Pre & Post Natal Causes of Mental Retardation

First Trimester

During which period of development is the fetus at greatest risk for developing abnormalities?

Ultrasonography (ultrasound)

Which diagnostic test is done to identify large birth defects in the fetus and to determine placental placement?

Ultrasound

Which diagnostic test is non-invasive and poses no risk to the fetus?

X-rays

Which diagnostic test must be avoided during the first trimester to avoid the risk of fetal abnormalities?

Amniocentesis

Which diagnostic tests are done to measure levels of alpha-feto protein?

Increased levels: Spina Bifida, Anencephaly, Myelomeningocele, Hydrocephaly. Decreased levels: Down Syndrome.

What abnormalities in the fetus will be detected by an elevation in alpha-feto protein in maternal serum?

Folic Acid (folate)

A deficiency of which nutrient has been associated with neural tube defects in the fetus?

Increased risk of neural tube defects

What may occur in the fetus if the mother is severely malnourished early in the pregnancy?

Fetus will not gain weight

What effect on the fetus will maternal malnutrition later in the pregnancy have?

Thalidomide

Which drug used to treat nausea & vomiting was later found to be a teratogen; and what were its effects on the babies?

Aldomet (Anti-Hypertension), Benadryl (Antihistamine), Codeine (Analgesic), Magnesium Sulfate (Anti-hypertension), Penicillin (Antibiotic), Phenobarbital (Anti-epilepsy, hypnotic), Tylenol (Non-narcotic Analgesic)

Which medications are generally considered as 'safe' to use during pregnancy; (the rest may be teratogens)?

Interfere with absorption of folic acid

What do antiepileptic drugs interfere with?

Neural tube defects (cranio-facial defects)

What birth defects are generally associated with the use of antiepileptic drugs?

Carbamazepine (Tegretol)

Increases risk of Spina Bifida and Cleft Palate

Phenytoin (Dilantin)

Fetal Hydantoin Syndrome (combination of defects)

Babies are born small for gestational age (low birth weight), possible decrease of intelligence (MR). Avoid smoking throughout pregnancy

What is tobacco smoking associated with during pregnancy and on the developing fetus; and what should a pregnant client be informed of?

Stillbirth, premature delivery, and low birth weight

What effect does tobacco smoking by the mother during pregnancy have on the child?

Increased risk of damage to the 8th cranial nerve (deafness)

Which detrimental effects would Streptomycin have on the developing fetus?

Deafness and loss of balance (vertigo)

Which deficits may be seen in a child who was exposed to Streptomycin during pregnancy?

Audiology testing every 3 months

Which assessment and tests should be done within the first three months of life and regularly thereafter on a child exposed to Streptomycin in utero?

Penicillin

Which medication is administered to the mother when she is infected with syphilis during pregnancy?

From touching raw meats and cat feces

How does a woman get exposed to the protozoa that causes toxoplasmosis?

Advise woman to wear heavy-duty gloves when emptying cat litter box

What instructions to give a woman to minimize exposure to toxoplasmosis?

Head abnormalities, brain damage, seizures, MR (mild-severe), eye infections with visual impairments, deafness (possible), spastic limbs

Which of the following birth defects may be seen in a baby that has been exposed in utero to toxoplasmosis?

Vaccinations of all children and checking titer for antibodies prior to pregnancy

Which intervention would prevent congenital Rubella in babies?

Heart defects, MR, Hearing loss/deafness, Cataracts (surgery and refraction/glasses), blindness, glaucoma (medication)

What are the defects that an infant should be monitored for if exposed to Rubella during pregnancy?

IV administration of ACYCLOVIR (Zovirax)

Which drugs are used to treat a mother and baby infected with Herpes simplex virus during pregnancy and birth?

Cesarean Section (C-section) is scheduled to avoid fetal contact with the lesions present in the birth canal.

When a mother is infected with genital Herpes Simplex virus, what approach will be taken with reference to delivery to decrease the risk of transmission to the fetus?

Aldomet (Alpha Methyldopa)

Which medication (DOC) would the physician most likely order to treat HTN in a pregnant woman?

