Nur 158 - Unit Iv - The Child With Problems Related To Psychosocial Function

Front 1

Prenatal factors that contribute to congenital anomalies.

Back 1

1. Chromosomal abnormalities.
2. Intrauterine environmental factors.
3. Correlation between SGA infant and congenital anomalies.

Front 2

Major reactions of and effects on the family.

Back 2

1. Crisis of losing a perfect child.
2. Task of adjusting to and accepting child and his condition.

Front 3

Stages of Adaptation.

Back 3

1. Shock and Denial
2. Adjustment (guilt and anger)
3. Reintegration and acceptance.

Front 4

Stages of Adaptation.
Shock and Denial

Back 4

Mechanism that allow individuals to distance themselves from onslaught of tremendous emotional impact and to collect and mobilize energies toward goal-directed, problem-solving behaviors.
Denial allows individuals to maintain hope in face of overwhelming odds.

Front 5

Stages of Adaptation.
Adjustment (Guild and Anger)

Back 5

Open admission that condition exists. May experience "chronic sorrow".
Overprotection
rejection
denial
gradual acceptance.

Front 6

Stages of Adaptation.
Reintegration and acceptance

Back 6

Incresed comfort with everyday livign. "A New Normal"

Front 7

Parent Response

Back 7

REactions depend on type and severity of defect.
Visibility
Threat to survival (life-threatening)
Previous Experience
Marital Harmony

Front 8

Child Response

Back 8

Depends on age of onset of problem: the earlier the onset, the better the child is able to adapt to it.
Depends on developmental level and available coping mechanisms. Children with more severe disorders often cope better than those with milder disorders.
Influenced by significant others.

Front 9

Sibling Response

Back 9

lives most affected in terms of parent-child relationship.
Feel abondoned.

Front 10

Nursing Diagnoses for Family

Back 10

Noncompliance
Aletered Family Processes.
Anticipatory grieving.
Impaired social interaction
Knowledge deficit

Front 11

Nursing Interventions

Back 11

Goal: Help family remain healty and functioning at maximum levels throughout child's life or beyond, if child dies.
Assess comping mechanisms an dsupport system
Provide support at time of diagnosis
Educate Family
Accept family's emotional reaction.
Help family to perceive the child as a child first, then as an individual with unique needs.
Promote normal development.
Establish realistic future goals.
Provide support at time of death, if child dies.

Front 12

Mental Retardation

Back 12

Definition: Significant subaverage general intellectual functioning existing concurrently with deficits in adaptive behavior and manifested during developmental period (between conception and 18th birthday)

Front 13

Mental Retardation Causes

Back 13

Genetic biochemical, viral and developmental events.
Infection and intoxication
Trauma or physical agent
Gross postnatal brain disease
Unknown prenatal influences
Gestational disorders
Psychiatric disorders
Environmental influences
Chromosomal abnormaliities

Front 14

Mental Retardation Classifications:
Mild

Back 14

50-55 to 70
educable

Front 15

Mental Retardation Classifications:
Moderate

Back 15

35-40 to 50-55
Trainable

Front 16

Mental Retardation Classifications:
Severe

Back 16

20-25 to 35-40

Front 17

Mental Retardation Classifications:
Profound

Back 17

Below 20-25

Front 18

Down Syndrome

Back 18

Most common chromosomal abnormality of generalized syndrome.
Trisomy 21.
Risk increase with maternal age.
Prenatal diagnosis iwth amniocentisis/chorionic villi sampling

Front 19

Down Syndrome Characteristics

Back 19

Broad nose
Large thick tongue
Lack of fold in eyelids
Large thick tongue
Stubby fingers
Broad, short skull.
Hand and foot abnormalities
Increased respiratory difficulty.
Congenital heart defects.
Varying degrees of mental retardation.
Affectionate.

Front 20

Dwon Syndrome Clinical Features

Back 20

Hypotonia
Developmental milestone delay
Oral motor/feeding problems.
Sensory deficits
Problem with balance and mobility.

Front 21

Nursing Care for Menatlly Retarded Child

Back 21

Developmental assessment (developmental age vs chronologic age)
Promotion of optimum development
Help family to set limits that are simple consistently applied and appropriate for developmental age.
May need special devices

Front 22

Hospitalized Mentally Retarded Child

Back 22

Prepare for procedures according to developmental age.
Find out routines, security items, behaviors that may require intervention.

