competency appraisal act 2

8/6/2019 Competency Appraisal Act 2

1/17

B

S

N

IV

J2

1Competency Appraisal 1 Activity 2

SAINT LOUIS UNIVERSITY

SCHOOL OF NURSING

COMPETECY

APPRAISALACTIVITY 2

Submitted to:

Mrs. Cheryl Bandaay

Sbmitted by:

BSN IV Block J Group 2

Yap, Carlo Enrico

Yogyog, Johnlee

Alma-in, Alyssa

Cayabyab, Thea Clarice

Condeno, Renalyn Roseclaire

Gamboa, Ceillo Marie

Guerrero, Nema Jovinni

Lad-ey, Jessa MaeLucero, Catherine

Palayen, Goldamaire

Ramos, Kristen

Saballa, Lyra

Valentin, Princes

CN110 Competency Appraisal 1

M 130 400 S502

June 20, 2011


2/17

B

S

N

IV

J2


WHY ARE NEWBORN BABIES OBLIGATE NOSE BREATHERS?

Newborns need to breatheprimarily through their nose arises

from the physical structure of their

mouth. In a newborns mouth, oral

breathing is potentially difficult

because the soft palate --a muscular

fold that extends from the back of

the roof of the mouth--is so close to

the epiglottis--a flap of cartilage

that covers and protects the

windpipe during the act ofswallowing.

According to Annie Bagnall, contributing authorfor "Feeding and Nutrition in the Preterm

Infant,"physical growth occurring at approximately 6 months of age moves the soft palate

and epiglottis further apart, thus leading to an opening up of the oral area and a marked

increase in your infant's ability to breathe orally.

In addition, babies have to breathe through their noses because nature designed them to use

their mouths to suckle firmly on the only intuitive interface. The only time babies breathe

through their mouths is when they cry.

WHY CHILDREN COMMONLY DEVELOP CROUPY COUGH COMPARED TO ADULTS?

The symptoms of croup are caused by inflammation, swelling and the buildup of mucus inthe larynx, trachea (windpipe) and bronchial tubes.

Since younger infants and children have smaller

airways, they are the ones most affected by croup.

Children are more likely to develop croup because

of their tiny airways. Their breathing passages

cannot accommodate the inflammation caused by

croup.

In contrast with the adults, they dont get croup

often because their trachea and larynx (the

breathing passages) are larger.

Figure 1 Comparison of the adult and infant upper airway

Figure 2 Narrow infant airways causes croup.


3/17

B

S

N

IV

J2


WHY ARE CHILDREN PRONE TO DEVELOP RESIRATORY TRACT ILLNESS COMPARED TO

ADULTS?

Children are more likely to develop infections in their lungs, because their lungs arent asstrong in fighting off theses infections. And, most often, viral respiratory tract infections

spread when children's hands come into contact with nasal secretions from an infected

person. These secretions contain viruses.

When the children touch their mouth, nose, or eyes,

the viruses gain entry and produce a new infection.

Less often, infections spread when children breathe

air containing droplets that were coughed or

sneezed out by an infected person.

For various reasons, nasal or respiratory secretions

from children with viral respiratory tract infections

contain more viruses than those from infected

adults. This increased output of viruses, along with

typically lesser attention to hygiene, makes children

more likely to spread their infection to others.

The possibility of transmission is further enhanced when many children are gathered together,

such as in child care centers and schools.

TRACE THE PATHOPHYSIOLOGIC OCCURANCES THAT LEAD TO THE DEVELOPMENT OF

BRONCHIECTATASIS.

Figure 3 Thumb sucking increases the

respiratory track illnesses in children.

