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Nsg213 Exam

bending of light rays through the lens of the eye refraction
rays focus on the front of the retina, nearsighted myopia
rays focus behind the retina, farsighted hyperopia
rays focused over a diffuse area on the retina rather than being clearly focused astigmatism
refractive powers of the eyes are unequal anisometropia
binocularity should occur by what age 6 months
What is strabismus? unequally aligned eyes, known as crossed or lazy eye
Is there a family history in patients with strabismus? 50% of children will have family history
What is extropia? In strabismus, when eye deviates out- divergent
What is estropia? In strabismus, eye deviates in- convergent
How do the eyes look if a patient has vertical strabismus? one pupil is higher than the other
Difference between monocular and alternating strabismus *monocular- same eye deviates constantly *alternating- one eye deviates and then the other
possible causes of strabismus *prematurity *traumatic brain injury *retinoblastoma *congenital rubella *genetic defects *cerebral palsy
Manifestations of strabismus *squinting *closes one eye to see *tilts head to side *inaccurate eye hand coordination *double vision *symptoms of refractory errors
What is ambient light in the infant? check to see if light relects on same part of eye on both eyes
Up to what age is occasional occurrence of strabismus normal? 6 weeks
What is the hirshberg's test? shining light at pupils to determine centering
What is the cover test? cover one eye for 5 seconds, remove cover, eye drifts back to normal position = latent strabismus
Management of strabismus *Correct Early!!! *muscle exercises *surgical correction of muscles
What is diminished receptive vision, can be unilateral or bilateral? Results when there are 2 different images (strabismus), brain supresses one image- blindness results ambylopia
How can ambylopia be avoided? Early intervention and correction- brain center reception complete by 6-7 years of age
Manifestations of cataracts *opacity of lens *infant fails to reach for objects *infant does not respond to visual stimuli *pupil opening white not black *older children report blurred vision
Post op care after cataract surgery *maintain light sedation *may have eye patches *slow intro to fluids/food to avoid n/v *avoid crying *fit with contact lens after healing
Manifestations of congenital glaucoma (recessive gene inheritance) *cornea appears enlarged *cornea edematous *cornea hazy *blue tinge to sclera Symptoms usually noticed shortly after birth
What is done for congenital glaucoma? *immediate surgery- goniotomy, new opening for canal of schlem- multiple surgeries *diamox- supresses production of aqueous humor *miotic- increases aqueaous humor drainage *laser therapy *avoid drugs that dilate pupils
What visual acuity is considered partially sighted? 20/70 to 20/200
Who is considered legally blind? acuity of 20/200 or worse in corrected eye
What are some etiologies of visual impairments in children? *perinatal or postnatal infections(gonorrhea, chlamydia, rubella, syphilis, toxoplasmosis) *retinopathy or prematurity *perinatal or postnatal trauma *fetal alcohol syndrome
How is conjuctivitis treated? *opthalmic antibiotics *systemic antibiotics if needed
What do you always want to use with caution regarding medication in the eyes? Use of steriods- could exacerbate viral infections
What is the risk of cellulitis in the face? may spread to eye and damage optic nerve if not treated with IV antibiotics
What are some ways to prevent visual impairment? *prenatal care/ prevention of prematurity *rubella immunizations for all children *safety counseling for preventing eye injuries
Screening and assessments for visual impairment *newborns-preschoolers- screen annually *older children- screen every 2-3 years *observe for squinting, rubbing of eyes, water/red eyes *distance of holding reading material *learning difficulties
What to do if a foreign body is in eye? evert upper lid, moistened cotton swap to remove debris
Chemical in eye- first action? flush with water
Treatment for corneal abrasions? antibiotic wash, patch eye
Treatment for hematoma of eye (black eye) ice pack 20 min on 20 min off
