Kinh Nghiệm Hướng dẫn What would a nurse assessing growth and development of a 2 year old child expect to find? 2022
Hä tªn bè đang tìm kiếm từ khóa What would a nurse assessing growth and development of a 2 year old child expect to find? được Update vào lúc : 2022-10-27 10:04:07 . Với phương châm chia sẻ Thủ Thuật về trong nội dung bài viết một cách Chi Tiết 2022. Nếu sau khi Read Post vẫn ko hiểu thì hoàn toàn có thể lại Comment ở cuối bài để Tác giả lý giải và hướng dẫn lại nha.Concerned About Your Child’s Development?
Act Early.
You know your child best. Don’t wait. If your child is not meeting one or more milestones, has lost skills he or she once had, or you have other concerns, act early. Talk with your child’s doctor, share your concerns, and ask about developmental screening. The American Academy of Pediatrics recommends that children be screened for general development using standardized, validated tools 9, 18, and 30 months and for autism 18 and 24 months or whenever a parent or provider has a concern.
Nội dung chính Show- What is Down Syndrome? PathophysiologyStatistics and IncidencesClinical ManifestationsAssessment and Diagnostic FindingsMedical ManagementNursing ManagementPractice Quiz: Down SyndromeWhich of the following would be an expected finding in an age assessment of a 2 year old?Which of these behaviors reported by a parent of an 18 month old toddler would the nurse report to the pediatrician as a cause for concern?Which of the following is a characteristic of a toddler's language development age 18 months?What does the nurse consider as an appropriate snack for a 2 year old child quizlet?
If you or the doctor are still concerned:
Ask for a referral to a specialist who can evaluate your child more; andCall your state or territory’s early intervention program to find out if your child can get services to help. Learn more and find the number cdc.gov/FindEI.For more on how to help your child, visit cdc.gov/Concerned.
Down syndrome is the most common chromosomal anomaly, occurring in about 1 in 700 to 800 births.
- What is Down Syndrome? PathophysiologyStatistics and IncidencesCausesClinical ManifestationsAssessment and Diagnostic FindingsMedical Management
- Pharmacologic
Management
- Nursing AssessmentNursing DiagnosesNursing Care Planning and GoalsNursing InterventionsEvaluationDocumentation Guidelines
What is Down Syndrome?
A drawing of the facial features of a child with Down syndrome.- It is primarily caused by trisomy of chromosome 21, which gives rise to multiple systemic complications as part of the
syndrome.
Langdon Down first described the condition in 1866, but its cause was a mystery for many years.In 1932, it was suggested that a chromosomal anomaly might be the cause, but the anomaly was not demonstrated until 1959.
Pathophysiology
Two different hypotheses have been proposed to explain the mechanism of gene action in Down syndrome: developmental instability (ie, loss of chromosomal balance) and the so-called gene-dosage effect.
Trisomy 21 (also known by the karyotype 47,XX,+21 for
females and 47,XY,+21 for males.- According to the gene-dosage effect hypothesis, the genes located on chromosome 21 have been overexpressed in cells and tissues of Down syndrome patients, and this contributes to the phenotypic abnormalities.Molecular analysis reveals that the 21q22.1-q22.3 region, also known as the Down syndrome critical region (DSCR), appears to contain the gene or genes responsible for the
congenital heart disease observed in Down syndrome.Abnormal physiologic functioning affects thyroid metabolism and intestinal malabsorption; patients with trisomy 21 have an increased risk of obesity; frequent infections are presumably due to impaired immune responses, and the incidence of autoimmunity, including
hypothyroidism and rare Hashimoto thyroiditis, is increased.Patients with Down syndrome have decreased buffering of physiologic reactions, resulting in hypersensitivity to pilocarpine and abnormal responses on sensory-evoked electroencephalographic (EEG) tracings.Decreased buffering
of metabolic processes results in a predisposition to hyperuricemia and increased insulin resistance.Children with Down syndrome are predisposed to developing leukemia, particularly transient myeloproliferative disorder and acute megakaryocytic
leukemia.Musculoskeletal manifestations in patients with Down syndrome include reduced height, atlantooccipital and atlantoaxial hypermobility, and vertebral malformations of the cervical spine.About 5% of patients with Down syndrome have GI manifestations, including duodenal atresia,
Hirschsprung disease, and celiac disease.
Statistics and Incidences
Down syndrome have been observed in nearly all countries and races.
