CHRONIC MEDICAL CONDITIONS

1
CHRONIC MEDICAL CONDITIONS

• A Multidisciplinary
• Team Approach
• To Provide Continuous and Supportive Care

2
We are the Team

• The CONSUMER
• Family
• Direct care staff
• Supports
• Health care pros
• Therapists
• Oversight people

3
The consumer is always the center of focus
CONSUMER
4
Who might be included in the circle of supports

• Inner Circle

• Outer Circle

5
Who Is This Training for?

• You
• Introduce yourself
• How do you support the consumer

6
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

7
Five Responsibilities of the Support Professional

• Observe Use your senses sight, hearing,
  smelling to detect when changes are taking
  place with a person.

8
Five Responsibilities of the Support Professional

• Document Documenting what youve observed
  provides a snapshot for how a person is doing at
  a certain point in time. Youll need to include
  both behavioral and physical observations in your
  documentation.

9
Five Responsibilities of the Support Professional

• Report Besides documenting what youve
  observed, youll often have to tell others such
  as your supervisor, the individuals legal
  representative, and medical personnel about a
  person youre 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
  persons diet, or anything else that might
  provide clues as to why the person is different.

10
Five Responsibilities of the Support Professional

• Take Action After youve reported a persons
  situation to someone else, YOU must make sure
  people you care for receive the medical attention
  they need. Youll need to learn the difference
  between life-threatening and non-life-threatening
  situations so that youll know what to do in each
  case.

11
Five Responsibilities of the Support Professional

• 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 persons health, and pushing for
  adequate health care when the person does not
  show a positive response to the current treatment
  plan.

12
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

13
Records

• Appointment logs
• Lab reports, x-ray and other test results
• Support plans
• Behavioral
• Incident reports
• Name some more
• Keep records of past medications

14
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

15
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

16
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

17
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

18
Continuing

• Technology changes
• Life circumstance changes
• Relationship to family
• New assistive devices

19
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

20
Care Planning (cont)

• Periodic re-assessment of needs and adjusting
  treatment plans accordingly
• Aging processes bring about health changes

21
Our Part in this

• Ongoing
• Each of us according to our level of training and
  services we provide
• Keep up with the information flow

22
Assessment (Continued)

• All providers have the training necessary to meet
  needs
• Keep all health and functioning information
  current
• Medication oversight in place

23
Knowing a Consumers 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
  consumers needs

24
Developmental Disabilities

• Mental Retardation
• Autism
• Cerebral Palsy
• Spina Bifida
• Prader-Willi Syndrome

25
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

26
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

27
Common Associations

• Maladaptive behavior and/or psychiatric disorders
• Cerebral Palsy
• Seizure disorders
• Autism or autistic like qualities

28
MR Associations continued

• Vision impairments
• Hearing impairments
• Attention deficit hyperactivity disorder

29
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

30
Monitoring continued

• Personal Hygiene
• Speech and language progress
• Socialization Issues
• Medication needs

31
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

32
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

33
Autism Spectrum Disorder

• A milder form Asperger Syndrome
• Symptoms vary from person to person
• Involves communication skills
• Social interactions are affected
• Involves Repetitive motions

34
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

35
Autism Continued

• Cognitive Delay
• Some areas of ability may be normal while others
  very weak
• Varying degrees
• Higher functioning Asperger Syndrome

36
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)

37
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

38
Autism - Risks

• Self injurious behavior
• Compulsive behavior
• May not feel cold
• May not feel pain
• Various behavioral issues
• Seizures

39
Autism continued

• Diet as therapy???
• Speech Therapy
• Behavior Therapy
• Psych medications
• Seizure medications
• Safety needs

40
Spina Bifida

• Compromised spinal cord to various degrees
• Myomeningocele creates severe damage to the nerve
  pathways
• Severe damage is what we will discuss

