Nursing in the neurology department

Indications for referral to the center:

Acute stroke

Condition after suffering a stroke, diseases and injuries of the brain and spinal cord, peripheral nervous system

Chronic cerebral ischemia

Demyelinating diseases of the central nervous system (multiple sclerosis) Defeat the extrapyramidal system (Parkinson's disease, dystonia) Epilepsy

Neuromuscular Diseases

Degenerative diseases of the brain, spinal cord

Radiculopathy

Patients with pain syndromes of the spine Long-term unconscious states.

Methods of diagnosis of diseases of the nervous system: Consultation by a neurologist, a speech therapist, aphasiology, neuropsychologist, rehab Laboratory research methods, lumbar puncture Electroencephalography (EEG), electroneuromyography (EMG), electromyography (EMG)Ultrasound examinations of the neck vessels and brain (USDS, ultrasonography) Magnetic resonance imaging (MRI), computed tomography (CT)Positron emission tomography (PET)Angiography (X-ray, magnetic resonance, computed).

Methods of treatment:Medical therapy, including thrombolysis in acute period (up to б hours of development) of ischemic stroke Conducting intensive care unitbotulinotherapy Physical rehabilitation including with the use of specialized devices for locomotion therapy "Lokomat", "ERIGO", "Armenia" Physical therapy (including electric, magnetic, laser, cryosauna) Acupuncture, mikroigloterapiya, aurikuloterapiya Leech therapy, vacuum therapy, acupressure Manual therapy, massage, therapeutic blockade Correction of speech disorders, psychological hyperbaric oxygen therapy.

The work that nurses do in Ukraine, in the literature called "task-centered nursing". This work is to fulfill the tasks set by the doctor. This is a 1 - to give medication (IVs, injections) and 2 - to do the procedure (dressings, etc.). Such work requires technical skill and practice, but in practice does not imply a conscious thought. That is, nurses, of course, learn the basics of biology and medicine, but they do not have to think and make decisions, this is not necessary. Moreover, in most Russian hospitals because of the enormous shortage of nurses and they do not have much time to think. A division of labor (Postovaya nurse, procedural, nurse, etc.) requires that elementary manage to "cover" all patients. That is, one is for all the sick and making shots, the second one is sitting in the treatment room and makes dressings, IVs third places. And so the whole shift. Thus the three of them manage to perform appointment in the department of the forty or even more people. Execution of business appointments and limited. Question of how to carry out a full nursing care (and sometimes even to know the diagnosis), is not there, because physically there is no such possibility. This is basically the case of either the patient or family members (if any).

In the USA, the nurse does what is called a "patient-centered nursing", and this is a fundamentally different approach. It requires, first, much less patients per nurse, and secondly, a much better education and a high level of clinical thinking, including knowledge of evidence-based medicine. Why? Because the nurse - this is the central person in charge of the treatment of the patient. Usually the nurse knows about his patient, everything from the diagnosis, clinical indicators of all necessary laboratory tests, medications, procedures, treatment plan, appetite, the need for physical therapy and other specialized treatments, ending the family situation and living conditions of the home, to plan and extract the most the main thing - to prevent subsequent hospitalization.

This is first and foremost the desire for quality care, but also the system as well. In the U.S., there is no such thing as a physician who is a full day in office. Attending physicians of patients coming to the department once a day, sometimes just for a short while, in the rest of the time they need to call. There are hospital doctors on duty, but they are also in the department do not always come only when necessary. A nurse - always. And patients in U.S. hospitals are mainly heavy and require active treatment, the lungs rarely get to the hospital (usually dealt with them in the emergency room and sent home), or written down very quickly. The maximum number of patients that can get a nurse in the medical department of the ordinary for a change - it's eight (in oncology less), and eight - it is very much. Usually try to assign no more than six patients a nurse, and in some states, this number is limited to four patients. The noon nurses working shifts, rather than daily. But they are not allowed to sleep on the job, for it is fired. Night nurses work as day. Plus, the nurses in each department, of course, there are nurses (in office in 30 people are usually two or three), whose main task - to wash, feed and change the bed every recumbent / dependent patients (and assistance to those who were able to get up), and measurement of each change in pressure, temperature and oxygen in all patients (and who should be - more often)

Care of Neurological Patients. The originality of the work in the neurology department due to the contingent of patients and health disorders that occur in diseases of the nervous system. This paralysis, decreased or increased sensitivity, disorders of pelvic organs (delay, incontinence).

Care for patients with paralysis and paresis requires, in addition to the general rules of the care of the seriously ill, careful observation of the purity of the skin, regularly emptying the bladder and bowel.

Paralysis, usually accompanied by a decrease in sensitivity by eating the skin, especially in those areas that are pressed against the weight of the body.

