MENTAL HEALTH DISORDERS Module G NUR 203.
Disorders of infancy, childhood or adolescence
Chapter 23
Mental Retardation—page 377
• Defined by deficits in general intellectual functioning and adaptive functioning
o Intellectual functioning is measure by IQ test.
o Adaptive functioning refers to the person’s ability to adapt to the requirements of daily living and
the expectations of his or her age, culture group.
• DSM-IV-TR Criteria—Box 23-1
A. Significantly subaverage general intellectual functioning: an IQ of about 70 or below on an
individually administered IQ test. For infants a clinical judgment of significantly subaverage
intellectual functioning
B. Concurrent deficits or impairments in adaptive functioning. Example is pt is not meeting the expectations
of age group or culture group in 2 of the following areas:
Communication, self-care, home living, social/interpersonal skills, use of community resources, self-
direction, and functional academic skills, work, leisure, health, and safety.
C. The onset is before age 18 years.
• 5 Predisposing factors- 30 to 40% etiology cannot be determined.
1. Hereditary factors- cause 5%,
o Inborn errors in metabolism- Tay-Sachs, PKU, hyperglycinemia, chromosomal disorders like
Down syndrome, Klinefelter syndrome, and single-gene abnormalities such as tuberous sclerosis
and neurofibromatosis.
2. Alterations in embryonic development- cause about 30%
o Alcohol, drugs are toxic factors. Maternal illness such as rubella, cytomegalovirus. Complications
of pregnancy are toxemia, uncontrolled diabetes can cause congenital mental retardation.
3. Pregnancy and perinatal factors- causes 10%
o Occurs during pregnancy fetal malnutrition, viral infections, prematurity, and trauma to the head
during the birth process, prolapse cord.
4. General medical conditions- Cause about 5%,
o Include infections such as meningitis, encephalitis, poisoning such as insecticides, meds, and
lead, physical trauma such as head injuries, asphyxiation, and hyperpyrexia.
5. Environmental influences and other mental disorders- cause 15 to 20%
o Deprivation of nurturance and social, linguistic, and other
stimulations Level—Table 23-1
Mild retardation- (50-70 IQ) - cable of independent living, capable of academic skills to 6th grade level can
achieve vocational skills for minimum self-support. Capable of social skills and functions in a structured
sheltering setting. Psychomotor skills usually not affected.
,Moderate retardation- (35-49 IQ) - Can perform some ADLS but requires supervision. Capable of academic skill to 2nd
grade level. When an adult may contribute in a sheltered workshop. May experience some limitation in speech
communication. May be hard to communicate with peers. Motor development in fair.
Severe retardation- (20-34 IQ) - May be trained in elementary hygiene and requires complete supervision. Unable to
benefit from academic or vocational training, has minimal verbal skills, poor psychomotor skills such as feeding.
Profound retardation- (below 20 - No capacity for independent functioning and requires constant aid and supervision.
Little or no speech development, Lack of ability for fine and gross motor movements. May be associated with other
physical disorder.
,Nursing Process for Mental
Retardation Assessment
• The degree of severity of mental retardation is identified by the clients IQ level.
• Nurses should assess and focus on each client’s strengths and individual abilities.
• Knowledge regarding level of independence in the performance of self-care activates is essential to
the development of an adequate plan for nursing care.
Diagnosis
• Safety is the number 1 priority
• Self-care deficit
• Impaired verbal communication
• Delayed growth and development
Planning
• Includes short and long term goals. Timelines are individually determined
• No physical harm.
• Interacts with others in a socially appropriate manner.
Implementation
• Direct plan toward individual client and family member/caregiver in the ongoing care of the client with
mental retardation.
• They need to receive info regarding the scope of the condition, methods of modifying behavior, and
community resources from which they seek assistance and support. (School)
Evaluation
• Should reflect positive behavior changes.
• Evaluation is accomplished by determining if the goals of care have been met through implementation of
the nursing action selected.
• Always assess for changes when outcomes have not been met.
ATTENTION-DEFICIT/HYPERACTIVITY DISORDER—PAGE 386
• Classic finding—persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequent
and severe than other individuals of the same developmental age
Subtypes
• ADHD, Combined Type- has at least 6 symptoms of inattention and at least 6 symptoms of
hyperactivity- impulsivity have persisted for at least 6 months.
o Most children and adolescents with this disorder have the combined type.
, • ADHD, Predominantly Inattentive Type- is used if at least 6 symptoms of inattention but fewer than 6
symptoms of hyperactivity-impulsivity have persisted for at least 6 months.
• ADHD, Predominantly Hyperactive-Impulsive Type- used if at least 6 symptoms of hyperactivity-impulsivity
but fewer than 6 symptoms of inattention that have persisted for at least 6 months.
