Special Care - Intellectual impairment Flashcards
What is intellectual impairment?
reduced intellectual ability and difficulty with everyday activities which affects someone for their whole life
- can either be born with it or develop it as a child
What are the 2 types of functioning that can be affected in an LI?
intellectual functioning - low IQ associated problems i.e. problem solving and judgement
adaptive functioning - problems with activities of daily life
What is the difference between impairment and disability?
Impairment is considered at an organ/system level
disability is considered with function;
a restriction in ability to perform an activity in the manner considered as normal for a human due to impairement
What syndromes are associated with learning disability?
ASD - not all DS Cerebral palsy - not all Fragile X Prader willi PKU
What causes DS? (3)
Trisomy of chromosome 21
mosaicism
chromosomal rearrangement of 21
What is a risk factor for having a child with DS?
Advanced maternal age
What medically features are commonly associated with DS? (9)
Intellectual impairment
congenital heart defects
alzheimers
epilepsy
leukaemia
hearing impairment
diabetes mellitus
coeliac and oral manifestations
thyroid disease
What are the dental implications of DS? (5)
Head positioning - atlanto-occipital instability
increased risk of periodontal disease
macroglossia
class III malocclusion
AOB
Why is DS associated with a higher incidence of periodontal disease? (5)
Altered immune system
poor manual dexterity and OH
don’t have full clearance when swallowing
higher prevalence of periodontal pathogens
altered saliva
What is Prader Willi?
genetic disorder which affects chromosome 15
What are the characteristics of prader willi?
constant desire to eat as they’re never full
intellectual impairment
lack of sexual development
behavioural problems - tantrum, stubborn
What is cerebral palsy?
neurological condition that affects movement and coordination and sometimes intellectual impairment - not always
What are the characteristics of CP?
Dependant on what type they have;
Muscle weakness and stiffness
uncontrolled body movement - intention tremor
balance and co-ordination problems
What are the benefits of providing care for people with learning disabilities in a primary care setting?
There are primary care setting closer to the patients which makes transport easier and less expensive
Family members and carers can attend with the patient
can provide longitudinal care - prevention, treatment, falls up
can establish a relationship
How do we prepare those with learning disabilities for the first visit?
send social stories home with the patient that prepares them for visiting the practice and receiving treatment
allow pre-visits - acclimatisation and trust
carry out a health passport - allows you to assess likes and dislikes (triggers)
when is best to carry out treatment on patients with learning disabilities? (2)
At the start of the day - so you’re not running late and so they don’t have to wait in the waiting room for long
find out what also suits them in terms of mood and medication administration times
What communication adjunct are useful for non-verbal patients?
Picture boards Makaton talking mats drawing and writing PECS - autism
What communication adjunct is not used for consent?
Talking mats
How can we gain better access to the mouth for patients with learning disabilities? (4)
Bedi shield
open wide mouth rest
mirrors with an internal light
head support and clinical holding - last resort and requires consent
What is the limitation of the bed shield?
can fracture
When should clinical holding be used? (3)
In an unplanned emergency
when the patient has consented and other people in the room have too
if the patient has no capacity and is at risk to themselves and others.
must record why it was used in the notes
What are the risk factors for oral disease in patients with learning disabilities? (4)
poor motor control - cannot carry out OH
mouth breathing and Dry mouth
imbrication (overlapping) of teeth
pouching and limited food clearance (leave food in the buccal sulcus)
What OH advice can we give to carers/people with learning disabilities? (5)
toothpastes with no taste or foam e.g. oranurse
establish a routine - brush at the same time every morning/night
start from a different quadrant every time you brush and ensure u use a systematic technique
use an adaptive toothbrush that suits the individual
stand behind and to the side
self injurious behaviour is associated with some LD, What are treatment strategies? (5)
distraction and challenge behaviour
behaviour psychology
pharmacological treatment i.e. diazepam
construct oral appliances
extract specific teeth - limited as they can use other teeth
What are causes of drooling? (4)
Impaired swallowing
abnormal head position
poor mouth closure
tongue thrust
What treatment strategies can be used for those with LD and dry mouth? (4)
depends on the level of disability - not all can be used
replacements - can’t be used in dysphagia
sugar free gum and fluids
fluoride rinses
high fluoride toothpastes
What treatment strategies can be used for those with LD and feeding problems?
promote good OH to ensure no debris is aspirated and causes aspiration pneumonia
use a low foaming toothpaste - risk for those with dysphagia
use a suction toothbrush
what do patients who are nil by mouth present with oral disease?
Since patients are NBM the family/carers don’t brush their teeth.
However, these patients still receive tasters which are usually very cariogenic (jam and honey)
Can LA be used in patients with learning disabilities?
can be used but not advised in patients with more severe LD as there is poor cooperation.
also not advised if there are large volumes of treatment required
Can conscious sedation be used in primary care settings in patients with learning disabilities? (4)
Yes but -
You must be able to carry out IV and airway management
the patient has to be able to understand and communicate their decision
patients medical status is below ASA 3
not on bleomycin therapy or has musculoskeletal discrepancies
Can GA be used in patients with learning disabilities?
Yes - used when there is an inability to cooperate.
They may need to be kept in hospital for observation after GA if they are high risk.
What are the advantages of using GA in patients with learning disabilities? (4)
Can carry out large volumes and varieties of treatment.
More controlled environment to cope with complex medical diseases
can have joint working
have the facilities for aftercare and monitoring
What are the disadvantages of using GA in patients with learning disabilities? (5)
risk of death and neurological issues
require 24 hour support post GA
can’t carry out crown and bridge
have to be radical and remove all disease so that they do not require another GA in the near future
doesn’t improve coping mechanisms, behavioural problems or ability to overcome fear
How long should there be between GA’s in patients with learning disabilities
8/10 years
name physical features of Downs. (4)
flat and broad face
short nose
flat back of head
slanting eyes with epicanthic eyefolds
