Recumbent patient care

Question 1

recumbent patient

Answer 1

ant patient with limited mobility

Question 2

how should we house recumbent patients?

Answer 2

non-skid surface, good padding, soft and absorbent for eliminations (can put pee pads right under them if they can’t move around), consider thickness (too thin= ulcers, too thick= injury if patient tries to dig out), things that can be easily cleaned/disinfected, add a personal touch

Question 3

what are other things with housing recumbent patients that should be considered?

Answer 3

elevate their head, do they have light/sound sensitivities?, do they have anxiety? (don’t walk in and out of their kennel more than needed)

Question 4

why do we turn recumbent patients?

Answer 4

so they don’t develop pressure sores or pulmonary atelectasis (partial or complete lung collapse due to pressure)

Question 5

how often should recumbent patients be turned?

Answer 5

every 2-4 hours

Question 6

how do you rotate a recumbent patient?

Answer 6

rotate with legs under to avoid turning the stomach and causing gastric dilation and volvulus
check skin for redness every time you turn
massage and flex/extend limbs

Question 7

how much should a recumbent patient’s head be elevated?

Answer 7

~30% to help passively decrease intracranial pressure
put a folded towel under their head

Question 8

when changing out the towel that is elevating a recumbent patient’s head, what should you do before putting down a new towel?

Answer 8

lower the head briefly to allow for the patient to expel mucus or fluids (use a smooth and gentle movement)

Question 9

what should you check with bandages on recumbent patients?

Answer 9

check for strike through and ensure it is clean
avoid using red or black vetwrap so you can see if there is strike through

Question 10

nursing care for recumbent patients

Answer 10

keep them clean and dry (baby wipes, waterless shampoo, butt paste, bathe and dry patients PRN)
replace soiled bedding right away
keep in mind their mental state (speak calmly and quiet, move smoothly and gently when handling, fluff pillows, straighten blankets, pet them, facilitate owner visits)

Question 11

what is a good rule to follow for bedding?

Answer 11

the heavier the patient, the thicker the padding

Question 12

bladder monitoring

Answer 12

monitor bladder size, amount, color, odor, and act of urination (straining, incontinence)

Question 13

how should a recumbent patient eliminate?

Answer 13

on their own if they can
or can express: only express ~50%, 4-6x a day
catheterize: only 3-4 days then change, record collected amount
can use drugs to help relax too: Diazepam (relaxes urethra), Bethanechol (relaxes contraction of bladder)

Question 14

recumbent patient defecation

Answer 14

record
enema or digital removal may be necessary
laxatives can be used
consider clipping hair of long-haired patients to keep clean

Question 15

recumbent patient body temperature

Answer 15

have trouble regulating
hypothermia can be corrected with warming cages, heating pads, forced air devices, or heating blankets
check temp regularly to monitor for hyperthermia
check skin for thermal burns

Question 16

recumbent patients: eating

Answer 16

many patients won’t want to eat or have the energy to eat
enteral route preferred
can hand feed, use appetite stimulants, feeding tubes, or total parenteral nutrition

Question 17

what are some important things about feeding recumbent patients?

Answer 17

never feed in lateral recumbency, only sternal
never force feed
don’t leave right under patient’s nose if they don’t want to eat right away when offered

Question 18

recumbent patient mobility

Answer 18

if able to walk, allow assisted opportunities to walk
it will improve patient’s muscles, respirations, circulation, and mental health
if assisting with a sling, be sure rear feet aren’t dragging

Question 19

recumbent patients muscles and joints

Answer 19

unused muscles quickly atrophy abd joints will become stiff and painful
consider physical therapy

Question 20

recumbent patients respirations

Answer 20

prolonged lateral recumbency can cause atelectasis of the down lung (auscultate lungs every time you flip)
sternal recumbency preferred
coupage can be performed to help clean airways
consider checking oxygen saturation (SPO2)

Question 21

recumbent patients circulation

Answer 21

measure BP every 4-6 hours
strive for: systolic= 100 mmHg
diastolic= 40 mmHg
mean= 60 mmHg
physical therapy helps increase circulation and lympathic drainage
edematous limbs can be massaged to facilitate lympathic drainage

Question 22

cold therapy

Answer 22

most effective in the 1st 24-48 hours after injury
helps decrease pain perception, decrease nerve conduction, decrease muscle spasms, causes local vasoconstriction, and decreases edema
ice pack or cold compress for 5-10 minutes 2-4x a day

Question 23

heat therapy

Answer 23

apply 48-72 hours after injury
caution in patients with sensory nerve damage or recovering from anesthesia
always have a barrier between pack and skin
104-113 F for 10 min 2-4x a day
helps with muscle relaxation, pain relief, local vasodilation, not for acute wounds= causes edema

Question 24

passive exercise: massage

Answer 24

helps enhance muscle tone, decreases stress, promotes relaxation, stimulates lymph flow and immunity
can start within a few days after surgery
state law regulates who can perform certain massages and under what level of supervision

Question 25

how to massage

Answer 25

use 2-3 fingers keeping them close together
maintain touch after making contact with patient
use gentle circular motions
increase pressure as patient relaxes

Question 26

range-of-motion

Answer 26

helps minimize muscle and joint contraction from lack of use
take the affected limb and gently flex and extend within normal range of motion for joint
5-10 min 2-4x a day
use slow and controlled movements
don’t overextend or hyperflex

Question 27

hydrotherapy

Answer 27

whirlpool or swimming therapy

Question 28

whirlpool hydrotherapy

Answer 28

provides vigorous massage
great for wound therapy
water temp: 102-105 F
allow patient to get used to water before turning on jets
start with 5 minute sessions and work up to 20 min

Question 29

swimming hydrotherapy

Answer 29

buoyancy and hydrostatic pressure of pool water provides support and allows voluntary exercise with minimal effect
water creates resistance to help build muscle
water temps should be lower (80-90 F) since patients build up heat during exercise

Question 30

acupuncture and acupressure

Answer 30

use of small sharp needles into acupoints along meridians (channels of energy in body)
helps stimulate nerves, trigger endorphine release, increase circulation, and relieve muscle spasms

Question 31

laser therapy

Answer 31

therapy laser is a class III-IV
works by photobiomodulation
increases cellular production of ATP, increases rate of cell mitosis and collagen synthesis, activates fibroblasts/ osteocytes/ other repair cells, increases release of endorphins, enhances lymph drainage, decreases inflammation by vasodilation
everyone in the room must wear eye protection
don’t use on suspected tumors and it has unknown effects on pregnant animals