HEHI Exam 3 Set 6-CP and Down Syndrome

What is the diagnostic criteria for an Intellectual Disability?
1. Intellectual functioning (IQ)
2. Functional strengths/weaknesses Impairement in at least 2/10 adaptive skill domains.
3. Must have onset <18 years

What are the 10 adaptive skills domains used in diagnoses of Intellectual Disability?
Communication
Self -Care
Home living
Social
Community
Self direction
Health/Safety
Functional academics
Leisure
Work

What standardized tests are used to diagnose Intellectual Disability? Which one can be done by nurse?
1. Bayley Scale of Infant Dev
2. Denver Dev. Screening Test-can be done by the nurse

What Standardized Test examines personal, social, fine motor, language & gross motor skills for Diagnoses of Intellectual Disability?
Denver Developemental Screening Test

True/False-Routine developmental screening assists in early ID of Intellectual Disability?
TRUE!

What are 6 etiologies for and Intellectual Disability?
1. Infection/Intoxication
2. Trauma or Physical Agent
3. Metabolism or nutrition
4. Chromosome Abnormalities
5. Gestational Disorders
6. Environmental influence

A patient has an IQ in the 50-70 range. What is the level of Intellectual Disability and how might the individual present?
Mild level Disability
Person may be slow to talk & walk but disabilities are not noticed by observers.

What are the IQ & level of impairment of patient with a Moderate Intellectual Disability?
IQ: 40-60
Person has noticeable delays in motor & skills development.

Which level of Intellectual Disability requires total care?
Profound-IQ is <20

What other neuromuscular disorder is often seen with Intellectual Disability?
CP

What is the primary GOAL in nursing care of a patient with an Intellectual Disability?
Promote optimum developement

How will a client with a severe level Intellectual Disability present? What is their IQ?
IQ 20-40
Client has pronounced delays with few communication skills.

What 5 CONSIDERATIONS are important in providing nursing care to clients with Intellectual Disabilities?
1. Education
2. Hospitalization
3. Discipline (training)
4. Social Skills
5. Play/Exercise
6. Sexuality

Why is sexuality an important consideration in Nursing Care of Intellectual Disability and what needs to be included in the care plan?
The client is vulnerable because they can be easily persuaded and may lack judgement.
A code of conduct MUST be included in the care plan that communicated in a way the client can understand.

True/False-Cerebral Palsy is a cognitive diagnoses.
FALSE! NO!

What type of disorder is Cerebral Palsy and what is it caused by?
-Group of nonprogressive disorders of movement & posture.
-Caused by abnormal development of or damage to motor control centers of the brain.

What causes impaired movement in CP?
Abnormal functioning of cerebral cortex

What neuromuscular disorder is the leading cause of disability children?
CP

What is the single most important risk factor for Cerebral Palsy?
Prematurity

What are postnatal risk factors/etiology for CP?
infection
kernicterus
toxins
traumatic brain injury

True/False-most prenatal cases of CP have a known etiology.
FALSE-70-80% cases have unknown cause

True/False-birth trauma attributes to CP in perinatal cases.
TRUE-but it is a VERY low % of overall cases

What type of CP is most common?
SPASTIC

What characterizes hypertonicity in Spastic CP?
Persistant primitive reflexes
Increased muscle tone
Development of contracture

What does a nurse or provider need to know about reflexes when they are assessing a patient for possible CP?
They MUST know when the primitive reflexes disapear.

What are the early manifestations of Spastic CP and how long must they last?
Generalized Hypotonicity MUST LAST up to 1 year.

What is the UNIVERSAL impairement of CP?
Delayed gross motor developement.

What changes in posture are seen in Cerebral Palsy?
1. Abnormal posturing at rest or with position changes.
2. Poor control of balance coordination

What are the manifestations of of Dyskinetic-Nonspasitc CP? What term is used to describe these manifestations?
Term is Athetoid:
1. Worm-like writhing movements involving extremities, trunk, neck, facial muscles & tongue.

