Special Patients :Special Patients


Hearing impairments :Hearing impairments


Hearing impairments :Hearing impairments Types Conductive deafness Sensorineural deafness


Etiologies :Etiologies Conductive deafness (curable) Infection Injury Earwax


Etiologies :Etiologies Sensorineural deafness (many incurable) Congenital Birth injury Medication-induced Viral infection Tumors Prolonged exposure to loud noise Aging


Recognition :Recognition Hearing aids Poor diction Inability to respond to verbal communication in absence of direct eye contact


Accommodations :Accommodations Retrieve hearing aid Paper/ pen Maintain position so patient can read lips Use of an “amplified” listener Picture of basic needs/ procedures


Accommodations :Accommodations American Sign Language (ASL) Interpreter Notify receiving facility as early as possible


Accommodations :Accommodations Do not shout 80% of hearing loss is related to loss of high-pitched sounds Use low-pitched sounds directly into ear canal Do not exaggerate lip movement


Visual impairments :Visual impairments


Etiologies :Etiologies Congenital Injury Infection (C.M.V.) Glaucoma Degeneration of eyeball, optic nerve or nerve pathways


Accommodations :Accommodations Retrieve visual aids Describe everything you're going to do Provide sensory information If ambulatory, guide by leading, not by pushing Allow guide dogs to accompany patient


Speech impairments :Speech impairments


Types :Types Language disorders Articulation disorders Voice production disorders Fluency disorders


Language disorders :Language disorders Etiologies Stroke Head injury Brain tumor Delayed development Hearing loss Lack of stimulation Emotional disturbance


Language disorders :Language disorders Recognition Slowness to understand speech Slow growth in vocabulary and sentence structure


Articulation disorders :Articulation disorders Etiologies Damage to nerve pathways from brain to muscles in larynx, mouth or lips Delayed development from: hearing problems slow maturation of nervous system Recognition Speech slurred, indistinct, slow, or nasal


Voice production disorders :Voice production disorders Etiologies Disorder affecting vocal cord closure Hormonal or psychiatric disturbance Severe hearing loss


Voice production disorders :Voice production disorders Recognition Hoarseness Harshness Inappropriate pitch Abnormal nasal resonance


Fluency disorders :Fluency disorders Etiology Not fully understood Recognition Stuttering


Accommodations :Accommodations Allow patient time to respond Provide aids when available


Obesity :Obesity


Etiologies :Etiologies Caloric intake > Calories burned Low basal metabolic rate Genetic predisposition


Accommodations :Accommodations Appropriately-sized diagnostic devices Maintain professionalism Additional assistance for lifting, moving


Paraplegia/ Quadriplegia :Paraplegia/ Quadriplegia


Description :Description Paraplegia Weakness or paralysis of both legs Quadriplegia Paralysis of all extremities and trunk


Accommodations :Accommodations Airway/ventilation management Patients with halo traction device Ostomies: Trachea Bladder Colon May require additional assistance/ equipment


Mental illness :Mental illness


Description :Description Any form of psychiatric disorder


Etiologies :Etiologies Psychoses Patient perceptions of reality radically different Neuroses Patient perceives reality normally but reacts to it inappropriately


Recognition :Recognition Behavior not always affected May present with signs and symptoms consistent with underlying illness


Accommodations :Accommodations Don't be afraid to ask about History of mental illness Prescribed medications Whether patient is taking medications as prescribed Concomitant ingestion of alcohol, other drugs


Accommodations :Accommodations Solicit permission before beginning assessment Treat as patient that does not have mental illness, unless call is related specifically to the mental illness


Developmental disabilities :Developmental disabilities Impaired or insufficient development of the brain Causes an inability to learn at a usual rate


Down's syndrome :Down's syndrome


Etiology :Etiology Chromosomal abnormality (trisomy -21) resulting in: Mild to severe mental retardation Characteristic physical appearance


Recognition :Recognition Eyes slope up at outer corners; folds of skin on either side of nose cover the inner corners of eye Small face, features Large, protruding tongue Flattening of back of head Hands short, broad


Accommodations :Accommodations IQ varies from 30-80 Approximately 25% have a heart defect at birth Articulation of C-1 on C-2 may be unstable


Emotional impairments :Emotional impairments Etiologies Neurasthenia Anxiety neurosis Compulsion neurosis Hysteria


Arthritis :Arthritis


Description :Description Inflammation of joint Characterized by: Pain Stiffness Swelling Redness


Types/etiologies :Types/etiologies Osteoarthritis Rheumatoid arthritis Uremic arthritis (gout)


Accommodations :Accommodations Decreased range of motion/ mobility may limit physical exam Limited mobility Make equipment fit patient, not vice-versa Pad all voids Elicit current medications


Cerebral palsy :Cerebral palsy Description Non-progressive disorder of movement and posture Caused by injury to brain during its early development A symptom complex rather than a specific disease


