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Neurology Nursing and Physiotherapy Flashcards

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1
Q

what are the main categories of disease which neurological patients fall into?

A

seizure
spinal cord injury
neuromuscular disease
head trauma

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2
Q

what are the main considerations of nursing the neuro patient?

A 
are they ambulatory
have they had surgery
are the continent
what is their temperament like
are they recumbent
what is their normal routine
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3
Q

what considerations may need to be made about a neuro patients temperament?

A

are they anxious
do they kennel guard
what effect will this have on the care possible

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4
Q

how should the kennel be set up for a neuro patient?

A

thick bedding (duvet or mattress) for the bottom layer
layer bedding with incontinence pads
use a soft vet bed as the top layer to wick away urine
pad the sides of the kennel with pillows

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5
Q

why should bedding be layered with incontinence sheets?

A

only one layer of bedding needs to be changed every time

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6
Q

why is vet bed used as the top layer of bedding?

A

will wick away urine and prevent the animal spending time sat in urine and urine scald

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7
Q

what must be considered about kennel access for the neuro patient?

A

how will the patient be moved in and out of the kennel and are they likely to kennel guard

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8
Q

what neuro patients may not be able to urinate for themselves?

A

paraplegic patients and some paretic

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9
Q

what are the 2 bladder types seen in neuro patients?

A

upper motor neuron bladder

lower motor neuron bladder

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10
Q

describe an upper motor neuron bladder

A

distended, difficult to express

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11
Q

describe a lower motor neuron bladder

A

distended

easy to express

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12
Q

how can a patients bladder be emptied?

A

manual expression
intermittent catheterisation
in-dwelling catheterisation

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13
Q

what does the method of emptying an incontinent patients bladder depend on?

A

the individual, how tolerant they are and their size

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14
Q

when does overflow incontinence occur?

A

when the patient is unaware that their bladder is full as their reflexes have been damaged

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15
Q

what happens during overflow incontinence?

A

bladder fills until it is overflowing

patient then leaks urine

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16
Q

what is the risk associated with a patient leaking urine due to overflow incontinence?

A

can cause urine scalding quite quickly

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17
Q

what is a continuously full bladder a risk factor for?

A

UTI

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18
Q

what can prevent the bladder from leaking and so avoid complications?

A

good bladder management such as catheterisation or bladder expression

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19
Q

when does urine scalding occur?

A

when urine is consistently left on a patients skin

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20
Q

what is caused by urine sitting on a patients skin?

A

soreness
erythema
breakdown of skin if left untreated

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21
Q

how is urine scalding prevented?

A

keeping incontinent patients clean and dry

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22
Q

what are the main causes of urine scald?

A

overflow incontinence

leaky bladder

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23
Q

how often should a patients bladder be expressed?

A

q6-8 hours (around 4 times a day)

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24
Q

how often should an intermittent catheter be placed?

A

BID

risk of iatrogenic trauma with each passing of the catheter

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25
Q

how often should an indwelling catheter bag be epmtied?

A

3-4 times a day depending on bag size

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26
Q

what sort of procedure is urinary catheterisation?

A

sterile

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27
Q

what are spinal injury patients very prone to?

A

UTI

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28
Q

what about the urine of neuro patients should be monitored?

A

smell
colour
turbidity

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29
Q

how should the neuro patients bladder be managed once at home?

A

owner needs to monitor for UTI and should speak to the vet if they have concerns

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30
Q

when does faecal incontinence occur?

A

when the patient is unable to control their bowel movements so faeces leak/fall out of the rectum

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31
Q

do the bowels continue to function in the paraplegic patient?

A

yes but the patient may not have full control

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32
Q

what may the faeces of an incontinent patient be like?

A

normally formed or may be soft

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33
Q

why must any faeces be removed from the patient’s bed quickly?

A

although they may be unaware they have passed is they can be very distressed by having faeces in their bed

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34
Q

what may be required to keep faecally incontinent patients clean and dry at all times?

A

regular bathing

check beds regularly

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35
Q

what is the issue with bathing patients with faecal incontinence?

A

may make the skin sore

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36
Q

how should a bath be performed on a patient who is having to be bathed regularly?

A

oatmeal shampoos
very gentle bathing
patting dry instead of rubbing to prevent trauma

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37
Q

what must faecally incontinent patients be checked for daily?

A

any changes to skin or sore spots

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38
Q

what can be applied if a faecally incontinent patient is becoming sore?

A

topical creams prescribed by vet and notedon hospital record

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39
Q

what is the issue with using nappies on pets once they are home to control faecal incontinence?

A

they may be left on for too long and so the faeces remain in contact with the skin and cause trauma

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40
Q

what patients are most at risk of decubital ulcers?

