(Test Bank) Paramedic Care: Principles & Practice, Vols. 5

Bledsoe,Porter,Cherry, 5

Nursing

Test Bank

5th Edition

• $15.00 $50.00

---

Description

Test Bank for Paramedic Care: Principles & Practice, Vols. 5, The downloadable file consists of 314 pages, and the total size of the file is 4.77 MB. Purchase now only for highly discounted price.

Author(s): Bledsoe, Porter, Cherry

---

---

Study Note Preview

©201 7 Pearson Education , Inc. Paramedic Care: Principles & Practice, Volume 5 , 5th Ed. Detailed Lesson Plan Chapter 6 Abuse, Neglect and Assault 160–180 Minutes Chapter 6 objectives can be found on the opening chapter page. These objectives, which form the basis of each chapter, were developed from the new Educa tion Standards and Instruc tional Guidelines. Minutes Content Outline Master Teaching Notes 5 I. Case Study Teaching Tips Have a student read the scenario. Tell students that the case will be reviewed after the lecture 5 II. Introduction A. Obtain ing accurate statics is difficult, owing to underreporting . B. Almost five children die per day from child abuse, elder abuse occurs at 700,000 to 1.1 million/year, and between 2 and 4 million women are battered each year . C. Abuse transcends gender, race, age , and socioeconomic status . D. Paramedic ’s responsibilit ies include identification of victims of abuse, initiation of action , and reporting of incident to proper authorities . E. Early detection is critical to breaking abuse cycle . 5 III. Partner Abuse A. Results when man or women subjects domestic partner to some form of physical or psychological violence B. May be wife, husband, girlfriend, boyfriend, roommate, same -sex partner C. Most widespread form of abuse is against women, but men can be abused by women . D. Abusive relationships follow same patterns and cycles . Points to Emphasize Stress to students that there are multiple forms of abuse. 10 IV. Reasons for Not Reporting Abuse A. Fear of reprisals to themselves or children B. Humiliation at powerlessness and inability to stop abuse C. Hope that abuse will end, especially when abuser promises to change D. Abuser may justify abuse, stating that victim deserved it . E. May lack financial mean s, job skills to seek help . F. Report of abuse is usually last resort . Discussion Topics Discuss with students the different reasons why someone might not report abuse. Discussion Topics Discuss with students the laws in your area regarding domestic violence. MASTER TEACHING NOTES  Teac hing Tips  Discussion Topics  Critical Thinking Questions  Class Activities  Points to Emphasize  Knowledge Application ©201 7 Pearson Education , Inc. Paramedic Care: Principles & Practice, Volume 5 , 5th Ed. Chapter 6 objectives can be found on the opening chapter page. These objectives, which form the basis of each chapter, were developed from the new Educa tion Standards and Instruc tional Guidelines. Minutes Content Outline Master Teaching Notes G. If intervention does not occur, victims are all too often are killed by abu ser. 10 V. Identification of Partner Abuse A. Several categories of abuse: physical, verbal, sexual B. Physical – application of force in many ways C. Verbal – words chosen to control or harm a person D. Sexual – forced sexual contact and includes marital and date rape E. Ten generic risk factors: 1. Male who is unemployed 2. Male uses ille gal drugs at least once a year 3. Different religious backgrounds 4. Family income below poverty level 5. Unmarried 6. Either partner violent toward children at home 7. Male did not graduate from high school 8. Male unemployed or has blue -collar job 9. Male between 18 and 30 years old 10. Male saw father hit mother 10 VI. Characteristics of Partner Abusers A. Abuse occurs in all demographic groups . B. Some characteristics of abusers include: 1. Trouble paying bills, or holding jobs 2. Unable to keep pace with technological changes, making their jobs obsolete 3. History of family violence 4. Abuser does not like being out of control, but powerless to change 5. Overly aggressive personali ty 6. Feelings of low self -esteem, insecurities, jealousy, unpredictable rages 7. Alcohol or drug use that increases feelings 8. Sense of remorse and shame after abusive episode, with promises to change 9. Cycle of violence repeats Critical Thinking Questions Why might the abuser call 911 several times before the abuse occurs? Class Activities Have a police officer who specializes in domestic violence speak to the class. ©201 7 Pearson Education , Inc. Paramedic Care: Principles & Practice, Volume 5 , 5th Ed. Chapter 6 objectives can be found on the opening chapter page. These objectives, which form the basis of each chapter, were developed from the new Educa tion Standards and Instruc tional Guidelines. Minutes Content Outline Master Teaching Notes 10 VII. Characteristics of Abused Partners A. Primary risk factor is history of violence between parents . B. Pregnancy increases risk in abusive relationship . C. Substance abuse D. Emotional disorders E. May attempt to protect attacke r F. May avoid eye contact, exhibit nervous behavior, or watch abuser G. Verbal clues : “I am always causing trouble ,” “We have been having problems lately .” Critical Thinking Questions What fears can you think of that might be felt by a person involved in an ab usive relationship and prevent that person from leaving the relationship? 