Mental Retardation pediatrics ppt.pptx

Pediatrics mental retardation unit

1. MENTAL RETARDATION

2. OBJECTIVES Define Mental Retardation . Pathophysiology of mental retardation . Etiology of Mental Retardation. Classification of mental retardation . Sign & symptoms of Mental Retardation . Diagnosis. Prevalence . Medical Management. Nursing Management. Care and Rehabilitation.

3. MENTAL RETARDATION Mental retardation is a part of a broad category of development disability and defined by the American Association of Mental Deficiency as “….Significantly sub average, general intellectual functioning existing concurrently with deficit in adaptive behavior and manifested during the developmental period (18 year of age ).” Adoptive behaviors include communication, self-car, work, leisure, health and safety.

4. Chromosomal abnormalities can be a cause of intellectual disability (formerly called mental retardation). This happens when there is a deletion (missing piece) of a chromosome. Chromosomes contain genes, which are the instructions for making proteins that the body needs to function. When a piece of a chromosome is missing, there may be missing genes or genes that are not working correctly. This can lead to problems with brain development and function, which can cause intellectual disability. PATHOPHYSIOLOGY

5. PATHOPHYSIOLOGY There are several chromosomal abnormalities that can cause intellectual disability, including Down syndrome, Turner syndrome, and Cri-du-chat syndrome . Down syndrome is the most common chromosomal abnormality, caused by having an extra copy of chromosome 21 . Turner syndrome is a condition that affects females and is caused by a missing or partially missing X chromosome. Cri-du-chat syndrome is a rare condition that is caused by a deletion of part of chromosome 5.

6. Prenatal cause Chromosomal disorder(e.g. Down syndrome) TORCHS infection Congenital primary hypothyroidism Family history of mental retardation Malformation of brain Perinatal causes Prematurity. Hypoxic-ischemic encephalopathy Birth trauma Intracranial hemorrhage Postnatal causes Birth trauma Intraventricular hemorrhages Bilirubin encephalopathy Hypoglycemic Bacterial meningitis, sepsis Viral encephalitis CAUSES

7. Structural defects Microcephaly Hydrocephalus Neural tube defects infection Post-encephalitis Post-meningitis Sub acute sclerosing Rubella Chromosomal disorder Down syndrome turner’s syndrome Cat-cry syndrome Fragile X syndrome Trisomy X syndromes Environmental factors Psychosocial deprivation Nutritional deprivation Cranial trauma CAUSES

8. Genetic / Metabolic Defects Cretinism Muco -poly- saccharidosis Leukodystrophy Galactosemia Phenylketonuria Wilson’s disease Physical damage & disorders Injury Hypoxia Gross disease of brain Neurofibromatosis Epilepcy intoxication Substance abuse Lead & certain drugs CAUSES

9. Classification of retardation MILD (50-70 IQ ) Common type of retardation 85-90% . These individual have minimum retardation in sensory-motor areas. PRESCHOOL: The child often is note noted as retarded, but is slow to walk, talk, and feed self. SCHOOL AGE: The child can acquire practical skills and learn to read and do arithmetic to sixth-grade level with special education classes. The child achieves a mental age of 8 to 12 years. ADULT: The adult can usually achieve social and vocational skills. Occasional guidance may be needed. The adult may handle marriage, but not child rearing.

10. 2. MODERATE ( 35-55 IQ) About 10% of mentally retardated come under this group. PRESCHOOL: Noticeable delays, especially in speech, are evident. SCHOOL AGE: The child can learn simple communication, health and safety habits, and simple manual skills. A mental age of 3-7 years is achieved. ADULT: The adult can perform simple tasks under sheltered conditions and can travel alone to familiar places. Help with self-maintenance is usually needed. Classification of retardation

11. 3. SEVERE (20-40 IQ ) Recognized early in life PRESHOOL: The child exhibits marked motor delay and has little to no communication skills. The child may respond to training in elementary self-help, such as feeding SCHOOL AGE: The child usually walks with disability. Some understanding of speech and response is evident. The child can respond to habit training and has the mental age of toddler. ADULT: The adult can perform to daily routines and repetitive activities, but needs constant direction and supervision in protective environment. Classification of retardation

12. 4. PROFOUND (Below 20 IQ ) Delayed developmental milestones PRESCHOOL: Gross retardation is evident. There is a capacity for function in sensorimotor areas, but the child need total care. SCHOOL AGE: There are obvious delays in all areas. The child shows basic emotional response and responds to skillful training in the use of legs, hands and jaws. The child needs close supervision and has the mental age of young infant. ADULT: The adult may walk but need complete custodial care. The adult will have primitive speech. Regular physical activity is beneficial. Classification of retardation

13. Intelligent quotient (IQ) Intelligent quotient (IQ) is the ratio between mental age (MA) & chronological age (CA). (Einstein’s IQ =160+) MA IQ = ---------------------- x 100 CA Chronological age is determined by date of birth, Mental age is determined by intelligence tests.

