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