What to do for a penetrating eye trauma? MEDICAL EMERGENCY- *patch both eyes to prevent movement
Occurs when the ciliary body is injured- opposite eye is at risk for becoming inflamed and blindness can occur in the non affected eye. Very serious condition. Sympathetic iritis
Possible causes if hearing impairment *anatomic malformation *low birth weight *ototoxic drugs *chronic otitis media *perinatal asphyxia *perinatal infection *cerebral palsy
To ensure proper speech, by what age must a hearing impairment be diagnosed and treated with a hearing aid? diagnosed by 3 mos and hearing aid by 6 mos
Conductive hearing loss- which part of ear is affected? middle
Type of hearing loss caused by nerve deafness sensorineural
What can cause a mixed conductive and sensorineural loss? recurrent OM with complications
What is organic hearing impairment? dysfunction of reception of stimuli and meaningful communication
What causes functional hearing impairment? non organic- psychological disorders
Red flags to alert you of possible hearing impairment in infancy *lack of startle reflex *absence of babbling by 7 mos *general indifference to sound *lack of response to spoken word
Therapeutic management of hearing dysfunctions *hearing aid *cochlear implants- 1 year and older- child must learn to re-hear, older children who learned sign language may have difficult time
High risk age group for otitis media 6mos-2years then 5-6 years
Risk factors for otitis media? *infants fed supine or use pacifier *recent infection (flu) *daycare *changes in climate *smoke *genetic predisposition
What is the purpose of the eustachian tube? flat, closed structure that allows drainage from iddle ear- when clogged, air cannot escape causing negative pressure- bacteria from nasopharynx can back up causing infection
Manifestations of what? red, bulging eardrum, poor eardrum mobility, rupture of eardrum, external drainage, crying, fussy, poor sleeping, pulls at ear, poor feeding, tinnitus, fullness otitis media
Management for otitis media *decrease pressure *reduce inflammation *antibiotics *prevent rupture of eardrum *preserve hearing *relieve pain *surgery *change risk factors
Surgical intervention for otitis media that involves incision in bottom of eardrum and drainage myringotomy
Insertion of tubes into ears tympanostomy- allows drainage and allows ability to dry up
Why would a child have their adenoids and tonsils removed? compound reoccurence of otitis media and tonsilitis or sleep apnea
If a child had a tympanostomy, what is important to teach? no swimming, keep ears dry
possible complications of otitis media? *mastoiditis *hearing loss *otitis externa
Which auditory condition? known as swimmers ear, very painful over pinna and tragus, may have drainage, swollen lymph nodes, lining of external ear canal is inflamed otitis externa
what to do for otitis externa? *bacterial or antifungal drops Prevent by using 2%acetic acid eardrops to keep ear dry
etiology of childhood seizures *brain center development *ionic microenvironment *immaturity of electrical circuits *reduced threshold for seizure signals
Major causes of seizures in children *birth injuries/head trauma *anoxia/hemorrhage/electrolyte/BS/drug withdrawal *congenital defects of CNS *genetic *tumor *acute infections
What are some common seizure triggers for children? *changes in dark light patterns *sudden loud noises *extreme temp changes *dehydration *fatigue
Diagnostics used to determine cause of seizure *EEG *MRI *glucose, electrolytes, BUN, Ca++ *Lumbar Punture
Are single seizures usually treated with long term meds and considered epilepsy? No, only recurrent seizures
Which type of seizure? prodromal period, aura, loss of consiousness, automatic behavior, postictal tiredness/sleeping. Occurs in temporal lobe. complex partial seizure
Which type of seizure? *prodromal period and aura *flexion, extension, tremors *apnea, cyanosis, noisy resperiations, incontinence, sudden brief cx of muscle *impaired consiousness *both hemispheres involved *may be mistaken as exaggerated startle re generalized tonic clonic
Which type of seizure? brief LOC 5-30 sec max,sudden onset, up to 20x/day, returns to prior activity, motor-lip smacking, twitching of eyes and face, no incontinence, misdiagnosed as daydreaming absence seizures, petit mal