10 VIII. Approaching the Battered Patient A. Direct questioning is best during assessment . B. Convey your awareness that partner may have caused harm, and be willing to discuss it; avoid judg mental statements . C. Listen to abused patient s, and encourage them to regain control over their lives. D. Share your knowledge of community resources, such as shelters, counseling, support services . E. Do not leave scene without advising patient to take all necess ary precautions by rehearsing the quickest way to leave home, where patient will go/call , and so forth . F. Abuser may be reported and taken into custody by police; you must inform patient that abuser can be released , and provide patient information about available protection programs . Discussion Topics Discuss with students the various domestic abuse programs available in your area. Class Activities Create a scenario involving domestic violence, including care provided. Have students compete a run report, foc using on appropriate documentation. 5 IX. Elder Abuse A. Elder abuse is a widespread medical and social problem that is caused by many factors, such as: 1. Increased life expectancies, increased dependency on others, decreased productivity in later years 2. Physic al and mental impairments, limited resources, economic factors that strain family resources, stress on middle -aged caregivers B. Elder abuse is expected to grow along with elderly population . C. Paramedic responsibility includes remaining alert to signs of elder abuse . Knowledge Application For homework, have students list signs and symptoms they may observe in an elder abuse victim. ©201 7 Pearson Education , Inc. Paramedic Care: Principles & Practice, Volume 5 , 5th Ed. Chapter 6 objectives can be found on the opening chapter page. These objectives, which form the basis of each chapter, were developed from the new Educa tion Standards and Instruc tional Guidelines. Minutes Content Outline Master Teaching Notes 5 X. Identification of Elder Abuse A. Domestic abuse – takes place when elder is being cared for in a home - based setting, usually by relatives B. Institutional elder abuse – elder being cared for by a person with legal or contractual responsibility to provide care, such as caregivers, nursing home staff, other professionals C. Both types of abuse can be acts of commission (physical, sexual , or emotional violence) or acts of omission (neglect) . D. Some signs are subtle, such as theft of belongings or loss of freedom ; others are obvious, such as wounds, decubitus ulcers, poor hygiene . Knowledge Application Have students research on the Internet different cases of elder abuse, including cases of financial abuse. 5 XI. Theories about Domestic Elder Abuse A. Four main theories about causes of domestic elder abuse : 1. Caregivers feel stressed and overburdened 2. Patient’s physical and or mental impairment 3. Family history of violence 4. Personal problems of caregivers Class Activities Have a representative from your local senior agency come in to discuss elder abuse. 5 XII. Characteristics of Abused Elders A. Affects all demographic groups B. Difficult to outline an accurate p rofile of abused elder C. Most common cases: 1. Elderly women abused by their sons 2. Elderly dependent on others for care 3. Elderly who are mentally and or physically challenged D. In cases of neglect: 1. Abused elders commonly live alone . 2. Fear asking for help due relativ es complaining about helping, or threats to place in nursing home E. Elderly abuse victims tend to be reluctant to give information about abusers for fear of retaliation . Critical Thinking Questions Is abandoning an elderly family member in a safe place consi dered neglect? What responses regarding injuries would you likely expect to hear from a patient who has suffered abuse? 