Monitor VS, administer Magnesium Sulfate (treats seizures r/t preeclampsia), aldomet. Monitor I&O, urine testing, protect from injury, emergency C-Section

Which nursing actions should be performed when a client has pre-eclampsia?

Take meds safe for pregnancy (aldomet, magnesium sulfate), limit salt intake, bed rest, quiet/darken room, protect from injury, emergency C-Section may be necessary

A client is diagnosed with pregnancy-induced hypertension. Which of the following precautions should the nurse tell the client and her family to take?

Magnesium Sulfate

Which is the drug of choice (DOC) to treat seizures related to eclampsia; and how has it shown to benefit the fetus?

Anticonvulsive medication shouldn't be stopped

What instructions should be given to a pregnant client who is on anticonvulsant therapy?

Fetal abnormalities, fetal largeness, delayed lung maturity, fetal death.

Which facts would the psychiatric technician include when discussing the effects of poorly treated maternal diabetes illness on the fetus?

ADA diet, BS monitoring, and Insulin

How can diabetes be managed during pregnancy?

4 or below is at risk for developmental disability and/or MR (10 is the highest/healthiest score)

Which APGAR scores indicate an increased risk for mental retardation in a newborn?

The blood incompatibility between mother Rh- and fetus who is Rh+. The mother's system produces antibodies against the Rh+ factor

What is hyperbilirubinemia/'Kernicterus'? And what causes Kernicterus?

When the mother's system produces antibodies against the Rh+ factor (antibodies attack the fetus)

How does the baby develop 'erythroblastosis fetalis' (hemolysis)?

RHO GAM to mother within 72 hrs after birth

Which intervention must be performed during the pregnancy on a woman to prevent Kernicterus in the fetus?

Native Americans, Asians, and Hispanics

Babies belonging to which ethnic groups are most at risk for developing hyperbilirubinemia?

Phototherapy (cover eyes to prevent blindness)

Which intervention is commonly used to treat mild cases of hyperbilirubinemia in the newborn baby?

Phototherapy

Commonly used to treat mild cases of hyperbilirubinemia in the newborn baby (cover eyes to prevent blindness).

Blood transfusions

Interventions that may be necessary to treat severe cases of hyperbilirubinemia (Kernicterus) in the fetus or newborn.

Fetal Alcohol Syndrome (F.A.S.)

Problems seen during infancy include brain damage/MR, visual/hearing problems, facial malformations, ADD/hyperactivity, behavioral problems, growth retardation, and brachydactyly.

Eye patch intervention

Common intervention to treat strabismus (eye patch on the unaffected eye strengthens the weaker eye).

Facial malformations

Deficits seen in a child with F.A.S. include short, upturned nose, malocclusion of teeth, and underdeveloped jaw.

Growth retardation

Deficits seen in a child with F.A.S. that may include joint abnormalities with motor dysfunction and brachydactyly.

Executive function

Responsible for planning, sequencing (dressing skills), self-monitoring, goal-directed actions, and social interactions.

Behavior problems

Common secondary problems seen in adolescents and adults with F.A.S.

Pregnant client instruction

Most important instruction is to avoid drugs, smoking, and alcohol, eat healthy, and take vitamins.

Opiate exposure in pregnancy

Problems seen in school-age children include irritability, tremulousness, seizures, vomiting and diarrhea, poor feeding/sleeping, yawning, sneezing, and respiratory distress.

Withdrawal symptoms

Symptoms that may be seen in a baby exposed to heroin and morphine in utero just prior to birth.

Narcotics withdrawal timing

Withdrawal from narcotics is most likely to occur in babies 72 hours after birth.

Cocaine effect on fetus

Cocaine causes small/decreased head circumference in the fetus.

Position on side

For a baby who is vomiting during withdrawal from cocaine or heroin position?

Interventions for cocaine withdrawal

Include total abstinence in pregnancy, medications, pacifier, swaddling, rocking, positioning on side, and monitoring I&O.

