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29 Cards in this Set
- Front
- Back
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3 diagnostic criteria for MR
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- intellectual functioning
- functional strengths and weaknesses - onset before 18yo *have to have impairment in 2 of 10 functional tasks |
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2 diagnostic tests for MR
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Baley Scale of Infant Development - used by specialist to dianose
Denver Developmental Screening - looks at 4 things HCP will need to refer for official diagnosis *do not do on a sick visit |
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Etiology of MR
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- infection and intoxication
- trauma or pysical agent - metabolism or nutrition - chromosome abnormalities - gestational disorders - environ. influences |
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Classification of MR
mild - IQ of moderate severe profound |
mild 50-70
mod 40-50 severe 20-40 profound < 20 |
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Nursing care
goal is to promote - other |
optimum development - social, physical, family, and as member of community
other education to their potential hopitalization - know G&D discipline social skills play/exercise sexuality (encourage families to be thinking about the future) |
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Cerebral palsy
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group of nonprogressive disorders of movement and posture caused by abnormal development or damage to motor control centers of the brain (cerebral cortex)
the leading cause of disability in children |
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CP Etiology
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80% is caused by unknown prenatal factors
-prenatal: placental abruption, birth trauma, maternal infection (rubella, CMV, tosoplasmosis), substance abuse -perinatal: LBW, prematurity, - postnatal: shaken baby syndrome *prematurity (<28wks 50x's more likely to have CP) and multiple births (5x's more likely for CP) |
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Types of CP
- Spastic: (p. 1808) - Athetoid: |
classified by nature of neuromuscular function
- spastic: most common, may involve one or both sides of body, hypotonicity (hyper in early manifestation) **delay in gross motor development -athetoid: dyskinetic, wormlike writhing mvmt, drooling, dysarthia (impaired speech) |
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Diagnostic Evaluation
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- neuro exam and history
- motor dysfunction - delay in achievment - persistence of primitive reflexes - Moro (startle response) and atonic neck -Differential diagnosis - hearing and vision (70% of CP have normal intellectual function) |
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Therapeutic Management
-Goal: |
to maximize mobility
-estab locomotion, communication, and self-help -gain integration of motor functions -correct assoc defects -provide educational opportunities -promote socialization experiences |
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Therapeutic Milieu
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- physical therapy
- occupational therapy - speech therapy - get involved before speech devel occurs - Education - family support - early intervention, main-stream - Recreation |
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Pharmacotherepy of CP
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-centrally acting muscle relaxants (balclofen, valium)
- skeletal muscle direct action (dantrolene) - local nerve block to prevent spasticity - anticonvulsants (phenobarbital, dilantin) - ADD-HD (ritalin) surgically implanted pumps that slow realease – helps to slow rhythmic twisting, dystonia, spasticity. |
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Physical signs of Down Syndrome
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Small square head, upslant eyes, protruding skin, depressed nasal bridge, mottled skin, decreased tone, stubby fingers, transverse palmer crease, plantar crease, low set ears, skin cracked and dry, flat profile, short broad neck,
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Etiology of Down Syndrome
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-extra 21st chromosome
-translocation of chromosome 21 -mosaicism - cells have both normal and abnormal chromosomes, degree of impairment is dependent on the %age. – will not know until baby grows up. |
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Incidence of DS
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1 in 800 live births
80% of DS born to women < 26yo; statistically inc if over >35yo. cardiac anomalies and respiratory are often the cause of death in the first year of life – we now have the surgery to increase life expectancy |
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Diagnosis of DS must be confirmed by
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analysis of chromosomes
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General health maintenance of DS
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-accurate information - there is a specific growth curve for DS
-frequent well child visits -immunizations as scheduled -monitoring physical growth -cognitive vs psychosocial - realistic expectations for development |
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Cardiac concerns for DS
r/t: |
Altered tissue perfusion
r/t: atrio-ventricular canal patent ductus arteriosus tetralogy of fallot mitral valve prolapse |
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Respiratory concerns for DS
r/t: |
impaired gas exchange
r/t susceptibility to infection compromised respiratory expansion acute and chronic obstructions - chronic problems b/c of flattened nasal bridge – frequent upper resp infections, frequent otitis media (ear infections) sleep apnea |
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GI concerns for DS
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Alteration in nutrition
12% have anomolies breastfeeding difficult b/c of tongue thrust - often misinterpreted as refusal -> FTT |
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GU concerns for DS
r/t: |
alteration in urinary elimination
r/t - risk for malformation of kidney, uteropelvic junction obstruction, hydronephrosis (distension and dilation of renal pelvis) - 2% hypospadias - urethra doen't come out tip of penis - req surgery) -25-50% have undescended testes (males often sterile but can have sex) |
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hematologic concerns for DS
r/t |
risk for infection
r/t risk for leukemia is 10-30x's general population lower remission rate, higher early mortality |
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Ocular and otorhino concerns for DS
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alterations in visual/ auditory perceptions
- ocular: congenital nystagmus (involuntary eye mvmt), cataracts, glaucoma - visual acuity: 50% refractive errors, 60% strabismus (crossed eyes) -hearing loss - mostly conductive |
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When should a DS child have their initial visual screening?
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18 months
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When should a DS child have their initial hearing screening?
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6 months
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Orthopedic concerns for DS
r/t: |
activity intolerance
r/t: - sumluxations, dislocations, common r/t muscle tone, ligamentous laxity - **atlantoaxial instability (14%) - instability btwn 1st and 2nd cervical vertebrae puts them at risk for spinal cord compression and injury - scoliosis common |
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Dermatologic concerns for DS
r/t |
risk for impaired skin integrity
r/t generalized dry skin skin ages rapidly |
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Endocrinologic concerns of DS
r/t |
altered G&D
r/t - deficient growth in infancy, adolescence -thyroid dysfunciton (hypo) -fertility in males is rare -ovulation present in most females (40-70%) |
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Neurologic concerns for for DS
r/t: |
risk for injury
r/t -diminished muscle tone -seizure (10%) -alzheimer's (by 51yrs) -cognitive mild to mod (IQ 40-70) expressive language disabilities strength seen in social ability |