As a result, pressure ulcers are formed with deep ulceration of the skin and subcutaneous tissue.

Prolonged exposure of the patient in the supine position may pose a threat of another complication - the occurrence of stagnation in the lungs with the development of pneumonia.

Prevention of congestive pneumonia requires the patient to shift periodically, enclose extra pillows under your back, from time to time by changing the slope of the bed to the right or to the left. It is important to monitor the regularity of urination and defecation.

At a delay of urine and feces to prevent overfilling of the bladder, kateteriziruya it regularly, and timely bowel movements (giving a laxative, enema). In some cases, urinary retention lasts for several weeks or months, then catheterization should also be treated with bladder introduction of sanitizing solution.

Incontinence of urine and feces must be especially careful to maintain the purity of the skin, as on skin droppings contribute to the formation of bedsores. Furthermore, infected skin may be a source of septic complications.

Patients who are comatose, require the nurse particularly careful attention. It is important to monitor the situation of the patient in bed, his head must be lifted slightly and turn to the side to avoid the ceasing of language and inhalation of saliva, mucus or vomit.

Necessary to monitor compliance with the rules of personal hygiene patients, cleanliness of underwear and bed linen.

At least once a week produced a sanitary bath. Patients with strict bed rest should regularly wash or wipe with a wet towel.

A number of nervous diseases has severe, difficult to treat, and sometimes leads to disability, loss of memory, intellect, and other disorders. In this context, each patient requires an individual approach by the physician, middle and junior medical staff.

For patients who are in a bad, dark mood, especially long and hard for those suffering from it, requires constant monitoring.

His observations of the patient, his mood nurse should tell your doctor. Caring for the mentally ill is of great importance in the treatment.

Food patients should be varied, given that the excited patients spend much energy as well as the disorders vitamin exchange treatment with antipsychotic agents. Give patients drugs at particular times. Nurse should strictly ensure that their patients are taking. Should be checked tables and pockets of patients, as they can accumulate unnecessary items and medicines. Lingerie patients should be changed promptly. Hold weekly hygienic bath. Weak patients flavored vinegar rubbed at least 1 time per week. You need to carefully monitor the condition of the skin in patients with weak, especially in the areas of maximum pressure - on the blades, sacrum, elbows. Weak patients turn over several times a day to avoid the development of congestive pneumonia. Bed weak patients should be smooth, wrinkle-free clothes .If necessary, use a skid circle. The department, along with the observation chambers should be wards for convalescent patients, rest rooms and rooms for occupational therapy. The daily routine should include a clock occupational therapy. ln addition to working indoors or outdoors (kind of work assigned by the doctor), while improving the condition of patients allowed to read newspapers, magazines and fiction, which should be picked up at the library hospital. Patients can watch TV.

Hypnotics prescribed for insomnia.

Necessary to carry out restorative therapy. Prescribed by a doctor can be used pine baths, a simple warm bath, gym, massage and other types of physical therapy.

Along with the standard measures for nursing special attention should be paid to the treatment of patients, physician behavior and tactics personnel.

Staff needs to learn the proper care of the sick, attentive to them with respect and observation, which prevents states expressed excitement, aggression and suicide attempts.

***

The human nervous system is the ideal point in his life, both in the normal state and in diseases. Basic structural and functional unit of the nervous system is the nerve cell, or neuron. Nervous system, its activity is provided by the coordinated functioning of all organs and adaptation of the whole organism to the conditions of its existence.

Neurological disease, this disease of the nervous system caused by organic (vascular, traumatic, toxic, etc.) or functional (neurotic) disorders. The origin of neurological diseases may be associated with genetic factors. These diseases can manifest symptoms of loss (paralysis, loss of sensitivity), irritation (pain, etc.), and the violation of the integration function of the nervous system, being able to dominate a mental disorder.

Neuralgia - a complex of symptoms characterized by bouts of acute pain extending along the trunk or branches of the nerve. The most common neuralgia is sciatica - sciatica. Trigeminal neuralgia can be nerve, intercostal, occipital, etc. The nature of the pain associated with neuralgia different, more often sharp, shooting, tearing, coupled with a burning sensation. Characterized by the appearance of pain or attacks without any apparent reason, or under the influence of movement, change position, light touch.

Neuritis, an inflammation of the nerves. In practice, this name are infectious, toxic, and other lesions of the nerves (eg, trauma, eating disorders nerves) when there is an inflammatory component. Manifested disease susceptibility disorders, paralysis and paresis. Depending on the nature and degree of destruction of nerve function can be turned off or is not fully depressed, or nerves may be able irritation often simultaneously decrease its functions. Among neuritis occupy an important place polyneuritis caused avitaminoses and eating disorders.

