Care of neurological patients. Care for neurological patients, practical advice Damage to cranial nerves

Performed by a student of the MS-142 group
Panov Roman

DEFINITION OF THE SUBJECT OF NEUROLOGY AND ITS PLACE AMONG OTHER MEDICAL DISCIPLINES

NEUROLOGY IS THE SCIENCE OF THE NERVOUS
HUMAN SYSTEM.
NEUROPATHOLOGY—THE SCIENCE OF
DISEASES OF THE NEURAL SYSTEM.
Studying lesions nervous system,
manifested by movement disorders,
sensitivity, disorder
functions of the senses, speech and
develops diagnostic methods,
treatment and prevention of nervous
diseases.

GOAL - to teach nurses to recognize the main neurological symptoms and syndromes, the features of working with neurological pain

GOAL - to teach nurses to recognize
basic neurological symptoms and syndromes
features of working with neurological
sick.
Nurse
Nurse
should know:
must be able to:
– participate in the survey
– anatomy and
sick;
nervous physiology
– evaluate results
systems;
nursing examination;
– main symptoms
- create a care plan and
neurological
perform manipulations;
disorders;
- evaluate your actions and
conduct the necessary
- basic principles
documentation (map
nursing process
nursing process)
in neurology;

From the WHO program on
nursing and
obstetrics:
Nursing process -
is a term used in a system of characteristic species
nursing intervention in health care
individuals, their families or population groups. Specifically he
implies the use scientific methods definitions
the health care needs of the patient/family or
society and on this basis the selection of those who can
be most effectively satisfied through
nursing care.

Basic concepts about nursing
process
Nursing process -
is a method of organizing and performing nursing
patient satisfaction-oriented care
physical, psychological, social
human needs,
family, society.
The purpose of the nursing process is
maintaining and restoring independence
patient, meeting basic needs
body.

The nursing process requires the nurse to:
good technical
preparation;
creative attitude
to patient care;
ability to work with patients
as a person, not as
with the object of manipulation.

Patient care is a complex of activities
aimed at maintaining and
restoring the patient's strength and creating for
its conditions and environment conducive to
favorable course of the disease,
preventing complications and more
quick recovery. It includes
hygienic maintenance of the premises, in
where the patient is located, maintaining
proper hygienic condition
the patient himself, device and equipment
comfortable bed, care for the cleanliness of it and clothes
the patient, organizing the patient’s nutrition,
assisting him with eating,
toilet, physiological functions and
various kinds painful conditions,
arising during the course of the disease (vomiting,
retention of urine, stool and gas, etc.).

Basic principles of care for neurological patients

1.
2.
3.
4.
Diseases of the nervous system often cause
severe movement disorders (paresis, paralysis),
disturbances of sensitivity, speech,
functional disorders pelvic organs,
possible seizures.
This determines the specifics of caring for this category.
sick.
take preventative measures from the very beginning, often
life-threatening complications that arise:
pneumonia,
formation of bedsores,
inflammation urinary tract.
contractures
The development of pulmonary complications is facilitated by constant
position of the patient on his back and entry into the respiratory
mucus pathways from the nasopharynx. To prevent these
complications of the patient should be often (every 2 hours) carefully
turn; you need to clean your mouth several times a day
and throat with a damp swab moistened boric acid,
use suction devices.
The fight against intestinal atony and urinary retention is important.

Nursing process for neurological diseases (problems)

The patient's main problems may be:
disturbance of consciousness;
headache;
nausea, vomiting;
self-care deficit (severe bed rest,
paresis, paralysis);
disturbance of urination and defecation;
state of epileptic seizure;
anxiety about the disease and its consequences;
depression;
sleep disturbance,
increased irritability;
concern about instability general condition;
loose stool;
unmotivated refusal to take medications;
weakness, etc.

10. The uniqueness of work in the neurological department

due to the patient population and health disorders,
which are observed in diseases of the nervous system. This
paralysis, decreased or increased sensitivity,
dysfunctions of the pelvic organs (retention, incontinence
urine and feces).
Caring for patients with paralysis and paresis requires, in addition to general
compliance with the rules of care for seriously ill patients, careful
monitoring the cleanliness of the skin, the regularity of bowel movements
Bladder and intestines.
Paralysis and decreased sensitivity are usually accompanied by
eating disorders skin, especially in those areas
which are pressed down by the weight of the body.
As a result, bedsores with deep ulceration are formed.
skin and subcutaneous tissue.
Prolonged stay of the patient in the supine position may
create a threat of another complication - the occurrence of congestive
phenomena in the lungs with the development of pneumonia.
Patients in comatose, require from
the nurse pays special attention. Important
monitor the patient's position in bed, the head is necessary
lift slightly and turn to the side to avoid
tongue sinking and getting into Airways saliva, mucus

11. Nursing process in neurology.

When starting to work with a patient, the nurse enters into
trusting relationship with the patient. Very important
ability to establish contact, listen to the patient, give
him to speak out and determine what bothers him.
Stage 1 SP - medical nursing examination; we establish violated needs and problems
patients. U neurological b-x the following are often violated
needs: eat, excrete, move, be clean,
communicate.
Stage 2 SP - identification of patient problems or nursing
diagnosis, that is, a description of the patient’s health.
3 stage - planning actions m/s (nursing
interventions).short-term and
long-term goals and a nurse action plan is developed.
4 stage - implementation planned actions (nursing
interventions) according to nursing care standards
sick. Dependent, independent, interdependent.
Stage 5 - assessment of the effectiveness of nursing care.

