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• Below average intellectual functioning - IQ of 75 or less
• Deficits in adaptive functioning for age and cultural group
• Onset before age 18

• 30% of the cases have no cause
• Genetic factors – 5% of cases
o PKU, Chromosomal disorders,
• Prenatal, Perinatal
o Prematurity
o Something that cuts off oxygen to fetus
o Major is Alcohol abuse – Fetal Alcohol Syndrome
o Illness during pregnancy: Toxemia, Uncontrolled diabetes
• Postnatal
o Anything that occurs during childhood 5%
o Meningitis Lead poisoning – Insecticides
o High fever Asphyxia
• Social, Cultural and Environmental Factors
o 20% of cases of MR
o Deprivation of nuturents and Lack of social stimulation

• IQ Tests or Lack of skills
o Coded on Axis II Peds book p. 569
o Mild (50-70)
 Capable of independent living but may need some assistance during times
of stress.
 Can go up to 6th grade in school
 Can function in a structured setting
 Can achieve vocational skills for minimum self support
 May not need to go to any type of facilities provided by Dept of Health
o Moderate (35-50)
 Requires supervision and can achieve a 2nd grade level of education
 Could contribute to their own support in a sheltered workshop
 May have some trouble with very fine motor skills, may have problem in
 May have some difficulty in peer relationships
o Severe (20-35)
 Might be trained in elementary hygiene skills and requires complete
supervision. NO academic or vocational training. Work with habits. Self-
care and Hygiene activity. Minimum verbal skills. Only able to perform
simple tasks under close supervision
o Profound (below 20)
 Unable to function independently. Constant aid and supervision.
 Cannot benefit from any vocational or academic training.
 May respond to minimum training in self-care. Must be one on one
 No speech development
 Constant supervision and care
• Genetic Counseling
o Advise couple not to have children
o A nurse would not do that; a physician would
• Prenatal Care
o Critical, Decrease premeaturity, and other birth complications
• Avoid Substance Abuse
o Teach mothers to avoid alcohol and drugs

• Nurse important in identifying impairment
o Because the nurse usually does the assessment in Dr’s offices
• Family and child education
o Family needs to be taught how to work with the child
o What Resources are available
• Early Intervention Programs
o Can begin at birth
o Help reduce some impairment
o Begin as newborn
o Mainstreamed in school


• High risk for injury
o Create a safe environment
o You as a nurse may have a MR client on a Med Surg floor with another illness. Be
careful if they are ambulatory they may not know not to put their hands in the
Sharps container.
o May have seizures – pad side rails
o Ask family about habits: What upsets them
• Self Care Deficit
o Talk with the family and know what the client is able to do
• Impaired Verbal Communication
o Learn from the family, words they may say or have the family assist you
understanding what they are saying so that you may have some type of
communication with them.
o May be non verbal signals – Know what they mean
• Impaired social interaction
o Keep safe; Don’t let them get into a setting where other people might make fun of
them. Or where they can be injured.
o Respond to token economy and Praise

• EEG – Done to identify a person that has seizures
o Look at Doctors and see if any medications or sleep needs to be withheld
prior to the EEG, because sometimes sleep is withheld to have the person
sleep through the EEG. May hold anticonvulsants, coffee or tea.***
o Need to eat prior to the test. May give oral sedative to induce sleep.
o May do activities during EEG to induce seizure.
• MRI - May have to be sedated – noisy NO METAL
• CT Scan – May have to be sedated
• Dexamethasone Suppression Test
o One way of diagnosing depression – not used much
o They give the person 1mg of decadron at 1100pm. Then the next day they
draw a plasma cortisol level at 4pm and 11pm.
o If greater than 5mg the person is likely to have depression
 If you are not depressed then the decadron level will be lower than 5
 In depressed people the body does not suppress the cortisol
o Thyroid Stimulating Hormone
o May be done to rule out a physical cause for depression
o Hypothyroid – Depressed
o Hyperthyroid – Manic
o Done also before a client is put on Lithium to make sure the Thyroid is
working fine.

• Personality Tests
o Objective
 Minnesota Multiphasic Personality Inventory
• 550 statements the person answers T or F or cannot say
• Will ask the same question over and over in different ways to
prevent you from lying
• Psychologists will give 3 tests to see how they correlate
 Beck Depression Inventory
• Answers questions
o Projective
 When the clients thoughts and feelings are projected on the subject
 Rorschach
• Ink Blot test
o The first thing that comes to mind
o Can help in diagnosis
o Given by a clinical psychologist
 Draw a person test
• What type of person is drawn
• Guidelines to go by

• Intelligence Tests
o Wechsler Adult Intelligence Scale
 Most common used for IQ testing
 Completes 11 sub tests which yields verbal and performance scores
 16 years and older
o Stanford-Binet Intelligence Test
 Test given to children and more useful in the mentally retarded