mental retardation treatment and management
TRANSCRIPT
-
7/29/2019 Mental Retardation treatment and management
1/12
Treatment & Management
Medical Care
1. Early identification of children
with developmental delays.
2. The mainstay of treatment ofMR/ID is developing a
comprehensive management
plan for the condition.
3. Physical activity and obesity are
major contributors to disease in
MR/ID.
-
7/29/2019 Mental Retardation treatment and management
2/12
Treatment & Management
4. Pain:
Manifestations of pain in peoplewith severe to profound MR/ID
include crying, screaming,grimacing, protective postures(eg, arching, fetal position),rocking, and aggression.
Common causes of acute paininclude dental caries/abscesses,GERD, constipation, UTI,spasticity (when MR/ID isassociated with cerebral palsy),pressure sores, and fractures.
-
7/29/2019 Mental Retardation treatment and management
3/12
Treatment & Management
In addition, neuropathic pain due
to dysautonomia or motor spasms
may create chronic disturbances.
5. Written, verbal and pictoral forms
of communication as well as
gestures and demonstrations are
helpful for those with MR/ID to
ensure mutual understanding and
improve treatment adherence.
-
7/29/2019 Mental Retardation treatment and management
4/12
Treatment & Management
6. Sedation/anesthesia: Patients
with MR/ID requiring anesthesia
may have different reactions than
the general population, such asparadoxical reactions to
benzodiazepines, and care should
be taken to use the lowest dose
and titrate slowly.
-
7/29/2019 Mental Retardation treatment and management
5/12
Treatment & Management
7. Sexuality/abuse: A significantly
higher proportion of children and
adults with MR/ID have
experienced some form of abuse,with some estimates of up to
70%, which contributes to mental
health issues. This should be
addressed at each medical visitand especially in the setting of
changes in behaviors, such as
increased aggression.
-
7/29/2019 Mental Retardation treatment and management
6/12
Treatment & Management
Consultations
Developmental pediatrician orpsychologist
Geneticist and counselor
Psychiatrist
Dentist
Podiatrist
Special education/educational therapist
Occupational, speech and/or physicaltherapist
Behaviorist
Pharmacist
Durable medical equipment providers
Social services agencies/social workers
-
7/29/2019 Mental Retardation treatment and management
7/12
Treatment & Management
Diet
Nutritional supplements are of no
proven benefit.
Activity Because obesity is more prevalent in
those with MR/ID, regular physical
activity should be included in the
management plan. Adaptive exerciseprograms for those with
concomitant physical disabilities
should be recommended as needed.
-
7/29/2019 Mental Retardation treatment and management
8/12
Treatment & Management
Nursing Management
1. Assess all children for signs ofdevelopmental delays.
2. Administer prescribed medicationsfor associated problems such asanticonvulsants for seizuredisorders, and methylphenidate
(Ritalin) for attention deficithyperactivity disorder.
3. Support the family at the time ofinitial diagnosis by actively listeningto their feelings and concerns andassessing their composite strengths.
-
7/29/2019 Mental Retardation treatment and management
9/12
Treatment & Management
4. Facilitate the childs self-care abilities byencouraging the parents to enroll the child
in an early stimulation program,establishing a self-feeding program,initiating independent toileting, andestablishing an independent groomingprogram (all developmentally appropriate).
5. Promote optimal development byencouraging self-care goals and emphasizethe universal needs of children, such asplay, social interaction and parental limitsetting.
6. Promote anticipatory guidance and problem
solving by encouraging discussionsregarding physical maturation and sexualbehaviors.
7. Assist the family in planning for the childsfuture needs (e.g. Alternative to home care,
especially as the parents near old age); referthem to community agencies.
-
7/29/2019 Mental Retardation treatment and management
10/12
Treatment & Management
8. Provide child and family teaching
Identify normal developmentalmilestones and appropriatestimulating activities including play
and socialization. Discuss the need for patience with
the childs slow attainment ofdevelopmental milestones.
Inform parents about stimulation,
safety and motivation. Supply information regarding normal
speech development and how toaccentual nonverbal cues, such asfacial expression and body language,to help cue speech development.
-
7/29/2019 Mental Retardation treatment and management
11/12
Treatment & Management
Explain the need for discipline that issimple, consistent and appropriate tothe child.
Review an adolescents need for simple,practical sexual information thatincludes anatomy, physicaldevelopment and conception.
Demonstrate ways to foster learningother than verbal explanation becausethe child is better able to deal with
concrete objects than abstractconcepts.
Point out the importance of positiveself-esteem, built by accomplishingsmall successes in motivating the child
to accomplish other tasks.
-
7/29/2019 Mental Retardation treatment and management
12/12
Treatment & Management
9. Encourage the prevention ofmental retardation
Encourage early and regular
prenatal care. Provide support for high risk
infants.
Administer immunizations,
especially rubella immunization. Encourage genetic counseling
when needed.
Teach injury prevention both
intentional and unintentional.