ch 37: impact of cognitive & sensory impairment on child & family Flashcards
EXAM 2 content
what does cognitive impairment (CI) mean? when would we make a diagnosis? what is used synonymously with?
any type of mental difficulty or deficiency
- synonym of “intellectual disability”
a diagnosis is made after a period of suspicion by family or health professionals
- some are made at birth (cerebral edema or microcephaly)
when it comes to children with lower intellectual functioning, they have a subaverage intellectual IQ, what is the avg score?
70-75 or below, can test until they’re older
out of 10 adaptive skills, children with CI are able to do how many?
2 out of 10 adaptive skills when it comes to functional strengths & weaknesses
what age will children get diagnosed with CI?
younger than 18
- 18 yo + will be classified as stroke, etc – traumatic brain injury
how are children with CI usually diagnosed & classified?
results from standardized test
- educable = mildly impaired characterizes, 85% of population w CI
- trainable = moderately impaired characterizes, 10% of population w CI
what are some adaptive skill areas when it comes to functional impairments?
- communication
- home living
- community use
- leisure
- health & safety
- self-care
- social skills
- academics
- work
- self direction
what is the etiology of CI?
- genetic
- biochemical
- infectious
- familial
- social
- environmental
- organic
what are some causes of CI?
- intrauterine infection & intoxication
- trauma: prenatal, perinatal & postnatal
- metabolic or endocrine disorders
- inadequate nutrition
- postnatal brain disease –> hypoxic after birth
- unknown prenatal influences
- chromosomal anomalies
- prematurity, LBW, postmaturity
- psychiatric disorders with onset in childhood
- environmental influences
how do we give nursing care for children with CI?
- early intervention of educating child & fam
- teach child self care skills
- promote child’s optimal development
- encourage play & exercise
- provide means of communication
- establish discipline
- encourage socialization
- they need strict rules & boundaries on info on sexuality!
- help fams adjust to future care
- care for the child during hospitalization
what are some measures to prevent CI?
- counseling & educating regarding nutrition and tobacco + THC use
- awareness of danger of chemicals, including prenatal exposure to alcohol
- rubella immunization
- genetic counseling
- folic acid supplementation
what is the most common chromosome abnormality? what is it’s rate? causes? occurance?
down syndrome aka trisomy 21
- 1 per 691-1000 live births
- unknown cause, multiple causes: trend with older moms
- occurs in populations of all races
when it comes to down syndrome causes, what is happening with the chromosomes with nonfamilial trisomy 21?
- extra chromosome 21 in 95% of cases
- translocation of chromosomes 15, 21 or 22 in 3-4% of cases
- mosaicism: mix of abnormal & normal cells in 1-2% of cases
what maternal ages increase risk of down syndrome?
- age 35: risk of 1 per 350 births
- age 40: risk of 1 per 100 births
how do we diagnose down syndrome? clinical manifestations? physical problems?
clinical manifestations
- square head with upward slant to eyes
- flat nasal bridge & protruding + thick tongue
- hypotonia
- poor feeding
chromosome analysis: karyotyping
physical problems
- congenital heart disease
- hypothyroidism
- leukemia
- atlantoaxial instability at c-spine (no movement)
if a child has down syndrome and has atlantoaxial instability at c-spine, what should we do?
increase risk of injury
- car seat needs to be rear facing longer
- they still have head lag
how do we have therapeutic management with children with down syndrome?
available therapies = supportive therapy
- surgery to correct congenital anomalies
- evaluation of hearing & sight
- periodic testing of thyroid function
- support child’s family at time of diagnosis
- prevent physical problems
- assist in prenatal diagnosis & genetic counseling
what is the second most common genetic cause of CI? what is the rate? what is it caused by?
fragile X syndrome
- boys: 1 per 3600
- girls: 1 per 4000-6000
- cause: abnormal gene on lower end of the long arm of the X chromosome (not fully developed)
what are the clinical manifestations of fragile x syndrome?
- large head circumference
- prognathism: long face w prominent jaw
- large & protruding ears
- large testes postpubertal
- manifestations are variable in female carriers of gene
what are the classic behavioral features of fragile x syndrome?