In the motor nerves, it's jerking or all of the muscle, or some of its parts. Break sensitivity gives off or reduce the sensitivity and perception in the relevant affected areas or organs. Often associated pain and reduced sensitivity. It may appear numbness," pins and needles the flow of electric current, rarely feeling the pressure of compression in the affected area. These and other disorders may be of a local character, but a sharp pain can spread widely and take unpleasant and painful nature of the defeat of sympathetic nerve fibers.

Polyneuritis, multiple inflammation of the nerves. The causes are varied polyneuritis, it is primarily intoxication and infection, malnutrition, vitamin deficiency. Polyneuritis may be allergic to the developing after the administration of vaccines, serum, drugs, and as a result of infectious diseases, allergic reactions giving (angina, rheumatism, scarlet fever, etc.).

When combined in various ways polyneuritis motor, sensory and trophic disorders which are often joined by disorders of the autonomic nervous system. This paresis or paralysis accompanied by muscle atrophy, decreased muscle tone, pain with different false sensations off and sensitivity, trophic disorders of the skin, nails and joints of the extremities.

Stuttering is a speech disorder in which smooth its course is interrupted by a repetition of individual sounds, syllables, or a delay in their speech utterance due to muscle cramps. Seizures occur just before the speech or just during it. Among boys who stutter more than girls.

Stuttering is most likely to occur in pre-preschool or school age during the formation of speech. Stuttering explained as neurosis preceding symptom is jerky speech disorder. Pathogenic factors of stuttering are trauma (fear), infections, trauma, endocrine disorders, etc. When frightened too powerful emotion of fear causes a nervous breakdown, resulting in the local functional abnormalities occur in the most vulnerable areas of speech motor. In very jerky response to the child he having in these cases, the primary effects of stuttering. Stuttering can be caused by any Bat somatic disadvantage (infection, trauma, etc.), as this also has disorders of the nervous system. Stuttering can be caused by imitation (imitation reflex) under the influence of convulsive speech of others, which can greatly affect not had time to form the child's speech.

Under favorable conditions, stuttering may disappear (but there is always the risk of recurrence), subject to the special vulnerability of children can become stable. At steady stuttering the child has sustained conditional seizure of speech communication in dealing with others, so in school, especially in adolescence, stuttering increases. The child begins to feel ashamed of his stutter, he becomes timid and shy, he has a pronounced fear of speaking and the other caused by the stuttering disorder. In the development of stuttering in speech communication with others, he formed new conditional pathological reflexes convulsive speech to the person, the situation, and so on. Therefore, any unusual forms of speech, and the situation occur it without stuttering. He does not stutter, and in those cases where he does not feel embarrassment or fear for his speech, alone, in terms of noise drowns it. During the observed period of stuttering neurosis is weakening, the gain convulsively.

Stuttering is weakened in most cases after 20 to 25 years of age and rarely stays in middle and old age.

Prevention of stuttering achieved by correct upbringing of children in the first place is the exception traumatic situations mentality of children, adults correct relationship. You can not bore the child's speech, forcing him to talk a lot, especially in fragile voice mechanisms. When adenoids and polyps should apply to the throat specialist, as these razrascheniya, causing breathing difficulties, can cause a child night terrors. When hasty speech at the child must be an example to teach others his smooth and correct speech. This is not to hurt the child and which began stuttering.

Teak is involuntary, rapid, clonic muscle contractions, repetitive, stereotyped. Tics similar to the expressive or purposeful movements, but distinct from his violent temper. If you are able to hold tics, then their subsequent attack becomes more intense. Tics are found not only in humans but also in animals.

The most common tick blink, can also be tiki face, neck, arms and legs. They may have the character of a "sniff", lick, grinding, chewing, clicking of tongue, sucking, biting, smacking, oskalivaniya of a different nature. Tiki neck can play a variety of movements, sometimes involving the muscles of the shoulder and scapula, and they can also be combined with facial tics. These tics can be expressed violently turning the head to the side or from one side to the other. Tiki nodding his head are more common in children. Tiki hands more complex, they reproduce the click of your fingers, twitching his shoulders, scratching, or flick buttoning clothes and other movements. Tiki legs are expressed in the rapid squat, sudden tucking the knees, pritantsovyvanii. Tics of any location can be accompanied by sighs, gasps, coughs, sneezes, hiccups, shouting interjections:" oh!, Ah!, Wow !". Verbal tics, it is senseless repetition of a word or set of words, often abusive, obscene. By tick also include some form of stuttering.

Common tick consists of a large group of motor tic disorder - excessive and involuntary movements such as compulsions forced execution of the action corresponding to the audible word, repeated pronunciation of the last word, and others.

