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nurs 345: children > ch 37: impact of cognitive & sensory impairment on child & family > Flashcards

ch 37: impact of cognitive & sensory impairment on child & family Flashcards

EXAM 2 content

1
Q

what does cognitive impairment (CI) mean? when would we make a diagnosis? what is used synonymously with?

A

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)

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2
Q

when it comes to children with lower intellectual functioning, they have a subaverage intellectual IQ, what is the avg score?

A

70-75 or below, can test until they’re older

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3
Q

out of 10 adaptive skills, children with CI are able to do how many?

A

2 out of 10 adaptive skills when it comes to functional strengths & weaknesses

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4
Q

what age will children get diagnosed with CI?

A

younger than 18
- 18 yo + will be classified as stroke, etc – traumatic brain injury

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5
Q

how are children with CI usually diagnosed & classified?

A

results from standardized test
- educable = mildly impaired characterizes, 85% of population w CI
- trainable = moderately impaired characterizes, 10% of population w CI

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6
Q

what are some adaptive skill areas when it comes to functional impairments?

A
  • communication
  • home living
  • community use
  • leisure
  • health & safety
  • self-care
  • social skills
  • academics
  • work
  • self direction
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7
Q

what is the etiology of CI?

A
  • genetic
  • biochemical
  • infectious
  • familial
  • social
  • environmental
  • organic
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8
Q

what are some causes of CI?

A
  • 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
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9
Q

how do we give nursing care for children with CI?

A
  • 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
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10
Q

what are some measures to prevent CI?

A
  • 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
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11
Q

what is the most common chromosome abnormality? what is it’s rate? causes? occurance?

A

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

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12
Q

when it comes to down syndrome causes, what is happening with the chromosomes with nonfamilial trisomy 21?

A
  • 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
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13
Q

what maternal ages increase risk of down syndrome?

A
  • age 35: risk of 1 per 350 births
  • age 40: risk of 1 per 100 births
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14
Q

how do we diagnose down syndrome? clinical manifestations? physical problems?

A

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)

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15
Q

if a child has down syndrome and has atlantoaxial instability at c-spine, what should we do?

A

increase risk of injury
- car seat needs to be rear facing longer
- they still have head lag

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16
Q

how do we have therapeutic management with children with down syndrome?

A

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
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17
Q

what is the second most common genetic cause of CI? what is the rate? what is it caused by?

A

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)

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18
Q

what are the clinical manifestations of fragile x syndrome?

A
  • large head circumference
  • prognathism: long face w prominent jaw
  • large & protruding ears
  • large testes postpubertal
  • manifestations are variable in female carriers of gene
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19
Q

what are the classic behavioral features of fragile x syndrome?

A
  • mild to severe cognitive impairment
  • delayed speech & language
  • hyperactivity
  • hypersensitive to taste, sounds & touch
  • autistic like behaviors (NOT autism)
  • aggressive behaviors – similar to toddler
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20
Q

what therapeutic management would we do for fragile x syndrome?

A
  • TEGRETOL & PROZAC: behavioral control
  • stimulants (ADDERALL): hyperactivity (similar to management of ADHD)
  • referral to early intervention program
  • normal life span expected
  • genetic counseling
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21
Q

what is the rate of hearing impairments in full term infants & premie infants?

A
  • healthy, full term infants: 1-6 per 1000
  • premature infants: 2-4 per 100
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22
Q

what kind of hearing impairment does a child have if they can have residual hearing with the use of an aid?

A

slight to moderately severe

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23
Q

what kind of hearing impairment does a child have if they can’t process linguistic information?

A

severe to profound hearing loss

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24
Q

what are the top two causes of hearing impairments? what are some other causes?

A
  1. chronic ear infections
  2. environment
  • anatomic malformation
  • fam history
  • LBW
  • ototoxic drugs
  • o2 administration
  • perinatal asphyxia
  • perinatal infections
  • cerebral palsy
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25
what are the different types of hearing loss?
- conductive - mixed - sensorineural
26
what are the causes of conductive hearing loss?
conductive = conductor is inside the train - fluid - foreign objects - allergies - ruptured eardrum - impacted earwax
27
what are the causes of mixed hearing loss?
- genetic disorders - infections - head trauma
28
what are the causes of sensorineural hearing loss?
- aging - noise damage - drug side effects - auditory tumors - blast/explosion
29
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
30
what are some therapeutic management for hearing impairment?
- medical or surgical interventions - hearing aids - cochlear implants - multichannel implants
31
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
32
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
33
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
34
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
35
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
36
what are some preventive measures from hearing impairments?
- treatment & management of recurrent otitis media - prenatal preventive measures - avoidance of exposure to noise pollution
37
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
38
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
39
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
40
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
41
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
42
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
43
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
44
what is the red reflex?
when pupils react to light = red light - if there is WHITE = tell provider IMMEDIATELY, white eye reflex
45
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
46
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
47
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
48
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
49
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
50
what are the different types of retinoblastoma eyes?
- esotropia = going inwards - exotropia = going outwards - hypertropia = going upwards - hypotropia = going downwards
51
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
52
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
53
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
54
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
55
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
56
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
57
what is ADHD?
attention deficit hyperactivity - inattention, impulsiveness & hyperactivity - onset before 7 yo
58
what is LD?
learning disorder - heterogenous group of disorders - difficulties in listening, speaking, reading, writing, reasoning, math &/or social skills
59
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
60
what do we use to test for ADHD & LD?
- iq - hand eye coordination - visual & auditory perception - comprehension - memory
61
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)
62
what are the medications we use for ADHD?
- stimulants - tricyclic antidepressants - norepinephrine transport inhibition = non stimulant
63
what are example drugs of stimulants?
- DEXEDRINE - METHYLPHENIDATE (Concerta, Metadate, Ritalin) - DEXTROAMPHETAMINE (Adderall) - DEXMETHYLPHENIDATE (Focalin)
64
what are example drugs of tricyclic antidepressants?
- CLONIDINE - GUANFACINE (Intuniv)

nurs 345: children (23 decks)

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