What is caused by involvement of Oral muscles in Dyskinetic Nonspastic CP?
Drooling
Dysarthria-Impaired Speech

What is the common cause of Nonspastic CP?
Kernicterus

What is the primary modality for diagnoses of CP?
Careful complete history and neuro exam

What must the nurse understand about appearance of motor dysfunction in pediatric patients with CP?
Motor dysfunction may not present until 2-4 months of age

What are the 5 GOALS in Therapeutic Management, Early Diagnoses & Early Intervention of Cerebral Palsy?
1. Early locomotion, communication & self help skills
2. Gain integration of motor function
3. Correct associated defects
4. Provide educational opportunities
5. Promote socialization experiences

What types of interventions are part of a multidisciplinary approach?
PT, OT and Speech therapy

When should speech therapy be started for a patient with CP?
Start before the child begins to talk for eating and communication.

What is the FIRST therapeutic intervention that nurses should implement for children with CP?
Why is this intervention beneficial?
Feeding therapy-SELF FEEDING

It is beneficial because it requires it requires integration of fine & gross motor skills and visual perceptions.

What is main complication associated with CP?
aspiration

True/False-Education and Recreation can be therapeutic interventions for CP?
YES! They are just as important as nutritin etc.

What drugs are used for PHARM therapy management of Cerebral Palsy? (4)
1. Baclofen-may be used as pump
2. Dantrolene
3. Botox
4.Anticonvulsants-Dilantin & Phenobarbital

What PHARM agent is a skeletal muscle relaxant?
Dantrolene

What role does a Baclofen pump play in management of CP?
Surgically implanted, externally loaded & releases at slow rate.

What must the nurse understand about PO Baclofen dosage for patients with CP?
High doses of PO Baclofen have significant side effects & poor relief of symptoms.

Which PHARM agent is a local nerve block used to decrease spasticity in children with CP?
Botox

What are the steps of Diagnoses of Down Syndrome? (2 parts)
1. Suspected with physical manifestations
2. Confirmed with karyotype

The majority of Down Syndrome children are born to women in what age group?
<35 years AND older women

What must the nurse understand about the intellectual capacity of a child with Down Syndrome?
Intellectual capacity can’t be determined at birth BUT cognitive disability IS expected.

A child with Down Syndrome exhibits inadequate drainage of mucus and is at risk for nasal obstruction. Why does the nurse know leads to this problem?
Underdeveloped nasal bone

What change makes feeding difficult for an infant/child with Down Syndrome?
Large tongue & hypotonia

What should the nurse teach the parent about tongue-thrusting during feeding of a child with Down Syndrome?
Tongue thrusting is NOT a sign of refusal.
Parents can learn to refeed with assistance of OT and speech therapy.

What is Atlantioaxial Instability in a child with Down Syndrome?
Lax muscles & ligaments in cervical spine can lead to spinal chord injury & damage with forcible flexing or stretching or the neck.

What problem contributes to conductive hearing loss in children with Down Syndrome?
otitis media
narrow canals & impacted cerumen

What are the leading causes of death in the first year of life in children with Down Syndrome?
Respiratory & Cardiac Anomalies since they are most prevalent.

When must a child with Down Syndrome be screened for Atlantioaxial Instability?
Must be done by 2nd birthday.

Why must children with Down Syndrome avoid activities that stress head & neck?
Atlantioaxial Instability

What are the DISTINCTIVE Physical Characteristics present in patients with Down Syndrome? (4)
1. Brushfield spots
2. Epicanthial Fold
3. Simian Crease
4. Hypotonia & Hyperflexibility

What is the current lifespan of patient with Down Syndrome?
55 years; lower than general population

By what age are guaranteed educational services available under the Disabilities Education act?
3 years

What 7 PHYSICAL Characteristics support a SUSPECT Diagnoses of Down Syndrome?
1. Flattened hypolastic midface
2. Depressed nasal bridge
3. Inner epicanthal folds
4. Upward obliquity of palepbral fissues
5. Small external ears.
6. Small mouth & narrow palate.
7. Prominent Palantine ridges.

