Pathophysiology of Nasothmoidal Meningocele With Mild Mental Retardation

Predisposing Factors Genetic conditions Family history of neural tube defects Congenital anomalies Spina bifida Encephalocele Maternal age Age above 30 years

Precipitating Factors Maternal lifestyle Alcoholism Cigarette smoking Strenuous activity Use of illicit drugs Maternal diet Low folic acid intake Low iodine intake Maternal gestational illness Rubella Low socioeconomic level Medications Amoxicillin

Legend: Related to client AB Flow of disease Factors present in the mother Signs and symptoms

Failure of neural tube to close completely during fetal development Creates a gap in the CSF, brain tissues and meninges Malformation of brain and skull Herniation of meninges

 Craniofacial abnormalities Neurologic problems Hydrocephalus Spastic quadriplegia Microcephaly Ataxia Developmental delay Vision problems Mental and growth retardation Seizures

Cerebrospinal fluid seep out through nasal bone and cartillages Craniofacial abnormalities Nasoethmoidal meningocele of brain development

Cerebrum

Cerebellum Temporal Lobe Malfunctions of different temporal lobe areas

Parietal Lobe Impaired sensation

Occipital Lobe Difficulty seeing Blurred vision Difficulty recognizing familiar objects

Frontal Lobe Malfunction of Brocas area Echolalia Poor speech process Difficulty articulating words Difficulty in talking

Altered walking gait Difficulty in balancing Ataxia

Wernickes area Difficulty understanding spoken language Reading ability is diminished (dyslexia)

Hippocampus Impaired short term and long term memory Has a hard time remembering names

Difficulty seeing Blurred vision Difficulty recognizing familiar objects

Mental Retardation (MR)

Mild MR Educable Cannot be distinguished among normal children until they attend school Tends to learn slowly but can eventually learn skills Is able to co-relate with the community

Moderate MR Trainable Language delay Learning and reasoning delay Imbalanced posture Dysfunctional eyes Has difficulty in problem solving Have poor social skills May need supervision as an adult

Severe MR Non-trainable Is able to learn basic skills Earliest motor milestones are delayed Will be able to learn a few words Will be able to learn a few self-help skills Needs support even in adulthood

Profound MR Educable Cannot be distinguished among normal children until they attend school Tends to learn slowly but can eventually learn skills Is able to co-relate with the community

With medical, surgical and nursing intervention Medical interventions Diagnostic procedures Intelligence test Infant development test Magnetic resonance imaging (MRI) Computed tomography scan (CT scan)

Without medical, surgical and nursing intervention Progression of the disease process Further damage to the brain caused by the pressure exerted by the protrusion

Therapies Speech therapy Physical therapy SpEd program Surgical interventions Reparative surgery for NEM Removal of protrusions (Intracranial repair of the NEM) Correcting deformities Placing of shunts Closure of open skin defects Reomval of non functional extracranial cerebral tissue Total craniofacial reconstruction Nursing interventions 1. Assess the causative or contributive factors to the disturbed thought processes of the client 2. Reorient to time, place, or person as needed and whenever client manifests flight of ideas 3. Maintain reality oriented relationships and environment by putting reminders like seasonal decor, personal items and verbal reminders by the significant others 4. Encourage the significant others to use a positive approach with examples and demonstration 5. give simple directions using short words, simple sentences and allow ample time for client to respond to the questions.

Inability to enhance skills

Inability to perform activities of daily living

Remains dependent to the significant others

Unable to socialize with the community

Self-isolation

Bad Prognosis Optimum Level of functioning Good Prognosis