Mental retardation
As defined by the American Association on mental Retardation ( AAMR) , mental
retardation is significantly sub average function coexisting deficits in adaptive
behavior and manifested during the developmental period ( before age 18).
Mental retardation is classified by AAMR Based on the IQ level as follows:
a. Mild ( educable mentally retarded ): IQ of 50-55 to about 70.
b.Moderate ( trainable mentally retarded ) : IQ of 35-40 to 50- 55.
c. Sever : IQ OF 20-25 TO 35-40
d. Profound : IQ below 20-25.
Etiology and incidence :
1.The most common development disability , mental retardation affects up to 3% of
the population .
2.Causes are classified as idiopathic , acquired , inherited or genetic , and endocrine
as follows :
a. Idiopathic : all cause of unknown cause ( the most common classification).
b. Acquired : prenatal infections ( e.g. mental infection such as rubella toxoplasmosis ,
syphilis ) other maternal illness : teratogenic effects of prescription or nonprescription
drugs used by the mother during pregnancy , birth injury , prenatal , or postnatal ,
hypoxia , kernicterus , trauma in infancy or childhood , malnutrition , brain tumor ,
sever psychosocial or psychological deprivation .
c. Inherited or genetic : chromosomal abnormalities such as Down's syndrome .
d. Endocrine : congenital hypothyroidism .
Assessmental findings
1.Clinical manifestations vary according to the child's age general signs include
development delays in motor , social , language or cognitive skills
2. Diagnostic evaluation typically include some or all of the following:
a. Neurologic examination . including CT
b. Radiologic studies to detect lesions.
c. Endocrine studies including urine screening for abnormal metabolic
d. Developmental screening tests such as the Denver developmental to identify
apparent developmental delays .
e. Intelligence evaluation with standardized tests such as the Stanford – binet
intelligence Scale .
f. Adaptive behavior evaluation using tools such as the AAMD adaptive behavior scale
.
g. Chromosomal analysis and genetic screening , in cases of a family history of mental
retardation or chromosomal abnormalities.
NURSING DIAGNOSIS:
1.Impaired verbal communication.
2. Altered family processes
3. Altered growth and development
4. Altered health maintenance
5. Hight risk for infection
6. Altered role performance
7. Self- care deficit
8. Hight risk for impaired skin integrity
9. Impaired social interaction
10. Social isolation.
Planning and implementation :
1 .support the family at time of initial diagnosis by actively listening to their feeling
and concerns and assessing their composite strengths .
2. Perform a task analysis before attempting to teach the child any new task , break
tasks into specific steps with each step building on the last
3. Facilitate the child's self-care by encouraging parents to enroll the child in an early
stimulation program establishing a self-feeding program , initiating independent
toileting and establishing an independent grooming program .
4. Promote optimal development by encouraging self- care goals and emphasizing the
universal needs of children such as play , social interaction , and parental limit setting.
5. Promote anticipatory guidance and problem solving by encouraging discussion
regarding physical maturation.
6. Assist the family in planning for their child's future needs , refer them to available
community agencies.
7. Provide patient and family teaching covering:
a. Normal development milestones and appropriate stimulating activities including
play and socialization.
b. The need for patience with the child's slow attainment of development milestones
.
c. Information regarding stimulation , safely and motivation.
d. Measures to help prevent skin breakdown keeping the child's skin clean and well
lubricated applying lip balm during dry weather and using soap sparingly.
e. Information regarding normal speech development and how to accentuate
nonverbal cues , such as facial expressions and body language , to help cue speech
development.
f. The need for discipline that is simple , consistent and appropriate to the child's
developmental level.
g. Demonstration as a better way of fostering learning than verbal explanation since
the child is better able to deal with concrete abject than abstract concepts .
h. The role of positive self- esteem, built by accomplishing small success in motivating
the child to accomplish other tasks