Introduction………………………………………………………………………………...3
1. Basic principles of care for neurological patients…………….4
2. Nursing process for neurological diseases……………….6
3. Bladder dysfunction…………………………………….8
4. Bedsores……………………………………………………………………………….9
Conclusion……………………………………………………………………………….11
Literature………………………………………………………………………………..12
Introduction
Neurology (Greek neuron - nerve, logos - teaching, science). The sum of disciplines whose object is the nervous system in normal and pathological conditions. This term is often used instead of the term “neuropathology,” although these concepts are not equivalent - the first is much broader.
Neurological disorders place an enormous burden on patients, their families and society. As life expectancy increases, more people are likely to fall victim to stroke, dementia and other brain diseases, leading to huge healthcare costs worldwide. It is very important that modern medicine begins to understand the brain basis of behavior and recognize mental disorders as cerebral, non-mental disorders. Meningitis, Creutzfeldt-Jakob disease, multiple sclerosis recognized as brain diseases mental disorders, as serious as AIDS or cancer.
The essence of the modern nursing model is how scientific theory, is the rationale for various approaches to the content and provision of nursing care. The concept of “nursing process” has entered the professional lexicon, which is understood as a systematic approach to providing nursing care, focused on the needs of the patient. The purpose of this approach is to strive to alleviate, eliminate, and prevent problems that arise in the patient due to changes in health status.
A number of care activities, such as, for example, elements relating to the personal hygiene of the patient, the hygienic maintenance of his bed, linen, room, are common to all groups of patients - therapeutic, surgical, neurological, gynecological, etc. However, in each of these groups care has its own characteristics, its own specifics. Particular difficulties arise when caring for seriously ill patients.
1. Basic principles of care for neurological patients
Patient care is a set of measures aimed at maintaining and restoring the patient’s strength and creating for him conditions and an environment conducive to a favorable course of the disease, preventing complications and more. quick recovery. It includes the hygienic maintenance of the room in which the patient is located, maintaining the proper hygienic condition of the patient himself, arranging and equipping a comfortable bed, taking care of the cleanliness of it and the patient’s clothes, organizing the patient’s meals, providing assistance to him with eating, using the toilet, physiological functions and other the kind of painful conditions that arise during the course of the disease (vomiting, retention of urine, stool and gas, etc.).
Directly related to care is the clear and timely implementation of all instructions prescribed to the patient. medical procedures And medicinal prescriptions, as well as monitoring his condition.
Chronic neurological diseases can manifest either as a permanent neurological defect or as a progressive increase in symptoms. In mild, non-progressive cases, with the help of orthopedic devices, rehabilitation measures, etc., the patient can be ensured a full-fledged existence. In severe cases, they strive to make maximum use of the remaining functionality.
For progressive diseases, treatment depends on the rate of increase and severity of symptoms. For example, multiple sclerosis and malignant tumors quickly lead to death, however, even in these cases, an explanation of the prognosis and supportive measures can be of great benefit to the patient and his family.
For illnesses nervous system Severe movement disorders, sensory disturbances, speech disturbances, dysfunction of the pelvic organs, and convulsive seizures are possible. This determines the specifics of care for this category of patients.
In case of stroke, as well as acute neuroinfections, it is necessary to take measures from the very beginning to prevent life-threatening complications that often arise: pneumonia, the formation of bedsores, inflammation urinary tract. The development of pulmonary complications is facilitated by the constant position of the patient on his back and getting into Airways mucus from the nasopharynx. To prevent these complications, the patient should be carefully turned frequently (every 2 hours); It is necessary to clean your mouth and throat several times a day with a damp swab moistened boric acid, use aspirators. The fight against intestinal atony and urinary retention is important.
The most common neurological disease is stroke ( acute disorder cerebral circulation). Most often, a stroke is accompanied by loss of consciousness. This condition of patients may continue long time.
The cause of a stroke may be: hypertonic disease in the acute stage (crisis), cerebral aneurysm. A stroke can occur suddenly and lead to the death of the patient in the first hours.
A developed stroke does not proceed the same way in different patients. It has the following symptoms:
- disturbance of consciousness;
- disturbance of sensitivity;
- aphasia (speech disorder, loss of ability to speak);
- amnesia (memory loss);
- paralysis (violation motor functions generally);
- paresis (incomplete paralysis);
- urinary and fecal incontinence;
- general mental disorder;
- bedsores that form faster than with other diseases.
