Download Chronically Ill Patients

Chapter 15
Special
Populations
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Outline
• Patients with Disabilities
• Critically Ill/Injured Patients
• Chronically Ill Patients
• Geriatric Patients
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Patients
with
Disabilities
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A disability is a physical impairment
that interferes with one or more
major life activities.
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Examples of Disabilities
• Impaired vision
• Impaired hearing
• Severe arthritis
• Paralysis or impaired
mobility due to stroke,
brain or spinal trauma,
or to neuromuscular disorders
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Special Considerations
• Don’t make physical contact with a person
who is visually impaired without first telling
him/her what you are going to do
• It may be difficult to exchange information
with persons who have impaired hearing
or speech
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Special Considerations
• Extra patience and assistance may be
required in allowing patients time to
comply with your requests
• If at all possible, do not separate a person
with disabilities from his/her service animal
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Impaired Hearing
• The patient may become frustrated if you
are unable to understand him/her, or
he/she is unable to understand you
• The patient may be able to read your lips,
write messages on paper or understand
your gestures or facial expressions
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Impaired Hearing
• Do not shout
– Shouting distorts understanding of the spoken
word and the formation of the words if the
person is lip reading
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Impaired Vision
• The unfamiliar sounds brought into the
environment by an emergency may be
frightening and confusing
• Talk with the patient about your actions
• Speak in a normal voice
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Impaired Vision
• If you will be guiding the patient while
walking ask how you can best be of
assistance
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Impaired Mobility
• Injuries may occur due to unawareness of
painful stimuli or because of inability to
move away from the harmful stimulus
• Whenever possible, allow the patient to
keep any assistive devices to maintain
independence
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Impaired Mobility
• If the patient has a special device (such as
an ostomy) ask the patient or his family
how to best manage it during assessment
and treatment
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Critically
Ill/Injured
Patients
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Critically Ill/Injured Patients
• Your first responsibility is to manage the
patient’s airway, breathing, and circulation
• Provide reassurance to the patient
• Be cautious of remarks made in the
patient’s presence, even if patient appears
to be unresponsive
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Chronically
Ill Patients
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Chronically Ill Patients
• A chronic illness is a condition of long-standing
– Heart disease
– Diabetes
– Chronic respiratory illnesses
– Cancer
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When caring for a chronically ill patient, try
to determine what changed that prompted a
call for help.
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Chronically Ill Patients
• Prone to decompensation under conditions of
physiological or psychological stress
• Some may be cared for in or by a hospice
organization
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Chronically Ill Patients
• Be aware of local policies concerning “Do Not
Resuscitate” orders
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Geriatric
Patients
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• Geriatric refers to the elderly, those
over 65 years of age
• The elderly are the fastest growing
group in the US population
• There are many stereotypes and
myths about the elderly
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• Physical and mental changes take
place with age, for the most part
these are subtle until age is welladvanced
• Dementia is not a consequence of
aging, it is a disease-related
process
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• Medications may have
side effects that cause
physical and cognitive
changes
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The Elderly
• Decreased ability to compensate for illness
and injury
– The circulatory system does not respond
as it did when the patient was younger
– The respiratory system is less able to
provide for increased ventilation needs
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• Risk factors for poor health
– Age over 75
– Living alone
– Cognitive impairment
– Immobility
– Recent loss of significant
other
– Recent hospitalization
– Incontinence of urine or
feces
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The Elderly
• Cardiovascular disease is the leading cause
of death in the elderly
• Trauma also plays a significant role in
morbidity and mortality
– Falls
– Motor vehicle crashes
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Communication
• Address by his or her title and last name
– For example: Mr. Jones or Mrs. Smith
• Avoid nicknames like “Honey” and “Buddy”
• Do not speak about the patient to others
in as if the patient is not there
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Communication
• Don’t assume
hearing impairment
• Allow time for the
patient to answer
• Verify the
information
privately, if
necessary, with a
family member
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Scene Safety
• Don’t assume the patient (or an elderly
family member or bystander) can’t harm you
• Some forms of dementia (such as
Alzheimer’s Disease) can lead to violent
behaviors
• Don’t assume combativeness is due to
dementia
– head injury, hypoxia, or low blood sugar
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Initial Assessment
• Poorly fitting dentures may
interfere with management of
airway and ventilation
• Curvature of the spine may
make cervical stabilization
difficult
• Respirator failure occurs more
easily in the elderly
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Initial Assessment
• Be prepared to suction, the elderly may
have a diminished gag or cough reflex
• Some medications do not allow blood to
clot normally
• Don’t assume confusion or decreased level
of consciousness is “normal”
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History
• Speak clearly; don’t shout
• Allow the patient time to answer
• Don’t become impatient
• Focus the patient on what happened today
– or recently – not a history of events over
the past several years
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Physical Examination
• Allow the patient time to move
• Be aware of decreased sensitivity to pain
• Be gentle in handling
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Abuse of the Elderly
• May take many forms
– Financial
– Physical
– Emotional
– Neglect
• The abuser may be anyone with access to the
patient
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Abuse of the Elderly
• Risk factors of being abused
– Female, over age 75
– Multiple chronic medical conditions
– Incontinence
– Impaired sleep patterns
– Dementia & behavioral issues
– Dependence on others
– Abuser has circumstances of household
conflict, financial, or other problems
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Abuse of the Elderly
• The elderly may be reluctant to admit or
report abuse due to fear of retribution by
the abuser
• Follow local policies regarding reporting of
suspected abuse
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Summary
• As a First Responder, you will encounter
patients who have special needs. Knowing
a few basic techniques in caring for them,
along with having empathy for the patient,
will increase your effectiveness in caring
for these patients.
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Questions?
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