Chapter 37: Patients with Special Challenges

Overview

• Focus on understanding and managing patients with special needs including developmental, sensory, and physical disabilities.
• Discuss unique anatomy, physiology, assessment, and treatment.
• Care considerations for patients relying on medical technology.
• Managing obese patients.

Developmental Disabilities

Intellectual Disability

• Impairments in physical, learning, language, or behavioral skills.
• Diagnosis before age 18.
• Causes: genetic, congenital, birth complications, environmental factors.

Autism Spectrum Disorder

• Characterized by deficits in social communication and repetitive behaviors.
• Abnormal sensory responses.
• More common in males.
• Communication tips: Use simple phrases, demonstrate techniques.

Down Syndrome

• Genetic defect causing intellectual impairment.
• Risk factors: increased maternal age, family history.
• Physical traits: round head, large tongue, slanted eyes.
• Medical complications: leukemia, heart defects, sensory issues.
• Interaction: Calm, friendly approach, explain procedures clearly.

Sensory Disabilities

Visual Impairment

• Causes: congenital, injury, or degeneration.
• Patient interaction: Identify yourself, describe surroundings.
• Transport: Ensure accessibility for canes, walkers, and service animals.

Hearing Impairment

• Types: sensorineural and conductive loss.
• Communication: Face the patient, use normal tone, offer paper/pencil.

Physical Disabilities

Cerebral Palsy

• Poorly controlled body movement.
• Causes: fetal brain damage, oxygen deprivation at birth.
• Interaction: Observe airway, ensure comfort, transport with walkers/wheelchairs.

Spina Bifida

• Birth defect involving incomplete spinal closure.
• Associated with hydrocephalus and paralysis.
• Interaction: Transport with care, check for latex allergies.

Special Patient Care

Bariatric Patients

• Obesity involves excessive body fat, may affect mobility.
• Interaction: Respect, plan for extra help, avoid injury during transport.

Patients with Medical Technology

Tracheostomy Tubes

• Provides airway access.
• Use DOPE mnemonic for obstruction: Displacement, Obstruction, Pneumothorax, Equipment failure.
• Suction as needed, monitor for infection.

Mechanical Ventilators

• Assist patients who cannot breathe independently.
• If malfunction occurs, provide manual ventilation.

Apnea Monitors

• Used for monitoring infants with respiratory issues.

Internal Cardiac Pacemakers

• Regulates heart rhythm.
• Note device location, avoid placing defib pads over it.

Vagal Nerve Stimulators

• Used for seizure control not managed by medication.

Hospice and Terminal Illness Care

• Hospice focuses on comfort and palliative care for terminally ill patients.
• Respect DNR orders and provide compassionate care.

Poverty and Homelessness

• Addressing emergency care needs for homeless or impoverished individuals.
• Advocate for social service resources in your community.

Key Learning Points

• Autism is associated with impaired social interaction.
• Down syndrome risk increases with maternal age.
• Intubation may be difficult in Down syndrome due to anatomical features.
• DOPE helps identify airway obstruction causes in tracheostomy patients.
• Hospice care improves quality of life near end-of-life.
• Emergency Medical Treatment and Active Labor Act ensures treatment regardless of payment ability.