A

recumbent and paraplegic patients

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41
Q

what is a decubital ulcer?

A

open skin wound caused by continued pressure of the skin on a firm surface. This pressure eventually causes tissue ischemia in the skin leading to injury

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42
Q

where do decubital ulcers most often occur?

A

bony prominences such as the ileum, ischium, hock, olecranon and foot

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43
Q

why must decubital ulcers be treated quickly?

A

to prevent infection and to stop the lesion from getting larger

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44
Q

how often should recumbent patients be turned?

A

every 4 hours as minimum

more regularly for more bony breeds

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45
Q

how can decubital ulcers be prevented?

A

turn every 4 hours
deep, padded bedding
keep patients clean and dry
donut bandages on hocks and elbows can prevent sores or aid healing
prop patients up into sternal for comfort

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46
Q

what is the issue with turning recumbent patients?

A

must be done with great care especially in patients with instabilities (e.g. spinal fractures)

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47
Q

should the hair around decubital ulcers be clipped?

A

not too close to prevent any further skin damage

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48
Q

what products can be used to prevent sores and care for patients skin?

A

clorexyderm
talcum powder
cavilon spray
flamazine (POM-V)

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49
Q

what is clorexyderm used for?

A

treatment of mild urine scalding

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50
Q

what is talc used for?

A

to help dry a patient after bathing and prevent excessive rubbing

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51
Q

what is flamazine used for?

A

surface thickness sores under the direction of a vet

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52
Q

what is cavilon spray used for?

A

no sting barrier used around anus and perineum when a patient has diarrhoea

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53
Q

should patients be exercised even if they can’t walk?

A

yes

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54
Q

why is it important that all patients are up and moving even if they cannot walk?

A

aids mental well-being by being allowed to exhibit normal behaviours e.g. sniffing outside for dogs

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55
Q

aside from mental well-being what is the other benefit of exercising a patient?

A

helps to mobilise joints and muscles in the limbs that work as well as the ones that don’t work

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56
Q

why must great care be taken when exercising plegic/paretic patients?

A

spine will be unstable so care and specialist equipment must be used

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57
Q

what equipment can be used to walk the paraparetic or paraplegic patient?

A

sling or rear harness

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58
Q

what position must the patients spine be in when walking using a sling/harness?

A

natural / neutral position

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59
Q

while being exercised what should patients be allowed to do?

A

exhibit normal behaviour and given the opportunity to pass urine/faeces if they are able to

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60
Q

how often should the paraparetic/paraplegic patient be turned if unable to turn themselves when rested?

A

every 2-4 hours

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61
Q

what equipment is used for paraparetic or paraplegic patients?

A

rear harness
foot covers
sling

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62
Q

how are foot covers used in paraparetic or paraplegic patients?

A

used to cover hind paws when walking to prevent trauma to hind toes and claws as they will drag on the floor

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63
Q

when may a sling be used for paraperetic/paraplegic patients?

A

when they are slightly more mobile

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64
Q

how should the tetraplegic/paratic patient be walked?

A

using a secure and supportive chest harness and a sling or rear harness

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65
Q

what equipment may be needed to move large tetraplegic/paratic patients?

A

hoist

if no hoist multiple people will be needed walk larger patients

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66
Q

why are foot cover required for tetraplegic/paratic patients?

A

all 4 paws should be covered to prevent damage to the patients feet when they drag along the floor

67
Q

are most tetraparetic patients continent?

A

yes

68
Q

how often should tetraplegic/paratic patients be turned?

A

every 2-4 hours

69
Q

what equipment is needed to exercise tetraplegic/paratic patients?

A

chest harnesses

foot covers

70
Q

what is the benefit of having a clip for a lead on a chest harness?

A

can be used if slip lead is contraindicated

71
Q

where will spinal surgery patients have a wound?

A

either on their back or under their neck

72
Q

which type of spinal surgery has the least wound complications?

A

ventral slot

73
Q

what is the main wound complication seen with hemilaminectomy patients?

A

seroma

74
Q

why is seroma more common in hemilaminectomy patients?

A

more skin movement
separation of more muscle and tissue layers
over the midline

75
Q

what can cause seroma?

A

over exercise post surgery

76
Q

what is the benefit of cold therapy for wound management?

A

provides analgesia

decreases inflammation

77
Q

how often should cold therapy be used on wounds?

A

15 mins
four times a day
48-72 hours post op

78
Q

what must you be careful of when using cold therapy on wounds?

A

wrap pack in a towel as direct contact with skin can lead to burns

79
Q

what dressing can be used on spinal wounds?

A

primapore - prevents interferance

80
Q

what should be used to walk ventral slot patients?

A

harness not slip lead

neck injury will be aggravated by lead on neck

81
Q

when may self mutilation occur?