All people who have suffered a stroke become bedridden patients for a long time, caring for them requires special skills and knowledge.
The nurse must have professional observation, allowing him to see, remember and evaluate in a nursing way the smallest changes in the physical and psychological condition of the patient. She must be able to control herself, learn to manage her emotions.
2. Nursing process for neurological diseases
Target nursing process– maintaining and restoring the patient’s independence in meeting the basic needs of the body. The patient's main problems may be:
- disturbance of consciousness; - headache; - nausea, vomiting; - deficit of self-care (strict bed rest, paresis, paralysis); - disturbance of urination and defecation; - state of epileptic attack; - anxiety about the disease and its consequences; - depression; - sleep disturbance, - increased irritability; - anxiety about instability general condition; - loose stool; - unmotivated refusal to take medications; - weakness, etc.
The nurse should monitor:
- Compliance with the rules general care.
- It is necessary to place soft cushions under the areas of paralyzed joints, which will eliminate stiffness, swelling, and bedsores.
- You can place a small rubber expander in the bent hand of the paralyzed arm.
- For headaches, apply an ice pack to your head.
- Monitor timely emptying of the bladder.
- When feeding, place the patient in a supine position.
- The person caring for the patient needs to write down and remember all the exercises prescribed by the exercise therapy methodologist, speech therapist, massage therapist, and try to repeat them with the patient after a certain period of time.
In patients with motor disorders of cerebral origin, paralyzed limbs are placed in a certain position to avoid muscle contractures. The paralyzed arm is placed on a pillow so that the shoulder joint and arm are at the same level in a horizontal plane, the arm is taken to the side, it should be straightened, and the hand should be turned palm up with straightened fingers apart. Sandbags and splints are used to hold the limb in this position.
The paralyzed leg is placed as follows: a cotton pad is placed under the knee joint, the foot is held at an angle of 90° using a rubber traction or a support in a wooden box. In the position on the healthy side, the paralyzed arm lies either along the body or bent at an angle of 90° on a pillow; the leg is bent at the hip and knee joint, put a pillow under it. The position of the patient on the back and side is changed every 2-3 hours.
Depending on the patient’s condition, the doctor prescribes passive and active gymnastics and massage at certain times. As movements are restored, the main focus should be on ensuring that patients include the affected limbs in self-care functions as early as possible.
If patients have speech disorders, it is recommended, if possible, to place them in wards with patients whose speech function is preserved, and to conduct classes with a speech therapist.
During an epileptic seizure, to prevent injury, it is advisable to place a pillow or some soft things under the patient’s head. The patient's arms and legs must be held, protecting them from bruise. To prevent biting the tongue and lips, it is recommended to insert a spatula or the edge of a towel into the mouth from the side. It is advisable to turn your head to the side so that saliva can flow freely. You need to unbutton your shirt collar.
Diseases spinal cord often accompanied by lower paraplegia or paraparesis of the legs, dysfunction of the pelvic organs, trophic disorders, and often the development of bedsores. In such cases, careful skin care is necessary from the first days of the disease. There should be no wrinkles on the mattress and sheets. An inflatable rubber circle should be placed under areas of the body that are subject to pressure. Several times a day it is necessary to change the patient’s position and wipe the skin with camphor alcohol.
To prevent contractures, you need to monitor the position of your legs, put them in the right position, and fight against sagging feet. The feet are placed at right angles to the lower leg using a stop; sometimes removable splints are applied. In case of urinary retention, repeated catheterization of the bladder is carried out under conditions of strict asepsis and using antiseptic agents. For urinary incontinence, a urinal bag is used. If stool is retained, cleansing enemas are indicated.
3. Bladder dysfunction
Bladder dysfunction most often develops as a result of spinal cord injury, less often with other lesions - multiple sclerosis, tumors, discogenic myelopathy, tabes dorsalis.
The main objectives of treatment for neurogenic dysfunction Bladder
1. Reduce the volume of residual urine and reduce vesicoureteral reflux in order to prevent hydronephrosis and urinary infection.
