1. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Chapter 27 Special Populations and Situations Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer

2. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer OBJECTIVES DIRECTORY 1.Define key terms introduced in this chapter. 42-4342-43 2.Describe the importance of interacting with the family and caregivers of patients with special challenges and considerations. 7, 9-1179-11 3.Give examples of common congenital and acquired diseases and conditions. 12-1812-18 4.Discuss considerations in communicating with and caring for patients with sensory impairments and loss of mobility. 19-2219-22

3. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer OBJECTIVES DIRECTORY 5.Explain the purpose, common problems, and emergency care of each of the following: 23-3323-33 a.Tracheostomies b.Ventilators c.Insulin pumps d.Implanted defibrillators e.Left ventricular assist devices f.Feeding tubes g.Indwelling catheters h.Urinary catheters i.Ostomy pouches

4. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer OBJECTIVES DIRECTORY 6.Describe the signs and management of the following: 36-38 36-38 a.Physical abuse b.Sexual abuse c.Emotional abuse d.Financial abuse e.Neglect 7.Describe your roles and responsibilities as an EMR in situations involving abuse or neglect. 3939

5. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer MULTIMEDIA DIRECTORY Slide 17Cystic Fibrosis Video Slide 18Information about Leukemia Video

6. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer TOPICS Technological Advances EMR Patient Assessment: Special Patient Populations EMR Emergency Care: Physical Impairments EMR Emergency Care: Medical Devices Abuse

7. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer INTRODUCTION Special needs and advanced medical equipment in the home Complicated medical conditions Back to Objectives

8. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Case Study: The Call Dispatch –You are in your dorm room at college and hear dispatch call responders to a 4-year-old female with abdominal pain –You know that the location of the call provided by dispatch is a daycare center very close to your current location

9. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Technological Advances Back to Topics

10. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Photo: © Family Voices

11. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Technological Advances Allow more people to access medical devices and care outside of the hospital environment Require the EMR to be prepared to care for patients with devices and conditions not previously encountered Back to Objectives

12. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer EMR Patient Assessment: Special Patient Populations Back to Topics

13. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Photo: © Ray Kemp / 911 Imaging

14. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Congenital Diseases and Conditions Present at birth Common diseases and conditions –Congenital heart disease –Cerebral palsy –Cystic fibrosis

15. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Acquired Diseases and Conditions Occurs after birth Common diseases and conditions –COPD –HIV –AIDS –Traumatic brain or spinal cord injuries

16. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer End of Life and Terminal Illness Palliative care Hospice DNR and living will

17. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Cystic Fibrosis Click on the screenshot to view a video about cystic fibrosis. Back to Directory

18. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Information about Leukemia Click on the screenshot to view a video with information about leukemia. Back to DirectoryBack to Objectives

19. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer EMR Emergency Care: Physical Impairments Back to Topics

20. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Photo: © Craig Jackson / In the Dark Photography

21. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Hearing Loss More common in the elderly Speak at a normal volume and speed Communicate through writing if necessary

22. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Mobility Problem more common in the elderly Assess patient’s ability to ambulate Back to Objectives

23. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer EMR Emergency Care: Medical Devices Back to Topics

24. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Photo: © AP Photo / The Charlotte Observer, David T. Foster III

25. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Tracheostomy Tubes Opening in the neck (stoma) Patient may or may not be able to speak Mucous buildup causes problems

26. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Breathe for the patient Reasons for call –Suctioning required –AC power failure Ventilators Photo: © Ray Kemp / 911 Imaging

27. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Used by diabetics to regulate blood glucose levels Insulin Pumps

28. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Implanted Defibrillators Automatic implanted cardiac defibrillator (AICD) Implanted in left upper chest Detects life- threatening cardiac rhythms Delivers internal defibrillations

29. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Left Ventricular Assist Device Called LVAD Mechanically pumps blood for the left ventricle Photo: © AP Photo / George Widman

30. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Feeding Tubes Patients who cannot feed themselves or swallow Two types –Nasogastric tube (NG-tube) –Gastric feeding tube (G-tube)

31. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Indwelling Catheters Central IV catheter

32. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Urinary Catheters For patients who cannot urinate or have lost the ability to regulate when they urinate

33. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Ostomy Pouches Connected to a section of bowel to allow for fecal drainage Back to Objectives

34. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Case Study: The Response On arrival the daycare director tells you that Savannah, a 4-year-old female, came in this morning tired and looking like she had been crying She turned down her mid-morning snack and was holding her stomach complaining of “really bad pain” in her stomach You talk to her, and she reluctantly allows you to see her stomach CONTINUED

35. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Case Study: The Response, continued You note multiple bruises in colors of yellow, brown, and black You ask what happened and she will not answer

36. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Abuse Back to Topics

37. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer

38. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer EMR Patient Assessment: Abuse Types of abuse –Physical abuse –Sexual abuse –Emotional abuse –Financial abuse –Neglect Back to Objectives

39. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer EMR Emergency Care: Abuse Reporting suspicions Documentation Photo: © Robert A. Felter, M.D. Back to Objectives

40. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Case Study: Transition EMS arrives, and you give your report The director states that she called the girl’s mother Your primary assessment reveals normal vital signs Her abdomen is tender Upon arrival at the hospital, the mother rushes to the girl and holds her hand CONTINUED

41. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Case Study: Transition, continued You privately report your suspicions to the physician in the ED You immediately report your suspicions to the appropriate office Two weeks later you hear that the girl’s uncle has been arrested for child abuse

42. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer REVIEW Define the following terms –Palliative care –Hospice –Living will –Tracheostomy –Ventilator –Insulin pump –Automatic implanted cardiac defibrillator (AICD) CONTINUED

43. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer REVIEW Define the following terms –Left ventricular assist device (LVAD) –Indwelling catheter –Urinary catheter –Ostomy –Physical abuse –Sexual abuse –Emotional abuse –Neglect Back to Objectives

44. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer STOP, REVIEW, REMEMBER You respond to a call for help and find a 49-year-old female patient in cardiac arrest. The patient has terminal cancer, and her husband presents you with a DNR. You should a)begin care. b)contact medical direction. c)withhold CPR. d)contact the patient’s family physician. CONTINUED

45. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer STOP, REVIEW, REMEMBER One of the best sources of information on a patient with congenital illness is the patient’s a)chart. b)doctor. c)family member. d)nurse. CONTINUED

46. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer STOP, REVIEW, REMEMBER A person suffering from a terminal illness may have a _______________ to guide family members about his wishes if he becomes unable to make decisions about his care. a)living will b)DNR c)palliative care d)doctor’s order CONTINUED

47. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer STOP, REVIEW, REMEMBER Your patient suffered a spinal cord injury and now has a surgical opening in his neck through which a breathing tube was placed. You know this to be a a)tracheostomy. b)urineostomy. c)colonostomy. d)cricothyrotomy.

48. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer REVIEW Discussion 1.Describe the importance of interacting with the family and caregivers of patients with special considerations. 2.Describe your role and responsibility when suspicious of abuse.

49. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Please visit www.bradybooks.com www.bradybooks.com and click on the mykit links to access content for this text. REINFORCE AND REVIEW