Front 23

Learning Disability

Back 23

Term used to define a group of disorders manifested by significant difficulties in acquistion and use of
Listening
Speaking
Reading
Writing
Reasoning
Mathematic abilities
social skills
Children with a learning disablity are often very bright.

Front 24

Attention Deficit Hyperactivity Disorder (ADHD)

Back 24

Child displays behavior that is not unusual child behavior- difference is in quality of motor activity and develomentally inapproprieate inattention, impulsivity and hyperactivity.

Front 25

Attention Control Systems of the Human Mind
Processing Control

Back 25

The mind's way of controlling information coming in (occurs in diverse and diffuse sites in the brain)

Front 26

Attention Control Systems of the Human Mind
Mental Energy Control

Back 26

The mind's way of controlling the flow of "fuel" for concentrating and acting right (brainstem)

Front 27

Attention Control Systems of the Human Mind
Production Control

Back 27

The mind's way of controlling its output - what it gets done- when and how (frontal lobe)

Front 28

ADHD Managing

Back 28

1 Medication: Psycho-stimulants (Ex. Ritalin, Dexedrine- long-term use may lead to growth suppression)
2 Environnment: Stable, predictable, regular routines.
3 Uncovering strengths is an important as exposuer of dysfunctions.
4 Assessment recurring themes (no one source of observations should be conclusively interpreted without multiple other corroborating evidence-combination of testing and professional consultations).
5 Multi-faceted approach to management

Front 29

Failure to Thrive (FTT)
Causes of Organic

Back 29

Prenatal events disorders of central nervous system gastrointestinal system, renal system, heart, endocrine system, chromosomal disorders, chronic infection, cystic fibrosis, idiopathic short stature.

Front 30

Clinical Manifestation of NonOrganic FTT

Back 30

Usually child less than 2 years
Weight below 5th percentile
No evidence of systemic disease or abnormality
Developmental retardation

Front 31

FTT
Most often result of psychosocial factors:

Back 31

Inadequate nutritional info
Deficiency in Maternal Care
Disturbance in maternal child attachment
Distrubance in child's ability to separate from the parent- food refusal to maintain attention

Front 32

FTT
Factors related to inadequate feeding:

Back 32

Poverty
Health Beliefs
Inadequate Nutritional Info
Family Stress
Feeding Resistance
Insufficient Breast Milk

Front 33

FTT
Characteristics of Infant

Back 33

Intense interens in inanimate objects
Much less interested in social interaction
Vigilant of people at a distance; increasingly distressed as they come closer.
Dislike being touched or held in face to face contact
History of difficult feedin, vomitting, sleep distrubances, excessive irritability
Demonstrate habit patterns
Irregularity in ADLs
"Difficult" temperament or passive, sleepy, lethargic infant
Degree of "fit" biggest issue

Front 34

FTT
Characteristics of Parent

Back 34

Isolation/Social Crisis
Inadequate support system
Poor parenting as a child
Lack of education
Physical and mental health problems
Immaturity
Lack of commitment to parenting

Front 35

Nursing Diagnosis for FTT Child/Parent
Altered Nutrition

Back 35

Altered Nutrition
Consistent care of staff to feed child
Quiet unstimulating environment
calm,even temperament while feeding
Gives directions about eating
Structured Routine
Maintain face to fc posture
be calm and persistent through 10-15 minutes of food refusal
avoid force feeding
introduce new food slowly
follow child's rhythm of feeding

Front 36

Nursing Diagnosis for FTT Child/Parent
Altered Growth and Development

Back 36

appropriate developmental stimulation

Front 37

Nursing Diagnosis for FTT Child/Parent
Altered parenting

Back 37

Increase self-esteem
develop rapport teach infant care
explain cues of child
allow them to gradually assume care
praise and encourage

Front 38

Definitions of Child Abuse (SC LAW)

Back 38

Physical Child Abuse: An inappropriate use of force against a child. Any nonaccidental form of injury or harm inflicted on a child (Under 18) by a parent or caregiver

Front 39

Child Neglect

Back 39

Family conditions which are assumed to be detrimental to the child's health, safety, physical and psychosocial development. It is further assumed that parents or caregivers have some control over these conditions.

Front 40

Abandoment

Back 40

Lack of supervision, adequate clothing and hygiene, medical dental care, education, nutrition, shelter.

Front 41

Sexual Abuse

Back 41

Perpetrated by a member of the child's family group and includes not only sexual intercourse but also any act designe to stimulate a child sexuality or to use the child for sexual stimulation for either the perpetrator or another person.