P&L Weeks 2-5 Flashcards
What are common co-occurring concerns for people with down’s syndrome?
- Congenital heart defects (e.g. AV septal defects, patent ductus arteriosus)
- Vision problems (cataracts present at birth, refractive errors [requiring glasses], nystagmus)
- Conductive hearing loss (worse immune system, different anatomy)
- Hypothyroidism
Explain the importance of using appropriate language when referring to, and speaking with, a patient with Down syndrome
- Preserves respect and dignity (person with down syndrome > down syndrome patient)
- Avoids stigmatisation (more likely to seek care)
- Builds trust and rapport (improved health outcomes, builds trust in healthcare system)
Explain the concept of financial consent in healthcare
- In order for a patient to pay for goods and services, they need to understand/agree to pay under consumer law
- We obtain financial consent by discussing the costs of treatment(s) with patients, including the costs of any follow-on referrals or other practitioners (e.g. anesthetist in surgery)
- Medical practitioners have a responsibility to openly discuss costs with their patients
What is the psychological/psychiatric definition of trauma? What’s the definition of trauma informed care?
- Trauma can have many definitions
- In this setting, it refers to the impact of distressing events on people (including events that involve physical, psychological, or emotional aspects etc)
- Trauma informed care is a comprehensive approach to healthcare based on the recognition and understand of the impact that such traumatic events could have on patients
What are the 6 components of trauma informed care?
- Safety
- Trustworthiness and Transparency
- Peer Support
- Collaboration and Mutuality
- Empowerment, Voice, and Choice
- Cultural, Historical, and Gender Issues
What are some potential barriers to trauma informed care?
- Feeling overwhelmed/underqualified
- Insufficient time
- Trying to “fix” the problem
- Practitioner’s own trauma
- Not recognising trauma presentations
Broad principles of safety planning in trauma informed care
- Private space
- Label threats to person
- High risk (ED), medium risk (phone lines, people they know, GP), low risk (phone lines, GP psych referral)
How might be perform safety planning when giving a breast exam to a patient with a
- Explain you’re aware, don’t ask for specifics
- Explain why you’re there (what will involve; removing clothes, touching, why you need to do these)
- Ask if that sounds suitable - agree on course of action
- Tell them at any point that you’ll stop if they ask you to
List as many strategies and principles for communicating with a child as you can think of.
- Use different language level
- Talk directly to child
- Touch only if appropriate (and ask permission of both the parent and the child)
- Tell the child what’s going to happen, when, and why
- Provide adequate warning about the end of the session
- Use toys/activities where appropriate to engage, comfort, and relax the child
Who is responsible for reported suspected cases of child abuse, and who should they report to (SA and otherwise)?
- All persons coming into contact with children in their healthcare settings are obligated to report
- In SA we report to Child Abuse Report Line (CARL); other states have their respective child protection lines also
What hx, exam, and investigations are important in cases of suspected child abuse
Can doctors be sued by families for allegations of child abuse?
- No
- Not as long as they’re acting reasonably and in goodwill
Do we have to tell the parents when we’re reporting for suspected child abuse? Should we? How do we keep the child safe in the meantime?
- Don’t have to tell them
- Most times, you should tell them
- To keep the child safe, short inpatient admission works
What types of injuries are suspicious for child abuse?
- Unexplained
- Head injury, bony fractures, bruising, heat injury, anogenital injury
What history questions help us understand whether an injury is a child protection issue?
- When did the injury occur?
- Where was the child at the time?
- What happened?
- Who witnessed it?
- Have they been injured before?
- Does the child have any developmental delays?
What exam findings make us suspicious of child abuse?
- Bite marks
- Bruises in soft, non-bony-prominences
- Bruises in more than one plane
- Grab marks
What investigation findings are suggestive of child protection issues?
X Ray:
- Healing fractures (been there longer than thought)
- Scapular/vertebral body fractures
CT Head:
- Haemorrhage
- Skull fractures
Fundoscopy:
- Retinal haemorrhage
Coags:
- Why are they bleeding?