Tics usually start in childhood (7-15 years). They are enhanced under the influence of passion (strong nerve stimulation). Tics can begin after exhausting infectious diseases or after trauma. Almost all patients with congenital nervous tics noted burdening. Sometimes they are fixed reflex or habitual movements, such as conjunctivitis can cause a reflex blinking, which remains even after the termination of inflammation. Children tick may appear as a bad habit of imitation, which in most of these cases can easily pass.

Tics that occur in adults, may have different origins, pain due to organic brain disorders, psychogenic. Featuring facial tics and spasms of the search predisposing factors, the case of doctors. The disease is chronic, but not hopeless, treatment can be effective.

Unconsciousness (loss of consciousness). Unconsciousness is characterized by sudden (often short-lived) the termination of all forms of higher nervous activity. In this state, the higher parts of the central nervous system does not react in any way perceptible to stimuli coming from the internal environment of the body or from the outside world. Unconsciousness due to dysfunction of the cerebral cortex and the development of the braking process. This dysfunction can be caused by eating the brain, oxygen deprivation, etc. However, the unconscious can be caused by overstimulation of the nervous system, which, together with the growing dysfunction leads to the development of inhibition. Loss of consciousness can occur due to pathological processes in the body, such as stroke, tumors of the brain and its membranes, some mental illnesses, pathologically running pregnancy, etc. Loss of consciousness may be caused by external influences - mechanical trauma, the introduction of poisons, the influence of high or low temperature, electricity, high or low atmospheric pressure, etc. The loss of consciousness testifies impassive expression, the lack of reaction to external stimuli (light, sound etc.), complete passivity. Some reflexes and protective responses are stored under partial loss of consciousness - such as painful stimuli. Unconsciousness can occur suddenly (syncope), or as the end of the growing complex of symptoms, such as coma. If unconscious, stops the process of perception of the world, there is no manifestation of mental activity. In duration loss of consciousness may be short-term (up to several seconds at a slight concussion of the brain) or long - a few days or weeks (infectious diseases, poisoning, severe trauma, coma). One of the consequences of unconsciousness may be amnesia - loss of memory, depending on the reasons for the loss of consciousness and duration of unconsciousness.

In an unconscious person can commit a crime, it is a pathological state of affect, delusions, insanity. While he is unconscious helplessness person can be subjected to violence - robbery, injure, loss of life, rape, etc.

Anorexia - is the relentless pursuit of weight loss by targeting long-term self-restraint in eating due to fear of obesity and weight gain.

Against the background of anorexia is often observed hormonal, metabolic disorders, and functional disorders. The disease often leads to life-threatening malnutrition, symptoms

The belief in the excessive fullness of the figure, contrary to obvious facts and not susceptible to dissuade

The lack of a critical attitude toward his condition even in patients with severe exhaustion

Fear of weight gain or obesity is retained even when the depletion

Characterized by excessive physical activity, intake vomiting, laxatives and diuretics, and drugs which reduce appetite.

Patients hide from others (especially from relatives) as the reasons for the refusal to eat, and all that is connected with the desire to lose weight (want to eat separately, using different tricks - seamlessly shift into another plate of food, throw it away, hide, give pet etc.)

During starvation typical tendency to overfeed the other family members, especially the younger brothers and sisters, as well as an interest in food preparation

Prefer complex ways of cooking and eating rituals.

Сomplications of anorexia:

- Weight loss

- Muscle atrophy, dry and flaky skin, brittle nails, hair loss, tooth decay and tooth loss

- Gastritis

- intestinal atony

- anemia

Low blood pressure (hypotension) Swelling

Cardiovascular failure Bone loss

Cessation of menstruation in women with established menstrual function

Convulsions.

Treatment

Bed rest controlled meal to weight gain of not less than 9.5 kg Gradual increase in caloric intake Gradual increase in exercise as weight gain Weigh first day, then three times a week

Hospitalization is indicated for reducing body weight by more than 30 % of the initial б months, confirmed by ECG significant electrolyte disturbances, suicide risk, failure of outpatient treatment

Tranquilizers: oxazepam 15 mg or 0.25 mg of alprazolam before meals, low doses of phenothiazine derivatives, such as chlorpromazine 10-25 mg / day, - in-patients, Cyproheptadine 4 mg / day and gradually increasing the dose to 32 mg / day

Antidepressants: fluoxetine 20 mg / day, once in the morning, or sertraline 50 -100 mg / day, once in the morning, or imipramine, ranging from 10 mg / day, with gradual dose escalation to 200 mg / day

Combination preparations of vitamins and minerals Metoclopramide, 10-15 mg before each meal and at bedtime psychotherapy

The course and prognosis of anorexia

40 % of patients recover, 30% - the condition is improving, in 30 % of cases, the disease takes a chronic form. 6% of patients die from starvation and suicide.