Special Care Flashcards
What help do people with learning disabilities need?
o Understand new or complex information.o Learn new skillso Cope independently
Ratio of people with LD across 2000?
40 mild or moderate8 will be severe or profound
Name causes of learning disabilities?
• Pre-natal, e.g. Drug/alcohol abuse, infection during pregnancy.• Natal, e.g. difficult birth causing hypoxia.• Post-natal, e.g. Infection (meningitis), or trauma.• Genetic condition, e.g. Down Syndrome, Fragile X• Idiopathic (unknown)
Name specific impairments associated with LD?
• Understanding• Problem solving• Communication • Sensory • Motor skills• Delayed development• Self direction• Emotional Regulation• Self Care• Coping Strategies• Self Awareness
What is the definition of a mild disability?
Have Speech for everyday purposes / hold conversations. However can lack comprehension.• Independence in self care - eating, washing, bowel/ bladder, rate of development may be slow.• Difficulty with formal Learning, such as reading and writing .• Underdeveloped coping strategies- Noticeable emotional, social immaturity.• Difficulty in transferring skills.• IQ = 55 - 69
What is the definition of moderate disability?
• Slow in developing comprehension, use of language.• Self care skills limited; supervision required throughout life.• As adults usually able to do simple practical work if tasks structured and skilled supervision available.• Complete independence is rarely achieved.• Generally fully mobile, physically active and shows evidence of social development, e.g. communication and social activities.• IQ = 45 - 54
What is the definition of evere disability?
• Very limited communication, keywords only• Lack of self-help skills• May have additional physical disabilities• Will require full time support• IQ = 25 - 44
What is the definition of profound disability?
• Individuals are severely limited in ability to understand or comply with requests, etc.. • Usually severely restricted in mobility and continence• Rudimentary forms of non-verbal communication used• Little or no ability to care for basic needs and require constant supervision• IQ below 25
Name the difficulties associated with learning disabilities?
• Motor problems - mobility, gross and fine motor skills.• Continence.• Epilepsy - the greater the degree of neurological damage, the greater the severity and incidence of seizures.• Vision.• Hearing.• Speech difficulties.• Memory problems.• Concentration and attention problems.• Communication• Understanding of social skills - anti social behaviour.• Understanding relationships and emotions.• Behavioural problems.• Sleep problems.• Psychiatric conditions.• Eating difficulties.• Self-injurious behaviour.• Aggressive behaviour
How to communicate effectively with a person with a LD?
Speak slowly and as clear as possible• Keep questions simple & only ask one at a time.• Give specific choices which require “Yes” or “No” answers if appropriate• Use visual clues such as Photographs• Give the person more time to respond.• Only give one instruction at a time• Beware of literal interpretation of language
WHat are the top tips for communcation with a patient having a LD?
Speak slowly and as clear as possible2. Find a good place to communicate in, lessen distractions3. Check with the person that you understand what they are saying4. If the person wants to show you something – go with them5. Watch the person (non verbal cues)6. Keep communication simple use key wordBeware of literal interpretation8. Learn from experience, ask carers for help9. Try drawing 10. Use gestures & facial expressions 11. Be aware that some people may find it easier to use real objects to communicate 12. Take your time
What impact does a positive environment have on a patient with a LD?
Well organised, with structured activities and routines• A stimulating environment offering opportunities for participation in activities.• An emphasis on positive and constructive communication and interaction between staff and clients.• Clear plans for activities based on client need.
What to assess during your clinical appointments for a patient with a LD?
Be aware that the patient may have had previous negative experience before hand.• If carers advise you that this individual has a fear or lack of tolerance consider the following:-• Waiting times• Graded exposure/ Desensitization work• Pictorial reinforcers of what is to happen (social story)
Describe the process of desensitisation? for a patient with a LD?
• Where the Patient visits the clinic prior to appointment• They see the waiting room and examination area.• It may take several visits to lesson anxiety.• Allowing Patient to see/touch equipment etc.• Sit in chairs in the clinical area.• Start with non-threatening items.• Less is best; do not over stimulate.• Don’t give too much information in advance.• Use clear positive communication.• Have a clear action plan, made in liaison with carers.• Offer debriefing where possible.
Tips for a successful acclimitisation appointment for a patient with a LD?
Change can be difficult for most people to cope with, but for individuals with LD even minor changes can cause major distress.• Plan ahead, consider small steps• Enhance understanding with visual aids, keep it concrete, transitional objects.• In the event of unplanned change consider careful communication, reassurance and future planning. These things may make a difference
What attitudes should the team show to a patient with a LD?
• Non Judgmental• Non Discriminating• Responsible / using common sense• Empowering• Being aware of your own values/culture and those of others• Good communication - verbal and non verbal• Listening • Being approachable• Providing suitable resources
Describe differents in diagnosis of mental disorders?
Diagnosis on basis of syndromes not single symptoms“Biopsychosocial model” - account taken of patient’s personality and culture as well as biologyDiagnostic manuals –l ists of conditions and their features provide criteria for diagnosis (ICD-10, DSM-5) – “operationalized”
Describe the aetiology of mental disorders?
