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.
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.
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:
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.
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.
In case of constipation, a mild laxative may be given.
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.