41
MylomeningoceleSpina Bifida

• Spinal deformities
• Paralysis, decreased sensation or muscle weakness
  below spinal opening
• Bowel dysfunction
• Bladder dysfunction
• Hydrocephalus
• Swallowing Problems
• Possible learning problems

42
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

43
Health Risks continued

• Dysphagia-difficulty swallowing
• Most often seen in childhood
• Sudden or slow to develop
• Immediate intervention is necessary

44
Health Risks continued

• Bowel incontinence from impaired nerve function
• Diarrhea
• Constipation
• Obesity- due to low levels of physical activity

45
Health Risks continued

• Respiratory
• Restrictive lung disease due to progressive
  scoliosis (preventable?)
• Latex Allergy
• Lack of weight bearing on bones
• Unbalanced weight management

46
Health needs

• Monitor skin
• Positioning needs
• Adaptive supports fit and used correctly
• Monitor nerve functioning
• Bowel and Bladder
• Diet, weight, blood pressure
• Psych needs

47
Management

• Keep up with the flow of health issues
• Keep medical records current
• Be Proactive
• Pay attention to detailsObservation
• Timely intervention

48
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

49
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

50
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

51
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

52
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

53
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

54
CP Low Tone Issues

• Bowel and Bladder issues
• Chronic urinary track infections
• Oral motor involvement
• Constipation- diet, meds
• Respiratory issues
• Osteoporosis

55
Team

• Physical Therapy
• Speech Therapy
• Occupational Therapy
• Dietary/Nutrition therapy
• Neurologist, Gastroenterologist, PCP,
• May need UrologistPsych
• Needs your support

56
Prader-Willi Syndrome

• Poor body temperature control
• Obesity
• gt BP, gt Cholesterol, HD and stroke
• Impulsive and other behavior issues
• Skin Picking
• Cognitive delay, speech delay

57
Prader-Willi cont.

• Scoliosis
• Diabetes
• Pulmonary hyper or hypo tension
• Sleep apnea
• Osteoporosis
• ADD
• Premature death

58
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

59
Seizures continued

• Does not return to normal within the individuals
  normal pattern
• Unusual seizure patterns
• Turns blue, aspirates, injures self
• First Aid video

60
Thyroid Issues

• Hyper
• Heat intolerance
• Diarrhea
• Anxious
• Insomnia,fatigue
• Tremors
• Low BP

• Hypo
• Sensitive to cold
• Constipation
• Hoarse voice
• Weight gain
• Aches and pains
• Depression
• Muscle weakness
• gt cholesterol

61
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

62
Asthma Symptoms

• Wheezing
• Coughing
• Shortness of breath
• Chest tightness
• Airways changes- narrow and fill with a thick
  mucus

63
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

64
Asthma

• Keep track of symptoms and when they occur
• Know the warning signs
• Know when intervention is needed for this
  consumer
• Medication
• Call doctorcall 911

65
Asthma

• May evolve into bronchitis or pneumonia
• May aggravate other health issues
• May increase feeding difficulties
• If nebulizer meds ordered-get the training

66
Psychiatric Co-Issues

• Subject to same psych illness as anyone else but
  is 30-70 higher
• Anxiety
• Depression
• Bi-Polar
• Obsessive compulsive
• Thought disorders

67
Psych cont

• ADHD
• Other maladaptive behaviors
• Sleep disorders
• Aggression
• Self-injurious Behavior
• Impulsiveness

68
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

69
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?

70
Treatment - Psych

• Medication (with)
• Behavior modification, Psych/behavioral therapy
• Requires a collaborative approach
• Evolves a plan, consumer oriented and approved,
  all supports

71
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

72
Immobility

• Poor air exchange
• Eats less
• Body stress leads to slow stomach emptying and
  diarrhea
• Osteoporosis
• Skin breakdown

73
Immobility

• Urinary track infections, kidney stones
• Incontinence
• Dehydration
• Reduces consumers interaction with environment
  gt behavior issues