Advanced Nursing of Spinal Patient 2 Flashcards
What is important to understand when assessing the spinal patient in terms of owner and patient?
- patient previous and current ailments
- normal activities
- owners desired and anticipated expectations
- owners ability to provide time and expertise
What is important to consider with the neurological patient?
- ambulation - non-ambulatory vs ambulatory
- surgery - surgical vs non-surgical
- continence - continent vs incontinent
- temperament
- recumbency
- normal routine
Common complications for spinal patients?
- decreased motor activity
- bladder and bowel management
- pressure sores
- wound management
- pain management
- respiratory support
Why is physiotherpay important?
- 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
What is the aim for physiotherapy?
promote motor and sensory recovery by generating movement for the patient
What is motor physiotherapy?
relearning movements
What is snesory physiotherapy?
stimulating proprioceptive relearning and retrain gait
What types of physiotherapy can we perform?
- massage
- passive range of motion (PROM)
- assisted exercise
- active exercise
- proprioceptive exercises
- neuromuscular electrical stimulation
- hot/cold therpy
- hydrotherapy
- laser therapy
What does massage help with?
- 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
What does PROM help with?
- aims to put each joint thorugh the normal range of motion and improve joint health without active muscule contraction
- aids with gait patterning
How do you perform PROM?
- 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
What are some examples of assisted exercise?
- assisted standing/walking
- assisted sit-stand
- three-legged standing
- weight shifting
What are active exercises?
- walking - straight line, circles, figure of 8, incline
- sit-stand
- sit-down
- hydrotherapy
What are proprioceptive exercises?
- standing
- wobble board
- uneven surfaces
- over poles
- weaving
- different surfaces - NOT ABRASIVE
What is included in hydrotherapy?
underwater treadmill or a pool
What does hot/cold therapy provide?
muscle relaxant and analgesia
What is Neuomuscular Electrical Stimulation?
increasing of the tissue perfusion and may aid in minimising onset and severity of muscle atrophy
What does neuromuscular electrical stimulation provide?
- sustained muscle contraction using dermal electrodes over the muscles
- increases tissue perfusion and can help to slow neurogenic muscle atrophy
Why would you use neuromuscular electric stimulation?
if a patient can’t produce active muscle contractions
What are the physiotherapy considerations, owner and patient?
- if patient has previous injuries/surgeries
- client expectations
- clients limits - time, expertise
- disease process
- neurolocalisation
- temperament
What bladder issues can spinal patients develop?
- upper motor bladder
- lower motor neuron bladder
What isupper motor bladder?
distended, difficult to express
Wha is lower motor neuron bladder?
distended but easy to express
If you pick a patient up and they dribble urine as slight pressure is applied, what type of bladder might they have?
lower motor neuron bladder
What is bladder atony?
weakening of thebladder muscle
What is pyelonephritis?
infection going up into the kidneys
What can happen if the bladder isn’t fully expressed?
UTI, bladder atony and pyelonephritis
Why are bladders that aren’t fully exptied prone to UTIs?
because the urine is static in the bladder
Why does overflow incontinence occur?
when the patient is unaware that their bladder is full
What can bladder overflow cause if it is constantly leaking onto the patient?
urine scalding
What is good bladder management?
catheterisation, bladder expression
How can we manage the bladder to gold standard?
- manual expression 3/4x daily
- intermittent aspetic catheterisation 2x daily
- indwelling catheterisation with closed connection system
- drug therapy
What are you monitoring with bladder care?
- change in colour or odour of urine
Why might a patient get faecal scalding?
they cannot move once they pass faeces so end up sitting it if not noticed
What bowel management can you do for a spinal patient?
- check and clean bottom regularly
- toilet training may be imprinted so opportunities to go outside important
- monitor patients with diarrhoea closely for scalding
What can pressure sores lead to?
ischemic necrosis
How can you prevent pressure sores?
- 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
How can you treat patients with pressure sores?
- keep clean and dry
- debride if necessary
- antibiotic if infection suspected
- bandaging
What spinal surgery causes more complications?
hemilaminectomy as there is a risk of seroma due to move skin movements
What can cold therapy be used for?
- analgesia
- decreasing inflammtion
How long should you provide cold therapy for?
15minutes 4x daily for 48-72 hours
What is important to remember when providing cold therapy?
cover the ice pack in something as cause cause cold burns
Why might a spinal patient self-mutilate?
- boredom
- paraesthesia
- stress
What patients might self-mutilation?
deeppain negative patients
What is paraesthesia?
- feeling of itchiness or pins and needles on a limb
Where can pain originate from?
- invertebral disc
- facets
- nerve roots
- muscles
- meninges
What types of pain is there?
- inflammatory
- neuropathic
- acute
- chronic
How can we identify pain?
- observation of the patients demeanous and self-mutilation
- palpation of the wound
- scoring - glasgow
How drugs can we give to prevent pain?
- opioids
- NSAIDs
- corticosteroids
- Alpha-2 agonists
- local anaesthetics
- cold therapy
What respiratory issues might spinal patients develop?
- hypoventilaiton
- atelectasis
- pneumonia
What is atelectasis?
partial collapse or incomplete inflation of the lung
How would you care for a patient with aspiration pneumonia?
- IV fluids
- oxygen therapy
- supportive care - respiratory physiotherapy
- close monitoring
What does physiotherapy aim for patients with aspiration pneumonia?
- aims to mobilise and expel the aspirated contents
What can you provide to patients with aspiration pneumonia?
- nebulisation, vibration and coupage
- walking//turning patients
- feeding balls of food from a height
How do you perform nebulisation?
- perform first to break up secretions
- place patient in sternal recumbency
- hold nebuliser close to patients nose/mouth for 10-15 minutes
How do you perform vibration for patients with aspiration pneumonia?
place hands on either side of the patients chest wall and create shaking movements each time the patient expires, loosening the aspirates
How do you perform coupage?
- 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
Why is nutrition important for the spinal patient?
- 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