At what age is a febrile seizure most common? between 6 mos and 3 years-- rare after age 5
When does a febrile seizure occur? WHEN temp is rising, NOT after,temp of greater than 101.8 usually, may last 15 minutes
What to do for a febrile seizure? *high doses of antipyretics *protect from injury *call 911 is lasts longer than 5 mins *diazepam (rectal)
What is status epilepticus and what to do for it? seizure lasting longer than 30 min- can cause intracranial insult. Maintain airway, IV access, meds
Dilantin- how many mg/min, what kind of fluids, side effects? *PO or IV push- less than 50 mg/min *no glucose, mix with normal saline only *SE: gingival hyperplasia, ataxia, rashes, acne, hirsutism, osteoporosis
Drugs of choice for status epilepticus *Valium- IV or intraosseous *Ativan-preferred in US,IV or intraosseous *no parenteral access, IM Versed
When would you give IV dilantin or cerybex, then go to phenobarbital or versed? for continuous seizures
Ceryebyx- given with what? What rate? What route? *glucose or saline *up to 150 mg/min *IV or IM
Valium- what routes? what is it used for? rectal (diastat) or IV- tx status epilepticus
Which drug of choice for seizures older than 2 years of age? Ativan causes less resp distress
Versed- What route? What is it used for? intranasal, used for acute epileptic seizures
Acute inflammation of the CNS, can be caused by many bacterial agents Bacterial Meningitis
Symptoms infants with bacterial meningitis may have *mild fever *blank stare, inactive *irritable *vomiting/anorexia *high pitched cry *bulging fontanel *can progress to seizures
Symptoms children older than 2 may have with bacterial meningitis *fever *n/v *fatigue/sleepiness *headache *discomfort looking at bright lights *confusion *nuchal ridgity *convulsions
A disease of the adrenal glands commonly caused by neisseria meningitidis- infectious process leads to meningococcemia with massive hemorrhage, low bp, shock, DIC, and purpura- leads to adrenocortical insufficiency Waterhouse-Friderichsen Syndrome
How is bacterial meningitis diagnosed? *signs and symptoms *opisthotonos- arching of back *CSF evaluation- turbid(wbcs) or xanthochromia(yellow, orange or pink- lysis of RBCs, breakdown of hemoglobin into oxyhemoglobin, methemoglobin, and bilirubin)
When does discoloration of the spinal fluid occur? after RBCs have been in fluid for about 2 hours and lasts 2-4 weeks
What will likely be seen in the spinal fluid within 12 hours of a subarachnoid hemorrhage? xanthochromia
CSF protein levels should be at least __________? 150 mg/dL
What does it mean if there is decreased glucose in the CSF? bacterial infection- bacteria uses up glucose
Management of bacterial meningitis *isolation *antibiotics *dexamethasone *hydration balance *electrolyte monitoring *assess for subdural effusion *DIC management
Causes of aseptic meningitis? *viruses *measles, mumps, herpes, leukemia
How is aseptic meningitis diagnosed? Lumbar punture
manifestations for aseptic meningitis? headache, fever, malaise
Inflammatory process of CNS with altered function of brain and spinal cord, usually secondary to othe infection, usually viral in cause- can be caused by mosquitos and ticks encephalitis
Diagnostics for encephalitis CSF, virus identification, R/O guillian barre syndrome, reye syndrome
Manifestations of encephalitis *malaise *fever *headache/ dizziness *stiff neck *n/v *ataxia *speech difficulties If severe- *high fever *disorientation *seizures *ocular palsies *paralysis
etiology of reyes syndrome unknown- but associated with ASA use and viral infections
Which illness? acute, non inlammatory encephalopathy reye syndrome
What organs does reyes syndrome affect? fatty degenerative changes in the brain, liver, and kidneys
Diagnostics for reyes syndrome *ELEVATED AMMONIA *liver biopsy *hypoglycemia *lactic acidosis *cerebral edema and IICP
What are the primary threats for a child with reyes syndrome? What is the prognosis? ammonia and IICP are the primary threats to recovery, may have subtle neuro deficits
