Cognitive & Sensory Impairment Flashcards
1
Q
Cognitive Impairment
A
Cognitive impairment of intellectual disability is a general term tht encompasses any type of mental difficulty or deficiency
2
Q
Cognitive Impairment - Diagnosis
A
- Made after a period of susicipion by family or health professionals
- In some instances, at birth
3
Q
Intellectual Disability
A
-
Subaverage intellectual function
> IQ of 70-75 or below - Functional strengths & weaknesses
- Younger than 18yrs at time of diagnoses
4
Q
Cognitive Impairment - Etiology
A
- Genetic
- Biochemical
- Infectious
- Familial
- Social
- Environmental
- Organic
5
Q
Nursing Care of Children w/ Impaired Cognitive Function
A
-
Educate child & family
> early intervention - Teach child self-care skills
- Promote child’s optimal development
-
Encourage play & exercise
> socialization - Provide means of communication
- Establish discipline
- Provide info on sexuality
- Help families adjust to future care
- Care for child during hospitalization
6
Q
Attention Deficit/Hyperactivity Disorder (ADHD)
A
-
Most common neurodevelopmental disorder of childhood
> inattention/distractibility
> impulsivity
> hyperactivity -
Child w/ ADHD has a disruption in learning, socialization, & compliance
> leads to significant demands on parents, teachers, & the community
7
Q
Attention Deficit/Hyperactivity Disorder (ADHD) - Diagnosis Criteria
A
- 6 or more findings from specific category are present
-
Ex:
> difficulty w/ attention
> does not seem to listen
> forgetful
> losing things easily
> fidgeting
> failing to remain sitting
> talking excessively
> interrupting often
8
Q
Attention Deficit/Hyperactivity Disorder (ADHD) - Patho
A
-
Not entirely understood but thought to be r/t alteration in dopamine/norepinephrine neurotransmitters
> familial tendency - Symptoms usually appear by 7yrs
-
Family support is very important
> educate parents -
Understand goals of IEP
> individualized education plan
9
Q
Attention Deficit/Hyperactivity Disorder (ADHD) - Medications
A
- Psychostimulants
- NOnstimulant norepinephrine reuptake inhibitors
10
Q
Autism Spectrum Disorder (ASD)
A
- Neurodevelopmental disorders
- Etiology unknown
- Behaviors impact the child’s abulity to communicate & interact w/ others
11
Q
Autism Spectrum Disorder (ASD) - CMs & Diagnostic Evaluation
A
- Deficits in social interactions, communication, & behavior
-
Common Delays (at least 1)
> social interactions
> social communication
> imaginative play
12
Q
Autism Spectrum Disorder (ASD) - Care Management
A
- Can be a severely disabling condition
-
No cure
> some improvement w/ language skills -
Numerous therapies needed
> recognize early
> attempt behavior modification
> provide a structured routine
> dcr unacceptable behavior - Often becomes a family disease
- Frequently family express guilt & shame
- Stress importance of family counseling
- Autism Society of America is good source of info
- Pts should be managed at home or in long-term placement facility
13
Q
Autism Spectrum Disorder (ASD) - Other Expected Findings
A
- 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
14
Q
Visual Impairment - Etiology
A
- Prenatal or postnatal infections
- Retinopathy of prematurity
- Trauma
- Postnatal infections
- Other disorders
- Sickle cell disease
- Juvenile rheumatoid arthitis
- Tay-Sachs disease
15
Q
Visual Impairment - Types
A
-
Refraction
> bending of light rays through the lens of the eye -
Myopia
> difficult to see objects far away -
Hyperopia
> difficult to see objects near -
Amblyopia
> lazy eye -
Strabismus
> may or may not be refractive
16
Q
Visual Impairment - Trauma
A
- Common cause of blindness in children
- Penetrating
- Nonpenetrating
-
Treatment:
> aimed at preventing further damage
17
Q
Visual Impairment - Infections
A
-
Conjuctivitis
> ophthalmic antibiotics
> systemic antibiotics in some cases
18
Q
Visual Impairment - Nursing Assessment
A
- Identify children who by virtue of their hx are at risk
- Observe for behaviors tht indicate a vision loss
- Screen all children for visual acuity
- Snellen letter, tumbling E, or picture chart
19
Q
Visual Impairment - Nursing Alert
A
Suspect visual impairment in a child of any age whose pupils do not react to light
20
Q
Visual Impairment - Nursing Care
A
- Promote parent-child attachment
-
Promote child’s optimal development
> independence
> play & socialization -
Education
> braille
> audio books & learning materials - Provide a safe envir’t
-
Hospitalized child
> provide reassurance during all treatment
> orient child to surroundings
