Mentally challenged

MENTALLY CHALLENGED
Rohini Pandey
1st Year M.Sc Nursing
KGMU Institute of Nursing

CONTENTS
1. Introduction
2. Definition
3. Classification of MR
4. Aetiology & Risk factors MR
5. Clinical Features of MR
6. Treatment Modalities of MR
7. Nursing Management

CONCEPT OF CHALLENGED…….
Thursday, April 14, 2016 4
INJURY OR
DISEASE
IMPAIREMENT
DISABILITY
CHALLENGED OR
HANDICAPPED

Classification…..

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.

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.
Thursday, April 14, 2016
7

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.

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
functioningThursday, April 14, 2016 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.

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.

TYPES OF MENTAL RETARDATION
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

ETIOLOGY
A. Genetic Factor
• Chromosomal
Abnormalities
• Cranial malformation
• Gross disease of brain
B. Prenatal Factor
• Infections
• Endocrine Disorders
• Physical Damage &
Disorders
• Intoxication
• Placental Dysfunction
C. Perinatal Factors
• Birth Asphyxia
• Prolonged or difficult
birth
• Prematurity
• Kernicterus
• Instrumental delivery
D. Postnatal Factors
• Infections
• Accidents
E. 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.

• 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 curiosity

Diagnosing MR
• History Collection
• Physical Examination
• Neurological Examination
• Assessing Milestone Development
• Investigations – Urine & Blood for
metabolic disorder, amniocentesis, hearing
& speech evaluation, EEG, CT Scan.

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.Thursday, April 14, 2016 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

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.

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.

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.

PRIMARY PREVENTION
Childhood:-
• 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.

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.

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.

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.Thursday, April 14, 2016 27

NURSING MANAGEMENT
1. Assessment
– History Taking
– Physical Assessment
2. Nursing Diagnosis
1. 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.

Mentally challenged

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Mentally challenged