Chapter 36 - Patients with special challenges

Question 1

What disease do common people live at home with?

Answer 1

Chronic diseases

Question 2

what is developmental disability?

Answer 2

Refers to insufficient development of the brain, resulting in some level of dysfunction or impairment.
2. Can include intellectual, hearing, or vision impairments that surface during infanthood or childhood.

Question 3

What is intellectual disability?

Answer 3

results in the inability to learn and socially adapt at a normal developmental rate

Question 4

What are the characteristics of a patient with a slight intellectual impairment?

Answer 4

May appear slow to understand or have a limited vocabulary

b. May behave immaturely compared to their peers
c. If severely disabled, may not have the ability to care for themselves, communicate, understand, or respond to surroundings

Question 5

What is an autism spectrum disorder?

Answer 5

Developmental disorder characterized by impairment of social interaction

	a. Severe behavioral problems
	b. Repetitive motor activities
	c. Impairment in verbal and nonverbal skills
	d. May be hyper- or hyposensitive to sensory stimuli
	e. May show their pain in unusual ways, such as humming, singing, and removing clothing

Question 6

What is down syndrome?

Answer 6

Characterized by a genetic chromosomal defect that can occur during fetal development, resulting in mild to severe intellectual impairment

Question 7

What is physical abnormalities?

Answer 7

Round head with a flat occiput

	b. Enlarged, protruding tongue
	c. Slanted, wide-set eyes and folded skin on either side of the nose, covering the inner corners of the eye
	d. Short, wide hands
	e. Small face and features

Question 8

What are the increased risk for medical complications?

Answer 8

As many as 40% may have heart conditions and hearing and vision problems.

Question 9

Why might intubation be difficult for someone with down syndrome?

Answer 9

Intubation may be difficult due to large tongues and small oral and nasal cavities.
5. Mask ventilation can be challenging—jaw-thrust maneuver or a nasopharyngeal airway may be necessary.

Question 10

What is patient interaction?

Answer 10

. Patient interaction

1. It is normal to feel somewhat uncomfortable when initiating contact with a developmentally disabled patient.
2. Approach the patient in a calm, friendly manner, watching for signs of increased anxiety or fear.
3. Have the members of your team hold back slightly until you can establish a rapport with the patient.
4. Introduce the team members and explain what they are going to do.
5. Move slowly but deliberately, explaining beforehand what you are going to do.
7. Watch carefully for signs of fear or reluctance from the patient, and do your best to soothe the patient’s anxiety and discomfort.
8. By initially establishing trust and communication, you will have a much better chance for a successful outcome.

Question 11

What is the range in degree of visual impairment?

Answer 11

• some patients lose peripheral or central vision

- Some can distinguish light from dark or shapes

Question 12

How to communicate with hearing impaired patient?

Answer 12

Locate and inserting any hearing aids.

b. Face the patient while you communicate.
c. Position yourself approximately 18″ directly in front of the patient.
d. Do not exaggerate your lip movements or look away.

Question 13

What is cerebral palsy?

Answer 13

. Group of disorders characterized by poorly controlled body movement

2. Range of mild to severe symptoms
3. Important considerations
	a. Observe airway closely
	b. Do not assume that patients have an intellectual disability.

Question 14

What are the considerations for Cerebral Palsy?

Answer 14

. Limbs are often underdeveloped and are prone to injury.

d. Patients who have the ability to walk may have an ataxic or unsteady gait and are prone to falls.
e. Pad the patient to ensure his or her comfort.
f. Never force a patient’s extremities into any position.
g. Whenever possible, take walkers or wheelchairs along during transport

Question 15

What is Spina Bifida?

Answer 15

Birth defect caused by incomplete closure of spinal column during embryonic or fetal development

2. Spinal cord is exposed.
3. Opening can be closed surgically, but often leaves spinal and neurologic damage.

Question 16

What are Spina Bifida associate conditions?