2. Reduce urinary incontinence.
3. Increase the functional capacity of the bladder so that emptying the bladder occurs no more than 4-6 times a day.
5. Permanent installation urinary catheter should be avoided if possible.
6. The urine bag should not be raised above the level of the bladder (otherwise bladder reflux is possible). Sometimes a disinfectant is added to the urine bag.
Urine flow can be improved by:
1) Early activation of the patient (walking or moving using a wheelchair). 2) Frequent changes in body position. 3) Raising the head of the bed.
Drinking plenty of fluids reduces the risk urinary infection and stone formation. In the absence of contraindications, all patients with a permanent catheter should drink 3-4 liters per day.
4. Bedsores
Prevention
1. Bedsores are often observed in patients with paralysis and sensory impairment. Most effective prevention- regular changes in body position, in particular - turning in bed. Thus, the prevention of pressure ulcers is entirely dependent on care.
2. Areas of bony protrusions (heels, ischial tuberosities, sacrum) require special protection. In children with chronic hydrocephalus, measures are taken against bedsores of the scalp.
3. To prevent bedsores, sheepskin pads, water mattresses and other soft materials are used. Do not use round pads, the central convex part of which can cause skin ischemia and contribute to the development of pressure ulcers.
4. Skin should be dry. This is especially important to monitor in patients with urinary incontinence. In the absence of permanent catheter put diapers on.
5. To prevent maceration, wet or sweaty areas of the skin are treated with emollient ointments (for example, Vaseline).
6. Prerequisite maintaining healthy skin - good nutrition.
7. With swelling, the skin becomes thinner and its blood supply deteriorates. To prevent skin cracks, prevention and treatment of edema of paralyzed limbs is necessary.
Treatment
1. If compression of the affected area of skin continues, then healing of the bedsore is impossible and, moreover, it may increase. Bedsores are treated saline solution or hydrogen peroxide, after which necrotic tissue is carefully removed.
2. For large bedsores, apply wet-dry dressings until fresh granulations form. Ointments with lytic enzymes are also used. These ointments are applied 2-3 times a day after pre-treatment. Enzymes are also used in the form of solutions, applying wet-dry dressings with them.
3. For extensive bedsores, it is necessary debridement. After treatment, the wound should remain dry (to do this, apply gauze or another light bandage to it).
Infection usually does not cause ulceration, but severe pressure ulcers may develop life-threatening sepsis. Local application Antibiotics are ineffective in this case.
Conclusion
All care for a neurological patient is based on the principles of the so-called protective regime, which protects and protects the patient’s psyche.
Eliminating all kinds of irritants, negative emotions, ensuring silence, peace, creating an atmosphere of comfort, affectionate and sensitive attitude towards the patient help maintain his cheerful mood, confidence in recovery and a successful outcome of the disease.
Demanding from the patient strict adherence to the established medical institution order and accurate implementation of the regimen prescribed by the doctor, medical personnel must understand and study the character traits of each patient and remember that under the influence of the disease, his psyche often undergoes significant restructuring: the patient’s reaction to the environment changes, he often becomes irritable, capricious, etc. P.
In order to find the right way to establish proper contact with the patient, earn his trust and thereby maintain his confidence in the successful outcome of the disease and the success of treatment, the caregiver must have inexhaustible patience, a sense of tact, and be extremely collected, disciplined when performing his duties, focused and attentive.
Literature
1. Veselova M.O. Stroke: modern look for treatment and prevention. St. Petersburg, 2005 – 48 p.
2. Demidenko T.D., Ermakova N.G. Fundamentals of rehabilitation of neurological patients. St. Petersburg, 2004 – 123 p.
3. Obukhovets T.P. Fundamentals of Nursing. Workshop. Series “Medicine for You” – Rostov n/a: “Phoenix”, 2002- 432s
4. Petrov S.V., Shishkin A.N. Fundamentals of general nursing). St. Petersburg, 1997 – 44 p.
Diseases of the nervous system often cause severe movement disorders, sensory disturbances, speech disorders, dysfunction of the pelvic organs, and convulsive seizures are possible. This determines the specifics of care for this category of patients.
