Mentally challenged

33
MENTALLY CHALLENGED Rohini Pandey 1 st Year M.Sc Nursing KGMU Institute of Nursing

Transcript of Mentally challenged

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MENTALLY CHALLENGED

Rohini Pandey1st Year M.Sc NursingKGMU Institute of Nursing

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CONTENTS

1. Introduction2. Definition3. Classification of MR4. Aetiology & Risk factors MR5. Clinical Features of MR6. Treatment Modalities of MR7. Nursing Management

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INTRODUCTION

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CONCEPT OF CHALLENGED…….

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INJURY OR DISEASE IMPAIREMENT

DISABILITYCHALLENGED OR HANDICAPPED

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Classification…..

CHALLENGED

physically challenged

Mentally challenged

Socially challengedMonday, May 1, 2023 5

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1. Physically challenged Grouped according to

affected part of the body e.g. orthopedically handicapped, sensory handicapped, neurologically handicapped and handicapped due to systemic diseases.

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2. Socially challenged Social disturbances are

found in the form of broken family, loss of parents, poverty, lack of educational opportunities, environmental deprivation and emotional disturbances as lack of tender loving care.

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3. Mentally challenged Mentally challenged is now

used for the condition mental retardation. At least 2 - 3 percent of Indian population are mentally handicapped in any one form.

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Mentally challenged

• Intellectual disability (ID)/ intellectual development disorder (IDD)/mental retardation (MR).

• Appears in children under the age of 18.

• Characterized by low IQ/intellectual functioning Monday, May 1, 2023 9

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Definition Mental Retardation is a generalized

disorder, characterized by significantly impaired cognitive functioning and deficits in adaptive behaviors with onset before the age of 18.

IQ Score under 70.

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Epidemiology• 3 % of the world population is estimated to be mentally retarded.

• In India 5 out of 1000 children are mentally retarded (Indian

express 13th march 2001). More than 20 million children are

suffering with mental retardation.

• Mental retardation is more common in boys than girls.

• Mortality is high in severe or profound mental retardation due to

associated physical condition.

• Common in the age group of 2 -3 years. Peak in 10-12 years of age.

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TYPES OF MENTAL RETARDATION

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It is classified depending upon IQ level. IQ or Intelligence Quotient is calculated by the formula: MA X 100

CA

Type IQ range in mental retardation

1. Mild (Educable) 50 - 70

2. Moderate (Trainable) 35 - 50

3. Severe (Dependent retarded) 20 - 35

4. Profound (Life support) < 20

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Genetic factor

Prenatal factor

Perinatal factor

Postnatal factor

Environment&

sociocultural factor

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ETIOLOGYA. Genetic Factor• Chromosomal Abnormalities• Cranial malformation• Gross disease of brainB. Prenatal Factor• Infections• Endocrine Disorders• Physical Damage &

Disorders• Intoxication• Placental Dysfunction

C. Perinatal Factors• Birth Asphyxia• Prolonged or difficult birth• Prematurity• Kernicterus• Instrumental deliveryD. Postnatal Factors• Infections• AccidentsE. Environmental &

sociocultural Factors

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SIGNS AND SYMPTOMS• Impaired developmental

milestones.• Deficiencies in cognitive

functioning.• Reduced ability to learn or to meet

academic demands.• Expressive or receptive language

problems.• Psychomotor skill deficits.

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• Difficulty performing self-care activities.

• Neurologic impairment• Medical problems such as seizures• Low self-esteem, depression and

labile moods• Irritability when frustrated or upset• Acting-out behavior• Lack of curiosityMonday, May 1, 2023 16

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Diagnosing MR• History Collection• Physical Examination• Neurological Examination• Assessing Milestone Development• Investigations – Urine & Blood for

metabolic disorder, amniocentesis, hearing & speech evaluation, EEG, CT Scan.

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Treatment modalities for MR…… Behavior management. Environmental supervision. Monitoring the child’s developmental

needs and problems. Programs that maximize speech,

language, cognitive, psychomotor, social, self-care, and occupational skills.

Ongoing evaluation for overlapping psychiatric disorders, such as depression, bipolar disorder, and ADHD.

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• Family therapy to help parents develop coping skills.

• Early intervention programs for children younger than age 3 with Mental Retardation

Provide Day schools to train the child in basic skills, such as bathing and feeding.

Vocational Training

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PREVENTION:-PRIMARY

PREVENTION SECONDARY PREVENTION

TERTIARY PREVENTION

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PRIMARY PREVENTION ………

Preconception:- Genetic counseling, Immunization for maternal rubella. Blood tests to identify the presence of venereal

disease. Adequate maternal nutrition. Family planning in terms of size.

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PRIMARY PREVENTION ……During gestation:-

Prenatal care:-

Adequate nutrition, fetal monitoring and protection

from diseases.

Avoidance of teratogenic substances like exposure to

radiation and consumption of alcohol and drugs.

Analysis of fetus for possible genetic disorder:-

By amniocentesis, fetoscopy, fetal biopsy and

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PRIMARY PREVENTION ………

At delivery:-

• Delivery conducted by expert doctors and staff,

especially in cases of high risk pregnancy.

• Apgar scoring done at 1 to 5 minutes after the

birth of the child.

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PRIMARY PREVENTIONChildhood:-

• Proper nutrition throughout the developmental period and

particularly during the first 6 months after birth.

• Dietary restriction for specific metabolic disorders until no

longer needed.

• Avoidance of hazards in the child’s environment to avoid

brain injury from causes such as lead poisoning, ingestion of

chemicals, or accidents.

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SECONDARY PREVENTION……

• Early recognition of presence of mental retardation.

A delay in diagnosis may cause unfortunate delay in

rehabilitation.

• Psychiatric treatment for emotional and behavioral

difficulties.

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TERTIARY PREVENTION……

• This includes rehabilitation in vocational, physical and social areas according to the level of challenged.

• Rehabilitation is aimed at reducing disability and providing optimal functioning in a child with mental retardation.

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CARE AND REHABILITATION OF MR

The prevention and early detection of mentally handicaps.

Regular assessment of the mentally retarded persons attainments and disabilities.

Advice, support, and practical measures for families.

Provision for education, training, occupation, or work appropriate for each handicapped person.

Housing and social support to enable self-care.

Medical, nursing, Psychiatric and psychological services those who require them as outpatients, day patients or inpatients.

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NURSING MANAGEMENT1. Assessment

– History Taking– Physical Assessment

2. Nursing Diagnosis1. Delayed Growth and Development r / t abnormalities in cognitive function.

Goal: Growth and development goes according to stages.

Interventions :Assess the factors causing developmental disorders of children.

• Identification and use of educational resources to facilitate optimal child development.

• Provide stimulation activities, according to age.• Monitor the patterns of growth (height, weight, head circumference and refer

to a dietician to obtain nutritional intervention)

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2. Impaired Verbal Communication r / t delayed language skills of expression and reception.

Goal: Communication fulfilled in accordance stages of child development.

Interventions:Improve communication verbal and tactile stimulation.

• Give repetitive and simple instructions.• Give enough time to communicate.• Encourage continuous communication with the

outside world, for example: newspapers, television, radio, calendar, clock.

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3. Risk for Injury r / t aggressive behavior / uncontrolled motor coordination.

Goal: Indicates changes in behavior, lifestyle to reduce risk factors and to protect themselves from injury.

Intervention:Provide a safe and comfortable position.

• Difficult child behavior management.• Limit excessive activity.• Ambulate with assistance; give special bathroom.

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ANY QUESTION

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SUMMARIZATION

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