Answer 16

Hydrocephalus

b. Partial or full paralysis of the lower extremities
c. Loss of bowel and bladder control
d. Extreme latex allergy 5. Ask patients or caregivers how to best move them before you transport them.

Question 17

What is paralysis?

Answer 17

Inability to voluntarily move one or more body parts

2. Possible causes
3. Patient may have normal sensation or hyperesthesia (increased sensitivity).
4. Facial paralysis may also cause communication challenges 
5. Diaphragm may not function correctly, requiring the use of a ventilator.

Question 18

What are the paralysis specialized equipment?

Answer 18

Urinary catheters

b. Tracheotomy tube
c. Colostomy tube
d. Feeding tubes

Question 19

What is obesity?

Answer 19

a person has excessive body fat

Question 20

How to treat interactions with patients with obesity?

Answer 20

. Patients may be embarrassed by their condition.

2. If transport is necessary, plan early for extra help and/or specialized equipment.
3. Treat the patient with dignity and respect. 
4. Ask your patient how it is best to move him or her before attempting to do so.
5. Avoid lifting the patient by only one limb, which would risk injury to overtaxed joints.
6. Coordinate and communicate all moves prior to starting to lift.To prevent significant soft tissue injury or deep venous thrombosis, look for pinch or pressure points from equipment. 8. Large patients may have difficulty breathing if placed in a supine position. 9. Plan egress routes to accommodate large patients, equipment, and the lifting crewmembers. 10. Notify the receiving facility early.

Question 21

What is tacheostomy tubes?

Answer 21

Tracheal stoma provides a path between the surface of the neck and the trachea and is kept open by a plastic tracheostomy tube

2. Can be temporary or permanent
3. For patients who:
	a. Depend on home automatic ventilators
	b. Have chronic pulmonary medical conditionsBecause it is foreign to the respiratory tract, the body reacts by building up secretions in or around the tube. 5. Tubes are prone to becoming obstructed by mucous plugs or foreign bodies.
a. DOPE mnemonic helps to recognize cause of obstruction 6. Common problems 7. Management

Question 22

What is mechanical ventilators?

Answer 22

used when patients cannot breathe without assistants

Question 23

What happens if ventilator malfunctions?

Answer 23

Remove the patient from the ventilator.

	b. Apply a tracheostomy collar. 
	c. Patients require assisted ventilation throughout transport.

Question 24

what are apnea monitors?

Answer 24

They are used for infants who are premature, have severe gastreosohageal reflux
Have family history of SIDS and experienced a life threatening event

Question 25

What happens when you use an apnea monitor?

Answer 25

. Used for 2 weeks to 2 months after birth to monitor the respiratory system 3. Monitor sounds an alarm if the infant experiences bradycardia or apnea. 4. If possible, bring the apnea monitor to the receiving hospital with the patient.

Question 26

What is internal cardiac peacemakers?

Answer 26

Internal cardiac pacemakers 1. Device implanted under the patient’s skin to regulate the heart rate 2. Pacemaker may also include an automated implanted cardioverter defibrillator (AICD) to monitor heart rhythm. 3. Never place defibrillator paddles or pacing patches directly over the implanted device. 4. Gather information about the cardiac pacemaker during history taking.

Question 27

What is left ventricular assist devices?

Answer 27

Medical device that takes over the function of one or both heart ventricles 2. Typically used as a bridge to heart transplantation while a donor heart is being located, or may be a permanent solution for patients who do not qualify for a transplant. 3. May be difficult to palpate a pulse in patients who use an LVAD. a. Assess perfusion 4. Care

Question 28

What is external defibrillator vest?

Answer 28

External defibrillator vest 1. A vest with built-in monitoring electrodes and defibrillation pads, which is worn by the patient under his or her clothing. 2. Attached to a monitor that provides alerts and voice prompts when it recognizes a dangerous rhythm and before it delivers a shock. 3. If the patient is in cardiac arrest, the vest should remain in place while you perform CPR unless it interferes with compressions.

