ATI PRACTICE
Causes of cognitive impairment
Specifically: chromosomal abnormalities, perinatal infections, perinatal anoxia, maternal drug/alcohol abuse, metabolic disorders (PKU, lead poisoning, hypothyroidism, prematurity)
If the child is demonstrating school avoidance, what kinds of suggestions could the nurse give to the parents?
-Avise parents to be firm in the morning if the child is refusing to go to school -Explain to the child that there is nothing wrong with them and that attendance of school is nonnegotioble -bring any somatic symptoms to the attention of the HCP. -Provide support and reassurance to the child
What other congenital defects are common with Down's syndrome?
-Congenital heart defects, which are ultimately the cause of death -Congenital hypothyroidism Other defects: -Leukemia -Anemia -Intestinal blockage at birth -Hip dislocation -Hirshsprung disese -Hearing Loss -Sleep apnea -Vision problems -Ear infections
What are the most common signs and symptoms of RAP?
-Afebrile -Constipation and Vomiting may be present -Abdominal pain, nonspecific -Periumbilical abdominal pain, or epigastric pain that is not associated with eaind, defecating or exercise.
If the child is demonstrating school avoidance, what kinds of suggestions could the nurse give to the parents?
-Convince the parents that their child is healthy and explain the diagnosis of school avoidance -Explain that it is stress related and it can occur in normal children
If a sexual abuse is suspected, what signs and symptoms are typically present?
-Difficulty walking or sitting -Torn, stained or bloody undergarments -Pain, swelling, or itching of the genitalia -Bruises, pain, bleeding, or lacerations of the genital or anal areas -Unwillingness to change clothes or participate in gym activities -Poor peer relations Foundations: -Non-specific symptoms such as sleep disturbances or abdominal pain -Promiscuous behavior -Withdrawal, fantasie, or infantile behavior -Age-Inappropriate sexual knowledge -Delinquenc -Prostitution -Forcing sexual acts on other children -Fear of being touched -Suicide attempts -Low self-esteem -Excessive or public mastrubation -Declining school performances Physical indicators: -Ecchymosis of the hard or soft palate -STD's in preteens -Adolescent pregnancy -Enuresis or encopresis -Vaginal or penile discharge -Foreign bodies in vagina or rectum -Presence of semen -Recurrent UTI's
What is the nurse's focus towards the family of a cognitive impaired child?
-Encourage parents to keep focus an normal needs such as love, play and social interaction as well -Provide parents with referrals to support groups and agencies
What is missing in child diagnosed with down's syndrome?
-Human growth hormone which results in delayed growth and height. -Intellectual impairment -Decreased Muscle Tone -Weakness in grammar and language -Delays in motor development -Weaker hearing
What diagnostic studies are used for the cognitive impaired child?
-Neurological examination -CT scan -Developmental screening tests-Denver II -Standardized intellectual test-Stanford-Binet Intelligence Scale;Wechsler Intelligence Test for Children, Revised -Chromosomal analysis -Genetic screening
What are the different types of child abuse?
-Physical abuse -Emotional abuse -Sexual abuse
What types of abuse are included in the category of child abuse?
-Physical abuse -Emotional abuse -Sexual abuse
What is the nurse's focus towards the family of a cognitive impaired child?
-Promoting optimal development and providing the family with support, education and referrals -Encourage parents to enroll the child in early intervention program to facilitate the child's self-care abilities
What counseling could be given to the parents of a child with ADHD? What would the parents be going through?
-Provide parents with information about the disorder and the treatment plan -encourage support groups for the parents -treatment options include behavioral therapy, medicatin, maintaining a consistent environment and appropriate classroom placement -behavioral therapy focuses on preventing undesirable behavior -instruct parents and child on importance of proper medication administration and the need for follow-up visits
Adolescent who just overdosed, what would be the number one diagnosis on the care plan?
-Risk for injury related to poisoning and cardiac dysfunction
What discharge instructions are given to the parents of a child with Down's syndrome?
-Supporting the family and referring to agencies that provide support and services. -Provide parents on information of normal developmental milestones, safety, speech development, sexual development and the role of self-esteem in motivating children to accomplish goals within their limitations. -Encourage stimulating play -Educate about providing nutritionally dense foods -Encourage physical activity and exercise -Praise child for acomplishments -Provide consistency in discipline -Screen children for atlanoaxial instability with neurological examination and radiographic study after the second birthday, before they engage in physical exercise and sports or rehab procedures.