12. Need for movement

Normal
vital activity
person
provided by a combination of biological,
social and spiritual needs.
Satisfying these needs determines
growth, development, harmony of man with the environment
environment.
Limited mobility or immobility
create many problems for humans. This
the condition can be long-lasting and
permanent. It may be due
injury followed by splinting,
by traction
limbs
With
application
special devices, pain if there is
chronic diseases, residual effects
violations cerebral circulation(stroke).

13.

The main problem is immobility; the patient cannot communicate with the environment.
environment, which has a significant
influence on personality formation. From
degree and duration of immobility
the patient may have problems with
psychosocial sphere; the ability to
learning, motivation decreases, impoverishment
feelings and emotions.
Nursing care is aimed at:
maximum possible recovery mobility;
independence when moving using crutches,
sticks, prostheses and has great value for improvement
quality of life of the patient.

14.

Bedsores
Contractures
Muscular dystrophy

15.

Patient problems:
Development of stiffness (ankylosis)
joints;
Risk of development (or already existing)
bedsores;
A state of depression caused by
loss of independence in carrying out
daily life activities;
The risk of developing muscular dystrophy,
contractures.

16.

Prevention of pneumonia
Execution sequence:
1) teach the patient breathing exercises;
2)perform percussion massage, vacuum massage
chest;
3) give the patient a semi-sitting position in bed;
4) ventilate the room;
5) produce uniform warming of the body;
6) use cups according to indications;
7) carry out inhalation with alkaline solutions and antibiotic therapy
according to indications;
8) ensure that painkillers are taken as prescribed by the doctor;
9) provide breathing with humidified oxygen;
10) use inflating rubber toys for the most complete
ventilation of the lungs.
Note. Particularly careful care is required for patients who
Ventilation is performed through a tracheostomy or endotracheal tube. These
patients have virtually no cough in the respiratory tract
accumulates a large number of sputum. Therefore every 30-40 minutes
secretions from the trachea should be aspirated, for which they use
a special catheter connected to an electric suction device.

17.

Purchased
contractures
underdevelopment
muscles and joints
underdevelopment of skin
integument (skin
membranes between
fingers
dermatogenic occur
during secondary healing
tension of large
skin defects after burns,
wounds, inflammation
dismogenic
develop with
wrinkling of fascia
ligaments and joint capsule
after damage
myogenic conditioned
injuries, acute and
chronic
muscle inflammation
tendogenic ones come
as a result
damage or
tendon inflammation
arthrogenic associated with
pathological
process in the joint

18. Care and prevention of contractures.

In paralyzed limbs, massage and
passive movements in all their segments.
like this therapeutic exercises do within 5-10
min several times a day, preferably every 1-2
hours.
Teach the patient’s relatives massage techniques.
The paralyzed limbs are given a position
opposite to the direction of developing
contractures.
The arm is fixed in abducted and supinated position
position
The leg is straightened, a support is placed under the foot, under
The knee joint is supported by a bolster.
The foot forms a right angle with the shin.

19. General hygiene care

Wash your face at least 2 times a day and
Wash and wash your hands more often.
Regular oral care.
Help brush teeth, rinse mouth,
for seriously ill patients - wipe the gums and
teeth with a gauze pad moistened
solution of boric acid or soda.
The eyes are washed with sterile
gauze pad soaked in
warmth antiseptic solution to wash away
discharge that sticks eyelashes together.
Care for nose, ears, hair,
nail cutting.

20. Care for dysfunction of the pelvic organs.

Retention of urine and feces leads to
additional intoxication.
Urinary retention - 2 times per
spend a day (morning and evening)
bladder catheterization
sterile catheter, lubricated
glycerin or petroleum jelly.
After urine removal, the bladder
rinse with antiseptic solution, 0.02% solution
furatsilin.
Leave the catheter in the bladder for
5-6 days.

21. Delayed defecation.

Include plant foods in the diet of patients
products and give sunflower or
Vaseline oil 2 tbsp. per day as
laxative.
If ineffective, use
laxatives - guttalax, forlax, drugs
hay), cleansing enemas.
Early patient activation and physiological
posture (sitting) during defecation.
For fecal and urinary incontinence, you can
use adult diapers with
anti-fecal barrier, absorbent
sheets.
After changing diapers it is mandatory
hygienic treatment of contaminated areas
liquid soap and warm water.

