General
What are 3 ways these children have limitations in both intellectual and adaptive functioning?
-Social interactions
-Use of language for self-expression
-Self-care abilities
So intellectual and developmental d/o affect these children with intelligence and adaptive behavior
Cognitive Impairment/ Intellectual disability's diagnosis is made how?
Made after a period of suspicion by FAMILY or HEALTH PROFESSIONALS not by teachers, etc
Made at birth in some instances. Younger than age 18 at time of diagnosis
What are the 10 adaptive skill areas that a cognitive impaired person might be impaired in? Normally impaired in 2/10
Communication Self-Care
Home living Social Skills
Community use Academics
Leisure Work
Health and Safety Self-direction
Down syndrome is a disorder of?
disorder of intellectual impairment
occurs when cell division is abnormal. Extra chrom 21, mixture of abnormal and normal cells, etc
Fragile X and Rett syndrome are disorders of
Americans with Disabilties act means that developmental disability includes children with
-intellectual disabilities
-sensory deficits
-orthopedic problems
-cerebral palsy
-autism spectrum d/o
Impairment in 2/10 skills
Problems r/t ID
Self injury
Fecal smearing
Temper tantrums, tearing personal items, disrobing
Severe
Clinical manifestations of down syndrome?
square head with upward slant to eyes
flat nasal bridge, protruding tongue
hypotonia
How common is this?
What is it caused by?
It is second most common genetic cause of cognitive impairment
Caused by abnormal gene on the lower end of the long arm of the X chromosome
Most important thing for nurses to do with families who have a cognitive impaired child?*****
Educate the child and family
EARLY INTERVENTION-->less likely to fall behind on those developmental milestones; promote optimal development!!!!!*******
Making a diagnosis of cognitive impairment is from
results of standardized tests
Problems r/t ID
Self esteem issues r/t the presence or absence of physical features, largely determined by the cause of the ID
Social isolation and loneliness
Depression
Mild
Diagnostic eval for down syndrome?
chromosome analysis
Clinical manifestations of Fragile X
large head circumference
Prognathism: long face with a prominent jaw
Large, protruding ears
Post-pubertal: large testes
Manifestations variable in female carriers of gene
What are some more nursing care interventions for CI children?
Teach self-care skills
Promote optimal development (increase time spent in a regular school setting)
Encourage play and exercise
Provide means of communication
Establish discipline
Encourage socialization
Help family adjust to future care
Assist in measures to prevent cognitive impairment
Dx of moderately impaired characterizes 10% of the population with a cognitive impairment. These moderately impaired people are considered to be ____.
Trainable; they are taught to do things but do not understand the purpose.
What are some causes of intellectual disability ?
Genetics
Alterations occurring during pregnancy - drugs, FAS
Neonatal alterations- hypoxic at birth --> neurological damage
Aquired childhood conditions or diseases --> mosquito-->malaria-->encephalitis
Environmental problems
Unknown causes (autism)
What are some physical problems of down syndrome?
cardiac defects
respiratory infections
feeding difficulties
delayed developmental skills
skeletal defects
altered immune function
endocrine dysfxns: hypothyroidism, diabetic muscular infarction (DMI)
Some classic behavioral features?
Mild-to-severe CI
Delayed speech and language
Hyperactivity
Hypersensitivity to taste, sounds, and, touch
Autistic-like behaviors
Aggressive behaviors
What is the most common chromosome abnormality? *******
Down syndrome *****
1 per 691 to 1000 births
Diagnosis of mildly impaired is 85% of the population with a cognitive impairment. These people are normally ___.
Educable. Mildly impaired are educable so they can learn, do and understand the purpose. Ex: why we brush our teeths (to keep them clean). So majority of the cognitively impaired are educable.
What are some disorders resulting in intellectual or developmental disability?
Down syndrome, fragile X and Rett syndrome, Fetal alcohol syndrome, failure to thrive, autism spectrum disorder
What are some therapeutic and care management tasks?
What is the nurses goal? *
Therapeutic- surgery to correct congenital anomalies, evaluation of hearing/sight, and periodic testing of thyroid fxn
Care- supporting them at time of Dx, preventing physical problems, assist in prenatal Dx and genetic counseling.
Nurses Goal: help child reach optimal level of functioning
Therapeutic management for Fragile X
Tegretol/Prozac for behavioral control, stimulants for hyperactivity, referral to early intervention program
Prognosis: normal life span
Care management: genetic counseling