In the event of a stroke, as well as acute neuroinfections, it is necessary from the very beginning to take measures to prevent life-threatening complications that often arise: pneumonia, the formation of bedsores, and inflammation of the urinary tract. The development of pulmonary complications is facilitated by the constant position of the patient on his back and the entry of mucus from the nasopharynx into the respiratory tract. To prevent these complications, the patient should be carefully turned frequently (every 2 hours); It is necessary to clean the mouth and throat several times a day with a damp swab moistened with boric acid, and use suction devices. The fight against intestinal atony and urinary retention is important.
In patients with motor disorders of cerebral origin, paralyzed limbs are placed in a certain position to avoid muscle contractures. The paralyzed arm is placed on a pillow so that the shoulder joint and arm are at the same level in a horizontal plane, the arm is taken to the side, it should be straightened, and the hand should be turned palm up with straightened fingers apart. Sandbags and splints are used to hold the limb in this position.
The paralyzed leg is placed as follows: a cotton pad is placed under the knee joint, the foot is held at an angle of 90° using a rubber traction or a support in a wooden box. In the position on the healthy side, the paralyzed arm lies either along the body or bent at an angle of 90° on a pillow; the leg is bent at the hip and knee joints, a pillow is placed under it. The position of the patient on the back and side is changed every 2-3 hours.
Depending on the patient’s condition, the doctor prescribes passive and active gymnastics and massage at certain times. As movements are restored, the main focus should be on ensuring that patients include the affected limbs in self-care functions as early as possible.
If patients have speech disorders, it is recommended, if possible, to place them in wards with patients whose speech function is preserved, and to conduct classes with a speech therapist.
During an epileptic seizure, to prevent injury, it is advisable to place a pillow or some soft things under the patient’s head. The patient's arms and legs must be held, protecting them from bruise. To prevent biting the tongue and lips, it is recommended to insert a spatula or the edge of a towel into the mouth from the side. It is advisable to turn your head to the side so that saliva can flow freely. You need to unbutton your shirt collar.
Diseases of the spinal cord are often accompanied by lower paraplegia or paraparesis of the legs, dysfunction of the pelvic organs, trophic disorders, and often the development of bedsores. In such cases, careful skin care is necessary from the first days of the disease. There should be no wrinkles on the mattress and sheets. An inflatable rubber circle should be placed under areas of the body that are subject to pressure. Several times a day it is necessary to change the patient’s position and wipe the skin with camphor alcohol.
Introduction
Neurology (Greek neuron – nerve, logos – teaching, science). The sum of disciplines whose object is the nervous system in normal and pathological conditions. This term is often used instead of the term “neuropathology”, although these concepts are not equivalent - the first is much broader.
Neurological disorders place an enormous burden on patients, their families and society. As life expectancy increases, more people are likely to fall victim to stroke, dementia and other brain diseases, leading to huge healthcare costs worldwide. It is very important that modern medicine is beginning to understand the brain basis of behavior and recognize mental disorders as brain disorders, rather than mental disorders. Meningitis, Creunzfeldt-Jakob disease, multiple sclerosis are recognized as diseases with brain-related mental disorders, as serious as AIDS or cancer.
The essence of the modern model of nursing, as a scientific theory, is the substantiation of various approaches to the content and provision of nursing care. The concept of “nursing process” has entered the professional lexicon, which is understood as a systematic approach to providing nursing care, focused on the needs of the patient. The purpose of this approach is to strive to alleviate, eliminate, and prevent problems that arise in the patient due to changes in health status.
A number of care activities, such as, for example, elements relating to the personal hygiene of the patient, the hygienic maintenance of his bed, linen, room, are common to all groups of patients - therapeutic, surgical, neurological, gynecological, etc. However, in each of these groups care has its own characteristics, its own specifics. Particular difficulties arise when caring for seriously ill patients.
1. Basic principles of care for neurological patients
neurological nursing care
Patient care is a set of measures aimed at maintaining and restoring the patient’s strength and creating for him conditions and an environment conducive to a favorable course of the disease, preventing complications and a faster recovery. It includes the hygienic maintenance of the room in which the patient is located, maintaining the proper hygienic condition of the patient himself, arranging and equipping a comfortable bed, taking care of the cleanliness of it and the patient’s clothes, organizing the patient’s meals, providing assistance to him with eating, using the toilet, physiological functions and other the kind of painful conditions that arise during the course of the disease (vomiting, retention of urine, stool and gas, etc.).
Directly related to care is the clear and timely implementation of all medical procedures and medications prescribed to the patient, as well as monitoring his condition.