5 XIII. Characteristics of Elder Abuse A. Difficult to profile abusers of elderly B. Several characteristics are commonly found in abusers: 1. Exhibit alcoholic behavior, drug addiction , or mental impairment 2. Dependent on income of elder, causing resentment, anger , or violence Discussion Topics Discuss with students the different stress factors that could be present in an elder abuser. ©201 7 Pearson Education , Inc. Paramedic Care: Principles & Practice, Volume 5 , 5th Ed. Chapter 6 objectives can be found on the opening chapter page. These objectives, which form the basis of each chapter, were developed from the new Educa tion Standards and Instruc tional Guidelines. Minutes Content Outline Master Teaching Notes 5 XIV. Child Ab use A. One of most difficult circumstances faced as a paramedic B. Child abuse ranges from physical, emotion al, to neglect of child’s basic needs . C. May be afflicted by parents, caregivers, foster parents, babysitters, stepparents, siblings, other relatives , or peers D. Damage lasts a lifetime ; perpetuate s a cycle of violence for generations Teaching Tip s This is one of the most difficult responses that EMS will have to deal with. Go over ways in which the EMS provider can cope with abuse . 10 XV. Characteristics of Chil d Abusers A. Cannot relate child abuse to social class, income, or education B. Patterns that do emerge include: 1. History of abuse within own family 2. Physically or emotionally abused as children 3. Prefer to use other forms of discipline but buckle under stress 4. Tend to be male 5. One or both of abuser’s parents are abusers C. Behavioral traits include: 1. Use or abuse of drugs/alcohol 2. Immaturity or preoccupied with self 3. Lack of obvious feeling for the child, rarely looking at or touching child 4. Apparent lack of concern about ch ild’s injury, treatment , or prognosis 5. Open criticism of child, with little indication of guilt or remorse for involvement in child’s condition 6. Little identification with the child’s pain, whether physical or emotional Discussion Topics Discuss with student s ways they think that the cycle of violence could be stopped . Go over with students the various child abuse prevention programs. 10 XVI. Characteristics of Abused Children A. Child’s behavior is one of the most important indicators of abuse . 1. Under age 6 usua lly appear excessively passive 2. Over age 6 seem aggressive B. Other behavioral clues include: 1. Hopeless crying during treatment, or no crying at all 2. Avoiding the parents or showing little concern for parental absence 3. Unusual wariness or fear of physical contact 4. Apprehension and/or constant alertness for danger 5. Prone to sudden behavior changes, absence of nearly all emotions 6. Neediness, constantly requesting favors, food , or things C. Use your instincts and knowledge of age -appropriate behavior to guide first impress ion. Discussion Topics Go over the age -appropriate behaviors observed in children . Class Activities Have students list ways in which they may be able to gain the confidence of a child . ©201 7 Pearson Education , Inc. Paramedic Care: Principles & Practice, Volume 5 , 5th Ed. Chapter 6 objectives can be found on the opening chapter page. These objectives, which form the basis of each chapter, were developed from the new Educa tion Standards and Instruc tional Guidelines. Minutes Content Outline Master Teaching Notes 20 XVII. Identification of the Abused Child A. Not all in jured children are abused . 1. Child volunteers story of injury without hesitation . 2. Child’s story matches story told by parents . B. Cases of parental or child behavior that raise index of suspicion create a challenge for the paramedic to distinguish between intentional injury and authentic accident C. Conditions that are commonly mistaken for abuse: 1. Car seat burns, staphylococcal scalded skin syndrome 2. Chickenpox, hematologic disorders that can cause bruising D. Physical Exam 1. Signs of physical mistreatment of child most often easiest to re cognize 2. Soft tissue injuries, multiple bruises, bites, burns , and defensive wounds E. Burns and Scalds 1. Burn tend to be in certain common locations with distinct patterns . 2. Soles of the feet , palms of hands, back, or buttocks; may or may not present with other injuries 3. Children scald more easily due to thinner skin . 4. Home water tends to be 140 °F, which will scald in about 5 seconds for an adult . 5. Accidental burns tend to have “splash” pattern s created by spattering water . 6. Intentional scalding is characteristic of lack of “splash” pattern s referred to as “dipping injuries” and are a common form of child abuse . F. Fractures 1. Second most common form of abuse 2. Sites of fractures include skull, nose, facial structures, upper extremities, ribs. 3. Twisting and jerking the upper extremity 4. Neck injuries from shaking 5. Ribs are very pliable in children ; with fractures at this site , maintain high index of suspicion for abuse . G. Head Injuries 1. Over time, abuse injuries progress from extremities and trunk to the head . 