Transcript The Challenged Patient

Chapter 5
The Challenged Patient
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Topics
Physical Challenges
Developmental Disabilities
Pathological Challenges
Other Challenges
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Hearing Impairments
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Conductive Deafness
A blockage of the transmission of
sound waves through the external ear
canal to the middle or inner ear
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Sensorineural Deafness
Deafness caused by the inability of
nerve impulses to reach the auditory
center of the brain because of nerve
damage to either the inner ear or to
the brain
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Recognizing Deafness
Asking questions repeatedly
Misunderstood questions or
inappropriate responses
Presence of a hearing aid
Sign language or gestures
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Hearing aids come in various shapes
and sizes.
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Accommodations for
Deaf Patients
Address patient face to face.
Speak slowly in a normal voice.
Reduce background noise as much
as possible.
Help find or adjust hearing aids.
Use pen and paper.
Utilize an interpreter.
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Visual Impairments
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Causes
Disease
Congenital conditions
Infection
Degenerative disorders
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
When approaching a service
dog, do not pet the dog or disturb
it while it is in its harness.
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Individuals who are visually impaired
can maintain active, independent
lives.
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Speech Impairments
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Types of Speech Impairments
Language disorders
Articulation disorders
Voice production disorders
Fluency disorders
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Accommodations for
Speech Impairments
Never assume the person lacks
intelligence.
Form questions that require short,
direct answers.
Never pretend to understand when you
don’t.
Let the patient write answers to
questions.
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Obesity
40% of people in the US are obese.
Excess weight can exacerbate the
complaint for which you were called.
Obesity can lead to many serious
medical conditions.
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Accommodations for
Obese Patients
Don’t dismiss signs or symptoms, such as
shortness of breath, as being a result of
obesity.
Adipose tissue presents an obstruction—
EKG electrodes may need to be placed on
the arms and legs.
Do not compromise your health or safety—
ask for assistance when lifting or moving a
patient.
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Paralysis
The patient may have a home
ventilator; be sure to keep the airway
clear and patent.
If the patient is in halo traction, be sure
to stabilize the traction before
transport.
Be aware of other assistive devices—
colostomy, canes, wheelchairs, etc.
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Developmental Disabilities
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Developmentally disabled people may
have trouble communicating, but can
often still understand what you say.
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Remember that a person with a
developmental disability can
recognize body language, tone, and
disrespect just like anyone else.
Treat them as you would any other
patient.
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Developmental Disabilities
Down Syndrome
Fetal Alcohol Syndrome (FAS)
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Pathological Challenges
Arthritis
Cancer
Cerebral palsy
Cystic fibrosis
Multiple sclerosis
Muscular dystrophy
Poliomyelitis
Previous head
injury
Spina bifida
Myasthenia gravis
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Rheumatoid arthritis causes joints to
become painful and deformed.
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Take every effort to protect cancer patients
from infection. Keep a mask on yourself and
the patient during transport and during
transfer at the hospital.
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Patients with multiple sclerosis and
muscular dystrophy may use a cane to aid
ambulation. Be sure to take such devices
with you on the ambulance.
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Other Challenges
Culturally diverse patients
Terminally ill patients
Patients with communicable diseases
Financial challenges
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
United States society is becoming diverse,
with the largest number of immigrants
coming from Asia and Latin America.
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
If a patient refuses care because of cultural
or religious beliefs, be sure to have the
patient sign a Refusal of Treatment and
Transportation form.
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Financial Challenges
Treat the patient, not the financial
condition the patient is in.
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Homeless people sometimes refuse care,
thinking they cannot afford to pay the
medical bills. Become familiar with public
hospitals and clinics that provide services
to the needy.
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Summary
Physical Challenges
Developmental Disabilities
Pathological Challenges
Other Challenges
Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