Plus-Hex CLINICAL
Rehabilitation interventions also serve to improve the patient ' s quality of life , through the psychological benefits of human interaction and stimulation . For VNs , the rehabilitation process can be very satisfying when progress is achieved in these patients .
Respiratory care
Figure 4 . Neck range-of-movement exercise using a treat .
VNs can implement interventions to reduce respiratory compromise in the patient . These aim to improve lung volume , remove secretions , maintain bronchial hygiene , re-expand lung segments , improve oxygenation , and reduce the risk of atelectasis and hypostatic pneumonia [ 6 ] . Patients should be repositioned every 2 hours , working through lateral and sternal recumbency and using props to support the patient . Repositioning reduces or prevents atelectasis and pooling of secretions [ 1 ] . Repositioning also helps to reduce pain caused by pressure on soft tissues and reduces decubitus ulcer development [ 2 ] . Postural drainage can be used to assist in removing tracheobronchial secretions from lung segments , preventing pooling [ 11 , 12 ] .
Bladder management
Figure 5 . Shoulder massage with trigger-point release .
Micturition is controlled by the central nervous system and requires normal bladder and urethral function to maintain continence and emptying through relaxation and contraction of the bladder and sphincters . Bladder dysfunction and urinary tract infections are common in patients with spinal cord dysfunction , due to indwelling urinary catheters , overstretched bladders , urine retention and urine leaking [ 6 ] . Bladder expression may be required and should be done every 6 – 8 hours , with the use of muscle relaxants to ensure full emptying if the patient ' s bladder is difficult to express . If available , the use of an ultrasound scanner to assess the size of the patient ' s bladder is helpful . This provides a quantitative measure and is more accurate and less invasive than palpation .
Urinary scalding should be pre-empted by clipping the patient ' s fur and using barrier sprays , along with absorbent bedding – without blankets as these decrease fluid wicking [ 11 ] . Indwelling urinary catheters can assist with the hygiene and comfort of these patients . When an indwelling urinary catheter is used , it should be placed aseptically and cleaned , emptied and urine production measured every 4 hours . If patients are able to void their bladder , they should be monitored for frequency , duration , stream , colour and full emptying .
Bowel management
Figure 6 . Shoulder massage .
Faecal elimination is controlled by the stretch of the rectal wall and voluntary control of the sphincter and abdominal muscles [ 6 ] . These patients should be allowed time outside , even if unable to walk , as patients may be unwilling to pass faeces in their kennel [ 2 ] .
Volume 39 ( 1 ) • February 2024
27