Prehospital Care 10th Edition Chapter 40
impairments may result from: - ANS aging, birth defects, chronic illnesses, trauma, abuse,
neglect, and other causes
sensory impairment - ANS might involve hearing, vision, or speech
this may lead to difficulty in the patient communicating with the patient
you must be resourceful when dealing with patients with disabilities in order to provide effective
emergency care
hearing impairment: - ANS occurs when there is a loss of diminishment in the person ability to
hear sounds
this becomes especially problematic when the hearing loss is significant enough to hamper
normal verbal communication
deafness is a term that is commonly used to describe the inability to head
may involve both or one ear and the patient may be partially or totally deaf
vision impairment - ANS ,multiple causes for visual impairments which can be loosely
categorized into three etiologies: loss from disease, loss from injury and loss from degenerative
disorders
certain disease such as glaucoma result in an abnormal increase in intraocular pressure that
damage the optic nerve, resulting in peripheral vision loss and eventual blindness
patients with diabetes mellitus may become blind from diabetic retinopathy which occurs when
the long-term effects of their disease damage the small blood vessels of the eye
injury to the eye can be caused by punctures or penetration injuries, blunt trauma to the face or
chemical and thermal burns
this type of vision loss is usually acute but may not be permanent, depending on the degree of
trauma endured by the eye and associated structures
with aging there may be some degeneration of the eyeball, optic nerve pathways or all three
cataracts are a condition of the lens of the eye becoming cloudy from pathological changes
within the lense itself, causes the pupil to look cloudy on assessment and over time the patient
experiences diminished in visual activity to the point where he may not be able to carry on with
activities of daily living, vision loss may have an acute onset or a slow onset
it may affect one eye or both eyes
some types of vision loss in a patient is the result of a chronic disability or a new finding from
some acute illness or injury that you are there to treat
speech impairment: - ANS communicating with the patient is of utmost importance
there are times when the patient is unresponsive and communication is impossible but that is
not the norm
, in the majority of patient contacts you will have during your career the patient will be able to
communicate however that does not mean that there is always effective communication
communication can become deranged by four basic types of speech impairments: articulation
disorders, voice production disorders, language disorders, fluency disorders
with articulation disorders: - ANS caused by impairment of the tongue or other muscles needed
for speech called dyarthia a patient cannot pronounce words correctly
improper articulation can result from learning words incorrectly or from a hearing impairment
it may also be manifested in a patient with damage to the nerve tracts that coordinate that brain
with the larynx, mouth or lips
voice production disorders occur: - ANS when there is damage to the larynx, vocal cords, or
related supporting structures from illness or injury the patient may attempt verbal communication
but the sounds he produces may be abnormally harsh hoarse or of unusual pitch and have
nasal distortion that makes his speech difficult to understand
language disorders occur when the patient: - ANS displays an impaired or absent ability to
understand the spoken word
this can result from congenital problems in children, hearing deficits, or inadequate language
stimulation in early life
in later life language disorders can occur as a result of a stroke, head trauma, brain tumor, or
even significant emotional distress
fluency disorders: - ANS present as stuttering speech patterns although the exact cause for this
disorder is not fully understood the patient struggles with pronouncing words fluidly the resulting
speech pattern has sounds or syllables that are repeated
communication may be possible but stuttering typically lengthens the interview process as the
patient struggles to provide answers
accommodations for patients with sensory impairments: - ANS the hearing impaired patient
may have a hearing aid, make sure it is on before trying to communicate
may hearing impaired patients lip-read so always position yourself so your face is in clear view
and the area is adequately lit
it may be necessary to communicate in writing if vital information is obtainable through oral
communication
if the patient is able to sign it may be necessary to have a family member or other person at the
scene who knows sign language to act as the interpreter
for visually impaired always explain what you are going to do before you do ti
some visually impaired may use a service dog this may become an issue when making the
decision to transport
the patient may insist on taking the service dog to the medical facility
you will have to follow your local protocol and service policies and procedures necessary for you
to act as a patients guide
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