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NURS 366 > Exam 2; Week 1 CLASS > Flashcards

Exam 2; Week 1 CLASS Flashcards

1
Q

What is a cognitive impairment?

A

any type of mental difficulty or deficiency.

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2
Q

What is cognitive impairment synonymous with?

A

mental retardation; permanent impairment in adaptive and cognitive behavior

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3
Q

How can a cognitive impairment be classified?

A
  1. mild
  2. moderate
  3. severe
  4. profound
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4
Q

What 3 components are part of a cognitive impairment?

A
  1. intellectual functioning
  2. functional strengths and weaknesses
  3. 18 years of age or less at time of diagnosis
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5
Q

What are types of functional abilities that could be impaired? (functional impairment in at least 2 of 10 areas:)

A
  1. social skills
  2. self care
  3. communication
  4. health and safety
  5. home living
  6. self-direction
  7. leisure
  8. community use
  9. functional academics
  10. work
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6
Q

What is a developmental delay?

A

Any significant lag in a child’s physical, cognitive, behavioral, emotional, and/or social development, when compared against developmental norms

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7
Q

When is developmental delay a more appropriate diagnosis?

A

when definitive evidence of cognitive impairment does NOT exist.

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8
Q

What can help determine cognitive deficits?

A

standardize tests

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9
Q

What are some early behavioral signs that may suggest cognitive impairment?

A
  1. Irritable or unresponsive to contact
  2. Decreased alertness to movement or voice
  3. Delayed or difficult speech
  4. Delayed gross motor skills
    - -> e.g., delayed rolling, sitting up, crawling, and walking
  5. Feeding problems
    - -> e.g., swallowing difficulties, disorganized feeding pattern
  6. Poor or abnormal eye contact during feeding
  7. Dysmorphic features
    - -> e.g., Down Syndrome and Fragile X Syndrome
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10
Q

What are the 3 primary causes of severe cognitive impairment?

A
  1. genetic
  2. biochemical
  3. infectious
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11
Q

What are events that may lead to cognitive impairment?

A
  1. Gestational disorders
  2. Prenatal influence
  3. Postnatal brain disease
  4. Infection and intoxication
  5. Trauma or physical cause
  6. Chromosomal abnormalities
  7. Metabolic disorders & Malnutrition
  8. Environmental influences
  9. Psychiatric disorders during child’s development
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12
Q

What are ways to provide nursing care for children with impaired cognitive impairment

A
  1. Educate child and family
  2. Early Intervention Programs
    - —-> Early and prompt referral is key!
  3. Teach child self-care skills
  4. Promote child’s optimal development
  5. Encourage play and exercise
  6. Provide means of communication
    - —> Receptive and expressive skills
    - —> Verbal and nonverbal communication
  7. Establish discipline
    - —> Limit setting appropriate for the child’s mental age
  8. Encourage socialization
  9. Provide information on sexuality
  10. Protect against sexual abuse and assault
  11. Help family adjust to future care
  12. Care for child during hospitalization
  13. Support measures to prevent cognitive impairment
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13
Q

What are ways to prevent cognitive impairment?

A
  1. prenatal care
  2. folic acid supplements
  3. proper maternal nutrition
  4. avoidance of maternal cigarette/drug use
  5. newborn screening
  6. rubella immunization
  7. early intervention for children with developmental delays
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14
Q

What is the most common chromosomal abnormality of a generalized syndrome?

A

Down syndrome (trisomy 21)

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15
Q

True or false: Down syndrome occurs slightly more in African Americans than in whites

A

false; more in whites than in African Americans

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16
Q

What are 95% of Down syndrome cases caused by?

A

extra chromosome 21 (non-familial)

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17
Q

When is there an increased risk of Down syndrome?

A

maternal age >35 years

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18
Q

How is Down syndrome diagnosed?

A
  1. Usually diagnosed by clinical manifestations alone

2. Chromosomal analysis confirms genetic abnormality

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19
Q

What are clinical manifestations of Down syndrome?

