CHRONIC MEDICAL CONDITIONS
A Multidisciplinary Team Approach
To Provide Continuous and Supportive Care
We are the Team The CONSUMER Family Direct care staff Supports Health care pros Therapists Oversight people
CONSUMER
The consumer is always the center of focus
Who might be included in the circle of supports Inner Circle Outer Circle
Who Is This Training for?
You Introduce yourself How do you support the consumer
Health Care Coordination Ensuring the health and safety of
the individual you work with The consumer and everyone
supporting this consumer is involved
Let us take a cue from Core training
Five Responsibilities of the Support Professional
1. Observe Use your senses – sight, hearing, smelling – to detect when changes are taking place with a person.
Five Responsibilities of the Support Professional
2. Document: Documenting what you’ve observed provides a snapshot for how a person is doing at a certain point in time. You’ll need to include both behavioral and physical observations in your documentation.
Five Responsibilities of the Support Professional
3. Report: Besides documenting what you’ve observed, you’ll often have to tell others – such as your supervisor, the individual’s legal representative, and medical personnel – about a person you’re caring for. Be ready to discuss:
Changes in a person over time
How long the changes have been happening How often they change Any new activities or changes in the person’s diet, or
anything else that might provide clues as to why the person is different.
Five Responsibilities of the Support Professional
4. Take Action: After you’ve reported a person’s situation to someone else, YOU must make sure people you care for receive the medical attention they need. You’ll need to learn the difference between life-threatening and non-life-threatening situations so that you’ll know what to do in each case.
Five Responsibilities of the Support Professional
5. Follow Up: You must follow up on the people who are receiving medical care to make sure they return to an optimal state of health. Tasks may include making sure the person completes prescribed rounds of medications, documenting changes in the person’s health, and pushing for adequate health care when the person does not show a positive response to the current treatment plan.
Deciding What Records to Keep
Document what you observe Forms used match the issues
observed Bowel charts, Urine charts, menstrual
cycle charts, weight charts Blood Pressure records, accu check
diaries…. MARs
Records
Appointment logs Lab reports, x-ray and other test
results Support plans Behavioral Incident reports Name some more Keep records of past medications
Records Keep a record of different doctors
the consumer has seen and for what reason
Keep a record of past medical issues
Medications that have been tried and did not work
Therapies
Health Information
Keep information current File properly, see chart of forms
used that states location Skin charts,etc…. Now that the charts and forms are
used Who should you share them with
On Going and Life Long Needs
Most consumers have ongoing needs for multiple services
These needs are not stable Many factors result in changes in
the mix and intensity of needs Underlying conditions Normal development Aging
Therapy Therapies are most effective when
started early Developmental processes,
especially during the first 5 years of life, build on each other and form the foundation for future development
Continuing Technology changes Life circumstance changes Relationship to family New assistive devices
Care Planning
Assessing needs Develop a treatment plan to meet those
needs Specify who will provide each plan
element Arrange for these services Follow-up to ensure that services were in
fact delivered and are they having the desired effect
Care Planning (cont) Periodic re-assessment of needs
and adjusting treatment plans accordingly
Aging processes bring about health changes
Our Part in this
Ongoing Each of us according to our
level of training and services we provide
Keep up with the information flow
Assessment (Continued) All providers have the training
