Special Nursing Considerations - Recumbent Patients PDF

Nursing 2 -- Lecture 13 **Recumbent Patients** Cannot stand, Can be resp patients, geriatrics, musculoskeletal, metabolic diseases, toxicities, neurological, coma Length of recumbency varies with conditions **Predispositions & Complications of a Recumbent Patient** (Cage Rest Complications) -...

Nursing 2 -- Lecture 13 **Recumbent Patients** Cannot stand, Can be resp patients, geriatrics, musculoskeletal, metabolic diseases, toxicities, neurological, coma Length of recumbency varies with conditions **Predispositions & Complications of a Recumbent Patient** (Cage Rest Complications) - Impaired ventilation - Desaturation (oxygen) - Vomiting, regurgitation Aspiration Pneumonia - Reduced gut motility - Pressure scores/decubitus ulcers - Infections -- keep al fluids / catheters lines clean (swab), hand hygiene, reduces risk - Up to us to prevent and reduce these from occurring **Nursing Considerations Related to a Recumbent Patient** 1. Bedding & Comfort 2. Pain meds/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 **Bedding & Comfort** - Reduces 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 no padding - Decrease FAS Provide appropriate sized space, hide boxes/covers, reduce noise - Daily light cycles, group treatments - TLC -- pet and provide attention 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 increase risk of infection Prevention prevention prevention - Appropriate bedding (padding plus blankets, pillows, wedges, "donuts" on pressure points   - Remove harnesses - Freq patients 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 ] Small Ulcers - Astringents Calamine lotion, burrows solution, zinc oxide - Antiseptics Povidone-iodine, H202 - +/- topical/systemic antibiotics - +/- anti-inflammatories, pain medications - Donut bandages Large Ulcers - Surgical treatment **Pain Meds** Goal is to keep them comfortable but not overly sedated Pain Meds: - 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 **IVF & IVC Care** - Palpate & visualize (take down and observe the skin & insertion site) Catheter patency, infection, phlebitis - Bandage must be changed immediately if wet - Level of hydration, patients ability or inability to respond to vascular volume (blood pressure, peripheral edema, urination) - Evaluate for redness, swelling, odor, discomfort, oozing (remove and replace in another limb if any of the above) - Flush with saline to assess patency or for any leakage around the catheter site **Nutrition** - 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 **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/conjunctiva sac prn with eye solution / eye flush - Palpebral reflex? - Corneal ulcer risk Fluorescein eye test prn as per DVM **Posture & Positioning Care** - Routinely change patient positions Q 4 hours, (36 or prn) if a patient is ansious, restless or for means of troubleshooting other  issues Place sternal to increase lung vol - Positioning will aid in ventilation & perfusion to increase lung vol prevent atelectasis redues work of breating reduces hypoxia esp in obese **Airway/Mouth Care** Oral (mouth) care - Keep tongue inside the mouth - Moisten lips, tongue, gingival to prevent ulcers - Wipe with water or chlorhexidine gauze on sponge forceps - Clean oropharynx to decrease risk aspiration pneumonia Intubated - Humidification - Sterile suctioning - Cuff deflation and repositioning Checking cuff pressure with device - Adjust ET tube tie daily - Changing sterile ETT daily - Applies to tracheostomy tube care as well **Bladder & Bowel Elimination** Risks - Infection - Urine scald - Fecal scald - Urinary obstruction - Constipation Bladder -- Monitor Bladder Size Completely Recumbent - Catheter & closed collection system - Express bladder carefully - Clean prepuce & vulva 3x daily with dilute chlorhexidine - Reduce catheter related infection risks Some Movement - Outside to attempt to void (sling) Avoid Scalding - Keep fur/skin dry and clean - Use appropriate bedding (absorbent, easy to clean/change) - Apply carrier cream (zinc oxide, Vaseline) Bowel Care Goal -- Prevent Constipation - Stool softeners / laxatives - Enemas as needed Avoid Scalding - Keep fur/skin dry and clean - Use appropriate bedding (absorbent, easy to clean or change) - Apply barrier cream - 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 **PROM** Passive range of motion & stretch techniques - Flex extend joints to appropriate end range without pain or force - Maintenance mobility, prevents soft tissue & joint contracture - Stabilize joint above & below Stimulate muscle contracture, help decrease wasting Reduces peripheral edema by increasing venous drainage & lymphatic flow - Can be relaxing for patient & increase human-animal bond **Ice/Heat** Cold therapy - Decreases pain, inflammation, discomfort - Acute injuries (first 24/48hrs - Wrap cold packs in towels - Place over affected area - 5-10 mins - Q 8-12hrs Mode of Action - Decrease tissue temp/inflammation - Decrease pain perception & muscle spasms - Vasoconstriction = less edema Heath Therapy Indications - Muscular sprains/strains - 48-72hrs post injury - After acute swelling ohase Procedure - Protect skin with towel - Heat source 40-45c - 10 mins - Q6-12hrs - Move it around frequently - Monitor skin temp closely Mode of Action - Localized vasodilation - Muscle relaxation - Pain relief **TLC\ **Important to build a bond with patient outside of treatments Grooming, petting Allow them to sleep