Mental Retardation..................pptx

Mental Retardation..................pptx

1. MENTAL RETARDATION MR. RUSHIKESH HANGE THIRD YEAR BASIC BSC NURSING

2. WHAT DO YOU MEANS BY MENTALLY RETARDAD PERSON .

3. DEFINITION MENTAL RETARDATION is defined as, a Significantly sub-average intellectual functioning associated with concurrent impairement in adaptive behaviour and manifested during the developemental period… - American Association on Mental Deficiency,1983

4. intellectual functioning : It is defined as the result obtained by the administration of the standardized general intelligence tests developed for the purpose and adopted to the conditions of the region/ country. Significant subaverage : it is defined as an intelligent quotient (IQ) of 70 or below on standardized measures of intelligence. The upper limit is intended as guidelines and can be extended to 75 or more, depending upon the reliability of intelligence test used .

5. Adaptive behaviour : it defines as the degrees with which the individual meets the standard of personal independence and social responsibilities expected of his age and cultural group. The deficits in adaptive behaviour may be reflected in following areas : During infancy and childhood:
Sensory and motor skills development
Communication skills
Self help skills
socialization

6. 2. During childhood And adolescence : a) Application of basic academic skills to daily life activities.
b) Application of appropriate reasoning and judgement in the mastery of environment. c) Social skills 3. During late adolescence : Vocational and social responsibilities and performance

7. ICD 10 Defined : Mental retardation is condition of arrested or incomplete development of mind ,which is especially characterized by impairment of skills manifested during development period that contribute to cognitive (knowledge),language , motor and social abilities.

8. EPIDEMIOLOGY About 3 % of the world population is estimated to be mentally retarded. In India, 5 out of 1000 children are mentally retarded. ▷ more common in boys and girls. ▷ For example: trauma, sepsis, Metabolic disease etc. 2)Incidence : Incidence of MR seems to increase sharply at age 5 with number of cases identified at age of 15 .

9. Difference In Mental Retardation And Mental Illness : Mental illness is a disease that can be cured. MR is developmental disorder in which there is impaired ability. So MR is not a disease. It cannot be cured. However the associated condition like deafness, poor vision and emotional disturbances can be treated. So the handicap can be cured

10. Myths about MR There is nothing like mental retardation.
Mental retardation is always hereditary.
Mental retardation is not common.
Mental retardation can be cured by tonic, vitamins and marriage.
All mentally retarded are a like.
Mentally retarded cannot be educated or trained.

11. ETIOLOGY :- 1) Genetic factors Chromosomal abnormalities •Fragile X syndrome
•Trisomy X syndrome
•Down’s syndrome
•Turner’s syndrome
•Cat-cry syndrome

12. Fragile X syndrome Trisomy X syndrome

13. Cat - cry syndrome Turner’s Syndrome

14. Metabolic disorders •Wilson’s disease • Galactosemia . •Cranial malformation. •Hydrocephaly •Microcephaly •Gross disease of brain •Neurofibromatosis
•Epilepsy

15. Hydrocephalus Microcephaly

16. 2).PRENATAL FACTORS •Infections •Rubella •Syphilis. •Herpes simplex -Endocrine disorders • Hypothyroidism
•Diabetes mellitus - Physical damage and disorders •Injury
•Hypoxia
•Hypertension
•emphysema

17. Hypothyroidism Diabetes mellitus

18. -Intoxication •substance abuse •certain drugs like Cocaine, ganja etc.. -A placental dysfunction. •toxemia of pregnancy. •placenta previa . •cord prolapse

19. Substance/Drugs Abuse

20. Placenta Previa Prolapsed Umbilical cord

21. 3).PERINATAL FACTORS birth asphyxia
prolonged birth
prematurity kernicterus
instrumental delivery(resulting head injury,) intraventricular hemorrhage

22. 4).POSTNATAL FACTORS Infection Sencephalitis Meningitis Septicemia Accidents

23. 5).ENVIRONMENTAL FACTORS AND SOCIO-CULTURAL FACTORS. •low socio economic status
•inadequate caretakers •child abuse

24. Low Socio economic status Child Abuse

25. Inadequate Caretaker

26. 1. Mild Retardation (IQ 50-70) This is commonest type of mental retardation accounting for 85-90% of all cases. These individuals have minimum retardation in sensory-motor area. 2. Moderate Retardation (IQ 35-50) About 10% of mentally retarded come under this group.

27. 3) Severe Retardation (IQ 20-35) Severe mental retardation is often recognized early in life with poor motor development & absent or markedly delayed speech & communication skills. 4). Profound Retardation (IQ below 20) This group accounts for 1-2% of all mentally retarded. The achievement of developmental milestones is markedly delayed. They require constant nursing care & supervision ,

28. SIGN AND SYMPTOMS • FAILURE TO ACHIEVED DEVLOPMENTAL MILESTONE. •DEFICIENCY INCOGNITIVE FUNCTION. •PSYCHOMOTAR SKILLS DEFICITS. •IRRITABILITY WHEN FRUSTRATED OR UPSET. •DEPRESSION OR LABIL MOOD. •ACTING OUT BEHAVIOUR. •INFANTILE BEHAVIOUR. •DIFFICULTY IN PERFORMING SELF-ESTEEM. •FAILURESTO ACHIEVED INTELLECTUAL. •REDUCED ABILITY TO LEARN.