Neuro-developmental delays

Seen in children who were exposed to cocaine in utero when they are entering school.

Recommended approach for drug-exposed children

Includes medication (Ritalin or stimulants), behavior modification, mainstreaming, sensory integration/neurological patterning exercises, and frequent positive reinforcement in school.

Importance of immunizations in HIV/AIDS

Very important because children with HIV/AIDS have a decreased immune system, leading to a greater risk of developing infections/diseases.

Opportunistic diseases in AIDS

Thrush is frequently seen in children with AIDS.

Clinical manifestations of HIV/AIDS

Include bacterial infections, internal organ abscesses, and lymphomas.

Family experience with HIV child

Families with a child with HIV experience social isolation.

What causes pain in children with HIV/AIDS, and how is it managed?

Depression over parents deaths (bereavement therapy)

Emotional reactions in HIV-infected children

Include depression and social isolation.

Treatment for older children with HIV

Recommended treatment includes antidepressants and psychotherapy.

Negative event for HIV child's development

Death of parent/parents has the most negative effect on their development.

School restrictions for HIV-infected children

May be restricted from attending school due to limited ability to fight infection.

Important attitude for HIV adolescents

Maintain non-judgmental attitudes.

HIV/AIDS prevention instructions

Most important instructions include abstinence of sex or use of condoms.

Inborn errors of metabolism

Disorders that can be detected through newborn screening include Phenylketonuria (PKU), detected by Guthrie test.

Diet compliance for PKU

Caregivers should focus on developing diet compliance and place the child on Lofenalac formula.

Foods limited in PKU diet

Include meat, cheese, poultry, beans, and nutrasweet.

Hyperactivity treatment in PKU

Most effective interventions include decreasing environmental stimulation and medications (stimulants similar to ADHD).

Nutritional needs for hyperactive PKU client

Best met by offering smaller, more frequent meals that are high calorie.

Compliance issue in PKU children

A common problem is non-compliance with the special diet.

Duration of PKU diet

Individuals with PKU should stay on their diet for the rest of their lives.

Pregnancy recommendation for PKU women

Adult females with PKU considering pregnancy should go back on their diet before getting pregnant.

Treatment for congenital hypothyroidism

Includes thyroid hormones (Thyroxine Synthroid, Levoxyl, Levothyroxine), iodized salt in diet, keeping the client warm, increasing fiber and fluids, and monitoring I&O/weight.

Foods high in folic acid

Include breads, cereals, leafy green vegetables (spinach), citrus fruits, and legumes.

Foods high in calcium for pregnant women

Include milk, yogurt, hard cheese, OJ with calcium, fortified cereals, kale, spinach, broccoli, and canned salmon with bones.

Goiters

Condition that may occur in the fetus when the mother's diet is deficient in iodine.

Iodized salt

A good source of iodine.

Dairy

A good source of iodine.

Shellfish

A good source of iodine.

Bread

A good source of iodine.

Rickets

Condition caused by a deficiency in vitamin D.

Vitamin D deficiency causes

Not enough sunlight exposure.

Fortified milk

A good source of Vitamin D.

Fish oils

A good source of Vitamin D.

1600-calorie ADA diet

Diet distributed as 3 regularly scheduled meals plus snacks for a client with Diabetes Mellitus.

Starch

Food group that potatoes belong to.

Milk group

Food group that cheese belongs to.

Room temperature

The correct temperature for a tube feeding.

30-40 degrees (fowler's)

Position a client should be placed in when administering a gastric gavage.

Confirm placement of the tube

Most important safety action prior to initiating a tube feeding.

X-ray

Best method for checking placement of a tube feeding in a 2-year-old child with an unrepaired cleft palate.

150 cc

Residual amount in the client's stomach that requires holding the feeding and re-checking in 2 hours.

Regurgitation

An adverse outcome that may occur if a naso-gastric gavage feeding is administered too rapidly.

Methylene blue

Used to distinguish secretions from a tracheostomy as sputum or feeding.

Teach to drink from a cup

Developmental task for a child prior to surgery for a cleft palate repair.