22. Care when feeding patients

Difficulty swallowing – individually
choose the consistency of food.
Feed tasty warm food,
mushy, slowly, so as not to cause
choking.
If swallowing is completely impaired or if you are sick
unconscious - we feed through
nasogastric tube
The doctor inserts a sterile probe to 50
centimeter mark - are we observing?
cough, difficulty breathing, cyanosis….not
whether the probe entered the trachea.
Next to the bed there is a vessel with water and through a flexible
Organize a straw for the patient to drink.

23. 24. Caring for patients with speech impairment.

Despite loss of speech (aphasia), patients
maintain consciousness and a certain circle
interests.
The nurse's task is to establish contact with
by the patient through facial expressions, gestures,
letters (if saved).
For motor aphasia, the nurse should
ask questions so that you can
get unambiguous answers (“yes”, “no”).
With sensory aphasia, the patient does not understand
speech addressed to him, therefore it should
reinforce your requests with a show
proposed action: for example, picking up
the patient's hand, at the same time ask him
raise your hand, etc.
When communicating with such patients, you need
gradually teach them the correct

25. Care of patients during lumbar puncture.

The day before, the patient should be reassured, perhaps given
sedative mixtures.
Before the puncture, the patient must empty his bladder
bladder and intestines.
Prepare for puncture: sterile instrument, medications (alcohol, iodonate, novocaine for anesthesia), sterile balls,
napkins, gloves, a diaper on which they lay
sterile material.
Assist the doctor, help with
liquorodynamic tests of Queckenstedt and Stuckey.
The resulting cerebrospinal fluid should be sent to the laboratory with instructions
patient's name, department, date.
After the puncture, the patient is carefully transferred to a gurney.
stomach down and taken to the ward, where they also carefully
put to bed face down without a pillow for two hours.
Bed rest is prescribed for 1-2 days.

26.

27. 28. Caring for comatose patients.

Regularly measure blood pressure, pulse rate and
breathing, temperature, pupils.
Monitor the accumulation of mucus in the nasal cavity
cavity, promptly remove it using
electric suction, make sure that there is no
retraction of the tongue, aspiration of vomit.
ABOUT sudden changes in a sick condition
urgently report to the attending physician or duty officer
doctor.
It is strictly forbidden to have conversations with
the patient’s bedside about the severity of his condition,
make assumptions about unfavorable
outcome. Performed by a student of the MS-142 group
Panov Roman

DEFINITION OF THE SUBJECT OF NEUROLOGY AND ITS PLACE AMONG OTHER MEDICAL DISCIPLINES

NEUROLOGY IS THE SCIENCE OF THE NERVOUS
HUMAN SYSTEM.
NEUROPATHOLOGY—THE SCIENCE OF
DISEASES OF THE NEURAL SYSTEM.
Studying lesions of the nervous system,
manifested by movement disorders,
sensitivity, disorder
functions of the senses, speech and
develops diagnostic methods,
treatment and prevention of nervous
diseases.

GOAL - to teach nurses to recognize the main neurological symptoms and syndromes, the features of working with neurological pain

GOAL - to teach nurses to recognize
main neurological symptoms and syndromes,
features of working with neurological
sick.
Nurse
Nurse
should know:
must be able to:
– participate in the survey
– anatomy and
sick;
nervous physiology
– evaluate results
systems;
nursing examination;
– main symptoms
- create a care plan and
neurological
perform manipulations;
disorders;
- evaluate your actions and
conduct the necessary
- basic principles
documentation (map
nursing process
nursing process)
in neurology;

From the WHO program on
nursing and
obstetrics:
Nursing process -
is a term used in a system of characteristic species
nursing intervention in health care
individuals, their families or population groups. Specifically he
involves the use of scientific methods for determining
the health care needs of the patient/family or
society and on this basis the selection of those who can
be most effectively satisfied through
nursing care.

The nursing process requires the nurse to:
good technical
preparation;
creative attitude
to patient care;
ability to work with patients
as a person, not as
with the object of manipulation.

Patient care is a complex of activities
aimed at maintaining and
restoring the patient's strength and creating for
its conditions and environment conducive to
favorable course of the disease,
preventing complications and more
quick recovery. It includes
hygienic maintenance of the premises, in
where the patient is located, maintaining
proper hygienic condition
the patient himself, device and equipment
comfortable bed, care for the cleanliness of it and clothes
the patient, organizing the patient’s nutrition,
assisting him with eating,
toilet, physiological functions and
various types of painful conditions,
arising during the course of the disease (vomiting,
retention of urine, stool and gas, etc.).

Basic principles of care for neurological patients

1.
2.
3.
4.
Diseases of the nervous system often cause
severe movement disorders (paresis, paralysis),
disturbances of sensitivity, speech,
disorders of the pelvic organs,
convulsive seizures are possible.
This determines the specifics of caring for this category.
sick.
take preventative measures from the very beginning, often
life-threatening complications that arise:
pneumonia,
formation of bedsores,
inflammation of the urinary tract.
contractures
The development of pulmonary complications is facilitated by constant
position of the patient on his back and entry into the respiratory
mucus pathways from the nasopharynx. To prevent these
complications of the patient should be often (every 2 hours) carefully
turn; you need to clean your mouth several times a day
and throat with a damp swab soaked in boric acid,
use suction devices.
The fight against intestinal atony and urinary retention is important.

