Nursing Recumbent Patients PDF

Nursing – Special Considerations Special The Recumbent Nursing Care Patient The Recumbent Patient VETC2011 Veterinary Nursing 2  Reading Reference: Emergency & Critical Care...

Nursing – Special Considerations Special The Recumbent Nursing Care Patient The Recumbent Patient VETC2011 Veterinary Nursing 2  Reading Reference: Emergency & Critical Care for Small Animals 4th ed. Battaglia & Steele Various chapters/pages. Ch 10.page 129 (posture & positioning) Ch. 8 page 103 (monitoring the ventilator patient) The Veterinary Nurse: The Veterinary Nurse - Nursing the recumbent patient What is a recumbent patient? One who can not stand Who is the recumbent patient? Any can be! geriatric, respiratory, trauma, musculoskeletal, metabolic disease, Toxicities, neurological, coma… How long? Varies with condition Predispositions and Complications of a Recumbent patient? (aka cage rest complications): Impaired ventilation and perfusion Desaturation (oxygen) Vomiting/regurgitation Aspiration pneumonia Reduced gut motility Pressure Sores/Decubitus Ulcers Infections – keep all fluid/catheter lines clean (swab), hand hygiene, reduce risk It is up to us to prevent and reduce these from occurring The Recumbent Patient What are the nursing concerns related to a recumbent patient ? 1. Bedding and comfort 2. Pain medications/Anesthesia 3. IV fluid and catheter care 4. Nutrition 5. Ocular care 6. Posture & Position 7. Bladder and bowel elimination 8. Mouth/Airway care 9. PROM/Physiotherapy 10. Ice or Heat pack 1. Bedding & Comfort - the recumbent patient Reduce risk of decreased circulation Blood flow or fluid- edema or swelling Reduce risk of decubital ulcers In hospital or at home Risk of muscle or nerve damage if not padding Decrease FAS Provide appropriately sized space, hide boxes/covers, reduce noise! Let them watch videos Daily light cycles, group treatments TLC – pet & provide attention not associated with treatments! Allow owners to visit! Pressure Sores Decubital ulcers AKA “Bed Sores”, Develop over bony prominences Due to continuous pressure Necrosis of tissue Organic debris increases risk of infection  Prevention Prevention *** Prevention*** An ounce of prevention is worth a pound of cure in the prevention of pressure sores Prevention of Pressure sores: Appropriate Bedding Padding plus blankets Pillows, wedges.. “donut” pillows on pressure points Remove harnesses Freq patient turning/repositioning Hygiene Goal: Prevent organic debris, avoid infection Good hygiene (hand, bedding, patient) to avoid infections Shave hair around perineum, ulcers Sponge bath daily (anogenital area, ulcers)and pat dry thoroughly Disposable diapers or bed pads for bedding Grates for drainage Treatment Challenging to treat Small ulcers: Astringents Calamine lotion, burrow’s solution, zinc oxide Antiseptics Povidone-iodine, H2O2 +/- Topical/systemic antibiotics +/- Anti-inflammatories, pain medications Donut bandages Large ulcers: Surgical treatment 2. Pain Meds - the recumbent patient Goal is to keep them comfortable but not overly sedated! Pain medications Pain control vital to return to function Often needed even if reason for hospitalization is not painful In time not moving will cause pain Stiffness of joints, pressure sores, weak/atrophy of muscles, edema Anesthesia May be required if patient needs mechanical ventilation or is extremely painful 3. IVF & IVC Care- the recumbent patient Palpate & Visualize (take down and observe the skin and insertion site) Catheter patency, infection, phlebitis Bandage must be change immediately if wet Level of hydration, patient’s ability or inability to respond to vascular volume (blood pressure, peripheral edema, urination etc..) Evaluate for redness, swelling, odor, discomfort, oozing.... ***Remove and replace in another limb is any of the 4. Nutrition - The Recumbent Patient Increase activity to increase GI motility – get them up! Will decrease ileus, stomach acid pooling, regurg, aspiration/pneumonia Nutrition - enteral vs parenteral Position to assist in drainage/digestion 5. Eye Care - The Recumbent Patient Ocular Care Lubricate eyes frequently Know your product, consult DVM Ointments last longer than some other lubes Apply q 4-6 hours Have a dedicated tube for recumbent patients *hand hygiene! Flush eye/conjunctival sac prn with eye solution/eye flsuh Palpebral reflex? Corneal ulcer risk Fluorescein dye test prn as per DVM 6. Posture & Positioning Care - The Recumbent Patient Routinely change patient positions Q 2-4 hours!!! (or PRN* *if