Dx Tests for cognitive impairment
-neurologic examination -CT scan -serum metabolic screening -developmental screening tests (Denver II)
Dx Tests for cognitive impairment
-standardized IQ tests (Stanford-Binet Intelligence scale, Wechsler Intelligence scale for children, Revised) -Chromosomal analysis -Genetic screening
Parent teaching with ADHD-what they need to focus on?
A critical role for the nurse is parent counseling. It is most important to allay an inappropriate feeling of guilt or responsibility that the parents might have. -Educate the parents on discipline -Teach them how to set limits that are appropriate and provide rewards -Encourage parents to establish strict daily routine -Counsel the parents regarding the dangers of controversial therapies (megavitamin and herbal supplements) -Stress on importance of accident prevention and safety -Explain the need of increased supervision while fostering independence -Assist in development of education plan -Explain about medication therapy, proper administration, risks and bnefits -Inform parents about importance of routine follow-up visits -Make sure to check children for medication side effects every 6 months and to assess the ongoing need for medication therapy ever year or as needed. -Encourage support group for the parents
What factors influence the personality of a child?
A variety of factors influence the personality and the developmental capabilities of a child such as: -genetic composition -environment -social support -culture
What needs to be present, in order to state child abandonment?
Abandonment is a child neglect: physical failure of a parent or caretaker to provide the child with adequate food, clothing, shelter , education or healthcare despite being financially able to do so or offered financial or other means to do so.
What are the characteristics of RAP-recurrent abdominal pain?
Aka Psychogenic Abdominal Pain-Recurrent abdominal pain that is usually multifactoral, organic, dysfunctional, or psychogenic in origin. It is most common in school-aged and adolescent children and the diagnosis is made if the pain is present for 3 consecutive months after other possible conditions have been ruled out. RAP is often related to emotional factors affecting the child such as: -poor self-esteem, anxiety, depression, school phobia, maternal depression, marital problems and divorce and other health-related family conditions. -Organic cause such as UTI, GI tract infections, Reproductive system infections should be considered until proven otherwise. Clinical manifestations: -Afebrile -Occasional Constipation and Vomiting -Nonspecific abdominal pain or pain that is periumbilical or epigastric that is not related to eating, defecation or exercise.
Ritalin drug?
CNS stimulant used to treat ADD and ADHD. May be habit forming. Take medication in the morning to prevent sleep problems. May impair thinking or reactions, do not drink alcohol.
What are the primary characteristics of Autism?
Autism is a complex developmental disorder of brain function that occurs in the presence of a broad range of intellectual and behavioral deficits, including impairment in social interaction, communication skills and behavior. Children with autism demonstrate several peculiar and bizarre characteristics: -Inability to maintain eye contact (hallmark) -Avoidance of body contact since infancy -Limited functional play and interaction with toys in an unusual manner -Bizarre, repetitive, rapid motor activities such as flexing and extending -distorted body movements -GI symptoms such as constipation -Lack of socialization skills -Language and speech delayed -Excel in particular areas-Savants -Self-abusive behavior -Cognitive disability at various degrees
What is child torment?
Behavioral indicators: -stranger anxiety -emotional withdrawal -inappropriate ferafulness -delinquency -lag in emotional and intellectual development -language difficulties -suicide attempts
Causes of cognitive impairment
Biochemical, infectious, genetic, endocrine, idiopathic factors
How would the nurse recognize a newborn with down syndrome when looking at the baby?
Characteristic facial appearance: -small, rounded skull with flatocciput -upward slanting eyes with epicanthal folds -braod, flat nose -protruding tongue -short, thick neck -small, low set ears -hypotonic extremities -mottled skin -simian crease on the palmar side of the hand -smaller hands and feet
What kind of children are typically abused?
Characteristics of the child sometimes place it at risk for maltreatment: -temperament -age -exceptional physical needs -disabilities -health or behavioral problems Situational factors include sources of stress and support within the family;s environment: -marital problems -financial dificultis -drug/alcohol abuse -lack of social support and inability of parent/caretaker to ask for support -poor social network -poor relationship with extended families
What is child maltreatment?
Child abuse is the nonaccidental physical injury or the nonaccidental act of omission of care by a parent or person responsible for a child:includes neglect, physical, emotional or sexual maltreatment.
What is child maltreatment?
Child maltreatment is a broad term used to describe physical and emotional neglect and physical, emotional and sex abuse of children.
How often the child with RAP needs to be seen?
Children diagnosed with RAP sometimes need to be seen as often as once every 2 weeks to a month for pain evaluation and reassurance.
What criteria is used to diagnose cognitive impairment?