Nursing considerations for reyes syndrome *intensive care *foley *ng tube *i and o *bleeding issues *ventilatory management *mannitol *vitamin k *may be in barbituate coma
How do you know a child with reyes syndrome is worsening? decorticate or decerebrate posturing
What condition? Neural tube defect- failure to close- could be in lumbar or lumbosacral, could be occulta(hidden), meningocele(meninges), or myelomeningocele(nerves and meninges) spinal bifida
Diagnostics for spina bifida *elevated alpha fetoprotein(amniocentesis, fetal ultrasound) *clinical presentation *MRI/CT *diagnostics to determine bowel and bladder status
Newborn care of a myelomeningocele or meningocele sac *moist NS dressings *assess for sac leaks *prone positon *hips slightly flexed *NO DIAPERING *keep perianal area clean at all times
Surgical closure of a meningocele sac must be done w/in how many hours to prevent risks of infection, hydrocephaly, b & b dysfunction, motor dysfunction, skin breakdown 24-72 hours
Post op care after surgical closure of a meningocele *prone position for several days *avoid holding in surgical area *assess b and b function *motor function *assess ICP *hydrocephalus/head circumference *skin for breakdown
What is ditropan given for in a child with spinal bifida? neurogenic bladder- souce of UTI, may have to self cath, may have urinary diversion
Why would a child with spinal bifida need fiber, laxatives, suppositories, and enemas? Also MACE- flush out colon. for neurogenic colon
What can cause hydrocephalus? *could be congenital *disturbances in CSF flow *tumor *myelomeningcele *spinal bifida
Which type of hydrocephalus? impaired absorption of CSF within the subarachnoid space communicating
Which type of hydrocephalus? obstruction to flow of CSF through ventricular system noncommunicating
management of hydrocephalus *head circumference *fontanel tension *sunset eyes *developmental delay *ICP monitoring *CO2 monitoring May have VP shunt
signs of IICP *irritability/restlessness *drowsiness, change in normal behavior *fatigue, somnolence *unable to follow commands, memory loss *weight loss *headache *seizures *diplopia *blurred vision *vomiting
How does oxygen and CO2 play a part in ICP? If low O2 and high CO2, vessels dilate, ICP increases If high O2 and low CO2, vessels constrict, ICP decreases
Sleep is restorative, it does the following: *repairs and renews epithelial cells *repairs and renews brain cells *triggers GSH from pituitary *less epinephrine is released so here is less interference with cell division and wound healing
Sleep is conservative, it does the following: *energy conservation du to lowered BM *lowered bp,p,r,temp *decreaesed digestive secretions *decreased urine production *decreased reflexes
Infants need how many hours of sleep per night? 9-11, total 15 hrs/day
night sleep patterns are developed by what age? 3-4 months, if they are breastfed, they will sleep less
Toddlers need how many hours of sleep per night? 10-12, naps
How much sleep does a preschooler need? 12hrs/night, usually no naps
How many hours of sleep does a school age child need? 8-10 hrs/night
Adolescents need how many hours of sleep per night? 8-9
Why do adolescents usually have episodes of tiredness and fatigue? Their heart and lungs have not grown enough keep up with demand
Downsideds of cosleeping? *SIDS *poor sleep *child becomes dependant of parents bed *suffocation of child *strangulation
Repetitive episodes of upper airway obstruction that occurs during sleep, usually associated with reduction in blood oxygen saturation obstructive sleep apnea
Symptoms of sleep apnea *daytime sleepiness *frequent episodes of obstructed breathing while sleeping *snoring *restless sleep *irregular breathing *excessive perspiring *bedwetting *nightmarees *night terrors *sleeps with mouth open *chest retraction *failure to thr
An overnight test that involves monitoring brain waves, muscle tension, eye movement, respiration, oxygen level, and audio monitoring for snoring, gasping, etc Polysomnogram
Management of a child with sleep apnea *tonsils and adenoids out if needed *c-pap *bi-level positive airway pressure *polyp removal *correction of facial deformities *fixing deviated septum
Sleep walking Somnambulism
