Transcript The Challenged Patient

The Challenged Patient
Ray Taylor
Valencia Community College
Department of Emergency Medical Services
Topics
 Physical
Challenges
 Developmental Disabilities
 Pathological Challenges
 Other Challenges
Introduction

Challenged Patients
– Hearing
– Visual
– Speech
– Obesity
– Paralysis
– Mental and
physical
impairments
– Arthritis
– Cancer
– Neuromuscular
Hearing Impairments
 Types
– Conductive deafness
– Sensorineural deafness
Conductive Deafness
Blockage of the transmission of sound
waves through the external ear canal to the
middle or inner ear
 Etiologies (Curable)

– Infection
– Injury
– Earwax
Sensorineural Deafness


Deafness caused by the inablility of nerve impulses to
reach the auditory center of the brain because of nerve
damage to either the inner ear or to the brain
Etiologies (Many incurable)
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Congenital
Birth injury
Disease
Medication induced
Viral infection
Tumor
Prolonged exposure to loud noise
Aging
Recognizing Deafness
Asking questions repeatedly
 Misunderstood questions or inappropriate
responses
 Presence of a hearing aid
 Sign language or gestures

Hearing aids come in various shapes and
sizes.
Figure 5-1
Accommodations for
Deaf Patients
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Address patient face to face.
Speak slowly in a normal voice.
– Do not shout
– 80% of hearing loss is related to the loss of high pitched
sounds
– Use low pitched sounds directly into ear canal
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Reduce background noise as much as possible.
Help find or adjust hearing aids.
Use pen and paper.
Utilize an interpreter.
Use of picture that illustrate basic need/procedures
Visual Impairments
Causes
 Disease
 Congenital
conditions
 Infection
 Degeneration
of eyeball, optic nerve or
nerve pathways
Individuals who are visually impaired can
maintain active, independent lives.
Figure 5-2
Accommodations
Retrieve visual aids
 Describe everything that you’re going to do
 Provide sensory information
 If ambulatory, guide by leading, not by
pushing
 Allow leader dogs to accompany patient

– Do not pet or handle dog while in harness
Speech Impairments
Types of Speech Impairments
 Language
disorders
 Articulation disorders
 Voice production disorders
 Fluency disorders
Etiology of Speech Disorders

Language disorders
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Stroke
Head injury
Brain tumor
Delayed development
Hearing loss
Lack of stimulation
Emotional disturbance
Etiology of Speech Disorders
 Articulation
disorders
– From damage to nerve pathways passing
from brain to muscles in larynx, mouth or
lips
– Delayed development from hearing
problems, slow maturation of nervous
system
Etiology of Speech Disorders
Voice production disorders
– Disorder affecting closure of vocal cords
– Hormonal or psychiatric disturbance
 Fluency disorders
– Not fully understood

Recognition

Language disorders
– Slowness to understand speech
– Slow growth in vocabulary and sentence
structure

Articulation disorders
– Speech can be slurred, indistinct, slow, or nasal
Recognition

Voice production disorders
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Hoarseness
Harshness
Inappropriate pitch
Abnormal nasal resonance
Fluency disorders
– Stuttering
Accommodations for
Speech Impairments
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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.
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

Obesity

Etiologies
– When a person has an
abnormal amount of
body fat
» 20-30% heavier than
normal weight
– Person’s caloric intake is
higher than the amount
of calories required to
meet his energy needs
– Genetic factors
– Low basal metab
Accommodations for
Obese Patients
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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.
Use appropriately sized
diagnostic devices
Paralysis

Paraplegia
– Weakness or paralysis of both legs

Quadriplegia
– Paralysis of all four extremities and trunk
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.

Mental Challenges

Mental illness
– Any form of psychiatric disorder
– Etiologies
» Psychosis

Caused by complex biochemical brain disease
» Neuroses
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Disease related to personality
– Recognition
» Behavior may be unaffected
» May present with signs and symptoms consistent with illness
Accommodations
 Obtaining
a history
– Don’t be afraid to ask about
» History of mental illness
» Prescribed medications
» Compliance with medications
» Concomitant ingestion of alcohol, other
drugs
Assessment and Management

Assessment
– Be sure to solicit permission before beginning

Management
– Treat as you would any patient that does not
have a mental illness, unless call is related
specifically to the mental illness
» Patients with mental illness also experience
myocardial infarctions, hypoglycemic episodes
Developmental
Disabilities
Developmental Disabilities

Description
– Impaired/ insufficient development of the brain,
causing an inability to learn at the usual rate

Recognition
– History
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Accommodations
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Obtaining a history
Assessment
Management
Transport
Developmentally disabled people may have
trouble communicating, but can often still
understand what you say.
Figure 5-3
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.
Developmental Disabilities

Down Syndrome
– A chromosomal abnormality resulting in mild to severe
mental retardation, and a characteristic physical
appearance
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Fetal Alcohol Syndrome (FAS)
– Mother with persistent alcoholism during
gestation
» Shortly after birth infants experience alcohol
» Deficient growth and mental capacity
Recognition of Down
Syndrome
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Eyes slope up at outer
corners; folds of skin on
either side of nose cover
the inner corners or eye
Small face and features
Large and protruding
tongue
Flattening on back of the
head
Hands short and broad
Recognition of Fetal Alcohol
Syndrome

