Features care and monitoring of neurological patients

August 12, 2017 17:50 | Nursing

Care of Neurological Patients has some specific features: systematic observation of the state of the patient, thorough and timely implementation of medical prescriptions, check your heart rate, breathing, blood pressure and temperature and recording the data in the observation sheet.The patient's condition during the first day monitored every 30 to 60 minutes.These observations and the implementation of medical prescriptions are entered in the map, consisting of the following columns: date, day, hour, minute, heart rate, breathing, blood pressure, temperature, water balance, fluid volume administered to the patient and the amount of the discharged liquid, a state of consciousness.A separate graph is given for writing perform assignments (transfusion of blood and blood substitutes, administration of various drugs, turning the patient, giving humidified oxygen, bladder catheterization, etc.).

Care integuments

very important when caring for patients who are unconscious, monitor the condition of the s

kin.In bedridden patients usually suffer from skin nutrition.The still position in the bed for several hours causes local disturbance of blood circulation leads to tissue ischemia and the formation of pressure sores.The first signs of pressure sores are redness and maceration.Most often, pressure sores are formed in the neck, shoulder blades, sacrum, buttocks, heels.As prevention of pressure sores of the patient is necessary every 2-3 hours to turn over in bed, gently massaging the skin and rub it a 33% alcohol solution or camphor alcohol regularly for a few hours to lay the patient on a rubber circle, covered with a diaper.To it was not on the sheet folds bind its corners to the legs of the bed.When skin maceration prescribe ultraviolet irradiation, lubrication a 2% solution of manganese.Bedsores can develop in paralyzed patients (stroke, myelitis, tumors, traumatic lesions of the spinal cord, and others.) After several hours in the same position under adverse conditions (wet bed, folds).

There are four stages of pressure ulcers:

• necrosis;

• formation of granulation tissue;

• epithelialization;

• formation of trophic ulcers.

necrosis nurse must release the wounds from necrotic masses, to eliminate streaks and "pockets".For this topically applied antiseptics (rivanola solutions - 1: 1000, 1: 500; furatsilina solution - 1: 4200), antibiotics, ultraviolet light wounds.

in the stage of formation of granulation is necessary to create conditions that will help fill the wound granulation tissue.At the same time spend ozocerite baths, mud.

In severe neurological diseases, paralysis and paresis can not use heating pads, hook as in violation of the sensitivity they can cause burns.Burns in these patients heal poorly of them may develop septic process and appear flexion contracture (stiffness) in the paralyzed lower limb.

nurse is obliged to monitor the cleanliness and frequency of change of bed linen.Sheets must be changed frequently.The change of bed linen in critically ill conducted as follows: the patient is placed on the edge of the bed and gently rotated or shifted carefully on the edge of the bed with a free clean dirty sheet and wiped the oilcloth.Clean sheets, coiled, rolled on the free part of the bed.The patient is turned over on the laid half, completely clean the dirty sheets and spread out before the end of the net.Change underwear need quickly, without causing, but chances are the patient any discomfort.

Oral Care

neurological patients, especially in difficult or unconscious needs thorough oral care.With the weakening of the body's defenses, even usual oral flora can become pathogenic and cause gingivitis, stomatitis, and inflammation of the parotid gland (mumps).It is necessary to wipe the mouth 2-3 times daily with a solution of 4.2% boric acid, 3% hydrogen peroxide solution, alkaline mucosa moisten with water to remove food debris.This can be done with a cotton swab dipped in the above solution.The wet pad can be held surgical tool - forceps or long tweezers.If the patient will not open your mouth, you can wear a glove on one hand on the index finger wound clean cloth soaked in the solution, and thoroughly treat the mouth by hand.

Under certain conditions, such as traumatic brain injuries, hemorrhagic stroke, often disturbed consciousness, and in some cases there is a violation of the external respiration;in such cases, impose a tracheostomy.Inhaled through the tracheostomy tube de-moisturized air or oxygen dries the mucous membrane of the trachea and bronchi, which may lead to the development of tracheitis, bronchitis, pneumonia.Therefore, you must strictly follow the order to inhale through the tracheostomy tube gas mixture it was warm and moist.Every 1-2 hours the output of the tracheostomy tube should be flushed, instilled into the trachea of ​​2-3 drops of 5% sodium carbonate solution with antibiotics, and at least 5-6 times a day with a soft plastic tube to suck mucus from the trachea through a tracheostomy.The bandage around the tracheostomy tube should be clean and dry.These activities improve pulmonary ventilation and increases the oxygen content in the blood.