- mild to severe cognitive impairment
- delayed speech & language
- hyperactivity
- hypersensitive to taste, sounds & touch
- autistic like behaviors (NOT autism)
- aggressive behaviors – similar to toddler
what therapeutic management would we do for fragile x syndrome?
- TEGRETOL & PROZAC: behavioral control
- stimulants (ADDERALL): hyperactivity (similar to management of ADHD)
- referral to early intervention program
- normal life span expected
- genetic counseling
what is the rate of hearing impairments in full term infants & premie infants?
- healthy, full term infants: 1-6 per 1000
- premature infants: 2-4 per 100
what kind of hearing impairment does a child have if they can have residual hearing with the use of an aid?
slight to moderately severe
what kind of hearing impairment does a child have if they can’t process linguistic information?
severe to profound hearing loss
what are the top two causes of hearing impairments? what are some other causes?
- chronic ear infections
- environment
- anatomic malformation
- fam history
- LBW
- ototoxic drugs
- o2 administration
- perinatal asphyxia
- perinatal infections
- cerebral palsy
what are the different types of hearing loss?
- conductive
- mixed
- sensorineural
what are the causes of conductive hearing loss?
conductive = conductor is inside the train
- fluid
- foreign objects
- allergies
- ruptured eardrum
- impacted earwax
what are the causes of mixed hearing loss?
- genetic disorders
- infections
- head trauma
what are the causes of sensorineural hearing loss?
- aging
- noise damage
- drug side effects
- auditory tumors
- blast/explosion
what is the pathology of all the hearing loss types?
- conductive: middle ear
- mixed: interference with transmission of sound
- sensorineural: damage to inner ear or auditory nerve
- there are organic & functional central auditory interception
what are some therapeutic management for hearing impairment?
- medical or surgical interventions
- hearing aids
- cochlear implants
- multichannel implants
what are some manifestations of hearing impairment in infancy?
- lack of startle reflex
- absence of reaction to auditory stimuli
- absence of well formed syllabes by age 11mo
- general indifference to sound
- lack of response to spoken words
what are some manifestations of hearing impairment in childhood?
- profound deafness: likely to be diagnosed in infancy
- if NOT detected in infancy –> identified when entering of school
- abnormalities in speech development
- learning disabilities
how do we promote communication with children with hearing impairments?
- lip reading
- cued speech
- sign lang
- speech lang therapy
- additional aids
- socialization
- support of child & family
if a child is in the hospital for hearing impairment, how do we care for them?
- reassess understanding of instructions that are given
- give supplemental visuals & tactile media
- provide communication devices
what kinds of communication devices can we give to a child with hearing impairments?
- picture board with common words
- assistance of child life specialist
- additional aids
what are some preventive measures from hearing impairments?
- treatment & management of recurrent otitis media
- prenatal preventive measures
- avoidance of exposure to noise pollution
what are some prenatal preventive measures we can take?
- genetic testing
- avoidance of ototoxic drugs
- testing to rule out syphilis, rubella, cytomegalovirus (CMV), or blood imcompatibility
what is the rate of visual impairment in children? how is it identified?
common problem during childhood
- U.S: 30-64 per 100k
- 5-10% of all preschoolers
- identified through vision screening programs
how do we classify visual impairment?
partially sighted (school vision) = 20/70 to 20/200
- educated in public school system
legally blind = 20/200 or poorer
- legal & medical term
what are the causes of visual impairment?
- prenatal infections
- postnatal infections: meningitis & sepsis
- retinopathy or prematurity
- trauma
other
- sickle cell disease
- juvenile rheumatoid arthritis
- tay-sachs disease
what are the types of trauma to vision? how do we treat that trauma?
COMMON cause of blindness for children
- injury to eyeball or adnexa
- penetrating: sharps, propulsive objects, blunt objects, & motor vehicle accidents
- nonpenetrating: lacerations, blows to eyes or head, & burns
treatment: prevent further damage
what is a huge example of an infection that causes visual impairment? how do we treat it?
conjunctivitis
- ophthalmic antibx (ointment is best)
- systemic antibx in some cases
- caution w steroids! can exacerbate viral infections
- infection control concerns
how do we assess for visual impairment?
nursing assessment
- identify children who by virtue of their hx are at risk
- observe for behaviors that indicate a vision loss
- screen all children visual acuity
nursing alert
- suspect visual impairment in a child of any age who’s pupils do NOT react to light
what is the red reflex?
when pupils react to light = red light
- if there is WHITE = tell provider IMMEDIATELY, white eye reflex
how do we care for children with visual impairment?
