Ch 17 - Special Populations

special populations possible considerations (5)

• assessment

• communication

• treatment

• transportation 

• OR no changes!

geriatric population

• 65+

• many changes occur as body ages

• due to dec mental acuity difficult to determine whether acute illness is trauma / medical 

gen dec in system function w age

• respiratory

• circulatory

• nervous

• endocrine

• gastrointestinal

• thermoreg

• MSK etc 

geriatric pop - respiratory

dec @ age 30 and only ½ as effective by age 65

geriatric pop - cardiac (3)

• volume of blood pumped / hb dec

• HR slow

• blood vessels harden

geriatric pop - integumentary

thinner more fragile

geriatric pop - brain

dec size = inc susceptibility to brain injury

geriatric pop - skeletal

inc become weaker and more brittle = more Fx

assessing geriatric pt (3)

communicate at eye level

ask about minor symptoms that may not seem significant

gather all meds they are taking

pt w disabilities may have the following (5)

service animals

assistive devices

visual impairments

hearing impairments

speech or language impairments 

service animals

• undergo extensive training

• try and keep service animal close to pt as possible

• service animal separated from its human should be followed - might be needing help

assistive devices

• assist w seeing, hearing, communicating or moving

• ensure that these devices stay with them

  • wheelchairs

  • walkers

  • canes

  • crutches

  • prosthetics

visually impaired (4)

• unable to see effectively or at all

• impairment of eyes / optic nerve

• usually no issues communicating

• relatively ID assessment

hearing impaired (4)

• result of injury / illness of ear or nerves

• communication unique challenge

• often point to ears or visually see hearing aids

• most adapted to learning to speak, lip read, sign or combo

who is considered to be a pediatric

birth to 18 yo

stages of development (6)

• neonates

• infants

• toddlers

• preschoolers

• school aged children

• adolescents 

neonates age range

0 to 28 days

infants age range

29 days to 1 year

toddlers age range

1 to 2 years

preschoolers age range

3-5 years

school aged children age range

6-12 years

adolescents age range

13-18 years

neonates

extreme vulnerable to injury and infection

infants

generally not bothered by presence

toddlers

freq uncooperative often best examined on parent/guardian’s lap

preschoolers

usually easy to examine but are very curious, allow to inspect and play w equipment 

school aged children

can communicate effectively, avoid technical medical terminology, respect modesty as much as possible

adolescents

typically more adults than children, direct questions to them (not parents)

assessing pediatric patients (7)

• observe child before touching him or her

• when speaking to kid lower yourself to eye lebel

• communicate clearly and talk slow

• remain calm

• keep child w loved ones unless necessary to separate them

• gain trust through your actions

• may be easier to do head to toe exam before vitals

child abuse S/Sx (4)

• Fx in child <2yo

• injuries at various stages of healing

• more injuries than normal for child that age

• injuries not fitting MOI

child abuse what to do

must report abuse or suspected abuse to police, EMS, CFS (do not need proof, just suspicion)

bariatrics

providing healthcare for those who have obesity 

• common concerns are diabetes, hypertension etc

• presents many challenges when doing assessments (complex Hx, equipment, meds)

palliative

those w terminal disease

• Tx consists of improving quality of life

• extremely emotionally charged situation 

chickenpox

viral infection that is most contagious 1-2 days before onset of rash

shaken baby syndrome (SBS)

refers to a variety of injuries that may result when an infant/young child is violently shaken

• treat as suspected child abuse

sudden infant death syndrome (SIDS)

sudden death of a seemingly healthy infant during sleep without evidence of disease

• treat as suspected child abuse = NO