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ACVN - SURGICAL NURSING > Advanced Nursing of Spinal Patient 2 > Flashcards

Advanced Nursing of Spinal Patient 2 Flashcards

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1
Q

What is important to understand when assessing the spinal patient in terms of owner and patient?

A
  • patient previous and current ailments
  • normal activities
  • owners desired and anticipated expectations
  • owners ability to provide time and expertise
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2
Q

What is important to consider with the neurological patient?

A
  • ambulation - non-ambulatory vs ambulatory
  • surgery - surgical vs non-surgical
  • continence - continent vs incontinent
  • temperament
  • recumbency
  • normal routine
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3
Q

Common complications for spinal patients?

A
  • decreased motor activity
  • bladder and bowel management
  • pressure sores
  • wound management
  • pain management
  • respiratory support
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4
Q

Why is physiotherpay important?

A
  • improves local and whole body circulation
  • reduce pain
  • bonding between nurse/physio and patient
  • prevent pressure sore
  • aids motor recovery
  • maintains joint health
  • limits muscle wastage
  • prevents contracture
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5
Q

What is the aim for physiotherapy?

A

promote motor and sensory recovery by generating movement for the patient

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6
Q

What is motor physiotherapy?

A

relearning movements

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7
Q

What is snesory physiotherapy?

A

stimulating proprioceptive relearning and retrain gait

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8
Q

What types of physiotherapy can we perform?

A
  • massage
  • passive range of motion (PROM)
  • assisted exercise
  • active exercise
  • proprioceptive exercises
  • neuromuscular electrical stimulation
  • hot/cold therpy
  • hydrotherapy
  • laser therapy
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9
Q

What does massage help with?

A
  • calming the patient and getting them used to be handled
  • aids with improvement in local and whole body circulation
  • mobilises the dermal and subdermal tissues
  • warms the muscles and tissues
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10
Q

What does PROM help with?

A
  • aims to put each joint thorugh the normal range of motion and improve joint health without active muscule contraction
  • aids with gait patterning
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11
Q

How do you perform PROM?

A
  • gently flex and extend each joint of the limb through its normal range of motion 10-15 times
  • start with the toes and work your way up to the hock, stifle then hip
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12
Q

What are some examples of assisted exercise?

A
  • assisted standing/walking
  • assisted sit-stand
  • three-legged standing
  • weight shifting
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13
Q

What are active exercises?

A
  • walking - straight line, circles, figure of 8, incline
  • sit-stand
  • sit-down
  • hydrotherapy
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14
Q

What are proprioceptive exercises?

A
  • standing
  • wobble board
  • uneven surfaces
  • over poles
  • weaving
  • different surfaces - NOT ABRASIVE
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15
Q

What is included in hydrotherapy?

A

underwater treadmill or a pool

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16
Q

What does hot/cold therapy provide?

A

muscle relaxant and analgesia

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17
Q

What is Neuomuscular Electrical Stimulation?

A

increasing of the tissue perfusion and may aid in minimising onset and severity of muscle atrophy

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18
Q

What does neuromuscular electrical stimulation provide?

A
  • sustained muscle contraction using dermal electrodes over the muscles
  • increases tissue perfusion and can help to slow neurogenic muscle atrophy
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19
Q

Why would you use neuromuscular electric stimulation?

A

if a patient can’t produce active muscle contractions

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20
Q

What are the physiotherapy considerations, owner and patient?

A
  • if patient has previous injuries/surgeries
  • client expectations
  • clients limits - time, expertise
  • disease process
  • neurolocalisation
  • temperament
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21
Q

What bladder issues can spinal patients develop?

A
  • upper motor bladder
  • lower motor neuron bladder
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22
Q

What isupper motor bladder?

A

distended, difficult to express

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23
Q

Wha is lower motor neuron bladder?

A

distended but easy to express

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24
Q

If you pick a patient up and they dribble urine as slight pressure is applied, what type of bladder might they have?

A

lower motor neuron bladder

25
Q

What is bladder atony?

A

weakening of thebladder muscle

26
Q

What is pyelonephritis?

A

infection going up into the kidneys

27
Q

What can happen if the bladder isn’t fully expressed?

A

UTI, bladder atony and pyelonephritis

28
Q

Why are bladders that aren’t fully exptied prone to UTIs?

