MMR Patient with special challenge Dr. Miada Mahmoud Rady.
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Transcript of MMR Patient with special challenge Dr. Miada Mahmoud Rady.
MMR
Patient with special challenge
Dr. Miada Mahmoud Rady
MMR
Care of Patients with Cognitive, Sensory, or Communication
Impairment
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Developmental disability
• Definition: Defined by CDC as a diverse group of severe
chronic conditions due to mental and/or physical impairments.
• Characteristic :
1. Impairments appear prior to age 22.
2. Usually continue throughout lifetime.
3. Numerous human attributes are adversely impacted.
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4. Certain conditions have uncertain causes (autism, for
example).
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Developmental Delay
• Definition : failure of child or an infant to reach a particular
developmental milestone by the expected time.
• Signs of problems may be in one developmental area or in
multiple areas.
• Delays are linked to many causes of developmental disabilities.
• Depending on causes, delays may persist into adulthood or
resolve as medical or social situation improves
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Down syndrome
• Definition : An inherited genetic disorder known as trisomy
21characterized by :
A. Developmental delay
B. Cognitive impairment
C. Unusual physical features ( Flattened face and nose ,Short
neck , Upward slanting eyes , Protruding tongue and Single
crease on hand palms ).
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• Risks include:
1. Sibling or mother with Down syndrome.
2. Older maternal age at time of conception.
• May have a shorter life expectancy
• Cognitive deficits range from barely noticeable to profound
impairment.
• May function relatively independently or require constant
assistance with basic tasks
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• Chromosomal abnormality in down may cause:
1. Structural heart defects
2. Seizures
3. Numerous gastrointestinal problems
4. Speech alterations
5. Hearing loss
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Mental retardation
• Definition : Cognitive disorder appearing during childhood,
accompanied by lack of adaptive behaviors including Ability to
live and function independently and Interact successfully with
others.
• A variety of tests are available, but intelligence quotient (IQ)
below 70 is a defining characteristic.
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Autism
• A condition involving developmental delay.
• Increased rates of diagnosis is possibly due to:
1. Better awareness and screening.
2. Actual increase in occurrence.
• May be completely nonverbal throughout their lifetime or during
periods of stress
• Developmental regression with no other cause should raise
concern.
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Management
A. Patients may react bizarrely or aggressively to commotion and
excess stimuli.
B. Physical contact should be:
1. Preceded with careful explanation.
2. Done from distal to proximal.
C. Questions to the patient should be repeated in a variety of
ways to ensure consistent response.
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D. Patients may show minimal reactions to pain or great
discomfort to minor physical contact or injuries.
E. Helpful to include caregivers in:
• Assessment
• Treatment
• Transport
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Hearing impairment
• Can be congenital or acquired.
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Congenital
1. Genetic factors cause 50% of congenital hearing loss in children.
2. Remaining 50% of congenital hearing loss is caused by:
Maternal infection
Rh incompatibility
Hypoxia
Maternal diabetes
Pregnancy-induced hypertension
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Acquired hearing loss
A. Majority of acquired hearing loss is from excessive exposure
to loud noise.
B. Other causes include:
1. Various infections (otitis media and viral infections)
2. Tumors (acoustic neuroma)
3. Ototoxicity of many medications
4. Diseases such as Meniere disease
5. Degenerative processes of aging
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Complication
1. Inhibit communication.
2. Limit social interaction.
3. Interfere with infant development.
4. Render many safety and warning devices
ineffective
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Types of hearing loss
1. Conductive hearing loss: inability of sound to travel from
outer ear through to the inner ear
2. Sensorineural hearing loss: problems with uptake of
sound through tiny hairs within the ear and subsequent
conduction of nerve impulses.
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