Download Congenital Neurologic Conditions

Impact of Cognitive
or Sensory
Impairment on the
Child and Family
Chapter 19
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Cognitive Impairment
• Any type of mental difficulty or deficiency
• AKA Mental retardation (MR)
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Early Behavioral Signs of
Cognitive Impairment
• Non-response to contact, voice,
movement
• Irritability
• Poor/slow feeding
• Poor eye contact during feeding
• Diminished spontaneous activity
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Mental Retardation
-American Academy of Mental Retardation
• Sub-average intellectual function
(IQ <75)
• Onset before age 18
• Functional impairments
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Functional Impairments
(at least 2 of these 10)
• Communication
• Self care
• Home living
• Social skills
• Community use
• Functional academics
• Leisure
• Work
• Health and safety
• Self-direction
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Causes of Mental Retardation
• Intrauterine infection and intoxication
• Trauma (prenatal, perinatal, postnatal)
• Metabolic or endocrine disorders
• Inadequate nutrition
• Postnatal brain disease
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Causes of Mental Retardation
(cont’d)
• Chromosomal anomalies
• Prematurity, LBW, postmaturity
• Environmental influences
• Unknown prenatal influences
• Psychiatric disorders with onset in
childhood
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Classification of MR (591)
• Educable/mild—IQ 50-75—EMR—
comprise 85% of MR
• Trainable/moderate—IQ 35-55—TMR—
10 %
• Severe—IQ 20-40
• Profound—IQ <20-25
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Primary Prevention of
Mental Retardation
• Rubella immunization
• Genetic counseling
• Use of folic acid supplements
• Educate about fetal alcohol syndrome
• Educate about lead exposure
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Interventions to Assist MR
• Task analysis
• Provide assistive devices
• Early intervention programs
• Teach self-care
• Promote good physical care and regular MD
visits
• Teach socially acceptable behavior
• Teach about safety issues
• Consider sexuality issues and contraception
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“Syndrome”
• A recognized pattern of malformations
with a single, specific, anatomic,
physiologic, or biochemical cause
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Down Syndrome (596)
• “Syndrome”—a recognized pattern of
malformations with a single, specific, anatomic,
physiologic, or biochemical cause
• AKA Trisomy 21
– Extra chromosome 21 in 95%
– Translocation of chromosome 21 in 3-4%
(not associated with parental age)
– Mosaicism in 1%-2%--refers to cells with
both normal and abnormal chromosomes
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Down Syndrome (cont’d)
• Etiology unknown—likely multiple
causality
• Most common chromosomal abnormality
– 1 in 800-1000 live births
• Most common genetic cause of mental
retardation
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Down Syndrome (cont’d)
• Maternal age
– Age 30: Incidence ~ 1 in 950
– Age 40: Incidence ~ 1 in 100
– In about 5% cases extra chromosome
is from father
– Most DS infants have moms <35 yrs
old
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Down Syndrome—
Manifestations (598)
• Head small, round, with flat occiput
• Face—flat, eyes slanted with inner folds and
Brushfield’s spots, ears low set, nose flat, tongue
protrudes
• Musculoskeletal—hypotonia, hyperflexibility,
short stature
• Chest—pectus excavatum, neck short, abdomen
protrudes
• Genitalia—small penis, crytorchidism, skin—dry
and mottling present
• Hands show Simian crease, feet have plantar
crease; both hands and feet are short & stubby
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Down Syndrome
Congenital Anomalies
• 40%-45% heart defects—most common
are septal defects. Heart defects coupled
with respiratory infection is leading cause
of death in first year
• Renal disease, Hirschsprung (congenital
bowel obstruction), T.E. fistula
• Altered immune function
• Skeletal defects—atlantoaxial instability
(neck pain, weakness, torticollis)
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Down Syndrome IQ
• Wide variation from severely retarded to
low-average intelligence
• Generally mild to moderate mental
retardation
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Nursing Interventions for DS
• Teach swaddling
• Re-feeding techniques, small freq feeds, watch
for obesity and constipation
• Use of bulb syringe for increased mucus,
vaporizer, changing positions
• Good skin care and sun protection
• Support if surgery is indicated for any congenital
anomalies
• Genetic counseling—teach about low alpha
fetoprotein
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Hearing Impairment (602)