Types :Types Spastic (70% of cases) Upper motor neuron involvement Abnormal stiffness and contraction of groups of muscles Hemiplegia Paraplegia Quadraplegia Diplegia (intermediate state between para-quadraplegia)


Types :Types Athetoid or dyskinetic (20%) Basal ganglia involvement Involuntary, writhing movements of: Extremities (athetoid) Proximal limbs and trunk (dyskinetic) Movements increase with emotional tension; disappear during sleep


Types :Types Ataxic (10%) Cerebellar involvement Loss of coordination and balance Unsteadiness Wide-based gait Difficulty with rapid or fine movements


Etiologies :Etiologies Prepartum Cerebral hypoxia Maternal infection Kernicterus (liver failure) Postpartum Encephalitis Meningitis Head injury


Accommodations :Accommodations 75% mentally retarded 25% have seizures Many with athetoid and diplegic cerebral palsy are highly intelligent


Accommodations :Accommodations May require additional resources to facilitate transport May need suctioning, due to increased oral secretions If contractures present: Pad appropriately Do not force extremities to move


Cystic fibrosis :Cystic fibrosis


Description :Description Inherited metabolic disease of exocrine glands and eccrine sweat glands Primarily affects digestive, respiratory systems Begins in infancy


Etiology :Etiology Autosomal recessive gene Both parents must be carriers Incidence Caucasians--1:2000 Blacks--1:17,000 Orientals--very rare


Pathophysiology :Pathophysiology Obstruction of pancreatic, intestinal gland, bile ducts Over-secretion by airway mucus glands Excess loss of sodium chloride in sweat


Recognition :Recognition History Airway obstruction, chronic cough Recurrent respiratory infections May be oxygen-dependent Frequent, foul-smelling stools Salty taste on skin Intolerance of hot environments


Accommodation :Accommodation May require respiratory support, suctioning, oxygen


Multiple sclerosis :Multiple sclerosis


Description :Description Progressive disease of CNS Scattered patches of myelin in the brain and spinal cord are destroyed Results in multiple, varied neurologic symptoms, signs


Etiologies :Etiologies Unknown Probably autoimmune disease Genetic factors influence susceptibility Women affected more often than men


Recognition :Recognition Painful muscle spasms Recurrent urinary tract infections Constipation Skin ulcerations Changes of mood, from euphoria to depression


Recognition :Recognition If brain affected: Fatigue Vertigo Clumsiness Muscle weakness Slurred speech Ataxia Blurred or double vision Numbness, weakness or pain in face


Recognition :Recognition If spinal cord affected Tingling, numbness, or feeling of constriction in any part of the body Extremities may feel heavy and become weak Spasticity


Accommodation :Accommodation Possible respiratory support Patient should not be expected to ambulate


Muscular dystrophy :Muscular dystrophy


Description :Description Inherited muscle disorder Slow progressive degeneration of muscle fibers Unknown Cause


Recognition :Recognition History Little or no movement of muscle groups


Accommodation :Accommodation Possible respiratory suport Patient should not be expected to ambulate


Poliomyelitis :Poliomyelitis


Description :Description Caused by virus Usually results in mild illness In more serious cases, attacks the CNS May result in paralysis or death


Recognition :Recognition History Paralysis


Accommodations :Accommodations If lower extremities paralyzed, patient may require catheterization If respiratory paralysis, patient may require tracheostomy Patient should not be expected to ambulate


Spina bifida :Spina bifida


Description :Description Congenital defect Part of one or more vertebrae fails to develop Leaves portion of spinal cord exposed


Etiology :Etiology Unknown May be related to dietary deficiencies during pregnancy (folic acid)


Recognition :Recognition History Often associated with: CNS infections Obstructive uropathies Hip joint dislocations


Accommodations :Accommodations Patient should not be expected to ambulate, although most can


Myasthenia gravis :Myasthenia gravis


Description :Description Autoimmune disorder Results in acetylcholine production, binding at neuromuscular junction Muscles become weak and tire easily Eyes, face, throat, and extremity muscles most commonly affected


Recognition :Recognition Drooping eyelids, double vision Difficulty speaking Chewing, swallowing may be difficult Extremity movement may be difficult Respiratory muscles may be weak


Accommodations :Accommodations Airway control Assisted ventilation Patient may be unable to ambulate


Culturally diverse patients :Culturally diverse patients


Variables :Variables Ethnicity Religion Language Gender Homelessness


Accommodations :Accommodations Obtain permission to treat when possible Beliefs may conflict with learned medical practice Attempt to recruit an interpreter Early notification of receiving facility


Terminally Ill Patients :Terminally Ill Patients Hospice Care Advance directives, DNR


Financial Challenges :Financial Challenges Apprehensive about seeking medical care