Transcript Acello Chapter13

Chapter 13
Caring for Patients with
Special Needs
Working with Interpreters
• Interpreter
– Communication professional who mediates
between speakers of different languages
– Some interpreters speak
– Others use sign language
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Working with Interpreters
• Qualified interpreters know the
expressions of the languages they are
interpreting
– Verbal and non-verbal
– Cultural values
– Beliefs
– Gestures and body language
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Domestic Violence
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Battering and injury
Psychological abuse
Sexual assault
Social isolation
Deprivation
Intimidation
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Domestic Violence
• Violent behavior
– Perpetrated by a person involved in an
intimate relationship with the victim
• Violence is used a as a means of control
• Victim may think abuse is his or her fault
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PCT Responsibilities
• You are not responsible for questioning,
counseling, or treating the patient
• Be aware of domestic violence and alert to
signs and symptoms
– If detected, inform RN
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PCT Responsibilities
• Keep communication and documentation
concise and accurate
• Be kind, empathetic, and supportive
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Delirium
• Acute confusional state caused by
reversible medical problems
• If left untreated the mortality is high
• Causes:
– Dehydration
– Physical illness
– Anesthesia and medications
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Delirium
• To eliminate delirium, the physician will
treat the underlying cause(s)
• Mental status may not be immediately
clear
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Nursing Care After a Seizure
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Reorient the patient
Check vital signs frequently until stable
Keep the side rails up
Provide incontinence care
Monitor for return of seizure activity
Administer oxygen or suction
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Spinal Cord Injury
• Move extremities slowly and gently
• Avoid rapid, rough movements
• If extremities move into flexion, gently
move them into extension
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Spinal Cord Injury
• If the extremities move into extension,
position them in flexion
• Prevent pressure ulcers
• Allow patient to direct care
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Autonomic Dysreflexia
• Treatment
– Identify the stimulus and remove it
• Inform RN if you observe any signs and
symptoms
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Chemotherapy
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Wear gloves when handling soiled linen
Use standard precautions
Monitor for and report signs of infection
Prevent bleeding and bruising
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Chemotherapy
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Promote good nutrition and hydration
Monitor I&O
Allow for frequent rest periods
Be empathetic and supportive
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Radiation Therapy
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Do not wash radiation markings off
Wash with lukewarm water and mild soap
Avoid rubbing or creating friction on skin
Dress in loose, comfortable clothing
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Radiation Therapy
• Follow radiation precautions
• Wear a dosimeter to monitor exposure
• Stay at least 3 feet away from the patient
unless giving direct care
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Immunotherapy Patients
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Monitor vital signs every 2-4 hours
Inform RN if systolic B/P less than 100
Monitor capillary refill
Weigh the patient daily
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Immunotherapy Patients
• Notify RN if patient has following
symptoms:
– Fever or chills
– Pulse over 100
– Respirations over 24
– Becomes cyanotic or dyspneic
– Restless or apprehensive
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Immunotherapy Patients
• Notify RN if patient has following
symptoms:
– Diarrhea
– Nausea
– Vomiting
– Itching
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Complementary and
Alternative Medicine (CAM)
• Diverse systems, practices, and products
– Not presently part of conventional medicine
• Area of research and scientific study
• CAM changes continually
– New practices and techniques are always
emerging
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Principles of Rehabilitation
and Restoration
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Begin treatment early
Activity strengthens
Prevent further disability
Stress the patient’s ability, not the
disability
• Treat the whole person
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The Pain Problem
• Patient’s self report of pain is the most
accurate indicator of the existence and
intensity of pain
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The Pain Problem
• Always respect and believe a patient
• Patients may be smiling, talking, or
sleeping and still be having pain
• Vital signs may be normal
– Avoid making assumptions about a patient’s
pain
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Types of Pain
• Acute pain
– Occurs suddenly; usually the result of tissue
damage
• Persistent pain
– Pain that lasts for 6 months
– May be intermittent or constant
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Types of Pain
• Phantom pain
– Occurs as a result of an amputation
– The pain is real
• Radiating pain
– Pain that moves from the site of origin to
other areas
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Pain Management Procedures
• Epidural catheter
– Implanted under skin into epidural space for
medication administration
• Transcutaneous electrical nerve
stimulation
– Electrical current stimulates nerve fibers to
block pain
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Pain Management Procedures
• Implantable medication pumps
– Placed under abdominal skin with a catheter
for medicine administration
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