MENTALLY CHALLENGED
Rohini Pandey1st Year M.Sc NursingKGMU Institute of Nursing
CONTENTS
1. Introduction2. Definition3. Classification of MR4. Aetiology & Risk factors MR5. Clinical Features of MR6. Treatment Modalities of MR7. Nursing Management
INTRODUCTION
CONCEPT OF CHALLENGED…….
Monday, May 1, 2023 4
INJURY OR DISEASE IMPAIREMENT
DISABILITYCHALLENGED OR HANDICAPPED
Classification…..
CHALLENGED
physically challenged
Mentally challenged
Socially challengedMonday, May 1, 2023 5
1. Physically challenged Grouped according to
affected part of the body e.g. orthopedically handicapped, sensory handicapped, neurologically handicapped and handicapped due to systemic diseases.
Monday, May 1, 2023 6
2. Socially challenged Social disturbances are
found in the form of broken family, loss of parents, poverty, lack of educational opportunities, environmental deprivation and emotional disturbances as lack of tender loving care.
Monday, May 1, 20237
3. Mentally challenged Mentally challenged is now
used for the condition mental retardation. At least 2 - 3 percent of Indian population are mentally handicapped in any one form.
Monday, May 1, 2023 8
Mentally challenged
• Intellectual disability (ID)/ intellectual development disorder (IDD)/mental retardation (MR).
• Appears in children under the age of 18.
• Characterized by low IQ/intellectual functioning Monday, May 1, 2023 9
Definition Mental Retardation is a generalized
disorder, characterized by significantly impaired cognitive functioning and deficits in adaptive behaviors with onset before the age of 18.
IQ Score under 70.
Monday, May 1, 2023 10
Epidemiology• 3 % of the world population is estimated to be mentally retarded.
• In India 5 out of 1000 children are mentally retarded (Indian
express 13th march 2001). More than 20 million children are
suffering with mental retardation.
• Mental retardation is more common in boys than girls.
• Mortality is high in severe or profound mental retardation due to
associated physical condition.
• Common in the age group of 2 -3 years. Peak in 10-12 years of age.
Monday, May 1, 2023 11
TYPES OF MENTAL RETARDATION
Monday, May 1, 2023 12
It is classified depending upon IQ level. IQ or Intelligence Quotient is calculated by the formula: MA X 100
CA
Type IQ range in mental retardation
1. Mild (Educable) 50 - 70
2. Moderate (Trainable) 35 - 50
3. Severe (Dependent retarded) 20 - 35
4. Profound (Life support) < 20
Genetic factor
Prenatal factor
Perinatal factor
Postnatal factor
Environment&
sociocultural factor
ETIOLOGYA. Genetic Factor• Chromosomal Abnormalities• Cranial malformation• Gross disease of brainB. Prenatal Factor• Infections• Endocrine Disorders• Physical Damage &
Disorders• Intoxication• Placental Dysfunction
C. Perinatal Factors• Birth Asphyxia• Prolonged or difficult birth• Prematurity• Kernicterus• Instrumental deliveryD. Postnatal Factors• Infections• AccidentsE. Environmental &
sociocultural Factors
SIGNS AND SYMPTOMS• Impaired developmental
milestones.• Deficiencies in cognitive
functioning.• Reduced ability to learn or to meet
academic demands.• Expressive or receptive language
problems.• Psychomotor skill deficits.
Monday, May 1, 2023 15
• Difficulty performing self-care activities.
• Neurologic impairment• Medical problems such as seizures• Low self-esteem, depression and
labile moods• Irritability when frustrated or upset• Acting-out behavior• Lack of curiosityMonday, May 1, 2023 16
Diagnosing MR• History Collection• Physical Examination• Neurological Examination• Assessing Milestone Development• Investigations – Urine & Blood for
metabolic disorder, amniocentesis, hearing & speech evaluation, EEG, CT Scan.
Monday, May 1, 2023 17
Treatment modalities for MR…… Behavior management. Environmental supervision. Monitoring the child’s developmental
needs and problems. Programs that maximize speech,
language, cognitive, psychomotor, social, self-care, and occupational skills.