Care at

hyperthermia in patients with traumatic brain injury with serious violations of consciousness are frequent cases of fever.Therefore, the body cooling using ice packs wrapped in a napkin, they are placed on the heart and large main vessels in the armpits, groin and popliteal regions, elbow.Ice packs placed on the patient's head.Hypothermia decreases the rate of cellular metabolism and brain edema phenomenon intracranial hypertension, and cerebral substance reduces oxygen demand.

care in acute disorders of cerebral circulation

Regardless of the nature of the stroke, the medical staff is necessary to observe a few rules:

• make sure that the patient is lying on his back;

• from the oral cavity as far as possible to remove the removable teeth;

• in the case of vomiting, the patient should be turned on its side and clean the mouth from vomit to avoid their aspiration and the subsequent development of aspiration pneumonia;

• if the deterioration of the reception to provide the necessary medicines, oxygen inhalation, systematically suck the mucus from the mouth and throat;

• carry out prevention of pneumonia, bedsores;

• Involuntary urination when you need to carry out bladder catheterization;

• with excessive excitation of the patient should do an enema with chloral hydrate (30-40 ml of a 4% solution);

• transport of patients in critical condition shall be permitted only in exceptional cases, as it may worsen their condition.

nurse must distinguish between two main types of stroke: ischemic and hemorrhagic;In addition, you need to know about and transient disorders of cerebral circulation, which are based on cerebral vasospasm.These disorders occur when cerebral atherosclerosis, hypertension, hypotension (drop in cardiac activity, blood loss), increase viscosity and coagulation, with cervical osteochondrosis.

In general cerebral crises observed headache, buzzing in the ears, dizziness, nausea or vomiting, paleness or redness of the skin, stress or weakening of the heart rate, increase or decrease in blood pressure, disorder of consciousness.

When localized cerebral focal symptoms crises prevails over the cerebral, and it is manifested paresis or paralysis, speech disorders, paresthesias.In such cases, the patient must be laid to create the conditions of peace to him.When high blood pressure do phlebotomy (up to 100 ml of blood from a vein in the elbow), put the leeches on the mastoid region, mustard plasters on the back of the neck or the area of ​​the calf muscles.Antispasmodics used antihypertensives and 2 ml of a 2% solution of papaverine in 10-20 ml 40% glucose solution intravenously Dibazolum 5.2 ml of 1% solution subcutaneously;10 ml of a 25% solution of magnesium sulfate 0.25% solution of novocaine intramuscularly;arterial hypotension - heart means: kordiamin, camphor, mezatona solution Korglikon 0.06% in a 20% glucose solution intravenously.When a headache - analgesics.

hemorrhagic stroke.Most often it occurs suddenly with hypertension or atherosclerosis, severe emotional or physical stress.Izlivshayasya destroys blood brain tissue, brain edema causes phenomena that leads to increased intracranial pressure.You receive a severe headache, flushing of the skin and mucous membranes, vomiting, increased blood pressure and body temperature, stupor, coma, agitation, signs of focal lesion (hemiparesis and hemiplegia), you may see blood in the cerebrospinal fluid.Characterized by respiratory disorders and cardiovascular activity.In such cases it is necessary to put mustard plasters on his head, with high blood pressure, pulse and intense purple-red face make phlebotomy (100-300 ml).. At the head put an ice pack for a few hours with breaks for 1-2 hours Applied coagulants: menadione, calcium gluconate.If you have high blood pressure - Dibazolum, papaverine, hydrochlorothiazide;introduce the lytic mixture - chlorpromazine 2.5% - 2 ml;diphenhydramine 1% - 2 ml;promedol 2% - 1 ml;procaine 0.5% - 50 ml 10% glucose - 300 mL.Dehydrating agents: glycerin, Lasix, novurit;intramuscularly - magnesium.When breathing disorders - tracheostomy.

ischemic stroke.Most often it occurs in the elderly against the background of atherosclerosis of brain vessels and arterial hypotension, increased blood clotting.Often it occurs during sleep.Development of stroke due to the presence of thrombus, embolus and cerebral circulatory insufficiency.Typically the presence of precursors of stroke, which can appear in a few hours, so the nurse need to be observant and, perhaps even once again to ask the patient whether he darkening of the eyes, dizziness, weakness, transient numbness of extremities.facial skin at the time had already developed an ischemic stroke is pale, weak pulse, blood pressure is lowered, the body temperature is normal, cerebrospinal fluid is not changed.In the first hours of stroke in the presence of low cardiac used cordial means: camphor, kordiamin, Korglikon;removal cerebral vasospasm - intravenous injection of 2.4 ml of 10% strength solution of aminophylline in 10 ml 40% glucose solution.Assign inhalation of carbogen, in order to reduce thrombus formation - dikumaril, sinkumar, heparin, fibrinolizin.In the presence of paresis or paralysis expedient massage, therapeutic exercise: initially - passive movements in the paralyzed limbs, and as the recovery of muscle strength - active movements.Exercise therapy combined with a light massage.An increase in muscle tone used Mydocalmum.Two weeks later, use absorbable therapy: potassium iodide solution (0.5-2% solution of 1 tbsp 2-3 times a day after meals for 3-4 weeks..);intramuscularly aloe (1-2 ml every other day № 15-20).

