Cognitive Impairment Flashcards
Cognitive impairment
General term for any type of intellectual, adaptive, or developmental disability before age 22
- at least 2 of the following domains: self-care, home living, self-direction, healthy dns after, academics, leisure, work, communication, social skills, etc
Nursing role for kids with CI
- identify and regular dev assess
- develop individualized edu plan and work with school sys
- edu child and family
- promote child’s optimum development
- promote ind self-help skills
Identification of kids with CI
- dysmorphic features
- irritable or non-responsive to eye contact***
- abnormal eye contact during feeding
- gross motor delay
- Dec alertness to voice or mvt
- lack of joint attentiveness (look at moon! Don’t turn and look)
- lang delay or prob
- feeding prob
Laws for CI kids in school
- ADA
- Ind with disabilities edu act (IDEA)
- Ind family service plan
- Ind edu plan
Educate fam on…
- short-term memory (need repetition)
- difficulty discriminating btwn 2+ stimuli—need low stimuli
- motivation probs
- technology
- early intervention programs
- communication
- need consistency and discipline
- socialization—encourage play and exercise
- sexuality—may not understand, vulnerable
- play and exercise
- promote independence with ADLs
Down Syndrome (Trisomy 21)
- 3rd copy of 21st chromosome
- parents don’t pass on affected gene but inc chx of having multiple kids with it
- higher chance with older mothers
Down syndrome CM
- depressed nasal bridge (often congested, cool mist, suction, inc risk URI)
- small nose
- excess/loose skin on back of neck
- atlantoaxial instability—more unstable neck, can cause discomfort and lack of neck support
- high arched palate, large protruding tongue
- inner epicanthal folds (corners of eyes)
- Dec muscle tone
- wide space btwn big and 2nd tone
- Simlan crease—connected crease in palm
- wide base stance
Down syndrome developmental CM
- lower intelligence
- social development delay
- cognitive abnormalities
- sensory problems
- growth—ht&wt dec but often obesity
- sexual dev often delayed
Down sx associated illnesses
Feeding probs, obesity, constipation, congenital heart defects, acute otitis media (ear infx), ALL, hypothyroidism, URI
Down syndrome NC
- fam support
- assist fam in preventing physical probs
- promote dev progress
- assist with genetic counseling
- might need longer time to feed bc tongue thrust
ASD cause and dx
Unknown
- often dx in toddlers bc recognize behaviors early
- 4x more common in boys
- unrelated to SES level or race
ASD CM and associated illnesses
Core deficits in
- social interactions
- communication
- behavior
- restricted repetitive behavior, interests, activities
Associated with GI problems, epilepsy, feeding problems, disrupted sleep, ADHD, anxiety, depression, OCD, schizophrenia, BPD
ASD social interaction deficits
- abnormal eye contact often earliest sign
- failure to smile
- failure to orient to name
- lack imitation
- lack interactive/imitative play
ASD communication deficits
- absent to delayed speech
- atypical lang like humming or grunting for extended periods, laughing inappropriately, use of echolalia
ASD behavioral abnormalities
Repetitive impulse, restrictive, and obsessive behavior
- rocking, flapping, nodding
- spinning, twirling
- difficulty with change
- self-injurious behavior like biting and picking at skin
ASD NC management
- therapy from multiple sources—child development, child life, OT, PT
- provide positive reinforcement
- inc social awareness
- teach verbal communication skills—simple language, no figures of speech, may need communication board
- Dec unacceptable behavior
- have parents bring in items they like, ask about how they interact
- Get food they will eat
- don’t overwhelm with lots of people, dim lighting, approach slowly
- may not understand facial expressions
- private room
Attention deficit/Hyperactivity disorder (ADHD)
Dev inappropriate degrees of inattention, impulsiveness, and hyperactivity in kids
- unknown cause
- decreased DP, NOR, EPI
- diagnosis based on activity in at least 2 diff settings and behavior present before age 7
- more boys than girls
ADHD dx
- types are inattentive and hyperactive
- assessment and physical exam
- multidisciplinary evaluation from 2 ppl who interact with child often like teacher, parent, therapist
ADHD CM and assoc problems
- school or academic difficulties
- social difficulties
- greater risk for conduct dx, oppositional defiant dx, dep and anx, dev dx like speech and language delay, learning disability
- 6+ sx
- social prob, not close attn to detail, problem with focusing, prob organizing tasks, poor time management, fidget, forget daily tasks, can’t sit still, prob waiting turn, intrusive
ADHD tx
- behavioral therapy and psychotherapy (first line in kids 4-5Y)—have kid sit closer, more positive reinforcement
- psychostimulants like methylphenidate (Ritalin) and dextroamphetamin
- TCAs, clonidine
ADHD NC
- have kid sit closer
- Dec distractions
- Clear and consistent rules
- focus on dev child’s strengths
- create organized and consistent enviro
ADHD drug NC
Stim side effects—wt loss, an pain, Dec appetite, sleeplessness, HA, growth velocity
- close monitoring of effectiveness every few months
- give meds at breakfast and noon
- avoid caffeine—can Dec effectiveness
- give immediate release formulations on empty stomach
- insulin dosing may need to be altered for kids with DM
- drug holiday not RECC
- psychstim can be addictive
