Neurology Nursing and Physiotherapy Flashcards
what are the main categories of disease which neurological patients fall into?
seizure
spinal cord injury
neuromuscular disease
head trauma
what are the main considerations of nursing the neuro patient?
are they ambulatory have they had surgery are the continent what is their temperament like are they recumbent what is their normal routine
what considerations may need to be made about a neuro patients temperament?
are they anxious
do they kennel guard
what effect will this have on the care possible
how should the kennel be set up for a neuro patient?
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
why should bedding be layered with incontinence sheets?
only one layer of bedding needs to be changed every time
why is vet bed used as the top layer of bedding?
will wick away urine and prevent the animal spending time sat in urine and urine scald
what must be considered about kennel access for the neuro patient?
how will the patient be moved in and out of the kennel and are they likely to kennel guard
what neuro patients may not be able to urinate for themselves?
paraplegic patients and some paretic
what are the 2 bladder types seen in neuro patients?
upper motor neuron bladder
lower motor neuron bladder
describe an upper motor neuron bladder
distended, difficult to express
describe a lower motor neuron bladder
distended
easy to express
how can a patients bladder be emptied?
manual expression
intermittent catheterisation
in-dwelling catheterisation
what does the method of emptying an incontinent patients bladder depend on?
the individual, how tolerant they are and their size
when does overflow incontinence occur?
when the patient is unaware that their bladder is full as their reflexes have been damaged
what happens during overflow incontinence?
bladder fills until it is overflowing
patient then leaks urine
what is the risk associated with a patient leaking urine due to overflow incontinence?
can cause urine scalding quite quickly
what is a continuously full bladder a risk factor for?
UTI
what can prevent the bladder from leaking and so avoid complications?
good bladder management such as catheterisation or bladder expression
when does urine scalding occur?
when urine is consistently left on a patients skin
what is caused by urine sitting on a patients skin?
soreness
erythema
breakdown of skin if left untreated
how is urine scalding prevented?
keeping incontinent patients clean and dry
what are the main causes of urine scald?
overflow incontinence
leaky bladder
how often should a patients bladder be expressed?
q6-8 hours (around 4 times a day)
how often should an intermittent catheter be placed?
BID
risk of iatrogenic trauma with each passing of the catheter
how often should an indwelling catheter bag be epmtied?
3-4 times a day depending on bag size
what sort of procedure is urinary catheterisation?
sterile
what are spinal injury patients very prone to?
UTI
what about the urine of neuro patients should be monitored?
smell
colour
turbidity
how should the neuro patients bladder be managed once at home?
owner needs to monitor for UTI and should speak to the vet if they have concerns
when does faecal incontinence occur?
when the patient is unable to control their bowel movements so faeces leak/fall out of the rectum
do the bowels continue to function in the paraplegic patient?
yes but the patient may not have full control
what may the faeces of an incontinent patient be like?
normally formed or may be soft
why must any faeces be removed from the patient’s bed quickly?
although they may be unaware they have passed is they can be very distressed by having faeces in their bed
what may be required to keep faecally incontinent patients clean and dry at all times?
regular bathing
check beds regularly
what is the issue with bathing patients with faecal incontinence?
may make the skin sore
how should a bath be performed on a patient who is having to be bathed regularly?
oatmeal shampoos
very gentle bathing
patting dry instead of rubbing to prevent trauma
what must faecally incontinent patients be checked for daily?
any changes to skin or sore spots
what can be applied if a faecally incontinent patient is becoming sore?
topical creams prescribed by vet and notedon hospital record
what is the issue with using nappies on pets once they are home to control faecal incontinence?
they may be left on for too long and so the faeces remain in contact with the skin and cause trauma
what patients are most at risk of decubital ulcers?
recumbent and paraplegic patients
what is a decubital ulcer?
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
where do decubital ulcers most often occur?
bony prominences such as the ileum, ischium, hock, olecranon and foot
why must decubital ulcers be treated quickly?
to prevent infection and to stop the lesion from getting larger
how often should recumbent patients be turned?
every 4 hours as minimum
more regularly for more bony breeds
how can decubital ulcers be prevented?
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
what is the issue with turning recumbent patients?
must be done with great care especially in patients with instabilities (e.g. spinal fractures)
should the hair around decubital ulcers be clipped?
not too close to prevent any further skin damage
what products can be used to prevent sores and care for patients skin?
clorexyderm
talcum powder
cavilon spray
flamazine (POM-V)
what is clorexyderm used for?
treatment of mild urine scalding
what is talc used for?
to help dry a patient after bathing and prevent excessive rubbing
what is flamazine used for?
surface thickness sores under the direction of a vet
what is cavilon spray used for?
no sting barrier used around anus and perineum when a patient has diarrhoea
should patients be exercised even if they can’t walk?
yes
why is it important that all patients are up and moving even if they cannot walk?
