Peds Exam 3b - Cog Imp.

Question 1

cognitive impairment

Answer 1

general term that encompasses any type of intellectual disability

Question 2

identifying child w/ CI (a nurses job)

Answer 2

-dysmorphic features
-irritability or non responsiveness to contact
-abnormal eye contact during feeding should be looking at you
-gross motor delays
-decreased alertness to voice or movement
-language difficulties or delays
-feeding difficulties

Question 3

nursing role for CI and schools

Answer 3

develop and implement the individualized education plan and work with school system

Question 4

how do you educate a CI kid

Answer 4

break the task down into step by step parts and do it so many times that eventually they get it
“it is time to brush teeth -> grab brush - apply paste -> get wet -> ect”

Question 5

what can support education in a CI kid

Answer 5

-motivation factors like ipad time or getting a new toy
-use of technology
-early intervention programs

Question 6

what areas are important to set boundaries in

Answer 6

-communication
-discipline
-socialization often picked on so they need to know what is not ok
-sexuality
-play & exercise

Question 7

what are the goal areas for independence in a CI kid

Answer 7

-feeding
-toileting
-dressing
-grooming

Question 8

trisomy 21 (downs)

Answer 8

extra copy of the 21st chromosome

Question 9

maternal age risk factor for Downs

Answer 9

getting pregnant after 35 yrs old, increases again at 40 yrs

Question 10

downs clinical manifestations

Answer 10

-depressed nasal bridge
-inner epicanthal folds
-small nose
-excess/loose skin on back of neck (also for CP)
-atlantoaxial instability
-high arched palate, large protruding tongue
-decreased muscle tone
-wide space between big toe
-delay in sexual development

Question 11

when a child has a small nose or depressed nasal bridge, what is our concern

Answer 11

child will be stuffy and have a hard time clearing mucus increased risk of res infections

Question 12

atlantoxial instability and decreased muscle tone leads to what nursing intervention

Answer 12

they need more support on their neck & swaddle to help w/ thermal regulation

Question 13

having a big space between the toes leads to what nursing intervention

Answer 13

increased fall risk

Question 14

in downs what happens with weight and height

Answer 14

reduced weight for height is high so obesity

Question 15

associated illnesses with downs

Answer 15

-feeding difficulties
-obesity
-constipation
-congenital heart defect
-acute otitis media
-leukemia
-hypothyroidism
-upper res infection

Question 16

trends in autism

Answer 16

seeing higher number of cases, seen more often in males than females

Question 17

core deficits in ASD

Answer 17

1) social interaction
2) communication
3) behavior

Question 18

several associated illness with ASD

Answer 18

-GI problems
-epilepsy
-feeding issues
-disrupted sleep
-ADHD
-anxiety/depression/ocd
-schizophrenia & bipolar

Question 19

ASD social interaction deficits

Answer 19

-abnormal eye contact earliest sign
-failure to smile and orient to name
-lack of imitation
-lack of interactive play
-lack of gesture use

Question 20

ASD communication deficits

Answer 20

-absent to delayed speech
-atypical language like humming or grunting
-laughing inappropriately
-use of echolalia (meaningless repetition)

Question 21

ASD behavioral impairments

Answer 21

repetitive, impulsive, restrictive and obsessive behavior
rocking, flapping, head nodding, spinning, twirling, difficulty w/ change, self injurious like biting

Question 22

ASD nursing care

Answer 22

-multiple sources of therapy
-provide positive reinforcement
-increase social awareness
-teach verbal communication skills
-decrease unacceptable behavior
structured routine is key

Question 23

what is a way to decrease frustration in a child with ASD

Answer 23

promote communication and use assistive devices to increase communication use pictures & ipads

Question 24

ASD care in the hospital

Answer 24

-limit number of people in the room
-tell them what to do vs what not to do “pls walk vs do not run”
-use the parents and get them involved in care
-point while speaking
-use dim lights
-do not wait well so make sure MRI is ready before taking
-short, straight phrases

Question 25

ADAH

Answer 25

developmentally inappropriate degrees of inattention, impulsiveness, and hyperactivity in children 4-18
before 4 normal

Question 26

causes of ADHD

Answer 26

decreased dopamine, norepinephrine or epinephrine

Question 27

dx of ADHD

Answer 27

based on activity in at least 2 different settings and behavior present before age 7 (more common in boys
parents as well as input from someone else like a teacher

Question 28

associated problems with ADHD

Answer 28

-difficult in school and academic
-social
-greater risk for: conduct disorders, oppositional defiant dis, depression & anxiety, dev dis like speech & lang, learning disabilities

Question 29

ADHD treatment

Answer 29

1st line: behavioral therapy (limiting distractions)
2nd: pharm (psychostimulants)

Question 30

psychostimulant side effects

Answer 30

wt loss, abdominal pain, decreased appetite, sleeplessness, headaches, and growth velocity
see every 2 months in clinic

Question 31

ADHD med admin

Answer 31

-BID (breakfast & noon)
-immediate release on empty stomach
-avoid caffeine
-insulin doses may need to be adjusted
-drug holidays not recommended
-frequent eval

Question 32

environmental manipulation for ADHD

Answer 32

-consistency
-front of class
-hw in room with no distractions
-organizational charts
-write down tasks
-give tasks 1 or 2 at a time, not more