Nursing Diagnoses and Interventions – Autism Spectrum Disorder (ASD) (Nursing)

00:00 So what are some of the nursing diagnoses that we are going to look at for ASD? Of course safety. I may come back to that. I want to start with impaired social interaction, impaired verbal communication, risk of self-harm and injury, and of course safety.

00:28 We want to make sure we keep this child safe. How do we maintain a safe environment for the child with ASD? Well, we could remove objects that would cause any injury, we can reduce stimuli in the room. We also want to make sure that we start developing a relationship with the child and the child's family, develop the therapeutic trusting relationship. How does that occur? That occurs because we take the time, number 1, to identify strengths. What can this child do? And then to explain everything that we're going to do slowly and carefully and remember silence is a very very good communication to all. And so if you explain something, wait a minute notice if the child is listening.

01:33 The child may not have eye contact with you. Do not insist "Look at me. Do you hear me? Look at me." If the child is uncomfortable with eye contact, forcing a child to look at you will not allow that child to engage the prefrontal cortex and hear you because now all of their being is on "I have to look." So we want to make sure that we are respecting the abilities of that child, recognizing where those abilities and not forcing that child past what is a comfort zone. We can do reflective listening. The child can let us know. If they are letting us know thru non-verbal mechanisms, you can say "I see that you are anxious. I wanna make this better. I wanna help. I'm just gonna sit here and I'm gonna make sure that you stay safe." We want to maintain consistency in all of our interactions so we would limit how many people are going to go in and work with this child. We're going to use familiar objects with this child. We won't walk in every single time with something new. And we're going to anticipate what their needs are since they can't verbally let us know. And we're going to make sure that those needs are met. So, one of the nursing interventions that we use with kids with ASD is positive reinforcement and that means that we recognize those actions that they are doing that are going to help them to advance emotionally and physically. So, how do we do that? We approach them with acceptance. We maintain a supportive attitude for them and then we use positive reinforcement, for example, sometimes it might be a sticker. So if we ask everyone to brush their teeth and we see the child with ASD is brushing his or her teeth, we put a little sticker on the calendar saying "This was a great day." And we say, "This was a great day, I noticed you brushing your teeth. That is so good." This kind of positive reinforcement is very effective with children with ASD. One of our most important nursing interventions for children with autism spectrum disorder as well as adults, but today we're focused on the children, is to assess them for actual as well as risk of self-mutilation. And what do we mean by self-mutilation? It could be scratching, it could be cutting, it could be hair pulling, it could be anything that causes mutilation of the skin or the body. Oftentimes this occurs, this kind of behaviors occur at times where there is increased anxiety and so we want to determine what might the cause of that increased anxiety be for this person. And if we notice that anxiety is beginning to build, we can involve the patient with some sort of diversions or perhaps a replacement activity.

05:15 An example of that is, say for example, one of the children doesn't like showers. The idea of showers, the way the shower feels on the skin the child is afraid and when they hear the shower go on on the unit they become very anxious and we can take them aside away from the shower and we can explain to them that there's a bath tub or they can also have a small tub where they can wash themselves. And we can also do diversion, we can move them in and have them watch TV while other people are taking the shower if that is the time where their anxiety goes up. It's important to consider working one on one, not surrounding the child with a lot of people which only would increase that level of anxiety.