Recumbency Flashcards
What can cause recumbency?
Illness Pain – injury or disease Paralised Fractures, seizuring, dehydration, shock, sun stroke, malnutrition RTAs Old age/ geriatric patients Post-surgery
Neurological signs associated with recumbent patients?
Depressed
Confusion – esp. if seizuring
- May not react to environment correctly/normally
- May cause aggression
Struggle to control bodily functions
- Eg urinary incontinence
- Express bladder? Urinary catheter?
Difficulty movement makes care normally difficult
Proprioception – coordination/reflexes/movement
- No deep pain sensation
Daily care for recumbent patients?
Toileting is a challenge - Cant get them mobile - Catheter instead? - Incontinent? Grooming/massage - stimulation - improves blood flow eating and drinking is hard - Tube feed? Hand feed? Species - Horses don’t manage well when recumbent
Secondary complications from recumbency?
Bed sores/ulcerations on bony prominences - Susceptible to infection Muscle wastage Gain weight Hypostatic pneumonia Urine and faeces Decreased gut function - Constipation and impactions - Cause colic
Decubitus ulcers?
Ulcers over bony prominences
- Have less subcutaneous tissues
- Very prominent so has constant pressure when recumbent
- So less blood supply and tissue perfusion
If skin is wet formation of ulcers are more likely
Takes a long time to heal
- Can be dangerous if secondary bacterial invasion - fatal
- Always aim to prevent
Decubitus ulcers – stages of progression?
1st – inflammation deep into tissue
2nd – erosion starts
3rd – erosion continues
4th – eroded to bone
How to prevent decubitus ulcers?
Keep patient clean and dry Remove any urine, faeces or vomit - Clean off then dry If in lateral - Turn over to other lateral - If can turn sternal using restraint methods - Min. every 2-4 hours – including nights Padding around prominences - Memory foam/thick bedding - Duvet - Blankets Check for fur loss around prominences - Place padding asap Remove any soiled bedding asap - Likely several bed changes - Inco pads useful Air and water beds
How treat decubitus ulcers?
Clip around wound to see extent of damage Clean and assess how deep Manage - Remove pressure - Keep clean and bandage Medication - Antibiotics - Pain relief
Care plans for recumbent patients?
Must be unique - Treat as individual - No two patients same - Handle pain and environment different Eating and drinking - normal? - routine? - assisted? - liquid/soft? - Water source? Body temperature? - use heat source but cant move away from them - 75% cool water/ 25% hot water mobilisation - Physiotherapy Elimination - Bladder management – help out to toilet? Express bladder? - Any commands? - Surface easy to clean Behaviour and grooming - Keep stimulated - Attention and TLC Medication - Everything needed given - Analgesia and supplements
Bedding for recumbent patients?
Small animal - Thick - Waterproof - Foam mattresses - Fleece topper - Thick layers of newspaper - Blankets - Incontinence pads Equine - Rubber matting - Deep bedding - paper/cardboard/straw/shavings - Pillows under head - Incontinence pads - Padded stable walls – esp. if thrashing about
Food and water for recumbent patient?
Within easy reach if can do themselves
- may be hand feeding or tube feeding
offer at regular intervals
diet should be concentrated and highly digestible
- may need increased nutrition – eg protein/carbs
- consider owner input if fussy
- consider weight – obesity likely
Preventing urine scalds?
Take incontinence dogs out regularly if possible
Manually express bladder if more appropriate
If neither possible then urinary catheter used with collection bag
Log amount, colour, smell and consistency
Soiled bedding must be removed immediately if patient urinates on it
Hair must be washed with antiseptic shampoo
- and dried thoroughly
areas that look contaminated/ likely to be contaminated should be clipped
- and protective barrier cream applied
Hypostatic pneumonia?
Caused by a pooling of blood or fluid in lungs - Removal not stimulated by movement Susceptible to secondary chest infection Signs - Rapid shallow respiration - Coughing - Increased respiratory effort - Moist, rattled respiration and gurgling - Blue MM - Depressed attitude Can be fatal
What is physiotherapy?
Treatment of disease, injury or deformity
holistic approach – body as a whole
using physical methods
- massage
- heat treatment
- exercise
relates to muscle, joints and nerves of body
When is physiotherapy used?
Used to treat
- bones, joints and soft tissue
- brain and nervous system
- heart and circulation
- lungs and breathing
Aims of physiotherapy?
Facilitate recovery and well being Improve quality of life Increase range of movement of damaged area - so increase function Aid recovery prevent pain/discomfort - but will hurt in early stages improve circulation – aid fluid drainage preventing future and further damage - to compromised features - eg weight bearing leg provide massage so relaxing provide comfort - better sleep - reduce stress and anxiety stimulated body waste elimination
Considerations when using physiotherapy?
