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
