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Peds Exam 2 > Cognitive & Sensory Impairment > Flashcards

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

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2
Q

Cognitive Impairment - Diagnosis

A
  • Made after a period of susicipion by family or health professionals
  • In some instances, at birth
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3
Q

Intellectual Disability

A
  • Subaverage intellectual function
    > IQ of 70-75 or below
  • Functional strengths & weaknesses
  • Younger than 18yrs at time of diagnoses
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4
Q

Cognitive Impairment - Etiology

A
  • Genetic
  • Biochemical
  • Infectious
  • Familial
  • Social
  • Environmental
  • Organic
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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
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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
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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
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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
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9
Q

Attention Deficit/Hyperactivity Disorder (ADHD) - Medications

A
  • Psychostimulants
  • NOnstimulant norepinephrine reuptake inhibitors
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10
Q

Autism Spectrum Disorder (ASD)

A
  • Neurodevelopmental disorders
  • Etiology unknown
  • Behaviors impact the child’s abulity to communicate & interact w/ others
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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
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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
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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
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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
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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
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16
Q

Visual Impairment - Trauma

A
  • Common cause of blindness in children
  • Penetrating
  • Nonpenetrating
  • Treatment:
    > aimed at preventing further damage
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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

Peds Exam 2 (23 decks)

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