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1. Course: DDSD Residential Health Training - Part 2 Lesson 7: What is “Typical” for the Individual? Welcome to Lesson 7 of Residential Health Training • This lesson will explain: • The importance of knowing what is typical • Recognizing health characteristics • Yellow and red flags You are required to read all information contained in this lesson, including linked information. Page 1 of 13

2. Course: DDSD Residential Health Training – Part 2 Lesson 7: What is “Typical” for the Individual? Recognizing What is “Typical” for the Individual Everyone is different. We all have traits that make us unique. This is true of our personalities, as well as our physical attributes. It is absolutely critical that you, as a direct service professional, learn the unique characteristics of the people you support. This is especially true when it comes to those characteristics that can have a direct impact on an individual’s health and safety. Why do we put so much emphasis on learning to recognize changes in a person’s health? Quite simply, it’s hard to argue with the old saying, “If you don’t have your health, what do you have?” If we can assist people with developmental disabilities to remain healthy, they can often achieve amazing things. Award-winning film and TV actress Paula Sage, an individual with Down Syndrome, receives her BAFTA award. Photo released into the public domain by BAFTA for publicity purposes. Page 2 of 13

3. Course: DDSD Residential Health Training - Part 2 Lesson 7: What is “Typical” for the Individual? • Learning About a Person’s Unique Health Characteristics is Key • How do we know what is normal or typical, especially when it comes to health issues? Medical literature and information on the internet can tell us what a “normal” range is for a particular vital sign, such as heartbeats per minute or temperature. We can even learn the classic signs of a seizure. However, the reality is that no two people will have the exact same seizure. A normal temperature for one person might be 98.6, but for someone else a normal temperature might be 99.8. Knowing what is “typical” for each individual is critical to ensuring their health and safety. • There are a number of ways in which we can learn about an individual’s personal health characteristics. The following list represents just a few methods we commonly use: • Read the individual’s health history and the Individual Plan (IP), especially the health section. • Review medical records and other health-related documents kept in the person’s home record. • Get to know key people in the person’s life. Ask them questions about the person’s past health issues. • If family members are available, ask them if there are any medical issues to consider. (This is especially important to know as the person ages. Is there a family history of diabetes? Heart disease? Breast Cancer? Other issues?) Page 3 of 13

4. Course: DDSD Residential Health Training – Part 2 Lesson 7: What is “Typical” for the Individual? Most experts believe individuals with developmental disabilities are at high risk of receiving inadequate health services. Few physicians and other medical professionals are comfortable working with this population. Studies show that people with developmental disabilities are at particular risk of experiencing sudden death or other serious adverse health outcomes. One of your biggest responsibilities as a Direct Support Professional is to make sure that the individuals you support remain healthy and receive the health-related services they need. No pressure, right? We all agree that Direct Support Professionals have a tough job. This is especially true when you have an emergency situation and must think fast. On the next screen is a chart to help you in an emergency. Print this chart and keep it handy so you can evaluate health-related situations that come up. Page 4 of 13

5. Course: DDSD Residential Health Training – Part 2Lesson 7:What is “Typical” for the Individual? Person isn’t feeling well • Are Any of the Following Present? • Chest pain • Respiratory distress • Severe allergic reaction • Unconsciousness or decreased level of responsiveness • Diabetic emergency • Drowning • Electrocution • Uncontrolled bleeding • Continuous seizures • Overdose / Poisoning • Other emergencies specific to individual YES! LIFE THREATENING Take Action: CALL 911 No,the situation is not life threatening. Notify key people – HCC, PC, Physician, other health professionals Begin emergency procedures: CPR, First Aid for choking, etc. • Constantly review symptoms • Take vital signs • Review for any changes in: • Appetite • Behavior • Sleep • Responsiveness • Pain level or discomfort YES Is the person’s condition worsening? Notify key people when it is safe to do so NO Document, report, take action Start back to beginning of the decision tree until the person’s condition improves or health professionals take over. Document the incident and what you did Page 1 of ___ Page 5 of 13

6. Course: DDSD Residential Health Training - Part 2 Lesson 7: What is “Typical” for the Individual? Now that you understand the importance of knowing the health characteristics that are “typical” for the individuals you support and you have your trusty emergency chart, let’s get to know Casey and David, a couple of individuals with developmental disabilities. Their stories can help clarify why it is so important to know a person’s “typical” health characteristics. Page 6 of 13

7. Course: DDSD Residential Health Training - Part 2 Lesson 7: What is “Typical” for the Individual? Casey has mild mental retardation, cerebral palsy with spasticity, and gastro esophageal reflux disease (GERD), a disorder where stomach contents sometimes “refluxes” back up into the throat. He also has problems with constipation and frequent urinary tract infections. Casey is unable to walk due to his spasticity, and uses an electric wheelchair for mobility. He is incontinent of bowel and bladder, and requires assistance with eating and drinking, transferring in and out of his wheelchair, and with all of his dressing and hygiene needs. Although he can speak, his speech is slurred and difficult to understand. David has moderate mental retardation, as well as a complex set of physical disabilities. He has a seizure disorder, myopia with astigmatism, chronic dermatitis, kyphoscoliosis of the spine, gingivitis and hyperplasia of the gums and a diagnosis of intermittent explosive disorder. He is able to walk with an unsteady gait, but prefers to get around in a manual wheelchair which he self propels with the use of his legs. He has trouble speaking clearly, and although he is able to take care of many of his needs, he requires verbal and sometimes physical assistance with many of his activities of daily living. David has been known to go into status epilepticus (continuous seizures) when he has an elevated temperature, constipation or an infection. Page 7 of 13