Facial features of a baby with Down Syndrome.- Each year, approximately 6000 children are born with Down syndrome.Down syndrome accounts for about one-third of all moderate and severe
mental handicaps in school-aged children.The prevalence of Down syndrome worldwide has increased because of increases in lifespan in the last few decades.The characteristic morphologic features will be obvious in children older than 1 year.On rare occasions, the disease can be observed in a few members of a family; the risk for recurrence of Down syndrome in a patient’s siblings also depends on maternal age.The male-to-female ratio is slightly higher
(approximately 1.15:1) in newborns with Down syndrome, but this effect is restricted to neonates with không lấy phí trisomy 21.Perhaps 50% of female patients with trisomy 21 are fertile, and these females have up to a 50% chance of having a live child who also has trisomy 21.
Causes
The cause of DS is not known, although several theories dominate.
Other common features include: a flat and wide face, a short neck, excessive joint flexibility, and a protruding tongue due to a small mouth and relatively large
tongue.- Down syndrome is caused by the following 3 cytogenetic variants: three full copies of chromosome 21, a chromosomal translocation that results in 3 copies of the critical region for Down syndrome, and mosaicism.Full copies of trisomy 21. A không lấy phí trisomy 21 results from nondisjunction during meiosis in one of the parents; this occurrence is correlated with advanced maternal and paternal age.Translocation.
Translocation occurs when genetic material from chromosome 21 becomes attached to another chromosome, resulting in 46 chromosomes, with 1 chromosome having extra material from chromosome 21 attached.Mosaicism. Mosaicism is considered a postzygotic sự kiện (ie, one that occurs after fertilization); most cases result from a trisomic zygote with mitotic loss of one chromosome; as a
result, two cell lines are found: one with a không lấy phí trisomy and the other with a normal karyotype; this finding leads to great phenotypic variability, ranging from near normal to the classic trisomy 21 phenotype.
Clinical Manifestations
On physical examination, patients with trisomy 21 have characteristic craniofacial findings, such as the following:
Physical characteristics: a small chin, slanted eyes, poor muscle tone, a flat nasal bridge, and a single crease of the palm.- Flat occiput and a flattened facial appearance. This is mostly recognized by
the time the child turns 1 year old or more.Small brachycephalic head. Brachycephaly or shortness of head is a common manifestation.Epicanthal folds. Epicanthal folds the inner angle of the eyes are present.Flat nasal bridge. Another common manifestation is the short, flattened bridge of the nose of the child.Upward-slanting palpebral fissures. There is an “almond-shaped” appearance of the
eyes.Brushfield spots. Brushfield spot is the speckling of the iris.Small nose and small mouth. The child is often identified as having a small nose and mouth.Protruding tongue. The protruding tongue is thick and fissured.Small and dysplastic ears. The child’s ears are also small and dysplastic.Generous nuchal skin. The child’s skin is dry, cracked, and fissured, and may be mottled.
Assessment and Diagnostic Findings
The diagnosis of Down syndrome is most commonly made by prenatal screening followed by definitive diagnostic testing.
Ultrasound
of fetus with Down syndrome displaying a large bladder.
Enlarged NT and absent nasal bone in a fetus 11
weeks with Down syndrome.- Laboratory studies. A complete blood count (CBC) with differential and bone marrow examination to rule out leukemia is indicated; thyroid-stimulating hormone (TSH) and thyroxine (T4) levels should be obtained birth, 6 and 12 months, and annually thereafter, to rule out
hypothyroidism; and perform Papanicolaou smears every 1-3 years in sexually active women starting the age of first intercourse.Cytogenetic studies. The clinical diagnosis of trisomy 21 should be
confirmed with cytogenetic studies; karyotyping is essential to determine the risk of recurrence; in translocation Down syndrome, karyotyping of the parents and other relatives is required for proper genetic counseling.Fluorescence in situ hybridization (FISH). Fluorescence in situ hybridization (FISH) may be used for rapid diagnosis of trisomy 21; it can be successful in both prenatal diagnosis and diagnosis in the neonatal period; a FISH study will detect the presence
of trisomy 21; however, it does not provide information about whether trisomy 21 is secondary to a translocation. therefore, a FISH test must be confirmed by a complete karyotype analysis.Prenatal screening and diagnosis. Prenatal screening using a combination of maternal serum biomarkers and ultrasonography can detect up to 95% of pregnancies affected by Down syndrome.Nuchal translucency (NT) scan. The nuchal translucency (NT) scan assesses
the amount of fluid in the dorsum of the fetal neck and is best assessed 11-14 weeks; an increased NT measurement is associated with an increased risk of genetic syndromes and can detect up to 70% of Down syndrome pregnancies.Amniocentesis. Amniocentesis, routinely performed 14-16 weeks’ gestation, remains the criterion standard of invasive diagnostic tests. Testing for
chromosomal disorders is 99.5% accurate.Chorionic villus sampling (CVS). Chorionic villus sampling (CVS) is performed 10-13 weeks’ gestation; earlier testing is thought to be associated with a 1 in 300-1000 risk of fetal transverse limb deficiency, a small risk of maternal cell contamination, and a 0.5-1% risk of a fetal loss after the procedure.
