Chapter 37 | Special Challenges Flashcards
• The variety of challenges that may be faced by patients with special needs • Types of disabilities and challenges patients may have • Special aspects of prehospital care for a patient with special challenges • Congenital and acquired diseases and conditions • Types of advanced medical devices patients may rely on • How to recognize and deal with cases of abuse and neglect
1
Q
Define:
disability
A
condition which interferes with ability to engage in major life activities
2
Q
Define:
developmental disability
A
disability caused by an impairment in physical, learning, language, or behavior areas
3
Q
Define:
terminal illness
A
disease that cannot be cured or adequately treated and is expected to result in the death of the patient
4
Q
True or false:
A patient with a terminal illness may have special emotional needs.
A
true
5
Q
True or false:
Whether or not a patient has a terminal illness is not a concern for an EMT because there is nothing to treat.
A
false
involves other considerations (advanced directives or emotional needs)
6
Q
True or false:
Obesity increases the risk of multiple diseases.
A
true
(hypertension, high cholesterol, stroke, CAD, T2D, gallbladder disease)
7
Q
True or false:
Special measures may be needed to care for obese patient.
A
true
may need to call assistance from bariatric unit
8
Q
Define:
ABCS of dealing with autistic patients
A
- awareness: adapt approach and strategies to patient
- basic: be clear with simple language
- calm: be calm
- safe: make patient feel safe
make the autistic patient feel these things
9
Q
List:
types of diseases
2 points
A
- congenital: structural or functional anomalies that occur during intrauterine life
- acquired: disease which appears in an individual over the course of their lifetime
10
Q
Fill in the blank:
Patient with a chronic disease [COULD/COULDN’T] experience sudden worsening of disease.
A
Patient with a chronic disease could experience sudden worsening of disease.
11
Q
Answer:
Could a patient with a chronic disease also develop an accute illness?
A
yes
acute illness may be more devastating due to coexisting chronic disease
12
Q
Define:
tracheostomy tube
A
tube connected to surgical opening through neck into trachea
13
Q
Fill in the blank:
A BVM [DOES/DOESN’T] fit on the end of a tracheostomy tube.
A
A BVM does fit on the end of a tracheostomy tube.
14
Q
Fill in the blank:
It is common for [BLANK] to build up in a patient’s tracheostomy tube.
A
It is common for mucus to build up in a patient’s tracheostomy tube.
15
Q
True or false:
It is uncommon for mucus to build up in a patient’s tracheostomy tube.
A
false
actually, it’s common
16
Q
True or false:
A vomiting patient with a tracheostomy tube may vomit through their stoma.
A
false
aspiration is still always a concern, but not super duper likely
17
Q
Fill in the blank:
A patient with a tracheostomy tube [CAN/CAN’T] speak.
A
A patient with a tracheostomy tube may or may not be able to speak.
gotcha! — it depends
18
Q
Define:
implanted pacemaker
A
medical device that generates electrical pulses delivered by electrodes to one or more of the chambers of the heart
19
Q
Define:
AICD
(abbreviation)
A
automatic implanted cardiac defibrillator
20
Q
Define:
automatic implanterd cardiac defibrillator (AICD)
A
device implanted under the skin of the chest to detect any life-threatening dysrhythmia and deliver a shock to defibrillate the heart
21
Q
Define:
LVAD
(abbreviation)
A
left ventricular assist device
22
Q
Define:
left ventricular assist device (LVAD)
A
pump that used for patients who have reached end-stage heart failure
(usually a bridge to a heart transplant)
23
Q
Fill in the blank:
A patient who is waiting for a heart transplant likely has [BLANK].
(a thing)
A
A patient who is waiting for a heart transplant likely has an LVAD.
left ventricular assist device
24
Q
Fill in the blank:
An AICD is implanted in the [BLANK] or [BLANK].
A
An AICD is implanted in the upper left chest or upper left abdominal quadrant.
25
# Fill in the blank:
An AICD detects **[BLANK]**.
An AICD detects **life-threatening cardiac rhythms**.
26
# Fill in the blank:
An AICD delivers shock in order to **[BLANK]**.
| (for what?)
An AICD delivers shockin order to **correct dysrhythmia**.
27
# True or false:
The shock delivered by an AICD *is not typically painful* to the patient.
false
| it's typically very painful
28
# True or false:
The shock delivered by an AICD *is typically painful* to the patient.
true
| it's typically *very* painful
29
# Fill in the blank:
During transport of a patient with a urinary catheter, keep the catheter bag **[BLANK]**.
| (where?)
During transport of a patient with a urinary catheter, keep the catheter bag **lower than the patient**.
30
# Answer:
At what point should a urinary catheter bag be emptied?
when ⅓ to ½ full
| (document amount emptied)
31
# Fill in the blank:
A patient's ostomy bag is connected to **[BLANK]**.
A patient's ostomy bag is connected to **the site of the colostomy or ileostomy**.