What methods of prenatal screening can be performed to screen for Down Syndrome? When? (4)
1. Nuchal Translucency Test-11-14 wks
*2. Chorionic Villus Sampling-8-12 wks
*3. Amniocentesis-15-20 wks
4. Percutaneous Umbilical blood sample-20 wks

What is the MOST important consideration for General health maintenance of a child with Down Syndrome?
1. Accurate Information

After accurate information, what are other concepts involved with general health maintenance of Down Syndrome?
2. Frequent well child visits
3. Immunization as scheduled
4. Monitor physical growth with special charts
5. Consider cognitive vs. social intelligence

What is the most common cardiac problem in children with Down Syndrome?
septal defects

Hypospadias in males
Alteration in GU system r/t altered urinary elimination
*Abnormal opening of male urethra upon undersurface of penia.

What is the concern with Leukemia in patients with Down Syndrome?
Low remission & High mortality rate

What alterations in visual acuity/perception are associated with Down Syndrome?
Refractive errors and Stabismus

What type of hearing loss is most common in patients with Down Syndrome? When should the initial screen be done?
Conductive
-initial screen by 6 months

What is a main concern related to nutrition in post natal cases of Down Syndrome?
Feeding Intolerance & vomiting

True/False-Obesity and Constipation are both common problems in patients with Down Syndrome
TRUE!

What is the major respiratory concern in patients with Down Syndrome r/t to impaired gas exchange?
Risk of Upper Respiratory Infection, & Obstruction.

What are the orthopedic problems in patients with Down Syndrome?
1. Subluxation & dislocation of hips
2. Atlantoaxial Instability

What must the nurse understand about reproductive effects in male patients with Down Syndrome?
Fertility in males is rare because genitalia is underdeveloped.

What type of thyroid dysfunction is common with Down Syndrome? How is this managed?
Hypothyroidism-managed with periodic testing

True/False-females with Down Syndrome are also infertile.
FALSE!-they even have menstruation at an average age.

What neurological conditions at have increased risk with Down Syndrome? What is the main risk associated with the neuro system?
A. Seizures
Alzheimer’s
Cognitive Impairments

B. Risk of injury r/t Diminished muscle tone.

How might a patient with Down Syndrome present with a Cognitive Impairment? What is the expected IQ?
A. Expressive language difficulties
B. Mild to Moderate IQ (40-70)

In which adaptive skill area of function do patients with Down Syndrome exhibit the most strength?
Social interaction

True/False-Family Issues, Developmental level and Physiological observation are ALL considerations critical in enhancing optimal development for a patient with Down Syndrome?
TRUE!- The nurse must be involved in all of these areas during management of care.

Cosmetic Surgery Is Not an Answer to Down Syndrome


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Introduction

Down syndrome is a genetic disorder that affects the mind and causes physical disability. It is caused by irregular division of cells which causes formation of a full or extra chromosome. A normal person should have a 21 pairs of chromosomes but, Down syndrome people have extra chromosomes (Suzedelis, 2006). The extra chromosome s alters the genetic composition of a person and this affects the normal growth. Notable physical features of a Down syndrome person include; small stature, cat-like cry, a flat forehead, flat nasal ridge and a singular crease across the palm (Ndss. 2014).

As stated earlier, the down-syndrome alters the physical attributes of a person especially it makes a person to have a funny face. There has a growing debate on whether parents of children’s with down syndrome subject their children to have cosmetic surgery to make them look more appealing. Advocates of the surgery exercise argue that the surgery is necessary to help the children become more conventional and minimize bullying from their peers. It raises the self-esteem of the affected people since other people start viewing them as normal people. Critics of the cosmetic surgery believe conducting the surgery will bring ethical concerns to the affected people.