> encourage independence
> treatment team members should be consistent
21
Q
Hearing Impairment - Etiology
A
- Fam hx
- Anatomic malformations
-
Perinatal asphyxia
> low oxygen during birth - Infections
- Substance abuse
- Chronic ear infections
- Cerebral Palsy
- Down Syndrome
- ELGAN
-
Ototoxic drugs
> O2 requirements
22
Q
Hearing Impairment - Types
A
-
Conductive
> middle ear -
Sensorineural
> inner ear, nerve damage - Mixed conductive-sensorineural
-
Central auditory imperceptions
> functional hearing loss; aphasia, agnosia, dysacusis
23
Q
Hearing Impairment - Manifs in Infants
A
- Lack of startle reflex
- Absences of reaction to auditory stimuli
- Absence of well-formed syllables by 11 months
- General indifference to sound
- Lack of response to spoken word
24
Q
Hearing Impairment - Manifs in Childhood
A
-
Profound deafness
> likely to be diagnosed in infancy - If not detected in infancy, identified upon entry into school
- Abnormalities in speech development
- Learning disabilities
25
Q
Hearing Impairment - Care Management
A
- Lipreading
- Cued speech
- Sign language
- Speech language therapy
- Additional aids
- Socialization
- Support child & fam
- Reassess understanding of instructions given
- Supplement w/ visual & tactile media
-
Provide communication devices
> picture board w/ common words
> assistance of child life specialist
> additional aids
26
Q
Chromosomal Abnormalities
A
-
Often have:
> intellectual disabilities
> learning disabilities
> behavioral problems
> distinct features (including birth defects) - Incrd risk of autosomal trisomy’s seen w/ advanced maternal age
-
EXs:
> Tay-Sachs, Prader-Willi, Angelman, Cri-du-chat, Wolf-Hirschhorn, Beckwith-Wiedemann
27
Q
Down Syndrome
A
- Most common chromosome abnormality
- Causes unknown; probably multiple
- Occurs in populations of all races
- Nonfamilial trisomy 21
-
Maternal age
> age 35: risk is 1 per 350 births - Chromosome analysis
28
Q
Down Syndrome - CMs
A
- Square head w/ upward slant to eyes
- Flat nasal bridge, protruding tongue
- Hypotonia
29
Q
Down Syndrome - Physical Probelms
A
- Congenital heart disease
- Hypothyroidism
- Leukemia
- Hip subluxation
- Dcr muscle tone
-
Hirschsprung’s disease
> nerves don’t develop properly in intestine; large intestine blockage -
Tracheoesophageal fistula
> esophagus & trachea abnormally connected - Strabismus/nystagmus
30
Q
Down Syndrome - Therapies
A
- Surgery to correct congenital anomalies
- Evaluation of hearing & sight
- Periodic testing of thyroid function
31
Q
Down Syndrome - Care Management
A
- Supporting child’s fam at time of diagnosis
- Preventing of physical problems
- Assist in prenatal diagnosis & genetic counseling
32
Q
Fragile X Syndrome
A
Second most common genetic cause of cognitive impairment after Down Syndrome
33
Q
Fragile X Syndrome - Etiology
A
Caused by abnormal gene on the lower end of the long arm of the X chromosome
34
Q
Fragile X Syndrome - CMs
A
- Large head circumference
-
Long face w/ a prominent jaw
> prognathism - Large, protruding ears
-
Large testes
> postpubertal - Manifs variable in female carriers of gene
35
Q
Fragile X Syndrome - Classic Behavioral Features
A
- Mild-severe cognitive impairment
- Delayed speech & language
- Hyperactivity
- Hypersensitivity to taste, sounds, touch
- Autistic-like behaviors
- Aggressive behaviors
36
Q
Fragile X Syndrome - Therapeutic Management
A
- Tegretol/Prozac for behavioral control
-
Stimulants for hyperactivity
> similar to management of attention deficit/hyperactivity disorder - Referral to early internvetion program
-
Prognosis
> normal life span expected -
Care management
> genetic counseling
37
Q
Turner Syndrome
A
-
Sex chromosome abnormality
> may only have 1 X -
Usually diagnosed in early childhood
> short stature
> failure to grow -
No cure
> hormonal therapy typically initiated - Therapeutic management focuses on managing the health issues r/t the syndrome
38
Q
Klinefelter Syndrome
A
-
Most common sex chromosomal abnormality
> 1 or more X chromosome is present - Often times not diagnosed until adolscence or adulthood
-
No cure
> infertility may be of concern
39
Q
Klinefelter Syndrome - CMs
A
- Lack of secondary sex characteristics
-
Cognitive impairments
> motor delay
> speech delay
> attention deficits
> learning disabilities -
Males present w/ female-like physical features
> testosterone deficiency
40
Q
Klinefelter Syndrome - Therapeutic Management
A
-
Focuses on managing health issues r/t the syndrome
> hormonal therapy typically initiated
> cosmetic surgery