Modifiable Factors:

Lifestyle

Environment

Diet

Non-modifiable Factors:

Idiopathic inflammatory

disorders

Predisposing Factors:

Recurrent Respiratory Infections

Measles

Influenza

Tuberculosis

Immuno-deficiency disorders

Toxic gas exposure

CF Young syndromeCiliary dyskinesia

Marfan Syndrome

Mounier-Kuhn syndrome

Williams-Campbell syndrome

Immunoglobulin A and G Deficiency


4/17

B

S

N

IV

J2


Inflammatory process

associated with pulmonary

infections damage to

bronchial wall

Loss ofpulmonary

supporting

structures

Thicksputum

Obstruction in

the bronchi

Impairement

of mucocillary

clearance

Chronic Infection

Recruitment of neurophils, T

lymphocytes, and monocyte-

derived cytokines

Release of inflammatory

mediators, elastases, and

collagenases

Inflammation and destruction

of elastic and muscularcomponents of bronchial

walls

Outward elastic recoil forces

surrounding lungparenchyma to exert traction Shortness of breath, productive cough,

chest pain, loss of appetite

Expansion of airway diameter

Bronchial arterial proliferation

Hemoptysis

Lung abscess

Exudates drains freely through the

bonchus

Retention of secretions

Cause alveoli distal to the

obstruction to collapse

Inflammatory scarring or fibrosis

replaces functioning lung tissue

BRONCHIECTASIS

Respiratory insufficiency

with reduced vital capacity,decreased ventilation,

increased, ratio of residual

volume to total lung capacity

Hyperventilation

Ventilation

perfusion

imbalance,

hypoxemiaClubbing of

fingers and nails


5/17

B

S

N

IV

J2


CATEGORIZE THE FOLLOWING ACCORDING TO ANATOMIC DEFECT AND DESCRIBE THE

SHUNTING OF BLOOD:

A. ATRIOSEPTAL DEFECT

B. VENTRICULAR SEPTAL DEFECT

C. TETRALOGY OF FALLOT

D. COARCTATION OF THE AORTAE. TRANSPOSITION OF GREAT ARTERIES

F. PULMONARY STENOSIS

G. PATENT DUCTUS ARTERIOSUS

SEPTAL DEFECTS SPECIFIC ANATOMICAL DEFECT SHUNTING OF BLOOD

SEPTALDEFECTS

Atrial Septal

Defect

An abnormal communication

between the two atria (an

acyanotic defect): An ASD is a hole

in the part of the septum that

separates the atriathe upperchambers of the heart. This heart

defect allows oxygen-rich blood

from the left atrium to flow into the

right atrium instead of flowing to

the left ventricle as it should.

Blood flow is from left to right

(oxygenated to deoxygenated) because

of the stronger contraction of the left

side of the heart. This causes an increase

in the volume in the right side of theheart and generally results in ventricular

hypertrophy and increased pulmonary

artery blood flow

Ventricular

Septal Defect

An opening is present in the

septum between the two

ventricles: A VSD is a hole in the

part of the septum that separates

the ventriclesthe lower chambers

of the heart. The hole allows

oxygen-rich blood to flow from the

left ventricle into the right ventricle

instead of flowing into the aorta

and out to the body as it should.

Because pressure in the left ventricle is

greater than that in the right ventricle,

blood shunts from left to right across the

septum (an acyanotic disorder). This

impairs the effort of the heart because

blood that should go into the aorta and

out of the body is shunted back into the

pulmonary circulation, resulting in right

ventricular hypertrophy and increase

pressure in the pulmonary artery.

COMPLEX HEART

DEFECT

SPECIFIC ANATOMICAL DEFECT SHUNTING OF BLOOD

C

OMPLEXDEFECT

Tetralogy of

Fallot

Four anomalies are present:

-pulmonary stenosis

-ventricular septal defect (usually

large)

-dextroposition of aorta

(overriding)

-hypertrophy of the right ventricle

Because of the pulmonary stenosis,

pressure builds up in the right side of the

heart. Blood then shunts from this area

of increased pressure into the left

ventricle and the overriding aorta. The

extra effort involved to force blood

through the stenosed pulmonary artery

causes the 4th

deformity, hypertrophy of

the right ventricle


6/17

B

S

N

IV

J2


VESSEL DEFECTS SPECIFIC ANATOMICAL DEFECT SHUNTING OF BLOOD

VESSELDEFECTS

Transposition

of Great

Vessels

The aorta arises in the right

ventricle instead of the left, and the

pulmonary artery arises from the

left ventricle instead of the right.

