Specific Population FINAL

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The 4 levels of Culture
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Terms in this set (65)
The 4 levels of Culture
Individual, family, community, region
People from different cultures arrive at truth in different ways. These different ways can be separated into faith, fact, and feeling. Most people use combinations of methods.
Accepted as 'Truth'
What type of "Use of Time"?

Prefer to organize their lives with a "one thing at a time" and "time is money" mentality. Adherence to schedules is highly important. Offended if kept waiting, or if COTA is attending to too many issues at once. They want undivided attention from COTA. Need small chit-chat to be kept to a minimum if paying for treatment.
Monochronic
What type of "Use of Time"?

Organize life around social relationships. For them, time spent with someone is directly correlated to their personal value. Usually feel rushed by schedules, can be late to appointments because of seeing an acquaintance.
Polychronic
Three types of Communication Styles
Context, High-Context, Low-Context
Rely less on verbal communication than on understanding through shared experience and history. Fewer words are spoken and more emphasis is placed on nonverbal cues and messages. Tend to be formal, reliant on hierarchy, and rooted in the past. Therefore, they change more slowly, and tend to provide more stability for their members.
High context
Includes the relationship to an individual with whom one is communicating. Meaning is not lost when words are not spoken.
Context
Focus on precise, direct, and logical verbal communication. They do not process the gestures, environmental clues, and unarticulated moods central to communication in high-context cultures. More sense of continuity and connection with the past.
Low context
PLISSIT model:

P
Permission--which requires the therapist to create an atmosphere which gives the individual permission to raise concerns about his/her sexuality and sexual activities
1) incorporating sexuality into the OT initial and ongoing evaluation in a matter-of-fact manner is an effective method
2) A therapist who is not comfortable with creating a permissive atmosphere for the discussion of sexuality due to person, social cultural or religious reasons must honestly acknowledge this fact to the client and refer them to a team member who is comfortable
3) It is the teams responsibility to ensure that at least one team member is comfortable with evaluating and intervening with individuals with sexuality concerns
4) Supervision and continuing professional development activities should be pursued by all to develop this needed comfort
PLISSIT:

