Nursing Care Plan and Nursing Diagnosis for Mental Retardation

INTRODUCTION

In this post we will discuss about the nursing care plan and nursing diagnosis for mental retardation. Intellectual Disability was referred to as mental retardation (MR) prior to the DSM-5. Intellectual disability is a condition with an onset in the developmental period of life and includes below-average general intellectual function and a lack of the skills necessary for independent daily living.

The general mental abilities that are examined in order to diagnose intellectual disability include: reasoning, problem solving, planning, abstract thinking, judgment, learning from instruction and experience, and practical understanding. These abilities are measured using individually administered tests of intelligence that are given by a trained clinician. Additionally, people with intellectual disability may struggle with the skills needed to function in daily life, such as communication, social participation, and independent living without ongoing support.

CLASSIFICATION OF MENTAL RETARDATION:

There are four levels of mental retardation: mild, moderate, severe, and profound. These levels are determined by performance on standardized IQ tests and by the potential to learn adaptive skills such as communication and social interaction.

Mild retardation

The vast majorities of people with mental retardation have IQ levels of 55 to 69 and are considered mildly retarded. Mildly retarded children often go undiagnosed until they are well into their school years. They are often slower to walk, talk, and feed themselves than most other children. They can learn practical skills, including reading and math, up to about the fourth to sixth grade level. Mildly retarded adults usually build social and job skills and can live on their own.

Moderate retardation

A much smaller number of people with mental retardation have IQs ranging from 40 to 54 and are considered moderately retarded. Children who are moderately retarded show noticeable delays in developing speech and motor skills. Although they are unlikely to acquire useful academic skills, they can learn basic communication, some health and safety habits, and other simple skills. They cannot learn to read or do math. Moderately retarded adults usually cannot live alone, but they can do some simple tasks and travel alone in familiar places.

Severe retardation

An even smaller percentage of people with mental retardation have IQs ranging from 20 to 39 and are considered severely mentally retarded. Their condition is likely to be diagnosed at birth or soon after. By preschool age, they show delays in motor development and little or no ability to communicate. With training, they may learn some self-help skills, such as how to feed and bathe themselves. They usually learn to walk and gain a basic understanding of speech as they get older. Adults who are severely mentally retarded may be able to follow daily routines and perform simple tasks, but they need to be directed and live in a protected environment.

Profound retardation

Only a very few people with mental retardation have IQs of 0 to 24 and are considered severely mentally retarded. Their condition is usually diagnosed at birth, and they may have other medical problems and need nursing care. Children who are profoundly retarded need to be continuously supervised. These children show delays in all aspects of development. With training, they may learn to use their legs, hands, and jaws. Adults who are profoundly retarded usually learn some speech and may learn to walk. They cannot take care of themselves and need complete support in daily living.

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CAUSES OF MENTAL RETARDATION:

Causes of intellectual disability are numerous, and specific causes may be unknown in many cases.

Failure to adapt normally and grow intellectually may become apparent early in life or, in the case of mild intellectual disability, may not become recognizable until school age or later. An assessment of age-appropriate adaptive behaviors can be made by using developmental screening tests. The failure to achieve developmental milestones is suggestive of intellectual deficits.

A family may suspect intellectual disability if motor skills, language skills, and other cognitive skills do not seem to be developing in a child or are developing far more slowly than among the child's peers.

The degree of impairment from intellectual disability ranges widely, from mild to profound. Less emphasis is now placed on degree of intellectual disability and more on the amount of intervention and care required for daily life.

Causes of intellectual disability can be roughly broken down into several categories:

• Trauma (prenatal and postnatal), such as oxygen deprivation before, during or after birth
• Infection (congenital and postnatal)
• Brain malformations
• Chromosomal abnormalities
• Genetic abnormalities and inherited metabolic disorders
• Seizure disorders
• Nutritional deficits such as severe malnutrition
• Environmental influences (alcohol, other drugs, toxins such as lead or mercury,
• teratogens)
• Severe and chronic social deprivation

SIGNS AND SYMPTOMS

• Failure to meet intellectual developmental markers
• Difficulties in learning academic skills
• Lack of curiosity
• Immaturity in social interactions compared with peers
• Difficulty regulating emotion and behavior
• Support needed in daily living tasks compared to peers
• Spoken language is limited

Nursing Care Plan for Mental Retardation (MR)

A. Assessment

The assessment consists of a comprehensive evaluation of the shortcomings and strengths associated with the adaptive skills; communication, self-care, social interaction, use of facilities in the community self-direction, health care and safety, functional academic, recreational skill formation, and tranquility.

B. Nursing Diagnosis for Mental Retardation

• Delayed Growth and Development related to abnormalities in cognitive function.
• Impaired Verbal Communication related to delayed language skills of expression and reception.
• Risk for Injury related to aggressive behavior / uncontrolled motor coordination.
• Impaired social interaction related to trouble speaking / social adaptation difficulties
• Family processes, Interrupted related to have children mental retardation.
• Self-care deficit related to the physical and mental incompetence / lack of maturity development

1. Delayed Growth and Development related to 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 dietitian to obtain nutritional intervention)

2. Impaired Verbal Communication related to 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 related to 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.

4. Impaired social interaction related to trouble speaking / social adaptation difficulties

Goal: Minimize disruption of social interaction.

Intervention:

• Help children identify personal strengths.
• Give knowledge to people nearby, about mental retardation.
• Encourage children to participate in activities with friends and other family.
• Encourage the children to maintain contact with friends.
• Give positive reinforcement on the results achieved by children.

5. Family processes, Interrupted related to have children mental retardation.

Goal: Family show an understanding of the child's illness and its treatment

Intervention:

• Assess understanding family about the child's illness and treatment plan.
• Emphasize and explain other health team, about the child's condition,
• Procedures and therapies are recommended.
• Use every opportunity to improve understanding of the disease and its treatment family
• Repeat as often as possible information.

6. Self-care deficit related to the physical and mental incompetence / lack of maturity development.

Goal: Perform self-care, appropriate age and developmental level of the child.

Intervention:

• Identification of the need for personal hygiene and provide assistance as Needed.
• Identification of difficulties in self-care, such as lack of physical movement, cognitive decline.

Education for parents:

• For each stage of child development ages.
• Support the involvement of parents in child care.
• Anticipatory guidance and management face a difficult child behavior.
• Inform the existing educational facilities and groups, etc.