Nursing The Recumbent Patient & Physiotherapy Flashcards
What does recumbent mean?
It describes a patient that is in lying position
(lateral, sternal, dorsal)
How is mobility assessed?
- must understand normal for the animal
- normal exercise routine, timing, frequency, limitations, concurrent conditions and life stage
- must observe and evaluate movement, weakness, stiffness, gait, posture, weight distribution, and if fully or partially recumbent
What can be impacted in recumbent patients?
- exercise
- urination
- defecation
- drinking or eating normally
- breathe normally
- maintain body temperature
- grooming
Potential problems caused by recumbency?
- unable to eat leading to weight loss
- unable to drink leading to dehydration
- difficulty urinating and defacating leading to accidents
- breathlessness or panting
- hyperthermia or hypothermia
- can’t groom themselves
- unable to move
What nursing intervention can be provided for recumbent patients?
- supported sitting
- supported standing and walking
(lifting, slings, harnesses, patient trolley) - physiotherapy
(massage, passive exercise)
Interventions for patients with difficulty eating and drinking?
- ensure they have access to bowls
- supported sitting and assisted feeding
- easy to swallow food
- pain and nausea management
- saliva or pinch skin to manage hydration levels
Interventions for patients with difficulty urinating and defacating?
- assisted walking techniques
- provide absorbent bedding
- manual expression or laxatives
- urinary catheterisation
- monitor frequency, consistency, colour, volume
What can cause soiling of skin/fur and what can it lead to?
- caused by urine, faeces, blood, saliva, vomit or pus
- can cause infection or disease of skin
- can be uncomfortable
Intervention for patients with soiled skin/fur?
- provide absorbent bedding
- bed baths (however risk of hyperthermia)
- assisted walking
- clipping hair/application of barrier creams
- tail bandaging
What is Hypostatic Pneumonia?
Where lack of movement results in pooling of blood within the lungs
This causes fluid to accumulate in the tissues, atelectasis, decreased oxygenation, and increasing risk of infection
What are signs of hypostatic pneumonia?
- rapid, shallow breathing
- dyspnoea
- moist breath sounds
- coughing
- depression
Treating hypostatic pneumonia?
- turn patients every 4 hours (3 - 6 hours)
- encourage supported sitting
- physiotherapy (massage, active exercise)
- refer to vet for pain management plan
What is Hypothermia?
- when the core body temperature is less than 37*
- seen in neonates, geriatrics, small patients, slim breeds, recumbent/low mobility, after anaesthetic or sedation
How can Hypothermia be treated?
- blankets, vet beds, socks (passive)
- heat mat, increased room temperature, hot hands (active-external)
- warmed IV fluids, warm water enema (active-internal)
- keep animal dry and warm gradually
What can cause Hyperthermia?
- if patient is unable to move away from the heat source causing overheating
- if room temperature is too high
- most common in stressed patients
What are Decubitus Ulcers and where are they seen?
- ‘bed sores’
- spine of scapula, elbow, sternum, pelvic pin bones, stifle
How can decubitus ulcers be prevented?
- soft bedding
- dry bedding
- regular turning
- padding bony prominences
- physiotherapy or assisted walking
- monitor skin circulation
How to treat decubitus ulcers?
- apply water soluble jelly to ulcer, clip hair then wash out
- dry and apply dressing, foam ring and bandage
- monitor and change dressings regularly
What is physiotherapy?
The treatment of disease or injury by physical means
What are the aims of physiotherapy?
- reduction of pain
- promote healing
- improvement of mobility
- return to pre-injury strength and flexibility
- prevention of recurrence of injury
- cardiovascular fitness and respiratory function
What conditions can use physio?
- musculoskeletal injury or disease
- pain
- respiratory disease
- neurological conditions
What are the 4 physiotherapy techniques?
- massage
- passive movements
- therapeutic exercise
- hot & cold therapies
Why is a massage technique used?
- mobilisation of skin
- management of scar tissue
- loosening secretions
- drainage of venous blood
- pain control
- reduction of tension/anxiety
- improved relaxation
Why may massage be unsuitable for use?
Not used where there is acute inflammation, pyrexia, unstable fractures, open wounds, or infectious skin diseases
Massage Techniques - effleurage
Hands passed up limb alternately stroking in smooth movements towards the body
Encourages venous return
Massage Techniques - petrissage
Pressure on muscles and sub-cut tissues, hands move in circular motion proximal up limb/trunk
Encourages blood flow/re muscle spasms
Massage Techniques - frictions
Using thumbs to make circular movements, towards heart
Massage Technique - coupage
Cupped hands clapping against chest, from diaphragm towards head
Encourages loosening secretions
What are passive movements?
Range of movement exercises are carried out to reduce the effect to immobilised joints, or to increase the suppleness of affected joints
How is passive movement massage carried out?
Supporting above and below the joint, gently flex and then extend the hip
What are therapeutic exercises?
A system of programmed exercise used to rehabilitate patients
Describe the different types of therapeutic exercises?
Active - passive movements
Active-assisted - supported standing and walking
Free Active - walking, flat to slopes and obstacles
Resisted - weight to increase strength or hydrotherapy
What are hot therapies and why are they used?
- heat applied using heat packs, baths and laser therapy
- assists in pain reduction, blood pressure reduction, increase of circulation, and tissue elasticity
What are cold therapies and why are they used?
- cold using ice or cold packs
- reduces pain, causes vasoconstriction, and reduces inflammation
What is hydrotherapy?
Any healing in water
Is controlled exercise
What are the benefits of hydrotherapy?
- relieves pain
- reduced swelling and stiffness
- circulatory benefits
- muscle strength
- joint mobilisation
- increased mental stimulation
What conditions are suitable for hydrotherapy?
- pre and post orthopaedic and spinal surgery
- orthopaedic conditions
- neurological conditions
- muscle atrophy
- obesity management
- behavioural issues (relieves energy)
What conditions are not suitable for hydrotherapy?
- sickness
- diarrhoea
- infections
- aural haematoma
- external fixators
- unstable fractures
- fleas and parasites
- severely obese
What are water treadmills?
Low water levels are harder for patients to manoeuvre as it provides less balance