necessary to meet needs Keep all health and functioning
information current Medication oversight in place
Knowing a Consumer’s Baseline
Health care for a consumer requires Knowing a consumer as an individual Knowing the “normal” for this consumer Knowing the medical complexity of this
individual (present and past health issues) Acquiring,if needed, the skill to meet this
consumer’s needs
Developmental Disabilities
1. Mental Retardation2. Autism3. Cerebral Palsy4. Spina Bifida5. Prader-Willi Syndrome
A Limited Overview Focusing on Primary Health Issues Focusing of Co-Health Issues Focusing on associated risk factors Focusing on care needed Focusing on records needed Focusing on the flow of information
Mental Retardation Cognitive functioning measured at
69 or less with onset before age 18 Life and health issues:
Communication, social/interpersonal skills
Self care, self direction, functional academic skills
Health and safety
Common Associations Maladaptive behavior and/or
psychiatric disorders Cerebral Palsy Seizure disorders Autism or autistic – like qualities
MR Associations continued Vision impairments Hearing impairments Attention deficit hyperactivity
disorder
Monitor MR Risk Factors Evaluate yearly--vision and hearing Mental and Behavioral issues Minimize significant changes in
caregivers and environment Regression and/ advances of skills
learned Oral and dental self care
Monitoring continued Personal Hygiene Speech and language progress Socialization Issues Medication needs
DOWN SYNDROME Mental Retardation Low muscle tone Small mouth Small ears, 75% with hearing loss
50-70% have chronic or frequent infections
Vision Impairments in 60% Frequent eye infections
Down Syndrome (cont.) Congenital heart disease (50%) Thyroid disease (15%) Cervical spine abnormality (10%) Seizures (5-10%) Obesity Psych and behavioral Problems Dementia in older years
Autism Spectrum Disorder A milder form– Asperger Syndrome Symptoms vary from person to
person Involves communication skills Social interactions are affected Involves Repetitive motions
Autism Associated Issues Sensory Impairment
Painfully oversensitive to certain sounds, textures, tastes and smells
May have impaired sensitivity to hot, cold, or pain
“ a light touch could make them cry out and yet may not feel a broken arm”
Autism Continued Cognitive Delay
Some areas of ability may be normal while others very weak
Varying degrees Higher functioning –Asperger
Syndrome
Autism Continued
Seizures Often begin in early childhood or
adolescence (generally get worse as they grow older)
Fragile X affects 2-5% Tuberous Sclerosis in 1-4% (genetic-
causes tumors to grow in the brain and other vital organs)
Autism Continued May also have hyperactivity
disorders May have Attention Problems Do not like “changes” The earlier the intervention the
better the response Many are able to live very
productive lives
Autism - Risks Self injurious behavior Compulsive behavior May not feel cold May not feel pain Various behavioral issues Seizures
Autism continued
Diet as therapy??? Speech Therapy Behavior Therapy Psych medications Seizure medications Safety needs
Spina Bifida Compromised spinal cord to
various degrees Myomeningocele creates severe
damage to the nerve pathways Severe damage is what we will
discuss
MylomeningoceleSpina Bifida
Spinal deformities Paralysis, decreased sensation or
muscle weakness below spinal opening Bowel dysfunction Bladder dysfunction Hydrocephalus Swallowing Problems Possible learning problems
Health Risks and Issues
Skin Breakdown Immobility Lack of sensation Use of orthotics
Bladder problems Urinary track infections Bladder may not empty becoming over filled May lead to Kidney failure and blood pressure issues
Health Risks continued Dysphagia-difficulty swallowing
Most often seen in childhood Sudden or slow to develop Immediate intervention is necessary
Health Risks continued Bowel incontinence from impaired
nerve function Diarrhea Constipation
Obesity- due to low levels of physical activity
Health Risks continued Respiratory Restrictive lung disease due to
progressive scoliosis (preventable?)
