Friday, October 9, 2009

Nursing care plans for Conduct Disorder

. Friday, October 9, 2009

Aggressive behavior is the hallmark of conduct disorder. The conduct is more serious than the ordinary mischief and pranks of children and adolescents. The disorder is more common in boys than in girls, and the behaviors may continue into adulthood, often meeting the criteria for antisocial personality disorder a child with this disorder fights, bullies, intimidates, and assaults others physically or sexually, and is truant from school at an early age. Typically, the patient has poor relationships with peers and adults and violates others' rights and society's rules. Conduct disorder evolves slowly over time until a consistent pattern of behavior is established.

Causes for Conduct Disorder
Studies have suggested that conduct disorder has both biological (including genetic) and psychosocial components. Roughly 30% to 50% of patients with conduct disorder also have attention deficit hyperactivity disorder (ADHD).

Predisposing Factors for Conduct Disorder
Physiological: Birth Temperament, Genetics
Psychosocial: Peer Relationships, Theory of Family Dynamics
  • Parental rejection
  • Inconsistent management with harsh discipline
  • Early institutional living
  • Frequent shifting of parental figures
  • Large family size
  • Absent father
  • Parents with antisocial personality disorder and/or alcohol dependence
  • Association with a delinquent subgroup
  • Marital conflict and divorce
  • Inadequate communication patterns
  • Parental permissiveness

Complications for Conduct Disorder
The prognosis is worse in children with earlier onset; these children are more likely to develop antisocial personality disorder as adults. Social complications may include poor performance in school and substance abuse, and the child may suffer physical injury from fights or accidents due to risk-taking behaviors. Patients with conduct disorder also tend to have higher incidences of other psychological disorders, including ADHD, oppositional-defiance disorder, mood disorders, anxiety disorders, depression, and learning difficulties

Nursing Assessment Nursing care plans for Conduct Disorder
Signs and symptoms of conduct disorder include: abusing others sexually, cheating in school, cruelty to animals, engaging in precocious sexual activity, fighting with family members and peers, skipping classes, smoking cigarettes, speaking to others in a hostile manner, stealing or shoplifting, using drugs or alcohol, vandalizing or destroying property.

  • Uses physical aggression in the violation of the rights of others.
  • The behavior pattern manifests itself it virtually all areas of the child’s life (home, school, with peers, and in the community).
  • Stealing, fighting, lying, and truancy are common problems.
  • There is an absence of feelings of guilt or remorse.
  • The use of tobacco, liquor, or no prescribed drugs, as well as the participation in sexual activities, occurs earlier than the peer group’s expected age.
  • Projection is a common defense mechanism.
  • Low self-esteem is manifested by a “tough guy” image. Often threatens and intimidates others.
  • Characteristics include poor frustration tolerance, irritability, and frequent temper outbursts.
  • Symptoms of anxiety and depression are not uncommon.
  • Level of academic achievement may be low in relation to age and IQ.
  • Manifestations associated with ADHD (e.g., attention difficulties, impulsiveness, and hyperactivity) are very common in children with conduct disorder.

Treatment for Conduct Disorder
Treatment focuses on coordinating the child's psychological, physiologic, and educational needs. A structured living environment with consistent rules and consequences can help reduce a variety of symptoms. Parents need to be taught how to deal with the child's demands. Juvenile justice interventions may also be used. Medication can be useful as an adjunct to treatment. Overt aggression responds to many medications, such as antipsychotics, lithium, clonidine, and selective serotonin reuptake inhibitors. ADHD, if present, must also be addressed.

Nursing diagnosis nursing care plans for Conduct Disorder
  • Risk for self-directed or other-directed violence
  • Defensive coping
  • Impaired social interaction
  • Ineffective coping
  • Low self esteem
  • Nursing Diagnosis Anxiety
  • Disabled family coping
  • Noncompliance
  • Impaired adjustment
  • Interrupted family processes

Nursing Key outcomes, Nursing interventions, and patient teaching nursing care plans for Conduct Disorder


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