Question 29

What is central venous catheter?

Answer 29

Central venous catheter 1. A catheter that has its tip placed in the vena cava to provide venous access 2. Used for many types of home care patients receiving: a. Chemotherapy b. Long-term antibiotic drug therapy or pain management c. Total parenteral nutrition (TPN) d. Hemodialysis 3. Common locations 4. Common problems

Question 30

What is gastrostomy tubes?

Answer 30

Gastrostomy tubes 1. Sometimes referred to as gastric tubes or G-tubes 2. Placed into the stomach for patients who cannot ingest fluids, food, or medication by mouth a. May be inserted through the nose or mouth into the stomach (using a nasogastric or orogastric tube) b. May be placed surgically directly into the stomach through the abdominal wall 3. May become dislodged during the patient’s normal daily activity a. Immediately stop the flow of any fluids. b. Assess for signs or symptoms of bleeding into the stomach.

Question 31

What is shunts?

Answer 31

For patients with chronic neurologic conditions 2. Tubes that drain excess cerebrospinal fluid 3. Types a. Ventricular peritoneum shunt—drains excess CSF from the ventricles of the brain into the peritoneum of the abdomen b. Ventricular atrium shunt—drains excess CSF from the ventricles of the brain into the right atrium of the heartDuring assessment, you will likely feel the fluid reservoir beneath the skin on the side of the head, behind the ear. 5. Blocked or infected shunt a. Changes in mental status and respiratory arrest may occur. b. Infections may occur within the first 2 months after insertion. 6. Signs of distress

Question 32

What is vagus nerve stimulators?

Answer 32

Treatment used for seizures that are not controlled with medication 2. Stimulate the vagus nerve to keep seizure activity from occurring 3. Located under the patient’s skin 4. About the size of a silver dollar

Question 33

What is colostomy or ileostomy?

Answer 33

Colostomy or ileostomy is a surgical procedure that creates an opening between the small or large intestine and the surface of the body. a. Allows for elimination of waste products into an external bag or pouch, which is emptied or changed frequently b. Assess for signs and symptoms of dehydration if the patient has been complaining of diarrhea or vomiting

Question 34

What is urostomy?

Answer 34

. Urostomy is a surgical procedure that connects the urinary system to the surface of the skin. a. Allows urine to drain through a stoma in the abdominal wall instead of through the urethra.

Question 35

Hospice care and terminally ill patients:

Answer 35

Hospice Care and Terminally Ill Patients A. Terminally ill patients may receive hospice care at a hospice facility or at home with diseases such as: 1. Cancer 2. Heart and lung failure 3. End-stage Alzheimer disease 4. AIDS B. Most patients have completed a do not resuscitate (DNR) order 1. May have medical orders for scope of treatment C. Comfort care 1. Palliative care (pain medication) 2. Improves the patient’s quality of life before the patient dies and allows the patient to be with family and friends. Follow your local protocols, the patient’s wishes, or legal documents such as a DNR order. E. If the patient is at home, the care you give will have a lasting impact on family; show compassion, understanding, and sensitivity. F. Ascertain the family’s wishes about having the patient remain in the home or having the patient transported to the hospital. G. Follow local protocols for handling the death of a patient.

Question 36

Poverty and Homelessness

Answer 36

Poverty and Homelessness A. People who live in poverty are unable to provide for all of their basic needs. 1. Housing 2. Food 3. Child care 4. Health insurance 5. Medication B. Disease prevention strategies (eg, dental care, nutrition, and exercise) are likely absent, which leads to increased probability of disease. C. Homeless population includes: 1. People with mental illness or prior brain trauma 2. Victims of domestic violence 3. Persons with addiction disorders 4. Impoverished families . Your job is to provide emergency care and transport to the appropriate facility. E. All health care facilities must provide assessment and treatment regardless of the patient’s ability to pay. F. You can be an advocate by becoming familiar with the social services resources within your community.