Test #1 Development: Normal Development (10)

Characteristics of Autism Spectrum Disorders

- Characterized by differences in behavior, communicating, and learning - Typically diagnosed b/w 1-3 yr - Symptoms vary in severity and quantity

Autism Spectrum Disorders

- Developmental disability caused by differences in the brain - Etiology is unknown, but some studies suggest genetic in nature - Types of Autism Spectrum Disorders: Autistic Syndrome & Asperger Syndrome

Symptoms of ASD

- Failure to point at objects - Mute or utter sounds; repeat phrases over and over - Spends hours in repetitive activity - Bizarre motor behaviors (hand flapping) - Resist cuddling - Avoid eye contact

Nutrition in Children with FTT

- Goal: child to ingest/receive calories sufficient to increase growth rate - Develop: feeding schedule - Maintain: strict intake & output records - Educate: parents on proper feeding techniques and amounts

Organic FFT

- Mental or physical impairment - Cerebral palsy, cardiac defects - Malabsorption - Diarrhea - Vomiting - Changes in metabolism/caloric needs related to chronic illness

Nursing Interventions for Cleft Lip/Palate

- Monitor weight - Aspiration precautions - Encourage parent-infant bonding - Surgical Intervention - Post op care

Nonorganic FFT

- Neglect - Abuse - Behavioral problems - Lack of maternal interaction - Poor feeding techniques - Lack of parental knowledge - Poverty

Nursing Interventions for Cerebral Palsy

- Promoting mobility - Maintain optimal nutritional intake - Patient and family support/education - Interdisciplinary Team (PT, OT, Speech) - Orthotics or Braces - Surgical Interventions

Nutrition in Children with Trisomy 21 (Down Syndrome)

- Risk for weight gain and obesity - Faster weight than height growth (lower basal metabolic rates) - Difficulty sucking due to decreased muscle tone - High fiber due to decreased gastric motility from lack of muscle tone - Encourage activity

M-CHAT-R

Modified Checklist for Autism in Toddlers-Revised

Causes of Cerebral Palsy

Prenatal: hypoxia, environmental toxins, pre-eclampsia, genetic abnormalities, and multiples Perinatal: prematurity, hypoxia, asphyxia, sepsis, placental complications, Chorioamnionitis, and cerebral hemorrhage Postnatal: seizures, viral/bacterial infection, intraventricular hemorrhage, Kernicterus, asphyxia

Nutrition for Children with Cleft Lip/Palate

Promoting Adequate Nutrition • Breastfeed • Utilize feeding devices • Assess sucking and feeding • Frequent burping • Sit upright after feeds • One way valve devices

Autism Spectrum Disorders Pharmacological Management

Stimulants to control hyperactivity •mixed amphetamine salts (MAS) •methylphenidate Antipsychotics are used to manage repetitive and aggressive behaviors •risperidone •aripiprazole

Dyskinetic/athetoid Cerebral Palsy

abnormal involuntary movements

Ataxic Cerebral Palsy

affects balance and depth perception

Mixed Cerebral Palsy

any combination of all types

What is an important nursing consideration post-operatively after a cleft lip/palate repair?a) Administering analgesics such as acetaminophen b) Maintaining a patent airway c) Feeding d) Suctioning mouth

b

Cerebral Palsy Pharmacological Management

baclofen diazepam glycopyrrolate botulinum toxin A

The healthcare team determines that the family of an infant with failure to thrive who is to be discharged will need follow-up care. Which approach would be the most effective method of follow-up? a) Daily phone calls from the hospital nurse b) Enrollment in community parenting classes c) Twice-weekly clinic appointments d) Weekly visits by a community health nurse

d

Spastic Cerebral Palsy

hypertonicity, permanent contractures

Types of Cerebral Palsy

spastic, athetoid, ataxic, mixed

Nursing Interventions for Autism Spectrum Disorders

• All children are unique • Assessments and accurate histories are important • Treatments

Trisomy 21 (Down Syndrome) at Risk for:

• Congenital heart defects (40-50%) • Visual & hearing deficits (75%) • Thyroid disease • Leukemia/Anemia/Polycythemia • Obstructive sleep apnea • Infections • Alopecia • Seizures • Life expectancy: ~ 60 years of age

Nutrition in Children with Cerebral Palsy

• Difficulty eating and swallowing due to poor motor control of mouth, tongue, and throat • May require a longer time to eat • Special diets: pureed or soft for easier swallowing • Proper position to reduce risk of aspiration • Severe swallowing/malnutrition: feeding tube placement

Complications of Cleft Lip/Palate

• Difficulty feeding • Altered dentition • Delayed speech development • Otitis media

Trisomy 21 (Down Syndrome)

• Genetic disorder defined by presence of all or part of an extra 21st chromosome • Most cases diagnosed in utero or within first few days of life • See in all races and socioeconomic levels • Highest risk for mothers >35 years of age

Failure to Thrive (FTT)

• Inadequate growth in infants and children • Child fails to demonstrate appropriate weight gain over a prolonged period • Children need adequate nutrition in the first 2 years of life for appropriate brain growth, as well as throughout childhood and adolescence • Multiple causes for FTT (organic vs. nonorganic)

Characteristics of Trisomy 21 (Down Syndrome)

• Intellectual disability • Slanted eyes • Depressed nasal bridge • Hypotonia • Short stature • Protrusion of tongue (small mouth) • Excessive skin at nape of neck • Excessive space between great and second toe

Surgical Intervention of Cleft Lip/Palate & Post-op care

• Lip repair: 2-3 months of age • Palate repair: 6-7 months of age • Observe airway for obstruction/bleeding • Prevent injury to suture line • Positioning supine and upright or side-lying • Facilitation of drainage • Facemask for O2 if needed • Cleansing suture line per MD order • Keep infant calm • Avoid items in mouth (i.e. straw, syringe, suction catheter, spoon)

Cleft Lip/Palate

• Most common congenital facial anomaly • Often associated with other genetic disorders • One in every 700 births worldwide • 50% of children who have cleft lip also have cleft palate • Tissue for lip fuses in early pregnancy (5-6 weeks gestation) • Palate closes early, too (7-9 weeks gestation) • Can be unilateral (typically left side) or bilateral

Cerebral Palsy

• Range of nonspecific clinical symptoms characterized by abnormal motor pattern/postures caused by nonprogressive abnormal brain function, and results in a neurologic lesion • Non-progressive disease • Abnormal development or damage to motor areas of the brain

Treatments of ASD

• Structured school environments (IEP) • Occupational, physical, and speech therapy • Cognitive-Behavior Therapy (CBT) • Relationship Development Intervention (RDI) • Applied Behavior Analysis (ABA) • Complementary/alternative behaviors

Nutrition for Children with Autism Spectrum Disorders

•Eat narrower range of foods •May have preference for specific textures, temperatures, colors, and smells of food as well as the environment of which mealtime occurs

Nursing Interventions for FTT

•Observe parent-child interaction •Weigh child daily •Provide support to alleviate parental anxiety related to child's inability to grow appropriately •Structured routine •Interdisciplinary team •Remain persistent

Nursing Interventions for Trisomy 21 (Down Syndrome)

•Provide supportive measures to promote growth & development •Prevent complications •Provide support and education to family and child