WHen does sleep walking occur? during 3rd or 4th non-REM sleep stages, early in the night, may be caused by fatigue or aniety
Typical age of sleepwalking 6-12 years old
Nightmares are a symptom of the child's what? insecurities
manifestations of night terrors *child bolts upright *eyes wide open, look of fear and panic *sweating, breathing fast, rapid heart rate *will seem awake but are inconsolable *lasts about 5-30 min, will not remember
Diagnosis of night terrors history of child waking up being inconsolable
Prevention of night terrors stick to bedtime routine, wake child up before they usually have night terrors
sleepwalking, sleeptalking, and night terrors are considered to be a disorder of what? arousal and are a partial arousal from non-REM sleep
What is the "phase shift" that adolescents experience during puberty? melatonin production tapers off later in the evening than it did in prior years- the brain's circadiam timing system switches on later at night as pubertal development progresses
What does the acronym "BEARS" refer to? 5 questions to see if your child has sleeping problems Bedtime, Excessive daytime sleepiness, Awakenings, Regularity and duration of sleep, Snoring?
Child abuse is thought to stem from what 3 factors interacting between the parent and child? 1. parental characteristics 2. characteristics of child 3. environmental characteristics
What are the effects of child abuse and neglect? lack of trust and relationship difficulties, core feelings of being worthless or damaged, trouble regulating emotions
Which type of child abuse? pattern of failing to provide for a child's basic needs, food, clothing, hygiene, supervision. child neglect
which type of child abuse? constant belittling, calling names, yelling, threatening, ignorning child for punishment, no hugs, kisses, exposing child to abuse of others emotional child abuse
Difference between physical abuse and discipline. Discipline has these factors: unpredictability- no clear boundaries or rules, lashing out in anger, using fear to control behavior
What usually results from sexual abuse? feelings of shame and guilt, self-loathing, sexual promiscuity later
Warning signs of emotional abuse in children *excessively withdrawn, fearful or anxious *extremes in behavior *doesn't seem attached to caregivers *acts inappropriately like an adult or infantile
Warning signs of neglect in children *clothes ill fitting, filthy *hygiene consistently bad *untreated illnesses or injuries *frequently unsupervised *frequently late for school or misses school
Warning signs of physical abuse in children *frequent unexplained injuries *always watchful and alert *injuries appear to have a pattern such as marks from hand or belt *shies away from touch, flinches at movement *wears inappropriate clothing, such as long sleeves on hot day
Disorder that results from severe abuse early in life- children are so disrupted that they have extreme difficulty establishing normal relationships and attaining normal developmental milestones Reactive attachment disorder
Risk factors for child abuse and neglect *domestic violence *substance abuse *untreated mental illness *lack of parenting skills *stress and lack of support
characteristics of children that contribute to abuse *illegitimate *unwanted *preemie *health problems *hyperactive
Once a suspected abused child is admitted to the hospital, after reported to CPS, how do you treat the family? *be positive *consistent nsg care *be a role model *praise child for abilities *show attention *avoid asking parents lot of questions *promote parental attatchement *encourage child to talk about feelings
Intentional production of physical or psychological signs and symptoms in another person who is under the individual's care munchausen's syndrome by proxy
Children at risk for munchausen's syndrome by proxy 15 mos to 6 years
Warning signs of munchausen's syndrome by proxy *illness prolonged, unusual *symptoms inapropriate *multiple allergies *symptoms disappear when caretaker leaves *one parent usually absent during visit *hx of SIDS in sibling *parent overly attached *parents show inordinate concern for feelings of
diagnosis of munchausen's syndrome by proxy *urine toxicology screening *chemistry panels *ecg *drug levels *cultures *coagulation tests *head ct scan -parent is removed from care