Blood enters the heart from the vena

cava to the right atrium, then flows to

the right ventricle, and goes out into the

aorta to the body completely

deoxygenated; it returns again by the

vena cava.

A secondary source of the blood enters

the heart from the pulmonary veins,

goes to the left atrium, left ventricle, and

out the pulmonary artery to the lungs to

be oxygenated, and returns to the left

atrium, a second close circulatory

system.

Patent

DuctusArteriosus

Ductus arteriosus is an accessory

fetal structure that connects thepulmonary artery to the aorta.

If it fails to close at birth blood will shunt

from the aorta (oxygenated blood) to thepulmonary artery (deoxygenated blood)

because of the increase pressure in the

aorta.The shunted blood returns to the

left atrium of the heart, passes to the left

ventricle, out to the aorta, and shunts

back to the pulmonary artery. This

causes increased pressure in the

pulmonary circulation from the extra

shunted blood; this leads to right

ventricle hypertrophy and ineffective

heart action.

OBSTRUCTIVE

DEFECTS

SPECIFIC ANATOMICAL DEFECT SHUNTING OF BLOOD

OBSTRUCTIVE

DEFECTS

Pulmonary

Stenosis

Narrowing of the pulmonary valve

or the pulmonary artery just distal

to the valve.

Inability of the right ventricle to

evacuate blood by way of the pulmonary

artery because of the obstruction leads

to right ventricular hypertrophy.

Coarctation

of the Aorta

Narrowing of the lumen of the

aorta due to a constricting band.

Two location in which this

commonly occurs:

1. Preductal- constrictionoccurs between the

subclavian artery and the

ductus arteriosus

2. Post ductal- constriction isdistal to the ductus

arteriosus

Because it is difficult for blood to pass

through the narrowed lumen of aorta,

blood pressure increases proximal to the

coarctation and decreases distal to it.

This results in increased blood pressure

in the heart and upper portions of the

body as pressure in the subclavian artery

increases.


7/17

B

S

N

IV

J2


DIFFERENTIATE SIGNS AND SYMPTOMS OF LEFT AND RIGHT SIDED HEART FAILURE.

Left-sided heart failure or left ventricular failure (LVF) is a reduction in the output from theleft ventricle. The pressure in the left atrium increases as the oxygen-rich blood from the lungs is

backed up since the left ventricle is not pushing out this blood fast enough or efficiently.

Right-sided heart failure or right ventricular failure (RVF) is a reduction in the blood outputfrom the right ventricle. The pressure in the right atrium may be decreased, normal or increased

depending on the return of blood from the rest of the body.

Signs/Symptoms Left-Sided Heart Failure Right-Sided Heart Failure

Pitting Edema

(Legs, Hands)

Mild to moderate. Moderate to severe

Fluid Retention Pulmonary edema (fluid in lungs)

and pleural effusion (fluid aroundlungs).

Abdomen (ascites).

Organ Enlargement Heart. Liver. Mild jaundice may be present.

Neck Veins Mild to moderate raised jugular

venous pressure (JVP).

Severe jugular venous pressure

(JVP). Neck veins visibly distended.

Shortness of Breath Prominent dyspnea. Paroxysmal

nocturnal dyspnea (PND).

Dyspnea present but not as

prominent.

Gastrointestinal Present but not as prominent. Loss of appetite, bloating,

constipation.

Symptoms are significantly more

prominent than LVF

OTHERS:

