Nursing care of severely retarded
Nursing care of the severely retarded is to meet the needs
of the patient and to help in maintaining and improving the various functioning
abilities. Keen observation of changes in the pattern of behaviour is essential
as the severely handicapped people are unable to express themselves.
Personal care:
A person needs help in carrying out hygiene measures. He
should be aided in the performance of these works. A careful observation must
be made of the skin, oral cavity etc. Daily note any changes. Various problems
can develop if basic skin care and oral hygiene are not attended regularly.
Washing the face should be a routine
for all patients first thing in the morning and before going to bed at night.
Cleanliness of skin is essential.
Ideally each patient should have a bath daily. Bathing may be in bathroom if
the patient is ambulatory or bed bath (sponge bath) if the person is bedridden.
There should care and handle gently. Extra help may be got for turning the
person. Always talk to the person though he may not take part in the
conversation.
While bathing, exercise the person'
s limbs and put the joints through the range of movements of which they are
capable. Do this gently and systematically including shoulders, elbow, wrist,
fingers, hip, knee and ankle joints and move the toes.
Care of pressure areas is another important aspect of
personal care. Pressure areas are the term applied to parts of the body where
the skin may be damaged because of excessive pressure, friction, or continued
exposure to moisture. Extra care should be taken for the bedridden, severely
handicapped person as they are unable to change their position frequently to
avoid excessive pressure on anyone part of the body.
Prevention of pressure sores:
The person' s position must be changed every two hours day
and night. The skin should be massaged to stimulate the circulation. The body
should be placed in such a way that limbs do not press on each other.
Air cushions, pressure pads and airbeds should be used when
required. The person must be attended whenever they are wet or soiled. The
affected parts of the body must be washed thoroughly and then dried wiping the
skin dry of perspiration and saliva.
Carefully groomed hair, which is
clean, enhances the appearances and gives a feeling of confidence. Care of the
hair includes, inspecting and treating for dandruff and head lice, brushing and
combing, washing and setting. Hair should be inspected routinely once a week to
make sure the person is free from dandruff, head lice, scratch marks on the
scalp.
Severely handicapped persons and those confined to the bed
will not be able to care for their teeth. They may be cleaned by using forceps,
cotton swabs and a cleaning solution (potassium permanganate solution or
hydrogen peroxide solution). During temporary illness accompanied by rise of
temperature, there may be loss of appetite, nausea, ulceration of mouth etc. In
such cases the mouth, which should be watched for and counteracted by frequent
cleaning and adequate fluid intake.
The person should be encouraged to
keep their mouth closed and breath through the nose. Excessive salivation and
inability to swallow salvia is found in a large number of handicapped persons.
For the helpless bed ridden persons, dribbling saliva can lead to skin rashes
on face and neck due to constant wetness. A protective cream should be used
after carefully washing and drying the skin.
Nutrition:
In the bedridden person because of
lack of exercise there is a decreased requirement of energy foods and an
increased need for tissue building nutrients. The person should receive a
balanced diet to promote optimal health.
There should be regular mealtimes to
foster the development of good eating habits. Good oral hygiene is needed to
promote an adequate intake of nutrient. There should be good standards of
cleanliness in the preparation and serving of food to prevent infections.
The type of diet depends on the person' s condition. A
semisolid diet is given if there is difficulty in chewing or swallowing. During
feeding the person should be raised slightly so that it is easy to take in
food. The person should be made to sit for sometime after having food to
prevent regurgitation. The water intake should be adequate.
Movement and exercise:
Aims:
1.
Maintenance of strength and tone in
unused muscles.
2.
Prevention of degeneration of
muscles
3.
Prevention of contractures that
could hinder the mobility of joints
4.
Restoration of strength and tone of
muscles that are impaired.
5.
Prevention of deterioration of the
persons and other functional abilities as a result of limited mobility.
Exercise are of two types:
1.
Active - the person does the
exercise by himself.
2.
Passive - when some one helps him to
do the exercise and there is no involvement of the person at all.
Elimination:
A high roughage diet helps in bowel
movement. Encourage regular toilet habits. Encourage intake of oral fluids. A
warm glass of milk in the morning helps to stimulate.
Bowel movement:
In case of constipation, a mild laxative may be given.
Sensory stimulation:
This is the basic human need. The
person requires a very stimulating environment to all the senses. Even if the
person does not respond, it is essential that there is continuous stimulation
of the senses.
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