Exam 2; Week 1 CLASS Flashcards
What is a cognitive impairment?
any type of mental difficulty or deficiency.
What is cognitive impairment synonymous with?
mental retardation; permanent impairment in adaptive and cognitive behavior
How can a cognitive impairment be classified?
- mild
- moderate
- severe
- profound
What 3 components are part of a cognitive impairment?
- intellectual functioning
- functional strengths and weaknesses
- 18 years of age or less at time of diagnosis
What are types of functional abilities that could be impaired? (functional impairment in at least 2 of 10 areas:)
- social skills
- self care
- communication
- health and safety
- home living
- self-direction
- leisure
- community use
- functional academics
- work
What is a developmental delay?
Any significant lag in a child’s physical, cognitive, behavioral, emotional, and/or social development, when compared against developmental norms
When is developmental delay a more appropriate diagnosis?
when definitive evidence of cognitive impairment does NOT exist.
What can help determine cognitive deficits?
standardize tests
What are some early behavioral signs that may suggest cognitive impairment?
- Irritable or unresponsive to contact
- Decreased alertness to movement or voice
- Delayed or difficult speech
- Delayed gross motor skills
- -> e.g., delayed rolling, sitting up, crawling, and walking - Feeding problems
- -> e.g., swallowing difficulties, disorganized feeding pattern - Poor or abnormal eye contact during feeding
- Dysmorphic features
- -> e.g., Down Syndrome and Fragile X Syndrome
What are the 3 primary causes of severe cognitive impairment?
- genetic
- biochemical
- infectious
What are events that may lead to cognitive impairment?
- Gestational disorders
- Prenatal influence
- Postnatal brain disease
- Infection and intoxication
- Trauma or physical cause
- Chromosomal abnormalities
- Metabolic disorders & Malnutrition
- Environmental influences
- Psychiatric disorders during child’s development
What are ways to provide nursing care for children with impaired cognitive impairment
- Educate child and family
- Early Intervention Programs
- —-> Early and prompt referral is key! - Teach child self-care skills
- Promote child’s optimal development
- Encourage play and exercise
- Provide means of communication
- —> Receptive and expressive skills
- —> Verbal and nonverbal communication - Establish discipline
- —> Limit setting appropriate for the child’s mental age - Encourage socialization
- Provide information on sexuality
- Protect against sexual abuse and assault
- Help family adjust to future care
- Care for child during hospitalization
- Support measures to prevent cognitive impairment
What are ways to prevent cognitive impairment?
- prenatal care
- folic acid supplements
- proper maternal nutrition
- avoidance of maternal cigarette/drug use
- newborn screening
- rubella immunization
- early intervention for children with developmental delays
What is the most common chromosomal abnormality of a generalized syndrome?
Down syndrome (trisomy 21)
True or false: Down syndrome occurs slightly more in African Americans than in whites
false; more in whites than in African Americans
What are 95% of Down syndrome cases caused by?
extra chromosome 21 (non-familial)
When is there an increased risk of Down syndrome?
maternal age >35 years
How is Down syndrome diagnosed?
- Usually diagnosed by clinical manifestations alone
2. Chromosomal analysis confirms genetic abnormality
What are clinical manifestations of Down syndrome?
- Separated sagital suture
- Oblique palpebral fissures (upward, outward slant)
- Small nose with depressed nasal bridge
- High, arched, narrow palate and protruding tongue
- Excess skin in neck folds
- Palmar creases
- Wide space & plantar crease between big and 2nd toes
- Hypotonia and hyperflexibility
What is the most common congenital heart malformations of Down syndrome?
septal defects (ASD/VSD)
What is the chief cause of death in children with Down syndrome?
respiratory tract infections
What are 5 other physical problems with Down syndrome?
- Hypotonicity of chest and abdominal muscles
- Dysfunction of immune system
- Thyroid dysfunction
- Increased incidence of leukemia
- Dry, cracked skin
Is there a cure for Down syndrome?
NO
What is important during the neonatal period for kids with Down syndrome?
echocardiogram
What are 2 types of regular medical care for children with Down syndrome?
- vision and hearing screenings
2. thyroid function tests
What would you want to do a radiological evaluation for in children with Down syndrome?
atlantoaxial instability
How would you use surgery in kids with Down syndrome?
- congenital heart defects
2. strabismus
What is some nursing care of children with Down Syndrome?
- support family at time of diagnosis
- assist family in preventing physical problems (correct positioning, measure to reduce risk for respiratory tract infections, support feeding and nutrition)
- Practice proper skin care to prevent cracking and infection
- —> Minimal soap to prevent drying of skin
- —> Apply lubricants and lip balm regularly - Assist in prenatal diagnosis and genetic counseling
- Amniocentesis and Chorionic Villus Sampling (CVS) of fetal cells will confirm the presence of trisomy or translocation
How do you want to support feeding in children with Down syndrome?