a patient is anxious, restless, or for means of troubleshooting other issues) Positioning will aid in ventilation & perfusion to increase lung volume (by placing in sternal recumbency) Prevents atelectasis Reduces work of breathing Reduces hypoxia esp in obese 7. Mouth/Airway Care - the recumbent patient Oral (mouth) Care Keep tongue inside the mouth Moisten lips, tongue, gingiva to prevent ulcers Wipe with water or chlorhex, gauze on sponge forceps Clean oropharynx to decrease risk aspiration pneumonia If intubated: Humidification Sterile suctioning Cuff deflation and repositioning Checking cuff pressure with device Adjusting ET tube tie location Changing sterile ET tube daily ET Tube cytology Applies to Tracheostomy tube care as well 7. Mouth/Airway Care - the recumbent patient Ventilated Patients – Mouth care *Coupage +/- nebulizing assists to mobilize lung secretions 9. Bladder & Bowel Elimination - The Recumbent Patient Risks: Infection Urine scald Fecal scald Urinary obstruction Constipation Bladder Care – monitor bladder size Completely recumbent: Catheter & closed collection system (3-4 day max) Express bladder carefully Clean prepuce and vulva 3 times daily with dilute chlorhexidine Reduce catheter related infection risks Some movement: Outside to attempt to void (sling) Always monitor bladder Avoid scalding!! size, output, character of Keep fur/skin dry and clean urine specific gravity, sediment, Use appropriate bedding (absorbent, easy to ensure no kinks in any clean/change) catheter lines (flush for Apply barrier cream (zinc oxide, Vaseline) patency PRN), swab lines from patient down to bag Bowel Care Goal: Prevent constipation Stool Softeners/laxatives (PEG 3350, Lactulose) Enemas as needed Warm water + lube + lactulose Avoid scalding Keep fur/skin dry and clean Use appropriate bedding (absorbent, easy to clean/change) Apply barrier cream (zinc oxide, Vaseline) Wrap tails – with moisture wicking cotton or kling gauze THEN vetwrap, Trim long fur – careful to not clip too short or as skin will be exposed and can lead to scalding 10. PROM – the recumbent patient Passive Range-of-Motion & Stretch Techniques Maintains mobility, prevents soft tissue & joint contracture Stimulates muscle contracture, help decrease wasting Reduces peripheral edema by increasing venous drainage and lymphatic flow o Can be relaxing for patient & increases human- animal bond 10. Physiotherapy  Cold therapy Decrease pain, inflammation, discomfort Indications: Q 8-12 hr Acute injuries First 24-48 hours Acute swelling phase Mode of action: Decrease tissue Procedure: temperature/inflammation Wrap cold packs in Decrease pain perception & towel muscle spasms Place over affected Vasoconstriction area = less edema 5 – 10 minutes > 30 minutes may cause edema  Heat therapy/Warm Pack Indications: Move it around frequently Muscular Monitor skin temperature closely sprains/strains Mode of action: 48 – 72 hours post injury Localized vasodilation After the acute “swelling” phase Muscle relaxation Procedure: Pain relief Protect skin with towel Heat source 40 – 45 C Example: thermotherapy before PROM exercises. 10 minutes ***Caution in post anesthetic or nerve q6–12hrs injury patient Don’t forget: TLC, grooming, & allow your patients to Recumbent Care Quiz Recumbent patients are at risk for which of the following? A.Pressure sore ulcers B.Oral ulcers C.Corneal Ulcers D.Atelectasis E.All of the above Recumbent Care Quiz Recumbent patients are at risk for which of the following? A.Pressure sore ulcers B.Oral ulcers C.Corneal Ulcers D.Atelectasis E.All of the above Recumbent Care Quiz Passive range of motion exercises are only important for musculoskeletal disease rehabilitation? a) True b) False Recumbent Care Quiz Passive range of motion exercises are only important for musculoskeletal disease rehabilitation? a) True b) False Recumbent Care Quiz A patient on mechanical ventilation should have their ET tube changed how often? a)Every 24 hours b)Every 48 hours c)Every 72 hours d)You should not remove the ET Tube on a patient being mechanically ventilated Recumbent Care Quiz A patient on mechanical ventilation should have their ET tube changed how often? a)Every 24 hours b)Every 48 hours c)Every 72 hours d)You should not remove the ET Tube on a patient being mechanically ventilated Recumbent Care Quiz Thorough pain assessment and control is vital to the care of the recumbent patient: a)True b)False Recumbent Care Quiz Thorough pain assessment and control is vital to the care of the recumbent patient: a)True b)False