Exam 11: Pediatric Patient with Sensory or Cognitive Impairment
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| Hearing impairment | the most common disability in the United States
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| Hearing impairment (Definition) | disability that may range in severity from mild to profound and includes the subsets of “hard of hearing” and “deaf”.
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| Deaf (Definition) | a person whose hearing disability precludes successful processing of linguistic (verbal) information through audition, with or without a hearing aid.
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| 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.
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| 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
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| Disorders of hearing d/t these locations | Conductive or middle-ear hearing loss.
Sensorineural hearing loss.
Central Auditory.
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| 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.
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| 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.
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| 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.
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| Central auditory imperception (Types) | Organic Type.
Functional Type.
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| Central auditory imperception: Organic Type | defect involves the reception of auditory stimuli along the central pathways; aphasia, agnosia, dysacusis
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| Central auditory imperception: Functional Type | no organic reason exists to explain a central auditory loss; conversion hysteria, infantile autism, childhood schizophrenia
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| acoustic feedback | an annoying whistling sound usually caused by improper fit.
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| Cochlear implants | bypass the damaged hair cells and directly stimulate surviving auditory nerve fibers so they can send signals to the brain.
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| What defects cause hearing loss? | Defect in sound transmission, damage to nerve pathways or a mixture of both.
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| What are some methods of communicating with a hearing-impaired child? | Visual aids, writing, drawing and sign language.
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| Acute Otitis Media (Ear infection): most Common Bacteria | a. Streptococcus pneumonia
b. Haemophilus influenza
c. Moraxella catarrhalis
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| 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
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| 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
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| Otitis Media: Therapeutic Management | Antibiotics:
-First line - amoxicillin (high dose)
-Second line
-Ceftriaxone injectable
Spontaneous resolution.
Supportive Care.
Surgery
-Myringotomy
-Tympanostomy
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| 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.
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| To inspect the ear canal in an older child, what is the proper method of pulling the pinna? | Up and back.
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| 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
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| 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.
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| 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.
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| 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.
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| 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.
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| hyperopia | farsightedness. ability to see objects at a distance. results from eyeball that is too short, causing image to focus beyond retina.
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| Protanomaly | confusion of gray with pink or pale blue with green
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| Deuteranomaly | confusion of gray with pale purple or green
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| Astigmatism | unequal curvatures in refractive apparatus. results from unequal curvatures in cornea or lens that cause light rays to bend in different directions.
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| Amblyopia | lazy eye-reduced visual acuity in one eye. results when one eye does not receive sufficient stimulation.
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| Strabismus | “Squint” or cross-eye-malalignment of eyes
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| Esotropia | inward deviation of eye
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| Exotropia | outward deviation of eye
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| 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.
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| What nursing responsibility is common to all three of these eye disorders? | Early detection of signs and symptoms and referrals.
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| Retinoblastoma | a rapidly developing cancer that develops in the cells of retina, the light-detecting tissue of the eye.
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| leukokoria | White eye reflex (most common sign)
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| Retinoblastoma: Diagnosis (eye abnormalities) | i. White reflex
ii. Strabismus
iii. Decreased vision
iv. Persistent painful erythematous eyes
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| Plaque brachytherapy | focal-surgical radioactive implant on the sclera until maximum dose has been delivered to tumor
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| Laser photocoagulation | focal-laser beam to coagulate blood supply to tumor
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| Cryotherapy | focal-freezing tumor by destroying the microcirculation to the tumor through microcrystal formation
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| Thermotherapy | focal-microwaves or infrared radiation to deliver heat to the tumor
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| Chemoreduction | chemotherapy used to reduce tumor size to facilitate focal intraocular treatment
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| Chemoprevention (chemoprophylaxis) | chemotherapy used to prevent metastatic disease; minimizes the use of external beam radiation treatment
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| What is Retinoblastoma? | The most common congenital malignant intraocular tumor of childhood
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| Autism Spectrum Disorders | Neurodevelopmental disorders of brain function accompanied by intellectual and social behavioral deficits
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| 3 Types of Autism Spectrum Disorders | Autistic Disorders.
Asperger Syndrome.
Persuasive development disease.
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| Autism | Genetic disorder of prenatal and postnatal brain development
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| Autism: Clinical Manifestations | Hallmark-inability to maintain eye contact
Red flag-sudden deterioration in extant expressive speech
Bizarre characteristics-social interactions
Limited functional play
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| What is Autism? | A developmental disorder of brain function.
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| Cognitive Impairments | any type of mental difficulty or deficiency
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| 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.
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| 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.
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| Down Syndrome | most common chromosomal abnormality occurring in 1 in every 800 to 1000 live births.
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| Fragile X syndrome | most common inherited cause of cognitive impairment and the second most common genetic cause of cognitive impairment after Down syndrome.
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| 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.
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| Cognitive Impairments: Dimension I | Intellectual functioning and adaptive skills
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| Cognitive Impairments: Dimension II | Psychological and emotional considerations
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| Cognitive Impairments: Dimension III | Physical, health, and etiology considerations
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| Cognitive Impairments: Dimension IV | Environmental considerations
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| 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.
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| Fragile X syndrome: Clinical Manifestations (Men) | Long faces with prognathism
Large, protruding ears
Macroorchidism
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| 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
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| What is the most common chromosomal abnormality? | Down syndrome.
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| What role does the nurse play in assisting a child with a cognitive impairment? | The major role is in supporting and educating the family.
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