29. 1. Failures to achieved developemental milestone .

30. Deficiency in cognitive function

31. 2.Phychomotar skill deficit

32. 3.Irritability when frustrated or upset.

33. 4.Depression or labil mood.

34. 5.ACTING OUT BEHAVIOUR.

35. 6.INFANTILE BEHAVIOUR.

36. DIFFICULTY IN PERFORMING SELF-ESTEEM.

37. 7.FAILURES TO ACHIEVED INTELLECTUAL

38. 8.REDUCED ABILITY TO LEARN.

39. 9.Lack of curiosity

40. 1) History Collection from parents or caretaker 2) Physical Examination 3)Neurological Examination 4) Investigation- -Urine and blood Analysis -Culture Test for cytogenic studies - Amniocenthesis -Hearing and speech evaluation -ECG(if seizuresare present) -CT brain or MRI (In Tuberous sclerosis)

41. 1) Behavioural therapy 2)Environmental Supervision 3) Monitoring the child developmental Needs. 4) Program that maximize speech, language, cognitive, psychomotor, social, self-care ,and occupational skills. 5) Ongoing evaluation for overlaping psychiatric disorder, such as depressions , bipolar disorder , and ADHD. 6) family therapy to help parents develop coping skills and deal with guilt or anger.

42. 1).Seizures 2) Cerebral palsy
3) Sensory deficits
4) Communication disorder
5) Neuron degenerative disorder 6)Psychiatric illnesses

43. 1.Primary prevention:- -Preconception. -During Gestation -At Delivery -Childhood 2.Secondary Prevention -Early detection and Treatment. -Early Recognition of the Presence of Mental Retardation. - Psychatric Treatment for Emotional and behavioral difficulties.

44. 3.Tertiary Prevention Vocational training are given to develop vocational or occupational skills and social skills to child to reduce the disability and provide optimal functioning
Utilizes rehabilitation measures adequately by the parents to prevent disability limitations.

45. Care & Rehabilitation of mentally ill patient .

46. 1) Early detection and early stimulation of Mentally Handicapped. 2)Regular assessment of Mentally ill person’s attainment and disabilities. 3)Advice, support and practical Measure for family. 4) Provision for education , occupation and training or work appropriate for each handicapped person. 5)Housing and social Support to unable self care .

47. A) Medical Management No specific drug available.
Neuroleptic drugs to reduce aggressive and antisocial behaviour . eg Phenothiazines Antipsychotics :
1. Risperidone 2. Clozapine. 3.Olanzapine Antidepressants 2.sertraline 3. Citalopram
3. fluxetine

48. B) Nursing Management: 1. Chid has to be brought regularily to the clinics. 2.to assess the developmental levels milestones. 3.Clarify the doubts of the parents. 4.Provide moral support to accept the child and to involve actively in provision of care. 5.If any medical condition associated, treat them adequately.

49. 1) For Profound MR children : 1. teach and train up them the basic survival skills very patiently
2. Make the chid to unlearn old habits and replace it by new one. 3. Provide habit training e.g. Hygienic care; sensory training eg . Identifying colours ; motor skills training e.g. Dressing, feeding.
4. If the child does any single task effectively, appreciate them for accomplished achievements
5. Safe guard the child from physical dangers. 6. Behaviour management techniques has to utilized.
7. Explain the parents not to over protect the child.

50. 2) For moderate MR children: 1) Train the child for routine procedures like following the table manners, norms, gardening, cleaning, etc. 2) Encourage the child to speak simple phrases,rhymes , songs, etc. 3) Train for protective measures against fire, traffic ,water, assaults, etc. Extensive attention, coaching has to be given for education. 4)Vocational skills has to be given such as blacksmith, laundry, scrubbing, polishing, etc.

51. 3) For mild MR children: Training has to be given in socialization, vocational skills, social living skills, deciplinary principles, etc. which the child has to follow in future for productive life. Provide small jobs like cooking, gardening, painting, printing, etc. ‘Token Economy’ is helpful for improvement among MR children. Meet the needs of the children specially psychological needs. Allow the child to participate in group and social activities. Teach the child only one aspect at a time, if possible demonstrate it, always advice them to practice it by following maxims like simple to complex, etc.

52. Nursing Diagnosis 1) Risk for injury related to altered physical mobility or aggressive behaviour . 2) Self care deficit related to altered physical mobility or lack of maturity

3) Impaired verbal communication related to developmental alterations

4) Impaired social interaction related to speech deficiencies or difficulty adhering to conventional social behaviour .

53. THANK YOU