|
|
|
In caring for
adults with more severe DD, it will be helpful to educate your office staff
in ways they can assist with making those appointments a success. In addition to the pointers offered
previously (asking that a good historian be in attendance, requesting records
and tracking sheets, etc.), it is often helpful to tailor the appointment
time such that the person does not risk a long wait before being seen. Medical settings are somewhat anxiety
provoking for most people and persons with DD may have limited coping
skills. A first after lunch or first
in the morning appointment or appointments on days when you know the
appointment load and/or interruptions will be minimized should be considered.
|
|
If physical
disabilities and/or behavioral issues are significant, extra staff may be
needed to assist with obtaining an exam.
If you do not have the internal capability to accommodate such a need,
request that family or attendant staff assist.
|
|
If this is the
first appointment and/or there have been difficulties with previous
appointments due to anxiety, consider requesting that a behavioral specialist
(who might already be working with the person) be engaged to “desensitize”
the person to the healthcare setting.
Like any good “allergic” management, it often helps to modify the
health care environment.
|
|
For certain
types of exams or procedures, e.g. those requiring prolonged periods of
stillness or which may potentially be painful, premedication or the use of
physical restraints may become necessary.
These interventions should be used only when behavioral supports have
failed. Rarely is it necessary to use
an anesthetic level of sedation.
Usually medications such as sedative hypnotics with or without
phenothiazines will suffice. Ask the
patient’s other physicians, dentists and/or staff what medications have been
used with success in the past. If you
anticipate the need for sedation for one intervention, plan ahead to complete
other needed testing/exams at the same time in order to eliminate the need
for repeated sedation.
|