Chronic neurological diseases can manifest either as a permanent neurological defect or as a progressive increase in symptoms. In mild, non-progressive cases, with the help of orthopedic devices, rehabilitation measures, etc., the patient can be ensured a full-fledged existence. In severe cases, they strive to make maximum use of the remaining functionality.
For progressive diseases, treatment depends on the rate of increase and severity of symptoms. For example, multiple sclerosis and malignant tumors quickly lead to death, but in these cases, an explanation of the prognosis and supportive measures can be of great benefit to the patient and his family.
Diseases of the nervous system often cause severe movement disorders, sensory disturbances, speech disorders, dysfunction of the pelvic organs, and convulsive seizures are possible. This determines the specifics of care for this category of patients.
In the event of a stroke, as well as acute neuroinfections, it is necessary from the very beginning to take measures to prevent life-threatening complications that often arise: pneumonia, the formation of bedsores, and inflammation of the urinary tract. The development of pulmonary complications is facilitated by the constant position of the patient on his back and the entry of mucus from the nasopharynx into the respiratory tract. To prevent these complications, the patient should be carefully turned frequently (every 2 hours); It is necessary to clean the mouth and throat several times a day with a damp swab moistened with boric acid, and use suction devices. The fight against intestinal atony and urinary retention is important.
The most common neurological disease is stroke (acute cerebrovascular accident). Most often, a stroke is accompanied by loss of consciousness. This condition of patients can last for a long time.
The cause of a stroke can be: hypertension in the acute stage (crisis), cerebral aneurysm. A stroke can occur suddenly and lead to the death of the patient in the first hours.
A developed stroke does not proceed the same way in different patients. It has the following symptoms:
– disturbance of consciousness;
– sensory impairment;
– aphasia (speech disorder, loss of ability to speak);
– amnesia (memory loss);
– paralysis (impairment of motor functions in general);
– paresis (incomplete paralysis);
– urinary and fecal incontinence;
– general mental disorder;
– bedsores that form faster than with other diseases.
All people who have suffered a stroke become bedridden patients for a long time, caring for them requires special skills and knowledge.
The nurse must have professional observation, allowing him to see, remember and evaluate in a nursing way the smallest changes in the physical and psychological condition of the patient. She must be able to control herself, learn to manage her emotions.
2. Nursing process for neurological diseases
The goal of the nursing process is to maintain and restore the patient's independence in meeting the basic needs of the body. The patient's main problems may be:
– disturbance of consciousness; - headache; - nausea, vomiting; – deficit of self-care (strict bed rest, paresis, paralysis); – disturbance of urination and defecation; – state of epileptic seizure; – anxiety about the disease and its consequences; – depression; – sleep disturbance, – increased irritability; – concern about the instability of the general condition; - loose stools; – unmotivated refusal to take medications; – weakness, etc.
The nurse should monitor:
– Compliance with general care rules.
– It is necessary to place soft cushions under the areas of paralyzed joints, which will eliminate stiffness, swelling, and bedsores.
– You can place a small rubber expander in the bent hand of the paralyzed arm.
– For headaches, apply an ice pack to your head.
– Ensure timely emptying of the bladder.
– When feeding, place the patient in a supine position.
– The person caring for the patient needs to write down and remember all the exercises prescribed by the exercise therapy methodologist, speech therapist, massage therapist, and try to repeat them with the patient after a certain period of time.
In patients with motor disorders of cerebral origin, paralyzed limbs are placed in a certain position to avoid muscle contractures. The paralyzed arm is placed on a pillow so that the shoulder joint and arm are at the same level in a horizontal plane, the arm is taken to the side, it should be straightened, and the hand should be turned palm up with straightened fingers apart. Sandbags and splints are used to hold the limb in this position.
The paralyzed leg is placed as follows: a cotton pad is placed under the knee joint, the foot is held at an angle of 90° using a rubber traction or a support in a wooden box. In the position on the healthy side, the paralyzed arm lies either along the body or bent at an angle of 90° on a pillow; the leg is bent at the hip and knee joints, a pillow is placed under it. The position of the patient on the back and side is changed every 2–3 hours.
Depending on the patient’s condition, the doctor prescribes passive and active gymnastics and massage at certain times. As movements are restored, the main focus should be on ensuring that patients include the affected limbs in self-care functions as early as possible.
