48 terms

care of the child with cognitive impairment

STUDY
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autism 1
identical twins 60-96%
frantial twins < 5 %
complex neurodevelopmental disorder of brain function accompained by intellectual and social behavioral deficits
fragile x
2nd gent. disorder
downs
1st gent disorder
translocation of chormosome 15,21,22
intellectual functioning
is measured by the iq of 70-75 or below
must demonstrate functional impairment in at least 2/10 differnet adaptive skill, communication, self care, homeliving, social skills leisure, health and safety, self direction, functional acadmecs, community use and work, the child with intellectual disabiltiy must demonstrate functional impairment,
3 components of cogn impairment
intellectucal functioning, functional strength and weakness, age < 18 yrs old when diagnosed
classifications ( 4 established dimensions of caring)
intellectual functioning and adaptive skills, psychological and emotional needs, physical health and etiology, environmental needs ( used to identify individuals specific needs
diagnosis
usually made after a period of suspicion by professional or the family that the child developmental progress is delayed, some are confirmed at time of delivery while others may only show up after problems develop, ***some developmental delays are not recognized until the child attends school****
early behavioral signs suggestive of CI
dysmorphic features, irritabitly or unresponsiveness to contact, abnormal eye contact, gross motor delay, decreased alertness to voice or movement, language difficulites, feeding difficulties, ****some are evident at the time of delivery, a lot of these the parents would expect to see in a normal child, most children respond to being cuddled, they like to look at the moms face, so the absence of these normal;bonding behaviors should be a RED FLAG for possible problems,
educable mentally retarded EMR
mildly impaired
85 %
trainable mentally retarded
moderate
10%
developmental delay
lag in childs physical, congitive, behavioral, emotional, social development, use standardized test to make dx, of ID/MR, more useful approach is based on educational potential
etiology
primarily genetic,biochemical, infections, etiology is unknown but family social , environmental or organic may predominate
nursing care
look for delayed milestones, high index of suspicion, take parental concerns seriously, regular dev. exams, sensitiviy and discretions, *****sometimes the family does not want anyone else to know about the problem
marked deficit
in abliltiy to discriminate between 2 or more stimuli, r/t difficulity recognizing cues,
early interventions programs
pt,speech, occupational therapy
optimal development
achievements of independece, but also acceptable social behaviors, and feelings of self esteem and worth
play
is just as important and should be based on dev. level
communication
some children may have either receptive or expressive disabilites we need to idenify and find manageable ways for them to comm
discipline
start early, must be simple, consistent, and age appropriate( mental age)
socialization
need to be taught manners, self dressing, grooming, and enrolled in acceptable preschool
sexuality
need practical information regarding anatomy, physilolgy, and conception also need well defined, concrete code of conduct
fragile x syndrome
fm carriers,
full mutation
when a carrier mother passes to offspring
none occurs
when carrier father passes to daughter
prenatal dx
possible with direct dna testing
treatment
tegretol, prozac, clonidine, speech, cardiologist, orthopedics, prognosis, nursing, no cure, selective serotonin reuptake inhibiors, ssris are needed to control the violent temper outburts that are common with these children
cardiologist
mvp
prognois
live a normal life span
parents
genetic counseling, any male or fm, with unexplained bi should be evaluated and if necessary referred for genetic workup
downs syndrome
trisomy 21, most common chromosomal disorder, 95% attributed to extra chromosome 21
degree of ci
is related to percentage of abnormal chromosome makeup
age 35
1:400
age 30
1:110
downs
low set ears, transverse palmar crease, tlat nasal bridge, protruding tongue,short broad neck, many end up with resp.infection, cardiac anomalies.,**hypotonicity including that of the chest wall and abdominal wall, thryoid dysfuntion, and increased risk for leukemia
hypotonicity
and means these babies dont curl up like other, means prone to temp regulation, feeding,hyperextension of joints.
autism 2
mild to severe defictis, noticed in early childhood, 24-48 mns, 1:166 children, 4x higher in males, females more severely affected , none related to socioeconomic, race, parenting, etilogy disorder of prenatal and postnatal brain development, no specific gene idenfified, immune and environmental factors may react with genetic susp. to increase incidience,
symtoms of autism
abnormal eeg, epilepsy, sz, delayed development of hand dominance persistence of primitive reflexes, metabolic abnormalities (increases serotonin)cerebellar hypoplasmia, no evidence with vaccines, increased incidence with number of other conditions (fragile x, rubella,etc) retrospective tie to prenatal and perinatal events ( bleeding, paternal age,low agar,fetal distress, jaudice),constipation/megarectum, savants- those children who excel in one particular area, limited play--these children may play with toys in unusual or odd mannner
hallmark characteristics --autism
inabilty to make eye contact, avoidance of body contact, language delay at an early age,
prognosis of autism
usually a severely disabiling condition, some do eventually gain independance but most require long adult supervision, the earlier the dx the better the outcomes,
nursing management of autism
no cure, hightly structed and intensive behavior modificiation, parents need to stay if child is hospitalizied, need individal assessments, decrease stimulation, avoid auditoy and visual distractions, bring familiar objects, limit physical contact, introduce new situations slowly, family support, help allevaite the grief, parents need expert couneling, encourage to care for at home, make aware of resources ***specialized are utilizing professional with advanced training
attention deficit hyperactivity disorder
inappropriate degrees of attention, impulsivness, and hyperactivity, to be dx before age 7, present in at least 2 settings, inattention cant be r/t other disorder, affects all aspects of life, more in classroom, early recog. necessary r/t possible interference of emotional and psy. dev. many children develop maladaptive behaviors,
learning disability
refers to a heterorgenous group of disorders manifested by significant difficulty in acquisition and use of listening, speaking, reading, and writing, reasoning, and math
dx of adhd
no unusual behavior, difference is in quality of motor activity and developmentally inappropriate inattention, impulsvitiy, and hyperactivity, that the child displays, range for few-many, mild to severe, varies with developmental level, battery of testing required, i q tests, hand eye coordination, auditory, and visual screenings, spatial organization, comprehension, memory, there is often a wide gap between verbal and performance scores on the iq test
tx of adhd
family education, meds, classroom placement, environmental manipulation, behaviroal therapy, psychotherapy,
meds of adhd
ritalin, dexadrine cause an increase in dopamine and norepinephrine which leads to stimulation of the inhibiltory status of cns, tricyclics are used occ. but mainly when the child has adhd and sleep distrubances,requires regular scheduled evals to assess for side effects of meds,
behaviroal therapy
focuses on prevention of undesireable behaviors, postive reinforcements, discipline, and organization charts,
environmental manipulation
parents need to learn to modify the enviroment to increase the childs chance of success
classroom placement
need orderly, predictialv and consistent enviornment, with clear, and consistent rules, may need to decrease amt of hw, and increase time they have for testing, verbal instructions as well as visiual, academidics need to be early in the morning, and they need frequent and regular breaks