A
  1. Separated sagital suture
  2. Oblique palpebral fissures (upward, outward slant)
  3. Small nose with depressed nasal bridge
  4. High, arched, narrow palate and protruding tongue
  5. Excess skin in neck folds
  6. Palmar creases
  7. Wide space & plantar crease between big and 2nd toes
  8. Hypotonia and hyperflexibility
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20
Q

What is the most common congenital heart malformations of Down syndrome?

A

septal defects (ASD/VSD)

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21
Q

What is the chief cause of death in children with Down syndrome?

A

respiratory tract infections

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22
Q

What are 5 other physical problems with Down syndrome?

A
  1. Hypotonicity of chest and abdominal muscles
  2. Dysfunction of immune system
  3. Thyroid dysfunction
  4. Increased incidence of leukemia
  5. Dry, cracked skin
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23
Q

Is there a cure for Down syndrome?

A

NO

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24
Q

What is important during the neonatal period for kids with Down syndrome?

A

echocardiogram

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25
Q

What are 2 types of regular medical care for children with Down syndrome?

A
  1. vision and hearing screenings

2. thyroid function tests

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26
Q

What would you want to do a radiological evaluation for in children with Down syndrome?

A

atlantoaxial instability

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27
Q

How would you use surgery in kids with Down syndrome?

A
  1. congenital heart defects

2. strabismus

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28
Q

What is some nursing care of children with Down Syndrome?

A
  1. support family at time of diagnosis
  2. assist family in preventing physical problems (correct positioning, measure to reduce risk for respiratory tract infections, support feeding and nutrition)
  3. Practice proper skin care to prevent cracking and infection
    - —> Minimal soap to prevent drying of skin
    - —> Apply lubricants and lip balm regularly
  4. Assist in prenatal diagnosis and genetic counseling
  5. Amniocentesis and Chorionic Villus Sampling (CVS) of fetal cells will confirm the presence of trisomy or translocation
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29
Q

How do you want to support feeding in children with Down syndrome?

A
  1. Nasal saline and suction prior to feedings
  2. Long, straight-handled spoon for feedings
    - —> Refeed thrust-out food
  3. Prevent constipation
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30
Q

What is the most common inherited cause of cog. impairment?

A

Fragile X Syndrome

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31
Q

What are the 2 most common genetic causes of cognitive impairment?

A
  1. Down syndrome

2. fragile X syndrome

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32
Q

What is the inheritance pattern of fragile x syndrome?

A

x-linked dominant with reduced penetrance

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33
Q

Who is usually more affected in fragile x syndrome, women or men?

A

men

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34
Q

What are the 2 etiology statements for fragile x syndrome?

A
  1. Abnormal gene on the lower end of the long arm of the X chromosome
  2. Fragile site is present in the cells of affected males and females and in carrier females
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35
Q

What is unique about people permutation (carriers) of the fragile X syndrome?

A

People with premutation (carriers) are generally intellectually normal, although may have some mild and varied symptoms of the disorder

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36
Q

What are clinical manifestations of fragile x syndrome?

A
  1. Long, narrow face with prominent jaw (prognathism)
  2. Large, protruding ears
  3. Large testes (macroorchidism) in postpubertal males
  4. Strabismus
  5. Mitral valve prolapse and/or aortic root dilation
  6. Hypotonia/hyperflexibility
  7. Mild to severe cognitive impairment
  8. ADHD/ADD and/or Autistic-like behaviors
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37
Q

Is there a cure for fragile x syndrome?

A

No, but expected to live a normal life span

38
Q

How can fragile x syndrome be pharmacologically managed?

A
  1. serotonin agents to control temper violent outburst

2. CNS stimulants to improve attention span and decrease hyperactivity.

39
Q

What are 3 early intervention programs for fragile x syndrome?

A
  1. speech and language therapy
  2. occupational therapy
  3. special education as needed
40
Q

What is autism spectrum disorder?

