I. Knowledge of the disease.
Spinal cord injury is damage to the structure and function of the spinal cord due to various causes, resulting in impairment of spinal cord function below the level of injury. Spinal cord injury can be divided into two categories according to the different factors of treatment: traumatic, non-traumatic spinal cord injury. The main causes of traumatic injuries are: fall from height or work-related injuries, car accidents, violence, sports injuries, etc.; non-traumatic injuries are mainly caused by lesions of the spine and spinal cord (tumors, tuberculosis, deformities, etc.), which account for about 30% of spinal cord injuries. So far, a variety of research and treatment methods have failed to achieve the purpose of reversing the effects of spinal cord injury, spinal cord regeneration, and functional recovery. The development of rehabilitation medicine and the use of rehabilitation training techniques have significantly improved and compensated for the dysfunction of spinal cord injury patients and improved the quality of life, making it a fact that they return to their families and return to society.
Second, clinical manifestations.
1, sensory disorders: according to the different parts of the injury, they are pain and temperature disorders, proprioceptive disorders, contralateral pain and temperature disorders, and ipsilateral tactile and deep sensory disorders. Complete paraplegia sensory disorder is the disappearance of all sensations below the plane of injury.
Spinal cord reflex dysfunction: loss of detrusor and flexor reflexes, blood pressure reflex, bladder reflex, fecal reflex and penile erectile reflex.
3, motor dysfunction: motor dysfunction below the plane of spinal cord injury, loss of movement; decreased muscle tone; diminished or absent tendon reflexes; loss of superficial reflexes. After the spinal shock period, there will be hyperactive tendon reflexes; increased muscle tone; positive pathological reflexes.
4. Urinary dysfunction; different degrees of bladder dysfunction are caused.
(1) Passive urinary incontinence can occur with urinary retention.
(2) Reflex bladder, a certain degree of bladder filling can cause a reflex to complete urination.
(3) Autonomic bladder, which causes increased bladder pressure and urine reflux into the ureter and kidneys, causing other complications.
(4) Circulatory disorders: patients may present with bradycardia, increased pulse pressure difference, and decreased blood pressure.
(5) Respiratory system disorders: high spinal cord injury can cause respiratory power muscle paralysis, narrowing of the trachea and bronchial lumen, accumulation of secretions; diaphragm function is reduced, resulting in the patient’s respiratory power is insufficient, lung capacity decreased. Patients appear to have insufficient gas exchange. Respiratory rate is accelerated and respiratory efficiency is decreased.
(6) Difficulty in dispatching stool; vegetative nerve disorder after spinal cord injury, slowed peristalsis of the digestive tract, rectal relaxation, and constipation of stool storage.
(7) other complications: pressure sores, urinary tract infection, pain, spasm, deep vein thrombosis, etc.
III. Psychological guidance.
1, the period of denial and frustration: the patient’s sudden loss of limb function with incontinence, its psychological trauma is much greater than the physical trauma because of the difficulty of accepting this fact, and therefore painful disappointment, and even pessimism and anxiety. The patient’s condition and possible prognosis should be explained to the family, so that the relatives are prepared, and assist the rehabilitation staff to do a good job of psychological guidance of the patient. Early detection of changes in the patient’s mood and active conversation with the patient. Care and attention to the patient, even if the communication, to give targeted psychological guidance, comfort, care, consideration, so that the patient to reduce pain, maintain a good mental state.
2.Calm re-recognition period: paralysis has become a reality, this period for the patient to carry out daily life self-care and vocational rehabilitation training. Gain the patient’s trust through good language and affable attitude, and understand the patient’s family, social background and occupation. Make the patient realize the value of self-existence, face the reality and take the initiative to participate in various functional training and vocational rehabilitation, so as to reduce the burden of family and society.
3. Image remodeling period: The next period is for the patient to re-establish a new consciousness, face social challenges, and solve a series of problems such as occupation and marriage. The patient should be explained the condition and the best turn of events step by step, so that the patient can be hopeful for the future, and be introduced to typical examples of self-reliance of disabled people, encouraged to communicate with similar patients, to give play to the patient’s remaining functions, to re-realize self-worth, and to achieve the purpose of self-care or reintegration into society.
