Question

1. Describe nursing interventions during the child’s hospitalization for failure to thrive.

2. Describe an individualized education program (IEP).

3. What is the purpose of a genetic consultation?

4. Describe the medications used to treat attention deficit/hyperactivity disorder. How long can these medications be prescribed?

5. Describe atlantoaxial instability in the Trisomy 21 (Down syndrome) patient. How is it diagnosed?

Answer 1

Ans 1. Nursing Interventions during hospitalization

These interventions addresses general concern related to nutritional deficits for the hospital or home setting.

Provide sensory stimulation : Attempt to cuddle the child and talk to him or her in a warm, soothing tone and allow for play activities appropriate for the child’s age.

Maintain adequate nutrition and fluid intake : Feed the child slowly and carefully in a quiet environment; during feeding, the child might be closely snuggled and gently rocked; it may be necessary to feed the child every 2 to 3 hours initially.

Postfeeding instructions : Burp the child frequently during and at the end of each feeding, and then place him or her on the side with the head slightly elevated or held in a chest-to-chest position.

Participation of caregiver : If a family caregiver is present, encourage him or her to become involved in the child’s feedings.

Document the intake : Carefully document food intake with caloric intake and strict intake and output records.

Monitor elimination patterns :   As food and fluids are gradually increased and the child becomes hydrated, bowel activity and urine production return to normal.

Promoting skin integrity : Lanolin or A and D ointment can be used to lubricate dry skin; apply the ointment at least once each shift and turn the child at least every 2 hours.

Providing family teaching : While caring for the child, point out to the caregiver the child’s development and responsiveness, noting and praising any positive parenting behaviors the caregiver displays.

Ans 2. The Individualized Education Program, often called the IEP, is a legal document under United States law that is developed for each public school child in the U.S. who needs special education. It is created through a team of the child's parent and district personnel who are knowledgeable about the child's needs.

An IEP outlines the special education experience for all eligible students with a disability. An eligible student is any child between the ages of 3-21 attending a public school and has been evaluated as having a need in the form of a specific learning disability, autism, emotional disturbance, other health impairments, intellectual disability, orthopedic impairment, multiple disabilities, hearing impairments, deafness, visual impairment, deaf-blindness, developmental delay, speech/language impairment, or traumatic brain injury. The IEP describes present levels of performance, strengths, and needs, and creates measurable goals based on this data. It provides accommodations, modifications, related services, and specialized academic instruction to ensure that every eligible child receives a "Free and Appropriate Public Education in the Least Restrictive Environment. The IEP is intended to help children reach educational goals more easily than they otherwise would. The four component goals are: conditions, learner, behavior, and criteria. In all cases, the IEP must be tailored to the individual student's needs as identified by the IEP evaluation process, and must help teachers and related service providers (such as paraprofessional educators) understand the student's disability and how the disability affects the learning process.The IEP describes how the student learns, how the student best demonstrates that learning, and what teachers and service providers will do to help the student learn more effectively. Developing an IEP requires the team to evaluate the student in all areas of suspected disability, consider the student's ability to access the general education curriculum, consider how the disability affects the student's learning, and choose a federal placement for the student.

As long as a student qualifies for special education, the IEP is mandated to be regularly maintained and updated up to the point of high school graduation. If a student in special education attends university upon graduation, they are no longer "children with disabilities" under the Individuals with Disabilities Education Improvement Act of 2004 (IDEA) and are instead protected under Section 504. They can apply for and receive Section 504 accommodations, but the process is very different. Placements in public schools often occur in "general education" classrooms. Other types of placements include RSP (within a resource room), Special Day Class, Self Contained Class, Co-Teacher and specialized classes, or sub-specialties taught by a special education teacher. Students can also be removed from an IEP if it is determined the student is no longer eligible upon reevaluation. An IEP is meant to ensure that students receive an appropriate placement not only in special education classrooms or special schools. It is designed to give the student a chance to participate in regular school culture and academics as much as is possible for that individual student. In this way, the student is able to have specialized assistance only when such assistance is absolutely necessary, and otherwise maintains the freedom to interact with and participate in activities to the same extent of their non-disabled/general education peers.

Ans 3. The purpose of genetic counseling is to inform at-risk individuals about the relevant genetic, biological and environmental risk factors related to the individual's inherited syndrome or cancer.

Genetic counseling involves pre-test and post-test counseling. Pre-test counseling focuses on informed consent. An individual is educated on why the test is being offered and is informed on the possible outcomes and accuracy of a test. Post-test counseling involves the disclosure of test results, a discussion of the significance of the results, and follow-up plans for the patient.

Genetic testing should be performed by a genetic counselor, with specialized education, training and experience in medical genetics and counseling.

It is the job of a genetic counselor to obtain and assess relevant information concerning an individual's risk and to provide information and support to families and individuals who may be at increased risk for a variety of inherited predispositions.

A genetic counselor should be able to explain how family history and laboratory testing provide an adjusted risk for developing cancer and provide a clear explanation of the risk for cancer development, along with the preventative, screening and diagnostic processes that are available to the patient based on the adjusted risk.

Ans 4. There are 5 types of medication licensed for the treatment of ADHD:

methylphenidate

dexamfetamine

lisdexamfetamine

atomoxetine

guanfacine

These medications are not a permanent cure for ADHD but may help someone with the condition concentrate better, be less impulsive, feel calmer, and learn and practise new skills.

Some medications need to be taken every day, but some can be taken just on school days. Treatment breaks are occasionally recommended to assess whether the medication is still needed.

If you were not diagnosed with ADHD until adulthood, your GP and specialist can discuss which medications and therapies are suitable for you.

If you or your child is prescribed one of these medications, you'll probably be given small doses at first, which may then be gradually increased. You or your child will need to for regular check-ups to ensure the treatment is working effectively and check for signs of any side effects or problems.

It's important to know about any side effects and talk to them if you feel you need to stop or change treatment.

Your specialist will discuss how long you should take your treatment but, in many cases, treatment is continued for as long as it is helping.

Ans 5. Atlantoaxial dislocation refers to a loss of stability between the atlas and axis (C1–C2), resulting in loss of normal articulation. The atlantoaxial joints can lose stable articulation from traumatic, inflammatory, idiopathic, or congenital abnormalities.

Children with Down syndrome are at increased risk of developing compression of the spinal cord called atlantoaxial instability. This problem is caused by a combination of low tone, loose ligaments and bony changes. The spinal cord can be pressed by the bones and cause nerve damage. Symptoms of nerve damage can occur at any time and there is no test or x-ray that can tell who is at risk.

Parents should watch their child for any changes in how they walk, use their arms or hands, a head tilt, complaints of pain in the neck, or change in bowel or bladder function, change in general function or new onset weakness.