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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
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
Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED. 4
Domestic Violence
• Battering and injury
• Psychological abuse
• Sexual assault
• Social isolation
• Deprivation
• Intimidation
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
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
Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED. 7
PCT Responsibilities
• Keep communication and documentation concise and accurate
• Be kind, empathetic, and supportive
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
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
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
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
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
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
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
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
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
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
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
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
Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED. 20
Immunotherapy Patients
• Notify RN if patient has following symptoms: – Diarrhea– Nausea– Vomiting– Itching
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
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
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
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
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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
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
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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
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Pain Management Procedures
• Implantable medication pumps– Placed under abdominal skin with a catheter
for medicine administration