type of behavior that is passed down from one generation to another, has emotional and behavioral characteristics that interfere with the individual's ability to have a healthy relationship. Also known as relatonship addiction co-dependency
Which type of child role in the "family trap"? usually the oldest child, overly responsible, assists co-dependent parent i running the family. As adults will feel superior to others and perfectionaly seek a better life,feels guilty when familyleft behind Hero
Which type of child role in the "family trap"? can be the second child, seeks attention by negative behavior as all positive attention is given to the hero, family troublemaker, often blamed for families troubles scapegoat
Which type of child role in the "family trap"? born into already highly stressed family, quiet, withdrawn, prefers to be alone, values items more than people. As adults, prefer non human contact careers, lonely lost child
Which type of child role in the "family trap"? child is family's pain eater, brings the whole family together by making them laugh. class clown, appear to be immature, as adults they maby be percived as insensitive and unable to be serious- numb inside mascot- extremeley vulnerable, fearful, and sad
Manifestations of IICP in infants *irritability/poor feeeding *high pitched cry, difficult to soothe *fontanels bulging *cranial sutures seperated/scalp veins distended *eyes/setting-sun sign *dolls eyes
Late signs of IICP *decreased LOC *decreased motor response to command *decreased sensory response *alterations in pupils *papilledema *decerebrate or decorticate posturing *cheyne-stokes resp
Nsg care for a child with IICP *HOB 30-45 degrees *cervical collar if needed *avoid extreme hip flexion *avoid valsalva-hold breathe when turning *well spaced activities *avoid isometric exercises
Disorder of impaired gross motor movement, coordination, posture, abnormal muscle tone, intellectual dysfunction, language deficits, and perceptual problems- caused by abnormalities in brain, no muscle or nerve involvement cerebral palsy
Manifestations of cerebral palsy growth and development milestones not attained- usually appears before a child reaches 3 years of age
Is cerebral palsy a progressive disorder? NO- if changes, it is not cerebral palsy
Possible etiologies for cerebral palsy *prenatal-brain abnormalities, infections *perinatal-asphyxia, CVA *preterm, low birth weight *kernicterus- brain injury due to hyperbilirubinemia *shanken baby syndrome *head trauma, cerebral infections early in life
Diagnostics done for a child with cerebral palsy *MRI- brain and spinal cord *EEG *genetic testing *hearing/vision
management for cerebral palsy *surgical release of tight tendons, neurosurgical rhizotomy, braces, assistive devices *meds *baclofen pump *botox injections *PT *anti seizure meds
Subsequent complications from head injuries *hypoxic brain injury *increasing ICP *infection *hematoma *cerebral edema
transient and reversible head injury, instantaneous loss of awareness and responsiveness lasting for minutes-hours, followed by amnesia and confusion concussion
damage to actual brain tissue laceration
coup injury bruising at the point of impact
countercoup injury bruising at the site opposite from the point of impact
What can a fracture on the underside of the skull result in? tearing of the meningeal artery causing severe hemmorhage with hypovolemic hyptotension
type of fracture? fracture line simple or complex linear fracture
type of fracture? associated with lacerations depressed fracture
type of fracture? depressed fracture with many fragments comminuted
type of fracture? follows suture line diastatic
type of fracture? serious, battle sign and raccoon eyes basilar
diagnostic evaluatin for head trauma *ABCs *vital signs *neuro exam *CT/MRI *behavioral/sensorium assessment
management for head trauma *frequent vitals and neuro checks *npo initially *possible surgical interventions *analgesia and sedation *rehab
Levels of consciousnss in descending order *full consciousness *confusion *disorientation *lethargy *obtundation *stupor *coma *persistent vegetative state
