Cognitive development

Question 1

What is Down syndrome?

Answer 1

Genetic Cause: 3rd copy of the 21st chromosome

Question 2

What are the manifestations of Down syndrome?
11 visual cues
4 other cues

Answer 2

visually..
excess loose skin on the back of the neck
inner epicanthal folds
depressed nasal bridge
small nose
high arched palate
protruding tongue
wide space between big toe and second
continuous hand crease
decreased muscle tone
-Growth: height & weight reduced, BUT 
weight is high for height = obesity
-Sexual development- often delayed

• Lower intelligence
• Social development delay
• Cognitive anomalies
• Sensory problems

Question 3

What are the nursing interventions for Down syndrome?

Answer 3

Family Support and genetic counseling

Promote child’s developmental progress

Assist family in preventing physical problems
Feeding Difficulties
Obesity
Constipation
Upper Respiratory Infections
Acute Otitis Media (ear infections)
 Leukemia
Hypothyroidism
 Congenital Heart Defects

Question 4

What is autism?

Answer 4

Demonstrate core deficits in:
1- Social interactions
2- Communication
3- Behavior

Question 5

What are the manifestations of autism?

Answer 5

Socially...
-Abnormal eye contact 
• Failure to smile
• Lack of imitation
• Lack of interactive play
• Lack of gestures - pointing or waving
communication..
• Failure to orient to name
-Absent to delayed speech
•   Atypical language such as humming or 
     grunting for extended periods
- laughing inappropriately, or use of echolalia

• Repetitive, impulsive, restrictive, and 
  obsessive behavior
 Rocking,  Flapping hands
 Head nodding
 Spinning, Twirling

 Difficulty with change
 Self-injurious behaviors

Question 6

What are the nursing interventions for autism?

Answer 6

how do we help in the hospital..
ask mom the best way to do things
round outside the room
show them not tell them

Provide positive reinforcement
Increase social awareness
Teach verbal communication skills
Decrease unacceptable behavior

STRUCTURED ROUTINE IS KEY
• May not understand body language, facial expression, or vocal tone BUT simple nonverbal communication is helpful (ie: pointing)
• Dim lighting
• Use few words
• NO figures of speech
 “You’re red as a tomato” (commenting on sunburn). Response from patient with ASD: “I’m not a tomato!”

Question 7

What is ADHD?

Answer 7

Developmentally inappropriate degrees of inattention, impulsiveness, and hyperactivity in children 4-18
• Cause of ADHD has only been theorized
 decreased dopamine, norepinephrine, or
epinephrine
• Diagnosis is based on activity in at least 2 different settings and behavior present before age 7
• Boys > girls

Question 8

What are the manifestations of ADHD?

Answer 8

School or academic difficulties
• Social difficulties 
• Greater risk for 
 Conduct disorders
      Oppositional defiant disorders 
      Depression & anxiety 
  Developmental disorders such as 
     speech & language delays 
 Learning disabilities

Question 9

What are the nursing interventions for ADHD?

Answer 9

Encourage family and school to focus on developing the child’s strengths, don’t focus on weaknesses
Modifications may need to be made in school
Environmental manipulation
Consistency
Organizational charts
Decrease distractions - child needs to concentrate

Question 10

What are the complications of ADHD medications?

What should we try before medications?

Answer 10

behavioral therapy first
the meds cause...
high heart rate 
high blood pressure
reduced appetite
reduced weight gain
abd pain
sleeplessness
dry mouth