The Child with Cognitive, Sensory, or Communicative Impairments
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| Diagnostic criteria for Mental Retardation: Subaverage intellectual function IQ below ____, Onset before age ____, and functional impairment in at least ____ adaptive skill domains. | IQ below 70-75, before 18 yo, 2 functional impairments
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| 10 Functional Impairment classifications (at least two of these lack adaptive skills to be classified as Mental Retardation) | Communication, Home living, Community use of resources, Work, Health and safety, Functional academics, Leisure, Self-direction, Self-care, and Social skills
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| One of the diagnosis of Mental Retardation: Delayed progress in achieving ____ milestones | developmental-DOES NOT SHOW RIGHT AWAY
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| One of the diagnosis of Mental Retardation: Some children are not identified until they demonstrate ___ performance in ____. | POOR performance in school
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| Early Behavioral Signs of Mental Retardation: | nonresponsive to contact, decreased alertness to voice, poor/slow feeding, poor eye contact during feeding, language delay, gross motor delay and presence of syndromes at birth that are known for MR
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| Causes of mental retardation: Intrauterine ____ and intoxication, ____ (Pre,peri,postnatal), Metabolic or ____ disorders, Prematurity,LBW,Postmaturity, Unknown ____ influences & intoxication, ____ disorders, Chromosomal ____, & ____ disorders. | Intrauterine infections and intoxication, Trauma (Pre,peri,postnatal), Metabolic or nutritional disorders, Prematurity,LBW,Postmaturity, Unknown prenatal influences, Gestational disorders, Chromosomal abnormalities, Psychiatric disorders
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| Mild (educable) IQ | 50-55 to 70-75 Mental age of 9-12 years: able to work and contribute to society
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| Moderate (trainable) IQ | 35-40 to 50-55 Mental age of 6-9 years: able to achieve some degree of independence in self-care, simple academic skills
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| Severe IQ | 20-25 to 35-40 Mental age of 3-6 years: learns simple skills but needs continuous support
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| Profound IQ | below 20-25 Mental age below 3 years: severe limitations in self-care, communication, and mobility
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| Which immunization is involved in primary prevention of MR | Rubella
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| What type of counseling is used for primary prevention of MR | Genetic
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| Use of ____ supplements during pregnancy is a primary prevention of MR | folic acid
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| Education of ____ syndrom and avoiding ____ during pregnancy is a primary prevention of MR | fetal alcohol syndrom - avoid alcohol
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| education about ____ exposure is a primary prevention of MR | Lead
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| Prenatal care and childhood ____ are primary preventions to MR | nutrition
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| Communication is promoted for optimum development of a MR child by working on ____ and ____ skills | verbal and non-verbal skills
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| Discipline and Socialization are part of promoting optimum development for a child with MR, socialization includes; teach social acceptable ____, maintain appropriate ____ and expose child to ____. | teach social acceptable behaviors, maintain appropriate appearance, and expose child to strangers and peers
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| play and exercise for a child with MR includes: have same needs as ____, may need assistance to ____ play activity, and prolonged need for ____ play | have same needs as other children, may need assistance to initiate play activity, and prolonged need for sensorimotor play
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| Even though the ____ are the primary caretaker and teacher of a child with MR, they have to have information about ____ available devices aid in achievement of independence | parents - commercially
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| Down Syndrome aka ____21 | Trisomy 21
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| T/F Down Syndrome is Most common chromosomal abnormality of a generalized syndrome. | True
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| Down Syndrome occures in 1 in ____ live births | 600-800
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| T/F Down Syndrome occures more in African-Americans than Caucasians | False-Occurs more in caucasians than African Americans
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| What is the most common genetic cause of MR? | Down Syndrome
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| Down Syndrome chromosome abnormality in 95% of cases is when the chromosome pairs fail to seperate during meiosis resulting in ____ chromosomes (____ chromosomes on the 21st pair), related to maternal ____ | 47 chromosomes (46 is normal) 3 chromosomes on the 21st pair, related to maternal age
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| 5% of cases of paternal age is a factor especialy if the father is ____ years or older | 55
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| 3-4% of down syndrome is caused by ____ in which part of the extra 21st chromosome is attached to another chromosome, and 1% is due to ____. | 3-4% translocation, 1% mosaicism
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| Mothers age and down syndrom: age 35 ____, age 40 ____, age 45 ____ | age 35 1:400, age 40 1:110 age 45 1:30
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| physical features of the head of a child with down syndrome include: ____ sagittal suture, ____ occipt, small rounded ____, ____ anterior fontanel, sparse ____ | Separated sagittal suture, flat occipt, small rounded skull, large anterior fontanel, sparse hair
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| physical features of the eyes of a child with down syndrome include: Upward, ____ slant, ____ folds, ____ spots | Upward, outward slant, epicanthal folds, Brushfield’s spots
