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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
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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.
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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
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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
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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
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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.
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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
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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
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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.
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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.
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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.
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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
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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
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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.
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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.
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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.
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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
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1004692-overview#a0104
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www.merckmanuals.com
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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
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allnurses.com
general-nursing-student
rt-vs-lt-263736.html
http:
www.lbcma.org.uk
newsArticles
NAhearing.asp
http:
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communication.htmlhttp:
kidshealth.org
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