8. Course: DDSD Residential Health Training – Part 2 Lesson 7: What is “Typical” for the Individual? Casey and David are obviously two very different people, and both present very different challenges to caregivers. The table below shows the typical body temperature for Casey and David, as well as their temperatures when staff came on shift this morning. Page 8 of 13

9. Course: DDSD Residential Health Training – Part 2 Lesson 7: What is “Typical” for the Individual? While we see that Casey and David had exactly the same body temperature (100 degrees) when their staff came on shift this morning, we know the risk to each individual was very different because their “typical” (or baseline) temperatures are so different. An individual’s typical vital signs are pretty easy to determine. Measure the person’s vital signs (temperature, blood pressure, pulse and respiration) at various times for several days, and then look for a range. For instance, if you count a person’s resting pulse for a full minute once in the morning and once in the evening for five days and find that it ranged from 74 to 86 beats per minute, any number between 74 and 86 would be considered the normal resting pulse rate. If the pulse was checked at some point in the future and found to be 56, you would document this as a low pulse and notify the Health Care Coordinator (HCC) or other person designated to oversee this individual’s health needs. Let’s see how Casey’s and David’s direct support staff handle the elevated temperatures using the handy emergency chart from page 5 of this lesson. Casey’s information is in green and David’s information is in blue. Page 9 of 13

10. Person isn’t feeling well Casey has a temperature of 100. His normal or typical temp is 98.6 David has a temperature of 100. His normal or typical temp is 96.8 No,the situation is not life threatening. Notify key people – Physician, health professionals Staff know the physician considers this temperature only a low grade temperature, and has a protocol in place to administer Tylenol and recheck temperature in 1 hour. • Are Any of the Following Present? • Chest Pain • Respiratory Distress • Severe Allergic Reaction • Unconsciousness or decreased level of responsiveness • Diabetic Emergency • Drowning • Electrocution • Uncontrolled bleeding • Continuous Seizures • Overdose / Poisoning • Other emergencies specific to individual No, the situation is not life threatening, Notify key people – HCC, PC, Physician, other health professionals David’s temperature is 3.2 degrees higher then his normal temp, which the physician considers a high temperature for David. David is given Tylenol and the physician wants his temperature rechecked in one hour. Constantly review symptoms. Take vital signs. Review for any changes in appetite, behavior, sleep, responsiveness and pain level or discomfort. After one hour, Casey’s temperature has come down to 98.8 and he is feeling better. Constantly review symptoms. Take vital signs. Review for any changes in appetite, behavior, sleep, responsiveness and pain level or discomfort. David vomits his PO Tylenol, and his temperature has now gone up to 100.4. He begins having seizures. YES! LIFE THREATENING Take ActionCALL 911 Is the person’s condition worsening? YES David’s temp is still elevated. David barely comes out of his first seizure, when a second one begins. Begin emergency procedures: CPR, First Aid for choking, bleeding, etc. Staff call 911 and follow David’s seizure protocol as they wait for ambulance Is person’s condition worsening? No Document, report, take action. Go back to beginning of decision tree until person’s condition improves or health professionals take over Notify key people when it is safe to do so. Document the episode. David’s staff notifies the PC as soon as the ambulance arrives. Page 10 of 13

11. Course; DDSD Residential Health Training – Part 2 Lesson 7: What is “Typical” for the Individual? That was a busy little screen, wasn’t it? Let’s wrap this lesson up and let you take a break. Just remember that it is critical you get to know the person you are supporting, and learn as much about his or her health needs as you can. You may be the first to notice problems starting. How quickly and correctly you respond can make all the difference. Here is a list of “yellow flag” health issues. The yellow flag, just like a yellow traffic light, tells you to be watchful and proceed with caution. If you see any of these health issues occurring, you need to closely monitor the person, contact your PC, the health care coordinator or physician, etc. Yellow flag issues can become red flag issues very quickly. Yellow Flags • Changes in normal health patterns • Unplanned weight loss or gain • Decreased mobility • Appetite changes • Change in mental status, • responsiveness or activity level • Vital sign changes • Behavioral changes • Blood sugar abnormalities • Seizure changes Page 11 of 13

12. Course: DDSD Residential Health Training – Part 2 Lesson 7: What is “Typical” for the Individual? The most important thing to remember from this lesson - health problems can usually be divided into two categories - yellow and red flag issues. Both categories require you to make the right decisions at the right time. Knowing what is typical for the person you support is crucial in making these decisions. • YELLOW FLAG ISSUES - When you suspect something is not typical this should warn you that further action is needed. • RED FLAG ISSUES – If you suspect something is seriously endangering the person, take immediate ACTION! In an emergency, call 911 before calling your supervisor. Remember, better safe than sorry! Page 12 of 13

13. Course: DDSD Residential Health Training – Part 2 Lesson 7: What is “Typical” for the Individual? Congratulations! You have completed Lesson 7 in the Residential Health Training course. You may now take the test. Good Luck! Page 13 of 13