Care of Mother and Child At-Risk or with

Problems (Acute and Chronic)-Lecture

STUDENT ACTIVITY SHEET BS NURSING / SECOND YEAR
Session # 40

LESSON TITLE: NURSING CARE OF A FAMILY WHEN A

CHILD HAS COGNITIVE ALTERATIONS
LEARNING OUTCOMES:
At the end of the lesson, the student nurse can:
1. Define the common intellectual and mental health disorders Materials:
that occur in children. Book, pen and notebook, index card/class list,
speaker and LCD projector
2. Integrate the knowledge of the common intellectual and
mental health disorders that occur in children and describe Reference:
these disorders that occur in these classifications of children in
formulating nursing care plan in giving quality maternal and Pilliteri, Adele and Silbert-Flagg, JoAnne (2018)
child health nursing care Maternal and Child Health Nursing, 8th Edition.
USA: Lippincott Williams and Wilkins

LESSON REVIEW/PREVIEW (5 minutes)

MAIN LESSON (50 minutes)

Please refer to Chapter 54: Nursing Care of a Family When a Child Has an Intellectual or Mental Health Disorder-
Neurodevelopmental Disorders p. 1534

NEURODEVELOPMENTAL DISORDERS
INTELLECTUAL DISABILITY
 commonly defined based on two criteria: intellectual functioning significantly below average —an IQ of 70 to 75
or lower with onset during the developmental period—and concurrent deficits in adaptive functioning in
conceptual, social, and practical domains.

COMMON CAUSES OF INTELECTUAL DISABILITY

 Chromosomal abnormalities such as Down syndrome and fragile X syndrome
 Infection in utero, such as rubella or cytomegalic inclusion disease
 Anoxia at birth from such causes as umbilical cord compression
 Fetal alcohol spectrum disorder
 Inherited metabolic disorders such as phenylketonuria or Tay-Sachs disease
 Head trauma, lead poisoning, or hypothyroidism
 Brain malformations such as anencephaly
 Very low birth weight
 Infections such as measles encephalitis
 Autism spectrum disorder
CLASSIFICATION
MILD INTELLECTUAL MODERATE MODERATE SEVERE INTELLECTUAL
DISABILITY INTELLECTUAL INTELLECTUAL DISABILITY
DISABILITY DISABILITY
 About 85% of children  Children in this  Children in this group  The IQ of children in

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 who are diagnosed with category have an IQ have an IQ range this group is less than
mild intellectual ranging between 35 between 20 and 34 and 20.
disability have an IQ and 49 and represent represent only about  Less than 1% of
range between 50 and about 10% of children 4% of children with children with intellectual
70. with moderate severe intellectual disability fall into this
 these children exhibit intellectual disability. disability. group.
difficulties in acquisition  these children,  These children develop  Children demonstrate
of academic skills, such language and a limited understanding only minimal capacity
as reading, writing, preacademic skills of language and for sensorimotor
math, time, or money, develop slowly during academic skills, with functioning and are
and are typically more preschool age, and minimal acquisition of nonverbal and non-
concrete in their continue to advance communicative speech, symbolic in
problem. slowly through school, such as with single communication
 Socially, they are typically peaking with words and phrases, or  Some are able to
observed as less academic skills at the augmented means respond to training in
mature, have a limited elementary level  They require parental minimal self-care, such
understanding of risk,  Socially, support in all activities as tooth brushing, but
and demonstrate communication is much of daily living, such as only very limited self-
poorer affect regulation less complex with poor eating, bathing, and care is possible.
than their similarly aged interpretation of social hygiene, and constant  They need a highly
peers. cues when compared supervision is structured environment
 As adults, they can to peers of a similar mandatory to ensure and are dependent on
usually achieve age. safety. others for activities of
adequate social and  Through adolescence daily living, help, and
vocational skills for and into adulthood, supervision for safety.
minimum self-support simple activities of daily
and independent living living such as dressing,
but need guidance and eating, hygiene, and
assistance with household chores can
complex daily living be learned through
tasks, such as grocery extended periods of
shopping, banking, teaching and caregiver
health decisions, or support
childcare.  As adults, they may be
able to contribute to
their own support by
performing unskilled or
semiskilled work under
close supervision.
ASSESSMENT THERAPEUTIC MANAGEMENT.
 Assessment for children with suspected  infant intelligence tests are not accurate and more
intellectual disability is completed through sophisticated tests are difficult to administer until
individualized IQ testing, culturally sensitive the preschool years.
standardized measures, and careful clinical  Because prediction based on these early tests
evaluation and judgment. involves some subjective input, a child’s potential
 Early assessment is key and should be done as may be overrated or underrated when using
soon as healthcare providers or parents become these.
aware of a delay in motor, language, or social  Once parents have a realistic expectation based
milestones. on the best judgment possible, however, they are
 Early assessment and diagnosis allow parents to ready, with guidance, to help their child achieve
appreciate and understand the needs of their his or her full potential.
child, adopt realistic expectations of their child,  Encourage parents to seek early intervention,
and identify and implement appropriate resources education, and support in their community through
and supports. involvement in support groups, parent education,
agencies like The Arc
 validate parents’ and caregivers’ own needs, such
as encouraging respite care through trusted family
members, friends, or their local department of
social services.

