Cognitive and Sensory Impairment Flashcards by Kelsey Klipfel

Cognitive impairment (CI) of intellectual disability is a general term that encompasses any type of mental difficulty or deficiency
Typ made when not meeting milestones - not reacting to environment in predictable way - not made at birth very often - seen when older unless know about genetic issue (Downs)
Diagnosis
Made after a period of suspicion by family or health professionals
In some instances, made at birth
Intellectual disability
Not interacting with environment in not predictable way or not interacting at all - not meeting milestones - can have large organ dysfunction

Cognitive impairment

How well did you know this?

Not at all

Perfectly

Intellectual functioning
Subaverage intellectual function: IQ of 70 to 75 or below - normal 85-115
Functional strengths and weaknesses - something very good and big struggle for them
Younger than age 18 at the time of diagnoses

Intellectual disability

How well did you know this?

Not at all

Perfectly

Genetic
Biochemical
Infectious - on meds while pregnancy; drugs or alcohol abuse; mom exposed to something (accutane - retinols on face) and same with adderoll
Familial - can be passed on
Social - more seen in severe abuse/neglect situations; no interactions
Environmental - more seen in severe abuse/neglect situations; no interactions
Organic

Cognitive impairment: etiology

How well did you know this?

Not at all

Perfectly

Big goal: help them communicate; how can we talk to them - nonverbal things - sign language helpful - help fams adjust to this
Educate child and family
Early intervention
Teach child self-care skills
Promote child’s optimal development
Encourage play and exercise (socialization)
Provide means of communication
Establish discipline
Provide information on sexuality
Help families adjust to future care
Care for the child during hospitalization

Nursing care of children with impaired cognitive function

How well did you know this?

Not at all

Perfectly

Most common neurodevelopmental disorder of childhood - very common
Lot less likely be diagnosed in females
Child with ADHD has a disruption in learning, socialization, and compliance (Leads to significant demands on parents, teachers, and the community.)
Specific diagnosis criteria
Pathophysiology
Symptoms usually appear by 7 years
Medications include:
Family support is very important
Educate parents
Understand goals of an IEP (Individualized education plan)

Attention deficit/Hyperactivity Disorder (ADHD)

How well did you know this?

Not at all

Perfectly

Inattention/Distractibility
Impulsivity
Hyperactivity - constantly moving
Teachers - annoyed and overwhelmed - child does pick up on that - lot higher risk of anxiety; lot negative feedback from adults - negative self-talk
IEPs - treatment: meds

Most common neurodevelopmental disorder of childhood - very common

How well did you know this?

Not at all

Perfectly

6 or more findings from specific category are present
Ex. Difficulty with attention, does not seem to listen, forgetful, losing thing easily, fidgeting, failing to remain sitting, talking excessively, interrupting often…

Specific diagnosis criteria

How well did you know this?

Not at all

Perfectly

Not entirely understood but thought to be related to alteration in dopamine/norepinephrine neurotransmitters.
Strong Familial tendency

Pathophysiology

How well did you know this?

Not at all

Perfectly

Psychostimulants
Methylphenidate (Ritalin)
Dexroamphetamine-Amphetamine (Adderall)
Nonstimulant norepinephrine reuptake inhibitors
Biggest concern: slow growing; not care to eat; take off during summer and not feel like self

Medications include:

How well did you know this?

Not at all

Perfectly

Neurodevelopmental disorders
Etiology—Unknown - lots of theories; hereditary
Clinical manifestations and diagnostic evaluation
Care Management
Behaviors impact the child’s ability to communicate and interact with others
Diff areas can fall on spectrum
How help them if struggle it
Trouble with eye contact, not understand empathy; line up toys
Highlight things struggle with and help support them
Prematurity increases risk
Forgetfulness common
Implement things into daily life - checklists helpful; normal routine helpful as well
Common delays (at least 1)
Other expected findings:

Autism spectrum disorders (ASD)

How well did you know this?

Not at all

Perfectly

Deficits in social interactions, communication, and behavior

Clinical manifestations and diagnostic evaluation

How well did you know this?

Not at all

Perfectly

Interprofessional care
Family support

Care Management

How well did you know this?