If patients have speech disorders, it is recommended, if possible, to place them in wards with patients whose speech function is preserved, and to conduct classes with a speech therapist.
During an epileptic seizure, to prevent injury, it is advisable to place a pillow or some soft things under the patient’s head. The patient's arms and legs must be held, protecting them from bruise. To prevent biting the tongue and lips, it is recommended to insert a spatula or the edge of a towel into the mouth from the side. It is advisable to turn your head to the side so that saliva can flow freely. You need to unbutton your shirt collar.
Diseases of the spinal cord are often accompanied by lower paraplegia or paraparesis of the legs, dysfunction of the pelvic organs, trophic disorders, and often the development of bedsores. In such cases, careful skin care is necessary from the first days of the disease. There should be no wrinkles on the mattress and sheets. An inflatable rubber circle should be placed under areas of the body that are subject to pressure. Several times a day it is necessary to change the patient’s position and wipe the skin with camphor alcohol.
To prevent contractures, you need to monitor the position of your legs, put them in the right position, and fight against sagging feet. The feet are placed at right angles to the lower leg using a stop; sometimes removable splints are applied. In case of urinary retention, repeated catheterization of the bladder is carried out under conditions of strict asepsis and using antiseptic agents. For urinary incontinence, a urinal bag is used. If stool is retained, cleansing enemas are indicated.
Caring for a severely neurological patient is difficult both in a hospital setting and, especially, at home. The attending physician must instruct the nurse caring for the patient, emphasizing the need for careful compliance with all recommendations, on which the fate of the patient literally depends. An important role in this is played by the nurse, who must practically familiarize the patient’s relatives and friends with the technique of performing the recommended manipulations, and carry out some of them personally (injections, catheterization, gastric intubation).
The attending physician and nurse For successful treatment for a severe neurological patient, it is necessary not only professional competence and the desire to improve their qualifications, but also love for their work.
In many diseases of the central nervous system ( inflammatory processes, tumors, cerebrovascular accidents, head injuries) disturbances of consciousness, vomiting, and convulsions are observed. In some patients, not only swallowing is impaired, but also salivation increases, which is why they may choke on saliva. With disorders of consciousness, the evacuation of food from the stomach may be impaired, which leads to profuse vomiting with aspiration of vomit. In addition, urinary retention, involuntary urination and defecation are common.
A nurse involved in caring for a patient with a swallowing disorder needs to be able to insert a tube through the nasal passage into the stomach to remove the contents and feed the patient. The procedure of catheterization of the bladder with a soft catheter in order to wash it and remove urine is also very important.
The nurse must not only master the technique of subcutaneous, intramuscular and intravenous injections, but also be able to use a system for intravenous drip administration of solutions, as well as a catheter installed in the subclavian, jugular or other large veins, and care for it. It is also necessary to master the technique of oxygen inhalation and other medicines.
Patients with neurological diseases often experience acute neuropsychic conditions - epileptic and hysterical seizures, alcoholic delirium. At epileptic seizure It is necessary, first of all, to protect the patient from injury. To avoid fractures, you should not hold the patient during convulsions, much less try to fix him by leaning on your whole body. You just need to support your head by turning it to one side, or put something soft under it. To prevent tongue biting, a spatula wrapped in gauze, a handkerchief or a bandage is inserted between the teeth. Do not insert the handles of forks, spoons or other metal objects if convulsive seizures follow one after another. They talk about status epilepticus. In these cases, 2 ml of seduxen is administered intravenously. Repeated administration is permissible no earlier than after 10 minutes. If the effect of seduxen is not observed, then 1-5% hexenal or sodium thiopental is administered intravenously very slowly.
The eminent French Jean Charcot called hysteria related to hysteria “a great malingerer,” meaning the variety of its manifestations, which can copy the signs of organic brain damage. A hysterical attack most often develops as a result of mental trauma. In this case, the patient does not lose consciousness, sometimes falls, but is never hurt. The convulsions are varied and fanciful; a hysterical arc may be observed: the patient rests only on his head and heels; eyes closed. Urination is possible, but defecation never occurs during an attack. Convulsions are varied, sometimes chaotic. Patients tear their clothes and hit their heads on the floor. During a seizure, the patient must be isolated, strangers removed from the room, a calm environment created, and tranquilizers administered.
