Palliative patients with neurological disorders - after a stroke, traumatic brain injury, with dementia or Alzheimer's disease, a CNS tumor or multiple sclerosis - suffer from movement disorders, hypertonicity, pain, swallowing disorders, uncontrollable vomiting, epileptic syndrome, impaired coordination of movements, etc. .d. How can you alleviate their condition?
Which of the patients with neurological deficit needs palliative care?
First of all, these are patients with various disorders of cerebral circulation, dementia, Alzheimer's disease; patients with consequences of traumatic brain injury, with multiple sclerosis, amyotrophic lateral sclerosis, with tumors of the central nervous system, Parkinson's disease and other diseases of the nervous system.
What do patients with neurological deficits suffer from? From paresis (motor disorders), hypertonicity, turning into spasticity, pain, swallowing disorders, vomiting, epileptic syndrome, impaired coordination, behavioral disorders, mood changes.
Why are paresis (motor disorders) dangerous in our patients?
Firstly, paresis, as a rule, leads to hypertonicity, leads to spasticity, the formation of contractures, which inevitably leads to the onset of pain.
Secondly, due to the fact that the patient becomes immobile, there is a danger of an extensive decubitus process, the consequences of which are difficult to cope with.
How can we work with spasticity, contractures in our departments?
• Using the correct positioning of patients: laying the distal and proximal parts of the limbs with special pillows, sometimes blankets, rollers, using orthoses. If we observe an increase in edema of the paretic limbs, then we can raise the distal sections - everything is done for the convenience of the patient;
• Applying physiotherapy exercises: provided that the patient is in a clear mind, understands the speech addressed to him, has a relatively favorable life and rehabilitation prognosis - then we involve specialists;
• And, finally, we must not forget about drug therapy: the selection of the correct dosages of muscle relaxants, vascular-metabolic therapy is very important.
Pain - why does it occur in a neurological patient? There are several options:
1. Pain due to spastic tone;
2. Pain due to incorrect position of paralyzed limbs. We have all seen patients with paresis of one arm: such a person walks with his arm hanging along the body, while the shoulder joint capsule is overstretched, and pain associated with this occurs;
3. Pain associated with the growth of volumetric formations of the spinal cord or brain;
4. Neuropathic pain in polyneuropathies of various origins.
How we work in the presence of pain in a patient:
• Drug therapy is required! (local anesthetics, tricyclic antidepressants, SNRI antidepressant, anticonvulsants, NSAIDs, non-opioid and opioid analgesics);
• Occupations by ergotherapy, exercise therapy (in case of pain caused by spastic tone or overextension of the joint capsule during paresis);
• Consultations of a psychotherapist (in the case of psychosomatic variants of pain - the connection of antidepressants, antipsychotics
Basic principles of care for neurological patients
• Prevention of development of decubituses;
• Fall risk prevention;
• Prevention of the development of pneumonia in severe, bedridden patients;
• Prevention of formation of contractures;
• Individual approach to feeding;
• Monitoring the functions of the pelvic organs (since our patients have incontinence or urinary retention, it is important to monitor this in time);
• Psychological support for the patient and his family;
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