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How are cognitive impairments measured?
3 parts to intellectual disabilities
Intellectual functioning IQ of 70-75 or below
Functional impairment in disability of 10 adaptive skill areas
Younger than 18 at diagnosis
Define ADHD and how to assess it.
No single cause; thought to be interaction between genes & environment
One of most common diagnosed childhood disorder
Affects self-regulation & executive function; social, cognitive, emotional, behavioral, and social functioning.
Core s/s:
inattention, impulsivity, and hyperactivity in at least 2 settings
Diagnosed by specific DSM criteria but includes:
S/s begin before 12 years of age
Occur in 2 or more settings and interfere with school, work, or social functioning.
3 types:
1. Predominantly Inattentive - at least 6 or more symptoms months
2. Predominantly Hyperactive/Impulsive - at least 6 or more at least 6 months
3. Combined Type - significant number of each
What are the major s/s of ICP? When might you assess ICP?
S/s in INFANTS:
• Irritability; poor feeding
• High-pitched cry; infant is difficult to soothe
• Fontanels are tense and bulging
• Cranial sutures are separated
• Eyes have the setting-sun sign
• Scalp veins are distended
• Increased occipitofrontal circumference
S/S in CHILDREN:
• Headache
• Vomiting, with or without nausea
• Motor weakness, discoordination, and seizures
• Diplopia and blurred vision
• Irritability, restlessness, and behavioral changes
• Sleep alterations and somnolence
• Personality changes
Late S/s:
• Bradycardia
• Decreased LOC (↓sensory & motor responses)
• Change in pupil size & reactivity
• Posturing (flexion or extension)
• Change in respirations; may have Cheyne-Stokes respiration
What medications are used as rescue medications to stop seizures?
4 Treatment options:
1. Drug therapy - anticonvulsant medications
oxcarbazepine, topiramate, valproic acid, phenobarbital
For emergency: rectal diazepam, intranasal midazolam, buco clonazepam
2. Ketogenic diet - high-fat/low carb/adequate protein diet
3. Vagus nerve stimulation
4. Surgical therapy.
What is the difference between a developmental delay and a cognitive impairment?
Developmental Delay: Significant lag in development. May catch up to peers.
Cognitive Impairment: Permanent
What are some red flags for Autism? How do we assess for Autism?
• Does not respond to name by 12 mo
• Does not point at objects
• Does not play Pretend
• Avoids eye contact
• Wants to be alone
• Can't understand feelings
• Delayed speech (Echolalia)
• Obsessive interests
• Gives unrelated answer to questions
• Upset by minor changes
• Unusual reactions to senses (to smell, sound, taste, touch/feel).
• Repetitive movements such as flapping hands, rocking, spinning in circles
• Fails to meet developmental milestones
• May excel in 1 particular area (e.g. art, music, math,memory
What is a Ventriculoperitoneal Shunt and when is it used?
A cerebral shunt that drains excess cerebrospinal fluid (CSF) [from the brain to end of abdomen] when there is an obstruction in the normal outflow or there is a decreased absorption of the fluid. Cerebral shunts are used to treat hydrocephalus.
How is a febrile seizure different from other seizures? When does it occur? Any treatment necessary?
most common in children / account for half of all seizure in children
occur at higher temperatures or as the fever continues to rise over 102.2 F
List common causes of hearing impairments
One of most common disabilities in the US (genetics or acquired)
Prevention includes: Prenatal care, avoiding ototoxic drugs, managing diabetes, avoiding alcohol & smoke exposure, routine immunizations, and minimizing noise pollution.
How would you distinguish ADHD from absence seizures?
Your child's attention/memory can be regained in the case of ADHD, while those with absence seizures might need a moment to reorient themselves to what they were doing
Define a concussion. What are the major s/s and treatment options?
