Rating Scale
Medical management• Individual, family, and group therapy
Slide 48Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Other DisordersOther Disorders
• Suicide (continued) Nursing interventions
• Mental health assessments of children and adolescents should be part of every health visit.
• If concerns exist, be direct in asking questions about thoughts of death or suicide.
• Any threat of suicide needs to be taken very seriously and immediately evaluated by a mental health professional.
• Help the child develop positive coping strategies in stressful situations.
Slide 49Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Other DisordersOther Disorders
• Suicide (continued) Prognosis
• Prognoses vary.
• The greatest risk lies in children who verbalize suicidal thoughts and those who attempt suicide.
• Appropriate mental health care can help these children to alleviate depression and develop a more positive self-image.
Slide 50Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Other DisordersOther Disorders
• Suicide (continued) Clinical manifestations
• Many completed suicides are the final result of previous attempts.
• Warning signs include Depression; withdrawal; loneliness Preoccupation with death Perceived or actual social isolation Poor school performance Drug and/or alcohol abuse Appetite and sleep disorders
Slide 51Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Other DisordersOther Disorders
• Psychogenic Abdominal Pain (Recurrent Abdominal Pain) Etiology/pathophysiology
• Psychogenic pain is often related to emotional factors in the child/or family members: poor self-esteem, anxiety, depression, school phobia, maternal depression, marital problems/divorce, or other health problems in family members.
• Organic causes should be considered until proved otherwise: infections of the urinary tract, GI tract, and reproductive tract.
Slide 52Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Other DisordersOther Disorders
• Psychogenic Abdominal Pain (Recurrent Abdominal Pain) (continued) Clinical manifestations
• Usually afebrile
• May have occasional vomiting and constipation
• Abdominal pain usually nonspecific
Slide 53Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Other DisordersOther Disorders
• Psychogenic Abdominal Pain (Recurrent Abdominal Pain) (continued) Diagnostic tests
• Organic causes must be ruled out.
• CBC, sedimentation rate, urinalysis and culture, serum albumin and amylase, stool for occult blood, and culture for bacteria and parasites
• In adolescent females, a pregnancy test may be considered.
Slide 54Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Other DisordersOther Disorders
• Psychogenic Abdominal Pain (Recurrent Abdominal Pain) (continued) Medical management
• Once organic causes have been ruled out, stressors in the child’s life need to be identified and addressed.
• Consult with a mental health professional. Nursing interventions
• Encourage parents to maintain a normal schedule for their child with regard to school, play, and exercise.