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children impairment
Care for Pediatric patient with Sensory or Cognitive Impairment
| Question | Answer |
|---|---|
| Loss of hearing can have an impact on: | Speech. Language. Social development. Emotional development. Behavior and academic achievement. |
| Hard of hearing is | when the person with use of a hearing aid, has hearing sufficient to process auditory information. |
| Causes | May be prenatal or postnatal. Family history. Anatomic malformations. Severe perinatal asphyxia. Perinatal infections. Chronic ear infections. Cerebral palsy. Down syndrome. Administration of ototoxic drugs. |
| Conductive or middle-ear hearing loss | results from interference of transmission of sound to the middle ear. |
| Perceptive or Nerve Deafness | involves damage to the inner ear structures or the auditory nerve. |
| Central Auditory Imperception | includes all hearing losses that does not demonstrate defects in the conductive or sensorineural structures. |
| Functional | type of hearing loss occur without lesions or another explanation for central hearing loss. |
| Nursing Considerations | Early diagnosis and treatment is key to preventing complications from hearing loss. Universal newborn hearing screening. Observe the reflexes. |
| Nursing Diagnoses | Sensory/perceptual alteration r/t hearing impairment.Impaired verbal communication r/t inability to hear.Altered growth and development r/t impaired communication. |
| Nursing Diagnoses | Risk for injury r/t environmental hazards, infection.Altered family processes r/t diagnosis of deafness. |
| Assisted communication techniques | Lip reading. Cued speech. Sign language. Speech therapy. Additional aids such as teletypewriters. Socialize children. Support child and family. |
| What defects cause hearing loss? | Defect in sound transmission, damage to nerve pathways or a mixture of both. |
| What are some methods of communicating with a hearing-impaired child? | Visual aids, writing, drawing and sign language. |
| May be caused by RSV and H. influenzae. Common in children ages 0-7, boys more than girls. Passive smoking increases the risk. | Otitis Media |
| what bacteria cause OM | Streptococcus pneumoniae, H. Influenzae and Moraxella are most common bacteria. |
| Otitis Media Clinical Symptoms | Ear pain. Fever. Purulent discharge. Crying. Irritability and restlessness. Holding, rubbing, or pulling on affected ear. |
| chronic Otitis Media Clinical Symptoms : | Hearing loss. Tinnitus. Vertigo. |
| Therapeutic Management | Amoxicillin. Ceftriaxone.Spontaneous resolution. Myringotomy. PE tubes if there are recurrent episodes of long duration. |
| Relieving pain: | Acetaminophen and Ibuprofen. Narcotics as ordered. |
| Facilitate drainage: | Clean external canal with cotton swabs. |
| Prevent complications: | With tubes, bathwater and shampoo should be kept out of ears. If tubes fall out, notify provider; not an emergency. |
| Prevent OM: | Feed sitting up. |
| Anticipatory guidance regarding temporary hearing loss. | Anticipatory guidance regarding temporary hearing loss. |
| What are common signs and symptoms of otitis media? | Common s/s include pulling on the affected ear, irritability, fever, loss of appetite and purulent discharge. |
| To inspect the ear canal in an older child, what is the proper method of pulling the pinna? | Up and back. |
| A newborn has a visual acuity of around 20/400 and may reach | 20/30 to 20/20 by 2-3 years of age. |
| Most effective for children 6 years or older. Child stands back 10 feet. Cover the left eye and read the appropriate line. Then switch and cover the right eye and read. | Snellen Letter Chart |
| To pass, the child must | correctly identify four of six symbols. |
| Tumbling E: | Useful for children who do not know their alphabet. Point in the direction that the E is facing. |
| HOTV: Child is given a board with HOTV | the examiner points to the letter on the wall and the child points to the correct letter on the board. |
| Allen Card | Uses common figures. Make sure to identify the figures prior to testing. |
| Visual Acuity Testing In newborns, test by | checking light perception.Assesses the ability to illicit a response. In infants, the ability to fix on and follow a target is an indication of vision. |
| When should vision screening first be performed? | At the earliest possible age and at regular intervals. |
| Refractive Errors | Myopia. Hyperopia. |
| Strabismus | Eye muscles do not coordinate.Condition can affect either one or both eyes and results in two images instead of one being received by the brain. |
| Common S & S: | Squinting. Closing one eye. Tilting head. Difficulty focusing. |
| Treatment | Treatment varies but no treatment will perfectly align the eyes. Goal: realign them as close to normal as possible. May patch stronger eye. |
| Amblyopia | Known as “lazy eye” – unclear image in effected eye – causing double vision Vision is lost in one eye because the child favors the “good” eye with clear vision Early detection is essential. |
| Treatment | correct primary reason for lazy eye with surgery, corrective lenses or patching of the good eye |
| Refractive Errors: | Ensure vision screening is done. |
| Strabismus: | Explain treatment plan and instruct parents on eye exercises and patches. |
| Amblyopia: | Be alert to signs and symptoms and provide instruction and support on patch use. |
| What nursing responsibility is common to all three of these eye disorders? | Early detection of signs and symptoms and referrals. |
| Legal blindness: | visual acuity of 20/200 or less and a visual field of 20 degrees or less. |
| Genetic and Prenatal or Postnatal conditions: | Perinatal infections. Retinopathy of prematurity. Trauma. Postnatal infections. Disorders such as sickle cell, juvenile rheumatoid arthritis, Tay-Sachs disease, albinism and retinoblastoma. |