Medical Management
Despite continued work, no notable medical treatments for intellectual disability associated with Down syndrome have been forthcoming. However, the dramatic improvements in medical care described below have greatly improved the quality of life for patients and increased their life expectancy.
Physical characteristics: Extra space between big toe
and second toe, abnormal patterns on the fingertips and short fingers.- Surgical care. Timely surgical treatment of cardiac anomalies, detected during the newborn period or early infancy, may be necessary to prevent serious complications and is crucial for optimal survival; surgical intervention may be necessary to reduce atlantoaxial subluxation and to stabilize the
upper segment of the cervical spine if neurologic deficits are clinically significant; congenital cataracts occur in about 3% of children and must be extracted soon after birth to allow light to reach the retina.Diet. No special diet is required unless celiac disease is present. A balanced diet and regular exercise are needed to maintain appropriate weight; feeding
problems and failure to thrive usually improve after cardiac surgery.Activity. No restriction of activities is necessary; parents should be counseled about sports with an increased risk of spinal injuries, such as football, soccer, and gymnastics; advise
the patient to exercise to maintain an appropriate weight.
The standard immunizations and well-child care should be provided. In addition, specific manifestations of the syndrome and associated conditions must be addressed, as follows:
- Thyroid hormone. Give thyroid hormone for
hypothyroidism to prevent intellectual deterioration and to improve the individual’s overall function, academic achievement, and vocational abilitiesDigitalis and
diuretics. Give digitalis and diuretics as necessary for cardiac management.Vaccines. Consider pneumococcal and influenza vaccination for children with chronic cardiac and respiratory disease; consider prophylactic palivizumab, since infants with Down syndrome are high risk for hospitalization with
a respiratory syncytial virus.Anticonvulsants. Administer anticonvulsants for tonic-clonic seizures or for infantile spasms (treat with
steroids).
Nursing Management
Nursing management for a child with Down syndrome are:
Nursing AssessmentAssessment of a child with Down syndrome include:
- Physical
assessment. The nurse should perform a thorough, systemic, head-to-toe assessment of the newborn.History. Nurses should obtain a history of mother’s pregnancy,
birth history, and genetic testing.
Based on the assessment data, the major nursing diagnoses are:
- Delayed growth and development related to impaired ability to achieve developmental tasks.Self-care deficit: bathing and hygiene, dressing, feeding, toileting related to cognitive impairment.Impaired
verbal communication related to impaired receptive or expressive skills.Risk for infection related to decreased muscle tone and poor drainage of mucus.
The major goals for a child with Down syndrome are:
- The child will be able to perform motor, social, and/or expressive skills typical of age group within the scope of present capabilities.The child will perform self-care and self-control activities appropriate for age.The child will be able to establish a method of communication in which needs can be expressed.The child will be able to achieve timely wound
healing; be không lấy phí of purulent drainage or erythema, and be afebrile.
Nursing interventions are:
- Provide adequate nutrition. Assess the child’ ability to swallow, provide
information on the proper way of giving food, and provide good nutrition counseling.Frequent consultations are a must. Encourage parents to have the child’s hearing and vision checked regularly.Assess understanding of Down syndrome. Educate the parents about Down syndrome and the care of a child with the disease.Provide
emotional support and motivation. The family caregiver needs support during these trying times; they need strong support and guidance from the time the child is born.
Goals are met as evidenced by:
- The child was able to perform motor, social, and/or expressive skills typical of age group within the scope of present capabilities.The child performed self-care and self-control
activities appropriate for age.The child was able to establish a method of communication in which needs can be expressed.The child was able to achieve timely wound healing; be không lấy phí of purulent drainage or erythema, and be afebrile.
Documentation in a child with Down’s syndrome include:
- Availability and use of support systems and community resources.
Plan of care.Teaching plan.Attainment or progress toward desired outcomes.Deviations from normal parenting expectations.
Practice Quiz: Down Syndrome
Here’s a 5-item quiz for Down Syndrome study guide. Please visit our nursing test bank page for more NCLEX practice questions.
