chapter 13 caring for patients with special needs

Chapter 13

Caring for Patients with Special Needs

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


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


Domestic Violence

• Battering and injury

• Psychological abuse

• Sexual assault

• Social isolation

• Deprivation

• Intimidation


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


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


PCT Responsibilities

• Keep communication and documentation concise and accurate

• Be kind, empathetic, and supportive


Delirium

• Acute confusional state caused by reversible medical problems

• If left untreated the mortality is high

• Causes:– Dehydration– Physical illness– Anesthesia and medications


Delirium

• To eliminate delirium, the physician will treat the underlying cause(s)

• Mental status may not be immediately clear


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


Spinal Cord Injury

• Move extremities slowly and gently

• Avoid rapid, rough movements

• If extremities move into flexion, gently move them into extension


Spinal Cord Injury

• If the extremities move into extension, position them in flexion

• Prevent pressure ulcers

• Allow patient to direct care


Autonomic Dysreflexia

• Treatment– Identify the stimulus and remove it

• Inform RN if you observe any signs and symptoms


Chemotherapy

• Wear gloves when handling soiled linen

• Use standard precautions

• Monitor for and report signs of infection

• Prevent bleeding and bruising


Chemotherapy

• Promote good nutrition and hydration

• Monitor I&O

• Allow for frequent rest periods

• Be empathetic and supportive


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


Radiation Therapy

• Follow radiation precautions

• Wear a dosimeter to monitor exposure

• Stay at least 3 feet away from the patient unless giving direct care


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



• Notify RN if patient has following symptoms: – Fever or chills– Pulse over 100– Respirations over 24– Becomes cyanotic or dyspneic– Restless or apprehensive



• Notify RN if patient has following symptoms: – Diarrhea– Nausea– Vomiting– Itching


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


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


The Pain Problem

• Patient’s self report of pain is the most accurate indicator of the existence and intensity of pain


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


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


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


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


Pain Management Procedures

• Implantable medication pumps– Placed under abdominal skin with a catheter

for medicine administration

chapter 13 caring for patients with special needs

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