Tics
Tics: Excerpt from Nursing: Interpreting Signs and Symptoms
A tic is an involuntary, repetitive movement of a specific group of muscles—usually those of the face, neck, shoulders, trunk, and hands. This sign typically occurs suddenly and intermittently. It may involve a single isolated movement, such as lip smacking, grimacing, blinking, sniffing, tongue thrusting, throat clearing, hitching up one shoulder, or protruding the chin. Or, it may involve a complex set of movements. Mild tics, such as twitching of an eyelid, are especially common. Tics differ from minor seizures in that tics aren't associated with transient loss of consciousness or amnesia.
Tics are usually psychogenic and may be aggravated by stress or anxiety. Psychogenic tics commonly begin between ages 5 and 10 as voluntary, coordinated, and purposeful actions that the child feels compelled to perform to decrease anxiety. Unless the tics are severe, the child may be unaware of them. The tics may subside as the child matures, or they may persist into adulthood. However, tics are also associated with one rare affliction—Tourette's syndrome, which typically begins during childhood.
History and physical examination
Begin by asking the parents how long the child has had the tic. How often does it occur? Can they identify any precipitating or exacerbating factors? Can the patient control the tics with conscious effort? Ask about stress in the child's life such as difficult schoolwork. Next, carefully observe the tic. Is it a purposeful or involuntary movement? Note whether it's localized or generalized, and describe it in detail.
Medical causes
Tourette's syndrome.Tourette's syndrome typically begins with a tic that involves the face or neck. Indications include both motor and vocal tics that may involve the muscles of the shoulders, arms, trunk, and legs. The tics may be associated with violent movements and outbursts of obscenities (coprolalia). The patient snorts, barks, and grunts and may emit explosive sounds, such as hissing, when he speaks. He may involuntarily repeat another person's words (echolalia) or movements (echopraxia). At times, this syndrome subsides spontaneously or undergoes a prolonged remission, but it may persist throughout life.
Nursing considerations
▪ Administer drugs, as indicated, to control tics.
▪ Provide referrals for psychotherapy, as indicated.
Patient teaching
▪ Explain the disorder and treatment plan.
▪ Help the patient identify and eliminate any avoidable stress.
▪ Discuss with the patient positive ways to deal with his anxiety.
▪ Offer emotional support to the patient and family.
Book Source Details
- Book Title: Nursing: Interpreting Signs and Symptoms
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
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- "Handbook of Signs & Symptoms (Third Edition)" (2006)
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- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
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- "Nursing: Interpreting Signs and Symptoms" (2007)
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- "The 5-Minute Pediatric Consult" (2008)
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: Tics (The 5-Minute Pediatric Consult)
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