Cognitive and Sensory Impairments Flashcards
1
Q
Visual Impairments
A
- visual impairments encompassed borsht partial sight and legal blindness
- common visual impairments in children include myopia, hyperopia, astigmatism, anisometropia, amblyopia, strabismus, cataracts, and glaucoma
2
Q
Health Promotion: Visual Impairments
A
- encourage the family to work with the children’s school to meet educational needs
- screen children for visual impairments early
3
Q
Risk Factors: Visual Impairments
A
- prenatal or postnatal conditions, such as retinopathy or prematurity, trauma, and postnatal infections
- perinatal infections, such as herpes, rubella, syphillis, chlamydia, gonorrhea, and toxoplasmosis.
- chronic illness, such as sickle cell disease, RA, retinoblastoma, and Tay-Sachs disease
4
Q
Myopia
A
- sees close objects clearly, but not objects in the distance
- headaches and vertigo
- eye rubbing
- difficulty reading
- clumsiness (frequently walking into objects)
- poor school performance
5
Q
Hyperopia ( farsightedness )
A
- sees distant objects clearly, but not objects that are close
- because of accommodation, not usually detected until age 7
6
Q
Astigmatism
A
- uneven vision in which only parts of letters on a page can be seen
- headache and vertigo
- appearance of normal vision because tilting the head enables all letters to be seen
7
Q
Anisometropia
A
- different refractive strength in each eye
- headache and vertigo
- excessive eye rubbing
- poor school performance
8
Q
Amblyopia (Lazy Eye)
A
reduced visual acuity in one eye
9
Q
Strabismus
A
Inward deviation of eye
Exotropia: outward deviation
- abnormal corneal light reflex or cover test
- misaligned eyes
- frowning or squinting
- difficulty seeing print clearly
- one eye closed to enable better vision
- head tilted to one side
- headache, dizziness, diplopia, photophobia, and cross eyes
10
Q
Cataracts
A
- decreased ability to see clearly
- possible loss of peripheral vision
- nystagmus
- strabismus
- gray opacity to the lens
- absense of red reflexed
11
Q
Glaucoma
A
- loss of peripheral vision
- perception of halos around objects
- red eye
- excessive tearing (epiphora)
- photophobia
- spasmodic winking (blepharospasm)
- corneal haziness
- enlargement of the eyeball (buphthalmos)
- possible pain
12
Q
Visual Screening
A
- this is completed using the Snellen letter, tumbling E, or picture chart
- place the client 10 ft from the chair with heels on the 10 ft mark
- client should be wearing glasses, if appropriate, and keep both eyes open during screening
- while covering one eye, the client reads each line on the chart, starting at the bottom of the chart, until he can pass line. The client needs to identify 4 fo the 6 characters in the line to correctly pass
- the client is then asked to start at the top and move down until he can no longer pass a line
- the procedure is repeated with the other eye
13
Q
Partial Visual Impairment
A
is classified as visual acuity of 20/70 to 20/200
14
Q
legal blindness
A
is classified as visual acuity of 20/200 or worse or a visual field of 20 degrees in the childs better eye
15
Q
Occular Alignment
A
observed using the corneal right reflex test
- a flashlight is shone directly into the clients eye, from a distance of 16”
- reflected light should be observed in the same location of both corneas
16
Q
Cover Test
A
clients asked to cover each eye and observe an object at a distance of 13”. The cover is removed and the eye is observed for movement, which should not occur
17
Q
Peripheral Vision
A
Evaluated by having the client fixate on an object
- a pencil is moved from beyond the field of vision into the range of peripheral vision
- the client is asked to say stop when the object is noted in the peripheral vision. this angle is then measured
- each quadrant of peripheral vision is tested. the test is then repeated in the other eye
- normal findings are 50 degree upward, 70 degree downward, 60 degree nasal ward, and 90 degree temporarily
18
Q
Color Vision
A
Evaluated using the Ishihara or Hardy-Rand- Rittler test
- the client is shown a set of cards and asked to identify the number of embedded in the confusion of colors
- the client should identify all of the numbers on the cards with correct color vision
19
Q
RN Care: Visual Impairments
A
- maintaining normal to bright lighting for the child when reading, writing, or participating in any activity that requires close vision
- assess infants and children for visual impairments, and identify children that are high-risk
- observe for behaviors that suggest a decrease or loss of vision
- promote child’s optimal development and parent-child attachment
- identify safety hazards, and prevent injuries to eyes (helmet, safety-glasses)
- provide information regarding laser surgery for clients who have myopia, hyperopia, or astigmatism.