Children typically fail to achieve developmental milestones at appropriate ages. Generally they tend to manifest delays in motor skills, social, cognitive and language skills or a combination.
Which diagnostic test is done to confirm Down syndrome?
Chromosomal analysis is the confirmatory diagnostic test for Down syndrome. It is support also by a physical examination of the newborn with the manifestation of a characteristic physical appearance of the baby.
What is down's syndrome?
Clinical Manifestatons: -characteristic facial appearance with small square head -upward slant to the eyes -flat nasal bridge -protruding tongue -mottled skin -hypotonia -small rounded skull with a flat occiput -short, thick neck -low-set ears -simian crease on the palmar side of the hand.
What are the four levels of categorizing cognitive impairment? Example: IQ 50
Cognitive impairment is separated into 4 categories based on IQ as follows: 1.Mild-IQ range 50-55 to 70 2.Moderate-IQ range 35-40 to 50-55 3.Severee-IQ range 20-25 to 35-40 4.Profound-IQ range below 25
What is the most common developmental disability in children?
Cognitive impairment is the most common developmental disability.
What is down's syndrome?
Down syndrome is a congenital chromosomal abnormality characterized by an additional chromosome on the 21-st pair, causing varying cognitive and physiological impairments. It is the most common chromosomal abnormality. Risk increases with maternal age over 35 with peak incidence in women over 40 years of age.
What disease is the most common chromosomal abnormality?
Down syndrome is the most common chromosomal abnormality.
If an adolescent is depressed and might be suicidal, what kinds of questions should the nurse ask?
If the nurse has any concerns that the child might be suicidal, he or she needs to be direct by asking about: -thoughts of death or suicide -when the thoughts occured -how long have these thoughts lasted -whether the patient has a plan Any threat of suicide needs to be taken very seriously and further evaluated.
Child that is taking antidepressants, what the nurse needs to monitor for closely in the first few weeks of treatment?
Increase in suicidal ideations and thoughts.
What is down's syndrome?
Individual abilities vary, but typically children with down syndrome will have: -strengths in visual processing over auditory -weakness in grammar and language -delays in motor development
What therapeutic nursing intervention would be appropriate for the hospitalized autistic child?
It is best if parents are present as much as possible, essential to the planning of care. -Have parents bring any items that the child is attached to -Provide private room and minimize visual and auditory stimuli and distractions -Recognize that not all autistic children are the same and will require individualized approach. -Limit physical and eye contact because it often upsets autistic children -Safety precautions with feeding-may not eat or swallow noneddible items -Introduce slowly to new situations and keep visits from staff caregivers short whenever possible -Need to be told directly what to do, keep communication brief, concrete and at the child's developmental level. -Determine the child's routines,schedule, and preferences and adhere to schedule and consistency as much as possible. -Determine in what specific ways the child communicates. -Initiate referrals to special programs -Provide support to parents. -Child's safety is the number one nursing priority.
When are nurses legally bound to report child abuse? If it happened in the past or is still occuring.
It is mandatory for the nurse to report an suspect of child abuse that has occurred or is occurring.
What is child torment?
Torment is an emotional abuse-the intentional attempt by a parent or caretaker to impair or destroy the mental or emotional state of a child.
How do learning disabilities impair a child and what specific things the child would have difficulty doing?
Learning disabilities impair a child's ability to understand, assimilate, recall, or produce information. There are usually significant discrepancies on tests of academic achievement in mathematics, writing, reading or some combination. The factors that underline learning problems typically exists before school entry but often do not become apparent until academic demands are placed on the child-school age.
Child with special needs, which characteristics are typical for them?
Learning disabilities impair the child's ability to understand, assimilate, recall, or produce information. There are usually significant discrepancies on tests of academic achievement in mathematics, reading, writing or some combination. Problems with: -speech -behavior -motor coordination -failure to master basic, grade-appropriate skills in one or more subjects -progressive decline in school performances -delayed acquisition of language -deficient social skills -avoidance behavior when confronted with challenging tasks -low frustration tolerance -disorganization -somnolence
What tasks might be difficult for the moderately cognitive impaired child? 10 and 12 years old
Manifestations may vary according to the child's age and degree of impairment. Children typically fail to achieve developmental milestones at appropriate ages. Generally, they tend to manifest delays in motor, social, cognitive, or language skills, or some combinations. The child manifests subaverage intellectual functioning along with deficits in adaptive skills.
What is the average life span for the individual with Down's syndrome?
More than 80% of individuals affected by Down syndrome will live to age of 55 and above.
What is child torment?
