Asking questions Misunderstood questions or inappropriate responses Presence of a aid Sign language or

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1 1 Chapter 45 The Challenged Patient 2 Hearing Impairments 3 Types of Hearing Impairments Deafness: a blockage of the transmission of sound waves through the external ear canal to the middle or inner ear. deafness: 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. 4 Recognizing Deafness Asking questions Misunderstood questions or inappropriate responses Presence of a aid Sign language or 5 Hearing aids come in various shapes and sizes. 6 Accommodations for Deaf Patients Address patient face to face. Speak in a normal voice. Reduce noise as much as possible. Help find or adjust hearing aids. Use pen and paper. Utilize an. 7 Visual Impairments 8 Causes Injury Disease : increased intraocular pressure on the optic nerve Diabetic : due to diabetes that results in disorders in the blood vessels that lead to the retina Congenital conditions Cerebral palsy, premature birth disorders: of the eye, optic nerve, or nerve pathways 9 Recognizing and Accommodating Visual Impairments Identify yourself clearly everything that you are doing When approaching a Seeing Eye dog, do not pet the dog or disturb it while it is in its Transport with patient Inquire about other tools that the patient may need 1

2 10 Speech Impairments 11 Types of Speech Impairments disorders Articulation disorders Voice production disorders disorders 12 Language Disorders Impaired ability to the spoken or written word May result from a variety of illnesses or injury : the inability to communicate in speech, writing, or signs aphasia: patient cannot understand the spoken word aphasia: patient cannot speak but can understand what is said aphasia: a combination of sensory and motor aphasia 13 Articulation Disorders AKA: : inability to be understood Sounds are put together incorrectly Speech may be May be associated with a hearing disorder 14 Voice Production Disorders Affects of a person s voice Caused by trauma due to overuse of the vocal cords or infection May also be caused by Characterized by hoarseness, harshness, and inappropriate 15 Fluency Disorders Present as Cause is not fully understood More prevalent in Do not interrupt or their answers Let patients complete what they have to say and do not correct how they say it Be patient and professional 16 Accommodations for Speech Impairments Never assume the person lacks. Form questions that require short, direct answers. Never to understand when you don t. Let the patient write answers to questions. 2

3 17 Obesity 40% of people in the US are obese. Excess weight can exacerbate the for which you were called. Obesity can lead to many serious medical conditions. May be due to genetic or disorders 18 Accommodations for Obese Patients Don t signs or symptoms, such as shortness of breath, as being a result of obesity. Excess tissue may present an EKG electrodes may need to be placed on the arms and legs. Do not your health or safety ask for assistance when lifting or moving a patient. Know weight limit of equipment 19 Paralysis The patient may have a home ; be sure to keep the airway clear and patent. If the patient is in traction, be sure to stabilize the traction before transport. Ask patient and/or Call the Be aware of other assistive devices colostomy, canes, wheelchairs, etc. 20 Halo Traction 21 Developmental Disabilities 22 Developmental Disabilities Those with impaired or insufficient development of the who are unable to learn at the usual rate Can be such as Down Syndrome Can be caused by brain injury from hypoxia or Can occur before birth, during birth, or anytime 23 Developmentally disabled people may have trouble communicating, but can often still what you say. 24 Remember that a person with a developmental disability can recognize body language, tone, and just like anyone else. Treat them as you would any other patient. 25 Down Syndrome Results from an extra. Instead of 46 3

4 chromosomes, these individuals have 47 Cause is Risk increases with of mother Often associated with physical ailments such as heart defects, intestinal defects, and chronic lung problems 26 Fetal Alcohol Syndrome (FAS) Similar facial characteristics as Down Syndrome Caused by excessive alcohol consumption during Small heads with multiple facial abnormalities, small eyes with short slits, wide, flat nose bridge, lack of a groove between the nose and lip, and small Often exhibit delayed growth, mental disabilities, and 27 Fetal Alcohol Syndrome (FAS) 28 Pathological Challenges 1 Cancer Cerebral Cystic Fibrosis Multiple Sclerosis 2 Muscular Dystrophy Previous injury Spina Bifida Myasthenia Gravis 29 Arthritis 3 most common types: rheumatoid arthritis: a connective tissue disorder that strikes before age 16 arthritis: an autoimmune disorder : a degenerative joint disease, most common in the elderly All forms causes painful swelling and irritation of the joints When transporting, keep in mind their 30 arthritis causes joints to become painful and deformed. 31 Cancer Many different diseases Abnormal growth of cells in tissues Disease and their treatments can provide many challenges for EMS Many have central IV lines and ports 4

5 Protect cancer patients from 32 Cerebral Palsy Group of disorders cause by damage to the in utero or by trauma during birth Patients have difficulty controlling motor functions Some may have high When transporting, make accommodations to prevent 33 Cystic Fibrosis AKA: Mucoviscidosis Inherited disorder that involves the (mucus producing) glands, primarily in the lungs and the digestive system Thick mucus causes bronchial obstruction and Thick mucus also causes blockage in the small ducts of the pancreas leading to decreased pancreatic enzymes Often requires oxygen and 34 Multiple Sclerosis (MS) Disorder of the central nervous system that usually strikes between the ages of 20 and 40 Exact cause is Slow onset that leads to severe weakness or paralysis Very susceptible to Transport assistive devices with patient 35 Muscular Dystrophy (MD) Group of hereditary disorders characterized by progressive weakness and of muscle tissues Ultimately affects respiratory muscles and the heart Primarily occurs in Respiratory support may be needed 36 Poliomyelitis Communicable disease that affects the matter of the brain and spinal cord Highly but due to polio vaccine, outbreaks are rare in developed nations Virus normally enters through GI tract and carried to CNS where the nerve cells are altered Most recover but are left 37 Previous Head Injury May not be easily recognizable is normally affected May display S/S of a Obtaining complete history is critical 5

6 Note S/S 38 Spina Bifida Congenital abnormality in which there is a defect in the of the backbone and spinal canal Some patients exhibits few outward signs of of deformity Some patients have spinal cord and covering membranes to protrude from the back, causing an obvious deformity Patients probably will have allergy 39 Myasthenia Gravis Autoimmune disease characterized by chronic weakness of voluntary muscles and progressive Caused by by a block of nerve signals to muscles In severe cases, paralysis of muscles can develop 40 Culturally Diverse Patients Communication can be challenging due to different Religious beliefs may impact patient consent Be patient and fully explain if patient refuses treatment Use an interpreter as needed Other professionals Translator Family or bystanders 41 If a patient refuses care, be sure to have the patient sign a of Treatment and Transportation form. 42 Terminally Ill Patients Can be an emotional Patient may wish to die at home but family member calls for EMS Respect wishes Support family members Seek medical control advise for resolution 43 Patients With Communicable Diseases yourself with BSI Provide appropriate care Be Legally, you cannot refuse to provide any needed or required to a person because of the presence of a communicable disease 44 Patients With Financial Challenges 6

7 Make patients understand that they can receive health care regardless of ability to pay Familiarize yourself with hospitals and clinic that provide services to people without money or insurance Treat the patient the financial condition the patient is in! 45 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. 7