- Nasal saline and suction prior to feedings
- Long, straight-handled spoon for feedings
- —> Refeed thrust-out food - Prevent constipation
What is the most common inherited cause of cog. impairment?
Fragile X Syndrome
What are the 2 most common genetic causes of cognitive impairment?
- Down syndrome
2. fragile X syndrome
What is the inheritance pattern of fragile x syndrome?
x-linked dominant with reduced penetrance
Who is usually more affected in fragile x syndrome, women or men?
men
What are the 2 etiology statements for fragile x syndrome?
- Abnormal gene on the lower end of the long arm of the X chromosome
- Fragile site is present in the cells of affected males and females and in carrier females
What is unique about people permutation (carriers) of the fragile X syndrome?
People with premutation (carriers) are generally intellectually normal, although may have some mild and varied symptoms of the disorder
What are clinical manifestations of fragile x syndrome?
- Long, narrow face with prominent jaw (prognathism)
- Large, protruding ears
- Large testes (macroorchidism) in postpubertal males
- Strabismus
- Mitral valve prolapse and/or aortic root dilation
- Hypotonia/hyperflexibility
- Mild to severe cognitive impairment
- ADHD/ADD and/or Autistic-like behaviors
Is there a cure for fragile x syndrome?
No, but expected to live a normal life span
How can fragile x syndrome be pharmacologically managed?
- serotonin agents to control temper violent outburst
2. CNS stimulants to improve attention span and decrease hyperactivity.
What are 3 early intervention programs for fragile x syndrome?
- speech and language therapy
- occupational therapy
- special education as needed
What is autism spectrum disorder?
complex neurodevelopment disorder of unknown etiology
What are 2 changes that occur in autism spectrum disorder?
- alterations in social interaction
2. verbal impairment
What kind of behavioral patterns do individuals with autism spectrum disorder show?
repetitive, restricted, and stereotyped
When is autism usually noticed? When do symptoms start? When is it diagnosed?
a. during early childhood
b. manifest between 18-36 months
c. diagnosed until 2-3 years
True or false: down syndrome is four times more common in males than in females
true
Who is more affected by autism, males or females?
females
Is the etiology known with autism?
no
What do people think are the etiologies of autism?
- Immune and environmental factors may interact with the genetic susceptibility to increase the incidence of ASD
- Strong evidence for genetic basis in twins is consistent with an autosomal recessive pattern of inheritance
- High risk of recurrence of ASD in families with one affected child
- No specific gene for ASD has been identified
- NOT caused by MMR or thimerosal-containing vaccines
- May be some relationship to prenatal & perinatal events
What is autism a disorder of?
prenatal and postnatal brain development
What are clinical manifestations of autism?
- Poor eye contact
- Avoidance of body contact
- Speech and language delay at an early age
- -> No babbling or gesturing by 12 months
- -> Lack of single words by 16 months
- -> No 2-word phrases by 24 months
- -> “Loss” of previously spoken words and/or sounds - Limited functional play
- Unusual and/or odd interactions with toys
- Significant gastrointestinal symptoms (e.g., constipation)
- Cognitive impairment ranging from moderate to severe
What are the areas that a child must have a total of 6 or more items to be diagnosed with autism?
- Qualitative impairment in social interaction (at least 2)
- Qualitative impairments in communication (at least 1)
- Restricted repetitive and stereotyped patterns of behavior, interests, and activities (at least 1)
Delays or abnormal functioning in at least one of the following areas, with onset before age 3 years for diagnosis of autism?
- Social interaction
- Language as used in social communication
- Symbolic or imaginative play
What is the prognosis of autism spectrum disorder?
- Usually a severely disabling condition
- Some children show improvement in language skills and communication with others
- Most require lifelong adult supervision, although some are ultimately able to achieve independence
- Girls have a greater tendency for continued deterioration
- Prognosis is most favorable for children with communicative speech development by age 5 years and with an IQ above 50 at time of diagnosis
- Early recognition and intervention is key to more positive outcomes/improved prognosis
What is nursing care of children with autism spectrum disorder?
- Promote positive reinforcement
- Increase social awareness of others
- Teach verbal communication skills
- Decrease unacceptable behavior
- Highly structured and intense behavior modification shows the most promising results
- provide family support –> family disease
What is key with children with autism?
structure routine is key
What are things to do with children who have been hospitalized for autism spectrum disorder?
- Parents should stay with child as much as possible
- Individualized care is key
- Decrease stimulation – private room
- Encourage family to bring child’s favorite items
- Minimize holding and eye contact
- Communication should be brief and concrete
- Use care when performing procedures or feeding/administering medications
- -> Child may refuse food/medications, gag, hoard, mouth and/or swallow inedible objects, or throw food
define ADHD?
developmentally inappropriate degrees of inattention, impulsiveness, and hyperactivity.
