Peds Exam 3b - Cog Imp. Flashcards
cognitive impairment
general term that encompasses any type of intellectual disability
identifying child w/ CI (a nurses job)
-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
nursing role for CI and schools
develop and implement the individualized education plan and work with school system
how do you educate a CI kid
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”
what can support education in a CI kid
-motivation factors like ipad time or getting a new toy
-use of technology
-early intervention programs
what areas are important to set boundaries in
-communication
-discipline
-socialization often picked on so they need to know what is not ok
-sexuality
-play & exercise
what are the goal areas for independence in a CI kid
-feeding
-toileting
-dressing
-grooming
trisomy 21 (downs)
extra copy of the 21st chromosome
maternal age risk factor for Downs
getting pregnant after 35 yrs old, increases again at 40 yrs
downs clinical manifestations
-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
when a child has a small nose or depressed nasal bridge, what is our concern
child will be stuffy and have a hard time clearing mucus increased risk of res infections
atlantoxial instability and decreased muscle tone leads to what nursing intervention
they need more support on their neck & swaddle to help w/ thermal regulation
having a big space between the toes leads to what nursing intervention
increased fall risk
in downs what happens with weight and height
reduced weight for height is high so obesity
associated illnesses with downs
-feeding difficulties
-obesity
-constipation
-congenital heart defect
-acute otitis media
-leukemia
-hypothyroidism
-upper res infection
trends in autism
seeing higher number of cases, seen more often in males than females
core deficits in ASD
1) social interaction
2) communication
3) behavior
several associated illness with ASD
-GI problems
-epilepsy
-feeding issues
-disrupted sleep
-ADHD
-anxiety/depression/ocd
-schizophrenia & bipolar
ASD social interaction deficits
-abnormal eye contact earliest sign
-failure to smile and orient to name
-lack of imitation
-lack of interactive play
-lack of gesture use
ASD communication deficits
-absent to delayed speech
-atypical language like humming or grunting
-laughing inappropriately
-use of echolalia (meaningless repetition)
ASD behavioral impairments
repetitive, impulsive, restrictive and obsessive behavior
rocking, flapping, head nodding, spinning, twirling, difficulty w/ change, self injurious like biting
ASD nursing care
-multiple sources of therapy
-provide positive reinforcement
-increase social awareness
-teach verbal communication skills
-decrease unacceptable behavior
structured routine is key
what is a way to decrease frustration in a child with ASD
promote communication and use assistive devices to increase communication use pictures & ipads
ASD care in the hospital
-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
ADAH
developmentally inappropriate degrees of inattention, impulsiveness, and hyperactivity in children 4-18
before 4 normal
causes of ADHD
decreased dopamine, norepinephrine or epinephrine
dx of ADHD
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
associated problems with ADHD
-difficult in school and academic
-social
-greater risk for: conduct disorders, oppositional defiant dis, depression & anxiety, dev dis like speech & lang, learning disabilities
ADHD treatment
1st line: behavioral therapy (limiting distractions)
2nd: pharm (psychostimulants)
psychostimulant side effects
wt loss, abdominal pain, decreased appetite, sleeplessness, headaches, and growth velocity
see every 2 months in clinic
ADHD med admin
-BID (breakfast & noon)
-immediate release on empty stomach
-avoid caffeine
-insulin doses may need to be adjusted
-drug holidays not recommended
-frequent eval
environmental manipulation for ADHD
-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
