Mental Retardation and Downs Syndrome

1
Mental Retardation and Downs Syndrome

• Peggy Pannell RN, MSN

2
Objectives

• Define MR and Downs Syndrome
• Signs and Symptoms
• Lab and Diagnostic studies
• Treatment modalities
• Plan of care
• Emotional needs of client and family

3
Definition (Objective 1)

• Mental Retardation
• Also known as Cognitive impairment. Any type of
  mental difficulty or deficiency.
• Downs Syndrome
• The most common chromosomal abnormality of a
  generalized syndrome.
• Trisomy 21 (95)
• Translocation of 15 and 21 or 22 (3-4)
• Mosaicism (1-2)

4
Causes of MR

• Genetic
• Downs Syndrome
• Other syndromes (fragile X, etc)
• Biochemical
• Alcohol, Drugs, exposures
• Infectious
• Rubella, syphilis, kernicterus
• Unknown
• Trauma, physical agent
• Hydrocephalus
• Nutrition
• Environmental factors
• Psychiatric disorders

5
Signs and Symptoms of MR Objective 2

• Developmental Delay
• Speech
• Mobility
• Early signs
• Non-responsiveness to contact
• Poor eye contact during feeding
• Diminished spontaneous activity
• Decreased alertness to voice or movement
• Irritability
• Slow feeding
• less than a normal child of that age

6
SS of Downs Syndrome (clinical manifestations)
obj 2

• Head
• Face
• Eyes
• Nose
• Ears
• Mouth
• Teeth
• Chest

• Neck
• Abdomen
• Genitalia
• Hands
• Feet
• Musculoskeletal
• Skin
• Other

7
Diagnostic Studies Objective 3

• Chromosome Analysis
• To determine Downs and other syndromes
• Standardized test
• Vineland Social Maturity Scale
• AAMR Adaptive Behavior Scale
• Classification
• Educable Mentally Retarded (EMR)
• Trainable Mentally Retarded (TMR)

8
Causes and Diagnostic Evaluation

• Causes
• Nonfamilial Trisomy 21 (95)
• Translocation of chrom 15, 21, 22 (3-4)
• Mosaicism (normal and abnormal chrom (1-2)
• Diagnosis
• Clinical Manifestation
• Chromosome Analysis

9
How MR is measured

• IQ (Intelligence Quotient)
• 70-75 or below
• Adaptive Skills
• 2 out of 10 possible
• Age of diagnosis
• 18 or younger

10
Intelligence Quotient

• Mild 50-55 to 70-75
• Moderate 35-40 to 50-55
• Severe 20-25 to 35-40
• Profound below 20-25

11
Adaptive Skills

• Communication
• Self Care
• Home Living
• Social Skills
• Leisure
• Will have difficulty in at least 2 areas

• Health and Safety
• Self Direction
• Functional Academics
• Community Use
• Work

12
Treatment Modalities

• Prevention
• Educate Child/Family
• Early Intervention
• Self Care Skills
• Optimum Development
• Play/Exercise
• Downs Syndrome

• Communication
• Discipline
• Socialization
• Sexuality
• Future Care
• Hospitalization

13
Treatment Modalities DS

• Corrective surgery for anomalies
• Cosmetic surgery for physical stigmata
• Regular evaluation of sight and hearing
• Periodic testing of thyroid
• Evaluate for atlantoaxial instability (for
  sports)

14
Emotional Needs

• During
• Initial Diagnosis
• At birth or later
• Hospitalization/medical care
• Developmental years
• Planning Future Care
• For complex care
• Respite care
• Permanent care giver

15
Plan of Care

• Diagnosis
• Altered Growth and Development Related to
  impaired cognitive functioning.
• Goal
• Child will exhibit evidence of appropriate growth
  and development behaviors for age and abilities.
• Page 1260

16
Plan

• Involve child and family in early intervention
• MS has early intervention
• McDougal Center, Region III Rehabilitation
• Assess development at regular intervals
• Varies
• Help family set realistic goals
• Not going to be a rocket scientist
• Emphasize childs normal needs
• Love, praise, acceptance, discipline, interaction
• Counsel child and parents on issues
• Sexuality, birth control, marriage, job
• Page 1260

17
Plan of Care

• Diagnosis
• Altered family processes related to having a
  child with mental retardation
• Goal
• Family members demonstrate acceptance of child
• Page 1260

18
Plan

• Inform family of infant problems ASAP
• Provide time to absorb and adjust
• Provide written materials
• Demonstrate your acceptance of child
• Explore families reaction to child
• Arrange for and participate in family conferences
• Assess resources and coping abilities
• Page 1260