Disorders of infancy, childhood or adolescence
Chapter 23
Mental Retardation—page 377
• Defined by deficits in general intellectual functioning and adaptive functioning
o Intellectual functioning is measure by IQ test.
o Adaptive functioning refers to the person’s ability to adapt to the requirements of daily living and
the expectations of his or her age, culture group.
• DSM-IV-TR Criteria—Box 23-1
A. Significantly subaverage general intellectual functioning: an IQ of about 70 or below on an
individually administered IQ test. For infants a clinical judgment of significantly subaverage
intellectual functioning
B. Concurrent deficits or impairments in adaptive functioning. Example is pt is not meeting the expectations
of age group or culture group in 2 of the following areas:
Communication, self-care, home living, social/interpersonal skills, use of community resources, self-
direction, and functional academic skills, work, leisure, health, and safety.
C. The onset is before age 18 years.
• 5 Predisposing factors- 30 to 40% etiology cannot be determined.
1. Hereditary factors- cause 5%,
o Inborn errors in metabolism- Tay-Sachs, PKU, hyperglycinemia, chromosomal disorders like
Down syndrome, Klinefelter syndrome, and single-gene abnormalities such as tuberous sclerosis
and neurofibromatosis.
2. Alterations in embryonic development- cause about 30%
o Alcohol, drugs are toxic factors. Maternal illness such as rubella, cytomegalovirus. Complications
of pregnancy are toxemia, uncontrolled diabetes can cause congenital mental retardation.
3. Pregnancy and perinatal factors- causes 10%
o Occurs during pregnancy fetal malnutrition, viral infections, prematurity, and trauma to the head
during the birth process, prolapse cord.
4. General medical conditions- Cause about 5%,
o Include infections such as meningitis, encephalitis, poisoning such as insecticides, meds, and
lead, physical trauma such as head injuries, asphyxiation, and hyperpyrexia.
5. Environmental influences and other mental disorders- cause 15 to 20%
o Deprivation of nurturance and social, linguistic, and other
stimulations Level—Table 23-1
Mild retardation- (50-70 IQ) - cable of independent living, capable of academic skills to 6th grade level can
achieve vocational skills for minimum self-support. Capable of social skills and functions in a structured
sheltering setting. Psychomotor skills usually not affected.
,Moderate retardation- (35-49 IQ) - Can perform some ADLS but requires supervision. Capable of academic skill to 2nd
grade level. When an adult may contribute in a sheltered workshop. May experience some limitation in speech
communication. May be hard to communicate with peers. Motor development in fair.
Severe retardation- (20-34 IQ) - May be trained in elementary hygiene and requires complete supervision. Unable to
benefit from academic or vocational training, has minimal verbal skills, poor psychomotor skills such as feeding.
Profound retardation- (below 20 - No capacity for independent functioning and requires constant aid and supervision.
Little or no speech development, Lack of ability for fine and gross motor movements. May be associated with other
physical disorder.
,Nursing Process for Mental
Retardation Assessment
• The degree of severity of mental retardation is identified by the clients IQ level.
• Nurses should assess and focus on each client’s strengths and individual abilities.
• Knowledge regarding level of independence in the performance of self-care activates is essential to
the development of an adequate plan for nursing care.
Diagnosis
• Safety is the number 1 priority
• Self-care deficit
• Impaired verbal communication
• Delayed growth and development
Planning
• Includes short and long term goals. Timelines are individually determined
• No physical harm.
• Interacts with others in a socially appropriate manner.
Implementation
• Direct plan toward individual client and family member/caregiver in the ongoing care of the client with
mental retardation.
• They need to receive info regarding the scope of the condition, methods of modifying behavior, and
community resources from which they seek assistance and support. (School)
Evaluation
• Should reflect positive behavior changes.
• Evaluation is accomplished by determining if the goals of care have been met through implementation of
the nursing action selected.
• Always assess for changes when outcomes have not been met.
ATTENTION-DEFICIT/HYPERACTIVITY DISORDER—PAGE 386
• Classic finding—persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequent
and severe than other individuals of the same developmental age
Subtypes
• ADHD, Combined Type- has at least 6 symptoms of inattention and at least 6 symptoms of
hyperactivity- impulsivity have persisted for at least 6 months.
o Most children and adolescents with this disorder have the combined type.
, • ADHD, Predominantly Inattentive Type- is used if at least 6 symptoms of inattention but fewer than 6
symptoms of hyperactivity-impulsivity have persisted for at least 6 months.
• ADHD, Predominantly Hyperactive-Impulsive Type- used if at least 6 symptoms of hyperactivity-impulsivity
but fewer than 6 symptoms of inattention that have persisted for at least 6 months.