Left-sided Heart Failure

y Ineffective left ventricular contractile function

o increased workload and end-diastolic volume enlarge the left ventricle

y Pumping ability of the left ventricle fails, cardiac output falls

o right ventricle becomes stressed because it's pumping against greater pulmonary

vascular resistance and left ventricle pressure

y Blood backs up into left atrium and then into lungs

o diminished function allows blood to pool in the ventricle and atrium and back up into

the pulmonary veins and capillaries

o rising capillary pressure pushes sodium and water into interstitial spaces

o fluid in the extremities moves into the systemic circulation


8/17

B

S

N

IV

J2


y Signs and symptoms

o dyspnea

o orthopnea

o paroxysmal nocturnal dyspnea

o reduced sympathetic stimulation while sleeping

o pulmonary congestion

o tachycardia

o S3

o S4

o Cool, pale skin

o restlessness

Right-sided Heart Failure

y Ineffective right ventricular contractile function

o stressed right ventricle enlarges with the formation of stretched tissue

y Blood backs up into right atrium and peripheral circulation

o blood pools in the right ventricle and right atrium

o backed-up blood also distends the visceral veins

y Patient gains weight and develops peripheral edema

o rising capillary pressure forces excess fluid from the capillaries into the interstitial space

y Signs and symptoms

o jugular vein distention

o positive hepatojugular refluxo hepatomegaly


9/17

B

S

N

IV

J2


DESCRIBE THE TIMELINE FOR DOING CORRECTIVE SURGERY FOR CLEFT LIP AND CLEFT PALATE

AND INCLUDE RATIONALE.

AGE

0

months

3months

6months

9months

1yea

r

2yea

rs

3yea

rs

4yea

rs

5yea

rs

6yea

rs

7yea

rs

8yea

rs

9yea

rs

10

ye

ars

11ye

ars

12ye

ars

13ye

ars

14ye

ars

15ye

ars

16ye

ars

17ye

ars

18ye

ars

CONDITION

Palatal Obturator

Repair cleft lip

Repair soft palate

Repair hard palate

Tympanostomy tube

Speech

therapy/Pharyngopla

sty

Bone grafting jaw

Orthodontics

Further cosmetic

corrections

PALATAL OBTURATOR

a prosthesis that totally occludes an opening such as an orinasal fistula (in the roof of the

mouth)

Rationale:

Palatal obturators are typically short-term prosthetics used to close defects of the hard/soft

palate that may affect speech production or cause nasal regurgitation during feeding.

Following surgery, there may remain a residual orinasal opening on the palate, alveolar ridge,

or labial vestibule. A palatal obturator may be used to compensate for hypernasality and to

aid in speech therapy targeting correction of compensatory articulation caused by the cleft

palate. In simpler terms, a palatal obturator covers any fistulas (or "holes") in the roof of the

mouth that lead to the nasal cavity, providing the wearer with a plastic/acrylic, removable

roof of the mouth, which aids in speech, eating, and proper air flow.


10/17

B

S

N

IV

J2


REPAIR OF CLEFT LIP

Within the first 23 months after birth, surgery is performed to close the cleft lip.

Rationale:

While surgery to repair a cleft lip can be performed soon after birth, often the preferred age is

at approximately 10 weeks of age, following the "rule of 10s" coined by surgeonsWilhelmmesen and Musgrave in 1969 (the child is at least 10 weeks of age; weighs at least 10

pounds, and has at least 10g hemoglobin).

REPAIR OF SOFT PALATE/HARD PALATE

Often a cleft palate is temporarily closed, the cleft isn't closed, but it is covered by a palatal

obturator (a prosthetic device made to fit the roof of the mouth covering the gap).

Cleft palate can also be corrected by surgery, usually performed between 6 and 12 months.

Approximately 20-25% only requires one palatal surgery to achieve a competent

velopharyngeal valve capable of producing normal, non-hypernasal speech. However,combinations of surgical methods and repeated surgeries are often necessary as the child

grows. One of the new innovations of cleft lip and cleft palate repair is the Latham appliance.

The Latham is surgically inserted by use of pins during the child's 4th or 5th month. After it is

in place, the doctor, or parents, turns a screw daily to bring the cleft together to assist with

future lip and/or palate repair.

If the cleft extends into the maxillary alveolar ridge, the gap is usually corrected by filling the

gap with bone tissue. The bone tissue can be acquired from the patients own chin, rib or hip.

TYMPANOSTOMY TUBE

a small tube inserted into the eardrum in order to keep the middle ear aerated for a

prolonged period of time.

Rationale:

The tube often allows for children to have improved hearing and provides other significant

benefits.