patients can not be given in a comatose state on the first day of food.If the patient swallows, via a feeder cup should be introduced liquid (tea, juice) in small portions.At disturbances may swallowing food and liquids from entering into the bronchi.Therefore feeding is carried out through a probe introduced into stomach through mouth or lower nasal passage.If the patient within a few days is unconscious, it is also fed through a tube.With the introduction of the probe can use the laryngoscope.Before introducing the probe through the nutrient mixture, make sure that the tube is in the stomach.If during feeding vomiting occurs, the head of the patient must be turned to the side to clear the mouth of vomitus.If choking the patient should be fed "kiseleobraznoy" food - jelly, liquid gruel, yogurt.Keep in mind that severe neurological patient need to be fed more often, in small portions, with breaks.It is necessary to ensure that the patient is not choked, not tired, or he may refuse to eat.Treat for the patient can be from a feeder cup or teaspoon, tea should not be hot.Food should be high-calorie, rich in vitamins, contain meat, dairy products, vegetables, fruit.

important to remember that people in a coma when feeding through a tube can often happen aspiration, therefore, in the first days of coma only parenteral nutrition should be used.Exclusively in parenteral nutrition patients are being rapidly depleted, and tube feeding begin on the third day.As used parenteral nutrition administration of isotonic sodium chloride solution intravenously or subcutaneously in the thigh, slowly, not more than 500-600 ml per session.For better absorption at the injection site briefly apply a warm heating pad through the diaper.The total amount of fluid injected on the first day does not exceed 1 liter, and the next, when assigning dehydration therapy is administered at least 2-3 liters.Furthermore, intravenously 300 ml of 40% glucose, to which was added 8.10 units of insulin and 500 ml of vitamin C, vitamin B, (50-100 ml intramuscularly).Patients in a coma occurs sokovydelitelnoy oppression and acid-forming functions of the stomach and digestive glands, so you can use the gastric juice and sokogennye extractive substances.Given that patients can be depleted, on the fifth day at the physician's discretion, may be assigned to anabolic steroid hormones (methyl-androstenediol, Nerobolum).Meals patients should be high-calorie: 3000 -4000 kcal per day, of which 95-120 g protein, 550-700 grams of carbohydrates, 40-60 grams of fat.In the case of paresis of the muscles of the pharynx and larynx impose a gastrostomy.

Care with bladder catheterization

In some diseases of the central nervous system (stroke, brain and spinal cord tumor, myelitis, a spinal injury and spinal cord) occur disorders of pelvic organs - the delay or incontinence.

patient unconscious with urinary retention is necessary to determine the filling of the bladder.By palpation and percussion reveal the contours of the bladder, the upper limit of which may be up to the navel, if it is full.At the anuria bladder is empty.When urinary retention resort to catheterization, which is carried out with sterile catheter (preferably rubber).Genitals are pre-treated with antiseptic solutions.Repeated ka-teterizatsiyah for the prevention of urinary bladder infection should be cleaned with antiseptics or antibiotics.If the patient is a permanent catheter, the catheter is introduced into the bladder, and the free end is dipped in a jar of antiseptic.A number of patients in severe chronic state of acute renal failure may occur.The main treatment of kidney failure is to assign a rational caloric diet, the composition of fats, carbohydrates, salt and the number of water injected into the body.You must know that in case of acute renal failure not prescribe corticosteroid hormones.

Gastric lavage

In renal failure excretory function assume the organs of the gastrointestinal tract and skin.Therefore patients stomach washed with 8.2 l of weak sodium bicarbonate solution 1-2 times a day.

enemas

Siphon enema put to wash the intestine.At high levels of residual nitrogen and urea in plasma raises the question of holding the patient hemodialysis or peritoneal dialysis.

Laxative enemas are used in delay chair.If conventional enema does not cause intestinal emptying make oil enema (100 ml of vegetable oil or petrolatum) or enema 30% solution of magnesium sulfate.From laxatives administered magnesium sulfate 20-30 g per reception, rhubarb 0.5 g 3 times a day, mineral oil 1 tbsp.l.3 times a day.