Caring For Clients With Nuerologic Deficits Chapter 46

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Caring For Clients With Nuerologic
DeficitsChapter 46

• Karyn Mills, RN, BSN

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Overview

• A neurologic deficit occurs when one or more
  functions of the central and peripheral nervous
  systems are decreased, impaired, or absent.
• Examples of neurologic deficits include
  paralysis, muscle weakness, impaired speech,
  inability to recognize objects, abnormal gait or
  difficulty walking, memory impairment, impaired
  swallowing, or abnormal bowel and bladder
  elimination.

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Phases of Neurologic Deficit

• Divided into 3 phases
• 1. Acute
• 2. Recovery
• 3. Chronic
• Not all individuals with a neurologic defict
  experience all 3 phases.

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Acute Phase

• Occurs after a sudden neurologic event, such as a
  CVA or a head or spinal cord injury
• During the acute phase, the client is usually
  critically ill.
• Many s/s may be present, such as altered LOC,
  HTN, Hypotension, fever, difficulty breathing or
  paralysis.

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Acute Medical Management

• Focus is to stabilize the client and prevent
  further neurologic damage.
• Medications, surgery, mechanical ventilation.

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Acute Nursing Management

• Frequent and thorough neurologic assessments
• Use the Glasgow Coma Scale
• V/Smaintain the BP to ensure adequate cerebral
  oxygenation.
• Measure I O
• Observe for electrolyte imbalances and
  dehydration
• Report a urinary output of less than 500 mL/day
  or urinary or bowel incontinence

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Recovery Phase pg 740

• Begins when the clients condition is stabilized.
• This phase may begin several days or weeks after
  the initial event and lasts weeks or months.
• Medical management aimed at keeping the client
  stable and preventing or treating complications,
  such as pneumonia, and further neurologic
  impairment.

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Recovery Nursing Management

• A successful rehabilitation program includes all
  members of the health care team.
• Devices that help a client walk, eat, groom, and
  perform other motor skills are recommended or
  devised to suit particular needs.
• Flotation pads for wheelchairs, walkers,
  sheepskin boots, and ROM exercises are examples
  of the many appliances and procedures used in
  rehabilitation.

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Chronic Phase pg 740

• The client shows little or no improvement,
  remains stationary, or becomes progressively
  worse.
• Physical and psychological rehabilitation is
  continued in the chronic phase to prevent
  complications such as pressure ulcers and muscle
  contractures.

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Chronic Medical Management

• Control of BP, PT, dietary management, and the tx
  of complications r/t disuse and immobility.
• Surgery is performed to correct deformities or
  problems that have developed
• Examples include muscle and skin grafts to close
  a pressure ulcer, surgery to correct a
  contracture deformity, or removal of a kidney
  stone (a complication of prolonged immobility)

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Chronic Nursing Management

• Often admitted to the hospital for treatment of
  complications.
• The prevention of physical and psychological
  complications.

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Assessment

• The initial assessment includes an evaluation of
  the airway, breathing, circulation, and LOC.
• Because neuromuscular and central nervous system
  disorders and spinal cord injury can affect bowel
  and bladder tone, auscultate the abdomen for
  bowel sounds and palpate the bladder for
  distention.
• Note ability to control bowel and bladder.

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ON YOUR OWN

• CARE PLAN
• IMPLEMENTING A BOWEL TRAINING PROGRAM PG 745

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Psychosocial Issues and Home Management pg 741

• Returning home with a life-altering disability
  can be tremendously frightening.
• The client and family need additional support to
  adapt to anew life-style.
• The burden of care often falls on the spouse who
  may have physical problems as well, or the adult
  children, who may not be available or willing to
  share this responsibility.

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Psychosocial Issues and Home Management

• Financial resources are strained during a lengthy
  hospitalization and may continue after discharge.
• Wide doorways, ramps instead of stairs, special
  fixtures in the bathroom for bathing and
  toileting are examples of changes that are often
  necessary.

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Nursing Management 741

• Evaluate the clients ability to perform
  self-care, to resume his or her role in the
  family, and to call on a support system.
• Assess the available facilities, the family
  support system, physical aids required (eg, a
  wheelchair, cane, or walker), and the amount of
  assistance required with activities of daily
  living when planning home care.

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Coping pg 742

• Address each client in an individual manner.
• Offer reassurance and emotional support and
  display understanding of the multiple problems
  faced by the client.
• Crises such as being unable to move, having
  limited movement, being unable to attend to ones
  most basic needs, and having to totally depend on
  others for housing, clothing, mobility, and food
  creates strong emotional responses.
• Some clients eventually accept their disability
  others do not.

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Coping

• Discouragement, depression, withdrawal, and anger
  are not unusual.
• Suicide Risk

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Skin Care

• Explain that the client may not feel discomfort
  caused by a beginning pressure ulcer.
• Recommend a change in the clients position at
  least every 2 hours to relieve pressure on bony
  prominences.

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Maintaining Body Alignment

• Demonstrate how to put joints through a full ROM.
  
• Demonstrate how various devices, such as rolled
  blankets or pillows, can be used to support or
  align areas of the body, such as the back, hips,
  and legs.
• Explain the use of a footboard or other type of
  device to prevent foot drop.

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Nutrition and Fluids

• Importance of a high fluid intake to prevent
  urinary tract complications.
• Emphasize that small meals and interval snacks
  may be better tolerated than three large meals
• Explain that the client who must be fed needs
  time to chew the food and take fluids.

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Bowel and Bladder

• Demonstrate clean technique, which must be used
  when irrigating, changing, or inserting catheters
  at home
• Advise inspecting the urine for cloudiness (which
  may or may not indicate a UTI), blood and
  offensive odor.
• Contact the MD if chills and fever occur or if
  the urine is bloody, cloudy, or has an offensive
  odor.

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Activity

• Stress the importance of social contacts,
  hobbies, and changes in the daily routine to
  relieve boredom
• Emphasize the importance of avoiding fatigue and
  exposure to infection
• Discuss the importance of having the client take
  deep breaths every 1 to 2 hours while awake and
  to cough to raise secretions

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On Your Own!!!

• Nutritional, Pharmacologic, and Gerontologic
  Considerations!!!