Nursing process for neurological diseases (problems)

The patient's main problems may be:
disturbance of consciousness;
headache;
nausea, vomiting;
lack of self-care (strict bed rest,
paresis, paralysis);
disturbance of urination and defecation;
state of epileptic seizure;
anxiety about the disease and its consequences;
depression;
sleep disturbance,
increased irritability;
concern about the instability of the general condition;
loose stools;
unmotivated refusal to take medications;
weakness, etc.

The uniqueness of working in the neurological department

due to the patient population and health disorders,
which are observed in diseases of the nervous system. This
paralysis, decreased or increased sensitivity,
dysfunctions of the pelvic organs (retention, incontinence
urine and feces).
Caring for patients with paralysis and paresis requires, in addition to general
compliance with the rules of care for seriously ill patients, careful
monitoring the cleanliness of the skin, the regularity of bowel movements
bladder and intestines.
Paralysis and decreased sensitivity are usually accompanied by
impaired nutrition of the skin, especially in those areas
which are pressed down by the weight of the body.
As a result, bedsores with deep ulceration are formed.
skin and subcutaneous tissue.
Prolonged stay of the patient in the supine position may
create a threat of another complication - the occurrence of congestive
phenomena in the lungs with the development of pneumonia.
Patients in a comatose state require
the nurse pays special attention. Important
monitor the patient's position in bed, the head is necessary
lift slightly and turn to the side to avoid
tongue sinking and saliva and mucus entering the respiratory tract

Nursing process in neurology.

When starting to work with a patient, the nurse enters into
trusting relationship with the patient. Very important
ability to establish contact, listen to the patient, give
him to speak out and determine what bothers him.
Stage 1 SP - medical nursing examination; we establish violated needs and problems
patients. In neurological patients the following are often impaired:
needs: eat, excrete, move, be clean,
communicate.
Stage 2 SP - identification of patient problems or nursing
diagnosis, that is, a description of the patient’s health.
Stage 3 - planning actions of m/s (nursing
interventions).short-term and
long-term goals and a nurse action plan is developed.
Stage 4 - implementation of planned actions (nursing
interventions) according to nursing care standards
sick. Dependent, independent, interdependent.
Stage 5 - assessment of the effectiveness of nursing care.

Need for movement

The main problem is immobility; the patient cannot communicate with the environment.
environment, which has a significant
influence on personality formation. From
degree and duration of immobility
the patient may have problems with
psychosocial sphere; the ability to
learning, motivation decreases, impoverishment
feelings and emotions.
Nursing care is aimed at:
maximum possible restoration of mobility;
independence when moving using crutches,
sticks, prostheses and is of great importance for improving
quality of life of the patient.

Bedsores
Contractures
Muscular dystrophy

Prevention of pneumonia
Execution sequence:
1) teach the patient breathing exercises;
2)perform percussion massage, vacuum massage
chest;
3) give the patient a semi-sitting position in bed;
4) ventilate the room;
5) produce uniform warming of the body;
6) use cups according to indications;
7) carry out inhalation with alkaline solutions and antibiotic therapy
according to indications;
8) ensure that painkillers are taken as prescribed by the doctor;
9) provide breathing with humidified oxygen;
10) use inflating rubber toys for the most complete
ventilation of the lungs.
Note. Particularly careful care is required for patients who
Ventilation is performed through a tracheostomy or endotracheal tube. These
patients have virtually no cough in the respiratory tract
A large amount of sputum accumulates. Therefore every 30-40 minutes
secretions from the trachea should be aspirated, for which they use
a special catheter connected to an electric suction device.

Care and prevention of contractures.

In paralyzed limbs, massage and
passive movements in all their segments.
Do this type of therapeutic exercise for 5-10
min several times a day, preferably every 1-2
hours.
Teach the patient’s relatives massage techniques.
The paralyzed limbs are given a position
opposite to the direction of developing
contractures.
The arm is fixed in abducted and supinated position
position
The leg is straightened, a support is placed under the foot, under
The knee joint is supported by a bolster.
The foot forms a right angle with the shin.

General hygiene care

Wash your face at least 2 times a day and
Wash and wash your hands more often.
Regular oral care.
Help brush teeth, rinse mouth,
for seriously ill patients - wipe the gums and
teeth with a gauze pad moistened
solution of boric acid or soda.
The eyes are washed with sterile
gauze pad soaked in
warm antiseptic solution to wash off
discharge that sticks eyelashes together.
Care for nose, ears, hair,
nail cutting.

Care for pelvic organ dysfunction.

Delayed defecation.

Nursing care

Caring for patients with speech impairment.

Caring for patients during lumbar puncture.

Caring for comatose patients.

