Care of coma and vegetative state

Currently, the treatment of VS in comatose patients, especially those in vegetative state, is a difficult problem in clinical neuroscience, and clinical practice has shown that nursing care is sometimes a key factor in determining the prognosis of comatose patients and those in vegetative state. Nursing care can effectively reduce complications and prolong survival time, mainly including nutritional support, oral care, respiratory management, gastrointestinal care, skin care, perineal care, limb rehabilitation, etc., and to strengthen the patient’s gastric tube, tracheal cannula, urinary catheter, and venous access (deep venous cannulae, intravenous indwelling needles) of the nursing care.1, Nutritional support: malnutrition combined with infections is often an important cause of death in the patient, early Parenteral nutrition should be combined with enteral nutrition; in the middle and late stages, enteral nutrition can be considered as the main focus.2. Swallowing training: Early dietary training is not advocated, and functional electrical stimulation of swallowing function training can be started. Because diet may induce the increase of oropharyngeal secretion, as well as the aspiration of dietary material, resulting in pneumonia.3, oral care and respiratory management: to maintain oral cleanliness and airway patting, regular turning and patting the back, sputum suction, tracheal cannula cleaning, disinfection is the main measures to prevent respiratory infection.4, skin care: as far as possible to use the electric air cushion, regular turning, alternating between supine position, lateral position, reclining position, full back massage, local massage to prevent respiratory infection, and to prevent the spread of the skin. The whole back massage, local massage to prevent and reduce the occurrence of pressure ulcers. 5, perineal care and urinary catheter management: give the patient more water, timely change of diapers, urinary catheter urine bag, regular bladder irrigation, keep the perineum clean and dry in order to prevent urinary tract infections, urinary tract stone formation. Do not advocate the use of diapers.6, rectal management: as far as possible to maintain bowel movement, reduce the frequency and degree of constipation.7, rehabilitation care: to enhance passive activities, maintain a good posture, and so on. Coma and vegetative state patients are bedridden for a long time, the treatment of good posture is the key to prevent muscle atrophy, joint contracture deformity; limb activities and massage is an important measure to prevent deep vein thrombosis of the lower extremities. 8, psychological care for family members: let the patient’s family members have a correct understanding of the disease and a positive attitude towards the treatment. Through the careful care of nurses and family members, complications such as pneumonia, pressure sores, deep vein thrombosis, urinary tract infection, joint contracture, muscle atrophy, etc. can be minimized, and a good foundation can be laid for the subsequent wake-up treatment and recovery after wake-up.