Not at all

Perfectly

Social interactions
Social communication
Imaginative play

Common delays (at least 1)

How well did you know this?

Not at all

Perfectly

Distress when routines are changed
Unusual attachments to objects
Inability to start or continue conversations
Grunting or humming
Delayed or absent language development
Lack of empathy

Other expected findings:

How well did you know this?

Not at all

Perfectly

Can be a severely disabling condition
No cure for autism
Some improvement with language skills
Numerous therapies used
Autism often becomes a family disease
Frequently parents express guilt and shame - commonly feel that fams fault; some science and blame self
Stress importance of family counseling
Autism Society of America is good source of information
Clients should be managed at home or in long-term placement facility

ASDs: care management

How well did you know this?

Not at all

Perfectly

Recognize early
Often have motor dysfunction - do things diff - motor funcs not work normally
Attempt behavior modification
Provide a structured routine
Decrease unacceptable behavior

Numerous therapies used

How well did you know this?

Not at all

Perfectly

Prevalence (In the US)
Identified through vision screening programs
Etiology
Types
Trauma
Infections

Visual impairment

How well did you know this?

Not at all

Perfectly

Prenatal or postnatal infections
Retinopathy of prematurity
Trauma
Postnatal infections
Other disorders
Sickle cell disease
Juvenile rheumatoid arthritis
Tay-Sachs disease
DM

Etiology

How well did you know this?

Not at all

Perfectly

Refraction
Bending of light rays through the lens of the eye
Myopia (bigger issue because of screens and tablets) - number one cause detached retina, Hyperopia, Amblyopia
Strabismus (may or may not be refractive)

Types

How well did you know this?

Not at all

Perfectly

Want to prevent this
Protective eyewear
Common cause of blindness in children
Penetrating:
Nonpenetrating
Treatment: Aimed at preventing further damage

Trauma

How well did you know this?

Not at all

Perfectly

Conjunctivitis
Not treated properly can lead to blindness - can do eye drops if done early enough - not as common
Ophthalmic antibiotics
Systemic antibiotics in some cases

Infections

Nursing assessment
Nursing alert
Promote parent-child attachment
Promote child’s optimal development
Education
Provide a safe environment
Hospitalized Child

Caring for the visually impaired child

Not react to changes in light
Pupils never change
Harder screen younger kids
Identify children who by virtue of their history are at risk
Observe for behaviors that indicate a vision loss
Screen all children for visual acuity
Snellen letter, tumbling E, or picture chart - talk

Nursing assessment

Suspect visual impairment in a child of any age whose pupils do not react to light - assess as much visual
Know have - support child and fam - bond as well as can - promote optimal development; want have independence; hospital - provide reassurance; orient to room - not change locations of things

Nursing alert

Independence Play and socialization

Promote child’s optimal development

Braille Audio books and learning materials

Education

Provide reassurance during all treatments Orient child to surroundings Encourage independence Treatment team members should be consistent

Hospitalized Child

More common Esp if child in NICU Hearing at adult level when born - premature - sensitive to loud noises; NICU - quiet and loud noises down Worry about kidneys and speech - understanding Etiology: Conductive (middle ear) - benefit from hearing aids; type have some delay - small batteries and love put in mouth - sleeping - take out Sensorineural (inner ear/nerve damage) - benefit from cochlear implants; type have some delay - small batteries and love put in mouth - sleeping - take out Parents as teachers - recognizing things like hearing loss early so not fall behind - quicker caught up - better for child Mixed conductive-sensorineural Central auditory imperceptions (functional hearing loss)

Hearing impairment

Family Hx Anatomic malformations Perinatal asphyxia Infections Substance abuse Chronic ear infections - most common reason Cerebral Palsy Downs sydrone ELGAN - prematurity Ototoxic drugs (genatmycin), O2 requirments

Etiology:

Aphasia - hear and understand - cannot form words Agnosia - talking to and cannot understand what saying

Central auditory imperceptions (functional hearing loss)

Lack of startle reflex Absence of reaction to auditory stimuli Absence of well-formed syllables by age 11 months General indifference to sound Lack of response to spoken word

Infancy - Manifestations

Kids not talking Loud monotone voice if not diagnosed - rare get to point Profound deafness: Likely to be diagnosed in infancy If not detected in infancy, identified upon entry into school Abnormalities in speech development Learning disabilities