2. Head injuries commonly found include scalp wounds, skull fractures, subdural hematomas, and repeated concussions . Teaching Tips Using pictures of injury patterns, go over with stu dents the various injuries sustained in child abuse cases (this may be difficult for some students to view) . Discussion Topics Discuss with students the neglect of a child. Have students list the signs of neglect . Class Activities Have a social worker, p olice officer, or medical professional who deals with abuse of children come in to speak with students . Points to Emphasize Remember that emotional abuse is just as damaging as any other abuse . Knowledge Application Create a chart with the various injuri es listed. For homework, have students list the identifying markers associated with each injury, along with treatment . ©201 7 Pearson Education , Inc. Paramedic Care: Principles & Practice, Volume 5 , 5th Ed. Chapter 6 objectives can be found on the opening chapter page. These objectives, which form the basis of each chapter, were developed from the new Educa tion Standards and Instruc tional Guidelines. Minutes Content Outline Master Teaching Notes 3. Head injuries claim the largest number of lives among abused children and account for most of the long -term disability . H. Shaken Baby Syndrome 1. Frequently occurs when a parent or caregiver becomes frustrated with a crying infant and all other attempts to quiet the child have failed 2. Occurs when person picks up infant and shakes baby vigorously 3. Movement causes permanent brain damage, such as subdural hematomas or diffuse swelling, injuries to neck and spine , and retinal hemorrhage, leading to blindness 4. If shaken hard enough or repeatedly, child may die . I. Abdominal Injuries 1. Small proportion of injuries suffered by child but usually very serious when they occur 2. Blunt trauma c an cause injury to liver, spleen, or mesentery . 3. Look for swelling, pain, vomiting, and hemodynamic compromise . J. Maternal Drug Abuse 1. Drug use during pregnancy is a subtle but devastating form of child abuse (fetal alcohol syndrome , “crack babies”) . 2. Cocaine and alcohol use during pregnancy are associated with long - term problems in child. K. Signs of Neglect 1. Child not provided with adequate food, clothing, shelter , or medical care 2. EMS has position to observe child’s home environment 3. Signs of neglect: a. Malnutrition, severe diaper rash, diarrhea/dehydration b. Hair loss ; untreated medical conditions ; inappropriate, dirty, or torn clothing or lack of clothing c. Tired and listless attitude, near constant demands for physical contact or attention L. Signs of Emotional Abuse 1. Often hardest form of abuse to identify 2. Six forms of emotional abuse: a. Ignore child, show indifference to needs, fail to provide stimulation b. Reject, humiliate, or criticize child c. Child isolated and deprived of normal human contact or nurturing d. Terrorized or bul lied through verbal assaults and threats, creating fear and anxiety ©201 7 Pearson Education , Inc. Paramedic Care: Principles & Practice, Volume 5 , 5th Ed. Chapter 6 objectives can be found on the opening chapter page. These objectives, which form the basis of each chapter, were developed from the new Educa tion Standards and Instruc tional Guidelines. Minutes Content Outline Master Teaching Notes e. Parent/caregiver encourages destructive or antisocial behavior f. Child overpressured by unrealistic expectations of success 5 XVIII. Recording and Reporting Child Abuse A. Paramedics have responsibility to report suspected cases of child abuse and may have opportunit y to provide early intervention . 1. Abusive adult may actively seek help by call ing EMS several times within 24 -hour period . 2. May summon help for inconsequential symptoms or demonstrate inability to handle impending crisis 3. Warning signs should be noted . B. As th e paramedic, conduct examination of abused child with another colleague present C. Keep personal reactions to yourself, document only objective observations; do not put assumptions in your report . D. Final document should be objective, legible , and written with knowledge that it may be used in court . E. Always put child’s interest first, treating with kindness and gentleness . Teaching Tips Obtain the number of the local agency to report suspected abuse . Points to Emphasize Remember that documentation must be done in a professional manner with no opinions of others . Knowledge Application Give students a child abuse scenario, along with the care provided. Have students complete a run report for homework, focusing on proper and complete documentation . 