32
# True or false:
You *should expect* an ostomy bag to be visible through the patient's clothing.
false
| (usually not visible)
33
# True or false:
You *should not expect* an ostomy bag to be visible through the patient's clothing.
true
34
# List:
common *complications* of **ostomy bags**
| 3 points
* infection (local to stoma site)
* blockage
* dislodgement
35
# List:
common *complications* of **hemodialysis**
| 2 points
* **bleeding** from AV fistula
* **infection**
36
# List:
common *complications* of **peritoneal dialysis**
| 2 points
* **dislodging** of catheter
* infection (**peritonitis**)
37
# Define:
vulnerable population
patients dependent on others
| more vulnerable to physical/sexual abuse, exploitation, or neglect
38
# Explain:
how to handle potential abuse
| (1 thing not to do and 2 things to do)
do not make accusations
get patient out of environment
report suspicions according to jurisdictional requirements
39
# Choose:
An important part of the assessment process for a patient with special needs is to:
## Footnote
**A.** interact with the caregiver.
**B.** interact with the patient.
**C.** talk to the manufacturer of the equipment being used.
**D.** transport immediately.
**A**
40
# Choose:
Which of the following statements regarding interaction with the caregiver of a child or adult with special health care needs is correct?
## Footnote
**A.** In most cases, it is more appropriate for the EMT to contact medical control prior to speaking with the patient's primary caregiver.
**B.** Before performing an assessment of the patient's ABCs, the EMT should ask the caregiver about the patient's medical condition.
**C.** In general, the EMT should only speak with a certified home health care provider because he or she is the expert on the patient's illness.
**D.** Communication with the patient's caregiver or family members is important because they are the most familiar with the patient's condition.
**D**
41
# Define:
colostomy
*surgical procedure* that creates an **opening between the intestine and the surface of the body** that allows for *elimination of waste products*
42
# True or false:
*Before performing an assessment of the patient’s ABCs,* the EMT should ask the caregiver about the patient’s medical condition.
false
| always treat ABCs first dumbass
43
# True or false:
*When treating a patient with intellectual disabilities,* speaking with the patient’s family is the least effective way to determine how much the patient understands.
false
| it's very effective
44
# True or false:
Patients with intellectual disabilities are susceptible to the same disease processes as other patients.
true
45
# True or false:
Most patients with intellectual disabilities have normal cognitive function, but abnormal physical features.
false
| that's backwards
46
# True or false:
An intellectual disability differs from mental retardation in that it is the result of a congenital abnormality.
false
| they are both congenital defects
47
# Fill in the blank:
Patients with a tracheostomy tube **[DO/DON'T]** require an attcached ventilator.
Patients with a tracheostomy tube **do *not*** require an attcached ventilator.
| but, most the time, it's attached to a ventilator
48
# Choose:
Which of the following would be the *most practical method* of communicating with a hearing-impaired patient until his or her hearing aids can be located?
## Footnote
**A.** Using a piece of paper and writing utensil to ask questions
**B.** Contacting dispatch and requesting a sign language interpreter
**C.** Using a high-pitched voice while speaking directly into the ear
**D.** Attempting to use body language to determine the problem
**A**
49
# Define:
PICC
| (abbreviation)
**p**eripherally **i**nserted **c**entral **c**atheter
50
# Describe:
most common *complication* of **IV catheters**
**infection** at site
| spreads very fast, literally goes into bloodstream
51
# Choose:
A 13-year-old child is on a home ventilator. The parents called because the mechanical ventilator is malfunctioning and the child has increasing respiratory distress.
**What should you do?**
## Footnote
**A.** reset the ventilator by unplugging it for 30 to 60 seconds.
**B.** disconnect the ventilator and apply a tracheostomy collar.
**C.** place a call to the home health agency treating this patient.
**D.** attempt to troubleshoot the mechanical ventilator problem.
**B**
52
# Choose:
A 70-year-old male complains of shortness of breath. During your assessment, you note that he has bilateral hearing aids. When you ask him questions related to his chief complaint, he does not answer you. You can hear a whistling sound coming from his hearing aids.
**What should you do?**
## Footnote
**A.** try repositioning the hearing aid or remove it and turn down the volume.
**B.** recognize that the batteries in his hearing aids are probably depleted.
**C.** remove his hearing aids, turn up the volume, and replace them in his ears.
**D.** remove both of his hearing aids and use pencil and paper to communicate.
**A**
53
# Fill in the blank:
A person is said to be obese when he or she is **[BLANK]** over his or her ideal weight.
| (percentage)
A person is said to be obese when he or she is **30% or more** over his or her ideal weight.
54
# Define:
DOPE
| (acronym)
* **displacement:** is the airway where it's supposed to be?
* **obstruction:** did the airway get plugged?
* **pneumothorax:** is the patient experiencing lung collapse?
* **equipment:** is everything hooked up properly?
| used during assessment of acute deterioration of intubated patient
55
# Choose:
According to the “E” in the DOPE mnemonic, which of the following actions should you perform to troubleshoot inadequate ventilation in a patient with a tracheostomy tube?