LI
Limited information: Elders can be educated about normal physiological changes with aging, myths, and stereotypes about the elder pop., and sexual activity.
PLISSIT Model: SSSpecific Suggestions--that are provided by the therapist to faciliate the individual's pursuit of satisfying sexual expression, either alone or with a partner 1) The individual's (and partner's) goals for sexual expression and activity are identified and strategies for achieving goals are explored 2) Principles of activity analysis, gradation, modification and simplification are used to facilitate goal attainment 3) Nonmedical methods to manage pain and stiffness (warm baths) are provided 4) Positioning alternatives and adaptive equipment to facilitate desired sexual expression are suggested 5) Energy conservation methods are suggested to those with limited endurance 6) Catheter care, hygiene concerns and skin care are addressed 7) Referrals to a physician for medical management of pain, impotence or other sexual dysfuctions, and hormonal treatmentsPLISSIT Model: ITIntensive therapy--which is indicated when the individual requires intervention for long-standing relationship problems and/or enduring sexual problems 1) These problems are often due to difficulties beyond the onset or presence of a disability 2) Specialized training is required to provide intensive therapy so a referral to the appropriate professional is indicated 3) OTs can become specialistsCONDITIONS /C SEXUAL FNX. COTAs should observe for motor abnormalities and other symptoms that can affect sexual function, including: hemiplegia, perceptual, cognitive, and visual spatial disturbances; speech problems, emotional manifestations, and sensory deficits.CVACONDITIONS /C SEXUAL FNX. Resume sexual activity in a gradual manner. Other than intercourse may be suggested. Should be instructed on precautions by MD before starting. Precautions like CP, SOB excessive fatigue, insomnia, fast or irreg. HB, dizziness, continuous increase in BP after sex, heart palpitations. Relaxation is important.Heart diseaseCONDITIONS /C SEXUAL FNX. Elders /c joint inflammation and pain may be particularly prone to sexual performance problems. Common intervention of ppl /c RA is to maintain or increase fnx'l abilities in all areas of life. Suggestions to reduce pain and discomfort and preserve energy. Exercises to increase and maintain muscle strength affect the motor aspect of sexual performance. Elders should be encouraged to take a warm shower or tub bath before sexual activity to help decrease pain and increase ROMArthritisCONDITIONS /C SEXUAL FNX. Hip arthroplasty, etc., follow precautions.Joint ReplacementsPOby mouthIMintramuscularIVintravenousSub-QsubcutaneousPRrectallySLsublingualDaily/QDonce dailyBIDtwice a dayTIDthree times a dayQIDfour times a dayHShour of sleepPRNas neededACbefore mealsPCafter mealsACTIVITY DEMANDS TO MAINTAIN MEDICATION ROUTINES: Space to complete medication routine/lightingSpace demandsACTIVITY DEMANDS TO MAINTAIN MEDICATION ROUTINES: Med. Routines require communication to refillSocial demandsACTIVITY DEMANDS TO MAINTAIN MEDICATION ROUTINES: Timing of medicationSequence/timingACTIVITY DEMANDS TO MAINTAIN MEDICATION ROUTINES: Opening and closing containers, manipulating objects.Required actions/Performance skillsACTIVITY DEMANDS TO MAINTAIN MEDICATION ROUTINES: Include mental, neuromusculoskeletal, speech functionsReq Body FnxACTIVITY DEMANDS TO MAINTAIN MEDICATION ROUTINES: Use of hands, eyes, and such.Req'd body structuresWhat are two types of restraints?physical and chemicalare described as a drug or medication when it is used as a restriction to manage the patients behavior or restrict the patients freedom of movement and is not a standard tx or dosage for the pt. conditionChemical Restraintcan be any manual, such as any physical or mechanical device that restricts the pt freedom of movementPhysical restraintWhat would be an approved restraint?Environmental adaptationsW/C not fitted properly (3 Items)Lead to fix or flexible deformities, pain, pressure ulcers, or fatigue, as well as decrease in overall function and greater need for assistance. Decreased physiological fnx. like breathing, swallowing, and digestion. Can also decrease socialization because of eye gaze. Decreased comfort will affect their endurance and activity tolerance sitting for long periods of time. Not fitted properly can cause posterior tilt of pelvis, sliding forward, leaning to one side, inadequate arm support, and the inability to self-propel.Multiple med. regiments, clinical conditions, cognitive disorders, age changes, environmental causes like poorly kept home, yard, poor lighting, uneven stairs, lack of handrails, unstable furniture, pets can be cause of what to happen?Mechanical FallsDecreased visual acuity, color discrimination, depth perception, figure ground and peripheral vision, increased sensitivity to glareCan impact Community mobilityMost common types of visual impairments (4)Cataracs, Diabetic Retinopathy, Glaucoma, Macular Degeneration.Occluding of lens which makes the vision blurry and dull by preventing adequate amounts of light to reach the retinaCataracsdiabetic retinopathyoccurs when diabetes damages