15 XIX. Sexual Ass ault A. Males and females of all backgrounds, from infancy to old age, can be victims of sexual assault B. Sexual assault – unwanted sexual contact, whether genital, oral, rectal , or manual (prosecuted as a crime) C. Rape – penile penetration of the genitalia or re ctum without the consent of the victim (felony offense) D. Characteristics of victims of sexual assault/ rape 1. Statistical patterns show that adolescent females younger than 18 are most likely group to be victimized ; rape occur s every 2 minutes on average; most likely to be raped by someone she knows 2. One-third of all juvenile sexual abuse victims are younger than 6 years old; children raised in families where there is domestic violence are 8 times more likely to be sexually molested 3. Sexual assault victims may be physically injured or killed and commonly Discussion Topics Discuss with students the steps they can take to preserve evidence in a sexual abuse case . Discuss with students the different date rape drugs used in sexual assault, along with the medical side effects the patient may present with. Critical Thinking Questions What range of emotions do you think you may see when administering care to a victim of sexual abuse? ©201 7 Pearson Education , Inc. Paramedic Care: Principles & Practice, Volume 5 , 5th Ed. Chapter 6 objectives can be found on the opening chapter page. These objectives, which form the basis of each chapter, were developed from the new Educa tion Standards and Instruc tional Guidelines. Minutes Content Outline Master Teaching Notes suffer internal injuries, infections, sexually transmitted diseases ( STDs ), unwanted pregnancies . 4. Psychological damage includes shame, anger, lack of trust . 5. Children find it difficult to speak about molestation; l ikely they know the person and fear reprisal; causes confusion of situation, and child fears no one will believe him. 6. Symptoms of sexual abuse include nightmares, restlessness, withdrawal tendencies, hostility, phobias, regressive behaviors, truancy, promi scuity, drug and alcohol abuse . E. Characteristics of Sexual Assailants 1. Assailants come from every background . 2. Some characteristics include abused as children, believe that domination is part of relationship, under influence of drug s or alcohol . 3. Victims may b e drugged by assailant, which will cause signs of extreme intoxication without smell of alcohol, or drug-induced amnesia, which will make questioning difficult . F. Date Rape Drugs 1. Medications that facilitate a sexual assault by rendering a person unresponsive , weaken the ability to resist attacker, cause amnesia of event 2. Drugs associated with rape (predator drugs) include Rohypnol, GHB, ketamine, MDMA . 3. Note any suspicions or observations that suggest use of date rape drugs . G. EMS Responsibilities 1. Primary respons ibility is safety for yourself, crew , and patient . 2. Provide safe environment . 3. Provide proper psychosocial care and privacy . 4. Use open -ended questions that allow patient to reestablish a sense of control . H. Human Trafficking 1. Human trafficking including sex traf ficking, labor trafficking, forced marriages, similar abuses . 2. Traffickers use violence, threats, deception, debt bondage, other manipulative tactics . 3. Vulnerable populations: children under 18 induced into commercial sex, adults over 18 induced into commerc ial sex, children and adults induced Class Activities Have a police officer from your community who specializes in investigation of sexual assault speak with students about the characteristics of this abuse . Points to Emphasize Remember to be nonjudgmental when dealing with sexual abuse patients . Knowledge Application Give students a sexual abuse scenario, with the care provided. Have students complete a run report f or homework, focusing on proper and complete documentation . ©201 7 Pearson Education , Inc. Paramedic Care: Principles & Practice, Volume 5 , 5th Ed. Chapter 6 objectives can be found on the opening chapter page. These objectives, which form the basis of each chapter, were developed from the new Educa tion Standards and Instruc tional Guidelines. Minutes Content Outline Master Teaching Notes to perform labor or services 4. Indicators: disconnected from friends, family and activities, stopped attending school, sudden change in behavior, engaged in commercial sex acts, disoriented or confused, show signs of abus e, act fearful or submissive, denied of care, someone else is in control of the situation, coached on what to say, live in unsuitable conditions, lack personal possessions, able to leave where they live, or unreasonable security measures 5. If you have identi fied someone in a human trafficking situation, contact law enforcement immediately . I. Hate Crimes 1. Crime of hatred or prejudice in which target is particular victim(s) because of perceived membership in certain social group 2. Groups include racial, religious, s exual orientation, political, disability, other social groups . 