Regularly measure blood pressure, pulse rate and
breathing, temperature, pupils.
Monitor the accumulation of mucus in the nasal cavity
cavity, promptly remove it using
electric suction, make sure that there is no
retraction of the tongue, aspiration of vomit.
About sudden changes in the patient's condition
urgently report to the attending physician or duty officer
doctor.
It is strictly forbidden to have conversations with
the patient’s bedside about the severity of his condition,
make assumptions about unfavorable
outcome.

Introduction

Neurology (Greek neuron – nerve, logos – teaching, science). The sum of disciplines whose object is the nervous system in normal and pathological conditions. This term is often used instead of the term “neuropathology”, although these concepts are not equivalent - the first is much broader.

Neurological disorders place an enormous burden on patients, their families and society. With increasing life expectancy, everything large quantity people are likely to fall victim to stroke, dementia and other brain diseases, leading to huge healthcare costs worldwide. It is very important that modern medicine begins to understand the brain basis of behavior and recognize mental disorders as cerebral, non-mental disorders. Meningitis, Creutzfeldt-Jakob disease, multiple sclerosis recognized as brain diseases mental disorders, as serious as AIDS or cancer.

The essence of the modern nursing model, as scientific theory, is the rationale different approaches to content and delivery nursing care. The concept of “nursing process” has entered the professional lexicon, which is understood as a systematic approach to providing nursing care, focused on the needs of the patient. The purpose of this approach is to strive to alleviate, eliminate, and prevent problems that arise in the patient due to changes in health status.

A number of care activities, such as, for example, elements relating to the personal hygiene of the patient, the hygienic maintenance of his bed, linen, room, are common to all groups of patients - therapeutic, surgical, neurological, gynecological, etc. However, in each of these groups care has its own characteristics, its own specifics. Particular difficulties arise when caring for seriously ill patients.

1. Basic principles of care for neurological patients

neurological nursing care

Patient care is a set of measures aimed at maintaining and restoring the patient’s strength and creating for him conditions and an environment conducive to a favorable course of the disease, preventing complications and a faster recovery. It includes the hygienic maintenance of the room in which the patient is located, maintaining the proper hygienic condition of the patient himself, arranging and equipping a comfortable bed, taking care of the cleanliness of it and the patient’s clothes, organizing the patient’s meals, providing assistance to him with eating, using the toilet, physiological functions and other the kind of painful conditions that arise during the course of the disease (vomiting, retention of urine, stool and gas, etc.).

Directly related to care is the clear and timely implementation of all instructions prescribed to the patient. medical procedures and drug prescriptions, as well as monitoring his condition.

Chronic neurological diseases can manifest either as a permanent neurological defect or as a progressive increase in symptoms. In mild non-progressive cases, using orthopedic devices, rehabilitation activities etc. the patient can be ensured a full existence. In severe cases, they strive to make maximum use of the remaining functionality.

For progressive diseases, treatment depends on the rate of increase and severity of symptoms. For example, multiple sclerosis and malignant tumors quickly lead to death, however, even in these cases, clarification of the prognosis and supportive measures can bring great benefit the patient and his family.

Diseases of the nervous system often cause severe movement disorders, sensory disturbances, speech disorders, dysfunction of the pelvic organs, and convulsive seizures are possible. This determines the specifics of care for this category of patients.

In the event of a stroke, as well as acute neuroinfections, it is necessary from the very beginning to take measures to prevent life-threatening complications that often arise: pneumonia, the formation of bedsores, and inflammation of the urinary tract. The development of pulmonary complications is facilitated by the constant position of the patient on his back and the entry of mucus from the nasopharynx into the respiratory tract. To prevent these complications, the patient should be carefully turned frequently (every 2 hours); It is necessary to clean the mouth and throat several times a day with a damp swab moistened with boric acid, and use suction devices. The fight against intestinal atony and urinary retention is important.

The most common neurological disease is a stroke ( acute disorder cerebral circulation). Most often, a stroke is accompanied by loss of consciousness. This condition of patients may continue long time.

The cause of a stroke may be: hypertonic disease in the acute stage (crisis), cerebral aneurysm. A stroke can occur suddenly and lead to the death of the patient in the first hours.

Developed stroke does not proceed the same way in different patients. It is inherent following symptoms:

– disturbance of consciousness;

– sensory impairment;

– aphasia (speech disorder, loss of ability to speak);

– amnesia (memory loss);

– paralysis (violation motor functions generally);

– paresis (incomplete paralysis);

– urinary and fecal incontinence;

– general disorder psyche;

– bedsores that form faster than with other diseases.

All people who have suffered a stroke become bedridden patients for a long time, caring for them requires special skills and knowledge.

The nurse must have professional observation, allowing him to see, remember and evaluate in a nursing way the smallest changes in the physical, psychological state patient. She must be able to control herself, learn to manage her emotions.

2. Nursing process for neurological diseases

The goal of the nursing process is to maintain and restore the patient's independence in meeting the basic needs of the body. The patient's main problems may be:

– disturbance of consciousness; - headache; - nausea, vomiting; – deficit of self-care (strict bed rest, paresis, paralysis); – disturbance of urination and defecation; – state of epileptic seizure; – anxiety about the disease and its consequences; – depression; – sleep disturbance, – increased irritability; – concern about the instability of the general condition; – loose stools; – unmotivated refusal to take medications; – weakness, etc.

