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Chapter 30

Chapter 30. The Child with a Cognitive Deficit. Cognitive Impairment (Mental Retardation). Defined as intelligence significantly below average; existing with limited adaptive skills IQ scores denoting cognitive impairment generally below 70 to 75 range.

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Chapter 30

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  1. Chapter 30 The Child with a Cognitive Deficit

  2. Cognitive Impairment (Mental Retardation) • Defined as intelligence significantly below average; existing with limited adaptive skills • IQ scores denoting cognitive impairment generally below 70 to 75 range

  3. Cognitive Impairment (Mental Retardation) Etiology • Congenital or early environmental factors • Result of head injuries, asphyxia, intracranial hemorrhage, infections, poisoning, or the presence or treatment of a brain tumor

  4. Cognitive Impairment (Mental Retardation) Clinical manifestations • Cardinal sign is delayed achievement of developmental milestones

  5. Cognitive Impairment (Mental Retardation) Diagnostic evaluation • Prenatal and postnatal history • Family history • Denver Developmental Screening Test II levels • Laboratory tests, including chromosomal analysis, blood levels for lead or enzymes • Neurologic examination; signs such as simian crease on palms, abnormal hair swirls, low-set ears

  6. Cognitive Impairment (Mental Retardation) Therapeutic management • Medical strategies directed toward preventing and treating infections, correcting structural deformities, and treating associated behaviors such as aggressiveness

  7. Cognitive Impairment (Mental Retardation) Nursing considerations • Early detection is essential • Support parents in choosing education program (mainstreamed into public school or special education classes) • Provide parental support and guidance as they experience shock and grief on diagnosis • Perform functional assessment to determine child’s ability to provide self-care, as appropriate

  8. Cognitive Impairment (Mental Retardation) Nursing considerations • Encourage socialization • May require occupational therapy and/or speech therapy • Provide optimal growth and development • Encourage promotion of self-esteem and self-care • Help parent establish behavior modification program if necessary • Educate parents about child’s needs for exercise and play tailored to child’s developmental age

  9. Therapeutic Exercise

  10. Autism • Developmental disorder of brain function characterized by deficits in intelligence and behavior • Involves abnormalities in behavior, interferes with the ability for social interactions, and impairs verbal communication

  11. Autism Diagnostic evaluation • Based on interview with parent regarding child’s behavior • CHAT screening tool available for use

  12. Autism Clinical manifestations • Disinterested in being held or cuddled • Stiffens when being held • Avoids eye contact • Demonstrates poor language development

  13. Autism • Minimal facial responsiveness (does not smile) • Appears not to hear when being spoken to • Exhibits abnormal activities such as head banging • Does not engage in social play with others

  14. Autism Nursing considerations • Decrease environmental stimuli • Maintain a safe environment; provide close supervision • Promote parental coping • Maintain hospitalized child’s daily routine as much as possible to minimize stress • Encourage activities and specialized educational programs to child’s ability to promote optimal growth and development

  15. Other Causes of Cognitive Impairment • Down syndrome • Fragile X syndrome • Fetal alcohol syndrome

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