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AUTISM SPECTRUM DISORDER (ASD) SPECIFIC DEVELOPMENTAL DISORDERS
 is marked by difficulties in three main areas: social  Developmental disorders in children can include
deficits, communications issues, and restricted all or any of the following:
behaviors, with onset in the early developmental  learning disorders
stages, that impair everyday functioning  communication disorders
 more commonly in males  and motor skills disorders.
ASSESSMENT  They can be diagnosed at varying times during
Common Symptoms in the Child With Autism Spectrum childhood.
Disorder  Learning disorders affect keystone academic
 Failure to develop social relations skills in reading, mathematics, or writing.
 Stereotyped behaviors such as hand gestures  Children need IEPs to help them achieve at the
 Extreme resistance to change in routine highest level possible and prevent low self-esteem
 Abnormal responses to sensory stimuli or deficits in social skills.
 Decreased sensitivity to pain  Communication disorders involve problems of
 Inappropriate or decreased emotional expressions speech (expressive production); language (form,
 Specific, limited intellectual problem-solving function, and use) including expressive disorders,
abilities phonologic disorders, and stuttering; and
 Stereotyped or repetitive use of language communication, both verbal and nonverbal.
 Impaired ability to initiate or sustain a  Like learning disorders, these conditions can lead
conversation to a lack of self-esteem unless a child receives
 children with ASD who do speak, deficiencies in support and encouragement from parents,
grammatical structure, an inability to name objects teachers, and healthcare providers.
(nominal aphasia) MANAGEMENT
 Echolalia (repetition of words or phrases spoken  Speech therapy is usually effective to improve
by others) and concrete interpretation are also these disorders and allow children to achieve
common findings sufficiently to become successful adults, and early
 labile mood (crying occurs suddenly and is prevention is best.
followed immediately by giggling or laughing or
vice versa)
THERAPEUTIC MANAGEMENT
 Primary treatment for children with ASD includes
educational, compensatory, and behavior
modalities
 applied behavior analysis (ABA) treatment based
on the associations between behavior and
learning.
 Atypical antipsychotic medications, such as
risperidone (Risperdal) and aripiprazole (Abilify),
are approved by the U.S. Food and Drug
Administration (FDA) for children and teens with
ASD.
 Advantages of these agents include improving
sociability while decreasing tantrums, aggressive
outbursts, and self-injurious behavior
 Melatonin is an over-the-counter medication that
may be recommended to reduce sleep difficulties

CHECK FOR UNDERSTANDING (30 minutes)

You will answer and rationalize this by pair. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.

MULTIPLE CHOICE

1. The nurse is discussing the need for early diagnosis and treatment of autism spectrum disorder (ASD)
with parents of children suspected of having the condition. Which statement should the nurse include?

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 A. "Early diagnosis and treatment provide the only means for a cure of ASD."
B. "Early diagnosis and treatment give your child the best chance of becoming a fully functioning adult."
C. "Early diagnosis and treatment provide the best way to ensure that your child can be admitted to an assisted
living facility as an adult."
D. "Early diagnosis and treatment prevent your child from developing any other mental condition."
ANSWER: B
RATIONALE: Early diagnosis and treatment of ASD provides access to treatments and therapies that give patients the
best chance to become fully functioning adults.

2. The nurse is assessing a 3-year-old child for symptoms of autism spectrum disorder (ASD). Which
assessment finding should lead the nurse to question the diagnosis?
A. Inability to react accordingly to social clues
B. Engages in repetitive behaviors
C. Comprehends language well beyond the complexity of age
D. Displays self-destructive behavior
ANSWER: C
RATIONALE: While children with autism may have high IQs, they do not understand the nuances of language and
therefore do not comprehend well beyond the complexity of their age, so this is not a clinical manifestation that supports
the diagnosis.