aids mental well-being by being allowed to exhibit normal behaviours e.g. sniffing outside for dogs
aside from mental well-being what is the other benefit of exercising a patient?
helps to mobilise joints and muscles in the limbs that work as well as the ones that don’t work
why must great care be taken when exercising plegic/paretic patients?
spine will be unstable so care and specialist equipment must be used
what equipment can be used to walk the paraparetic or paraplegic patient?
sling or rear harness
what position must the patients spine be in when walking using a sling/harness?
natural / neutral position
while being exercised what should patients be allowed to do?
exhibit normal behaviour and given the opportunity to pass urine/faeces if they are able to
how often should the paraparetic/paraplegic patient be turned if unable to turn themselves when rested?
every 2-4 hours
what equipment is used for paraparetic or paraplegic patients?
rear harness
foot covers
sling
how are foot covers used in paraparetic or paraplegic patients?
used to cover hind paws when walking to prevent trauma to hind toes and claws as they will drag on the floor
when may a sling be used for paraperetic/paraplegic patients?
when they are slightly more mobile
how should the tetraplegic/paratic patient be walked?
using a secure and supportive chest harness and a sling or rear harness
what equipment may be needed to move large tetraplegic/paratic patients?
hoist
if no hoist multiple people will be needed walk larger patients
why are foot cover required for tetraplegic/paratic patients?
all 4 paws should be covered to prevent damage to the patients feet when they drag along the floor
are most tetraparetic patients continent?
yes
how often should tetraplegic/paratic patients be turned?
every 2-4 hours
what equipment is needed to exercise tetraplegic/paratic patients?
chest harnesses
foot covers
what is the benefit of having a clip for a lead on a chest harness?
can be used if slip lead is contraindicated
where will spinal surgery patients have a wound?
either on their back or under their neck
which type of spinal surgery has the least wound complications?
ventral slot
what is the main wound complication seen with hemilaminectomy patients?
seroma
why is seroma more common in hemilaminectomy patients?
more skin movement
separation of more muscle and tissue layers
over the midline
what can cause seroma?
over exercise post surgery
what is the benefit of cold therapy for wound management?
provides analgesia
decreases inflammation
how often should cold therapy be used on wounds?
15 mins
four times a day
48-72 hours post op
what must you be careful of when using cold therapy on wounds?
wrap pack in a towel as direct contact with skin can lead to burns
what dressing can be used on spinal wounds?
primapore - prevents interferance
what should be used to walk ventral slot patients?
harness not slip lead
neck injury will be aggravated by lead on neck
when may self mutilation occur?
deep pain negative patients
why is self mutilation seen in deep pain negative patients?
paraesthesia
boredom
stress
what is paraesthesia?
an abnormal sensation, typically tingling or pricking (‘pins and needles’), caused chiefly by pressure on or damage to peripheral nerves
what should you do if a patient begins to lick or bite at any part of their body?
apply buster collar
look for potential triggers e.g. sores
what is an essential part of rehabilitating a patient with a spinal injury?
physiotherapy
what is the aim of physiotherapy for neuro patients?
can help keep joints and muscles mobile as well as retrain limbs to move correctly as mobility improves
what may be used alongside physiotherapy in some patients?
hydrotherapy
what physiotherapy can be performed by nurses?
basic exercises and massage under the direction of a chartered physiotherapist
what are the 2 main reasons to perform physiotherapy?
promote recovery
prevent further complications
how is physiotherapy involved in treatment of neuromuscular disease?
long term plan for physiotherapy
how is physiotherapy used to treat acute spinal chord damage?
aggressive therapy 1-2 weeks after trauma
what are examples of acute spinal cord damage?
fracture
fibrocartilaginous embolysm
how is physiotherapy used to treat chronic spinal cord damage?
low impact
low intensity
preservation of neuromuscular function
what is an example of chronic spinal cord damage?
disc herniation
how can physiotherapy be used to help patients with degenerative myopathy?
can lead to longer survival times
what are the benefits of physiotherapy?
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
what is the role of the VN in physiotherapy?
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)
where should patients be before physio is commenced?
should be clinically stable with all critical surgical and medical needs addressed
what is involved in the nursing care plan?
actual and potential problems identified
nursing interventions in place to solve and prevent
nursing evaluation
physio is involved in this
what must be encouraged during handing and moving of patients?
natural movement
when should patient handling and moving sessions occur?
short and regular
what is vital when handling and moving neuro patients?
keep the spine in line
take it slow
why are short and regular handling and moving sessions needed?
prevent fatigue and ensure that all movements are performed properly
what are the opportunities for good handling and moving?
grooming bathing massage turning feeding going outside
when involved in handling and moving what must you remember about teh experience for the patient?
make it a positive one - positive reinforcement
what are the main factors involved in deciding how and if physio should be provided?
patient
client
facility
staff
what are the patient factors involved in deciding how and if physio should be provided?
size (and so staff needed) temperament degree of disability location of incision(s) IV or urinary catheter bandages and external coapation comorbidities
what are the client factors involved in deciding how and if physio should be provided?
physical abilities financial resources schedule and household restrictions emotional needs any concerns
what are the facility factors involved in deciding how and if physio should be provided?
size of space indoor or outdoor availability of lift equipment appropriate modalities facility hours adequate bedding and housing
what are the staff factors involved in deciding how and if physio should be provided?
availability of sufficient support staff
proper training and experience
physical ability to lift and transport patients
access to specialists
what are the considerations involved in providing physiotherapy?
