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M6 13-005

Exam 11: Pediatric Patient with Sensory or Cognitive Impairment

Hearing impairment the most common disability in the United States
Hearing impairment (Definition) disability that may range in severity from mild to profound and includes the subsets of “hard of hearing” and “deaf”.
Deaf (Definition) a person whose hearing disability precludes successful processing of linguistic (verbal) information through audition, with or without a hearing aid.
Hard-of-hearing (Definition) a person who, generally with the use of a hearing aid, has residual hearing sufficient to enable successful processing of linguistic information through audition.
Hearing Loss Causes Family Hx- Anatomical Malformations- Low Birth Weight- Severe Perinatal Asphyxia- Perinatal Infections- Chronic Ear Infections- Cerebral Palsy- Down Syndrome- Ototoxic Drugs- ↑-Risk Neonates- Environmental Noise-Loud noise
Disorders of hearing d/t these locations Conductive or middle-ear hearing loss. Sensorineural hearing loss. Central Auditory.
Conductive or middle-ear hearing loss results from interference of transmission of sound to the middle ear. Most common type of all hearing loss, frequently a result of recurrent serous otitis media.
Sensorineural hearing loss, also called perceptive or nerve deafness damage to the inner ear structures or the auditory nerve. Most common causes are congenital defects of inner ear structures or consequences of acquired conditions.
Central auditory imperception includes all hearing losses that are not linked to defects in the conductive or sensorineural structures. They are usually divided into organic or functional losses.
Central auditory imperception (Types) Organic Type. Functional Type.
Central auditory imperception: Organic Type defect involves the reception of auditory stimuli along the central pathways; aphasia, agnosia, dysacusis
Central auditory imperception: Functional Type no organic reason exists to explain a central auditory loss; conversion hysteria, infantile autism, childhood schizophrenia
acoustic feedback an annoying whistling sound usually caused by improper fit.
Cochlear implants bypass the damaged hair cells and directly stimulate surviving auditory nerve fibers so they can send signals to the brain.
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.
Acute Otitis Media (Ear infection): most Common Bacteria a. Streptococcus pneumonia b. Haemophilus influenza c. Moraxella catarrhalis
Otitis Media: Blocked Eustachian Tubes (Non-infectious etiology). a. Edema of URIs b. Allergic rhinitis c. Hypertrophic adenoids d. Chronic OM is frequently an extension of AOM
Clinical Symptoms AOM -Otalgia acute onset -Fever -Purulent discharge (otorrhea) -Crying, irritability, restlessness, difficulty comforting child -Holding, rubbing, pulling on affected ear -Loss of appetite -Lethargy
Otitis Media: Therapeutic Management Antibiotics: -First line - amoxicillin (high dose) -Second line -Ceftriaxone injectable Spontaneous resolution. Supportive Care. Surgery -Myringotomy -Tympanostomy
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.
Myringotomy surgical incision in the eardrum which is performed to relieve severe pain and provide drainage of infected middle ear fluid in the presence of complications
Tympanostomy tube placement and adenoidectomy surgical procedures that are used to treat recurrent OM. Tympanostomy tubes act as a pressure-equalizer (PE) to facilitate continued drainage of fluid and allow ventilation of the middle ear.
School vision, also known as partially sighted refers to visual acuity between 20/70 and 20/200. The child should be able to obtain an education in the usual public school system with the use of normal-sized print.
Legal blindness visual acuity of 20/200 or less and/or a visual field of 20 degrees or less in the better eye, is useful only as a legal definition, not as a medical diagnosis.
myopia nearsightedness. ability to see objects clearly at close range but not at a distance. results from the eyeball that is too long, causing image to fall in front of retina.
hyperopia farsightedness. ability to see objects at a distance. results from eyeball that is too short, causing image to focus beyond retina.
Protanomaly confusion of gray with pink or pale blue with green
Deuteranomaly confusion of gray with pale purple or green
Astigmatism unequal curvatures in refractive apparatus. results from unequal curvatures in cornea or lens that cause light rays to bend in different directions.
Amblyopia lazy eye-reduced visual acuity in one eye. results when one eye does not receive sufficient stimulation.
Strabismus “Squint” or cross-eye-malalignment of eyes
Esotropia inward deviation of eye
Exotropia outward deviation of eye
True or False: The goal of medical interventions of one with strabismus is to return the eyes to normal functioning and position. False. There is no treatment that will perfectly align the eyes. The goal therefore is to realign them as close to normal as possible.
What nursing responsibility is common to all three of these eye disorders? Early detection of signs and symptoms and referrals.
Retinoblastoma a rapidly developing cancer that develops in the cells of retina, the light-detecting tissue of the eye.
leukokoria White eye reflex (most common sign)
Retinoblastoma: Diagnosis (eye abnormalities) i. White reflex ii. Strabismus iii. Decreased vision iv. Persistent painful erythematous eyes
Plaque brachytherapy focal-surgical radioactive implant on the sclera until maximum dose has been delivered to tumor
Laser photocoagulation focal-laser beam to coagulate blood supply to tumor
Cryotherapy focal-freezing tumor by destroying the microcirculation to the tumor through microcrystal formation
Thermotherapy focal-microwaves or infrared radiation to deliver heat to the tumor
Chemoreduction chemotherapy used to reduce tumor size to facilitate focal intraocular treatment
Chemoprevention (chemoprophylaxis) chemotherapy used to prevent metastatic disease; minimizes the use of external beam radiation treatment
What is Retinoblastoma? The most common congenital malignant intraocular tumor of childhood
Autism Spectrum Disorders Neurodevelopmental disorders of brain function accompanied by intellectual and social behavioral deficits
3 Types of Autism Spectrum Disorders Autistic Disorders. Asperger Syndrome. Persuasive development disease.
Autism Genetic disorder of prenatal and postnatal brain development
Autism: Clinical Manifestations Hallmark-inability to maintain eye contact Red flag-sudden deterioration in extant expressive speech Bizarre characteristics-social interactions Limited functional play
What is Autism? A developmental disorder of brain function.
Cognitive Impairments any type of mental difficulty or deficiency
Cognitive Impairments (Definition-consists of three components) Intelligence quotient (IQ) of 70-75 or below. Impairment in at least 2 of 10 different adaptive skill areas. Younger than 18 years of age at time of diagnosis.
When a child with cognitive impairment 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 occurring in 1 in every 800 to 1000 live births.
Fragile X syndrome most common inherited cause of cognitive impairment and the second most common genetic cause of cognitive impairment after Down syndrome.
Fragile X syndrome: Etiology 1. The syndrome is caused by an abnormal gene on the lower end of the long arm of the X chromosome. A fragile site is noted on the DNA and is replicated in affected individuals.
Cognitive Impairments: Dimension I Intellectual functioning and adaptive skills
Cognitive Impairments: Dimension II Psychological and emotional considerations
Cognitive Impairments: Dimension III Physical, health, and etiology considerations
Cognitive Impairments: Dimension IV Environmental considerations
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.
Fragile X syndrome: Clinical Manifestations (Men) Long faces with prognathism Large, protruding ears Macroorchidism
Fragile X syndrome: Clinical Manifestations (Young Children) less obvious, behavioral manifestations may suggest diag. -Mild to severe CI; intolerance to change routine -Speech delay -Short attention span -Hypersensitivity—taste, sounds, touch -Autistic-like behaviors
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: jtzuetrong