Mental Health Nursing

1. Mental retardation
Prepared by :
Laxmi Dahal

2. Introduction
• Also known as mentally handicapped or
mentally retarded.
• In nepali also called as Lethebro, latheuro,
gwajengro, murkha etc but better word is “
susta manasthithi”.

3. Definition
• Mental retardation is a condition of arrested
or incomplete development of the mind,
which is especially characterized by impaired
of skills, manifested during developmental
period that contribute to cognition, language,
motor and social abilities.
Acc to ICD 10

4. Causes
Approximately 30% of cases seen clinically, the
etiology cannot be determined.
5 major causes has been implicated:
1. Genetic condition (5%) :
- Down syndrome
2. Problems during pregnancy (30%) :
- iodine and folic acid deficiency
- severe malnutrition

5. - Use of substance like: alcohol, nicotine, cocaine.
- Medical exposure (eg: anticonvulsants, warfarin,
thaladomides, phenytoin and radiation)
- Maternal illness :toxemia, DM, hypoglycemia,
hypothyroidism.
- Maternal infection : rubella, STIs, toxoplasmosis,
HIV
- Lack of oxygen to brain before birth.

6. 3. Problems at birth (10%) :
- birth trauma
- prolonged labor
- complicated labor
- instrumental delivery
- premature birth
- very low birth weight
- asphygia
- Rh incompatibility

7. 4. Health problem after birth and during infancy
(5%):
- whooping cough
- brain infections as meningitis, encephalitis
- severe and prolonged malnutrition
- febrile convulsion
- head injury
- exposed to poisons like lean or mercury
- neurological damage

8. 5. Social, cultural and environmental
factors(5%):
- lack of app sensory stimulation for
intellectual development.
- low socio-economic status- poverty-
malnutrition- inadequate medical care
- inadequate care taker
- child abuse

9. Clinical feature
Features depends upon severity of the degree of
MR:
• Sit up, crawl or walk later than other children
• Learn to talk later, or have trouble speaking or
decreased learning ability.
• Find it hard to remember things.
• Difficulty in understanding social rules
• Difficulty in solving problems and thinking
logically

10. • Not understanding how to play for things
• Inability to meet educational demand of
school
• An intelligence quotient (IQ) score below 70
on a standarlized IQ test.

11. Degree of mental retardation acc to
ICD 10
1. Mild MR: IQ (50-69)
2. Moderate MR: IQ (35-49)
3. Severe MR: IQ (20-34)
4. Profound MR: IQ below 20

12. Diagnosis
• History taking (developmental milestones
below and above years)
• Physical examination (too small/ large head,
slanting eyes, thick protruding tongue, rough
skin, low set ear)
• Level of intelligence and ability to learn:
IQ= Mental age (MA) X 100
Chronological age (CA)

13. • Mental age reflects a person’s level of
intellectual functioning
• Chronological age is the person’s actual age in
year.
• Normally, mental age of a certain age is the
same as the child’s chronological age.
• Normal/ average IQ is (90-109).

14. Complication
• Social isolation
• Inability to care of self
• Inability to interact with others appropriately

15. Management
1. Assessment
2. Proper information to the parents :
- They will be in shock after the diagnosis, so
councel them
- Help them to understand about the condition
- Emotional support to the child
- Explain the condition is not curable, so visits
to dhami/ doctors is not necessary.

16. - Training them will help
- Encourage them to live a normal life as others,
let them do as much they can
3. Help the family to train the child:
- Training in language development (speech,
group participations, communication skills)
Training in motor development: (throwing balls,
skipping, using hammer)

17. - Health habits: (daily self care like care of face,
hair, nails, toileting, dressing etc)
- Training in social development: (good
manners, good table manners, caring personal
stuffs, sincerity in performing duties etc)
- Give your child routine (acc to her age,
attention span). Teach them skills step by step.

18. eg: take a brush hold it in your hand- tell the child
to hold it in similar manner- put paste on your
brush and child’s brush- take near your mouth-
make the child repeat it- open your mouth put
teeth together and brush-repeat the activities for
several days and weeks.
• Follow up these child and family regularly.
• Find out what skills child is learning at school and
follow it at home. Eg: if child is learning lesson
about money, take child to supermarket, help
them to count and pay money.

19. • Find out opportunities in community for social
activities like: recreation, sports etc
4. Special education
- Mild and moderate mental retarded child can
have a planned education program in a special
school.
5. Vocational training:
- This job can be manual depending on the
capacities of the individual.