Care of patients in a vegetative state

  Those in a vegetative state appear to be awake, blink freely, stare or turn their eyes without a purpose, but there is no conscious activity, lack of perception, thought, emotion, will, etc., no spontaneous language or purposeful limb activity, lack of conscious response to the environment and things around speech, no speech, no subcortical conscious activity, such as: chewing, gag reflex, pupil-to-light reflex, corneal reflex, eyelash reflex, cough reflex. The patient may have painful expressions or avoidance responses to pain or noxious stimuli, but usually no localization responses, unconscious crying, irregular sleep-wake cycles, visual reflexes may be preserved to some extent, primitive reflexes such as sucking and strong grip may be present, and bilateral pathological reflexes are positive. Even though the patient’s heartbeat, respiration, blood pressure and body temperature are normal, he or she is incontinent.  There is still a lack of effective treatment for vegetative state, mainly for different etiologies. Therefore, nursing is the main task of vegetative state: 1. Balanced nutritional support to ensure the patient’s daily intake of important nutrients, such as: protein, fat, starch; also give a certain amount of vegetables and fruits, pay attention to the supplementation of various vitamins and trace elements, etc.  2. Maintain water and electrolyte balance, give sufficient water intake every day, about 2000-2500ml for adults; in addition, electrolyte supplementation should not be missing, such as salt intake, potassium and calcium supplementation, etc.  3. Skin care, regular turning every day, local skin care of the pressure area; cleaning the bed and drying the bed sheets and bedding is essential.  4, respiratory care, these patients have poor sputum excretion function, they should be turned regularly and patted on the back, and should be done at the right time if possible, drink more water, keep the room air moist, etc. are conducive to the health of the respiratory tract.  5, urinary tract care, such patients have urinary incontinence, so there is no indwelling urinary catheter must be changed at any time wet bedding; indwelling catheter should be regularly put urine, do not make the urine in the bag too full backflow such as bladder; indwelling catheter should be changed regularly. Pay attention to washing the perineum every day to prevent infection.  6, digestive tract care, such patients are bedridden for a long time, their biggest problem is the digestion and excretion of food. First of all, poor digestive function, full stomach emptying, slow intestinal peristalsis, so we should give easily digestible food, and pay attention to the supplement of coarse fiber to promote intestinal peristalsis and prevent constipation; it is better to develop the habit of regular bowel movement every day. Also pay attention to food hygiene and prevention of gastrointestinal infection.  7, care of limb function, the patient has no voluntary activities, it is easy to have joint contracture, stiffness, so regular daily movement of the joints of the limbs, massage muscle.  8.Nervous system care, the vegetative state is a state without consciousness, so the hope of therapeutic care is to be able to wake up the patient, the simple and easy method is sensory stimulation, including: auditory stimulation, visual stimulation, olfactory stimulation, taste and oral stimulation, tactile stimulation and postural stimulation and other kinds of stimulation.  Sensory stimulation includes (1) auditory stimulation is the most commonly used stimulation method, put on headphones, play the patient’s favorite music or relaxing radio program before the disease, the volume of 20-50dB, to the normal people can hear clearly appropriate 15min / time, 6-8 times / day through the family call, talk with the patient, more communication with the patient, let the patient’s closest people call his name, name, nickname, to tell the patient his most (2) Visual stimulation, use strong visual stimulation, and use the patient’s eyes and ears.  (2) Visual stimulation, alternating light stimulation with strong light, low light and colored light, natural light exposure 2 times/day, 40 minutes/time, in a darker light environment, using a flashlight wrapped in red, blue, green, colored paper and this light source to irradiate the side and front of the head respectively, 6 times/day, 10 round trips each time, using colored objects, family photos and TV programs of 10-15 minutes each time, etc., to the patient Visual stimulation, when the patient can see the object and focus on it, try visual tracking, let the patient’s eyes move with the stimulus, and arrange appropriate outdoor activities, let the patient receive sunlight, air and humidity stimulation outdoors, 2 times/day, 30 minutes/time.  (3) Tactile stimulation. Instruct the patient’s relatives to continuously touch the patient’s skin with the patient’s clothes or skin lotion, especially the most sensitive areas of the head and face such as the lips and earlobes, and pat and massage the patient’s limbs and trunk. Use warm and cold clothes, a metal spoon dipped in hot or cold water for 30 seconds to stimulate the patient hot and cold 6 times/day with 8-10 strokes/time, and use water of appropriate temperature to scrub the patient’s whole body. A copper wire about 5 cm long and 4 mm in diameter with a certain degree of hardness is used for pain stimulation in sensitive parts of the patient’s limbs, such as: soles of the feet and fingers with a certain degree of pressure without damaging the skin 6 times/day. 8-10 seconds/time.  (4) Olfactory stimulation with ground coffee, perfume, floral water, body wash, vinegar, wine and the patient’s favorite food, and inform the patient what kind of odor it is. The olfactory stimulation should be done after the patient washes, and the stimulation time of the items should be no more than 10 seconds. The herbs with brain-awakening effect are made into fragrant pillows and placed under the patient’s head, and the medicinal gas emitted by them can stimulate the olfactory nerves in the nasal cavity and directly enter the brain to produce effects.  (5) Taste and oral stimulation, when the patient can control saliva and exclude the danger of easy inhalation into the lungs, taste stimulation should be carried out. A cotton swab with sour, sweet, salty and bitter solutions can be used to stimulate the front part of the tongue and to inform the proper taste sensation. In daily oral care, the lips, perioral and oral cavity can be stimulated, and the mouth can be massaged with sponge or glycerin medicine swab, while passive swallowing function training, such as: oral ice stimulation, passive movement of swallowing organs, and passive swallowing training.  (6) Motor stimulation, passive movement of the whole body joints from proximal to distal. 2 times/day, about 1 hour each time, lying position using good limb position; bed standing exercises 1 time/day, 30 minutes/time, standing training should follow the principle of lying – sitting – standing, step by step. Use the standing exercise bed to practice standing when slowly raised to the standing position.  Most patients in a vegetative state will continue to survive as long as they are properly cared for, and there is no shortage of patients who survive for 10-20 years.