A

deep pain negative patients

82
Q

why is self mutilation seen in deep pain negative patients?

A

paraesthesia
boredom
stress

83
Q

what is paraesthesia?

A

an abnormal sensation, typically tingling or pricking (‘pins and needles’), caused chiefly by pressure on or damage to peripheral nerves

84
Q

what should you do if a patient begins to lick or bite at any part of their body?

A

apply buster collar

look for potential triggers e.g. sores

85
Q

what is an essential part of rehabilitating a patient with a spinal injury?

A

physiotherapy

86
Q

what is the aim of physiotherapy for neuro patients?

A

can help keep joints and muscles mobile as well as retrain limbs to move correctly as mobility improves

87
Q

what may be used alongside physiotherapy in some patients?

A

hydrotherapy

88
Q

what physiotherapy can be performed by nurses?

A

basic exercises and massage under the direction of a chartered physiotherapist

89
Q

what are the 2 main reasons to perform physiotherapy?

A

promote recovery

prevent further complications

90
Q

how is physiotherapy involved in treatment of neuromuscular disease?

A

long term plan for physiotherapy

91
Q

how is physiotherapy used to treat acute spinal chord damage?

A

aggressive therapy 1-2 weeks after trauma

92
Q

what are examples of acute spinal cord damage?

A

fracture

fibrocartilaginous embolysm

93
Q

how is physiotherapy used to treat chronic spinal cord damage?

A

low impact
low intensity
preservation of neuromuscular function

94
Q

what is an example of chronic spinal cord damage?

A

disc herniation

95
Q

how can physiotherapy be used to help patients with degenerative myopathy?

A

can lead to longer survival times

96
Q

what are the benefits of physiotherapy?

A 
pain management
improve range of motion
reduce muscle contracture and tension
stimulate nervous system
improve blood perfusion
improve cardiorespiratory capacity
encourage relearning of motor patterns
weight management
97
Q

what is the role of the VN in physiotherapy?

A

physio not always available and nurse will be on ward
full work up will happen with VS and nurse
discussion and plan made with VS, VN and PT
VN to record any changes seen (positive or negative)

98
Q

where should patients be before physio is commenced?

A

should be clinically stable with all critical surgical and medical needs addressed

99
Q

what is involved in the nursing care plan?

A

actual and potential problems identified
nursing interventions in place to solve and prevent
nursing evaluation
physio is involved in this

100
Q

what must be encouraged during handing and moving of patients?

A

natural movement

101
Q

when should patient handling and moving sessions occur?

A

short and regular

102
Q

what is vital when handling and moving neuro patients?

A

keep the spine in line

take it slow

103
Q

why are short and regular handling and moving sessions needed?

A

prevent fatigue and ensure that all movements are performed properly

104
Q

what are the opportunities for good handling and moving?

A 
grooming
bathing
massage
turning
feeding
going outside
105
Q

when involved in handling and moving what must you remember about teh experience for the patient?

A

make it a positive one - positive reinforcement

106
Q

what are the main factors involved in deciding how and if physio should be provided?

A

patient
client
facility
staff

107
Q

what are the patient factors involved in deciding how and if physio should be provided?

A 
size (and so staff needed)
temperament
degree of disability
location of incision(s)
IV or urinary catheter
bandages and external coapation
comorbidities
108
Q

what are the client factors involved in deciding how and if physio should be provided?

A 
physical abilities
financial resources
schedule and household restrictions
emotional needs
any concerns
109
Q

what are the facility factors involved in deciding how and if physio should be provided?

A 
size of space
indoor or outdoor
availability of lift equipment
appropriate modalities
facility hours
adequate bedding and housing
110
Q

what are the staff factors involved in deciding how and if physio should be provided?

A

availability of sufficient support staff
proper training and experience
physical ability to lift and transport patients
access to specialists

111
Q

what are the considerations involved in providing physiotherapy?

A

assessment of the patient to ensure correct care
involve patient and owner
understand: comorbidities, normal activities, owners expectations, owners provision of time and their expertise

112
Q

what are the main areas involved in physiotherapy?

A 
massage
passive range of motion (PROM)
assisted exercises
active exercises
proprioceptive exercises
neuromuscular electrical stimulation
113
Q

what other therapies may be involved with physio?

A

hot/cold therapy
hydrotherapy
laser therapy

114
Q

what are the main massage techniques used?

A

effleurage
petrissage
percussion
vibration

115
Q

when is effleurage used?

A

at the start of each physio session

116
Q

describe effleurage

A

gentle contact with the palm of the hand - stroke towards the heart

117
Q

where can effleurage be used?

A

all over the body

118
Q

how long should effleurage last for?

A

~5 mins

119
Q

what happens during petrissage?