Multifactorial – genetic and environmental (abuse/neglect/trauma) risk factorsDisorders can - overlap (e.g. Neurodevelopmental Disorders)- evolve (Bipolar Disorder)Disorders may be final common pathways- Depression (familial v life-events)- SchizophreniaOverlap with normal experience - e.g. depression, anxiety
How to take a good history to garner information on mental disorders?
History of Presenting ComplaintSocial HistoryFamily HistoryPast Medical History – esp. illness which may mimic psychiatric illness e.g. hypothyroidismPast Psychiatric History – admissions, treatments, complicationsPersonal History – Birth, childhood, school, work, relationships, forensic history
Describe the categopries included for a mental state examination?
Appearance and Behaviour – attire, self-care, agitationSpeech – rate/rhythm/volumeThought Form e.g. tangential, concrete, flight-of-ideasThought Content e.g. preoccupations, delusionsMood e.g depressed, euthymicPerception (sensory) e.g. illusions, hallucinationsInsight – patient’s view of their symptomsCognition i.e. orientation, memory, language, visuospatial abilities (construction), abstract reasoning, executive functioning
Name the simple invesitagations that may give reason to mental disorder?
Depression – TFT, FBC, glucoseDementia – FBC, U&E, LFT, TFT, B12&Folate, glucoseNeuroimaging (CT/MRI)
Describe the possible bioloigcal treatment for mental disorders?
Antidepressants (5HT,NA); Antipsychotics (DA); Mood stabilizers; Sedatives; Dementia drugsSome may have significant side-effects, esp. if used long-term
Describe the possible psychological treatment for mental disorders?
e.g. Cognitive Behavioural Therapy (CBT), Psychodynamic psychotherapy, CounsellingNot free from adverse effects
Describe the possible social treatment for mental disorders?
e.g. exercise, groups, employment, “wellbeing” interventions
What is the definition of capacity?
Capacity is ability to make reasoned decisions about finances and welfare (includes medical & dental Rx)Capacity is assumedSometimes worth questioning if mental illness is likely interfering with capacity to consent to treatment
What can impede capacity?
In Scotland, must have a psychiatric or physical condition which prevents decision-making by impairing (one or more of):- Comprehension- Weighing up information- Memory- Communicating decisions- Acting on decisions
Describe psychosis - specific features and causes?
Loss of contact with realitySpecific features:- Delusions (fixed false beliefs)- Hallucinations (false perceptions)- Disordered thought-form (thinking-patterns)Not a specific illnessCauses:- Mood disorders, schizophrenia, organic conditions
Give a description of schizophrenia? - prevalence? positive symptoms? negative symptoms? treatment?
“Fractured mind” not “Split personality”Prevalence - 1% of population“Positive” symptoms – psychotic symptoms – DA overactivity- Delusions – usually paranoid - Hallucinations – auditory – 3rd person- Thought-form disorder Disturbed behaviourNegative” symptoms – DA underactivity- Lack of thoughts, absence of emotion, lack of drive, social and occupational difficultiesCause disabilityTreatments- Antipsychotics – DA blockers – for positive symptoms- Rehabilitation (non-medical interventions) if negative symptoms causing ongoing disability
Give a description of dementia? - prevalence? positive symptoms? negative symptoms? treatment?
Not a normal part of ageing i.e. not normal age-related memory declineCognitive decline (not just memory)Functional declineBPSD (Behavioural and Psychological Symptoms of Dementia) e.g. anxiety, depression, hallucinations, unusual preoccupations, repetitive behaviourProgressiveTypes - Alzheimer’s, Vascular, Lewy Body Dementia, Fronto-Temporal DementiaDecreased Acetyl-Choline functioningTreatment- Exclude reversible causes- Medication for Alzheimers e.g. Donepezil, Galantamine, Rivastigmine, Memantine- Social Care
Give a description of delirium? - prevalence? positive symptoms? negative symptoms? treatment?
Acute confusional state- Disorientation- Delusions – usually change rapidly- Hallucinations – usually visual e.g. delirium tremens- Hyperactive/hypoactiveOften fatal (up to 40%)Not an illness in itselfCaused by an underlying organic condition e.g. infection, metabolic disturbance, drug withdrawal, head injuryOften occurs in the elderly due to pre-existing poor cholinergic (acetyl choline) functionTreatment:- Investigate and treat underlying cause- Good nursing- Sedation if necessary – using antipsychotics - not Benzodiazepines (BZs) in the elderly- Delrium Tremens (“The DTs”) - BZs
Give a description of depression? - prevalence? positive symptoms? negative symptoms? treatment?
Not just unhappinessSyndromeCore features; low mood, limited enjoyment, low energyOther symptoms; poor sleep, poor appetite, poor concentration, tearfulness, low libido, negative thoughts, suicidal thoughtsThought to be associated with Serotonin (5HT) and Noradrenaline (NA) underactivityCauses – (there isn’t always a “reason” for depression)- Psychological- Social - BiologicalComplications- psychosis- suicide- social and occupational problems e.g. loss of job or relationship- chronicityTreatment- Mild – Psychological treatments (usually based around CBT, can be using books, online or by telephone)- Moderate, Severe – Medications, Electro-Convulsive Therapy (ECT)