3. The nurse is presenting to a group of parents whose children are suspected of having autism spectrum
disorder (ASD). Which statement by the nurse should be included?
A. "The features of autism are typically apparent by the time a child is 3 years of age."
B. "You should notice deficits in your child by the age of 5."
C. "A feature of ASD is the ability to understand nonverbal behavior."
D. "A child with ASD should be able to successfully engage in imaginative play."
ANSWER: ________
RATIO:__________________________________________________________________________________________
_________________________________________________________________________________________________
______________________________________________________________

4. The nurse is addressing a group of parents whose children are suspected of having autism spectrum
disorder (ASD). Which statement by the parents indicates that additional teaching is necessary?
A. "The essential features of autism are typically noticed by 3 years of age."
B. "We should notice deficits in our children by the age of 5."
C. "A feature of ASD is the inability to understand nonverbal behavior."
D. "A child with ASD should will not engage in imaginative play."
ANSWER: ________
RATIO:__________________________________________________________________________________________
_________________________________________________________________________________________________
______________________________________________________________

5. The parents of a child diagnosed with autism spectrum disorder (ASD) are trying to determine why their
child has the disorder. In response, the nurse should include which etiology?
A. Genetic factors
B. Chemical factors
C. Psychological factors
D. Toxins
ANSWER: ________
RATIO:__________________________________________________________________________________________
_________________________________________________________________________________________________
______________________________________________________________

6. The graduate nurse is caring for a family with a child who was recently diagnosed with autism spectrum
disorder (ASD) and is discussing treatment options for the child. Which goal of collaborative therapy
would require correction from the preceptor?
A. Advocating for parent support and coping groups

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 B. Use of focusing techniques and behavior management
C. Implementing treatments that decrease maladaptive behaviors such as rigidity and stereotype
D. Behavior modification through electroconvulsive therapy
ANSWER: ________
RATIO:__________________________________________________________________________________________
_________________________________________________________________________________________________
______________________________________________________________

7. The nurse is caring for a child with an autism spectrum disorder (ASD). For which condition should the
nurse screen the patient?
A. Depression
B. Schizophrenia
C. Diabetes mellitus
D. Gout
ANSWER: ________
RATIO:__________________________________________________________________________________________
_________________________________________________________________________________________________
______________________________________________________________

8. The nurse is teaching about autism spectrum disorder to a group of community members. Which risk
factor should the nurse include?
A. Maternal age over 40
B. Female gender
C. Paternal age less than 20
D. Parents who are close in age
ANSWER: ________
RATIO:__________________________________________________________________________________________
_________________________________________________________________________________________________
______________________________________________________________

9. Which of the following is not part of the Diagnostic and Statistical Manual of Mental Disorders, Fifth
Edition (DSM-5) diagnostic criteria for autism spectrum disorder (ASD)?
A. Stereotyped or repetitive motor movements, use of objects, or speech
B. Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment
C. Hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and
inappropriate for the person’s developmental level
D. Highly restricted, fixated interests that are abnormal in intensity or focus
ANSWER: ________
RATIO:__________________________________________________________________________________________
_________________________________________________________________________________________________
______________________________________________________________

10. Mental health is defined as:

A. The ability to distinguish what is real from what is not.
B. A state of well-being where a person can realize his own abilities can cope with normal stresses of life and
work productively.
C. Is the promotion of mental health, prevention of mental disorders, nursing care of patients during illness and
rehabilitation
D. Absence of mental illness
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________

RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among
yourselves. Write the correct answer and correct/additional ratio in the space provide d.

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 1. ANSWER: ________
RATIO:_______________________________________________________________________________________
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2. ANSWER: ________
RATIO:_______________________________________________________________________________________
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3. ANSWER: ________
RATIO:_______________________________________________________________________________________
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4. ANSWER: ________
RATIO:_______________________________________________________________________________________
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5. ANSWER: ________
RATIO:_______________________________________________________________________________________
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6. ANSWER: ________
RATIO:_______________________________________________________________________________________
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7. ANSWER: ________
RATIO:_______________________________________________________________________________________
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8. ANSWER: ________
RATIO:_______________________________________________________________________________________
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9. ANSWER: ________
RATIO:_______________________________________________________________________________________
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10. ANSWER: ________
RATIO:_______________________________________________________________________________________
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LESSON WRAP-UP (5 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.
PERIOD 1
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
PERIOD 2
17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
PERIOD 3
32 33 34 35 36 37 38 39 40 41 42 43 44 45 46

AL STRATEGY: CAT 3-2-1

3-2-1
Three things you learned:

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 1. __________________________________________________
2. __________________________________________________
3. __________________________________________________

Two things that you’d like to learn more about:

1. __________________________________________________
2. __________________________________________________

One question you still have:

1. __________________________________________________

(For next session, review Chapter 54: Nursing Care of a Family When a Child Has an Intellectual or Mental Health
Disorder-Anxiety Disorders p. 1546 and Eating Disorders-1547)

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