It is the wish of all parents to deliver perfect and healthy children who do not have any birth defects. Unfortunately, some parents are not lucky because they deliver children with disorders such as Down syndrome. The frustration of having a kid with physical disabilities makes them to look for alternative ways that will rectify the defect. The parents want to shield their children from societal stigma especially from their peers. Moreover, they believe when the children grows up, they will have esteem problems. However, parents should realize that having Down syndrome children is not a curse but a normal thing.

This paper wants to take a stand on the controversial issue and explain why parents should not take their Down syndrome children to have cosmetic surgery. Using insights from past researches the paper will provide negative factors that will make parents consider their stands on having corrective surgeries for their children.

Parents should realize that the decision to have a corrective surgery should be a consultative move that involved many stakeholders. For instance, they should seek expert opinion from health experts, other parents who have done the surgery, affected children and even relevant governmental agencies. More importantly, they should seek the opinion of the Down syndrome child because he/she is directly affected by the surgery. Therefore, they should not hurriedly make the move of doing the surgery without waiting to hear the opinion of the child. It is thus advisable for parent to wait till they are old enough to make decisions and then seek their stands before going ahead with the surgery. Moreover, they can learn from other parents who have done the surgery to their children. If they realize that the positive effects of the surgery outweigh the negative effects then they can proceed with the surgery. However, if they realize the surgery has brought more complications then they should abandon it. This means that parents should not completely abandon the decision to have the surgery but, rather take time.

As many studies have indicated, not all corrective surgeries are successful (Ndss. 2014). There are some surgeries that may cause health complications to their victims. For instance, instead of correcting the facial defects, the surgery may worsen the facial appearance of the victims. Besides that, the success of the surgery depends on the infrastructural capacity of the health care institution as well as technical expertise of the surgeons. Therefore, if the parents choose an incompetent surgeon or an inadequately equipped health-care facility then there is a high chance the surgery will not go well and may bring other health complications. If the surgery brings more complications the parents will live with guilt and this may relations issues with the child. Specifically, the child may develop hatred to the parents.

As mentioned earlier, the main goal of having a surgery is to help the child integrate well into the society. Specifically, it seeks to protect the child from discrimination and bullying from peers. However, studies have shown that people nowadays have changed the perception of Down syndrome people. Unlike in the past, the current society tolerates the Down syndrome people and they are given equal respect as other people (NHS.2014).Moreover, children are sensitized to treat other Down syndrome children with respect and show love. Therefore, parents should not worry about their children’s discrimination because the society is tolerant to their disorder. People nowadays treat the disorder as any other disability. In fact, many jurisdictions have put enough mechanisms that seek to protect the rights of the disability people in the society.

A facial reconstruction surgery is normally costly and requires parents to heavily invest financial resources. Many reputable hospitals and surgeons require parents to deposit huge sums of money before the surgery takes place. For those parents who are low income earners, paying for this surgery is next to impossible. If they proceed with paying for the surgery, the economic livelihood of the family may be affected. It is thus advisable to abandon the surgery move if the move will affect the living standards of the family. Instead, families can channel the funds in other demanding ventures that will improve the overall welfare of the family.

As indicated earlier, some physical attributes of a Down syndrome child are unique and dominant. Therefore, even if a surgery is done some features will still be portrayed. For instance, Down syndrome people have clubbed fingers and usually produce a funny voice when they cry (NHS.2014). For people who understand how the disorder works, the surgery will still not change their views on the Down syndrome child.

As shown earlier, Down syndrome is a genetic disorder. This means that even if a parent decides to perform the surgery the offspring of the victim may still have the disorder. Therefore, they should not opt for the surgery since they cannot be always performing the surgery to all affected family members.

The paper has clearly justified why parents should not consider performing surgeries for their children. This is because performing the surgery has many adverse effects. For instance, the surgery can lead to development of other health complications especially if it is performed by incompetent personnel. Secondly, the surgery is costly and may affect the financial resources of a family. The surgery may not heal the facial features caused by the disorder. Therefore, parent should always consider many factors and involve other people especially the victim before they can make the final decision to perform the surgery.

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