- promote parent child attachment: touch, feeling & hugging
- promote child’s optimal development
- development & independence
- play & socialization: try not to move anything in the house
- education: braille & audio books + learning materials
how do we care of a child with visual impairment that is in a hospital?
- provide a safe environment
- provide reassurance during all treatments
- orient child to surroundings: using clock with meal tray
- encourage independence
- treatment with team members should be consistent
how do we prevent visual impairment?
- prenatal care & prevention of prematurity
- rubella immunizations for all children
- safety counseling for preventing eye injuries
- periodic screening of all children
what can happen with kids with BOTH hearing & visual impairment? how can we help them?
- profound effects on development
- motor milestones usually achieved
- other development often delayed
- “finger spelling”
- develop future goals for the child
what is retinoblastoma? rate? causes? manifestations?
most common congenital malignant intraocular TUMOR in children
- 11 per million annually (if not treated, they can get blind)
- usually younger than 5 yo
- causes: genetic mutation or inherited
- manifestations: white eye reflex, strabismus, & blindness
what are the different types of retinoblastoma eyes?
- esotropia = going inwards
- exotropia = going outwards
- hypertropia = going upwards
- hypotropia = going downwards
what is ASD? rates? who is it more common in?
autism spectrum disorders
- a complex neurodevelopmental disorder with intellectual & social alterations
- verbal effects: repetitive (echolalia) & restrictive behavior patterns (fixated on toys, flailing arms)
- 1 per 100-150 children
- 4x more common in boys
what are the causes of ASDs?
- genetic disorder: prenatal & postnatal brain development
- immune & environmental factors: interacts with genetic susceptibility
- high risk of recurrence in families with one affected child
what are some examples of immune & environmental factors?
- a child develops normally & all of a sudden stops
- oxidative stress: so stressed that it affects genetic code with an imbalance of O2
what are the clinical manifestations of ASDs? when is it usually diagnosed
peculiar & bizarre characteristics:
- socialization: doesn’t want to be with other kids
- communication, lang delay: late talkers, late fine motor skills
- behavior: due to lack of communication
- difficult with eye & body contact: cries if held
diagnosed is delayed until 2-3 yo
- to see a pattern
how do we care for a child with ASDs?
no cure for autism
- some improvement with language skills
- recognize early
- attempt behavior modification
- provide a structured routine: DO NOT CHANGE ROUTINE
- decrease unacceptable behavior
how do we support the family with a child with ASDs?
- can be seen to them as a disease
- parents express guilt & shame
- stress importance of family counseling
- autism society of america = good source of info
- patients should be managed at home or in a long term placement facility
what is ADHD?
attention deficit hyperactivity
- inattention, impulsiveness & hyperactivity
- onset before 7 yo
what is LD?
learning disorder
- heterogenous group of disorders
- difficulties in listening, speaking, reading, writing, reasoning, math &/or social skills
how do we diagnose ADHD & LD?
developmentally inappropriate inattention, impulsivity & hyperactivity!!
- quality of motor activity
- wide variation of severity
- diagnostic criteria developed by American Psychiatric Association
what do we use to test for ADHD & LD?
- iq
- hand eye coordination
- visual & auditory perception
- comprehension
- memory
how do we give therapeutic measurement for ADHD?
- classroom
- family education & counseling
- behavioral &/or psychotherapy for child
- environmental manipulation: removing external distractions
- medication (but try everything before meds)
what are the medications we use for ADHD?
- stimulants
- tricyclic antidepressants
- norepinephrine transport inhibition = non stimulant
what are example drugs of stimulants?
- DEXEDRINE
- METHYLPHENIDATE (Concerta, Metadate, Ritalin)
- DEXTROAMPHETAMINE (Adderall)
- DEXMETHYLPHENIDATE (Focalin)
what are example drugs of tricyclic antidepressants?
- CLONIDINE
- GUANFACINE (Intuniv)