Childhood - Manifestations

Lipreading Cued speech Sign language Speech language therapy Additional aids Socialization Support child and family Reassess understanding of instructions given Supplement with visual and tactile media Provide communication devices Picture board with common words Assistance of child life specialist Additional aids

Care management

Common Downs most common Often have: Increased risk of autosomal trisomy's seen with AMA (advanced maternal age) - older mom is more likely for mom to have this Examples: Tay-Sachs, Prader-Willi, Angelman, Cri-du-chat, Wolf-Hirschhorn, Beckwith-Wiedemann - thousands

Chromosomal abnormalities

Intellectual disabilities Learning disabilities Behavioral problems Distinct features (including birth defects)

Often have:

Most common chromosome abnormality Causes unknown; probably multiple Occurs in populations of all races Nonfamilial trisomy 21 Increases with increased maternal age Clinical manifestations Chromosome analysis High risk Physical problems Available therapies Prognosis Care management

Down syndrome

Square head with upward slant to eyes - eyes widespread and low - low set ears - sign chromosomal abnormality Flat nasal bridge - nose under developed, protruding tongue Hypotonia - floppy - lot longer to meet milestones

Clinical manifestations

Strabismus Herscrupung’s Leukemia CHD - septal defects DDHD

High risk

Congenital heart disease Hypothyroidism Leukemia Hip subluxation Decreased muscle tone Hirschsprung's disease Tracheoesophageal fistula Strabismus/nystagmus

Physical problems

What child presenting and struggling with Surgery to correct congenital anomalies Evaluation of hearing and sight Periodic testing of thyroid function

Available therapies

Expectancy white: 40 yrs Expectancy black: 20 yrs - more likely more severe heart defects Other ethnicities: 10 yrs Part disparities in healthcare

Prognosis

Supporting child’s family at time of diagnosis Preventing of physical problems Assist in prenatal diagnosis and genetic counseling

Care management

Second most common genetic cause of cognitive impairment after Down syndrome Caused by abnormal gene on the lower end of the long arm of the X chromosome - deals with abnormal gene Large head circumference and large face In males and females; males more symptomatic and males severe; females more carries and some manifestations Can reproduce Long face with a prominent jaw (prognathism) Large, protruding ears Large testes (postpubertal) Manifestations variable in female carriers of gene Classic Behavioral Features Therapeutic Management

Fragile X syndrome

Mild-to-severe cognitive impairment Delayed speech and language - confused for ADHD; some ASD behaviors; treatment sim to those Hyperactivity Hypersensitivity to taste, sounds, and touch Autistic-like behaviors Aggressive behaviors

Classic Behavioral Features

Tegretol/Prozac for behavioral control Stimulants for hyperactivity (similar to management of attention deficit/hyperactivity disorder) Referral to early intervention program Prognosis Normal life span expected Care management Genetic counseling - passed on to siblings

Therapeutic Management

Sex chromosome abnormality May only have one X Only females present with this Usually diagnosed in early childhood Cannot reproduce No cure Hormonal therapy typically initiated - give estrogen Therapeutic management focuses on managing the health issues related to the syndrome.

Turner syndrome

Short stature Failure to grow Failure to growth More likely have osteoporosis, overweight, heart issues, cognitive impairment, no estrogen

Usually diagnosed in early childhood

In males Present with feminine features, Cognitive delays Missed early age - assume has ADHD - struggle in school; learning disabilities; unless do genetics Small testes; gynecomastia, fat deposits not typ see in male pop Around puberty realize something more going on Most common sex chromosomal abnormality One or more X chromosome is present Often times not diagnosed until adolescence or adulthood Males present with female-like physical features (testosterone deficiency) No cure Infertility may be of concern - majority time are infertile Therapeutic management focuses on managing the health issues related to the syndrome.

Klinefelter Syndrome

Lack of secondary sex characteristics Cognitive impairments such as motor delay, speech delay, attention deficits, and learning disabilities

Often times not diagnosed until adolescence or adulthood

Hormonal therapy typically initiated - given testosterone Very tall typ Cosmetic surgery

Therapeutic management focuses on managing the health issues related to the syndrome.