the tiny blood vessels in the retina, causing blood to leak into the posterior segment of the eyeballSerious ocular condition that involves excessively high pressure inside the eye d/t excessive buildup of fluid in eyeball. Causes damage to optic nerve.GlaucomaTwo types of this where one results in yellowish deposits forming under the macula- causing it to be thin and dry out. Other, is caused by rapid growth of small blood vessels beneath the macula. The vessels leak out causing scarring, resulting in vision loss.Macular Degeneration. Dry and Wet ARMDLow Vision Adaptationslow vision accessibility features on computer, books, newspapers, magazines, magnification to enlarge the screen, voice over, use of a narrator.Different types of hearing loss and how they present: Loss of auditory nerve fibers. Condition affects ability to distinguish speech sounds in higher frequencies. Does not affect ability to hear pure tones.Neural Hearing LossDifferent types of hearing loss and how they present: Neural, mechanical, and/or sensory damage to the inner ear or auditory nerves. Leads to impaired hearing, most common is loss of high frequency sounds.Sensorineural hearing lossDifferent types of hearing loss and how they present: Degeneration of the vibrating membrane within the cochlea. Condition leads to gradual loss of hearing in all frequencies; ability to distinguish sounds becomes increasingly difficult.Mechanical Hearing lossDifferent types of hearing loss and how they present: Inability of the external ear to conduct sound waves to the inner ear; may be related to buildup of earwax, fluid accumulation in the middle ear, or upper respiratory infection. Can be corrected by cleaning the ear, medications, or surgery.Conductive Hearing lossDifferent types of hearing loss and how they present: Atrophy and degeneration of the hair cells at the base of the basilar membrane. Condition affects loss of high-frequency sounds but does not interfere with the discrimination of speech.Sensory Hearing lossDifferent types of hearing loss and how they present: May be related to conductive or sensorineural loss, Meniere's, osteoporosis, presbycusis, ear wax buildup, lesions, or fluid in the middle ear. Buzzing, ringing, whistle roar in ears, most noticeable at night. May be necessary to rule out underlying conditions before implementing interventions designed to symptoms.TinnitusCommunication strategies (5)Work on them regaining their confidence with asking for adaptations (/c role playing) Environmental adaptations that first focus on identifying and minimizing the influence of background noises. COTAs can recommend going to environments like a restaurant during times that are less crowded, request to sit in less crowded areas, or away from distracting background noises. Recommend personal environmental mods for reducing background noise like adding carpet to floors, acoustical tiles to ceilings, hanging drapes on windows. Banners to high ceilings. Provide assistive hearing devices.Urinary incontinence in nursing homes:43-77%, avg. 58%Noninstitutionalized adults:15-38%, women generally twice as likely as men.STRATEGIES TO MAINTAIN CONTINENCE (5):Timed Voiding and Habit training Prompted Voiding Bladder training Environmental Adap. Clothing Adap. Adap. for clients /c functional incontinence Prevention of Skin ErosionDysphagia: First steps before feeding /c residentCollect info Inform Elder Create env. Ensure proper fit Assess Position safely Complete oral prep as Rx'd by OTR Check food trayTypes of AE and Mods that clients would benefit from d/t dysphagia (11)Hole punched in plastic lid of a cup Built-up handles Universal cuff Swivel spoon Nonslip mats/plates /c custom suction cups Plate guards and plates /c lips Cutout cups and straws Straws and cups /c spouted lids Small rubber-coated spoons Rocker knives Mobile arm-supportsDEMENTIA & AD communication techniques (5):Care enough to listen carefully (clients have difficulty using nouns early onset of AD) Use creative reality /c the elders by focusing on the emotions being expressed and responding appropriately by validating feelings. Use "therapeutic fibs" Caregivers should be aware of nonverbal messages such as acting rushed, looking at the clock, sighing, or raising voice. People with AD need to experience acceptance and success, esp. as their language skills diminish. Keep the dialogue flowingImportant aspects to consider when creating tx plan (3):ANALYZE the elders occ performance to identify his or her assets, problems, potential problems. Admin. the Folstein-Mini Mental state to measure cognitive performance. Admin. the Allens Cognitive Performance Test and ROutine task Inventory.PSYCH CONDITIONS: (11) Associated Assessments.Evaluation of Social Interaction (ESI) Assess. of Motor and Process Skills (AMPS) Canadian Occ Performance Measure (COPM) Activity Card Sort (ACS) Comprehensive Occ Therapy Eval (COTE) Kohlman Eval of Living Skills (KELS) Volitional Questionnaire (VQ) Rand SF-36 Health Survey Questionnaire Beck Anxiety Inventory (BAI) Beck Depression Inventory (BDI) Mini Mental Status Exam (MMSE)Common Mental health d/o (7)Depression Anxiety Suicide Dementia Alcoholism Aging with Psychosis Mood d/o