The nurse should monitor:

– Compliance with general care rules.

– It is necessary to place soft cushions under the areas of paralyzed joints, which will eliminate stiffness, swelling, and bedsores.

– You can place a small rubber expander in the bent hand of the paralyzed arm.

– For headaches, apply an ice pack to your head.

– Ensure timely emptying of the bladder.

– When feeding, place the patient in a supine position.

– The person caring for the sick person needs to write down and remember all the exercises prescribed exercise therapy methodologist, speech therapist, massage therapist, try to repeat them with the patient after a certain period of time.

In patients with motor disorders of cerebral origin, paralyzed limbs are placed in a certain position to avoid muscle contractures. The paralyzed arm is placed on a pillow so that shoulder joint and the hand were at the same level in a horizontal plane, the hand is taken to the side, it should be straightened, and the hand should be turned palm up with straightened fingers apart. Sandbags and splints are used to hold the limb in this position.

The paralyzed leg is placed as follows: a cotton pad is placed under the knee joint, the foot is held at an angle of 90° using a rubber traction or a support in a wooden box. In the position on the healthy side, the paralyzed arm lies either along the body or bent at an angle of 90° on a pillow; the leg is bent at the hip and knee joint, put a pillow under it. The position of the patient on the back and side is changed every 2–3 hours.

Depending on the patient’s condition, the doctor prescribes certain deadlines passive and active gymnastics and massage. As movements are restored, the main focus should be on ensuring that patients include the affected limbs in self-care functions as early as possible.

If patients have speech disorders, it is recommended, if possible, to place them in wards with patients whose speech function is preserved, and to conduct classes with a speech therapist.

During an epileptic seizure, to prevent injury, it is advisable to place a pillow or some soft things under the patient’s head. The patient's arms and legs must be held, protecting them from bruise. To prevent biting the tongue and lips, it is recommended to insert a spatula or the edge of a towel into the mouth from the side. It is advisable to turn your head to the side so that saliva can flow freely. You need to unbutton your shirt collar.

Diseases spinal cord often accompanied by lower paraplegia or paraparesis of the legs, dysfunction of the pelvic organs, trophic disorders, and often the development of bedsores. IN similar cases From the first days of the disease, careful skin care is necessary. There should be no wrinkles on the mattress and sheets. An inflatable rubber circle should be placed under areas of the body that are subject to pressure. Several times a day it is necessary to change the patient’s position and wipe the skin with camphor alcohol.

To prevent contractures, you need to monitor the position of your legs, put them in the right position, and fight against sagging feet. The feet are placed at right angles to the lower leg using a stop; sometimes removable splints are applied. In case of urinary retention, repeated catheterization of the bladder is carried out under conditions of strict asepsis and using antiseptic agents. For urinary incontinence, a urinal bag is used. If stool is retained, cleansing enemas are indicated.

In patients with motor disorders of cerebral origin, paralyzed limbs are placed in a certain position to avoid muscle contractures. The paralyzed arm is placed on a pillow so that the shoulder joint and arm are at the same level in a horizontal plane, the arm is taken to the side, it should be straightened, and the hand should be turned palm up with straightened and spread fingers. Sandbags and splints are used to hold the limb in this position.

The paralyzed leg is placed as follows: a cotton pad is placed under the knee joint, the foot is held at an angle of 90° using a rubber traction or a support in a wooden box. In the position on the healthy side, the paralyzed arm lies either along the body or bent at an angle of 90° on a pillow; the leg is bent at the hip and knee joints, a pillow is placed under it. The position of the patient on the back and side is changed every 2-3 hours.

Depending on the patient’s condition, the doctor prescribes passive and active gymnastics and massage at certain times. As movements are restored, the main focus should be on ensuring that patients include the affected limbs in self-care functions as early as possible.

If patients have speech disorders, it is recommended, if possible, to place them in wards with patients whose speech function is preserved, and to conduct classes with a speech therapist.

Diseases of the spinal cord are often accompanied by lower paraplegia or paraparesis of the legs, dysfunction of the pelvic organs, trophic disorders, and often the development of bedsores. In such cases, careful skin care is necessary from the first days of the disease. There should be no wrinkles on the mattress and sheets. An inflatable rubber circle should be placed under areas of the body that are subject to pressure. Several times a day it is necessary to change the patient’s position and wipe the skin with camphor alcohol.

Caring for a severely neurological patient is difficult both in a hospital setting and, especially, at home. The attending physician must instruct the nurse caring for the patient, emphasizing the need for careful compliance with all recommendations, on which the fate of the patient literally depends. An important role in this is played by the nurse, who must practically familiarize the patient’s relatives and friends with the technique of performing the recommended manipulations, and carry out some of them personally (injections, catheterization, gastric intubation).

