'I-28Sfuuy-WR10okMSia3VYeZTm2RHA2LZDel59TlF8' name='google-site-verification'/>www ghs.google.com 6dseurqgapmn gv-v6egtfduggmq3k.dv.googlehosted.com Autismwarriormama: Handling Severely-Autistic Patients Admitted to Hospitals

Living with Autism

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May 25, 2011

Handling Severely-Autistic Patients Admitted to Hospitals

Hospitalization of Severely-Autistic Patients with Behaviors: Helpful Tips for Nurses and Physicians

·       Have doctor order CNA (sitter) to provide 1:1 protective supervision

·       Ask family or caregiver to provide list of favorite foods, so food service can prepare what patient prefers, thereby avoiding tantrums, weight loss or refusal to take meds (you can hide some meds in soft foods) while hospitalized

·       If no advice given regarding feeding, consider autistic patients may prefer various textures and tastes (crunchy, soft, salty, sweet) and/or have aversions to certain smells or temperatures (cold or hot food). You may also have to mix crunchy with soft or salty and sweet to encourage eating

·       Reduce noise level around patient (turn OFF loud, continuous beeping sounds)


·       Consider ear plugs, if tolerated, to avoid aversive sounds (i.e.…other patients screaming, loud conversations outside the door)

·       Avoid straight catheters, if possible


·       Consider extra pillows, sheets and blankets for extra sensory support

·       Consider using TV or music for audio-visual distraction while attempting IV, changing tubing, etc…

·       Autistic patients may not tolerate staying in bed. If safe, have doctor order CNA sitter and/or nurses to frequently walk patient to prevent agitation, feeling “trapped” from sitting still for too long

·       Ask family or caregivers to provide familiar items, posters, toys, etc…that may comfort patient during stay

·       Consider side effects of many drugs may trigger or exacerbate disruptive behaviors


·       Many autistic patients are hypersensitive to side effects of drugs and/or may present with PARADOXICAL response to drugs (i.e.…diazepam may ‘energize’ instead of ‘sedate’ and anti-psychotics may trigger psychotic behavior)

·       Non-Verbal Autistics are at particular risk of being misdiagnosed or undiagnosed due to inability to communicate pain, discomfort or underlying medical problems

·       Example: Pt. screams when you touch right leg. Pain meds are given. Reality: There is no pain. Pt. is hypersensitive to touch—this is baseline behavior


·       Example: Pt. is behaving WAY off baseline. Tugging at ears. Punching stomach. (This may not indicate location of pain-- it may be explosive reaction to pain in other area of body). CBC test normal. CT head and Chest x-rays normal. Liver panel normal. Physical exam shows nothing. Now what? Consider elevated ammonia levels. Gastrointestinal issues Impaction? Gluten sensitivity? Acidic stomach? Ear, nose & throat exam? H-pylori (especially if live in group home setting).


·       NON-verbal autistics require more than a routine exam when they suddenly behave way OFF baseline. Why? The answer should be obvious as to why, but in case it’s not obvious: Because they can’t tell you what’s wrong. Research shows numerous cases of explosive or/and chronic behaviors in autism linked to undiagnosed medical issues. Investigate and rule out until probable etiology identified. And, treatment stabilizes and—ideally- heals (from whatever acute or perhaps newly identified chronic medical problem it is) patient. Don’t just sedate and send home

·       Please, try not to get ‘easily offended’ by parents or caregivers who advocate for autistic patients. It’s critical for the autistic patient’s health and safety. Be happy they care. Work together.

2 comments:

Jean said...

AMEN and thank you!!!!!!

Maruud said...

Great suggestions Thanks from a nurse!

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