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CH 56: Patient With a Disability DH201 Clinician Sciences Lisa Mayo, RDH, BSDH “If you judge people, you have no time to love them.” Mother Theresa.

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Presentation on theme: "CH 56: Patient With a Disability DH201 Clinician Sciences Lisa Mayo, RDH, BSDH “If you judge people, you have no time to love them.” Mother Theresa."— Presentation transcript:

1 CH 56: Patient With a Disability DH201 Clinician Sciences Lisa Mayo, RDH, BSDH “If you judge people, you have no time to love them.” Mother Theresa

2 Disabilities United States Americans with Disabilities Act (ADA) defines an individual with a disability as a person who “has a physical or mental impairment that substantially limits one or more major life activities, has a record of such impairment, or is regarded as having such impairment.” The World Health Organization International Classification of Functioning, Disability, and Health (ICF) is a universal classification of disability and health that provides a standard language and framework for the description of health and health-related states. Table 56-1 in the text lists categories and descriptions.

3 Dental Hygiene Care Ask direct questions about a patient’s disability Guardian: person is declared incapacitated in a legal process, a guardian is appointed (consents, signatures on forms) Caregiver: Patient may rely on caregiver for daily life activities but may or may not be the legal guardian of patient and contact person to plan appointments

4 Wheelchair Accessibility Wheelchairs require more space for turning & positioning Parking Reserved area, clearly marked, near the building entrance 13 feet wide Walkways: 3-foot-wide, solid and nonslip surface Entrance Entrance to the building on ground level accessible by a ramp Handrail (height 30 to 34 inches) Door Opens 32in+

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8 Wheelchair Accessibility Passageways 3ft+ wide Handrails Floors Level, nonslip Unattached, movable rugs hazards Reception area: Furniture positioning: allow access around Chairs: 18-inch-high, do NOT slide easily

9 Wheelchair Accessibility: Tx Room Dental chair Ability to lower 19” from the floor X-rays machine in the same tx room Wheelchair used during treatment When pt is in a total support wheelchair, transfer to the dental chair may not be advisable Some wheelchairs are self-reclining and have headrests Portable headrest Dental chair can be swiveled to permit the wheelchair to be backed up to place the patient’s head in a usual treatment position

10 NBQ Your client is in a wheelchair. Which of the following is the minimal width needed to ensure doorway access? a.20 inches b.25 inches c.30 inches d.32 inches

11 NBQ Your client is in a wheelchair. Which of the following is the minimal width needed to ensure doorway access? a.20 inches b.25 inches c.30 inches d.32 inches

12 Portable headrest attached to wheelchair

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15 Wheelchair Transfers Selection of a transfer technique Size, weight, and mobility of the patient Patient preferences (may prefer to transfer from one side of the chair depending on which side of the body is stronger) Can be a frightening for patient

16 Wheelchair Transfers: Preparation 1 st thing to do: Clear the area in the operatory (NBQ) Transfer special padding (prevent sores) Bags and catheters May be attached to the leg of the patient or to the wheelchair After transfer, the tubing must be checked to be sure it is not bent or twisted Ask patient or caregiver best way to transfer Allow patient to do as much as possible

17 Review In preparing for a wheelchair transfer, what should you do first? A) Move chair padding to dental chair B) Place the wheelchair parallel to the dental chair C) Find someone else in the office to help with the transfer D) Clear the area of any items that may be in the way

18 Review In preparing for a wheelchair transfer, what should you do first? A) Move chair padding to dental chair B) Place the wheelchair parallel to the dental chair C) Find someone else in the office to help with the transfer D) Clear the area of any items that may be in the way

19 Transfer Techniques Mobile Patient 1) “Stand & Pivot” 2)Sliding Board Immobile Patient: 2-aid assisted

20 Mobile Patient Transfer When a patient can support his or her own weight, the “STAND & PIVOT” technique can be used Step #1: Wheelchair Safety Face the wheelchair in the same direction as the dental chair at approximately an angle of 30 degrees Set brakes, remove footrests and wheelchair armrests The patient will adjust a power-driven chair and set the brakes before turning it off

21 Mobile Patient Transfer Step #2: Dental Chair Adjust the dental chair to the same height as or lower than the wheelchair Uplift the dental chair arm Step #3: Lifting Patient out of Wheelchair Detach pt safety belt Face the patient and place feet outside the patients feet for pivoting Clinician’s knees should be close to or against the pt’s knees to prevent buckling Place hands under pt’s arms & grasp the waist belt in back Patient places arms around clinician’s neck or places hands on wheelchair to push up Clinician lifts patient to standing position

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23 Mobile Patient Transfer Step #4: Place Pt in Dental Chair Pivot together slowly until the patient is backed up to the side of the dental chair, with the backs of the legs touching The patient is gently lowered to a sitting position Reposition the arm of the dental chair Grasp pt’s legs together between the ankles and knees, and lift him or her onto the dental chair Step #5: Transfer Back to Wheelchair Repeat in reverse: after the appointment, return the patient to the wheelchair in the reverse order of procedure

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25 Mobile Patient Transfer Sliding Board Position the wheelchair in the same direction as and parallel with the dental chair, set the brakes, remove the footrests Adjust the seat of the dental chair to slightly lower than the wheelchair seat, Move the arm of the dental chair out of the transfer area, and remove the arm of the wheelchair Adjust the sliding board Pt & clinician places the sliding board well under the hip of the patient. The board is extended across the dental chair.