3. Based on bias and referred to as bias -motivated crime 4. Involve vandalism, intimidation, assault, violence 5. EMS safety requires treating hate crimes as dangerous situation s and involv ing law enfor cement early . J. Legal Considerations 1. Abuse and assault are crime s. 2. You have a responsibility for reporting suspected cases, accurately documenting your findings, and learning about available resources in your area . 3. Remember that evidence must be maintained . 5 XX. Summary A. You will likely experience an abuse case during your paramedic career . B. Remember that you have a duty to report abuse situations, whether or not you transport the patient . C. It is impor tant to recognize the significant physical and emotional assessment findings, as well as the characteristics of victims and assailants, as you may be the only chance a victim has of being saved from further abuse . 5 XXI. Case Study Class Activities Discuss t he case with students now that they are familiar with the chapter. ©201 7 Pearson Education , Inc. Paramedic Care: Principles & Practice, Volume 5 , 5th Ed. Chapter 6 objectives can be found on the opening chapter page. These objectives, which form the basis of each chapter, were developed from the new Educa tion Standards and Instruc tional Guidelines. Minutes Content Outline Master Teaching Notes 5 XXII. You Make the Call Class Activities Read and discuss the call and questions as a group. 5 XXIII. Review Questions Class Activities Pass out review questions before the lesson starts. Have st udents answer them . Go over the questions again after the lecture to a ssess students’ understanding of the information. ©201 7 Pearson Education , Inc. Paramedic Care: Principles & Practice, Volume 5 , 5th Ed. . 1 Detailed Lesson Plan Chapter 7 The Challenged Patient 100–120 Minutes Chapter 7 objectives can be found on the opening chapter page. These objectives, which form the basis of each chapter, were developed from the new Educa tion Standards and Instruction al Guidelines. Minutes Content Outline Master Teaching Notes 5 I. Case Study Teaching Tips Have a student read the scenario. Tell students that the case will be reviewed after the lecture . 5 II. Introduction A. During your EMS career, you will encounter patie nts who live with a variety of special needs . B. Treating the “challenged” patient involves understanding and recognizing the special condition of your patient and making any needed accommodations . 25 III. Physical Challenges A. Physical impairment – condition tha t limits the use of one or more parts of the body B. Important to quickly recognize impairment and adjust assessment accordingly C. Hearing Impairment s 1. Decrease or loss in ability to distinguish or hear sounds 2. Inability to hear is called deafness (complete or pa rtial); can be present at birth or result from aging, accident , or illness . 3. Two types of deafness are conductive deafness and sensorineural a. Conductive – any condition that prevents sound waves from being transmitted from external ear to middle/inner ear; c an be temporary or permanent (otitis media, earwax, swimmer’s ear, obstructions, etc.) b. Sensorineural deafness – inability of nerve impulses to reach auditory center of brain due to damage to inner ear or brain; usually Teaching Tips Pull up common w ords used in EMS that are transferred to American Sign Language . Discussion Topics Discuss with students ways in which they can avoid injuring themselves and their patient s when providing care for individuals who are obese . Discuss with students the diff erent medical tests and assessments that may need to be altered in an obese patient ( e.g., electrocardiogram [ECG] placement, blood pressure cuff size, lung sounds, etc.) . MASTER TEACHING NOTES  Teaching Tips  Discussion Topics  Critical Thinking Questions  Clas s Activities  Points to Emphasize  Knowledge Application ©201 7 Pearson Education , Inc. Paramedic Care: Principles & Practice, Volume 5 , 5th Ed. . 2 Chapter 7 objectives can be found on the opening chapter page. These objectives, which form the basis of each chapter, were developed from the new Educa tion Standards and Instruction al Guidelines. Minutes Content Outline Master Teaching Notes a permanent condition (congenital def ect, birth injur y, illness, tumor, concussion, injur y, loud noises, presbycusis) 4. Recognition of deafness – repeat of questions, misunderstand answers, respond inappropriately, hearing aids, poor diction, use of hands for gesturing or sign language 5. Accommod ations for deaf patients : Identify yourself, face patient, speak in normal voice or use low -pitched voice directly into ear, turn off background noises, offer pen and paper, use interpreter for sign language, notify hospital . D. Visual Impairments 1. Important t o note whether visual impairment is a permanent disability or new symptom 2. Many causes for visual impairments, such as injury, disease, congenital conditions, infection, and degeneration of retina, optic nerve , or nerve pathway 3. Injury – Penetrating injuries can cause enucleation (removal of eyeball); chemical/thermal burns can damage cornea and lead to permanent vision loss if not treated quickly . 