childhealthnursing

1. MENTAL RETARDATION

2. Mental Retardation
Mental retardation is a condition of arrested or
incomplete development of the mind, which is
especially characterized by impairment of skills
manifested during the developmental period,
which contribute to the overall level of
intelligence, i.e. cognitive, language, motor, and
social abilities.
Retardation can occur with or without any other
mental or physical disorder.

3. • dvelopmental disability that first appears
under the age of 18
• it is defined as a level of intellectual
functioning that is below average and results
in significant limitation in person’s daily living
skills

4. Causes
majority of cause are idiopathic. known causes
are categorised as:
• Prenatal factors
• natal factors
• postnatal factors

5. Prenataal Factors
❑Use of teratogens in the first trimester of
pregnancy
❑TORCH positive during pregnancy
(Toxoplasmosis, Rubella, CMV, Herpes
simplex, HIV and Syphilis)
❑Placental insufficiency,
❑Radiation during pregnancy

6. Natal Factors
• Birth injuries
• Hypoxic, ischemic encephalopathy
• Intracerebral hemorrhage
• Prematurity
• Low birth weight

7. Postnatal
• Infections of CNS
• Head injuries
• Thrombosis of cerebral vessels
• Post-vaccinal encephalopathies
• Kernicterus
• Hypoglycemia
• Hypoxia
• Hypothyroidism
• Malnutrition
• Child abuse, autism

8. Classification of Mental Retardation
• Profound Mental Retardation: 0-20 IQ
❑May attain mental age of young infant.
❑Requires total care.
• Severe Mental Retardation: 21-35 IQ
❑Barely trainable: can achieve a mental age of 0
to 2 years.
❑Totally dependent on others and in need of
custodial care.

9. Contd. of MR
• Moderate Mental Retardation:36-50 IQ
❑Trainable: can achieve a mental age of 3 to 7
years.
❑Can learn the social skills can be trained to work
in a sheltered workshop.
• Mild Mental Retardation:51-70 IQ
❑Educable: can achieve a mental age of 3 to 12
years.
❑Can learn to read, write, do arithmetic achieve a
vocational skill, and function in society.

10. Borderline
❏ IQ between 71-90
❏ risk to develop MRbut not mentally retarded
at
❏ slow learners and need educational
assisstance

11. Clinical Findings
• Mental age is below the chronological age
• Delayed milestones: infant fails to suck, head lag
after 4 to 6 months of age; slow in learning ; slow
to respond to new stimuli; slow or absent speech
development
• Mental abilities are concrete; abstract ability is
limited; may have echolalia (meaningless
repetition of another person's spoken words

12. Contd…
• Lack power of self-appraisal; doesn’t learn
from errors
• Cannot carry out complex instructions; learns
rote responses and socially acceptable
behavior
• Doesn’t relate to peers; more secure with
adults; comforted by physical touch
• Short attention span; but usually attracted to
music.

13. Contd.
• Behaviour syndrome of cerebral dysfunction;
hyperactivity, poor concentration, poor
memory, impulsiveness, awkward clumsy
movements, disturbed sleep, emotional
instability

14. Diagnosis
History taking
• Developmental delay
• Hyperactivity
• Short attention span
• Distractibility
• Poor concentration
• Poor memory
• Impulsiveness
• Awkward clumsy movements

15. Contd…
Family history
Physical Examination
• Developmental delay
• Various syndromes in which mental handicap
is a feature should be looked for
⮚Cretinism
⮚Dysmorphic states
⮚Rubella syndrome
⮚& Down Syndrome

16. Contd…
• Investigations include: blood, urine, chromosomal
analysis and metabollic screening
• Investigations for hypothyroidism;thyroid
hormone, TSH estimation
• Chromosomal studies for suspected chromosomal
anomalies, Down Syndrome, Fragile X Syndrome

17. Contd….
• Blood examinations for appropriate enzymes:
excessive or deficient metabolites
• Serological tests for intrauterine infections
❑X-ray skull
❑CSF examination to rule out infections of CNS
❑EEG
❑Computed tomography to rule out underlying
causes
❑MRI

18. Prevention
• Genetic Counseling: The risk of disorders with
autosomal recessive inheritance is high in
consanguinous marriages.
• Vaccination of girls with rubella vaccine
• Good antenatal care and advice on avoidance of
teratogens, hormones, iodides, and anti-thyroid
drugs.
❑Mothers should be protected from contact with
patients suffering from viral diseases.

19. Contd.
❑When indicated, amniocentesis may be done
for study of amniotic fluid for tissue culture,
chromosome studies, alpha fetoprotein and
enzyme for prenatal diagnosis.
• During labor, good obstetric and postnatal
supervision is essential to prevent occurrence
of birth asphyxia, injuries, jaundice and sepsis.

20. Therapeutic Interventions
• Prevent causes that damage brain cells such
as hypoxia, untreated PKU
• Identify condition early
• Minimize long term consequences: treatment
of associated problems; infant stimulation;
parental education

21. Nursing Management
A. Assessment
1. Developmental screening
2. Associated illnesses/risk factors

22. Nursing Diagnosis
• Altered family process related to having a
child who is cognitively impaired
• Altered family coping related to
situational/developmental crisis
• Altered growth and development related to
impaired cognitive function

23. Implementation
• Minimize alteration in family process
❑Help the parents to consider the child’s
developmental age instead of chronological age.
❑Educate the parent regarding developmental age
❑Near adolescence, sexual feelings accompany
maturation and need to be explained according
to the child’s mental capacity
❑ Help to seek community resources

24. Contd…
• Increase family coping
❑Set realistic goals: teach by simple steps for
habit formation rather than for understanding
❑Break down the process of skills learning into
simple steps
❑Ensure each step is learned completely before
teaching the child the next step
❑Praise accomplishments to develop the child’s
self-esteem

25. Contd….
• Help for the growth and development
❑Keep discipline simple
❑Develop routines
❑Praise accomplishments to develop the child’s
self-esteem
❑Provide dietary therapy if MR is due to
metabolic

26. Evaluation
• Performs activities of daily living at optimum
level.
• Family members make realistic decisions
based on their needs and capabilities.

27. References
• Saxton, D.F., Nugent, P.M., & Pelikan, P.K.
(1999). Mosby’s Comprehensive Review of
Nursing for NCLEX-RN, 16th ed.