26 Mobile Patient Transfer Sliding Board Transfer Pt shifts weight, balances on hands, and walks the buttocks across the board The clinician can assist or do the transfer by holding the patient under the axillae 2 persons are needed when the patient is heavy or less mobile Board is removed and replaced after the appointment

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28 Assistance for Mobile Patient Braces, a cane, crutches, walker Ask patient how much and what kind of assistance is needed Raise chair slightly above the patient’s knee level and adjust chair arm out of the way Stand aside or assist while patient moves until back of legs touch chair and then bends knees to lower into dental chair If assistance is needed grasp ankles, lift legs, and turn patient into dental chair Service dogs that accompany a patient are allowed to lie quietly nearby during the dental appointment

29 Assistance for Mobile Patient Rising from the chair After telling patient, slowly rise the chair to upright position, with the seat slightly higher than the patient’s knee level to minimize need to bend knees when rising Allow time for adjustment to upright position in order Avoid POSTURAL HYPOTENSION Ask or assist patient to move feet down to the floor Retrieve assistive aids and hold them for patient to grasp with the dominant hand Offer support by placing arm under the patient’s arm on the nondominant side until balance is obtained for walking

30 Immobile Patient Transfer When the patient is unable to support his or her own weight: 2 aides are needed Positioning Position the wheelchair in the same direction & parallel with the dental chair, set brakes, remove footrests Adjust the dental chair to the same height as or lower than the seat of the wheelchair Move the arm of the dental chair out of the transfer area, and remove the arm of the wheelchair

31 Immobile Patient Transfer Aide #1 (a) Positioned behind the wheelchair Place feet, one on either side of the rear wheel nearest the dental chair Place hands under the patient’s arms below the elbows, pressing forearms against the patient’s lower thorax area Clasp hands or wrists under the patient’s rib cage

32 Immobile Patient Transfer Aide #2 (b) Face patient and grasp hands under the patient’s knees, place one arm under the thighs and the other under the calves of the lower legs Transfer On signal and a steady motion Lift and gently transfer the patient to the dental chair Repeat in reverse to transfer back to wheelchair

33 NBQ When completing a wheelchair transfer in the dental hygiene practice setting, what is the desired relationship of the dental chair to the wheelchair? a.The dental chair should be slightly higher than the wheelchair b.The dental chair should be even with the wheelchair c.The wheelchair should be slightly higher than the dental chair d.The dental chair should be three feet higher than the wheelchair

34 NBQ When completing a wheelchair transfer in the dental hygiene practice setting, what is the desired relationship of the dental chair to the wheelchair? a.The dental chair should be slightly higher than the wheelchair b.The dental chair should be even with the wheelchair c.The wheelchair should be slightly higher than the dental chair d.The dental chair should be three feet higher than the wheelchair

35 NBQ If a 200-pound patient arrived for an appointment in a wheelchair with his attendant, which of the following is NOT an option for performing a wheelchair transfer to the dental chair? a. Asking him if he can transfer with someone’s help b. Asking the attendant to transfer him c. Transferring him yourself using a one person transfer technique d. Ask the dental assistant or dentist to help perform a two person transfer technique e. Use a transfer board

36 NBQ If a 200-pound patient arrived for an appointment in a wheelchair with his attendant, which of the following is NOT an option for performing a wheelchair transfer to the dental chair? a. Asking him if he can transfer with someone’s help b. Asking the attendant to transfer him c. Transferring him yourself using a one person transfer technique d. Ask the dental assistant or dentist to help perform a two person transfer technique e. Use a transfer board

37 Supportive and Protective Stabilization Prevent injury to the patient and the dental practitioner Use of restraint is controversial Never used as punishment Explain to the patient/ legal guardian Informed consent signed Least restrictive method of stabilization is selected Last resort

38 Supportive and Protective Stabilization Body enclosure Although a small patient may be held by a parent, such positioning can be tiring for the parent, insecure, and may not provide good body mechanics for the clinician Pediwrap or papoose board Adjustable arm or leg immobilizer wraps with velcro closures or a padded board with wide fabric wraps around upper body, middle body and legs are available in adult and pediatric sizes Need clinician training before use

39 Oral Stabilization: Mouth Prop, Bite blocks,

40 Oral Stabilization Assist pt who has difficulty maintaining an open mouth Training needed Ratchet type (Molt’s mouth prop) Most stable mouth prop Opened gradually to hold the jaws to the necessary position Bite blocks: rubber, tie floss through the holes in case of a sudden respiratory change, the prop can be quickly pulled out and breathing normalized Precautions: mobile teeth, informed consent, muscle fatigue, TMD

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