Transient & Reversible
Minor concussion - alteration in neurological or cognitive function w/ or w/o LOC
Major concussions - more & more severe symptoms, take longer to resolve
S/s of concussions include:
Reasons to take child to ED
*Motor Vehicle Accidents
*Under 2 and fell greater than 3 feet; infants w/unwitnessed falls
*Any neuro changes: LOC, confusion speaking or walking, seizures
*Vomiting > 3 times
*Fluid leaking from ears or nose
*Infants with bulging fontanel
What is the difference between spina bifida occulta & cystica? How is each treated?
spina bifida cystica - where lesion occurs = degree of impairment
spina bifida occulta - many not have observable s/s
Therapeutic Management:
1. Surgical closure with in first 24-72 hours
2. Neurologic and orthopedic assessments
3. Management of any associated issues or complications
Describe sensorineural hearing loss.
Involves damage to the inner ear structure and/or auditory nerve.
Can be congenital defect or result of infection, ototoxic drugs, or excessive noise exposure
Results in distorted sounds, unable to distinguish sounds; affects comprehension
Cochlear implants for severe hearing loss
Management: Lip reading, sign language; Other assistive devices
What is Reye Syndrome? What may precede it? How is it treated?
Is an acute encephalopathy with hepatic dysfunction. Characterized by fever & profoundly impaired consciousness.
Often follows viral illness; typically varicella or influenza
Diagnosis: by liver biopsy.
Treatment is aggressive supportive therapy. Nursing care: need careful observation for an change in LOC or s/s of increased ICP
What are the major s/s of tetanus?
S/s → progressive stiffness & tenderness of neck & jaw (“Lock jaw”), difficulty opening mouth, facial muscle spasm causing "sardonic smile
Later s/s → rigid abdomen, difficulty swallowing, respiratory involvement
What are the major s/s of Cerebral Palsy?
A non-progressing brain anomaly or injury that occurred before, during, or shortly after birth.
May also have issues with sensation, perception, communication, cognition, and behavior depending on severity and location of the anomaly or injury.
Exact prenatal and perinatal causes unknown.
Post-natal causes include bacterial meningitis, viral encephalitis, child abuse, car accidents.
S/s: Persistent primitive reflexes
Poor head control after age 3 months
Stiff or rigid limbs
Arching back; pushing away
Floppy tone
Unable to sit without support at age 8 months → should be examined for CP
Clenched fists after age 3 months
What is sensory overload? What interventions might one try?
Children with sensory processing challenges can be either overly sensitive or desensitized to a particular type of sensory input. This can have a negative effect on mood, the ability to perform daily functions, and learning.
Preventing Sensory Overload
Keep a diary of your child's behavior to identify sensory overload triggers
Be proactive to anticipate and prevent sensory overload
Use a quiet and calm voice when talking to your child
Use appropriate sensory-control tools such as noise-canceling earphones and sunglasses
What are the major s/s of meningitis? What are the differences between the bacterial & viral forms? What can prevent meningitis? How do you test for it? Major treatment options?
Meningitis is an inflammation of the meninges (the membranes that cover the brain & spinal cord)
It can be either Bacterial or Viral cause
Bacterial typically more serious than viral forms
Decrease in cases since introduction of Hib, pneumococcal, and meningococcal vaccines
S/s → fever, headache, nausea, vomiting, irritability, anorexia, photophobia, confusion, back pain and nuchal rigidity (aka stiff neck). May have petechial or purpuric rash
Positive Kernig sign and Brudzinski sign
Diagnosis → Lumbar puncture definitive test
Management → Isolation, antibiotics, maintain airway, reduce ICP, control temp, seizures, & shock.
Nursing care → Keep room quiet & decrease stimuli, may be more comfortable w/o pillow and side-lying because of nuchal rigidity, careful vitals, observe for changes in LOC.
Name different types of seizure disorders. What are the major s/s of each?
Generalized Seizures
Absence Seizures (aka Petit Mal): brief changes in LOC, goes unnoticed, abrupt onset, happens 20x a day, confused for ADHD, slight eye/facial twitching, amnesia for episode
Atonic (aka Drop Attacks): Sudden loss of muscle tone & control
Infantile Spasms: occur during the first 6-8 months of life, numerous daily seizures. no postictal stage
Febrile Seizures: most common in children; brief but may last within 15 mins, can be simple or complex