Diagnostics for neurological symptoms *labs-glucose, CBC, elecrolytes, blood culture if fever, liver *CT/MRI, echo, ultrasound, brain scan, PET scan *Lumbar Pucture *EEG *Xray
cerebral hypoxia lasting longer than ___ hours may cause irreversible brain damage 4
medications for neuro patients *osmotic diuretics *antiseizure meds *sometimes barbituates *paralyzing agents *antipyretics
Nsg care for unconscious child *i and o *foley *moniter urinary output q2-4hrs *fluid restriction *osmotic diuretics *vs, high range normal bp *no closed mouth coughing *pupil assessments *cognition *turgor *do not suction nares *monitor temp *test stols for blood
pain management for comatose child *assess for signs of pain, pain increases ICP *alterations in vs
drug therapies for a comatose child in pain *opiods *fentanyl+versed+vecuronium *tylenol with codeine
Central diabetes insipidus can bbe caused by: head injury, infection, surgery, tumor- damage to hypothalamus or pituitary gland
SIADH can result from what? Increased intracranial pressure
Which problem occurs from altered pituitary secretion and involves decreased urine output with hyponatremia and hypo-osmolality SIADH-fluid restriction, observe for electrolyte imbalances, vasopressin
What are some possible causes for cognitive dysfunction? *genetic predisposition *perinatal injury *environmental eposures *neurologic and medial conditions
Interventions for a child with cognitive dysfunction *sensory deficits need to be diagnosed and corrected *address self esteem and confidence *avoid misdiagnosing by labeling the behavior (ADHD)
Defined as substantially subaverage intellectual functioning, considerable limitations in adaptive functioning in 2 or more of the following: communication, home living, interpersonal skills, self care, self direction, academic skills, health, work,etc. intellectual disability
Prevention of intellectual disability *rubella vaccination *genetic counseling *use of folic acid *educate about fetal alcohol syndrome *educate about lead exposure
Known as trisomy 21, most common chromosomal abnormality down syndrome
eitiology for down syndrome *likely multiple causes *maternal age- most downsyndrome children have mothers less than 35
manifestations for down syndrome *seperated sag sutures *small nose & chin, flat nasal bridge, round face, high arched palate, protruding tongue *eyes upward outward slant *hyperflexible, hypotonia *neck, thick w/excess skin *short limbs, space between 2nd & big toe *simian crease
congenital anomalies that may go along with down syndrome *40-45% heart defects *renal, hirschsprung, TE fistula *altered immune function *skeletal defects
Do children with down syndrome generally have intellectual disabilities? yes, generally mild to moderate disability, from severe disability to low-average intelligence
Second most comon genetic cause of intellectual disability after down syndrome, x linked dominance with reduced penetrance, gender differences, most common in males fragile x syndrome
How does fragile x syndrome affect males? females? Most males are mentally deficient, while onlye 30% of females are.
Physical appearance of a child with fragile x syndrome *long face, proganthic jaw, large ears, strabismus *mitral valve prolapse *macro-orchidism *palate- high arch *hyperextensible finger joints/ palmar crease *flat feet
Behavioral manifestations of a child with fragile x syndrome *mild to severe intellectual disability/normal IQ with learning disabilities *delayed speech and language *hyperactivity *autistic-like behaviors *aggressive behaviors
Therapeutic management for fragile x syndrome *tegretol/prozac *stimulants for hyperactivity *mimic behavior
Which dysfunction? Brain dysfunction accompanied by broad range and severity of intellectual and behavioral deficits Autism
Diagnostic criteria for autistic disorder *impairment in social interaction and communication *restricted repetitive and stereotype patterns of behavior, interests, and activities *delays or abnormal functioning with onset before 3 years
Nursing considerations for autism *wide variations in individual client response to tx *no cure *highly structured routines and intensive behavior modification programs *pet therapy
Created by: 1656878667