Caring for patients with physical challenges (Case study)

Harriette Brown is a 56-year-old woman who called the outpatient clinic requesting an urgent appointment due to a low-grade fever, dry cough, and shortness of breath. She was diagnosed with type 2 diabetes 10 years ago and has had ongoing difficulty taking her medications consistently. As a result, she developed a foot wound that became infected and progressed to osteomyelitis, ultimately leading to a right below-knee amputation 18 months ago.

Ms. Brown arrives at the clinic in a transportation van.

With the driver’s help, she carefully lowers herself down the steps, taking them one at a time until she reaches the pavement.

Using her walker, she makes her way to the clinic door, only to realize there’s no automatic button to open it. As she struggles to pull the door open, Nick, the physician assistant, arrives for work and steps in to help.

Once inside, Mercedes, the receptionist gives Ms. Brown a tablet to fill out her registration information, but she hasn’t used one before, and the words on the screen look blurry.

She eases herself into a chair in the waiting room, breathing heavily from the effort it took to get inside the clinic, and takes a moment to catch her breath before trying to focus on the screen.

Lynette, the nurse, calls for Ms. Brown and walks with her toward the scale to obtain her weight.

Ms. Brown is unable to step up or stand on the scale without holding onto the walker. She tells the nurse her prosthesis weighs 8 lbs.

Ms. Brown’s current weight is deferred, and she’s escorted to the examination room, where she’s asked to sit on the exam table; however, Ms. Brown isn’t able to lift her right leg onto the step.

Lynette calls for help, and together, Nick and Lynette assist Ms. Brown onto the table.

To help patients of all abilities safely enter and navigate public buildings like clinics, health care spaces should follow accessibility requirements and use universal design principles. That means building environments that are easier, safer, and more intuitive for everyone to use—not just for people with disabilities. In addition, the Americans with Disabilities Act, or ADA and the European Accessibility Act, or EAA, outline specific standards to ensure access and for people with physical or mental impairments.

The clinic that Ms. Brown is visiting can improve accessibly by installing a blue button, or push plate, on the front door that automatically swings the door open when activated. They can also help patients who are unfamiliar with using a tablet to input patient information, by asking patients if they need assistance or ensuring tablets with a voice activated button are available to assist patients with inputting information.

The clinic would also need a height adjustable scale for patients who are unable to step up and balance on the scale, and a height adjustable examination table with grab bars to help patients with mobility issues.

Now, Ms. Brown’s current respiratory condition has developed because of several interconnected factors. To start, she has had difficulty consistently taking her prescribed medications for type 2 diabetes, which led to persistently high blood glucose levels. Over time, this caused a number of complications, including peripheral neuropathy, or nerve damage that reduced sensation in her feet; peripheral artery disease, which limited blood flow to her lower extremities; and a weakened immune system, which increased her risk for infection.

Together, these issues set the stage for a foot ulcer that eventually became infected. When the infection spread to the bone, it led to osteomyelitis and ultimately required a below-knee amputation.

The amputation restricted Ms. Brown’s mobility and had some significant detrimental effects. Reduced mobility impaired her lung expansion and weakened her respiratory muscles, making it difficult for her to clear respiratory secretions through deep breathing and coughing. As a result, secretions began to pool in her lungs, creating an environment where bacteria could grow and increasing her risk for pneumonia. On top of that, her already weakened immune system made it even harder for her body to fight off infection.

Lynette measures Ms. Brown’s vital signs, which are temperature 100.7°F or 38.2°C, pulse 92 beats per minute, respiratory rate 22 breaths per minute, and blood pressure 142/88 mmHg. Her oxygen saturation is 95% on room air, and she reports mild pain, rating it a 2 out of 10 on a 10-point scale.