Patients with Special Challenges Flashcards
A group of conditions that may impair development in the areas of physical ability, learning, language development, or behavioral coping skills
Developmental disability
An intellectual disability characterized by deficits in social communication and interactions along with restricted, repetitive patterns of behavior, interests, and activities
Autism spectrum disorder
ASD
Autism spectrum disorder
Characterized by a genetic chromosomal defect resulting in mild to severe intellectual impairment
Down syndrome
The normal human somatic cell contains ___ pairs of chromosomes
23
Down syndrome is also known as ___
Trisomy 21
When does Down syndrome occur?
The two 21st chromosomes fail to separate, so that the ovum or sperm contains 24 chromosomes. When fertilization occurs, a triplication (trisomy) of chromosome 21 occurs
Where the first two cervical vertebrae meet
Atlantoaxial joint
Two most common causes of deafness
- Sensorineural deafness
- Conductive hearing loss
What causes sensorineural deafness?
Nerve damage results from a lesion or damage to the inner ear
What causes conductive hearing loss?
Faulty transmission of soundwaves
Hearing aid types
- Behind the ear
- Conventional body
- In the canal and completely in the canal
- In the ear
Group of disorders characterized by poorly controlled body movement
Cerebral palsy
Cerebral palsy is the the result of ___
Damage to the developing fetal brain in utero, oxygen deprivation at birth, traumatic brain injury at birth, or infection such as meningitis during early childhood
Unsteady gait
Ataxia
Adequate maternal intake of ___ reduces the risk of spina bifida
Vitamin B9 (folic acid)
Increased sensitivity
Hyperesthesia
Three main components of a standard tracheostomy tube
- Outer cannula with a flange
- Inner cannula within the outer cannula
- Rigid obturator
Flange on the outer cannula helps ___
Support and stabilize the device as it passes through the neck
The outer cannula may have a cuff that ___
Seals the trachea off from the upper airway
The cuff is inflated through ___
A pilot balloon and valve on the outside of the device
The inner cannula has a ___ that allows for a bag-mask device or ventilator circuit to be attached
15-mm adapter
Mnemonic to remember the possible causes of an airway obstruction with a tracheostomy tube
DOPE
DOPE
D. Displaced, dislodged, or damaged tube
O. Obstructed tube
P. Pneumothorax
E. Equipment failure
Some patients with tracheostomy tubes and special health care needs may have ___ that will not allow you to place them in the typical semi-Fowler position
Muscle contractions
If suctioning of the tracheostomy tube is necessary, first attempt ___
To use the patient’s suction device
How to estimate the size of the suction catheter for a tracheostomy tube
Double the inner diameter of the tracheostomy tube. To get the length, ask of measure a spare tube
If the length of the tracheostomy tube cannot be determined, insert the suction device no more than ___
1 - 2 inches
How to suction tracheostomy tube
Suction unit set to 100 mm Hg. May need to instill 2 - 3 mL of saline before suctioning thick tracheal secretions. Do not suction for more than 10 seconds. Oxygenate before and after. Call for ALS backup
Two types of oxygen delivery systems that patients use
- Compressed oxygen cylinders
- Home oxygen concentrator
Home oxygen concentrators max oxygen supply generally
10 L/min
Portable oxygen concentrators max oxygen supply generally
1 to 3 L/min
Questions to ask someone on home oxygen supply
- Why they are on home oxygen
- How long they have been on home oxygen
- What their baseline home oxygen requirement is
- Whether their requirement has changed recently
An apnea monitor is used for ___ after birth of these high-risk infants
2 weeks to 2 months
A typical episode of apnea may last for ___, during periods of sleep
About 15 to 20 seconds
The apnea monitor is designed to ___
Sound an alarm if the infant experiences bradycardia or an episode of apnea occurs
The apnea monitor is attached with ___
Electrodes or a belt wrapped around the infant’s chest or stomach
Pacemaker placement
Nondominant side of the chest, or the abdomen if the patient is small or thin
VAD
Ventricular assist device
Device that regulates the heart rate
Pacemaker
Medical equipment that takes over the function of one or both ventricles
VAD
Most common VAD
Left ventricular assist device
How to assess perfusion in patient with a VAD
Note level of consciousness, skin color, temperature, moisture, and BP
Risk factors associated with a VAD
- Excessive bleeding following surgery
- Infection
- Blood clots leading to strokes
- Acute heart failure
How to tell if an external defibrillator vest has already delivered a shock
Look on the upper back for a blue gel
A catheter that has its tip placed in the vena cava to provide venous access
Central venous catheter, or central line
Central venous catheters are often located ___
In the chest, upper arm, or subclavicular area
If bleeding occurs with a central venous catheter ___
Apply direct pressure to the tubing and provide prompt transport to the hospital
Placed into the stomach of patients who cannot adequately ingest fluids, food, or medication by mouth
Gastrostomy tubes (gastric tubes or G-tubes)
Patients with gastric tubes who have difficulty breathing should be transported while ___
Sitting or lying on the right side with the head elevated 30° to prevent the contents of the stomach prom passing into the lungs
Patients with diabetes who receive insulin and gastric tube feedings may become ___ quickly if the gastric tube feedings are discontinued
Hypoglycemic
Patients with chronic neurologic conditions may have ___ in place
Shunts
Tubes that drain excess cerebrospinal fluid from the ventricles of the brain to keep pressure from building up in the brain
Shunts
A shunt will likely be felt ___
On the side of the head, behind the ear
Drains excess fluid from the ventricles of the brain into the peritoneum of the abdomen
Ventriculoperitoneal (VP) shunt
Drains excess fluid from the ventricles of the brain into the right atrium of the heart
Ventriculoatrial (VA) shunt
Infections as a result of the shunt placement may occur within the first ___ after shunt insertion
2 months
If the shunt is unable to drain ___
ICP may increase
Stimulate the ___ at predetermined intervals to prevent seizure activity
Vagus nerve
Surgical procedure that creates an opening from the small or large intestine to the surface of the body that allows for elimination of waste products
Colostomy or ileostomy
The special opening for a colostomy is called ___
A stoma
Surgically created connection between the urinary system to the surface of the skin that allows urine to drain through a stoma in the abdominal wall instead of the urethra
Urostomy
