Nursing care of children with impaired cognitive function

  • Nursing care of children with impaired cognitive function
    • Educate child and family
      • Early intervention
        • A systematic program of therapy, exercises, and activities designed to address developmental delays in children with disabilities to help achieve their full potentials
        • The child’s education should begin as soon as possible, because it has been shown that increased and early intervention exposure relates directly to greater improvements in cognitive development
    • Teach child self-care skills
      • Before beginning a self-feeding program, the nurse performs a task analysis.
      • After a task analysis, the child is observed in a particular situation, such as eating, to determine what skills are possessed and the child’s developmental readiness to learn the task. 
      • Family members are included in this process, because their “readiness” is as important as the child’s. 
      • Numerous self-help aids are available to facilitate independence and can help eliminate some of the difficulties of learning, such as using a plate with suction cups to prevent accidental spills
    • Promote child’s optimal development
      • It requires appropriate guidance for establishing acceptable social behavior and personal feelings of self-esteem, worth, and security.
        • They must arise from the genuine love and caring that exist among family members
      • Ensuring the child’s physical well-being
        • Any congenital defects, such as cardiac, gastrointestinal, or orthopedic anomalies, should be repaired. 
        • Plastic surgery may be considered when the child’s appearance can be substantially improved. 
        • Dental health is significant, and orthodontic and restorative procedures may improve facial appearance immensely.
    • Encourage play and exercise
      • The nurse will need to guide parents toward selection of suitable play and exercise activities
      • The type of play is based on the child’s developmental age, although the need for sensorimotor play may be prolonged
      • Parents should use every opportunity to expose the child to as many different sounds, sights, and sensations as possible. 
      • Appropriate toys include musical mobiles, stuffed toys, floating toys, a rocking chair or horse, a swing, bells, and rattles. 
      • The child should be taken on outings, such as trips to the grocery store or shopping center.
    • Provide means of communication
      • Some children may need tongue exercises to correct the tongue thrust or gentle reminders to keep the lips closed.
      • Nonverbal communication may be appropriate for some of these children, and various devices are available
      • For children with physical limitations, several adaptations or types of communication devices are available to facilitate selection of the appropriate picture or word
    • Establish discipline
      • Control measures are based primarily on teaching a specific behavior rather than on understanding the reasons behind it.
      • Stressing moral lessons is of little value to a child who lacks the cognitive skills to learn from self-criticism or evaluation of previous mistakes. 
      • Behavior modification, especially reinforcement of desired actions, and use of time-out procedures are appropriate forms of behavior control.
    • Encourage socialization
      • Opportunities for social interaction and infant stimulation programs should began at an early age
        • Parents should be encouraged early to teach their child socially acceptable behavior: waving goodbye, saying “hello” and “thank you,” responding to his or her name, greeting visitors, and sitting modestly. 
        • The teaching of socially acceptable sexual behavior is especially important to minimize sexual exploitation. 
        • Parents also need to expose the child to strangers so that he or she can practice manners, because there is no automatic transfer of learning from one situation to another.
    • Provide information on sexuality
      • This may pose a level of difficulty to the parents
        • Possibility of pregnancy
        • Future plans to marry
        • Ability to be independent
      • The nurse should help in this area by providing parents with information about sexuality education that is geared to the child’s developmental level.
        • Adolescent girls need a simple explanation of menstruation and instructions on personal hygiene during the menstrual cycle
        • Practical sexual information regarding anatomy, physical development, and conception
          • Because they are easy to persuade and lack judgment, they need a well-defined, concrete code of conduct with specific instructions for handling certain situations.
    • Help families adjust to future care
      • Older parents may not be able to continue care responsibilities after they reach retirement or older age. 
      • The decision regarding residential placement is a difficult one for families, and the availability of such facilities varies widely. 
      • The nurse’s role includes assisting parents in investigating and evaluating programs and helping parents adjust to the decision for placement
    • Care for the child during hospitalization
      • To prevent engaging in this nontherapeutic approach, nurses must use the mutual participation model in planning the child’s care.
      • Parents should stay with their child but not be made to feel as if the responsibility is totally theirs.
      • The nurse also assesses the child’s functional level of eating and playing; ability to express needs verbally; progress in toilet training; and relationship with objects, toys, and other children. 
      • The child is encouraged to be as independent as possible in the hospital.
    • Assist in measures to prevent cognitive impairment
      • Counseling and education can reduce or eliminate such factors (e.g., poor nutrition, cigarette smoking, chemical abuse), which increase the risk for prematurity and intrauterine growth restriction.
      • Interventions are directed toward improving maternal health by educating women regarding the dangers of chemicals, including 
        • Prenatal alcohol exposure, which affects organogenesis, craniofacial development, and cognitive ability.
        • Adequate prenatal care
        • Optimal medical care of high-risk newborns
        • Rubella immunization
        • Genetic counseling
        • Prenatal screening, especially in terms of Down syndrome or FXS. 
      • The use of folic acid supplements prevents neural tube defects during pregnancy and during the childbearing years; and the use of newborn screening for treatable inborn errors of metabolism (e.g., congenital hypothyroidism, phenylketonuria, and galactosemia) are early appropriate therapies to prevent developmental disabilities in children.

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