What does neurology nursing contain

Some complications in neurology are also relatively serious complications. Once these complications occur, it will have a serious impact on a patient. Therefore, some patients in this situation want to know specifically what kind of care is provided in neurology. In order for you to have a comprehensive understanding, let's take a look at the following care contents.

Complications care

1. Mechanical complications

Nasopharyngeal esophageal injury is a complication of long-term enteral nutrition via the nasopharynx and esophagus. It is related to the long-term placement of a nasogastric feeding tube that compresses and irritates the gastroesophageal mucosa. A feeding tube that is too hard or too large in diameter may be a factor leading to nasopharyngeal esophageal injury. Through clinical nursing observation, it was found that common mechanical complications of enteral nutrition include nasopharyngeal discomfort, nasopharyngeal mucosal erosion and necrosis, nasal abscess, acute sinusitis, hoarseness, esophagitis, tracheoesophageal fistula, etc. Nursing should be strengthened, standardized operating techniques should be mastered, and a nasogastric tube with a small diameter and soft texture should be selected.

2. Diarrhea

Diarrhea is the most common complication of enteral nutrition. The reasons are contamination during the nasogastric feeding operation, excessive infusion volume, too fast speed, too low temperature, and when hyperosmotic nutrition quickly enters the gastrointestinal tract, the gastrointestinal tract will secrete a large amount of water to dilute the nutrient solution, stimulating accelerated intestinal peristalsis. Therefore, the quality should be guaranteed and nutritionally balanced nutrient solution should be used. Nurses should pay attention to:

(1) Continuously drip the nutrition through an enteral nutrition pump for 16-24 hours. Adjust the drip rate according to the total amount of nutrient solution. The rate can be slowed down to 20 ml/h at the beginning. After the gastrointestinal tract adapts, adjust the maximum rate to no more than 120 ml/h according to the patient's gastrointestinal function.

(2) While controlling the speed, pay attention to the temperature and concentration of the nutrient solution. Use an infusion heater on the infusion pipeline, but change its position regularly to avoid local overtemperature. Adjust the temperature according to the distance of the heater from the inlet and maintain the temperature at around 38°C.

(3) Regularly assess bowel sounds and the frequency and nature of bowel movements.

(4) Once opened, the nutrient solution should not be left for more than 24 hours. If intestinal infection occurs, antibiotics can be used as prescribed by the doctor and nasogastric feeding can be suspended if necessary.

3. Reflux and aspiration

Aspiration is the most serious and dangerous complication of enteral nutrition. The insertion of endotracheal tube and gastric tube increases respiratory and oral secretions, which increases the patient's discomfort, making them prone to nausea and vomiting, thus causing reflux. The swallowing reflex of intubated patients is weakened or lost, and vomiting, coughing, and suctioning may cause accidental inhalation of nutrient solution into the trachea. According to relevant reports, the reflux rate of nasogastric feeding in patients with tracheotomy is as high as 30%, and the reflux rate of nasogastric feeding in patients with neurological diseases is as high as 12.5%. Therefore, the following should be noted in clinical nursing work: (1) The insertion depth of the gastric tube should be 55-60 cm so that the front end of the gastric tube reaches the gastric body or pylorus to prevent food from refluxing. Before nasogastric feeding, make sure the gastric tube is in the correct position, be gentle when suctioning sputum, and stop suctioning if severe choking occurs. (2) When implementing enteral nutrition, unless there are contraindications, the head of the bed should be elevated 30°-45° in the supine position. Use gravity to accelerate gastric emptying and prevent gastric retention and reflux. (3) The cuff pressure of the endotracheal tube or endotracheal cannula should be maintained at 25-30 cmH2O to seal the airway and prevent aspiration pneumonia. (4) When vomiting or regurgitation occurs, keep the patient in a side-lying position, suck out the vomit from the respiratory tract, mouth and nasal cavity as quickly as possible, and stop nasogastric feeding.

4. Metabolic complications

The care of metabolic complications includes abnormalities in the metabolism of water, electrolytes, sugar, vitamins and proteins. Common clinical complications include hyperglycemia, excessive water, dehydration, hypoglycemia, sodium and potassium ion imbalance and fatty acid deficiency. During nursing, the intake and output should be recorded daily, and the complete blood count and prothrombin time should be monitored regularly. At the beginning of nutrition, changes in blood glucose, creatinine, urea nitrogen, and serum electrolytes should be measured every 2 days. Thereafter, the measurement was performed once/w. Attention should be paid to changes in serum bilirubin, aminotransferase, etc. to adjust the infusion rate and amount of nutrient solution. To control blood sugar in critically ill patients, intravenous infusion or subcutaneous injection of insulin should be given as ordered by the doctor when necessary. The target blood sugar control level in the acute phase is 1.0-2.0 g/L, and it should be controlled at 1.0-1.5 g/L after the condition stabilizes.

5. Infectious complications

(1) Aspiration pneumonia: Aspiration is the most serious and fatal complication of EN. The clinical manifestations are shortness of breath, increased heart rate, and pulmonary infiltration shadows on X-rays. If a large amount of enteral nutrition solution is suddenly inhaled into the trachea, acute pulmonary edema may occur within a few seconds. Critically ill patients in the neurology department often have impaired consciousness, and weakened or absent swallowing and cough reflexes. An appropriate body position should be adopted during each EN, the position of the feeding tube should be checked before nasogastric feeding, and tube displacement should be avoided during feeding. Gastric retention should be monitored. If the retention volume is >200 ml, the infusion should be temporarily stopped and the infusion rate should be reduced. At the same time, pay attention to whether there is choking, respiratory changes and cyanosis. Once it occurs, EN should be discontinued immediately and the gastric contents should be aspirated. Even if a small amount is aspirated, the patient should be encouraged to cough and cough out the liquid in the trachea. If food particles enter the trachea, fiberoptic bronchoscopy should be performed immediately to clear them out, antibiotics should be used to treat lung infection, and intravenous infusion and corticosteroids should be given to eliminate pulmonary edema.

(2) Contamination of nutrient solution: usually caused by improper operation. Therefore, during EN, the nutrient solution must be kept clean and sterile, and hands must be washed and a mask must be worn before operation. It is best to prepare the nutrient solution and use it immediately. After opening, unused liquid should be kept in the refrigerator for no more than 24 hours. The nutrient solution should be appropriately heated during infusion, generally maintained at 37-38°C, especially in winter, to avoid irritating the gastrointestinal tract and causing diarrhea.

The above is a detailed introduction to neurological care. Therefore, for many people, when some neurological diseases occur, they must have a comprehensive understanding of the above care, because neurological diseases must be well cared for so that they can recover better through care.