What are there impairments in with kids who have ADHD?
Clinically significant impairment in social, academic, or occupational functioning
define learning disability
Heterogeneous group of disorders manifested by significant difficulties in the acquisition and use of listening, speaking, reading, writing, reasoning, or mathematic skills
What are the tests used to confirm a learning disability?
- IQ tests
- Hand-eye coordination tests
- Measurements of auditory and visual perception
- Measurements of spatial organization
- Measurements of comprehension and memory
- Often there is a wide gap between verbal and performance scores on IQ tests
How is ADHD diagnosed?
- ≥ 6 symptoms of inattention AND ≥ 6 symptoms of hyperactivity-impulsivity
+Symptoms must be present for ≥ 6 months
+Symptoms are maladaptive & inconsistent with developmental level
+Symptoms must have been present before age 7 years
+Symptoms must be present in at least 2 settings
True or false: every child has every symptom of ADHD
false
true or false: inattention must be a symptom of another disorder for ADHD
false: inattention must not be a symptom of another disorder
What is key with ADHD and LD?
early detection
Can ADHD be relatively stable with appropriate intervention?
yes; symptoms may continue into adulthood or subside
What are ways to care for someone who has ADHD?
- Work with families and school personnel to help plan and implement therapeutic regimens and evaluate the effectiveness of therapy
- Coordinate services
- Serve as a liaison between health and education professionals
- Educate patient and family about diagnosis, prognosis and treatment plan
What are the 3 most common eating disorders?
- obesity
- anorexia nervosa
- bulemia
What is the most accurate screening measure for obesity in children and adolescents?
Body mass index
define obesity
an increase in body weight resulting from an excessive accumulation of body fat relative to lean body mass
What is considered an obese BMI?
greater than 95th percentile for age, gender, and height
define overweight
the state of weighing more than average for height and body build
What is considered an overweight BMI?
between 85th and 95th percentiles for age, gender, and heigh
What is the most common cause of obesity in children and adolescents?
overeating
- institutional factors support unhealthy eating
- increased availability and promotional pricing of high-fat and high-sugar foods
What is another important contributing factor to obesity in children and adolescents?
physical inactivity
fewer than 5% of childhood obesity mass can be attributed to what?
underlying disease
What can also negatively affect eating patterns?
psychologic factors
What is the primary role of a nurse caring for a child with obesity
PREVENTION through counseling and promotion of proper nutrition and exercise
What may a treatment plan include for a child with obesity?
- Nutritional counseling/diet modification
- Behavioral therapy
- Group involvement
- Family involvement
- Increased physical activity
what is an eating disorder characterized by a refusal to maintain a minimally normal body weight, as well as weight loss in the absence of obvious physical causes?
anorexia nervosa
What is the average age of onset for anorexia nervosa?
13 years old (as early as 10, and as late as 25)
What is a common initiating factor of anorexia?
dieting
Who is more commonly affected by anorexia nervosa?
males
What is diagnostic criteria for anorexia nervosa?
- Refusal to maintain body weight over a minimal normal weight for age and height
- Intense fear of gaining weight or becoming fat, even though underweight
- Disturbance of body image
- Denial of seriousness of the current low body weight
5, Amenorrhea in postmenarchal females
What are some clinical manifestations of anorexia nervosa?
- Bradycardia and hypotension
- Hypothermia/cold intolerance
- Dry skin, brittle hair & nails, and lanugo hair
What are repeated episodes of binge eating followed by inappropriate compensatory behaviors (purging)?
bulemia nervosa
What are some ways that people might represent bulemia?
- Self-induced vomiting
- Excessive exercise
- Fasting
- Misuse of laxatives, enemas, diuretics, or other medications
How is binge behavior characterized?
secretive, frenzied consumption of large amounts of high-calorie (or “forbidden”) foods during a brief time (<2 hours)
What are binge-purge cycles followed by?
- Self-deprecating thoughts
- Depressed mood
- Awareness that the eating pattern is abnormal
What is a common initiating factor of bulimia?
dieting
What group is most commonly affected by bulemia?
adolescent girls and young women
What are 2 additional types of clinical manifestations for bulemia nervosa?
- Tooth erosion and esophageal damage
2. Diarrhea, constipation, and/or other GI symptoms
What are things you can do to care for children with anorexia and bulemia nervosa?
- Maintain a kind and supportive yet firm manner
- Avoid creating a passive-dependent attitude
- Encourage activities that strengthen self-esteem
- Closely monitor vital signs, especially CV status
- Maintain consistency and structured environment
- Communication among team members is essential
- Consider a behavioral contract
- Remove binge foods; restrict eating to one room
- Refer to appropriate community resources