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| Physical features of the mouth and nose of a child with down syndrome: ____ palate, ____ tongue, ____ mouth, ____ nose, ____ nasal bridge | Short palate, protruding tongue, open mouth, small nose, depressed nasal bridge
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| physical features of the ears of a child with down syndrome are ____ with overlapping upper ____ | Small ears, overlapping upper helixes
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| The neck of a child with down syndrome is ____. | short and broad
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| Musculoskeletal manifestations of a child with Down Syndrome include: ____ stature, hypotonic, ____ weakness, hyperflexibility, ____ rib cage | Short stature, hypotonic, muscle weakness, hyperflexibility, shortened rib cage
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| Hands and feet manifestations of a child with Down Syndrome include: Broad ____ hands, ____ palmer crease, ____ between big and second toe, broad short ____ feet | Broad short hands, transfers palmer crease, wide space between big and second toe, broad short stubby feet
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| Abdomen and genitalia manifestations of a child with Down Syndrome include: Protrusion, ____ muscles, ____ hernia, ____ penis, ____ (absence of one or both testes) | Protrusion, flabby muscles, umbilical hernia, small penis, cryptorchidism (absence of one or both testes
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| A child with Down Syndrome generally has intelligence in the ____ range | mild-moderate (average 50)
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| A child who has Down Syndrome is commonly overweight by ____ yo | 3 yo or 36 months
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| ____% of children with Down Syndrome have congenital heart disease (CHD) especially septal defects | 40-50%
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| Renal agenesis, Duodenal atresia, Hirschsprung disease, TE fistula, skeletal defects, atlantoaxial instability are deficts that can be seen in children with ____ | Down Syndrome
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| Strabismus, nystagmus, asigmatism, hyperopia, myopia, excessive tearing, cataracts are some sensory problems seen in children with ____ | Down Syndrome
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| Hearing problems such as Hearing loss, otitis media, narrow ear canals can be seen in children with | Down Syndrome
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| T/F, a child who has Down Syndrome typically has an altered immune function, decreased incidence of leukemia and no thyroid problems | False - Altered Immune function, increased incidence of leukemia, Thyroid dysfunction
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| T/F although men with down syndrome are sterile and femals can be fertile | True
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| Special ____ charts are available for children with Down Syndrome | Growth charts
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| Second most common genetic cause of MR after Down syndrome | Fragile X Syndrome
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| Fragile X Syndrome occures in 1 in ____ live births | 2000-3000
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| Fragile X syndrome affects males or females more often | males
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| With Fragile X Syndrome, ____ males and ____% of females are mentally deficient | most males, 30% of females
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| Fragile X Syndrome is Caused by an abnormal gene on the lower end of the long arm of the ____ chromosome | X
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| In Fragile X Syndrome, The gene involved is responsible for the production of a protein that is needed for ____ and ____ development and function. | brain and neurological
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| Physical Characteristics of ___ Large head circumference, Long face with prominent jaws, Large prominent ears, High arched palate, Large testes (macroorcidism), Mitral valve prolapsed, Hypotonia and hyperextensible finger joints, Flat feet, Palmer creases | Fragile X Syndrome
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| Fragile X Syndrome has manifestations similar to ____ which include: Rocking, talk to self, social anxiety, avert gaze. Sensitivity to sensory stimulation, and Hand flapping | Autism
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| Speech and language delay of ___ include: More expressive problems than receptive and stuttering and repetition of words | Fragile X Syndrome
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| Children with Fragile X Syndrome may experience inability to tolerate ____ in routine and have ____ behavior | change in routine and aggressive behavior
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| It is estimated that 2 in ____ children are born with permanent hearing problems | 1000
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| Range of hearing impairment: difficulty hearing faint or distance speech. Unaware has a problem | Slight - hearing aid works well
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| Range of hearing impairment may have speech difficulties, understands speech at 3-5ft | Mild to Moderate - hearing aid helps
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| Range of hearing impairment Loud conversation only, difficulty with group discussion, needs speech training | Moderately Severe - hearing aid can help
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| Range of hearing impairment Hears a loud voice if near and loud environmental noises, understands vowels only, needs speech training | Severe (deaf) - hearing aid doesn't help
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| Range of hearing impairment, may hear only loud sounds, needs extensive speech training | Profound (deaf) - hearing aid doesn't help
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| T/F Low birth weight and anoxia pre or post delivery are etiologies of hearing impairmnts | True
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| T/F Sensorineural hearing loss is the most common of all hearing loss of childhood | False - conductive hearing loss is