Paralysis, paresis of the limbs, sensory disturbances, muscle hypotonia in neurological patients increase the likelihood of the formation of infiltrates and abscesses at injection sites. To prevent these complications, it is recommended to inject on the healthy side. There is no need to administer drugs intramuscularly in the area of the anterior surface of the thigh, since here, with the formation of an abscess, pus can quickly spread through the fascial spaces with the formation of extensive phlegmon. Intravenous infusions are also given on the healthy side. Injecting solutions into veins should be avoided lower limbs bedridden patients, since muscle hypotonia, lack of movement and passive position in bed contribute to blood stagnation. Any violation of the integrity of the venous wall can cause phlebothrombosis, and with thrombosis of the leg veins, thromboembolism develops in many cases pulmonary arteries, often fatal. It is preferable to place the catheter in the subclavian or jugular vein. This is especially important for intravenous infusion in patients with impaired consciousness, convulsions, and anyone who is expected to infuse significant volumes of liquids. Installation of a catheter is a medical procedure. The nurse should prepare the system for intravenous administration liquids. After the vein is punctured and the catheter is installed, it is necessary to check its correct position. To do this, a syringe half filled with saline solution or 0.25% novocaine is attached to the catheter and, by pulling towards itself, a few milliliters of blood are drawn. Part of the contents of the syringe is injected back into the vein. When carrying out such a manipulation, the nurse should not feel resistance or make any effort. After checking, the system can be connected to the catheter and, having attached it to the skin with an adhesive tape, the drugs can be administered. When there is no longer a need for continuous injection of the solution, the system is turned off. The catheter left in the vein is filled with 0.3-0.5 ml of heparin solution and closed with a stopper. This allows for repeated administration of drugs to avoid additional injury to the vein.
The doctor and nurse observing the patient should promptly notice both a decrease in breathing (up to 10 per minute) and an increase in breathing (28-30 per minute), the appearance of pauses, additional breaths, asynchrony of the respiratory movements of the chest, diaphragm and abdominal muscles. In order for the airways to remain free, you need to turn the patient on his side, clear the oropharynx of mucus and vomit using suction or a tampon, install an air duct if the tongue is retracted, and establish inhalation of humidified oxygen. When monitoring cardiac activity, the nurse notes a decrease (less than 60 per minute) and an increase (more than 90 per minute) in the pulse, its rhythm or arrhythmia; increase (above 140/90) decrease (below 100/60) pressure. Any abnormalities noticed should be reported to your doctor immediately.
Cardiac arrest can occur due to massive bleeding, brainstem herniation, thromboembolism and a number of other conditions. The doctor and nurse must be able to carry out the simplest cardiopulmonary resuscitation, which consists of performing mouth-to-mouth ventilation and indirect (external) cardiac ventilation. Such artificial maintenance is vital important functions possibly for tens of minutes and even several hours and allows you to ensure blood circulation, enrich it with oxygen and prevent the development of irreversible changes in the brain. The sooner resuscitation begins (3-5 minutes after cardiac arrest), the greater the chance of success. The main signs of the effectiveness of resuscitation measures are the appearance of a pulse on carotid artery, reduction of marbling skin, visible excursions of the chest when air is blown in. A good prognostic sign, which indicates the preservation of brain functions, is the constriction of the pupils, which dilated during cardiac arrest, restoration of the corneal reflex and the reaction of the pupils to light. During the period of mechanical ventilation and cardiac massage, the administration of drugs and the use of other resuscitation methods begin.
At the same time, we should not forget the statement of the famous Russian anesthesiologist-resuscitator A.P. Zilber, who noted that resuscitation should support life and not prolong death. If at least a minimal effect from resuscitation measures is not observed, they should be carried out for 30 minutes.