IV. Symptomatic rehabilitation guidance.
1. Rehabilitation of respiratory system: keep the respiratory tract unobstructed, regular turning and back-buttoning, etc.; give nebulized inhalation or phlegm-forming agent when sputum is not easily expelled; give ventilator or tracheal intubation for breathing difficulty; apply antibiotics to prevent lung infection.
2, rehabilitation of the urinary system: 1 early indwelling catheterization, 4-6 hours regularly open. 2 intermittent catheterization: one day and night every 4-6 hours catheterization; limit the amount of fluid intake, 400 ml each in the morning, lunch and dinner; 10 a.m., 4 p.m., 8 p.m. 200 ml each, can be changed to every 8 hours catheterization. After equilibrium is reached, catheterization is terminated.3 Stimulation method: squeeze the small abdomen; pull the pubic hair; perform rhythmic tapping on the pubic symphysis for electroacupuncture stimulation.4 Drug application to control infection: reduce residual urine; increase bladder capacity and prolong storage time.
3, management of defecation: diet should be high in fiber, calories and nutrients. For difficult defecation, massage according to the direction of the colon, use laxatives or low-pressure enemas. The frequency of defecation should be once every 2-3 days.
4.Deep vein thrombosis of lower limbs: instruct patients to move both lower limbs passively and actively, pressurize regularly, promote blood circulation, take anticoagulant drugs, ultraviolet radiation, etc.
5.Rehabilitation of spasticity: placement of anti-spasticity position, placing the limb in a comfortable, non-pressure and convenient functional position. Regular turning, active activities, avoiding limbs in a fixed position for a long time; surgical treatment; medication; reducing the intensity of myoclonus and enhancing physical strength.
6, prevention and treatment of osteoporosis: exercise and calcium supplements. Diets rich in calcium from dairy, frequent sun exposure, and moderate supplementation of vitamin D-rich things.
V. Rehabilitation training guidance.
1.Standing training on inclined bed
2.Muscle strength training
3.Mat training
4.Transfer training
5.Balance training
6.Self-care training
7.Wheelchair training
8.Walking training
Sixth, rehabilitation nursing health education focus on guidance.
1, the patient’s functional training must be the trinity of medical care, family members and the patient to participate in the entire training program, the intervention of family members to create conditions for the patient to return to the family; education of family members to master the knowledge of rehabilitation and training skills, can prevent complications and secondary disabilities.
2, psychological care throughout the entire course of the disease, guide the family to understand the patient’s psychology, give psychological support, give full play to the patient’s potential, improve the level of training, improve the quality of life.
3, training should be from easy to difficult, step by step, persistent, and gradually transition from passive movement to active, from alternative care to self-care mode.
4.The diet should have enough calories and more fiber to replenish the energy consumption during training in time; eat more vegetables and fruits to reduce constipation; eat more acidic food and drink more water; eat less high-fat and alkaline food; prevent long bone decalcification and urinary tract stone formation.
5.Patients who need to live in wheelchairs should pay attention when they go home: placement of toilet, bed height 40-50 cm, indoor placement of simple handrails, etc.
6.Prevention of pressure sores: change position once every 2 hours. For those who have difficulty turning over, air beds, turning beds and sand beds are available. Observe and record the skin of pressure sore-prone areas. Turning should not be pushed and pulled. The bed surface is flat and free of debris. Keep the skin clean and dry. Use soft pillows to avoid pressure concentration on the bony prominence. Explain to family members the general knowledge and essentials of skin care.
7, accident prevention: pay attention to safety during training to prevent accidental injury. Patients with postural hypotension should add waist circumference to increase abdominal pressure. The lower limbs can be wrapped with elastic bandages to improve venous reflux and increase the amount of blood returned to the heart.
8.Regular follow-up, pay attention to the general condition, if there are complications, early diagnosis and treatment, and regular review in the hospital.