2. Objectives
• At the end of this presentation the student will be able to:
• Define visual & hearing impairment and down’s syndrome.
• Enlist causes, signs and symptoms of the above cognitive disorders.
• Discuss medical diagnosis and treatment for these mentioned disorders.
• Make nursing diagnosis and nursing interventions for the above disorders.
3. Vision impairment
• Vision impairment is defined as a limitation of one or more functions of the
eye (or visual system).
• The most common vision impairments affect:
– The sharpness or clarity of vision (visual acuity)
– The normal range of what you can see (visual fields)
– Colour
4. Causes of vision impairment
• Genetic conditions
• Maternal infections during pregnancy (e.g., rubella,
cytomegalovirus)
• Consequences of disease (e.g., diabetes, glaucoma,
trachoma)
• Birth complications
• Trauma, poisoning, and tumors
• Diabetic retinopathy
• Ageing and age-related conditions such as macular
degeneration, cataracts and optic nerve atrophy.
5. Signs and Symptoms
• Double vision
• Cloudy or blurry vision,
• Difficulty in colors
differentiation
• Difficulty reading or
watching TV
• Strabismus
• Poor vision
• Unequal size of pupil
• Difficulty in focusing
• Frequent blinking
6. Diagnosis
• Simple tests that an ophthalmologist may perform include:
– Visual acuity test. Aperson reads an eye chart to measure how
well he or she sees at various distances.
– Visual field test. Ophthalmologists use this test to measure side,
or peripheral, vision.
– Tonometry test. This test determines the fluid pressure inside
the eye to evaluate for glaucoma.
7. Treatment
• An eye condition that is likely to cause visual impairment, so by treating the
condition can reduce incidence of visual impairment.
• Options may include eyeglasses, contact lenses, and eye drops or other
medicines.
• In some cases, surgery may be required. For instance, cataracts are often
treated by removing the clouded lens and replacing it with an intraocular lens
8. Nursing diagnosis
• Risk for Injury related to impaired vision
• Risk for Ineffective Family Coping related to child’s prolonged disability
from sensory impairment
• Risk forAltered Growth and Development related to impaired vision
• Sensory/PerceptualAlteration related to altered reception, transmission, and
integration resulting from retinopathy.
9. Nursing interventions
• Provide kinaesthetic, tactile, and auditory stimulation
during daily care.
• Evaluate environment for potential safety hazards.
• Eliminate safety hazards and protect the child from
exposure.
• Assess growth and development to identify the child’s
strengths and needs.
• Provide explanation of visual impairment as appropriate.
• Assist parents to plan for meeting developmental, and
safety needs of their visually impaired child.
10. Hearing impairment
• Hearing impairment is the decreased ability to hear and discriminate among
sounds. The level of impairment can vary from mild to severe or total loss of
hearing.
• It is one of the most common birth defects.
• Hearing impairment may be
– Congenital hearing impairment or
– Acquired hearing impairment.
13. Etiology
Congenital causes
• Maternal rubella or certain other
infections during pregnancy
• Birth asphyxia
• Severe jaundice in the neonatal
period.
Acquired causes
• Infectious diseases such as
meningitis, measles and mumps
• Chronic ear infection
• Otitis media
• Head injury
14. Signs and Symptoms
Infants
• Failure to surprise at
loud sounds.
• Not turning toward the
sound of a voice at
about 6 months of age
• Lack of babbling by 12
months of age
• Failure to respond to
name by 12 months
• Not using single word
by 18 months of age
Older children
• Develop vocabulary
more slowly than their
peers.
• Often ask for words to
be repeated
• Turn on the TV too loud
• Appear inattentive at
school and have trouble
learning to read
• Poor hearing
15. Diagnosis
Newborns and infants
• Automated auditory brainstem
response (AABR) test
• Otoacoustic emissions (OAE) test
Older children
• Audiometry
• Whisper test
• Rinn’s test
• Weber’s test
• Watch test
16. Treatment
• Achild with hearing impairment should begin receiving treatment before 6
months of age.
• Treatment options are available
– Hearing aids
– Cochlear implant
– Surgery
17. Nursing diagnosis
• Sensory/perceptual alterations (auditory) related to hearing loss.
• Impaired verbal communication related to congenital hearing
impairment.
• Risk for activity intolerance related to hearing loss and impaired
verbal communication.
18. Nursing interventions
• Label the patient's chart so all hospital personnel are aware of her
hearing loss.
• Ask the patient what communication methods work best for her.
• Face the patient and get her attention before speaking.
• Check that hearing aids are in place and batteries are functioning.
• Talk with patient with out wearing a mask.
19. Down syndrome
• Down syndrome (DS), also called Trisomy 21, is a condition in
which extra genetic material causes delays in the way a child
develops, both mentally and physically.
• It affects about 1 in every 800 babies.
23. Clinical features
• Small ears that fold over at the top.
• Small, flattened nose.
• Small mouth, making tongue appear large.
• Short neck.
• Small hands with short fingers.
• Low muscle tone (hypotonia).
• Single deep crease across center of palm.
• Looseness of joints.
• Delayed closure of fontanels.
24.
25. Clinical features cont….
• Delayed eruption of teeth.
• Small skin folds at the inner corners of the eyes.
• Excessive space between first and second toe.
• In addition, down syndrome always involves some degree of mental
retardation.
• Compromised immune response.
• Congenital heart diseases.
26. Diagnosis
• Characteristics clinical features.
• Diagnostic test during pregnancy includes:
– Chorionic villus sampling (CVS): sample
of the placenta, either through the cervix or
a needle inserted in the abdomen.
– Amniocentesis: removal of a small amount
of amniotic fluid through a needle inserted
in the abdomen.
– Percutaneous umbilical blood sampling
(PUBS): this test uses a needle to retrieve a
27. Management
• There is no known treatment for this disorder.
• Therapy is directed towards specific problems e.g. antibiotics for
infection, digoxin or cardiac surgery for heart problems.
• Support for parents and family advice is important.
28. Nursing diagnosis
• Potential for Injury due to poor vision, hearing and hypotonia.
• Potential for infection related to increased susceptibility for illness secondary
to compromised immune system and heart disease.
• Activity Intolerance related to cardiac condition
• Self care deficit related to inability to doADL’s due to hypotonia.
29. Nursing interventions
• Assess for associated problems.
• Administer medications which may be prescribed for
associated problems.
• Avoid exposure to infection.
• Assists infants in feeding because feeding difficulties
occur due to a protruding tongue and hypotonia.
• Encourage fluids and foods rich in fiber because
constipation results from decreased muscle tone.
• Provide good skin care because the skin is dry and
prone to infection.
30. References
• National Institute on Deafness and blindness. Hearing aids. 2002
Feb. NIH Pub. No. 99-4340.http:
• //www.nidcd.nih.gov/health/hearing/hearingaid.asp.
• Basis of paediatric by Dr PervezAkbar Khan.