| Nursing Diagnoses: | Altered family processes r/t diagnosis. Altered growth and development r/t surgery/perceptual alterations. Risk for injury r/t environmental hazards, noncompliance with plan. |
| Nursing Considerations Con’t | At birth, observe neonate’s response. During childhood, school nurses do vision testing. Promote parent-child attachment for blind children. Help the child learn self-help skills and communication techniques. |
| What are the most common types of visual disorders in children? | Refractive error. |
| Retinoblastoma | Most common congenital malignant intraocular tumor. Caused by a mutation in the gene. May be inherited or occur sporadically. |
| Clinical Manifestations: | Cat’s eye reflex. Strabismus. Red, painful eye. Blindness is a late sign. |
| Therapeutic Management | preserve useful vision and eradicate the tumor. |
| Common therapies include: | Plaque brachytherapy. Laser photocoagulation. Cryotherapy. Thermotherapy. Chemotherapy. Enucleation. |
| What is Retinoblastoma? | The most common congenital malignant intraocular tumor of childhood. |
| Autism | Autism is a developmental disorder. Occurs in 1 in 500, more common in males. |
| The etiology is unknown, but there has been a reported association between autism and what conditions? | conditions such as fragile X, meningitis and structural brain anomalies. |
| Autism Symptoms: | failure to make eye contact.Limited functional play. May have significant GI symptoms such as constipation. Majority has some degree of mental retardation. |
| Highly structured and intensive behavior modification and routine.Recognize that not all children with autism are the same and require individual assessment and treatment. | Nursing Considerations |
| Decrease stimulation: | Private room. Avoid extraneous auditory and visual distractions. Have parents bring in possessions of the child. |
| Nursing Considerations Con’t | May willfully starve themselves or gag to prevent eating.Communicate at the child’s developmental level, brief and concrete. |
| What is Autism? | A developmental disorder of brain function. |
| Cognitive Impairment | Encompasses any type of mental difficulty or deficiency/mental retardation. 3 components: |
| Intellectual functioning with an IQ of 70 or less. 3 components: Impairment in at least 2 of 10 different skills. younger than 18 when dx/ | Communication. Self-care. Home living. Social skills. Leisure. Health and safety. Self-direction. Functional academics. Community use. Work. |
| Diagnosis is made after progress is delayed. Classifications: | Educable mentally retarded (mild). Trainable mentally retarded (moderate). |
| The causes are primarily genetic, biochemical and infectious or unknown. Events may lead to retardation: | Infection and intoxication. Trauma that causes brain injury. Gross postnatal brain disease. Chromosomal abnormalities. |
| Major role in identifying children. | Take parental concerns seriously. Conduct developmental assessments and note delays. |
| Educate the family and child: | Basic skills. Use simple directions. Use positive reinforcement. Encourage involvement in an early intervention program. |
| Care during hospitalization: | Parents should be encouraged to stay. Allow the child to be as independent as possible. Take a detailed history. Focus on the things that the child can do. |
| When a child with mental retardation is hospitalized, what can be done to help the child adjust? | Allow a parent to stay with the child; allow the child to be as independent as possible; focus on things the child can do. |
| Down Syndrome | Most common chromosomal abnormality. Occurs in 1 in every 800-1000 live births. Cause is unknown; 95% have an extra chromosome 21. Risk is greater in women over 35 years. |
| Several physical problems are associate with Down syndrome: | Congenital heart malformations. Respiratory infections. Thyroid dysfunction. |
| Support family: | Provide reading material. Refer them to support groups, chaplain or other families with Down. |
| Assist family with preventing physical problems. Teach measures to lessen respiratory infections: | Using bulb syringe. Rinse mouth after feedings. Increasing fluid intake. Use a cool-mist vaporizer. |
| Educate parents on feeding: | Use a small but long straight-handled spoon. Tongue thrust is not an indication of refusal to feed; refeed food if thrust out. |
| Skin care: | Minimum soap. Apply lubricants including lip balm. |
| Fragile X Syndrome | The most common inherited cause of mental retardations. Second most common genetic cause of mental retardation. More common in males. Females are carriers. |
| Fragile X Syndrome Etiology | Caused by an abnormal gene on the lower end of the long arm of the X chromosome. The inheritance pattern has been termed X-linked dominant. |
| Fragile X Syndrome Clinical Manifestations Adult men: | Long faces with prominent jaw. Large protruding ears. Large testes. |
| Children: | Cognitive impairment. Speech delay. Short attention span. Hypersensitivity to taste, sounds and touch. Autistic-like behaviors. May be aggressive. |
| Therapeutic Management | There is no cure. Serotonin agents are used to control outbursts. CNS stimulants such as clonidine are used to improve attention span and decrease hyperactivity. Care is the same care that is given to any family with child with mental retardation. |
| What is the most common chromosomal abnormality? | Down syndrome. |
| What role does the nurse play in assisting a child with a cognitive impairment? | : The major role is in supporting and educating the family. |
Created by:
redhawk101
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