Pediatrics Test 2: Child with Special Needs

Question 0

Impact on the family

Answer 0

Make sure they have extra help and utilize a support system
Adaptive tasks
   - ways to deal with stress
   - counseling
   - finance, insurance, FMLA 
   - personal health
   - mental well being as a couple 
Educating others

Question 1

What are major concepts in care for a special needs child

Answer 1

Developmental
Family-centered
Normalization
Home care: what children remain in home
Mainstreaming: language applied to school system and daycare. Go to same school as others their age
Early intervention: identify those at risk and have access to systems that can help them

Question 2

Family stress points

Answer 2

Primarily when they come to milestones

1. Diagnosis
2. When don’t walk/ talk at the same time
3. Suppose to start school
4. Hit a developmental wall
5. Adolescence
6. Future placement
7. Reach end of a road

Question 3

Stages of adaptation to chronic illness

Answer 3

1. Shock, disbelief, denial
   
   • regret diagnosis for amount of time, physican shopping, attribute symptoms to minor sickness, delay treatment
2. Adjustment
   
   • understand diagnosis, go through blaming, bitterness, guilt, overprotection, gradual move to acceptance
3. Reintegration and Acknowledgement
   
   • gradual process and developing realistic expectations. Develop chronic sorrow

Question 4

How do families move forward

Answer 4

Vary depending on the problem
Activites of daily living
Promoting normal development
Advocating and inclusion
Building support systems
Planning for realistic futures

Question 5

Impact on the child

Answer 5

Coping
  - develops competence and optimism
  - feels affrent and withdraws 
  - irritable, moody, acts out
  - complies with treatment and seeks support
Hope 
Self care

Question 6

Cognitive impairment levels

Answer 6

Mild: 50-70 IQ social skills, self maintenance, manage money, have relationships, can be married
Moderate: 36-46 IQ simple tasks, live in apartment, travel alone in familiar surroundings
Severe: 20-35 IQ daily routine, respetitive, needs watched
Profound: <20 need complete care, nonverbal

Question 7

Areas for functional strength and weaknesses

Answer 7

Communication
Self care
Home living
Social skills
Leisure
Health and safety
Self direction
Functional academics

Question 8

Areas of care

Answer 8

Education
Self care
Optimal development
Play/ exercise
Communication stratigies 
Discipline
Socialization
Behavioral stratigies

Question 9

Hospitalized child with intellectual disability

Answer 9

Mutual participation mode, for planning care
Pre-hospitalization visit
Detailed history
Distraction activities
Explain procedures
Determine child’s preferred communication strategy

Question 10

Down’s Syndrome Clinical Manifestations

Answer 10

Intelligence
Social development 
Congenital anomalies: have congenital anomalies, hypothyroidism, bipolar
Growth
Growth differences
  - separated Sagital suture
  - oblique para rail
  - high arch narrow palate
  - protruding tongue
  - extra skin at neck
  - short broad hands and feet
  - simian crease

Question 11

Fragile X

Answer 11

Cause of inherited mental retardation

Diagnosed by DNA analysis

Question 12

Fragile X clinical manifestations

Answer 12

Long narrow face with prominent jaw
Large protruding ears
Mild to severe cognitive Impairment
Speech delay
Short attention span
May be aggressive

Question 13

Sensory impairment - hearing

Answer 13

5-10 in 1000 infants have hearing loss

Can be acquired

Question 14

Hearing impairment levels

Answer 14

Severe to profound
- precludes successful processing of linguistic information through audition
Slight to moderate
- has residual hearing sufficient to enable successful processing of linguistic information through audition

Question 15

Classifications of haring loss

Answer 15

Slight: 16-25 dB difficulty heating faint sounds
Mild: 26-50 dB some speech difficulties but understand 3-5 feet
Moderate: 41-55 dB understand conversation and have problem with group
Severe: 71-90 dB hear loud environmental noises
Profound: >90 dB

Question 16

Locations of hearing loss

Answer 16

Conductive or middle ear: interferes with transmission to middle ear
Sensorineural: inner ear or auditory nerve (get distortion, don’t hear individual sounds well)
Mixed-conductive sensioneural
Central: disruptions of brain itself

Question 17

Clinical manifestations

Answer 17

Parental concern
Loss of cooing by the age of 6-9 months
Presentation may vary depending on degree of hearing loss
Infant
- lack of stable reflex to loud sound
- failure to localize sound by 6 months
- absence of babble by 7 months
- lack of response to spoken word
Children
- use gestures rather than verbalization
- failure to develop speech by age 24 months

Question 18

Different visual impairments

Answer 18

Myopia: nearsighted, rub eyes, tilt head
Hyperopia: farsighted, around 7
Astigmatism: unequal curvature
Amblyopia: blindness
Strabismus: eye wandering in or out, squint, bad hand-eye coordination
Cataracts
Glaucoma

Question 19

Clinical burns in eye

Answer 19

Irrigate with copious amounts of tap water for 20 minutes
Every upper eye lid to flush
Take to ER 
have child rest with eyes closed
Do not rub
Keep room darkened

Question 20

Hematoma in eye

Answer 20

Hit with something
Check with flashlight to see if there was a hemorrhage
Apply ice for 24 hours
Rest with closed eyes

Question 21

Communication impairment

Answer 21

Inability to receive or process symbols, represent concepts or symbols, transmit and use symbols
May occur in:
  - hearing
  - speech
  - language
      - repetitive and expressive