The attending physician and nurse For successful treatment for a severe neurological patient, it is necessary not only professional competence and the desire to improve their qualifications, but also love for their work.

In many diseases of the central nervous system ( inflammatory processes, tumors, cerebrovascular accidents, head injuries) disturbances of consciousness, vomiting, and convulsions are observed. In some patients, not only swallowing is impaired, but also salivation increases, which is why they may choke on saliva. With disorders of consciousness, the evacuation of food from the stomach may be impaired, which leads to profuse vomiting with aspiration of vomit. In addition, urinary retention, involuntary urination and defecation are common.

A nurse involved in caring for a patient with a swallowing disorder needs to be able to insert a tube through the nasal passage into the stomach to remove the contents and feed the patient. The procedure of catheterization of the bladder with a soft catheter in order to wash it and remove urine is also very important.

The nurse must not only master the technique of subcutaneous, intramuscular and intravenous injections, but also be able to use the intravenous system drip administration solutions, as well as a catheter installed in the subclavian, jugular or other large veins, to care for it. It is also necessary to master the technique of oxygen inhalation and other medicines.

Patients with neurological diseases often experience acute neuropsychic conditions - epileptic and hysterical seizures, alcoholic delirium. At epileptic seizure It is necessary, first of all, to protect the patient from injury. To avoid fractures, you should not hold the patient during convulsions, much less try to fix him by leaning on your whole body. You just need to support your head by turning it to one side, or put something soft under it. To prevent tongue biting, a spatula wrapped in gauze, a handkerchief or a bandage is inserted between the teeth. Do not insert the handles of forks, spoons or other metal objects if convulsive seizures follow one after another. They talk about status epilepticus. In these cases, 2 ml of seduxen is administered intravenously. Repeated administration is permissible no earlier than after 10 minutes. If the effect of seduxen is not observed, then 1-5% hexenal or sodium thiopental is administered intravenously very slowly.

The outstanding French Jean Charcot called hysteria related to “a great simulator,” meaning the variety of its manifestations, which can copy signs organic lesions brain Hysterical attack most often develops as a result of mental trauma. In this case, the patient does not lose consciousness, sometimes falls, but is never hurt. The convulsions are varied and fanciful; a hysterical arc may be observed: the patient rests only on his head and heels; eyes closed. Urination is possible, but defecation never occurs during an attack. Convulsions are varied, sometimes chaotic. Patients tear their clothes and hit their heads on the floor. During a seizure, the patient must be isolated, strangers removed from the room, a calm environment created, and tranquilizers administered.

Paralysis, paresis of the limbs, sensory disturbances, and muscle hypotonia in neurological patients increase the likelihood of the formation of infiltrates and abscesses at injection sites. To prevent these complications, it is recommended to inject on the healthy side. There is no need to administer drugs intramuscularly in the area of the anterior surface of the thigh, since here, with the formation of an abscess, pus can quickly spread through the fascial spaces with the formation of extensive phlegmon. Intravenous infusions are also given on the healthy side. Injecting solutions into veins should be avoided lower limbs bedridden patients, since muscle hypotonia, lack of movement and passive position in bed contribute to blood stagnation. Any violation of the integrity of the venous wall can cause phlebothrombosis, and with thrombosis of the leg veins, thromboembolism develops in many cases pulmonary arteries, often fatal. It is preferable to place the catheter in the subclavian or jugular vein. This is especially important for intravenous infusion in patients with impaired consciousness, convulsions, and anyone who is expected to infuse significant volumes of liquids. Installation of a catheter is a medical procedure. The nurse should prepare the system for intravenous administration liquids. After the vein is punctured and the catheter is installed, it is necessary to check its correct position. To do this, a syringe half filled with saline solution or 0.25% novocaine is attached to the catheter and, by pulling towards itself, a few milliliters of blood are drawn. Part of the contents of the syringe is injected back into the vein. When carrying out such a manipulation, the nurse should not feel resistance or make any effort. After checking, the system can be connected to the catheter and, having attached it to the skin with an adhesive tape, the drugs can be administered. When there is no longer a need for continuous injection of the solution, the system is turned off. The catheter left in the vein is filled with 0.3-0.5 ml of heparin solution and closed with a stopper. This allows for reintroduction medications to avoid additional and injury to the vein.

The doctor and nurse observing the patient should promptly notice both a decrease in breathing (up to 10 per minute) and an increase in breathing (28-30 per minute), the appearance of pauses, additional breaths, asynchrony breathing movements chest, diaphragm and abdominal muscles. In order for the airways to remain free, you need to turn the patient on his side, clear the oropharynx of mucus and vomit using suction or a tampon, install an air duct if the tongue is retracted, and establish inhalation of humidified oxygen. When monitoring cardiac activity, the nurse notes a decrease (less than 60 per minute) and an increase (more than 90 per minute) in the pulse, its rhythm or arrhythmia; increase (above 140/90) decrease (below 100/60) pressure. Any abnormalities noticed should be reported to your doctor immediately.