Physical Indicators: -Failure to thrive -Feeding difficulties -Enuresis or Encopresis -Sleep disturbances Emotional abuse: -Speech disorders -Habit disorders such as sucking, biting, rocking -psychoneurotic reactions -learning disorders -suicide attempts
What are the physical indications that a child might be abused?
Physical indicators of abused child: Physical neglect: -FTT -lag in growth and development -Consistent hunger -Poor personal hygiene -Inappropriate dress for season -Unattended medical needs -Abandonment Physical abuse: -Ecchymosis, welts, bite marks -Ecchymosis reflecting the shape of the object used to inflict injury -evidence of human bite marks -lacerations or abrasions -burns that are symmetric that have no splash marks -cigar or cigarette burns on soles, palms, back, or buttocks -fractures (various stages of healing, to skull,nose, face, multiple or spiral, not reported by family) Sexual abuse: -Difficult in walking or sitting -torn, stained and bloody undergarments -pain or pruritus in genital area -ecchymosis or bleeding in external genitalia, anal area, vagina -ecchymosis to the hard or soft palate -STD's in preteens -adolescent pregnancy -enuresis or encopresis -vaginal or penile discharge -foreign bodies in vagina or rectm -presence of semen -recurrent UTI's Emotional Neglect and Abuse: -FTT -Feeding difficulties -Enuresis or Encopresis -Sleep disturbances
What is the primary nursing goal with Down syndrome?
Primary nursing goal includes supporting the family at the time of diagnosis and referring the child and family to agencies that provide support and services. The family will also need education regards their child's condition.
What is down's syndrome?
Prone to: -URI -Frequent Otitis Media -Congenital Heart defects-chief cause of death, particularly during the first year of life) Associated health problems: -Increased incidence of leukemia -Dysfunction of the immune system -Thyroid dysfunction, especially hypothyroidism congenital
If the autistic child excels in certain areas, what are they called?
Savant/Savants -Excel in particular area such as art, memory, music , mathematics, or perceptual skills such as puzzle buildding.
Ritalin drug?
Side effects: -mood swings, agression, hostility -chest pain, flutters, syncopal feeling -numbness, pain, cold feeling -easy bruising -penile erection lasting more than 4 hours and is painful -loss of appetite, weight loss, stomach pain, nausea, vomiting -headachae, diziness, drowziness -insomnia
What are possible causes of depression in a child?
The cause of major depression have not been established, however possible risk factors are genetics and environment. -There is a 3 to 6 time greater chance of developing depression in a child who's parent has suffered from the disorder -Cognitive theories attribute feelings of hopelessness and helplessness to an actual or perceived loss -Psychosocial theories point factors such as: -disturbance in family dynamics and parent-child relationship -a family move -death of a loved one -divorce -abuse or maltreatment
What kinds of behaviors would the nurse expect to see in a child with ADHD?
The child with ADHD will exhibit: -decreased attention span -impulsivity -failure to follow instructions -hyperactivity -poor self-regulation -noncompliance -aggression -fidgeting -immaturity during play -failure to follow rules of play games -lack of turn taking during play -easy distraction by external stimuli Associated problems: -poor school performances -learning disabilities -antisocial behavior such as ling -cheating -stealing -excessive anxiety -sleep disturbances -poor peer relationships -limited fine motor skills -additional psychiatric diagnoses
What is the most important nursing intervention with child maltreatment?
The most important role of any health care provider, especially nurses, is the identification of a child who is being mistreated. -Thorough history and physical examination and support of the child during the exam -Provide safe environment for the child and establish trusting relationship with the child -Assess and assist parents and family -Report and document any abuse or suspicion of it
What counseling could be given to the parents of a child with ADHD? What would the parents be going through?
The parents might be experiencing guilt or responsibility for the disorder.
What needs to be present, in order to state child abandonment?
There are indicators that are present with child neglect: -Behavioral indicators -Physical indicators -Emotional indicators
Which babies are at risk for Down's syndrome?
Those of mothers older than 35 years of age, with the peak of incidence in the age over 40.
What are tricyclic antidepressants and what the patient need to be cautioned about in the first 1 to 2 weeks of treatment?
Tricyclic antidepressants or serotonin re-uptake inhibitors (SRI's) such as Fluoxetine (Prozac), Trazodone (Desyrel), Sertraline (Zoloft), Bupropion (Wellbutrin), Venlafaxine (Effexor), and Paroxetine (Paxil) are used to alleviate symptoms of depression. Parents and children on these medications need to be cautioned about the increased risk of suicidal thoughts and ideations during the first and second weeks of therapy.
