1. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Special Populations Chapter 15

2. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Outline Patients with Disabilities Critically Ill/Injured Patients Chronically Ill Patients Geriatric Patients Patients with Disabilities Critically Ill/Injured Patients Chronically Ill Patients Geriatric Patients

3. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Patients with Disabilities

4. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. A disability is a physical impairment that interferes with one or more major life activities.

5. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Examples of Disabilities Impaired vision Impaired hearing Severe arthritis Paralysis or impaired mobility due to stroke, brain or spinal trauma, or to neuromuscular disorders Impaired vision Impaired hearing Severe arthritis Paralysis or impaired mobility due to stroke, brain or spinal trauma, or to neuromuscular disorders

6. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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 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

7. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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 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

8. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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 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

9. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Impaired Hearing Do not shout –Shouting distorts understanding of the spoken word and the formation of the words if the person is lip reading Do not shout –Shouting distorts understanding of the spoken word and the formation of the words if the person is lip reading

10. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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 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

11. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Impaired Vision If you will be guiding the patient while walking ask how you can best be of assistance

12. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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 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

13. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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

14. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Critically Ill/Injured Patients

15. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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 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

16. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Chronically Ill Patients

17. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Chronically Ill Patients A chronic illness is a condition of long-standing –Heart disease –Diabetes –Chronic respiratory illnesses –Cancer A chronic illness is a condition of long-standing –Heart disease –Diabetes –Chronic respiratory illnesses –Cancer

18. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. When caring for a chronically ill patient, try to determine what changed that prompted a call for help.

19. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Chronically Ill Patients Prone to decompensation under conditions of physiological or psychological stress Some may be cared for in or by a hospice organization Prone to decompensation under conditions of physiological or psychological stress Some may be cared for in or by a hospice organization

20. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Chronically Ill Patients Be aware of local policies concerning “Do Not Resuscitate” orders

21. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Geriatric Patients

22. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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 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 Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

23. Physical and mental changes take place with age, for the most part these are subtle until age is well- advanced Dementia is not a consequence of aging, it is a disease-related process Physical and mental changes take place with age, for the most part these are subtle until age is well- advanced Dementia is not a consequence of aging, it is a disease-related process Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

24. Medications may have side effects that cause physical and cognitive changes Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

25. 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 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

26. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

27. 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 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 Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

28. 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 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

29. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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 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

30. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Communication Don’t assume hearing impairment Allow time for the patient to answer Verify the information privately, if necessary, with a family member Don’t assume hearing impairment Allow time for the patient to answer Verify the information privately, if necessary, with a family member Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

31. 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 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

32. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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 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

33. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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” 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”

34. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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 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

35. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Physical Examination Allow the patient time to move Be aware of decreased sensitivity to pain Be gentle in handling Allow the patient time to move Be aware of decreased sensitivity to pain Be gentle in handling

36. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Abuse of the Elderly May take many forms –Financial –Physical –Emotional –Neglect The abuser may be anyone with access to the patient May take many forms –Financial –Physical –Emotional –Neglect The abuser may be anyone with access to the patient

37. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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 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

38. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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 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

39. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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.

40. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Questions? Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.