4. Disease – Glaucoma increases intraocular pressure on optic nerve, leading to loss of peripheral vision and blind ness if not treated (primary and secondary glaucoma); diabetic retinopathy results from diabetes, which causes disorders in blood vessels leading to retina, leading to slow loss of vision and blindness . 5. Congenital and degenerative disorders – cerebral pals y, premature birth, aging, cytomegalovirus (seen in AIDS) 6. Recognizing and accommodating visual Impairments – Identify yourself as you approach, describe everything you are doing, do not pet service dog and ask permission of patient to touch animal, have pe rson take your arm for guidance . E. Speech Impairments 1. Difficulty with communication can hinder treatment and information 2. Types of speech impairment s include language, articulation, voice production , and fluency disorders . 3. Language disorders – Impaired abilit y to understand spoken or written word; loss of ability to communicate in speech, writing , or signs is known Discuss with students the different speech impairments listed. Have students list various medical conditions that can present with speech difficulties. Discuss with students patients with halo devices. Have students discuss various ways they may have to make accommodations for transport. Critical Thinking Questions What are ways in whi ch you can prevent hearing loss as a result of your job? Class Activities Have a student use ear plugs to limit hearing and wear a blindfold to limit sight. Have another student interview the first student and perform an assessment, using various communic ation techniques . Have students practice their lifting techniques using a stretcher, stair chair, Reeves, and other equipment. Blindfold a student and have another student practice how to guide a patient with sight lim itations . Points t o Emphasize Empha size to students that patients who have visual, hearing , or speech limitations usually have normal intelligence. Stress how the other senses are usually heightened in these patients . ©201 7 Pearson Education , Inc. Paramedic Care: Principles & Practice, Volume 5 , 5th Ed. . 3 Chapter 7 objectives can be found on the opening chapter page. These objectives, which form the basis of each chapter, were developed from the new Educa tion Standards and Instruction al Guidelines. Minutes Content Outline Master Teaching Notes as aphasia . a. Sensory aphasia – can no longer understand spoken word b. Motor aphasia – can no longer use the symbols of speech; will understand what yo u are saying, but cannot clearly articulate response c. Global aphasia – patient has both sensory and motor aphasia; cannot understand nor respond 4. Articulation disorders – dysarthria; affect the way a person’s speech is heard by others 5. Voice production disord ers – quality of person’s voice is affected (hoarseness, harshness, inappropriate pitch, abnormal nasal resonance, total loss of speech) 6. Fluency disorders – stuttering 7. Accommodations for speech impairments : Do not assume that patient lacks intelligence, ma y be impossible to complete a thorough interview, do not rush patient or predict answers, use questions that require short and direct answers, look directly at patient, ask to repeat if you do not understand, have patient write information . F. Obesity 1. More th an 40% of people in U .S. are considered obese . 2. Obesity more difficult for EMS in regard to lifting ; exacerbation of medical problems from excess weight ; leads to hypertension ( HTN), heart disease, diabetes, joint and muscle problems 3. Etiologies a. Occurs when person has an abnormal amount of body fat and weight is 20–30% heavier than normal b. Occurs from caloric intake greater that amount of calories needed, genetic factors, low basal metabolic rate 4. Accommodations for obese patient s: medical history, equipment accommodations due to excess adipose tissue ( electrocardiogram [ECG] placement , large blood pressure [ BP] cuff, lung sounds), lifting assistance, special weight -bearing stretchers G. Paralysis 1. Paraplegic (paralyzed from waist down) or quadriplegic (paralysis of all four extremities) Knowledge Application Create a definition list of the various impairment s. For homework, have students list the meaning of each impairment listed .