A

therapist rolls, squeezes, compresses and kneads the skin and muscles

120
Q

what is the aim of petrissage?

A

increase circulation

121
Q

what is involved in percussion?

A

gentle tapping of the skin with the palm or the side of the hand

122
Q

what is the aim of percussion?

A

increases blood supply and aids relaxation of muscle

123
Q

when is percussion often performed?

A

not always used but often at the end of a session

124
Q

what happens during vibration?

A

limbs are gently shaken to stimulate the whole limb

125
Q

what is vibration good for?

A

relaxation at the end of the massage session

126
Q

when is respiratory physiotherapy important?

A

in recumbent patients and those suffering from pulmonary disease or aspiration pneumonai

127
Q

what is the aim of respiratory physio?

A

loosens secretions and assists in airway clearence by coughing

128
Q

what patients should not receive respiratory physio?

A

those with fractured ribs
thoracic trauma
patients who cannot cough

129
Q

how is coupage performed?

A

cupped hands beat on the chest from caudal to cranial

130
Q

what is the most common type of physio used?

A

PROM

131
Q

what is involved in PROM?

A

external force applied to the limbs/axial skeleton to aid joint mobilisation and stretching within normal range of motion

132
Q

what must you monitor for when performing PROM?

A

pain

133
Q

what is the aim of PROM?

A

joint mobilisation and stretching

134
Q

when should PROM be performed?

A

3-4 times a day for 10 mins

135
Q

where should PROM be started?

A

at toes and move more proximally

136
Q

what must be considered when performing PROM?

A

any co-morbidites that may reduce or impact PROM

137
Q

what is involved in assisted exercises?

A

helping patient to perform a familiar movement (e.g. sit)

138
Q

what can be included in assisted exercises?

A

assisted standing/walking
assisted sit-stand
three legged standing
weight shifting

139
Q

what is the benefit of three legged standing?

A

aid proprioception

140
Q

what is involved in weight shifting during assisted exercise?

A

hold hips and move from side to side to get the patient to rectify the movement

141
Q

what is the aim of proprioceptive exercise?

A

improves sensation and awareness of limbs

142
Q

what exercises are involved in proprioceptive exercise?

A 
standing
wobble board
uneven surface
over poles
weaving
different surfaces
143
Q

what proprioceptive exercises are used?

A

depends on where the patient is in their recovery

144
Q

why are active exercises performed?

A

improve strength

promote independence with functional activities

145
Q

how are active exercises performed?

A

actively carry out movement or part of a movement to encourage memory
functional exercises
repeated to stimulate nerves

146
Q

what is involved in active exercise?

A

lead exercise - slow and gradually increase
add in steps, stairs and ramps
figure of 8 and circles to improve balance
sit to stand
pole walking
weight sifting
movement of head and neck with balls and treats
hydrotherapy

147
Q

what can be used for hydrotherapy?

A

underwater treadmill

pool

148
Q

where should the water level be to start with in a underwater treadmill?

A

start high to support weight and reduce joint impact

149
Q

what patients cannot use the pool initially?

A

ventral slot

150
Q

why is the pool not suitable for ventral slot patients until after they have fully healed from surgery?

A

swimming position puts strain on neck and wound

151
Q

what is E-stim?

A

neuromuscular electrical nerve stimulation

152
Q

what is E-Stim applied to?

A

skeletal muscle

153
Q

what is the E-Stim used for?

A

stimulation of muscle contraction

154
Q

how is E-Stim delivered to the muscles?

A

percutaneously

155
Q

what is the effect of E-Stim lng term?

A

increases tissue perfusion and can help to slow neurogenic muscle atrophy

156
Q

what is the other type of E-Stim?

A

electrical muscle stimulation performed through needle shaped electrodes inserted into the muscle - not commonly used and invasive

157
Q

what are the benefits of E-Stim?

A 
increases muscle strength
increases ROM
improves muscle tone
enhances function
control of pain
oedema reduction
reduction of muscle spasm
158
Q

how are effective muscle contractions generated by E-Stim?

A

1 electrode placed by the motor point of the muscle
the other placed along the muscle body
check for muscle contraction (will be quick)

159
Q

is E-Stim continuous?

A

no - contraction and rest cycles

160
Q

what are the most common E-Stim settings?

A

1:2 or 1:5

161
Q

who chooses the E-Stim settings for each patient?

A

physio

162
Q

can pulse intensity be altered on E-Stim?

A

yes

163
Q

how much E-Stim should a patient have per day?

A

10-20 mins if tolerated

164
Q

how are electrodes applied for E-Stim?

A 
clip hair over muscle
clean with spirit
apply conducting gel to clipped patches in correct loaction (U/S)
place electrodes on gel
set cycle

x clinical veterinary nursing theory (70 decks)

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