A

complex neurodevelopment disorder of unknown etiology

41
Q

What are 2 changes that occur in autism spectrum disorder?

A
  1. alterations in social interaction

2. verbal impairment

42
Q

What kind of behavioral patterns do individuals with autism spectrum disorder show?

A

repetitive, restricted, and stereotyped

43
Q

When is autism usually noticed? When do symptoms start? When is it diagnosed?

A

a. during early childhood
b. manifest between 18-36 months
c. diagnosed until 2-3 years

44
Q

True or false: down syndrome is four times more common in males than in females

A

true

45
Q

Who is more affected by autism, males or females?

A

females

46
Q

Is the etiology known with autism?

A

no

47
Q

What do people think are the etiologies of autism?

A
  1. Immune and environmental factors may interact with the genetic susceptibility to increase the incidence of ASD
  2. Strong evidence for genetic basis in twins is consistent with an autosomal recessive pattern of inheritance
  3. High risk of recurrence of ASD in families with one affected child
  4. No specific gene for ASD has been identified
  5. NOT caused by MMR or thimerosal-containing vaccines
  6. May be some relationship to prenatal & perinatal events
48
Q

What is autism a disorder of?

A

prenatal and postnatal brain development

49
Q

What are clinical manifestations of autism?

A
  1. Poor eye contact
  2. Avoidance of body contact
  3. 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
  4. Limited functional play
  5. Unusual and/or odd interactions with toys
  6. Significant gastrointestinal symptoms (e.g., constipation)
  7. Cognitive impairment ranging from moderate to severe
50
Q

What are the areas that a child must have a total of 6 or more items to be diagnosed with autism?

A
  • 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)
51
Q

Delays or abnormal functioning in at least one of the following areas, with onset before age 3 years for diagnosis of autism?

A
  1. Social interaction
  2. Language as used in social communication
  3. Symbolic or imaginative play
52
Q

What is the prognosis of autism spectrum disorder?

A
  1. Usually a severely disabling condition
  2. Some children show improvement in language skills and communication with others
  3. Most require lifelong adult supervision, although some are ultimately able to achieve independence
  4. Girls have a greater tendency for continued deterioration
  5. Prognosis is most favorable for children with communicative speech development by age 5 years and with an IQ above 50 at time of diagnosis
  6. Early recognition and intervention is key to more positive outcomes/improved prognosis
53
Q

What is nursing care of children with autism spectrum disorder?

A
  1. Promote positive reinforcement
  2. Increase social awareness of others
  3. Teach verbal communication skills
  4. Decrease unacceptable behavior
  5. Highly structured and intense behavior modification shows the most promising results
  6. provide family support –> family disease
54
Q

What is key with children with autism?

A

structure routine is key

55
Q

What are things to do with children who have been hospitalized for autism spectrum disorder?

A
  1. Parents should stay with child as much as possible
  2. Individualized care is key
  3. Decrease stimulation – private room
  4. Encourage family to bring child’s favorite items
  5. Minimize holding and eye contact
  6. Communication should be brief and concrete
  7. 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
56
Q

define ADHD?

A

developmentally inappropriate degrees of inattention, impulsiveness, and hyperactivity.

57
Q

What are there impairments in with kids who have ADHD?

A

Clinically significant impairment in social, academic, or occupational functioning

58
Q

define learning disability

A

Heterogeneous group of disorders manifested by significant difficulties in the acquisition and use of listening, speaking, reading, writing, reasoning, or mathematic skills

59
Q

What are the tests used to confirm a learning disability?

A
  • 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
60
Q

How is ADHD diagnosed?

A
  • ≥ 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
61
Q

True or false: every child has every symptom of ADHD

A

false

62
Q

true or false: inattention must be a symptom of another disorder for ADHD

A

false: inattention must not be a symptom of another disorder

63
Q

What is key with ADHD and LD?

A

early detection

64
Q

Can ADHD be relatively stable with appropriate intervention?