Small head with
multiple facial
abnormalities
– Small eyes with short
slits
– Wide, flat nasal bridge
– Midface that lacks a
groove between the lip
and nose
– Small jaw
Pathological Challenges
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Arthritis
Cancer
Cerebral Palsy
Cystic Fibrosis
Multiple Sclerosis
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Muscular Dystrophy
Poliomyelitis
Previous head injury
Spina Bifida
Myasthenia Gravis
Arthritis
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Inflammation of a joint; characterized by pain,
stiffness, swelling, redness
Accommodations
– Decreased range of motion/mobility may limit physical
exam
– Be sure to solicit current medications before
considering the administration of medications
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Management
– Limited ability to be mobile
– Make equipment fit patient, not vice-versa, pad all
voids
Rheumatoid arthritis causes joints to become
painful and deformed.
Cancer
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Primary site of origin of the cancer cells
determines the type of cancer
– Carcinoma
– Sarcoma
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Treatments for the disease do tend to produce
telltale signs
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Alopecia (hair loss)
Anorexia
Radiation tattoos
Physical changes
Cancer
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Management
– Patient’s risk for
infection
» Chemotherapy leaves
patient neutropenic
– Veins may have
become scarred
– Use of med ports
» Requires specialized
training
Cerebral Palsy
Nonprogressive disorders of movement and
posture
 Types
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– Spastic
» Abnormal stiffness and contraction of groups of
muscles
– Athetosis
» Involuntary, writhing movements
– Ataxia
» Loss of coordination and balance
Cerebral Palsy
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Etiologies
– Most occur before birth
– Prepartum
» Cerebral hypoxia
» Maternal infection
– Postpartum
» Encephalitis
» Meningitis
» Head Injury
Recognition
Spastic: muscles of one or more extremities
are permanently contracted
 Athetoid: involuntary writhing movement
 Quadriplegia
 Mental retardation in about 75% of all
people with with CP
 Many people with athetoid and diplegic CP
are highly intelligent
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Cystic Fibrosis (Mucoviscidosis)
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An inherited metabolic disease of the lungs and
digestive system, manifesting itself in childhood
– A defective, recessive gene
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Recognition
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History
Patient may be oxygen dependent
Salty taste in mouth
Productive cough
Management
– May require respiratory support, suctioning, oxygen
Multiple Sclerosis
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A progressive autoimmune disease of the CNS,
whereby scattered patches of myelin in the brain
and spinal cord are destroyed
Unknown etiology
Recognition
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Fatigue, vertigo
Clumsiness, muscle weakness
Slurred speech, ataxia
Blurred or double vision
Numbness, weakness or pain in face
Multiple Sclerosis
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Spinal cord affected
– Tingling, numbness, or feeling of constriction
in any part of the body
– Extremities may feel heavy and become weak
– Spasticity may be present
Multiple Sclerosis
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Accommodations
– Recognize characteristic presentation
– May be accompanied by
» Painful muscle spasms
» UTI
» Constipation
» Skin ulcerations
» Changes in mood, from euphoria to depression
Muscular Dystrophy
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An inherited muscle disorder of unknown cause in
which there is slow but progressive degeneration
of muscle fibers
Little or no movement of muscle groups
Management: possible respiratory support, patient
should not be expected to ambulate
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.
Figure 5-6
Poliomyelitis
Caused by a virus, which usually results in a
mild illness
 In more serious cases, it attacks the CNS:
may result in paralysis or death
 Patients with severe polio may present with
paralysis (including respiratory)
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Poliomyelitis
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Accommodations
– If lower extremities are paralyzed, patient may
require catherterization
– If respiratory paralysis, patient may require
tracheostomy
– Patient should not be expected to ambulate
Patients with Previous Head
Injury
 Recognition
– Physical appearance may be
uncharacteristic
– Speech and mobility may be affected
– Short term memory loss
Spinal Bifida
A congenital defect in which part of one or
more vertebrae fails to develop, leaving a
portion of the spinal cord exposed
 Unknown etiology
 Recognition: History
 Transport: patient should not be expected to
ambulate
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Myasthenia Gravis
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A disorder in which muscles become weak and tire
easily
Eyes, face, throat, and extremity muscles most
commonly affected
Etiology: Autoimmune disorder of unknown etiology
Recognition
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Drooping eyelids, double vision
Difficulty speaking
Chewing, swallowing may be difficult
Movement of extremities may be difficult
Respiratory muscles may be weakened
Other Challenges
Culturally diverse patients
 Terminally ill patients
 Patients with communicable diseases
 Financial challenges
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United States society is becoming diverse,
with the largest number of immigrants coming
from Asia and Latin America.
Figure 5-7
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.
Figure 5-8
Financial Challenges
Treat the patient, not the financial
condition of the patient.
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.
Figure 5-9
Summary
 Physical
Challenges
 Development Disabilities
 Pathological Challenges
 Other Challenges