1. Chapter 13 Caring for Patients with Special Needs

2. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.2 Working with Interpreters Interpreter –Communication professional who mediates between speakers of different languages –Some interpreters speak –Others use sign language

3. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.3 Working with Interpreters Qualified interpreters know the expressions of the languages they are interpreting –Verbal and non-verbal –Cultural values –Beliefs –Gestures and body language

4. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.4 Domestic Violence Battering and injury Psychological abuse Sexual assault Social isolation Deprivation Intimidation

5. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.5 Domestic Violence Violent behavior –Perpetrated by a person involved in an intimate relationship with the victim Violence is used a as a means of control Victim may think abuse is his or her fault

6. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.6 PCT Responsibilities You are not responsible for questioning, counseling, or treating the patient Be aware of domestic violence and alert to signs and symptoms –If detected, inform RN

7. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.7 PCT Responsibilities Keep communication and documentation concise and accurate Be kind, empathetic, and supportive

8. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.8 Delirium Acute confusional state caused by reversible medical problems If left untreated the mortality is high Causes: –Dehydration –Physical illness –Anesthesia and medications

9. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.9 Delirium To eliminate delirium, the physician will treat the underlying cause(s) Mental status may not be immediately clear

10. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.10 Nursing Care After a Seizure Reorient the patient Check vital signs frequently until stable Keep the side rails up Provide incontinence care Monitor for return of seizure activity Administer oxygen or suction

11. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.11 Spinal Cord Injury Move extremities slowly and gently Avoid rapid, rough movements If extremities move into flexion, gently move them into extension

12. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.12 Spinal Cord Injury If the extremities move into extension, position them in flexion Prevent pressure ulcers Allow patient to direct care

13. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.13 Autonomic Dysreflexia Treatment –Identify the stimulus and remove it Inform RN if you observe any signs and symptoms

14. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.14 Chemotherapy Wear gloves when handling soiled linen Use standard precautions Monitor for and report signs of infection Prevent bleeding and bruising

15. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.15 Chemotherapy Promote good nutrition and hydration Monitor I&O Allow for frequent rest periods Be empathetic and supportive

16. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.16 Radiation Therapy Do not wash radiation markings off Wash with lukewarm water and mild soap Avoid rubbing or creating friction on skin Dress in loose, comfortable clothing

17. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.17 Radiation Therapy Follow radiation precautions Wear a dosimeter to monitor exposure Stay at least 3 feet away from the patient unless giving direct care

18. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.18 Immunotherapy Patients Monitor vital signs every 2-4 hours Inform RN if systolic B/P less than 100 Monitor capillary refill Weigh the patient daily

19. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.19 Immunotherapy Patients Notify RN if patient has following symptoms: –Fever or chills –Pulse over 100 –Respirations over 24 –Becomes cyanotic or dyspneic –Restless or apprehensive

20. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.20 Immunotherapy Patients Notify RN if patient has following symptoms: –Diarrhea –Nausea –Vomiting –Itching

21. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.21 Complementary and Alternative Medicine (CAM) Diverse systems, practices, and products –Not presently part of conventional medicine Area of research and scientific study CAM changes continually –New practices and techniques are always emerging

22. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.22 Principles of Rehabilitation and Restoration Begin treatment early Activity strengthens Prevent further disability Stress the patient’s ability, not the disability Treat the whole person

23. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.23 The Pain Problem Patient’s self report of pain is the most accurate indicator of the existence and intensity of pain

24. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.24 The Pain Problem Always respect and believe a patient Patients may be smiling, talking, or sleeping and still be having pain Vital signs may be normal –Avoid making assumptions about a patient’s pain

25. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.25 Types of Pain Acute pain –Occurs suddenly; usually the result of tissue damage Persistent pain –Pain that lasts for 6 months –May be intermittent or constant

26. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.26 Types of Pain Phantom pain –Occurs as a result of an amputation –The pain is real Radiating pain –Pain that moves from the site of origin to other areas

27. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.27 Pain Management Procedures Epidural catheter –Implanted under skin into epidural space for medication administration Transcutaneous electrical nerve stimulation –Electrical current stimulates nerve fibers to block pain

28. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.28 Pain Management Procedures Implantable medication pumps –Placed under abdominal skin with a catheter for medicine administration