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

The consumer is always the center of focus CONSUMER

Who might be included circle of supports in the  Inner Circle  Outer Circle

Who Is This Training for?

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You

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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

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

Five Responsibilities of the Support Professional

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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:     C hanges 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

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Developmental Disabilities

Mental Retardation Autism Cerebral Palsy Spina Bifida 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% ( vital organs) genetic causes tumors to grow in the brain and other

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

Mylomeningocele Spina 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

         Hypo Sensitive to cold Constipation Hoarse voice Weight gain Aches and pains Depression Muscle weakness > cholesterol Thyroid Issues        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