mentally retardation

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Mentally challenged Child:

Mentally challenged Child Kirandeep Randhawa M.Sc (N) 2 nd year

Introduction::

Introduction: Mentally challenged is an euphemism which has been used for terms like; mental retardation, developmental disabilities e.t.c To be mentally challenged, or to have a developmental disability, is to be confronted with a cognitive, emotional or physical impairment, especially one related to abnormal sensory or motor development. The difficulty appears in infancy or childhood and involves a failure or delay in progressing through the normal developmental stages of childhood.

Definition::

Definition: Mental retardation is a generalized disorder, characterized by significantly impaired cognitive functioning and deficits in two or more adaptive behaviors with onset before the age of 18. It has historically been defined as an Intelligence Quotient score under 70.

Epidemiology :

Epidemiology Studies have shown that it affects about 3% of the general population, common in males with a ratio of 2:1 About ¾th of total cases are only mild type and 5% are having severe to profound mental retardation.

Classification::

Classification: It is classified dependig upon IQ level. IQ or intelligence Quotient is calculated by the formula: mental age ---------------------- * 100 Chronological age The mental retardation can be classified as: Mild 70-50 Moderate 49-35 Severe 34-20 Profound <20

Causes of mental retardation: :

Causes of mental retardation: Genetic disorders e.g Down syndrome Congential anamolies e.g cranial malformation The fetal environment Maternal infections Chronic conditions Blood incompatibilities between mother and child Radiation Malnutrition Factors associated with age and stress of mother

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4. Problems during birth Prematurity Low birth weight Lack of oxygen during birth process Too-rapid progress through the birth canal 5. Damage to the nervous system after birth Infections (encephalitis) Extreme malnutrition Blows to the head Tumors Oxygen deprivation due to accidents (such as near drowning) Environmental poisons (lead paint)

Clinical manifestation:

Clinical manifestation Failure to achieve age appropriate development to some degree. Poor maturation with learning difficulties Inappropriate family and social adjustment Convulsions may present Microcephaly Subaverage intellectual function with significant limitations in adaptive functioning that begins before age 18

Infancy ::

Infancy : Poor feeding Uncoordinated sucking leading to poor weight gain Decreased visual altertness and auditory response Delayed head and trunk control Poor mother and child interaction

Toddler ::

Toddler : Delayed speech Language disabilities Delayed motor milestones Short attention span Poor memory Emotional instability Sleep problems Impulsiveness Low frustration tolerance

Diagnostic evaluation :

Diagnostic evaluation

Con……………..td:

Con……………..td Detailed history Physical examination and neurological examination IQ test Detection of associated diseases Other investigations like urine test for metabolic diseases.

Problems of mentally challenged ::

Problems of mentally challenged : Children with mental retardation may learn to sit up, to crawl, or to walk later than other children, or they may learn to talk later. Both adults and children with mental retardation may also exhibit the following characteristics: Delay with oral language development Difficulty learning social rules Deficits in memory skills

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Difficulty with problem solving skills Lack of social inhibitions The limitations of cognitive functioning will cause a child with mental retardation to learn and develop more slowly than a typical child. Children may take longer to learn language, develop social skills, and take care of their personal needs such as dressing or eating. Learning will take them longer, require more repetition, and skills may need to be adapted to their learning level. Nevertheless, virtually every child is able to learn, develop and become participating members of the community .

Management ::

Management : Mentally retarded child needs management in multidisciplinary team approach. Adequate diagnostic facilities to detect associated problems and associated problems. Family members need counselling regarding various aspects of the conditions. Routine basic care, immunization, growth monitoring, nutritional requirement Psychological support and emotional support needed for parents and family members. Special educational arrangement and available facilities should be discussed with the parents.

Prevention of mental retardation::

Prevention of mental retardation : Primary prevention Public education about need for prenatal care, dangers of pregnant women drinking, and dangers of exposure of children to lead Amniocentesis and ultrasound scanning that may lead to termination of pregnancy Secondary prevention Treatment, as in special diet for PKU children

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Tertiary prevention Maximizing child’s skills and potential School- and community-based educational, vocational, and skills training programs Welfare of the girl child should be emphasized. Proper marriage age should be emphasized. Genetic counselling is important measure to prevent genetic and chromosomal abnormalities. Good obstetric care is essential. Essential neonatal care to be provided.

Vocational and social skill training for mentally retarded child::

Vocational and social skill training for mentally retarded child: Job preparation – Sheltered workshops Learning how to deal with personal, financial, and sexual exploitation Teach social skills and how to say “no” Training in appropriate sexual behavior

Recognition and treatment of psychological problems::

Recognition and treatment of psychological problems: Forty percent of mentally retarded meet criteria for some other disorder Severely and profoundly retarded often have autism or pervasive developmental disorder One-fourth have a personality disorder Many adolescents have temper tantrums, aggressive and destructive behavior, and alcohol and drug abuse Children and adults with Down syndrome often suffer from depression

Nursing care::

Nursing care: Mental retardation was clearly associated with poverty and social deprivation. There was fear of degradation of the population if sufferers were permitted to reproduce freely. Hence mentally retarded patient where usually kept in institution remote and custodial in character which were usually poorly financed and attracted poor quality and ill trained staff. Recently (over the past 30 yrs) the Aim of care has shifted towards promoting personal independence.

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This might be difficult on the patient alone hence the need for the parents to be fully involved. This is been achieved through Advocacy (legal and civil right) Restricting new admission into institutional care Relocating existing residence into the ‘community’.

Refereces :

Refereces Marlow.Dorothy.R ,Redding Barbara. “A.Text book of Pediatric Nursing”.6 th edition. Singapore:Harcourt Brace & Company Asia PTE LTD;1998. Wong.L.Donna, Eaton.Marilyn Hockenberry ,“Essentials of Pediatric  Nursing”.6 th edition. Missouri:Mosby Publishers; 2001 www.prenhall.com www.radford .edu www.effiwe.net

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