Latex Allergy Lack of weight bearing on bones Unbalanced weight management
Health needs Monitor skin Positioning needs Adaptive supports fit and used
correctly Monitor nerve functioning Bowel and Bladder Diet, weight, blood pressure Psych needs
Management Keep up with the flow of health
issues Keep medical records current
Be Proactive Pay attention to details—
Observation Timely intervention
Cerebral Palsy
Spastic Issues in 50% Mostly lower extremities May involve one arm and leg same
side Athetoid-weak floppy muscles in
20% Ataxic- weak floppy muscles in
10%
Cerebral Palsy A central nervous system disorder Non progressive Goals: promote optimal function,
maintain health, gain new skills and to anticipate-prevent-and treat complications
There may be other associated deficits
Health Issues- Spastic Greater if all limbs plus neck and trunk
are affected (quadraplegic) May have severe cognitive delay Seizures
Hemiplegic-mostly lower extremities Average cognition, may have seizures
Hemiplegic-one arm/leg same side Average cognition, may have seizures
Spastic Issues Muscle stiffness, jerks or spasms
Unusual pulls and strains on joints Contractures, Scoliosis, limb shortening
Skin breakdown May compromise function of lungs Seizures Eating difficulties - Poor Nutrition
GERD Ulcers, stomach emptying issues Excessive drooling, Aspiration
Spastic Issues Eye issues in 3 out of 5 (one eye pulls out) Dental Issues Hearing issues in 30-40%, Speech issues Bowel and bladder issues If one side of the body is affected may not
be aware of (sense) the position of the affected side Must look to see how a hand is pointing May act as though it is not there even if motor
disability is mild
Low muscle tone issues Affects balance, depth perception, and
gait Associated with abnormal, uncoordinated
and uncontrollable movements May develop Spasticity in late childhood
Speech affected Hearing may be affected Cognitive delay varies from low to severe Skin breakdown
CP –Low Tone Issues Bowel and Bladder issues
Chronic urinary track infections Oral motor involvement Constipation- diet, meds Respiratory issues Osteoporosis
Team Physical Therapy Speech Therapy Occupational Therapy Dietary/Nutrition therapy Neurologist, Gastroenterologist, PCP, May need Urologist……Psych Needs your support
Prader-Willi Syndrome Poor body temperature control Obesity
> BP, > Cholesterol, HD and stroke Impulsive and other behavior
issues Skin Picking
Cognitive delay, speech delay
Prader-Willi cont. Scoliosis Diabetes Pulmonary hyper or hypo tension Sleep apnea Osteoporosis ADD Premature death
Seizures Safety Issues Multiple medications
Multiple side effects Vagal Nerve Stimulator When does this become dangerous?
Back to back within a short period of time Last longer than 5 minutes
Seizures continued Does not return to normal within
the individuals normal pattern Unusual seizure patterns Turns blue, aspirates, injures self First Aid video
Thyroid Issues Hypo Sensitive to cold Constipation Hoarse voice Weight gain Aches and pains Depression Muscle weakness > cholesterol
Hyper Heat intolerance Diarrhea Anxious Insomnia,fatigue Tremors Low BP
Asthma Early Warning Signs
Sneezing Moodiness Headache Runny/stuffy nose Coughing Chin or throat
itches
Tiredness Dark circles under
eyes Poor exercise
tolerance Trouble sleeping
Asthma Symptoms Wheezing Coughing Shortness of breath Chest tightness Airways changes- narrow and fill
with a thick mucus
Severe Asthma Symptoms Severe coughing Wheezing SOB and chest
tightness Difficulty talking Walking causes
SOB
Nasal flaring Substernal
retractions Bluish color to lips Hunched
shoulders
Asthma Keep track of symptoms and when
they occur Know the warning signs Know when intervention is needed
for this consumer Medication Call doctor—call 911
Asthma May evolve into bronchitis or
pneumonia May aggravate other health issues May increase feeding difficulties If nebulizer meds ordered-get the
training
Psychiatric Co-Issues Subject to same psych illness as
anyone else but is 30-70% higher Anxiety Depression Bi-Polar Obsessive compulsive Thought disorders
Psych cont ADHD Other maladaptive behaviors
Sleep disorders Aggression Self-injurious Behavior Impulsiveness
Psych Issues A mismatch between needs,
abilities,and goals of a consumer with his/her environment
Frustration and confusion our consumers feel as a result of cognitive and physical challenges and limitations
Multi origins-biological, psych., and environment all factor together
Psych cont Find and understand the causes Evaluate medical, psychological,
and environmental inputs Physical, and lab work to rule out
infection and metabolic disorders, GERD?, Cardiac?, Orthopedic-arthritis
Medication side effects?
Treatment - Psych Medication (with) Behavior modification,
Psych/behavioral therapy Requires a collaborative approach Evolves a plan, consumer oriented
and approved, all supports
Hazards of Immobility Low BP, postural hypotension Heart works 30% harder May have blood clots Lowered muscle tone Low rate of metabolism Hinders respirations, poor coughs
Immobility Poor air exchange Eats less Body stress leads to slow stomach
emptying and diarrhea Osteoporosis Skin breakdown
Immobility Urinary track infections, kidney
stones Incontinence Dehydration Reduces consumer’s interaction
with environment > behavior issues