- inform the child and family about corrective measures
- myopia: biconcave lenses, laser surgery\
- Hyperopia: convex lenses, laser surgery
- Astigmatism: lenses that compensate for refractive errors, laser surgery
- Anisometropia: Lenses that compensate for refractive errors, preferably corrective contacts, laser surgery
- Amblyopia: treat primarily visual defects
- Strabismus: occlusion therapy (patch stronger eye), surgery
- cataracts and glaucoma: surgery
20
Q
Hearing Impairments
A
affect speech and the ability to clearly process linguistic sounds
21
Q
Health Promotion: Hearing Impairments
A
- screen for hearing impairments
- help families identify community resources for children who have hearing loss
- teach the children and families to avoid further damage and hearing loss
- avoid exposing children to hazardous noise
- encourage children to wear ear protection if loud environmental noise cannot be avoided
22
Q
Risk Factors: Hearing Impairment
A
- exposure to loud environmental sounds
- Hearing defects can be caused by a variety of conditions, including anatomic malformation, maternal ingestion of toxic substances during pregnancy, perinatal asphyxia, perinatal infections, chronic ear infection, and ototoxic medications
- Hearing defects are associated with chronic conditions such as Down Syndrome and cerebral palsy
23
Q
Conductive Losses
A
involve interference of sound transmission, which can result from otitis media external ear infection, foreign bodies, or excessive ear wax
24
Q
Sensorineural Losses
A
involve interference of the transmission along the nerve pathways, which can result from congenital defects or secondary to acquired conditions (infection, ototoxic medication, exposure to constant noise {as in NICU})
25
Central Auditory Imperception
involves all other hearing losses (aphasia, agnosia [inability to interpret sounds])
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Expecting Findings: Hearing Impairment: Infants
- lack of startle reflex
- Failure to respond to noise
- Absence of vocalization by 7 months
- Lack of response to the spoken word
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Expected Findings: Hearing Impairments: Children
- using gestures rather than talking after 15 months
- failure to develop understood speech by 24 months
- yelling to express emotions
- irritability due to inability to gain attention
- seeming shy or withdrawn
- inattentive to surroundings
- speaking in monotone
- need for repeated conversation
- speaking loudly for situation
28
Nursing Care: hearing Impairment
- assess children for hearing impairment
- promote speech development, lip reading, and sue of cued speech (hand gestures with verbal communication)
- encourage socialization and use of aids to promote independence (flossing lights when the doorbell or phone rings, telecommunication devices, CC on TV)
- refer child and family to community support groups
- use sign language or an interpreter if appropriate when working with a child who has hearing loss. always talk to the child and not the interpreter
- assess gait/balance for instability
- identify safety hazards and adjust environment as needed
- assist with use of hearing aids
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Complications of Hearing Impairment
Delayed Growth and Development
visual and hearing impairments can affect the childs speech and motor development. Identifying the impairment early can minimize this
- encourage self care and optimal independence
- make inter professional referrals as needed (social services, speech therapy, physical therapy, occupational therapy, teachers)
- assist the family to obtain and access appropriate assertive devices
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Down Syndrome
- most common chromosomal abnormality of a generalized syndrome. Trisomy 21 is seen in 97% of cases of Down Syndrome
- many medical conditions accompany Down syndrome (congenital heart malformation, hypotonicity, dysfunction fo the immune system, thyroid dysfunction, leukemia)
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Risk Factors: Down Syndrome
- the cause is unclear but may be multicausal in nature
- maternal age greater than 35
- paternal age greater than 55
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Expected Findings: Down Syndrome
- separated sagittal suture
- enlarged anterior fontanel
- small round head
- flattened forehead
- upward, outward slant to eyes
- small nose with depressed nasal bridge (saddle nose_
- small ears with short pinna
- epicanthal folds
- high- arched narrow palate
- protruding tongue
- short, broad neck
- shortened rib cage
- possible congenital heart defect
- protruding abdomen
- incurved fifth finger (clinodactyly)
- broad, short feet and hands with stubby toes and fingers
- transverse palmar crease
- large space between big and second toes with plantar crease
- short stature
- hyperflexiblity, muscle weakness, and hypotonia
- dry skin that cracks easily
33
Diagnostic Procedures: Down Syndrome
- Prenatal: testing for alpha-fetoprotein in maternal serum
| - Infant: chromosome analysis and echocardiography
34
RN Care: Down syndrome
- swaddle the infant to precent heat loss due to limp, extended body position
- assist family with feeding difficulties, and monitor dietary intake
- promote good skin care
- assess developmental progress at regular intervals
- support family at the time of diagnosis
- make appropriate referrals
- assist the parents in holding and bonding with the infant
35
Therapeutic Procedures: Down Syndrome
Surgical Intervention: depend on the associated congenital abnormalities. These can include cardiac defects or strabismus
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Interpersonal Care: Down Syndrome
Social work, home health, school early intervention, genetic counseling, speech therapy, physical therapy, occupational therapy.
