. MENTAL RETARDATION Doa’a jassim al_khafagi

Out line  Objectives  Introduction  Definition  Etiologic implication  Common features  Degrees of (MR)  Nursing diagnosis & intervention  Types of (MR)  summary  Conclusion  Evidence base research  reference

At the end of this seminar, you will be able to: 1) Identify the degrees of (MR) and how to deal with it.  2) Identify nursing diagnosis and intervention for mental retardation  3) List types of (MR)

Etiological Implications 1.single-gene abnormalities 2.chromosomal disorders 3.Toxicity (alcohol or other drugs) 4.Maternal illnesses and infections during pregnancy  5.during pregnancy (e.g. fetal malnutrition, viral and other infections)

 6.during the birth process (trauma to the head premature separation of the placenta  7.infections, such as (meningitis and encephalitis)  8.poisonings, such as (from insecticides, medications, and lead)  9.physical trauma

Common features  Delays in oral language development  Deficits in memory skills  Difficulty learning social rules  Difficulty with problem solving skills  Delays in the development of adaptive behaviors such as self-help or self-care skills.

Degrees of (MR) according to (IQ) level . Mild Mental Retardation IQ Moderate Mental Retardation IQ Severe Mental Retardation IQ Profound Mental Retardation IQ

Mild (50–70) IQ:  Cognitive: Capable of academic skills to sixth grade level.  Social: Capable of developing social skills.  Psychomotor skills: usually not affected, although may have some slight problems with coordination.  Self-Care Activities: Capable of independent living, with assistance during times of stress.

Moderate (35–49) IQ  Self-Care Activities: Can perform some activities independently. Requires supervision.  Cognitive: Capable of academic skill to second- grade level..  Social: May experience some limitation in speech communication..  Psychomotor skills: Motor development is fair. Vocational capabilities may be limited to unskilled gross motor activities

Severe (20–34) IQ  Self-Care Activities: May be trained in elementary hygiene skills. Requires complete supervision.  Cognitive: Unable to benefit from academic or vocational training.  Social: Minimal verbal skills..  Psychomotor skills: Poor psychomotor development. Only able to perform simple tasks under close supervision

Profound (below20) IQ  Self-Care Activities: No capacity for independent functioning. Requires constant aid and supervision.  Cognitive: Unable to profit from academic or vocational training.  Social: Little, if any, speech development. No capacity for socialization skills.  Psychomotor skills: Lack of ability for both fine and gross motor movements. Requires constant supervision and care.

Nursing diagnosis Risk for injury related to altered physical mobility or aggressive behavior ● Self-care deficit related to altered physical mobility or lack of maturity ● Impaired verbal communication related to developmental alteration. ● Impaired social interaction related to speech deficiencies

Nursing intervention  RISK FOR INJURY. Create a safe environment for the client. 2. Ensure that small items are removed from area where client will be ambulating and that sharp items are out of reach. 3. Store items that client uses frequently within easy reach. 4. Pad side rails and headboard of client with history of seizures. 5. Prevent physical aggression and acting out behaviors by learning to recognize signs that client is becoming agitated

 SELF-CARE DEFICIT 1. Identify aspects of self-care that may be within the client’s capabilities. Work on one aspect of self-care at a time. Provide simple, concrete explanations. Offer positive feedback for efforts. 2. When one aspect of self-care has been mastered to the best of the client’s ability, move on to another. Encourage independence.

 IMPAIRED VERBAL COMMUNICATION 1. Maintain consistency of staff assignment. 2. Anticipate and fulfill client’s needs until satisfactory communication patterns are established. 3-Learn (from family, if possible) special words client uses that are different from the norm. 4-Identify nonverbal gestures or signals that client may use to convey needs if verbal communication is absent.

 IMPAIRED SOCIAL INTERACTION 1. Remain with client during initial interactions with others on the unit. 2. Explain to other clients the meaning behind some of the client’s nonverbal gestures and signals. Use simple language to explain to client which behaviors are acceptable and which are not. 3. Establish a procedure for behavior modification with rewards for appropriate behaviors and aversive reinforcement for inappropriate behaviors

Types of (MR) 1.Down`s syndrome  2.phenylketonu-ria (PKU)  3.Cranial Anomalies

Down Syndrome  Down syndrome is a chromosomal condition characterized by the presence of an extra copy of genetic material on the (21st chromosome),

 Often Down syndrome is associated with some impairment of cognitive ability and physical growth, and a particular set of facial characteristics.  Individuals with Down syndrome tend to have a lower-than-average cognitive ability, The average IQ of children with Down syndrome is around 50.

Phenylketonuria (PKU)  Phenylketonuria is a rare metabolic disorder. In PKU the baby appears normal at birth but lacks an enzyme needed to break down phenylalanine, an amino acid found in protein foods. When this condition is undetected, the phenylalanine builds up in the blood and leads to brain damage.

The disorder usually becomes apparent between 6 and 12 months after birth.

Cranial Anomalies  1.Microcephaly  2.Hydrocephalus

Microcephaly  “(small head)". It refers to a type of mental retardation resulting from impaired development of the brain and a consequent failure of the cranium to attain normal size. The most obvious characteristics of microcephalic is a small head, the circumference of which rarely exceeds 17 inches, as compared with normal of approximately 22 inches.

Hydrocephalus  Hydrocephalus is a relatively rare condition in which the accumulation of an abnormal amount of cerebrospinal fluid within the cranium causes damage to the brain tissues and enlargement of the cranium

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 People with MENTAL RETARDATION can live, satisfying, and productive lives, within their own communities, when provided adequate supports. So We encourage their families,their communities, organizations, and governments to work to improve the lives of these people,so they can achieve and Puts their mark in life.

   Essentials of pediatric nursing, wong’s textbook  Pediatric handbook for clinical training