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
what are the main areas involved in physiotherapy?
massage passive range of motion (PROM) assisted exercises active exercises proprioceptive exercises neuromuscular electrical stimulation
what other therapies may be involved with physio?
hot/cold therapy
hydrotherapy
laser therapy
what are the main massage techniques used?
effleurage
petrissage
percussion
vibration
when is effleurage used?
at the start of each physio session
describe effleurage
gentle contact with the palm of the hand - stroke towards the heart
where can effleurage be used?
all over the body
how long should effleurage last for?
~5 mins
what happens during petrissage?
therapist rolls, squeezes, compresses and kneads the skin and muscles
what is the aim of petrissage?
increase circulation
what is involved in percussion?
gentle tapping of the skin with the palm or the side of the hand
what is the aim of percussion?
increases blood supply and aids relaxation of muscle
when is percussion often performed?
not always used but often at the end of a session
what happens during vibration?
limbs are gently shaken to stimulate the whole limb
what is vibration good for?
relaxation at the end of the massage session
when is respiratory physiotherapy important?
in recumbent patients and those suffering from pulmonary disease or aspiration pneumonai
what is the aim of respiratory physio?
loosens secretions and assists in airway clearence by coughing
what patients should not receive respiratory physio?
those with fractured ribs
thoracic trauma
patients who cannot cough
how is coupage performed?
cupped hands beat on the chest from caudal to cranial
what is the most common type of physio used?
PROM
what is involved in PROM?
external force applied to the limbs/axial skeleton to aid joint mobilisation and stretching within normal range of motion
what must you monitor for when performing PROM?
pain
what is the aim of PROM?
joint mobilisation and stretching
when should PROM be performed?
3-4 times a day for 10 mins
where should PROM be started?
at toes and move more proximally
what must be considered when performing PROM?
any co-morbidites that may reduce or impact PROM
what is involved in assisted exercises?
helping patient to perform a familiar movement (e.g. sit)
what can be included in assisted exercises?
assisted standing/walking
assisted sit-stand
three legged standing
weight shifting
what is the benefit of three legged standing?
aid proprioception
what is involved in weight shifting during assisted exercise?
hold hips and move from side to side to get the patient to rectify the movement
what is the aim of proprioceptive exercise?
improves sensation and awareness of limbs
what exercises are involved in proprioceptive exercise?
standing wobble board uneven surface over poles weaving different surfaces
what proprioceptive exercises are used?
depends on where the patient is in their recovery
why are active exercises performed?
improve strength
promote independence with functional activities
how are active exercises performed?
actively carry out movement or part of a movement to encourage memory
functional exercises
repeated to stimulate nerves
what is involved in active exercise?
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
what can be used for hydrotherapy?
underwater treadmill
pool
where should the water level be to start with in a underwater treadmill?
start high to support weight and reduce joint impact
what patients cannot use the pool initially?
ventral slot
why is the pool not suitable for ventral slot patients until after they have fully healed from surgery?
swimming position puts strain on neck and wound
what is E-stim?
neuromuscular electrical nerve stimulation
what is E-Stim applied to?
skeletal muscle
what is the E-Stim used for?
stimulation of muscle contraction
how is E-Stim delivered to the muscles?
percutaneously
what is the effect of E-Stim lng term?
increases tissue perfusion and can help to slow neurogenic muscle atrophy
what is the other type of E-Stim?
electrical muscle stimulation performed through needle shaped electrodes inserted into the muscle - not commonly used and invasive
what are the benefits of E-Stim?
increases muscle strength increases ROM improves muscle tone enhances function control of pain oedema reduction reduction of muscle spasm
how are effective muscle contractions generated by E-Stim?
1 electrode placed by the motor point of the muscle
the other placed along the muscle body
check for muscle contraction (will be quick)
is E-Stim continuous?
no - contraction and rest cycles
what are the most common E-Stim settings?
1:2 or 1:5
who chooses the E-Stim settings for each patient?
physio
can pulse intensity be altered on E-Stim?
yes
how much E-Stim should a patient have per day?
10-20 mins if tolerated
how are electrodes applied for E-Stim?
clip hair over muscle clean with spirit apply conducting gel to clipped patches in correct loaction (U/S) place electrodes on gel set cycle
