Autism Spectrum Disorders - Nursing Case Study

Pathophysiology

• Primary mechanism: Altered brain development - Autism is associated with changes in brain development during early childhood. This includes irregularities in the growth and development of the neural networks that facilitate communication between different parts of the brain. This can affect social interactions, behavior, and language skills.

• Secondary mechanism: Genetic factors - Autism often runs in families, suggesting a genetic component. Certain genetic mutations may make a child more susceptible to the disorder. These mutations may be inherited, or they may occur spontaneously at conception.

• Key complication: Social communication difficulties - Autism affects a child's ability to interact with others. They can struggle with understanding social cues, expressing emotions, and maintaining conversations. This can lead to difficulties in forming and maintaining relationships.

Patient Profile

Demographics:

8 years old, male, student

History:

• No significant past medical history

• Currently not on any medications

• No known allergies

Current Presentation:

• Chief complaint: Difficulty in social interaction and communication, repetitive behaviors

• Key symptoms: Avoids eye contact, prefers solitary play, has trouble understanding other people's feelings, has delayed speech and language skills, repeats words or phrases over and over, gets upset by slight changes in routine

• Vital signs: Temperature 98.2 F, Heart rate 82 bpm, Respiration rate 20 breaths per minute, Blood pressure 100/65 mm Hg.

Section 1

Initial Assessment Findings:

During the initial assessment, the nurse observes that the child exhibits a lack of interest in engaging with others, including the nurse and his mother, and seems to be preoccupied with a toy car. He repeats the same action of moving the car back and forth, showing a strong tendency towards repetitive behavior. When asked simple questions by the nurse, the child does not respond verbally but points or uses other non-verbal cues. His mother mentions that he has a limited vocabulary and often repeats the same phrases. The child also shows signs of agitation and distress when the nurse tries to interrupt his play to conduct the physical examination, indicating an intolerance to changes in routine.

Despite the behavioral challenges, the child's physical health appears to be good. His weight is within the 50th percentile for his age, and his height is within the 60th percentile. His skin is warm and dry with good turgor, and his heart and lung sounds are normal. The nurse also notes that the child’s motor skills seem to be consistent with his age, as he is able to manipulate the toy car with dexterity, suggesting that his difficulty lies primarily in the social and communication aspects of development.

This initial assessment suggests that the child's symptoms are consistent with Autism Spectrum Disorder (ASD), and a referral to a developmental pediatrician for a comprehensive evaluation would be the next logical step. In the meantime, the nurse recommends that the mother consider speech therapy and behavioral interventions to address the child's communication and social interaction difficulties.

Section 2

Following the initial assessment, the nurse facilitates the child's referral to a developmental pediatrician. The pediatrician conducts a series of diagnostic evaluations, including a comprehensive neurodevelopmental assessment, an audiological examination to rule out hearing impairment, and genetic testing to investigate possible underlying genetic disorders. The neurodevelopmental assessment confirms the nurse's initial suspicion of Autism Spectrum Disorder (ASD). The audiological examination reveals normal hearing, and the genetic tests show no identifiable genetic abnormalities.

The pediatrician shares these findings with the mother and the nurse, emphasizing that although ASD is a lifelong condition, early intervention can significantly improve the child's ability to function and interact with others. They discuss various therapeutic options, including applied behavior analysis (ABA), occupational therapy, and speech therapy. The mother expresses concern about the child's limited verbal communication and decides to start with speech therapy.

The child begins speech therapy sessions twice a week. The speech therapist employs play-based techniques to encourage verbal communication, and the child starts to show small but positive responses. He is gradually able to associate words with objects and actions, and his vocabulary begins to expand slightly. However, he still prefers non-verbal communication and exhibits distress when required to break from his routines. These small but steady improvements show that the child is responding to the intervention, but it also underscores the need for continued therapy and support. It is clear that managing ASD will be a long-term process, requiring ongoing assessment and individualized care.

Section 3

Three months into the speech therapy sessions, the nurse notices a change in the child's status during a routine follow-up. The child, previously passive and calm, appears more agitated and restless. He is also exhibiting new self-stimulatory behaviors such as hand-flapping and rockings. His mother reports that his sleep has been disturbed for the past couple of weeks and he seems to have lost his appetite too, leading to a 2-pound weight loss over the one month.

Upon further assessment, the nurse takes the child's vital signs which are within normal ranges (BP: 95/60 mmHg, HR: 85 bpm, RR: 22/min, Temp: 98.6°F). However, the nurse also documents a rash on the child's arms and legs. The mother mentions that it started as a small spot but spread quickly over the past week. The nurse recognizes these signs could indicate a new complication such as an allergic reaction or an infection. She recommends the mother to consult with the pediatrician for a complete physical examination and blood tests, including complete blood count (CBC) and C-reactive protein (CRP), to determine the cause of the rash and address the child's restlessness and appetite loss. The nurse reassures the mother that managing these new challenges early can prevent them from hindering the child's progress with his speech therapy.

Section 4

A week later, the mother returns with the child for a follow-up visit. The mother reports that the pediatrician found the child to have an allergic reaction, likely from a recent change in laundry detergent. The rash had begun to subside with the help of a prescribed topical cream and switching back to the previous detergent. Despite this, the child's agitation and restlessness remained consistent, causing further disruption in his sleep and appetite.

The nurse notes that the child's weight has dropped another pound over the week and his sleep pattern remains disturbed, with the mother reporting him getting approximately 5-6 hours of sleep per night, instead of the usual 9-10 hours. The nurse recognizes these continued symptoms may be signs of anxiety, a common co-occurring condition with Autism Spectrum Disorder. She suggests that the mother consult with the child's pediatrician and a mental health professional to discuss possible strategies or interventions to manage the child's anxiety levels and improve his sleep and appetite. The nurse also emphasizes the importance of maintaining a stable environment and routine for the child, as sudden changes can often trigger anxiety in children with autism.

Section 5

Upon the next visit, the mother reports a slight improvement in the child's restlessness after implementing a more consistent routine and avoiding any sudden changes in his environment. However, the child's sleep patterns still remain disturbed, causing him to be irritable during the day. The nurse takes the child's vital signs and notes a slightly elevated heart rate of 100 beats per minute and a reduction in weight by another half pound. She also observes that the child appears more withdrawn and less responsive than usual.

The nurse recommends the mother to share these observations with the pediatrician and the mental health professional, suggesting they might want to conduct a comprehensive assessment for anxiety. This could involve a detailed behavioral observation, parent interviews, and potentially, use of standardized anxiety rating scales suitable for children on the autism spectrum. The nurse provides reassurance to the mother, explaining that early detection and management of anxiety can significantly improve the child's quality of life and overall development. The nurse also reinforces the importance of maintaining the child's routine and monitoring his reactions to changes in his environment.