Features of care for patients with spinal cord diseases
Diseases Of The Spine / / August 12, 2017
main diseases that lead to the defeat of the spinal cord, are his injuries and tumors, as well as inflammatory and vascular diseases of the spinal cord.Patients with injuries and tumors of the spinal cord most commonly treated in the neurosurgical departments and specialized spinal centers.In the same neurological hospital core group consists of patients with acute myelitis and its consequences, patients with multiple sclerosis and spinal cord impaired circulation.In the treatment of their organization for the proper care and rehabilitation it is particularly important.
must know that the severity of the condition of patients with spinal cord lesion is due to the severity of movement disorders (paralysis), sensory disturbances, trophic tissue and pelvic organs.Careful systematic care in such cases has a decisive influence on the further course of the disease and helps prevent serious complications that threaten the life of the patient: pressure ulcers, urinary tract infections, pneumonia, and contractu
particularly severe category are patients with high spinal cord lesions, which often do not survive because of the grave disorders of breathing function and the cardiovascular system caused by involvement in the pathological process of the vital functions of the brain stem.In such cases, the careful care of the upper respiratory tract, which is the regular removal of mucus from the mouth and throat, if necessary suction mucus from the trachea, sometimes in the acute period of these patients are in need of mechanical ventilation in the intensive care unit environment.Meals should be balanced, easily digestible food is supplied in a liquid or semi-liquid form in the presence of swallowing difficulties.Feeding in such cases can be accomplished by a silicone tube with a diameter of 0.5 cm, which is not oxidized, it is odorless and does not alter the taste of food.
due to paralysis of the limbs and trunk muscles of patients with spinal cord injury are not able to independently change the position of the body in the bed.In addition, as a result of spinal cord lesions violated its trophic function, ensuring normal diet and metabolism in tissues innervated.All patients with spinal cord lesion in need of carrying out activities aimed at preventing the development of pressure ulcers in the buttocks, sacrum, heels, shoulder blades.It must be remembered that the most dangerous period for the development of bedsores - the first 2-3 days.which developed after acute spinal cord injury as a result of trauma, vascular or inflammatory process.Therefore, prevention of bedsores should begin with the first day of the disease.Prevents the development of pressure ulcers can be, especially the frequent change of position of the patient in bed.It is considered appropriate to lay sick on the foam mattress thickness of 20 cm, they are light, elastic, breathable, create a simulation of weightlessness.Sheets should be well proglazheny not have scars, to prevent the formation of folds in the sheets it is advisable to tie it taut ribbons at the corners to the bedposts.Underwear patient should always be clean and dry.Under the skin, exposed to the greatest pressure (sacrum, iliac crest, and the shovels, heel, ankle) is necessary to lay a cotton-gauze "donut".Under the sacrum enclose rubber circle in a cotton pouch, filled half with water and half air.
Particular attention should be paid to skin care.It should always be clean and dry, especially in the urinary organs and the anus.Spin and place of possible bedsores should be wiped with alcohol camphor, vinegar with water, rubbing the skin to redness.Effective use of local darsonvalization, ultraviolet irradiation.If severe injuries and deep venous disorders are unable to prevent development of pressure sores, the meticulous care of the sick to avoid their spread and infection.Slight depth prevalence of pressure ulcers can be lubricated with a thick layer kleola.The resulting thick crust prevents the necrotic area from moisture and infection.For the conversion of the necrotic area in a dense crust of its surface smeared with a concentrated solution of potassium permanganate.The skin around the bedsore after cleansing should be treated with an alcohol or an alcoholic solution of brilliant green.One of the most effective methods of pressure ulcers treatment is ultraviolet radiation (UVR), carried out through the day.Under the influence of ultraviolet irradiation sores dry up, quickly covered with a crust, disappearing inflammatory response.After irradiation, the bandage with ointment or emulsion is performed dusting powder bedsores antiseptic.Local treatment should be combined with the use of tonic tonics, easily digestible, high-calorie, nutrition fortified.
Danger are abnormalities in the gas authorities.Dysuria threaten the development of cystitis, ascending infection of the urinary tract and urosepsis.Infection urine to some extent contributes to its alkaline reaction.To convert urine acidic reaction in a patient prescribed lemon juice, cranberry juice, furadonin and others. It should be timely and regular excretion of urine.Catheterization elastic bladder catheter made 2-3 times a day in compliance with all rules of asepsis.Before catheterization nurse washes his hands with soap and brush and handles alcohol or putting on sterile gloves.After the toilet of external genitals external opening of the urethra thoroughly treated with an antiseptic solution.The sterile catheter is lubricated with a sterile paraffin oil and gently with tweezers and gently injected into the bladder.Urine is necessary to release slowly as rapid emptying of the bladder can sometimes cause heavy bleeding as a result of a sharp decline in its urine pressure.