If necessary, the nurse feeds the patient through a tube. Puréed food or special nutritional mixtures are administered using Zhane's shiritsa. It is recommended to administer no more than 400-500 ml of the mixture per feeding, since a larger amount of food pushes the diaphragm into the chest, squeezing the lungs and heart and making cardiac activity and breathing difficult. The daily diet is divided into 5-6 meals
A large place in the work of a nurse is occupied by hygienic and therapeutic and preventive care for seriously ill patients: toileting the oral cavity, washing and scrubbing, making beds, changing linen. Measures to prevent bedsores are important: turning the patient from one position to another every 1.5-2 hours, wiping the skin camphor alcohol or alcohol solution with shampoo, which is also a kind of massage. A rubber circle or vessel is placed under the sacrum, and shoulder blades are placed under the back of the head. elbow joints and heels - special rings
In preventing congestion in the lungs great importance and places breathing exercises, which is carried out for seriously ill patients several times a day.
The disease, especially a chronic one, is accompanied by anxiety and can cause fear, irritability, and depression, which affects the course of the disease and the results of treatment. We must try to reassure the patient, instill in him confidence, if not in recovery, then in improving his well-being - this is a humane task and the duty of doctors.
In some cases, doctors have to hide the diagnosis from the patient in order to avoid severe psycho-emotional reactions.
Many neurological patients are elderly and old people. It is known that with age, many people’s character changes, resentment and vulnerability appear or intensify, and there is often a low mood caused by thoughts of mastered uselessness. Some patients consider themselves a burden to their family and society. This uniqueness of the human psyche, provoked or enhanced by a neurological disease, requires careful treatment from medical personnel. A nurse caring for such a patient needs great patience, tact and restraint. She should not react negatively to the patient’s verbosity, inconsistency, and whims. The nurse should express all her comments in the most tactful manner. Irritability is unacceptable, and even more so aggressive behavior towards the patient, which often leads to open conflict. This interferes with the first step of being a nurse - establishing a trusting relationship. Of course, such behavior can significantly worsen the patient’s condition and even negate the effect of therapy.
A family doctor and nurse must be able to establish contact with patients and resolve possible conflicts. On the one hand, this makes their work easier, and on the other hand, it allows them to improve the conditions for the patient to stay at home.
The article was prepared and edited by: surgeonThe nursing process in neurology is relevant because it is aimed at ensuring the physical independence of patients.
Stage I – medical nursing examination: passport data, complaints, objective examination, collection of social data and assessment of the patient’s psychological state. The patient's needs and problems are identified.
In neurological patients, the following needs are most often violated: to eat, to excrete, to move, to be clean, to communicate.
Stage II – nursing diagnosis, that is, a description of the patient’s health status.
For neurological patients, the following nursing diagnoses are most typical:
Pain associated with damage to various parts of the spine;
Numbness of any part of the body;
Headache various localizations and character associated with the disease;
Nausea, vomiting due to illness;
Decline physical activity due to paralysis (pain);
Inability to perform self-care;
Inability to feed yourself;
Overweight;
Urinary incontinence or retention;
Impaired bowel movements due to inability to use the toilet (defecation in a supine position);
Risk of bedsores;
Risk of contractures;
Risk of pulmonary congestion;
Sleep disturbance due to noise in the department (pain, etc.);
Difficulty communicating due to speech impairment;
Withdrawal from communication due to depression emotional state;
Uncertainty, anxiety due to helplessness;
Fear for your future.
Stage III - nurse action planning.
Goals are determined - short-term and long-term. A nurse action plan is drawn up and recorded in the nursing history or nursing care record.
Stage IV – implementation of planned actions– carried out according to the standards of nursing care for patients.
Stage V – assessment of the effectiveness of nursing care.
Evaluation criteria: patient response to nursing intervention; the degree to which the stated goals of nursing care are achieved; the effectiveness of nursing care on the patient’s condition; active search and assessment of new patient problems.
To provide complete care for neurological patients, a multi-level nursing care, including a junior nurse (medic).
Control questions:
1. What signs of movement disorders do you know?
2. Name the signs of sensory impairment.
3. What are the main differences clinical picture central and peripheral paralysis?
4. Name the symptoms of extrapyramidal movement disorders.
5. How is the conduction type of sensitivity disorder clinically different from the segmental one?
6. What symptoms of speech impairment do you know?
7. Name the symptoms of cerebellar damage.
8. Name the types of pelvic function disorders.
9. Name the symptoms of ANS disorders.
10. How is the function of movement studied?
11. How functions are studied cranial nerves?
12. How is sensitivity studied?
13. How is the function of the ANS studied?
14. Name additional research methods in neurology.
Date added: 2015-02-05 | Views: 1009 | Copyright infringement
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