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| ____ hearing loss Interference with sound transmission to or by the middle ear. | conductive
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| Most frequent cause of conductive hearing loss is ____ otitis media | serous
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| conductive hearing loss involves the ____ of sound | loudness
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| perceptive or nerve deafness is called ____ hearing loss | sensorineural
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| Sensorineural hearing loss is Caused by damage to the ____ ear structures or the ____ itself | inner ear or auditory nerve
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| With sensorineural hearing loss ____ is distorted and have problems with discrimination of sounds loss, ____ | Sound
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| Causes of ____ hearing loss include congenital deficits, ototoxic drugs, infections, or exposure to excessive noise | Sensorineural
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| Mixed conductive-sensorineural hearing loss is caused by recurrent ____. | otits media
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| ____ hearing loss usually involves actual brain damage which results in the inability to process information | Central hearing loss - such as aphasia, agnosia ect.
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| Infants with hearing loss lack the ____ reflex to sound | startle or blink reflex
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| Infants should be able to localize sound by ___ months | 6
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| Infants babble and make voice inflections by ____ months | 7
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| Yelling or screaming to express pleasure, annoyance, or need are manifestations of ____ impairment in children | hearing
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| T/F hearing aids can help with sensorineural loss | False - used to amplify sound only
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| ____ implant - Bypasses damage and directly stimulates undamaged nerve fibers to transmit signals to brain | cochlear implant
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| ____ speech Uses hand signals to augment lip-reading | cued
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| ___% of children have had at least one episode of otitis media by three years of age | 80%
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| Children ____ to ____ months of age have the highest incidence of otitis media | 6 to 20 months
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| Children living in households with many members (especially ____) are at risk for otitis media | smokers
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| ____ is an inflammation of the middle ear without reference to etiology or pathogenesis | Otitis Media
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| ____ is an inflammation of the middle ear space with a rapid onset of the signs and symptoms of acute infection such as fever and pain | acute otitis media
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| ____ is fluid in the middle ear space without symptoms of acute infection | Otitis Media with Effusion
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| ____ otitis media is often caused by Streptococcus pneumoniae, H. influenzae, and Moraxella catarrhalis | Acute Otitis Media
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| ____is most often caused by RSV and influenza and also by blocked Eustachian tubes from the edema of URI’s or allergic rhinitis, or large adenoids | Otitis Media
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| T/F Otitis Media with effusion is an extension of an acute episode | True
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| Structure that connects the middle ear with the nasopharynx and allows the middle ear to drain secretions into the nasopharynx. | Eustachian Tubes
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| ____ tubes helps to equalize the air pressure within the middle ear and atmospheric pressure in the external ear | Eustachian Tubes
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| ____ Allows an accumulation of secretions in the middle ear | Mechanical obstruction - caused by infection or allergy or blockage by enlarged adenoids
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| ____ obstuction caused by collapse of the Eustachian tubes resulting in negative middle ear pressures that produce an effusion in the middle ear | functional obstruction
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| Conductive Hearing Loss such as Tympanic membrane retraction, Perforation and scaring of the eardrum, Adhesive OM (glue ear), Cholesteatoma, Mastoiditis, Meningitis are complications of ____ | Otitis Media
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| Pain, irritability, High temperature common, Enlarged lymph glands, Signs of respiratory infection, Vomiting and Diarrhea, Loss of appetite, Discomfort with sucking and chewing are all clinical manifestations of ____ | acute otitis media
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| Severe pain or fever is usually absent, Feeling of “fullness” in ear, Popping sensation when swallowing, Feeling of motion in ear, Decreased hearing, Exudate accumulates & pressure increases with a potential for rupture are manifestations of ____ | Otitis Media with Effusion
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| Acute otitis media tympanic membrane is ____ color and otitis media with effusion has ____ color | bright red or yellow - orange
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| What type of otitis media has a bulging immobile membrane with no landmarks or light reflex | Acute otitis media
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| In which type of otitis medis can you see a visible fluid level behind drum if air is present above the fluid | otitis media with effusion
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| ____ are used to treat Acute Otitis Media but not Otitis Meda with Effusion | Antibiotics
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| When should tympanostomy tubes be implanted? | Recurrent acute otitis media and 4-6 months of bilateral otitis media with effusion