Ongoing evaluation for overlapping psychiatric disorders, such as depression, bipolar disorder, and ADHD.
Monday, May 1, 2023 18
• Family therapy to help parents develop coping skills.
• Early intervention programs for children younger than age 3 with Mental Retardation
Provide Day schools to train the child in basic skills, such as bathing and feeding.
Vocational Training
PREVENTION:-PRIMARY
PREVENTION SECONDARY PREVENTION
TERTIARY PREVENTION
Monday, May 1, 2023 20
PRIMARY PREVENTION ………
Preconception:- Genetic counseling, Immunization for maternal rubella. Blood tests to identify the presence of venereal
disease. Adequate maternal nutrition. Family planning in terms of size.
Monday, May 1, 2023 21
PRIMARY PREVENTION ……During gestation:-
Prenatal care:-
Adequate nutrition, fetal monitoring and protection
from diseases.
Avoidance of teratogenic substances like exposure to
radiation and consumption of alcohol and drugs.
Analysis of fetus for possible genetic disorder:-
By amniocentesis, fetoscopy, fetal biopsy and
ultrasound. Monday, May 1, 2023 22
PRIMARY PREVENTION ………
At delivery:-
• Delivery conducted by expert doctors and staff,
especially in cases of high risk pregnancy.
• Apgar scoring done at 1 to 5 minutes after the
birth of the child.
Monday, May 1, 2023 23
PRIMARY PREVENTIONChildhood:-
• Proper nutrition throughout the developmental period and
particularly during the first 6 months after birth.
• Dietary restriction for specific metabolic disorders until no
longer needed.
• Avoidance of hazards in the child’s environment to avoid
brain injury from causes such as lead poisoning, ingestion of
chemicals, or accidents.
Monday, May 1, 2023 24
SECONDARY PREVENTION……
• Early recognition of presence of mental retardation.
A delay in diagnosis may cause unfortunate delay in
rehabilitation.
• Psychiatric treatment for emotional and behavioral
difficulties.
Monday, May 1, 2023 25
TERTIARY PREVENTION……
• This includes rehabilitation in vocational, physical and social areas according to the level of challenged.
• Rehabilitation is aimed at reducing disability and providing optimal functioning in a child with mental retardation.
Monday, May 1, 2023 26
CARE AND REHABILITATION OF MR
The prevention and early detection of mentally handicaps.
Regular assessment of the mentally retarded persons attainments and disabilities.
Advice, support, and practical measures for families.
Provision for education, training, occupation, or work appropriate for each handicapped person.
Housing and social support to enable self-care.
Medical, nursing, Psychiatric and psychological services those who require them as outpatients, day patients or inpatients.
Monday, May 1, 2023 27
NURSING MANAGEMENT1. Assessment
– History Taking– Physical Assessment
2. Nursing Diagnosis1. Delayed Growth and Development r / t abnormalities in cognitive function.
Goal: Growth and development goes according to stages.
Interventions :Assess the factors causing developmental disorders of children.
• Identification and use of educational resources to facilitate optimal child development.
• Provide stimulation activities, according to age.• Monitor the patterns of growth (height, weight, head circumference and refer
to a dietician to obtain nutritional intervention)
2. Impaired Verbal Communication r / t delayed language skills of expression and reception.
Goal: Communication fulfilled in accordance stages of child development.
Interventions:Improve communication verbal and tactile stimulation.
• Give repetitive and simple instructions.• Give enough time to communicate.• Encourage continuous communication with the
outside world, for example: newspapers, television, radio, calendar, clock.
3. Risk for Injury r / t aggressive behavior / uncontrolled motor coordination.
Goal: Indicates changes in behavior, lifestyle to reduce risk factors and to protect themselves from injury.
Intervention:Provide a safe and comfortable position.
• Difficult child behavior management.• Limit excessive activity.• Ambulate with assistance; give special bathroom.
ANY QUESTION
SUMMARIZATION