1. Which of the following assessment findings would lead the nurse to suspect Down syndrome in an infant?
A. Transverse palmar crease
B. Small tongue
C. Large nose
D. Restricted joint movement
1. Answer: A. Transverse palmar crease.
- Option A: Down syndrome is
characterized by the following a transverse palmar crease (simian crease), separated sagittal suture, oblique palpebral fissures, small nose, depressed nasal bridge, high arched palate, excess and lax skin, wide spacing and plantar crease between the second and big toes, hyperextensible and lax joints, large protruding tongue, and muscle weakness.Option B: The child with Down
syndrome has a protruding tongue that is thick and fissured.Option C: A small nose is manifested by children with Down syndrome.Option D: There is no restricted joint movement, rather the child has joint hyperextensibility or hyper-flexibility.
2. When planning care for an 8-year-old boy with Down syndrome, the nurse should:
A. Plan interventions according to the developmental levels of a 5-year-old
because the child will have developmental delays.
B. Plan interventions according to the developmental level of a 7-year-old child because that’s the child’s age.
C. Direct all teaching to the parents because the child can’t understand.
D. Assess the child’s current developmental level and plan care accordingly.
2. Answer D. Assess the child’s current developmental level and plan care accordingly.
- Option D: Because children
with Down syndrome can vary from mildly to severely mentally challenged, each child should be individually assessed.Options A & B: Nursing care plan should be planned according to the developmental age of a child with Down syndrome, not the chronological age.Option C: A child with Down
syndrome is capable of learning, especially a child with mild limitations.
3. A nurse is monitoring the intake and output of a toddler with Down syndrome receiving furosemide (Lasix) IV. Which of the following method is the most appropriate for measuring the urine output?
A. Weighing the diaper.
B. Insert Foley catheter.
C. Ask the mother regarding the number of diaper changes.
D. Compare intake with output.
3. Answer: A. Weighing the diaper.
- Option A: The most appropriate method for measuring urine output of an infant is by weighing the diaper.Option B: Inserting a Foley catheter will provide the most accurate measurement but it gives the
infant the risk of urinary tract infection.Options C & D: These will not provide the accurate measurement of the urine output.
4. Dustin who was diagnosed with Down syndrome has Hirschsprung’s disease. He developed fever and watery explosive diarrhea. Which of the following would Nurse Joyce do first?
A. Monitor the child every 30 minutes.
B. Notify the physician immediately.
C. Administer an anti-diarrheal.
D. Nothing. (These findings are common in
Hirschsprung’s disease.)
4. Answer: B. Notify the physician immediately.
- Option B: For the child with Hirschsprung’s disease, fever and explosive diarrhea indicate enterocolitis, a life-threatening situation. Therefore, the physician should be notified directly.Option A: The child is acutely ill and requires intervention, with
monitoring more frequently than every 30 minutes.Option C: Generally, because of the intestinal obstruction and inadequate propulsive intestinal movement, antidiarrheals are not used to treat Hirschsprung’s disease.Option D: Hirschprung’s disease typically presents with chronic constipation.
5. A patient with Down syndrome recently started on phenytoin (Dilantin) to control simple complex seizures is seen in the outpatient clinic. Which information obtained during his chart review and assessment will be of greatest concern?
A. The gums appear enlarged and inflamed.
B. The white blood cell count is 2300/mm3.
C. Patient occasionally forgets to take the phenytoin until after lunch.
D. A patient wants to renew his driver’s license in the next month.
5. Answer: B. The white blood cell count is 2300/mm3.
- Option B: Leukopenia is a serious side effect of phenytoin and would require discontinuation of the medication.Options A, C, D: The other data indicate a need for further assessment and/or patient teaching, but will not require a change in medical treatment for the seizures.
Which of the following would be an expected finding in an age assessment of a 2 year old?
3. Which of the following would be an expected finding in an age assessment of a 2 year old? At 2 years old child, a patient should have reached certain developmental milestones. The child will be developing their vocabulary and in addition to knowing almost 300 words, will be developing 2-4 sentences.Which of these behaviors reported by a parent of an 18 month old toddler would the nurse report to the pediatrician as a cause for concern?
Which behavior reported by a parent of an 18-month-old toddler would the nurse report to the pediatrician as a cause for concern? By 18 months, a toddler should have been walking alone for several months. The toddler who walks holding onto furniture should be evaluated by a developmental specialist.Which of the following is a characteristic of a toddler's language development age 18 months?
By the end of 18 months, your child might: Recognize names of familiar people, objects and body toàn thân parts. Follow simple directions accompanied by gestures. Say as many as 10 words.What does the nurse consider as an appropriate snack for a 2 year old child quizlet?
What does the nurse consider as an appropriate snack for a 2-year-old child? (Applesauce is a healthy and safe snack food for the toddler. Tải thêm tài liệu liên quan đến nội dung bài viết What would a nurse assessing growth and development of a 2 year old child expect to find?