Cardiac arrest can occur due to massive bleeding, brainstem herniation, thromboembolism and a number of other conditions. The doctor and nurse must be able to carry out the simplest cardiopulmonary resuscitation, which consists of performing mouth-to-mouth ventilation and indirect (external) cardiac ventilation. Such artificial maintenance is vital important functions possibly for tens of minutes and even several hours and allows you to ensure blood circulation, enrich it with oxygen and prevent the development of irreversible changes in the brain. The sooner resuscitation begins (3-5 minutes after cardiac arrest), the greater the chance of success. The main signs of the effectiveness of resuscitation measures are the appearance of a pulse on carotid artery, a decrease in the “marbling” of the skin, visible excursions of the chest when air is blown in. A good prognostic sign, which indicates the preservation of brain functions, is the constriction of the pupils, which dilated during cardiac arrest, restoration of the corneal reflex and the reaction of the pupils to light. During the period of mechanical ventilation and cardiac massage, the administration of drugs and the use of other resuscitation methods begin.

At the same time, we should not forget the statement of the famous Russian anesthesiologist-resuscitator A.P. Zilber, who noted that resuscitation should support life and not prolong death. If at least a minimal effect from resuscitation measures is not observed, they should be carried out for 30 minutes.

If necessary, the nurse feeds the patient through a tube. Puréed food or special nutritional mixtures are administered using Zhane's shiritsa. It is recommended to administer no more than 400-500 ml of the mixture per feeding, since a larger amount of food pushes the diaphragm into the chest, squeezing the lungs and heart and making cardiac activity and breathing difficult. Daily diet divided into 5-6 doses

A large place in the work of a nurse is occupied by hygienic and therapeutic and preventive care for seriously ill patients: toileting the oral cavity, washing and washing, making beds, changing linen. Measures to prevent bedsores are important: turning the patient from one position to another every 1.5-2 hours, wiping the skin camphor alcohol or alcohol solution with shampoo, which is also a kind of massage. A rubber circle or vessel is placed under the sacrum, and shoulder blades are placed under the back of the head. elbow joints and heels - special rings

In warning stagnation in the lungs great importance and places breathing exercises, which is carried out for seriously ill patients several times a day.

An illness, especially a chronic one, is accompanied by anxiety and can cause fear, irritability, and depression, which affects the course of the illness and the results of treatment. We must try to reassure the patient, instill in him confidence, if not in recovery, then in improving his well-being - this is a humane task and the duty of doctors.

In some cases, doctors have to hide the diagnosis from the patient in order to avoid severe psycho-emotional reactions.

Many neurological patients are elderly and old people. It is known that with age, many people’s character changes, resentment and vulnerability appear or intensify, and there is often a low mood caused by thoughts of mastered uselessness. Some patients consider themselves a burden to their family and society. This uniqueness of the human psyche, provoked or enhanced by a neurological disease, requires medical personnel caring attitude. A nurse caring for such a patient needs great patience, tact and restraint. She should not react negatively to the patient’s verbosity, inconsistency, and whims. The nurse should express all her comments in the most tactful manner. Irritability is unacceptable, and even more so aggressive behavior towards the patient, which often leads to open conflict. This interferes with the first step of being a nurse - establishing a trusting relationship. Of course, such behavior can significantly worsen the patient’s condition and even negate the effect of therapy.

A family doctor and nurse must be able to establish contact with patients and resolve possible conflicts. On the one hand, this makes their work easier, and on the other hand, it allows them to improve the conditions for the patient to stay at home.

The article was prepared and edited by: surgeon

Care of neurological patients. Care for neurological patients, practical advice Damage to cranial nerves

DEFINITION OF THE SUBJECT OF NEUROLOGY AND ITS PLACE AMONG OTHER MEDICAL DISCIPLINES

GOAL - to teach nurses to recognize the main neurological symptoms and syndromes, the features of working with neurological pain

Basic principles of care for neurological patients

Nursing process for neurological diseases (problems)

10. The uniqueness of work in the neurological department

11. Nursing process in neurology.

12. Need for movement

13.

14.

15.

16.

17.

18. Care and prevention of contractures.

19. General hygiene care

20. Care for dysfunction of the pelvic organs.

21. Delayed defecation.

22. Care when feeding patients

23.

24. Caring for patients with speech impairment.

25. Care of patients during lumbar puncture.

26.

27.

28. Caring for comatose patients.

DEFINITION OF THE SUBJECT OF NEUROLOGY AND ITS PLACE AMONG OTHER MEDICAL DISCIPLINES

GOAL - to teach nurses to recognize the main neurological symptoms and syndromes, the features of working with neurological pain

Basic principles of care for neurological patients

Nursing process for neurological diseases (problems)

The uniqueness of working in the neurological department

Nursing process in neurology.

Need for movement

Care and prevention of contractures.

General hygiene care

Care for pelvic organ dysfunction.

Delayed defecation.

Nursing care

Caring for patients with speech impairment.

Caring for patients during lumbar puncture.

Caring for comatose patients.

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