SPEECH THERAPY/PHARYNGOPLASTY

Babies who suffer from cleft palate may have a number ofspeech problems. Some speech

problems develop directly as a result of anatomical differences due to the birth defect. An

example of an anatomical difference that could cause trouble is velopharyngeal inadequacy,

which is the inability of the soft palate to shut the opening from the throat to the nasalcavity. Velopharyngeal inadequacy makes it difficult for children to make many speech sounds

as the soft palate is integral to this function. These types of errors are somewhat common and

can be corrected after palate repair.

Pharyngoplasty is a kind of plastic surgery for the pharynx (soft tissue at the back of the

mouth) when the tissue at the back of the mouth is not able to close properly. It is typically

used to correct speech problems in children with cleft palate.


11/17

B

S

N

IV

J2


BONE GRAFTING JAW

Bone grafting is a surgical procedure that replaces missing bone in order to repair bone

fractures that are extremely complex, pose a significant health risk to the patient, or fail to

heal properly.

ORTHODONTICS

Surgical repair of the lip and palate invariably leads to a series of secondary growth

disturbances. These early surgeries tend to result in poor skeletal and dental growth in the

transverse and antero-posterior planes, especially in the maxilla.

MAKE A 24 HOUR MEAL PLAN FOR A 10 MONTH OLD CHILD WITH CELIAC DISEASE AND

CONSIDER SCHEDULE OF FEEDING.

Meal Time ContentsBreakfast 6:00 AM > 6oz apple juice

> Buckwheat porridge with dried fruit and 1% milk

>Gluten-free bread with margarine and jelly, honey or

peanut butter

AM Snack 8:30 AM >Yogurt

>Gluten-free rice crackers with cheese and tomato

Lunch 11:30 AM >2 oz roasted chicken breast/any lean meat

>2 slices gluten free bread

>1 cup mixed salad

>1/2 cup carrot sticks>1/2 cup bell pepper slices

>1 medium apple, or 1/2 cup yogurt (check ingredients)

->Water, fruit juice, 1% milk

PM Snack 3:00 PM >Frozen fruit with gluten-free custard or ice cream

> Gluten-free muesli with fresh or canned fruit and milk

Dinner 6:30 PM >3 oz broiled pork chop

>1 cup basmatic rice/rice noodles

>1/2 cup green beans/stir-fry vegetable mix

>Fruit juice, or water

Guidelines:

Do not eat any foods that contain gluten. These include bagels, bread, crackers, maltedbreakfast cereals, pasta, and pizza.


12/17

B

S

N

IV

J2


Look for wheat or wheat products added to foods such as ice cream, salad dressing, candy,

canned and frozen soups and vegetables, and other processed foods.

When you eat out, look for restaurants that serve gluten-free food.

You might ask if the chef is familiar with cooking without any gluten.

Also look for grocery stores that sell gluten-free pizza and other foods

On a gluten-free eating plan, you can still have:

y Eggs and milk products such as cheese. Some cheese and cheese spreads may contain

gluten, so check the labels for additives. You may need to avoid milk and milk products at

the beginning of treatment.

y Flours and starches made from rice, corn, buckwheat, potatoes, soybeans, or tapioca.

y Fresh, frozen, or canned unprocessed meats. Examples of processed meats are hot dogs,

salami, and deli meat. Read labels for additives that may contain gluten.

y Fresh, frozen, dried, or canned fruits and vegetables, if they do not have thickeners or other

additives that contain gluten.

IN PARADIGM FORM, COMPARE AND CONTRAST PHYSIOLOGIC EVENTS THAT LEAD TO

DEVELOPMENT OF NEPHROTIC SYNDROME AND ACUTE GLUMERULONEPHRITIS.

