Intellectual Disability Nursing Flashcards
What do we mean by ‘Intellectual disability?
Significantly subaverage general intellectual functioning accompanied by significant limitations in adaptive functioning in at least 2 of the following areas
- Communication
- Self-care
- Home living
- Social/interpersonal skills
- Use of community resources
- Self-direction
- Academic skills
- Leisure
- Work
- Health and safety before the age of 18
What are the four sub-average intellectual functioning IQ levels?
Mild 50 – 69
Moderate 35 – 49
Severe 20 – 34
Profound below 20
Is it all about the persons IQ?
Diminishment of adaptive behaviour, assessment is according to levels of support needed and these can be labelled as intermittent
What else is measured?
Assistance with budgeting, meal planning, has some limited social/work skills, but requires frequent support with supervision and budgeting and living assistance
Extensive (can perform tasks with assistance but not independently) or pervasive unable to perform day to day functions and requires full assistance
Why do people with intellectual disabilities have higher rates of mental illness than the general population?
Because of limitations affecting communication abilities, processing skills, cognitive functioning and social skills. Consider recovery principles, strengths, hope, and resilience, may people with ID for whatever reason, may not have these attributes.
If someone with an intellectual disability (ID) presents with a mental disorder, can they be placed under the MHA92 for compulsory treatment? Explain your answer:
Yes, because the MHA works to assist people to manage their mental disorder and as people with ID as just as susceptible to mental illness (if not more) then they are afforded the same rights as any other citizen accessing health care.
What communication factors does the nurse have to consider when assessing someone with an ID for both physical and mental health?
- Acquiescence, saying yes to please
- Shyness and confusion, use repetitive (echolalia) speech
- Problems generalising speech and will seek familiar contexts such as home ie, voices come from the TV
- Limited capacity for conversation, primary disability, hearing/speech impediments
Who would you include in your assessment?
Everybody you can
Summarise the categories of the JOMAAC assessment: Judgement
Behaviours that assess judgement impairment such as perception of events, appropriate social behaviours, interpretation of vulnerable situations (stranger danger), Aggression, responses to significant life events (death of a loved one can be confusing), no improvement in behaviour despite input.
Summarise the categories of the JOMAAC assessment: Orientation
Awareness of surroundings, internal stimuli and name, location and reason for hospitalisation, and their impaired level of consciousness.
Summarise the categories of the JOMAAC assessment: Memory
Recent memory test, for example what did you have for breakfast? and Remote memory test, for example what is your date of birth?, what was the name of your high school?.
Summarise the categories of the JOMAAC assessment: Affect
Emotional status, acting out behaviour and reluctant to engage with other people or activities, withdrawal behaviour, body language, sleep disturbance, loss of interest or decreased concentration, reluctant to be with familiar people or surrounding
Summarise the categories of the JOMAAC assessment: Attitude
If a person is uncooperative, sarcastic, apprehensive or hostile
Summarise the categories of the JOMAAC assessment: Cognition
Understanding, speech (thought form), hallucinations (visual, auditory, tactile, olfactory or gustatory) emotional dissociation, paranoid behaviour, false beliefs
Reiss et al. (1982) coined the term ‘diagnostic overshadowing’. What does this mean?
Attributed behaviours solely to the ID or without looking for other underlying causes for example aggressive behaviour is because they don’t understand rather than considering reasons for behaviour such as pain, anxiety or mood fluctuation
Sophie is a 19-year-old woman with an intellectual disability living at home with her family. She needs extensive support and has been admitted as an involuntary patient with suspected psychosis. A history of Sophie’s recent changes was taken from the family. Sophie reported feeling afraid of her parents, she believed them to be evil. She indicated hearing voices in her head. She was heard talking to herself but dismissed this as singing. She became more withdrawn and became aggressive when approached by her parents. Her hygiene deteriorated and Sophie refused to change clothes or come out of her room except for meals. She began displaying behaviours such as hitting her head when stressed. Sophie slowly responded to treatment as rapport with staff grew (Harmon et al., 2017).
The key concerns identified in this case study are similar to any individual regardless of intellectual functioning. The assessor needs to consider already present behaviours, what is not typical behaviour for Sophie and communication issues. The mental health support plan does not try to address Sophie’s intellectual disability. It is intended to assist the family and healthcare team to manage the co-existing mental illness that has emerged causing Sophie and her family considerable distress.
What are the key concerns (nursing diagnoses) that need to be addressed here?
- The distress that her voices are causing her and possible risks associated with isolation, fear, aggression and command hallucinations
- Her diminished capacity to engage in ADL’s, not showering and risk of skin integrity and infection
- Self-harm behaviour, hitting her head
Sophie is a 19-year-old woman with an intellectual disability living at home with her family. She needs extensive support and has been admitted as an involuntary patient with suspected psychosis. A history of Sophie’s recent changes was taken from the family. Sophie reported feeling afraid of her parents, she believed them to be evil. She indicated hearing voices in her head. She was heard talking to herself but dismissed this as singing. She became more withdrawn and became aggressive when approached by her parents. Her hygiene deteriorated and Sophie refused to change clothes or come out of her room except for meals. She began displaying behaviours such as hitting her head when stressed. Sophie slowly responded to treatment as rapport with staff grew (Harmon et al., 2017).
The key concerns identified in this case study are similar to any individual regardless of intellectual functioning. The assessor needs to consider already present behaviours, what is not typical behaviour for Sophie and communication issues. The mental health support plan does not try to address Sophie’s intellectual disability. It is intended to assist the family and healthcare team to manage the co-existing mental illness that has emerged causing Sophie and her family considerable distress.
What are the potential stigma and discrimination issues associated with this case?
- Mental health stigma can be associated with being “crazy”. Risk of service rejection i.e some community care providers do not support mental illness
- Family could be discriminated against, accused of not caring for her properly
- Risk of diagnostic overshadowing, assumption her intellectual disability is the cause
What rights does Sophie have?
Same as everybody else
