Mental Retardation

MENTAL RETARDATION (MR) is a generalized disorder appearing before adulthood, characterized by significantly impaired cognitive functioning and deficits in two or more adaptive behaviors. It has historically been defined as an Intelligence Quotient score under 70.

Signs and Symptoms

The signs and symptoms of mental retardation are all behavioral. Most people with mental retardation do not look like they have any type of intellectual disability, especially if the disability is caused by environmental factors such as malnutrition or lead poisoning.

Delays in oral language development Deficits in memory skills Difficulty learning social rules Difficulty with problem solving skills Delays in the development of adaptive behaviors such as self-help or selfcare skills Lack of social inhibitors

Causes

Genetic conditions. Sometimes disability is caused by abnormal genes inherited from parents, errors when genes combine, or other reasons. Problems during pregnancy. Mental disability can result when the fetus does not develop properly. For example, there may be a problem with the way the fetus' cells divide as it grows. A woman who drinks alcohol or gets an infection like rubella during pregnancy may also have a baby with mental disability.

Problems at birth. If a baby has problems during labor and birth, such as not getting enough oxygen, he or she may have developmental disability due to brain damage. Exposure to certain types of disease or toxins. Diseases like whooping cough, measles, or meningitis can cause mental disability if medical care is delayed or inadequate. Exposure to poisons like lead or mercury may also affect mental ability. Malnutrition is a common cause of reduced intelligence in parts of the world affected by famine, such as Ethiopia.

Diagnosis

Three criteria must be met for a diagnosis of mental retardation:

1.An IQ below 70 2.Significant limitations in two or more areas of adaptive behavior (as measured by an adaptive behavior rating scale, i.e. communication, selfhelp skills, interpersonal skills, and more) 3.And evidence that the limitations became apparent before the age of 18.

It is formally diagnosed by professional assessment of intelligence and adaptive behavior.

IQ below 70
Class IQ

Profound mental retardation Below 20 Severe mental retardation 2034 Moderate mental retardation 3549 Mild mental retardation 5069 Borderline intellectual functioning 7084

Significant limitations in two or more areas of adaptive behavior

Adaptive behavior, or adaptive functioning, refers to the skills needed to live independently (or at the minimally acceptable level for age). Certain skills are important to adaptive behavior, such as: Daily living skills, such as getting dressed, using the bathroom, and feeding oneself Communication skills, such as understanding what is said and being able to answer Social skills with peers, family members, spouses, adults, and others

Nursing interventions : Involve children and families in early infant stimulation program. Rational: to help maximize growth in children. Assess the progress of the child's development with regular intervals, for which detailedrecords to distinguish subtle changes in function. Rational: so the treatment plan can be repaired as needed. Help families set goals for the child's reality. Rationale: to encourage the successful achievement of goals and self-esteem. Provide positive reinforcement / specific tasks to the behavior of children. Rational: as this can improve motivation and learning. Provide information on adolescent social practices and codes of behavior that is concrete and well defined. Rational: because of the ease and lack of assessment of

Spina Bifida

Spina bifida (Latin: "split spine") is a developmental congenital disorder caused by the incomplete closing of the embryonic neural tube. Spina bifida is a birth defect. Most children who have spina bifida do not have problems from it. It occurs when the bones of the spine (vertebrae) do not form properly around part of the babys spinal cord. It can affect how the skin on the back looks. And in severe cases, it can make walking or daily activities hard to do without help.

Spina bifida malformations fall into three categories:

Spina bifida occulta Spina bifida cystica with meningocele Spina bifida cystica with myelomeningocele

The most common location of the malformations is the lumbar and sacral areas. Myelomeningocele is the most significant and common form, and this leads to disability in most affected individuals. The terms spina bifida and myelomeningocele are usually used interchangeably. Spina bifida can be surgically closed after birth, but this does not restore normal function to the affected part of the spinal cord. Intrauterine surgery for spina bifida has also been performed, and the safety and efficacy of this procedure are currently being investigated.

Spina Bifida Occulta

Occulta is Latin for "hidden". This is the mildest form of spina bifida. In occulta, the outer part of some of the vertebrae is not completely closed. The splits in the vertebrae are so small that the spinal cord does not protrude. The skin at the site of the lesion may be normal, or it

Spina bifida cystica with meningocele

Spina bifida cystic with meningocele is where the outer parts of the vertebral bones are split opened and the meninges (or covering of the spinal cord) protrude out through the opening. In this type of spina bifida the spinal cord remains intact and only the covering of the spinal cord protrudes out of the spine. Causes of meningocele include teratoma and other tumors of the sacrococcyx and of the presacral

Myelomeningocele
This type of spina bifida often results in the most severe complications. In individuals with myelomeningocele, the unfused portion of the spinal column allows the spinal cord to protrude through an opening. The exposure of these nerves and tissues make the baby

Signs and Symptoms

Physical complications Physical signs of spina bifida may include: Leg weakness and paralysis Orthopedic abnormalities (i.e., club foot, hip dislocation, scoliosis) Bladder and bowel control problems, including incontinence, urinary tract infections, and poor renal function Pressure sores and skin irritations Abnormal eye movement

Causes
The exact cause of spina bifida is unknown. No one knows what disrupts complete closure of the neural tube, causing a malformation to develop. Scientists suspect that genetic, nutritional, and environmental factors may play a role in causing spina bifida. Research studies indicate that insufficient intake of folic acid in the mother's diet is a key factor in causing spina bifida and other neural tube defects. Prenatal vitamins that are prescribed for pregnant mothers typically contain folic acid as well as other vitamins.

Diagnosis
In most cases, a diagnosis of spina bifida is made before birth. However, mild cases may go unnoticed until after birth. Very mild cases, in which there are no symptoms of spina bifida, may never be detected. Tests that are used to make a spina bifida diagnosis include:

Second-trimester maternal serum alpha-fetoprotein screening Fetal ultrasound Multiple-marker screens Amniocentesis.

Nursing interventions
1- Kept flat on his abdomen with a single layer of sterile gauze. 2- The genitalia and buttocks must be kept clean. 3- The ankles should be supported with foam rubber pads so that the toes do not rest upon the bed. 4- Antibiotics must be given if infection is suspected. 5- Emptying the infants bladder every 2 hours during the day and once at night, pressure should be applied firmly but gently beginning in the umbilical area and slowly progressing under the symphysis pubis and toward the anus. 6- If evidence of urinary infectionoccurculture should be done to determine the antibiotics. 7- The infant should be held for his feeding. 8- The nurse records the activity of the legs and the degree of continence, whether there is constant or intermittent dribbling , noting whether there is retention of urine or fecal impaction .All thevital signsshould be taken and recorded with extreme care.

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