Predisposing factor:

Children 2 years of

age

Precipitating factors:

Previous infection caused by Group A

-Hemolytic Strep, Impetigo, Acute Viral

Infections

Modifiable Risk factor:

Exposure to certain

meds,or foreign serum

Precipitating Factors:

Chronic Glumerulonephritis, Diabetes mellitus

with intercapillary glumerulosclerosis,

Amyloidosis of the kidney, Systemic lupus

erythematous, Multiple myeloma, Renal vein

thrombosis

Previous infection caused

formation of antigen-antibody

complex in the blood stream

Deposition of immune complexes

in the glumerulus

NEPHROTIC SYNDROMEACUTE GLUMERULONEPHRITIS

LEGEND:

S/Sx for AGN Common for S/Sx S/Sx for NS


13/17

B

S

N

IV

J2


LATE

O

NSET

EARLY

ONSET

WBC infiltrates

the glumerulus

Thickening of the glumerular

filtration membrane

Decreased GFR

Oliguria

UO < or =

30ml

Initiation of

inflammatory

process

Circulatory overload

Dyspnea, Jugular

Vein Distention,

Cardiomegaly,

Pulmonary Edema

Increased

permeability of

glumerular

membrane

Damaged glumerular

capillary membrane

Glumerular

Injury

ProteinuriaCola-colored

urine because of

RBCs, protein

plugs, and casts

Hematuria

Loss of plasma

protein

Stimulation of

synthesis of

lipoprotein

Hyperlipidemia

Hypoalbuminemia

Decreasedoncotic pressure

Fluid shifting from

vascular spaces to

extracellular space

Activation of Renin-

Angiotensin System

Sodium Retention

Generalized Edema


14/17

B

S

N

IV

J2


DESCRIBE THE APPROPRIATE COMMUNICATION TECHNIQUE TO BE USED WHEN CARING FOR

A CHILD WITH:

A. SPEECH AND LANGUAGE DISORDER

y Language intervention activities. In these exercises an SLP will interact with a child by playing and

talking. The therapist may use pictures, books, objects, or ongoing events to stimulate language

development. The therapist may also model correct pronunciation and use repetition exercises to

build speech and language skills.

y Articulation therapy. Articulation, or sound production, exercises involve having the therapist model

correct sounds and syllables for a child, often during play activities. The level of play is age-

appropriate and related to the child's specific needs. The SLP will physically show the child how to

make certain sounds, such as the "r" sound, and may demonstrate how to move the tongue to

produce specific sounds.

y Oral motor/feeding therapy. The SLP will use a variety of oral exercises, including facial massage and

various tongue, lip, and jaw exercises, to strengthen the muscles of the mouth. The SLP may also

work with different food textures and temperatures to increase a child's oral awareness during

eating and swallowing.

Communication Techniques:

y Learn the specifics of the childs speech or language impairment. The more you know, the

more you can help and make communication or intervention fruitful.]y Before starting the interaction minimize distractions or noise from the environment

y Look at the child when talking with him. Be patient. The language-impaired child, like every

child, has a whole lifetime to learn and grow.

y Give the child chores or activities. Chores build confidence and ability. It keeps the childs

age, attention span, and abilities in mind.

y Break down activities

interventions into smaller steps or shorter time. Explain what to do,

step by step, until the job is done. Demonstrate. Provide help when its needed. Praise a job

(or part of a job) well done.

y Listen to the child. Dont rush to fill gaps or make corrections.

y Dont force the child to speak. Be aware of the other ways in which communication takesplace between people.

y Avoid or dont use inappropriate pitch or harsh voice

y Speak slowly and clearly.

y If the child has difficulty understanding, the use of short and simple sentences is beneficial.

y Pairing gestures with speech to help comprehension also helps.


15/17

B

S

N

IV

J2


y Allowing the child ample time to respond and the formulation of questions that can be

answered easily with a yes or no or other single word.