• Ranges from mild to profound
• Deaf: a person whose hearing disability
precludes processing linguistic
information with or without hearing aid
• Hard of hearing: Generally able to hear
with hearing aid
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Etiology of Hearing
Impairments
• Anatomic malformation
• LBW
• Ototoxic drugs
• Chronic ear infections
• Perinatal asphyxia
• Perinatal infections
• Cerebral palsy
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Pathology of
Hearing Impairments
• Conductive hearing loss—middle ear—most
common usually from chronic serous otitis media
• Sensorineural hearing loss—nerve deafness
• Mixed conductive-sensorineural loss—may
follow recurrent OM with complications
• Central auditory imperception
– Organic—inability to express or interpret
sounds, inability to discriminate sounds
– Functional—autism, hysteria, schizophrenia
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Symptom Severity
• Measured in decibels (dB) at 500, 1000,
and 2000 levels (listening speech ranges)
• Hearing threshold—measured by
audiometer
• Effect on speech
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Therapeutic Management
• Lipreading, sign language
• Speech/language therapy
• Telecommunications devices
• Closed captioning
• Hearing aid—for conductive loss
• Cochlear implants—for sensorineural loss
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Manifestations of Hearing
Impairment in Infancy
• Lack of startle reflex
• Absence of babbling by age 7 months
• General indifference to sound
• Lack of response to spoken word
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Childhood
• Profound deafness likely to be diagnosed
in infancy
• Entry into school usually requires hearing
test. If not, hearing is tested in school at
early age
• Concerns with speech development
usually prompts officials and/or parents to
seek help of professional
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Care for Hearing Impaired
Child During Hospitalization
• Reassess understanding of instructions
given
• Supplement with visual and tactile media
• Communication devices
– Picture board
– Common words and needs (food,
water, toilet)
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Prevention of Hearing Loss
• Treatment and management of recurrent
otitis media
• Prenatal preventive measures
• Avoid exposure to noise pollution
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Visual Impairment
• General term that refers to visual loss that
cannot be corrected with regular
prescription lenses
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Visual Impairment
• General term that refers to visual loss that
cannot be corrected with regular prescription
lenses
• Partially sighted—AKA school vision
– Acuity of 20/70-20/200
– Usually able to read type of print used in
public school system
• Legal blindness
– Acuity of 20/200 or less
– Legal as well as medical term to allow for
special considerations
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Etiology of Visual Impairments
• Perinatal or postnatal infections
– Gonorrhea, chlamydia, rubella,
syphilis, toxoplasmosis
• Retinopathy of prematurity
• Perinatal or postnatal trauma
• Other disorders—SCD, JRA,
retinoblastoma
• Unknown causes
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Refractive Errors
• Refraction: bending of light rays through
the lens of the eye
• Myopia (near-sighted)—most common
• Hyperopia (far-sighted)
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Other Visual Impairments
• Astigmatism—uneven cornea
• Amblyopia—blindness in one eye from
lazy eye
• Strabismus—crossed eyes or lazy eye
• Cataracts
• Glaucoma
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Nursing Assessment
• Infancy
– Response to visual stimuli
– Parental observations and concerns
– Expect binocularity by age 6 months
• Childhood
– Visual acuity testing
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Promoting Child’s Optimum
Development
• Play and socialization—should focus on
fine and gross motor skills, and
stimulation of other senses and promoting
interactions outside of home to prevent
development of “blindisms”
• Development of independence—Braille
tags, tapping, guides
• Education—Braille, audio books and
learning materials
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Hospitalization of the Visually
Impaired Child
• Safe environment
• Reassurance
• Orient child to surroundings and do not
change furniture. If something is moved,
tell child
• Encourage independence—tying rope
from bed to bathroom, for instance, can
help with mobility
• Consistency of team members
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Measures to Prevent
Visual Impairment
• Prenatal care/prevention of prematurity
• Rubella immunizations for all children
• Safety counseling for preventing eye
injuries
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