- listen to the concerns of the parents and discuss ethical dilemmas regarding treatment for physical defects. Provide standard postoperative care with emphasis on wound care, respiratory care, and pain management
- teach postoperative and home-care management
- reinforce the therapeutic plan of care
37
Client Education: Down Syndrome
- teach the family how to aspirate nasal secretions
- teach the family to rinse the clients mouth after feeding
- teach the family to use cool mist int eh room to assist in moistening secretions
- encourage the family to change the infants position frequently
- teach the family feeding strategies to accommodate for the protruding tongue
- teach the family skin care and the need for moisturizing creams daily
- encourage a diet high in fiber and fluid to prevent constipation, and monitor calorie intake to prevent obesity
- encourage regular health care visits
- monitor developmental milestones
- monitor height and weight by plotting growth on charts
- prepare for surgery for cardiac problems or strabismus if indicated
- evaluate eyesight and hearing frequently
- preform frequent thyroid functioning tests
- assess for atlantoaxial instability (neck pain, weakness, and torticollis)
- teach the family how to prevent complications
38
Complications: Down Syndrome: Intelligence
mental capacity varies typically from mild to moderate cognitive impairment
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Complications: Down syndrome: Social Development
developmental can be 2-3 years beyond the mental age
40
Complications: Down syndrome: Cognitive Abnormalities
about 40-45% have congenital heart disease. Other possible abnormalities include hip subluxation, patella dislocation, duodenal atresia, tracheoesophageal fistula, and HIrschsprungs disease
41
Complications: Down syndrome: Sensory Problems
Occular Problems; include strabismus, nystagmus, astigmatism, myopia, hyperopia, head tilt, excessive tearing, and cataracts
Hearing Loss: occurs in a large percentage of children who have Down Syndrome. Frequent otitis medications, narrow canals, and impaired cerumen can contribute to the hearing problems
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Complications: Down syndrome: Other Physical Disorders
- frequent respiratory tract infections
- increase incidence of leukemia
- thyroid dysfunction
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Complications: Down syndrome: Growth
both height and weight are reduced. Weight gain is more rapid than growth in height and can result in excessive weight by 36 months
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Complications: Down syndrome: Sexual Development
male and female genitalia can be underdeveloped and delayed
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Complications: Down syndrome: Respiratory Infections
Respiratory infections are common due to decreased muscle tone and poor drainage of mucus because of hypotonicity and associated underdevelopment of nasal bone
- rinse the childs mouth with water after feeding and at other times of the say when it is dry. Mucous membranes are dry due to constant mouth breathing, which can also increase the risk of respiratory infections
- provide cool mist humidification and clearing of the nasal passages with a bulb syringe as needed
- encourage physical activity and exercise
- teach the parents and child good hand hygiene
- encourage frequent repositioning of the child to promote respiratory function
- reinforce the need for routine immunizations
- teach parents to seek health care at the earliest indication of infection
- reinforce the need to follow the antibiotic schedule if prescribed