B. VISUAL IMPAIREMENT

y Always announce your presence when entering the childs room and identify yourself withyour name.

y Explain the sounds in the environment.

y Stay in the childs field of vision if the patient has a partial vision loss.

y Tell the child if you are leaving. Let him

her know if others will remain in the room or if

he

she will be alone.

y Speak in a warm and pleasant tone of voice. Speak louder only when necessary.

y Use whatever vision remains.

y Allow the child to take your arm for guidance.

y When you speak, let the child know whom you are addressing.

y Ask how you may help: increasing the light, reading the menu, describing where things are,

or in some other way.y Always explain w hat you are about to do before touching the patient

y Call out the childs name before touching. Touching lets a person know that you are

listening.

y Explain what you are doing as you are doing it, for example, looking for something or

putting the wheelchair away.

y Describe walks in routine places. Use sound and smell clues.

y Encourage familiarity and independence whenever possible.

y Leave things where they are unless the person asks you to move something.

y Indicate when the conversation or interaction has ended and when you are leaving.

C. HEARING IMPAIREMENT

Communication Techniques:Reduce Noise in the Environment

We use hearing to communicate and to hear environmental sounds. Even a mild hearingloss may interfere with clear communication. If a child can't hear speech clearly andconsistently, then she will have more difficulty participating fully in activities with otherpeople.

y For a child with a mild hearing loss, you will want to make sure that backgroundnoise levels and loud music do not compete with conversation.

y Carpets, area rugs, and soft wall coverings help make a child care environment lessnoisy.

y Sound-absorbent material, such as cork board or carpet tiles on the walls, will helpminimize noise in a room.


16/17

B

S

N

IV

J2


Face the Child when you Speak

A child with a hearing loss needs to see as well as hear what you say to him. You do notneed to exaggerate lip movements but you must speak clearly.

y Do not position yourself so he faces bright light and make sure visual barriers areminimized so that "line of sight" communication is possible.

y Furniture and bookcases should be low enough for children to see over them.y When you show a child with a hearing impairment how to do something, use more

demonstrations and gestures than you might with other children, but don't overdo it.

Use Non-Verbal Cues to Communicate

One way to get the attention of a child with a hearing impairment is to tap or thump onthe table (if it's not too distracting for other children). She will respond to the vibration.You also can touch her on the shoulder or arm to get her attention if she is busy playing.Other visual cues include waving your arms, stamping your foot, or flashing the lights(flip the switch up and down a few times).

y Children in your setting can "role play" interactions so they learn how tocommunicate with each other.

y Explain to other children that if she does not respond to a verbal cue, it doesn'tmean she's ignoring them.

Be a Good Role Model

Other children see how you behave and will copy you. If you develop effectivecommunication strategies, other children will, too. If you ignore the hearing-impairedchild, other children also may do the same thing.

y Watch for signs of isolation, such as the child with a hearing impairment playingalone rather than with a group, or other children deliberately turning their backs onthat child.

y If you see problems, handle it the same way you would any social or interpersonaldifficulty.


17/17

B

S

N

IV

J2


REFERENCES:http:

en.wikipedia.org

wiki

Cleft_lip_and_palate

http:

www.minfirm.com

nj-pa-birth-injury-attorneys-topamax-cleft-lip-speech-hearing-problems

Maternal and child health nursing care of the childbearing and the childrearing family 6th

volume 2

edition pages 1207-1213 by Adele Pillitterihttp:

www.nhlbi.nih.gov

health

dci

Diseases

chd

chd_types.html

Brunner and Suddarth's Textbook of Medical-Surgical Nursing 10th edition

http:

emedicine.medscape.com

article

1004692-overview#a0104

http:

www.merckmanuals.com

home

sec04

ch047

ch047a.html

http:

www.nhlbi.nih.gov

health

dci

Diseases

brn

brn_diagnosis.html

http:

emedicine.medscape.com

article

296961-overview#a0104

http:

naturalhealthperspective.com

home

riskfactors.html

http:

www.webmd.com

digestive-disorders

celiac-disease

eating-plan-for-celiac-disease

http:

www.healthhype.com

left-vs-right-sided-heart-failure-differences-in-signs-symptoms.html

http:

allnurses.com

general-nursing-student

rt-vs-lt-263736.html

http:

www.lbcma.org.uk

newsArticles

NAhearing.asp

http:

www.comeunity.com

disability

speech

communication.htmlhttp:

kidshealth.org

parent

system

ill

speech_therapy.html#

-

competency appraisal act 2

Documents