14. SIGN AND SYMPTOMS Failure to achieve developmental milestones Deficiency in cognitive functioning such as inability to follow commands or directions Reduced ability to learn or to meet academic demands Distractibility , poor concentration Poor memory Psychomotor skill deficits Difficulty performing self-esteem Irritability when frustrated or upset (low frustration tolerance Impulsiveness Persistence of infantile behavior

15. diagnosis History collection from parents & caretakers Physical examination Neurological examination (GCS) Assessing milestones development EEG, especially if seizure are present CT Scan or MRI brain (tuberous sclerosis) Thyroid function tests when cretinism is suspected Investigation : Chorionic villi sampling Amniocentesis in infant chromosomal disorders Culture for cytogenic & biochemical studies Urine and blood testing for metabolic disorders Chromosomal analysis

16. Diagnosis Serology for TORCHS infection X-ray skull (head injury) Hearing & speech evaluation Psychological tests like stanford binet intelligence scale & wechsler intelligence scale for childern’s (WISC) for categorizing the child’s level of ability . The Gesell and Bayley scales and the cattell infant intelligence scale are most commonly used with infants.

17. PREVALENCE The prevalence is 1% in the general population, with 6 per 1000 persons having a severe mental disability.

18. MEDICAL MANAGEMENT Treatment for mental retardation depends on the type of illness. If your or your loved one's symptoms are mild, you may only need limited intervention and medication to manage symptoms DRUG THERAPY No specific drugs available.. Neuroleptic drugs to reduce aggressive antisocial behavior. Eg phenothiazines . Antipsychotic drugs. Antidepressant drugs.

19. Nursing process Assessment : Nurse should assess and focus on each client’s strengths and individual abilities. Knowledge regarding level of independence in the performance of self-care activities is essential to the development of an adequate plan for the provision of nursing care. Neurological examination (sensory impairment, disturbance in motor areas are manifested by abnormalities of muscle tone, reflexes and involuntary movements.

20. Nursing diagnosis Self-care deficit related to altered physical mobility or lack of maturity. Impaired verbal communication related to developmental alteration. Risk for injury related to aggressive behavior or altered physical mobility. Delayed growth and development related to isolation from significant others ; inadequate environmental stimulation; hereditary factors. Anxiety (moderate to severe) related to hospitalization & absence of familiar surroundings.

21. NURSING CARE PLAN Primary prevention Preconception: Genetic counselling Immunization for maternal rubella Blood test to identify presence of vuneral diseases Adequate maternal nutrition Family planning Primary prevention During gestation : Prenatal care Adequate nutrition Analysis of fetus for possible genetic disorders At delivery: should be conducted by experts , APGAR scoring Childhood : proper nutrition , avoidance of hazards prevention of accidents

22. Nursing care plan Secondary prevention Early detection & treatment Early recognition of presence of MR Psychiatric treatment for emotional and behaviour difficulties

23. CARE AND REHABILITATION OF THE MENTALLY RETARDED The main elements in a comprehensive service for mentally retarded individuals and their families include The prevention and early detection of mental handicaps . Regular assessment of the mentally retarded person's attainments and disabilities. Advice , support, and practical measures for families Provision for education, training, occupation, or work appropriate for each handicapped person. Housing and social support to enable self- care . Medical, nursing, and other services for those who require them as outpatients, day patients, or inpatients. Psychiatric and psychological services.

24. REFERENCES Pervez Akber Khan (8 th Ed) Basis of Pediatrics (2011) published by paramount publishing enterprise . http:// www.slideshare.net/renitacresenciya/mental-retardation-100060437?from_m_app=android http:// www.slideshare.net/divya2709/mental-retardation-232170205?from_m_app=android

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