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
Hearing Impairment - Care Management
- **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
Chromosomal Abnormalities
- **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
Down Syndrome
- **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
Down Syndrome - CMs
- **Square head w/ upward slant to eyes**
- **Flat nasal bridge, protruding tongue**
- **Hypotonia**
29
Down Syndrome - Physical Probelms
- **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
Down Syndrome - Therapies
- **Surgery to correct congenital anomalies**
- **Evaluation of hearing & sight**
- **Periodic testing of thyroid function**
31
Down Syndrome - Care Management
- **Supporting child's fam at time of diagnosis**
- **Preventing of physical problems**
- **Assist in prenatal diagnosis & genetic counseling**
32
Fragile X Syndrome
**Second most common genetic cause of cognitive impairment after Down Syndrome**
33
Fragile X Syndrome - Etiology
**Caused by abnormal gene on the lower end of the long arm of the X chromosome**
34
Fragile X Syndrome - CMs
- **Large head circumference**
- **Long face w/ a prominent jaw**
> prognathism
- **Large, protruding ears**
- **Large testes**
> postpubertal
- **Manifs variable in female carriers of gene**
35
Fragile X Syndrome - Classic Behavioral Features
- **Mild-severe cognitive impairment**
- **Delayed speech & language**
- **Hyperactivity**
- **Hypersensitivity to taste, sounds, touch**
- **Autistic-like behaviors**
- **Aggressive behaviors**
36
Fragile X Syndrome - Therapeutic Management
- **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
Turner Syndrome
- **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
Klinefelter Syndrome
- **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
Klinefelter Syndrome - CMs
- **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
Klinefelter Syndrome - Therapeutic Management
- **Focuses on managing health issues r/t the syndrome**
> hormonal therapy typically initiated
> cosmetic surgery
