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Patient with special challenge

Dr. Miada Mahmoud Rady

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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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