Chapter 37 - Special Challenges

Disability

Condition interfering with ability to engage in ADLs

Can be developmental or a result of a traumatic injury or medical injury

Terminal illness

End-stage cancer, heart failure, kidney failure, progressive fatal diseases

Obesity

Obesity = BMI >_ 30

BMI categories:

< 24.9 = healthy

25-29 = overweight

>30 = obese

risks with obesity

• diabetes

• hypertension

• stroke

• heat disease

• sleep apnea

• respiratory problems

Supine can cause breathing difficulty

• use position of comfort during transport

Autism patient ABCD

A - Awareness

B - Basic

C - Calm

D - Safe

Congenital vs Acquired diseases

Congenital

• congenital heart disease

• cleft palate

• congenital deafness

Acquired

• COPD

• AIDS

• traumatic spinal cord injury

• deafness

CPAP - continuous positive airway pressure

may be used for sleep apnea, keeps airway open for proper ventilation

Tracheostomy tubes

Surgical opening through neck into trachea where breathing tube is placed

mucus can build up in tube (may need to suction)

patient may or may not be able to speak

BVM can fit on end of tube

Home ventilators

Make sure vent tube has no mucus

Implanted pacemaker

sends electrical impulses to heart to ensure it beats at normal rate + pumps blood efficiently

AICD

• detects dangerous heart rhythms and delivers shock

• shock can be very painful

LVAD

Left ventricular assistive device

mechanically pumps heart

patient may have no pulse

Feeding tube

secure tube to patient’s body with tape before transport

keep nutrients higher than tube

prevent leakage by using protective cap

Urinary catheters

keep catheter bag lower than patient (not on floor)

document urine discoloration/odor

Ostomy bag

connected to site of colostomy or ileostomy

common problems:

• infection at stoma site

• blockage

• dislodgment

Hemodialysis

Occurs at dialysis center

Patient attached to external machine

Complications:

• bleeding from AV fistula

• infection

Do not take BP on AV fistula arm

Peritoneal dialysis

• can be done at home

• permanent catheter implanted through abdominal wall into peritoneal cavity

• peritonitis —> infection

Central IV catheters

surgical inserted for long-term delivery of meds or fluids

PICC = peripherally inserted central catheter

complication = infection at site

VP Shunts

• drain excess brain fluid

Complications:

• infection

• increased ICP

Signs of child abus

• bruises (patterns)

• burns (cigs)

• fractures (multiple stages)

• head injuries