manual squeezing it out of the bladder can be used for urinary retention in the acute period and the absence of trophic disorders.The technique of the procedure is simple.Nurse gets left on the patient's face to his feet, his fist right hand lay flat on the abdominal wall above the pubis and gradually pushes them until then, until the urine starts to flow.As its outflow nurse continued to press with the same force in the suprapubic area, gradually turning fist near the symphysis pubis presses already back its surface.With continuous pressure-sensitive urine flows easily and freely from the crowded bubble.This procedure is performed regularly 2-3 times a day in the same clock.If you have symptoms of cystitis to manual squeezing the urine can not be resorted.
incontinence bladder indwelling catheter is introduced.By the skin of a sexual member of the catheter is fixed with thin strips of adhesive plaster.The distal end of the catheter is lowered into the duck-urinal partially filled pre-antiseptic solution.Interim urinal for men may be a conventional plastic bag tying ribbons to the root of the penis.After emptying a urinal compulsorily treated with an antiseptic solution.
In severe spinal cord lesions, when you can not count on enough speedy recovery of bladder function (severe spinal cord trauma, myelitis), make the operation - the imposition of suprapubic fistula.Fistula daily cleaned of mucus and pus drainage tube boil.In order to avoid maceration, the skin around the fistula smeared with Vaseline.
Regardless of the method of urine excretion is taking steps to prevent cystitis.Every day or every other day after the removal of urine the bladder washed with an antiseptic solution of methylene blue 0.02% aqueous solution (solution furatsilina, potassium permanganate, etc.).The use of antibiotics for bladder irrigation should be short-term (5-7 days) and alternate with antiseptic solutions.The temperature of the solutions introduced into the bladder should correspond to body temperature.The most effective for the prevention of urinary tract infection Monroe application system with the tidal drainage.
for bowel apply oil or microclysters microclysters with hypertonic solution of sodium chloride;efficient use of rectal suppositories bisacodyl, which operates within the first hour.The rectum is administered 1-2 candles (0.01-0.02 grams) per day.increase the dose if necessary.bowel movements should be performed at least once in 2-3 days.With the ineffectiveness of an enema is necessary to finger excretion of feces from an ampoule of the rectum.
frequent complication, particularly in high spinal cord lesions, is pneumonia.The appearance of it is associated with reduced mobility of the diaphragm, stagnant (hypostatic) phenomena in the lung tissue, delayed phlegm in the bronchi.In such cases, since the first days of hospitalization are used all kinds of curative and respiratory gymnastics.A necessary part of the change of position of the patient from the holding of the chest massage.To liquefy sputum appointed expectorants.By reducing the cough reflex and accumulation of mucus in the larynx and trachea should be regularly aspirate it using electric pumps.In the case of pronounced respiratory disorders in pneumonia in these patients is sometimes necessary to overlay tracheostomy in order to fully drain the tracheobronchial tree, administration of antibiotics and drugs, thinning mucus (soda solution protёoliticheskie enzymes - trypsin).
great therapeutic and prophylactic value have physiotherapy, massage the back and limbs.They must be carried out regularly, several times a day.During the working day physiotherapy, massage holds a Methodist, in the rest of the time - the nurse on duty, which should have the knowledge and skills sufficient to carry out these activities itself, and teach them how to conduct the patient's relatives.Uses simple massage techniques such as stroking, light kneading, effleurage.After the massage in each joint paralyzed limbs at a slow pace and is full of 3-4 passive movement.With care should be taken in order not to droop stops in order to prevent pathological installation limb joints.Keeping them at a right angle to the ankle joint is carried out by the way into the special box installed in the foot end of bed.
patients with acute spinal cord injury, or inflammatory disease (myelitis, meningomielopo-liradikulonevrit) due meningism accompanying phenomena are very sensitive to normal stimuli, they often can not tolerate bright lights and sounds even usual volume.Such patients needs gentle protective regime.Some people are sensitive to changes in air temperature and constantly feel chilly even in a warm room.In these cases, they can be heat lamp "solljuks", giving them extra warm drink, warmer shelter them.It should also be remembered that patients undergoing spinal their existing defect so severe that they develop depression.These patients need to be especially careful, sensitive and careful treatment.Recent advances in the treatment of patients with trauma, inflammatory and vascular diseases of the spinal cord give reason to hope for improvement in these patients or their recovery, allowing patients to instill this hope.
complex therapeutic measures aimed at improving the condition of the affected spinal cord, including the holding in the case of the need for timely surgery, prescriptions, improving collateral circulation, stimulate the nerve cells in the affected area and the improvement of the general compensatory capacity of the organism.In addition to drug therapy aimed at the same comprehensive physical therapy: pulsed magnetic field, electrophoresis eufillina using sinusoidal modulated currents, common sulfide baths, exercise therapy, massage, in violation of the functions of the pelvic organs - intestines electrical and bladder.