1. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Chapter 37 Impact of Cognitive and Sensory Impairment on the Child and Family

2. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  “Cognitive impairment” (CI) is a general term that encompasses any type of mental difficulty or deficiency  Used synonymously with “intellectual disability”  Diagnosis  Made after a period of suspicion by family or health professionals  In some instances, made at birth Cognitive Impairment 2

3. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  Intellectual functioning  Subaverage intellectual function: IQ of 70-75 or below  Functional strengths and weaknesses  Impairment in 2 of 10 adaptive skills  Younger than age 18 at the time of diagnoses Intellectual Disability 3

4. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  Communication  Home living  Community use  Leisure  Health and safety Functional Impairments (Adaptive Skill Areas) 4  Self-care  Social skills  Academics  Work  Self-direction

5. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  Results of standardized tests are used in making a diagnosis of cognitive impairment  Diagnosis of mildly impaired characterizes 85% of the population with CI  Educable  Diagnosis of moderately impaired characterizes 10% of the population with CI  Trainable Cognitive Impairment (CI): Classification 5

6. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  Intrauterine infection and intoxication  Trauma (prenatal, perinatal, postnatal)  Metabolic or endocrine disorders  Inadequate nutrition  Postnatal brain disease Cognitive Impairment: Causes 6

7. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  Unknown prenatal influences  Chromosomal anomalies  Prematurity, low birth weight, postmaturity  Psychiatric disorders with onset in childhood  Environmental influences Cognitive Impairment: Causes (Cont.) 7

8. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  Educate child and family  Early intervention  Teach child self-care skills  Promote child’s optimal development  Encourage play and exercise Nursing Care of Children with Impaired Cognitive Function 8

9. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Nursing Care of Children with Impaired Cognitive Function (Cont.) 9

10. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Nursing Care of Children with Impaired Cognitive Function (Cont.) 10

11. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Nursing Care of Children with Impaired Cognitive Function (Cont.) 11

12. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Nursing Care of Children with Impaired Cognitive Function (Cont.) 12

13. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  Provide means of communication  Establish discipline  Encourage socialization  Provide information on sexuality  Help families adjust to future care  Care for the child during hospitalization Nursing Care of Children with Impaired Cognitive Function (Cont.) 13

14. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Nursing Care of Children with Impaired Cognitive Function (Cont.) 14

15. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  Counseling and education regarding nutrition and tobacco use  Awareness of danger of chemicals, including prenatal exposure to alcohol  Rubella immunization  Genetic counseling  Folic acid supplementation Measures to Prevent Cognitive Impairment 15

16. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  Most common chromosome abnormality  1 per 691-1000 live births  Causes unknown; probably multiple  Occurs in populations of all races Down Syndrome 16

17. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  Nonfamilial trisomy 21  Extra chromosome 21 in 95% of cases  Translocation of chromosomes 15 and either 21 or 22 in 3%-4% of cases  Mosaicism, a mixture of abnormal and normal cells, in 1%-2% of cases  Maternal age  Age 35: risk is 1 per 350 births  Age 40: risk is 1 per 100 births Down Syndrome: Causes 17

18. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  Clinical manifestations  Square head with upward slant to eyes  Flat nasal bridge, protruding tongue  Hypotonia  Chromosome analysis  Physical problems  Congenital heart disease  Hypothyroidism  Leukemia Down Syndrome: Diagnostic Evaluation 18

19. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Down Syndrome: Diagnostic Evaluation (Cont.) 19

20. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  Available therapies  Surgery to correct congenital anomalies  Evaluation of hearing and sight  Periodic testing of thyroid function  Supporting child’s family at time of diagnosis  Prevention of physical problems  Assist in prenatal diagnosis and genetic counseling Down Syndrome: Therapeutic Management 20

21. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  Second most common genetic cause of cognitive impairment after Down syndrome  1 per 3600 boys  1 per 4000-6000 girls  Caused by abnormal gene on the lower end of the long arm of the X chromosome Fragile X Syndrome 21

22. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  Large head circumference  Long face with a prominent jaw (prognathism)  Large, protruding ears  Large testes (postpubertal)  Manifestations variable in female carriers of gene Fragile X Syndrome: Clinical Manifestations 22

23. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  Mild to severe cognitive impairment  Delayed speech and language  Hyperactivity  Hypersensitivity to taste, sounds, and touch  Autistic-like behaviors  Aggressive behaviors Fragile X Syndrome: Classic Behavioral Features 23

24. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  Tegretol/Prozac for behavioral control  Stimulants for hyperactivity (similar to management of attention deficit/hyperactivity disorder)  Referral to early intervention program  Normal life span expected  Genetic counseling Fragile X Syndrome: Therapeutic Management 24

25. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  1-6 per 1000 healthy full-term infants  2-4 per 100 premature infants  Slight to moderately severe  Residual hearing with the use of an aid  Severe to profound hearing loss  Cannot process linguistic information Hearing Impairment 25

26. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  Anatomic malformation  Family history  Low birth weight  Ototoxic drugs, O 2 administration  Chronic ear infections  Perinatal asphyxia  Perinatal infections  Cerebral palsy Hearing Impairment: Causes 26

27. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  Conductive hearing loss: middle ear  Sensorineural hearing loss: damage to inner ear or auditory nerve  Mixed conductive-sensorineural loss: interference with transmission of sound  Central auditory interception  Organic  Functional Hearing Impairment: Pathology 27

28. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  Measured in decibels (db)  A unit of loudness  Measured at varying frequencies  Hearing threshold  Critical listening speech range  Effect on speech Hearing Impairment: Symptom Severity 28

29. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  Medical or surgical interventions  Hearing aids  Cochlear implants  Multichanneled implants Hearing Impairment: Therapeutic Management 29

30. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Hearing Impairment: Therapeutic Management (Cont.) 30

31. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  Lack of startle reflex  Absence of reaction to auditory stimuli  Absence of well-formed syllables by age 11 months  General indifference to sound  Lack of response to spoken word Hearing Impairment: Manifestations in Infancy 31

32. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  Profound deafness: likely to be diagnosed in infancy  If not detected in infancy, identified upon entry into school  Abnormalities in speech development  Learning disabilities Hearing Impairment: Manifestations in Childhood 32

33. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  Lip reading  Cued speech  Sign language  Speech-language therapy  Additional aids  Socialization  Support of child and family Hearing Impairment: Promoting Communication 33

34. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  Reassess understanding of instructions given  Supplement with visual and tactile media  Provide communication devices  Picture board with common words  Assistance of child life specialist  Additional aids Hearing Impairment: Care for Child During Hospitalization 34

35. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  Treatment and management of recurrent otitis media  Prenatal preventive measures  Genetic testing  Avoidance of ototoxic drugs  Testing to rule out syphilis, rubella, or blood incompatibility  Avoidance of exposure to noise pollution Hearing Impairment: Preventive Measures 35

36. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  Common problem during childhood  In the United States, prevalence of blindness or serious visual impairment is 30-64 per 100,000  5%-10% of all preschoolers  Identified through vision screening programs Visual Impairment 36

37. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  Partially sighted (school vision)  Acuity of 20/70 to 20/200  Education usually in public school system  Legally blind  Acuity of 20/200 or poorer  Legal and medical term Visual Impairment: Classification 37

38. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  Prenatal or postnatal infections  Retinopathy of prematurity  Trauma  Postnatal infections  Other disorders  Sickle cell disease  Juvenile rheumatoid arthritis  Tay-Sachs disease Visual Impairment: Causes 38

39. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  Refraction  Bending of light rays through the lens of the eye  Myopia  Hyperopia  Strabismus (may or may not be refractive)  Amblyopia Visual Impairment: Types 39

40. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  Common cause of blindness in children  Injuries to eyeballs or adnexa  Penetrating: sharp instruments, propulsive objects, blunt objects, motor vehicle accidents  Nonpenetrating: lacerations, blows to the eyes or head, burns  Treatment: aimed at preventing further damage Visual Impairment: Trauma 40

41. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  Conjunctivitis  Ophthalmic antibiotics  Systemic antibiotics in some cases  Caution with use of steroids: may exacerbate viral infections  Infection control concerns Visual Impairment: Infections 41

42. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  Nursing assessment  Identify children who by virtue of their history are at risk  Observe for behaviors that indicate a vision loss  Screen all children for visual acuity  Nursing alert  Suspect visual impairment in a child of any age whose pupils do not react to light Visual Impairment: Care Management 42

43. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  Promote parent-child attachment  Promote child’s optimal development  Development and independence  Play and socialization  Education  Braille  Audio books and learning materials Visual Impairment Care Management (Cont.) 43

44. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  Provide a safe environment  Provide reassurance during all treatments  Orient child to surroundings  Encourage independence  Treatment team members should be consistent Visual Impairment: Hospitalization of Affected Child 44

45. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  Prenatal care/prevention of prematurity  Rubella immunizations for all children  Safety counseling for preventing eye injuries  Periodic screening of all children Visual Impairment: Preventive Measures 45

46. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  Profound effects on development  Motor milestones usually achieved  Other development often delayed  “Finger spelling”  Developing future goals for the child Hearing-Visual Impairment 46

47. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  Most common congenital malignant intraocular tumor in children  11 cases per million annually  Affects primarily children younger than 5 years  Caused by genetic mutation or is inherited Retinoblastoma 47

48. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Retinoblastoma (Cont.) 48

49. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Retinoblastoma (Cont.) 49

50. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  Complex neurodevelopmental disorder accompanied by intellectual and social alterations  Verbal effects, repetitive and restrictive behavior patterns  1 per 100-150 children  Four times as common in boys Autism Spectrum Disorders (ASDs) 50

51. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  Genetic disorder of prenatal and postnatal brain development  Immune and environmental factors that may interact with genetic susceptibility  Relatively high risk of recurrence of ASDs in families with one affected child ASDs: Causes 51

52. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  Peculiar and bizarre characteristics primarily in specific areas:  Socialization  Communication  Behavior  Difficulty with eye and body contact  Language delay  Diagnosis often delayed until age 2-3 years ASDs: Clinical Manifestations and Diagnostic Evaluation 52

53. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  Severely disabling condition  No cure for autism  Some improvement with language skills  Numerous therapies used  Recognize early  Attempt behavior modification  Provide a structured routine  Decrease unacceptable behavior ASDs: Care Management 53

54. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  Autism often becomes a family disease  Frequently parents express guilt and shame  Stress importance of family counseling  Autism Society of America is good source of information  Clients should be managed at home or in long- term placement facility ASDs: Family Support 54

55. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.  The nurse is discussing sexuality with the parents of an adolescent girl with moderate cognitive impairment. What should the nurse consider when dealing with this issue? A. Sterilization is recommended for any adolescent with cognitive impairment. B. Sexual drive and interest are limited in individuals with cognitive impairment. C. Individuals with cognitive impairment need a well- defined, concrete code of sexual conduct. D. Sexual intercourse rarely occurs unless the individual with cognitive impairment is sexually abused. Question 55