Good knowledge of healing times for tissue effected - condition important to consider Thorough working knowledge of anatomy Permission/experience/training Can use pain therapy alongside - be careful - could over work muscles causing damage - so need to feel pain/threshold for ROM
Main approaches of physiotherapy
Active techniques
Tailored exercises and physical advice
Designed to improve movement and strength in a specific part of body
Repeated regularly over a set period of time
Activities that involve moving whole body
- eg walking/running/swimming
- avoid sprinting, short sharp turns and jumping
Can by hydrotherapy or aquatic therapy
- relaxes/supports muscles and joints
- provides resistance to encourage strengthening
Provision of mobility aids
- slings – towel or commercial made
- harnesses
- wheels
- protective shoeing/socks
- protective bandages
Main approaches of physiotherapy
Passive techniques
manual therapy
- use of hands to relieve pain and stiffness
- manipulating
- joint mobilising
- massaging
- stretching
- positioning methods
- acupuncture
Respiratory physiotherapy aims?
Reduce respiratory effort Increased O2 uptake and gaseous exchange Increase lung volume Increased secretion clearance - So decreased pooling of secretions More comfort for animal
Positional physiotherapy?
Place in best position to aid lungs
Should be encourage to stand where possible
Should be supported in sternal recumbency
- SA – sandbags, cushions, rolled up towels
- EQ – large foam blocks/wedges, foal cradle, straw bales
Maintain 10-15 mins, 3-4 times daily
passive physiotherapy techniques for recumbent patient?
Assist secretion clearance
If lateral - Uppermost lung treated - Head slightly lower than body Sessions should last 5-10 mins, 4-5 times a day must communicate with VS - only do under guidance - must be shown how to
Percussion or coupage
- Create energy waves that transmit up airways
- loosens secretions so can be coughed up
Vibrations and gentle shaking
- Performed on expiration
- to loosen secretions
Contraindications
- thoracic surgery
- trauma
- osteoporosis
postural drainage?
Gravity is used to assist in secretion clearance
- more gentle technique
Lung to be treated is positioned uppermost
Patients head should be positioned slightly lower than body
- secretions drain into bronchoil airways
- then coughed up
must communicate with VS
- only do under guidance
- must be shown how to
position is maintained 10-15 minutes, 3-4 times daily
Massage techniques?
Stroking - Gentle, long sweeping movements with palm of hand across muscles - Relaxing, warm tissue so prep for working with deeper muscles - Animal becomes accustomed to touch – trust and compliance Effleurage - Similar to stroking but more pressure - Follow muscle curvature - Care over bony projections and joints Tapotement - Gentle to firm percussion - More vigorous and stimulating - Introduce gradually to prevent alarm Petrissage - Like kneading bread - Vigorous and stimulating kneading type movements - Introduce gradually to prevent alarm Vibration - Gentle shaking of limb - Stimulate o used as relaxation at end Not over bony areas – uncomfortable
Joint mobilisation?
Moving joints through normal physiological range of motion
Passive
- Gently take joints from flexion to extension and back again
Active
- Animal takes own joints through flexion to extension and back again
- Treadmills, make walk (use poles, steps), make sit/stand lie down
Be repeated rhythmically 15-20 mins
Why do joint mobilisation?
Necessary for normal joint nutrition and cartilage health
Prevent stiffness
Retain function
Reduce any risk of further degeneration
Therapeutic exercises?
Should be
- planned with clear goal in mind – allowed by a VS
- repetitive series of events
- be progressively incremental - to reach end goal – realistic?
- used to facilitate muscle hypertrophy
- used to improve joint ROM
- used to stimulate balance and co-ordination
- influence CV/ respiratory endurance and fitness
- restore function of neuromusculoskeletal, CV and respiratory systems
- stresses focused on muscles, joints, ligaments, tendons and nervous system
Types of therapeutic exercises?
horse lunging in gadget slings poles balance balls gym balls
Thermal modalities?
Cryothermy (cold)
- good for sprains, strains
- reduce swelling and heat – post surgery or injury
- natural pain relief
- blood vessels restrict
- once removed increases blood flow as rushes back
- careful as cant move away – cool not cold
Thermotherapy (heat)
- loosens muscles/tissues
- make more comfortable as improve flexibility
- good prior to massage
- heat lamps/packs
- blankets, hot water bottles, bear huggers
- careful as cant move away – warm not hot
Electrotherapy?
Machines that produce electrical energy in various waveforms
- ultrasounds – vibrations of sound waves delivers energy to tissues
- laser – stimulate cells around tissue – good for healing
- electrical nerve stimulation (NMES TENS) – stimulate nerves and muscles
- shock wave
require training – care needed
don’t use on infected area – encourage growth/development
Hydrotherapy?
Swimming in a pool
- depends on individual
- not idea with back injuries as arches back
Walking on a water treadmill
Therapeutic effects
- buoyancy – allows for free movement as takes weight off
- hydrostatic pressure as limbs move causes strengthening
- viscosity – resistance – warm water easier than cold
benefits
- allows easer movement
- phycological benefits