A

yes; symptoms may continue into adulthood or subside

65
Q

What are ways to care for someone who has ADHD?

A
  • 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
66
Q

What are the 3 most common eating disorders?

A
  1. obesity
  2. anorexia nervosa
  3. bulemia
67
Q

What is the most accurate screening measure for obesity in children and adolescents?

A

Body mass index

68
Q

define obesity

A

an increase in body weight resulting from an excessive accumulation of body fat relative to lean body mass

69
Q

What is considered an obese BMI?

A

greater than 95th percentile for age, gender, and height

70
Q

define overweight

A

the state of weighing more than average for height and body build

71
Q

What is considered an overweight BMI?

A

between 85th and 95th percentiles for age, gender, and heigh

72
Q

What is the most common cause of obesity in children and adolescents?

A

overeating

  1. institutional factors support unhealthy eating
  2. increased availability and promotional pricing of high-fat and high-sugar foods
73
Q

What is another important contributing factor to obesity in children and adolescents?

A

physical inactivity

74
Q

fewer than 5% of childhood obesity mass can be attributed to what?

A

underlying disease

75
Q

What can also negatively affect eating patterns?

A

psychologic factors

76
Q

What is the primary role of a nurse caring for a child with obesity

A

PREVENTION through counseling and promotion of proper nutrition and exercise

77
Q

What may a treatment plan include for a child with obesity?

A
  1. Nutritional counseling/diet modification
  2. Behavioral therapy
  3. Group involvement
  4. Family involvement
  5. Increased physical activity
78
Q

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?

A

anorexia nervosa

79
Q

What is the average age of onset for anorexia nervosa?

A

13 years old (as early as 10, and as late as 25)

80
Q

What is a common initiating factor of anorexia?

A

dieting

81
Q

Who is more commonly affected by anorexia nervosa?

A

males

82
Q

What is diagnostic criteria for anorexia nervosa?

A
  1. Refusal to maintain body weight over a minimal normal weight for age and height
  2. Intense fear of gaining weight or becoming fat, even though underweight
  3. Disturbance of body image
  4. Denial of seriousness of the current low body weight
    5, Amenorrhea in postmenarchal females
83
Q

What are some clinical manifestations of anorexia nervosa?

A
  1. Bradycardia and hypotension
  2. Hypothermia/cold intolerance
  3. Dry skin, brittle hair & nails, and lanugo hair
84
Q

What are repeated episodes of binge eating followed by inappropriate compensatory behaviors (purging)?

A

bulemia nervosa

85
Q

What are some ways that people might represent bulemia?

A
  1. Self-induced vomiting
  2. Excessive exercise
  3. Fasting
  4. Misuse of laxatives, enemas, diuretics, or other medications
86
Q

How is binge behavior characterized?

A

secretive, frenzied consumption of large amounts of high-calorie (or “forbidden”) foods during a brief time (<2 hours)

87
Q

What are binge-purge cycles followed by?

A
  1. Self-deprecating thoughts
  2. Depressed mood
  3. Awareness that the eating pattern is abnormal
88
Q

What is a common initiating factor of bulimia?

A

dieting

89
Q

What group is most commonly affected by bulemia?

A

adolescent girls and young women

90
Q

What are 2 additional types of clinical manifestations for bulemia nervosa?

A
  1. Tooth erosion and esophageal damage

2. Diarrhea, constipation, and/or other GI symptoms

91
Q

What are things you can do to care for children with anorexia and bulemia nervosa?

A
  1. Maintain a kind and supportive yet firm manner
  2. Avoid creating a passive-dependent attitude
  3. Encourage activities that strengthen self-esteem
  4. Closely monitor vital signs, especially CV status
  5. Maintain consistency and structured environment
  6. Communication among team members is essential
  7. Consider a behavioral contract
  8. Remove binge foods; restrict eating to one room
  9. Refer to appropriate community resources

NURS 366 (7 decks)

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