Sensory+Cognitive+Issues

Cognitive Sensory Rounds

Fragile X Syndrome media type="youtube" key="_qRwdnP1r-Y" width="604" height="451"

Fragile X syndrome (FXS), also known as Martin-Bell syndrome, or Escalante's syndrome Genetic Half autistic Intellectual disability Physical: Long face, large ears, Behavioral characteristics: Social anxiety,

Down Syndrome

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media type="youtube" key="cZ_i3yioHlo" width="560" height="315" Chromosomal abnormality – trisomy 21 – accompanying medical conditions include: Heart malformations (40-45%), TEA, Hirschsprungs, thyroid or immune dysfunction, leukemia
 * Down Syndrome: **

Enlarged anterior fontanel Small round head with flattened forehead Upward outward slant to eyes with depressed nasal bridge <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Short stature, short neck, protruding tongue, transverse palmar crease <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Muscle weakness, hypotonia <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Mental capacity varies
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Assessment findings: **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Chromosome analysis, echocardiogram, vision/hearing tests, thyroid function tests
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Tests: **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Assist parents with coping <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Assist with feeding due to possible hypotonia <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Monitor growth and development <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Refer as needed and provide necessary <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Support if surgeries needed for heart or strabismus
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Nursing Care: **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">**Education** to include: respiratory care, skin care, diet to prevent constipation, obesity, can have vision and hearing problems, Respiratory infections due to hypotonia and mouth breathing

<span style="color: #ca2121; font-family: 'Times New Roman',Times,serif; font-size: 170%;">Autism Spectrum Disorders media type="youtube" key="FuWWie1DlJY" width="546" height="408"

<span style="color: #ca2121; font-family: 'Times New Roman',Times,serif; font-size: 170%;">Sensory Processing Disorder

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<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Possible genetic component <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Delays in social interaction, social communication, imaginative play <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Spends time alone, avoids eye contact, withdraws from physical contact, labile emotions <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Sensory sensitivity <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Delays in speech, may grunt or hum, echoalia <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Unusual attachment to objects <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Distress when routines or surrounding changed, repetitive movements
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Autism Spectrum Disorder: **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Checklist for Autism in Toddlers (CHAT) <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Refer to speech, OT, PT, support groups, respite if needed <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Assist with behavior modification <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Decrease environmental stimulation <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Introduce to new situations slowly
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Assessment: **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Medications may be used to help with compulsions, labile emotions and attention problems: SSRIs, melatonin

<span style="color: #ca2121; font-family: 'Times New Roman',Times,serif; font-size: 170%;">Hearing

<span style="color: #ca2121; font-family: 'Times New Roman',Times,serif; font-size: 170%;">media type="youtube" key="7O-adw-HyrQ" height="315" width="560"

media type="youtube" key="3yQzm_36DMY" width="560" height="315" <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Infants are screened at birth <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Can be congenital (toxic sub in pregnancy, anatomic malformations, Downs syndrome) or acquired (ototoxic substances, chronic ear infections, foreign bodies) <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Conductive (physical blockage) or sensorineural (interference with nerve pathways)
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Hearing impairments: **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">No startle reflex <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Failure to respond to noise <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">No vocalization by 7 months <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">No response to spoken word <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Later children will gesture rather than speak <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Irritable, angry since unable to gain caregivers attention <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Withdrawn, inattentive
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Assessment: **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Hearing aids <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Surgery
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Treatments can include: **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Use sign language or interpreter to communicate with child <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Assess environment for safety issues <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Refer for support
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Nursing care: **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">The earlier vision and hearing problems are identified the better the outcome!

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<span style="color: #ca2121; font-family: 'Times New Roman',Times,serif; font-size: 170%;">Visual

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<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Can be attributed to prenatal conditions such as rubella, postnatal conditions such as retinopathy of prematurity or chronic conditions such as sickle cell or JIA.
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Vision Difficulties: **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Myopia – nearsighted <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Hyperopia – far sighted <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Astigmatism – uneven vision <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Amblyopia – lazy eye – decreased acuity in one eye <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Stabismus: inward or outward deviation of the eye <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Nystagmus – involuntary movement of eyes, ‘dancing eyes’ <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Cataracts – Decreased ability to see clearly with gray opacity of the lens, absent red reflex <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Glaucoma – Loss of peripheral vision, halos, red eye, excessive tearing, photophobia, pain, enlarged eyeball

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<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Farsighted, nearsighted, astigmatism may need corrective lens <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Amblyopia and strabismus may need patches or corrective surgery <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Glaucoma may need optic drops or surgery <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Cataracts require surgery
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Treatments: **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Visual screening with Snellen chart or preschool chart <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">10 feet away, start at bottom until can read a line correctly identifying 4 of 6 characters, then back to the top and move down until can no longer pass a line
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Tests: **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Partial visual impairment - 20/70 – 20/200 <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Legal Blindness – visual acuity of 20/200 or worse or a visual field of 20 degrees or less

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Color vision is assessed with the Ishihara or Hardy-Rand Rittler – identify number or image embedded in colors

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Peripheral vision – Pencil is moved from beyond field of vision into the field until the patient can see it. Patient says stop and angle is measured. Angle should be 50 degrees upward, 70 degrees downward, 60 degrees nasally, and 90 degrees temporally

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Cover test: Patient asks to cover eye and look at object 13 inches away. Cover is removed and eye is observed for movement. (There should not be any movement).

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Ocular alignment – Corneal light reflex – light shone in eye from 16 inches, reflected light should be in the same location in each eye.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Assess for eye rubbing, head tilting during reading or eye exams <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">If patching is required pretend to be a pirate <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">If surgery is required protective goggles after to prevent rubbing <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Always introduce self before touching child <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Orient child to new environment, d <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">escribe environment to patient, do not move articles without telling patient, clock for plate <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Promote independence with needed services <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Interventions to assist with sensory loss <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Encourage social interaction <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Bright colors and large print, visual and nonvisual aids, large print books, recorded books, lighted mirror <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Regular eye exams, glasses if appropriate, do not rub eyes, artificial tears, assist with, teach eye drop administration
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Nursing Care: **

<span style="color: #11c5c5; font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Nursing Diagnosis: <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Disturbed sensory perception <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Risk for injury <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Social Isolation <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Diminished eyesight affects independence, leads to a lack of stimulation, inability to read, fear of blindness, coping, anxiety

<span style="color: #ca2121; font-family: 'Times New Roman',Times,serif; font-size: 170%;">Foreign body in eye/ Eye injuries

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<span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 130%;">Fragile X located at http://youtu.be/_qRwdnP1r-Y

Downs syndrome http://youtu.be/XGZnO5Im5bM

Down's Syndrome with Ace http://youtu.be/cZ_i3yioHlo

Autism Spectrum disorder located at http://youtu.be/FuWWie1DlJY

Sensory processing disorder http://youtu.be/ws5NMPKCvZI

Hearing/Sound http://youtu.be/7O-adw-HyrQ

What its like not to hear https://youtu.be/3yQzm_36DMY Hearing loss http://youtu.be/DLo8cEUNQi0

Vision http://youtu.be/gvozcv8pS3c https://youtu.be/p0BBRbvde2U?list=PL0845054182A36EFE Retinoblastoma http://youtu.be/XZQ2Za5Mwc8

Eye Injuries http://youtu.be/9BwcSFhfXw8

<span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Turner Syndrome <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">[]

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