## Footnote
**A.** Attempt to pass a suction catheter into the tube.
**B.** Listen to breath sounds to assess for a pneumothorax.
**C.** Look for blood or other secretions in the tube.
**D.** Check the mechanical ventilator for malfunction.
**D**
56
# Define:
EMTALA
| (abbreviation)
**E**mergency **M**edical **T**reatment and **A**ctive **L**abor **A**ct
57
# Choose:
According to the Emergency Medical Treatment and Active Labor Act (EMTALA):
## Footnote
**A.** a patient maintains the legal right to recant his or her consent to emergency treatment, even after signing in to the emergency department.
**B.** all health care facilities are legally obligated to provide assessment and care only if the patient is critically ill or injured.
**C.** all health care facilities must provide a medical assessment and required treatment, regardless of the patient’s ability to pay.
**D.** a health care facility has the right to refuse assessment and treatment to a patient, but only if his or her condition is not deemed critical.
**C**
58
# Choose:
Because a tracheostomy tube bypasses the nose and mouth:
## Footnote
**A.** severe swelling of the trachea and bronchi can occur.
**B.** secretions can build up in and around the tube.
**C.** the risk of a local infection is significantly high.
**D.** bleeding or air leakage may occur around the tube.
**B**
59
# Choose:
Common complications associated with central venous catheters include all of the following, *except*:
## Footnote
**A.** clotting of the line.
**B.** a local infection.
**C.** bleeding around the line.
**D.** rupture of a central vein.
**D**
59
# Choose:
Cerebral palsy is characterized by poorly controlled movement of the:
## Footnote
**A.** neck
**B.** eye
**C.** body
**D.** extremity
**C**
59
# Describe:
*genetic defect* that causes **Down syndrome**
triplication of chromosome 21
| trisomy 21
60
# Define:
spina bifida
birth defect caused by **incomplete closure of the spinal column**
61
# Define:
shunt
**hollow tube** surgically placed in the brain (or occasionally in the spine) **to help drain cerebrospinal fluid** and redirect it to another location in the body where it can be reabsorbed
62
# Describe:
*purpose* of a **ventricular peritoneum shunt**
to **prevent excess cerebrospinal fluid from accumulating** in the brain
| drains to **abdominal cavity** (sometime to perfuse stored cranium)
63
# Describe:
*circumstance* under which an **LVAD** is used
as a bridge to heart transplantation while a donor heart is being located
| (LVAD is **l**eft **v**entricular **a**ssist **d**evice)
64
# Choose:
When caring for a patient who is visually impaired, it is important to:
## Footnote
**A.** allow a service dog to remain with the patient at all times, even if the patient is critically ill.
**B.** stand to the side of the patient when speaking if his or her peripheral vision is impaired.
**C.** tell him or her what is happening, identify noises, and describe the situation and surroundings.
**D.** leave items such as canes and walkers at the residence if the patient will be carried on a gurney.
**C**
65
# Choose:
Which of the following conditions would *most* likely be encountered in a patient with cerebral palsy?
## Footnote
**A.** Paralysis
**B.** Brain tumors
**C.** Seizure disorder
**D.** Type 2 diabetes
**C**
66
# Fill in the blank:
The inner tip of a central venous catheter rests in the **[BLANK]**.
| (where inside)
The inner tip of a central venous catheter rests in the **vena cava**.
67
# Choose:
A ventricular atrium shunt drains excess fluid from the ventricles of the brain into the:
## Footnote
**A.** left atrium of the heart
**B.** right ventricle of the heart
**C.** right atrium of the heart
**D.** left ventricle of the heart
**C**
68
# Choose:
If a patient’s mechanical ventilator malfunctions, you should remove the patient from the ventilator and:
## Footnote
**A.** Begin ventilations with a bag-valve mask.
**B.** Place the patient on a nasal cannula.
**C.** Contact medical control.
**D.** Place the patient on a nonrebreather mask.
**A**
69
# Define:
ileostomy
surgical opening between the small intestine and the outside of the body
70
# Define:
tracheostomy tube
plastic tube placed in a stoma
71
# True or false:
Patients with autism may have extreme difficulty with complex tasks that require many steps.
true
72
# True or false:
Patients with autism talk with normal tone and speech patterns.
false
73
# True or false:
Patients with autism have difficulty making eye to eye contact.
true
74
# True or false:
Patients with autism fail to use or understand nonverbal communication.
true
75
# True or false:
Which of the following is *not* a complication of Down syndrome?
## Footnote
**A.** Endocrine complications
**B.** Cardiovascular complications
**C.** Respiratory complications
**D.** Gastrointestinal complications
**C**
76
# Choose:
Which of the following does *not* usually contribute to or cause obesity?
## Footnote
**A.** Genetic predisposition
**B.** Rapid metabolism
**C.** High caloric intake
**D.** Low metabolic rate
**B**