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| Other than drainage, why are tympanostomy tubes used for? | ventilation of middle ear and prevent scar formation and loss of elasticity
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| ____ may be necessary with recurrent AOM or Chronic OME | Adenoidectomy
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| T/F The use of steroids, decongestants, and antihistamines are recommended for therapeutic management of otitis media | False
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| Nursing care for child with otitis media includes Teach proper ____ of infants sitting upright rather than in a supine position. | feeding
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| Between ____ and ____ children per 100,000 population have a serious visual impairment or blindness | 30 and 64
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| refractive disorders, ambylyopia and strabismus are all etiology of ____ impairments | visual
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| Black eye: apply ____ for 24 hours and Rest | ice
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| Chemical injury to the eye: Irrigate eye immediately with copious amounts of water for ____ minutes | 20
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| Observe all penetrating and “blow” injuries for the development of ____ (collection of blood in the anterior chamber of the eye) | hyphema - see an opthalmologist
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| Examine eye for presence of object. Evert upper lid to examine. If freely moveable use corner of a moistened gauze pad to remove. Do not ____ or ____ eye | irrigate or rub
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| ____ is the most common infection of the eye | conjunctivitis - t opthalmic antibiotics
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| Severe conjunctivitis infections may require ____ antibiotics | systemic
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| Another word for amblyopia | lazy eye
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| Amblyopia is Reduced ____ in one eye | visual acuity
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| T/F In amblyopia, Vision in the weaker eye will be lost | True
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| with amblyopia Misalignment of eyes so that one focuses better than the other. ____ occurs | diplopia (double vision)
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| Tx of ____ includes Correct misalignment or obstruction with surgery or corrective lenses, Patching of good eye to force the weaker eye to work | amblyopia and strabismus
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| Usually involves an imbalance in the extraocular muscles. Caused by congenital defect, paralysis, or poor vision. Brain receives two images. | Strabismus (cross-eye)
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| Inward devision of strabismus | estropia
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| outward deviation of strabismus | extropia
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| How do parents overcome the challenges of bonding with a child who is born blind? | Parents must establish ways of communicating with the infant other than sight. Touch, breathing patterns, stimulate other senses to induce pleasure in the child. Parents need to learn cues of child that indicates pleasure or pleasing responses
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| How do parents overcome challenges of childrens motor abilities who are born bind? | Need non visual cues such as tactile or ambulatory to get child motivated to move and develop motor skills. Need to learn to feel movement. Slower to develop skills
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| With a hearing impaired child, Need to talk to child and encourage ____ . Describe characteristics of objects. Language often delayed | verbalization
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| Self-stimulating behaviors are common and they develop mannerisms to alleviate boredom and sensory deficits are common in children born with ____ impairment | visual
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| visually impaired children need to gain ____ by becoming motivated to do for themself | independence
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| A visually impaired child can learn perception of space and body image by learning ____ from ____ and how it relates to space, use special techniques for ---- and education by use of ____ | learn left and right, use special techniques for mobilization and use of braille (as well as records, talking books, special calculators, computers with voice synthesizer.
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| A deaf-blind child uses the ____ method which is use of hand over the speakers face to monitor facial movements | Tadoma
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| T/F A deaf-blind child can Use methods similar to blind child to encourage sensory experiences. | True
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| Autistic spectrum disorders manifests from ____ to ____ months | 18 to 36
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| T/F etiology is unknown for autistic specgtrum disorders | True
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| Autistic spectrum disorders occures 1-2 in ____ children | 500
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| autistic spectrum disorders are 4 times more common in ____ than ____ | 4 times more common in males than females
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| Autistic spectrum disorders have qualitative impairments in ____ and ____ | social interaction and communication
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| Restricted repetitive and stereotypical patterns of behavior, interests, and activities are a diagnostic criteria for | Autistic Spectrum Disorders
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| T/F children with autism are unable to maintain eye contact | True
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| About half or majority of children with autism have some degree of MR | majority
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| Promote positive reinforcement, Increase social awareness of others; Teach verbal communication skills, Decrease unacceptable behavior are all teaching objectives for | The autistic child
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