A

because the urine is static in the bladder

29
Q

Why does overflow incontinence occur?

A

when the patient is unaware that their bladder is full

30
Q

What can bladder overflow cause if it is constantly leaking onto the patient?

A

urine scalding

31
Q

What is good bladder management?

A

catheterisation, bladder expression

32
Q

How can we manage the bladder to gold standard?

A
  • manual expression 3/4x daily
  • intermittent aspetic catheterisation 2x daily
  • indwelling catheterisation with closed connection system
  • drug therapy
33
Q

What are you monitoring with bladder care?

A
  • change in colour or odour of urine
34
Q

Why might a patient get faecal scalding?

A

they cannot move once they pass faeces so end up sitting it if not noticed

35
Q

What bowel management can you do for a spinal patient?

A
  • check and clean bottom regularly
  • toilet training may be imprinted so opportunities to go outside important
  • monitor patients with diarrhoea closely for scalding
36
Q

What can pressure sores lead to?

A

ischemic necrosis

37
Q

How can you prevent pressure sores?

A
  • thick padded bedding
  • turn patients every 204hours
  • donut bandage
  • porous bedding such as a vetbed
  • incontience pads
  • non-slippery surfaces
  • prop patients up on pillows for comfort
  • physical therapy
  • monitor
  • ensure skin is dry
  • express bladder/indwelling catheter
  • clean dry bedding
38
Q

How can you treat patients with pressure sores?

A
  • keep clean and dry
  • debride if necessary
  • antibiotic if infection suspected
  • bandaging
39
Q

What spinal surgery causes more complications?

A

hemilaminectomy as there is a risk of seroma due to move skin movements

40
Q

What can cold therapy be used for?

A
  • analgesia
  • decreasing inflammtion
41
Q

How long should you provide cold therapy for?

A

15minutes 4x daily for 48-72 hours

42
Q

What is important to remember when providing cold therapy?

A

cover the ice pack in something as cause cause cold burns

43
Q

Why might a spinal patient self-mutilate?

A
  • boredom
  • paraesthesia
  • stress
44
Q

What patients might self-mutilation?

A

deeppain negative patients

45
Q

What is paraesthesia?

A
  • feeling of itchiness or pins and needles on a limb
46
Q

Where can pain originate from?

A
  • invertebral disc
  • facets
  • nerve roots
  • muscles
  • meninges
47
Q

What types of pain is there?

A
  • inflammatory
  • neuropathic
  • acute
  • chronic
48
Q

How can we identify pain?

A
  • observation of the patients demeanous and self-mutilation
  • palpation of the wound
  • scoring - glasgow
49
Q

How drugs can we give to prevent pain?

A
  • opioids
  • NSAIDs
  • corticosteroids
  • Alpha-2 agonists
  • local anaesthetics
  • cold therapy
50
Q

What respiratory issues might spinal patients develop?

A
  • hypoventilaiton
  • atelectasis
  • pneumonia
51
Q

What is atelectasis?

A

partial collapse or incomplete inflation of the lung

52
Q

How would you care for a patient with aspiration pneumonia?

A
  • IV fluids
  • oxygen therapy
  • supportive care - respiratory physiotherapy
  • close monitoring
53
Q

What does physiotherapy aim for patients with aspiration pneumonia?

A
  • aims to mobilise and expel the aspirated contents
54
Q

What can you provide to patients with aspiration pneumonia?

A
  • nebulisation, vibration and coupage
  • walking//turning patients
  • feeding balls of food from a height
55
Q

How do you perform nebulisation?

A
  • perform first to break up secretions
  • place patient in sternal recumbency
  • hold nebuliser close to patients nose/mouth for 10-15 minutes
56
Q

How do you perform vibration for patients with aspiration pneumonia?

A

place hands on either side of the patients chest wall and create shaking movements each time the patient expires, loosening the aspirates

57
Q

How do you perform coupage?

A
  • cup hands over patients chest and perform rhythmic clapping movements cranially up the chest
  • should be performed for 10 minutes 3 to 4 times daily
  • aims to lossen contents durther
  • patients should cough up secretions
58
Q

Why is nutrition important for the spinal patient?

A
  • patients have undergone physical and psychological stress
  • some are unwilling/unable to eat important to calculate RER
  • hand feed or ask owners to come in for feeding

ACVN - SURGICAL NURSING (17 decks)

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