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2. Objectives. Define MR and Down\'s SyndromeSigns and Symptoms Lab and Diagnostic studies Treatment modalities Plan of care Emotional needs of client and family. 3. Definition (Objective
Mental Retardation and Down s Syndrome

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1. Mental Retardation and Down?s Syndrome Peggy Pannell RN, MSN

2. 2 Objectives Define MR and Down?s Syndrome Signs and Symptoms Lab and Diagnostic studies Treatment modalities Plan of care Emotional needs of client and family

3. 3 Definition (Objective #1) Mental Retardation Also known as Cognitive impairment. Any type of mental difficulty or deficiency. Down?s Syndrome The most common chromosomal abnormality of a generalized syndrome. Trisomy 21 (95%) Translocation of 15 and 21 or 22 (3-4%) Mosaicism (1-2%)

4. 4 Causes of MR Genetic Downs Syndrome Other syndromes (fragile X, etc) Biochemical Alcohol, Drugs, exposures Infectious Rubella, syphilis, kernicterus Unknown Trauma, physical agent Hydrocephalus Nutrition Environmental factors Psychiatric disorders

5. 5 Signs and Symptoms of MR Objective 2 Developmental Delay Speech Mobility Early signs Non-responsiveness to contact Poor eye contact during feeding Diminished spontaneous activity* Decreased alertness to voice or movement* Irritability Slow feeding * less than a normal child of that age

6. 6 S&S of Down?s Syndrome (clinical manifestations) obj: 2 Head Face Eyes Nose Ears Mouth Teeth Chest Neck Abdomen Genitalia Hands Feet Musculoskeletal Skin Other

7. 7 Diagnostic Studies Objective 3 Chromosome Analysis To determine Down?s and other syndromes Standardized test Vineland Social Maturity Scale AAMR Adaptive Behavior Scale Classification Educable Mentally Retarded (EMR) Trainable Mentally Retarded (TMR)

8. 8 Causes and Diagnostic Evaluation Causes Nonfamilial Trisomy 21 (95%) Translocation of chrom 15, 21, 22 (3-4%) Mosaicism (normal and abnormal chrom (1-2%) Diagnosis Clinical Manifestation Chromosome Analysis

9. 9 How MR is measured IQ (Intelligence Quotient) 70-75 or below Adaptive Skills 2 out of 10 possible Age of diagnosis 18 or younger

10. 10 Intelligence Quotient Mild: 50-55 to 70-75 Moderate: 35-40 to 50-55 Severe: 20-25 to 35-40 Profound: below 20-25

11. 11 Adaptive Skills Communication Self Care Home Living Social Skills Leisure Will have difficulty in at least 2 areas Health and Safety Self Direction Functional Academics Community Use Work

12. 12 Treatment Modalities Prevention Educate Child/Family Early Intervention Self Care Skills Optimum Development Play/Exercise Down?s Syndrome Communication Discipline Socialization Sexuality Future Care Hospitalization

13. 13 Treatment Modalities; DS Corrective surgery for anomalies Cosmetic surgery for physical stigmata Regular evaluation of sight and hearing Periodic testing of thyroid Evaluate for atlantoaxial instability (for sports)

14. 14 Emotional Needs During : Initial Diagnosis At birth or later Hospitalization/medical care Developmental years Planning Future Care For complex care Respite care Permanent care giver

15. 15 Plan of Care Diagnosis: Altered Growth and Development Related to impaired cognitive functioning. Goal: Child will exhibit evidence of appropriate growth and development behaviors for age and abilities. Page 1260

16. 16 Plan Involve child and family in early intervention MS has early intervention McDougal Center, Region III Rehabilitation Assess development at regular intervals Varies Help family set realistic goals Not going to be a rocket scientist Emphasize child?s normal needs Love, praise, acceptance, discipline, interaction Counsel child and parents on issues Sexuality, birth control, marriage, job Page 1260

17. 17 Plan of Care Diagnosis Altered family processes related to having a child with mental retardation Goal Family members demonstrate acceptance of child Page 1260

18. 18 Plan Inform family of infant problems ASAP Provide time to absorb and adjust Provide written materials Demonstrate your acceptance of child Explore families reaction to child Arrange for and participate in family conferences Assess resources and coping abilities Page 1260


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