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M6 13-005
Exam 11: Pediatric Patient with Sensory or Cognitive Impairment
| Term | Definition |
|---|---|
| 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
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