TIPS FOR A HOSPITALISED PATIENT
Once the patient is admitted to the hospital for neurological or other diseases there are various duties of the family members for proper care of the patient. Especially if the patient is unconscious, the condition is very serious or is extremely weak at that time; special care is very essential.
If the relatives of a hospitalized patient are aware of the following information regarding the various treatments, it can be very helpful during patient mangement. Only highly specialized metropolitan hospitals have adequate staff and appropriate care facility. Elsewhere, if following instructions are strictly followed by relatives, several lives can be saved.
As and when the patient requires, oxygen has to be given continuously or every alternate hour. It is essential to supervise that the nasal tube is in place. The bubbles in the bottle kept besides the oxygen cylinder indicate that the patient is getting oxygen. Thus, an eye should be kept on this bottle. The hospital staff should be informed before it becomes empty. Now-a-days, in many city hospitals oxygen is supplied through a central line, where such supervision is not required.
If the patient is being given IN. .fluids the relatives should take care of the following points:
i. Care should be taken by the relative that the patient does not move the hand or foot where the IN. needle is injected.
ii. It can be so arranged that exact number of drops of the fluid per minute comes from the bottle. If there is any problem nurse should be informed immediately. If the fluid stops or leaks or the speed of the fluid falls or increases or there is a swelling or redness in the place where the needle is injected or the patient feels cold or shivering occurs or gets fever the attending nurse/staff should be immediately informed.
· lA nurse normally does the job of feeding through this tube. If the relative of a patient has to perform this function, he should understand the procedure very clearly.
· The feeding is started only after permission of the doctor.For nasal feeding tea, milk, coffee, lemon water, coconut water, electral powder water, liquidized rice, khichdi, protein powder or ready made packets for energy-calorie like Recupack, Tenolip, Tenotube, Nourish powder, filtered dal soup, vegetable soup or fruit juice - fruit shake etc., liquids should be given in a fixed quantity at regular intervals as per the doctor’s advice. As instructed, one should give these liquids in the quantity decided by the doctor every 2 to 3 hours and a note of the same should be maintained for the doctor’s information.
· While the liquid is being given through the tube and in case the patient starts coughing or becomes breathless, the feeding should be immediately stopped and the doctor should be informed immediately.
· Before starting a feed, every time first a fluid from the stomach has to be sucked with a syringe to ensure that the feed can be given, if the amount of liquid is more than 50 c.c feeding should not be given. After an hour repeat the procedure to confirm and then only feeding is started. If the withdrawn fluid is red or coffee colored, the doctor should be informed immediately.
· After feeding any liquid, the tube should be thoroughly cleaned with 10- 15c.c of water.
· l It is essential to replace the tube at every 15 days.
· If the patient remains unconscious or semiconscious for long, Ryle’s tube (nasal) feeding can be problematic, it may lead to aspiration pneumonia (i.e. infection in the lungs). This is one of the five main causes of death in an unconscious, patient. Under these circumstances gastrostomy tube feeding is preferable. This is done through a small cut in the skin over the abdomen, a special long - lasting tube is inserted into the stomach. If the patient is likely to remain unconscious for more than 1-2 weeks the hazards of nasal tube feeding can be averted with such gastrostomy tube insertion, which can save life of the patient.
One should make a note of the total amount of urine passed by the patient during 24 hours and this should be reported to the doctor.
· If the patient passes more than 2500m1 or less than 1000m1 urine in 24 hours or if the urine is extremely yellow (turmeric color), red or white because of pus, the doctor should be informed.
· The quantity of urine passed every hour should be observed. If it seems to be reducing, the doctor or nurse’s attention should be drawn towards it.
· Usually, if the catheter is indwelling then it should be changed at every 15 days, and if the catheter is not indwelling (outside) then it should be changed at every third day.
· However if silicon (silastic) catheter is used, it can be kept for a longer period.
· The cathetered area should be cleaned and dressing should be done carefully.
It is better that the patient voids his bowels everyday.
If the patient does not pass stool for more than two days the doctor should be informed. As per doctor’s advice, some drug through ‘the feeding tube or enema or suppository via the anus should be used carefully.
If the eyes of the unconscious patient always remain open they can became red and an ulcer may develop on delicate cornea and eyesight can be lost. Therefore, the eyes shouldbe covered with pads according to the doctor’s advice and appropriate eye drops like Moisol can be used or if found necessary antibiotic eye drops should be instilled in the eyes.
To avoid ulcers and thrush in the mouth, the mouth should be checked everyday. Medicated glycerin and mouth fresheners should be used twice a day. The tongue should be cleaned with a tongue cleaner. Cleaning the teeth is very important. If the patient is conscious, gargles should be done.
Sometimes the patient has to keep exercising for a long period. In order to continue these exercises at home, complete information regarding these should be obtained from the physiotherapist or a doctor. The types of exercise, timing and duration should be noted and religiously adhered to.
a) If the patient has paralysis, exercises should be done accordingly for the paralysed part,
b) If the patient is unconscious, every two hours the limbs should be given passive exercise for fifteen minutes,
c) Usually, the exercise is done 4 to 8 times a day, for 10 to 30 minutes, without tiring the patient, and
d) If there is a swelling or redness in the legs of the patient, the doctor should be informed. Sometimes it can be a sign of a very dreadful disease-Deep vein thrombosis (DVT).
When the patient is in the lying position for a long time, respiratory problems may also arise. The chest becomes’ congested with cough and sounds can be heard in the chest. This can cause pneumonia. It also hampers the process ofbreathing. For such patients suction is done frequently with a thin tube to clear the respiratory passage. This process is usually done by the hospital staff, but can also be done by relatives who are aware of the procedure. Actually use of disposable catheters for this purpose is more appropriate.
If the patient has breathing difficulty and excessive cough formation (expectoration) or if the patient is unconscious then Portex endotracheal tube is inserted through the mouth or nose in to the trachea (wind-pipe). This can be left in place for 7-14 days.
With this, suction of secretions becomes easier and patient can breathe better. If there is no improvement in the level of consciousness or excessive cough continues to accumulate in the lungs; doctors usually decide to perform tracheostomy. In this procedure a small hole is made in front of the neck on the windpipe and a plastic or metal tube is inserted into it, so as to facilitate the breathing process. The secretions accumulated in the respiratory tract can be easily removed through suction and the risk of pneumonia is minimised. It also improves the patient’s breathing. When breathing starts improving, level of consciousness improves and secretions decrease, then gradually the diameter of the tube can be decreased, thus decreasing the size of the hole. With time tracheotomy wound close and healing starts.
In order to avoid secretions from accumulating and thereby preventing hypostatic pneumonia and maintain normal breathing, chest physiotherapy should be initiated early. Appropriate drugs and steam inhalation may be given through nebuliser. This keeps the airways patent clean and warm.
lThe patient’s bed should be kept clean and wrinklefree. The bed should be arranged in such a way that the patient’s head is 15 to 2U° higher. Ifnecessary powder should be sprinkled on the bed. Relatives should avoid sitting on this bed as far as possible.
· If the patient is unconscious, he should be made to lie in such a manner that his head remains 30 to 40° higher than the body.
· The patient should be kept in a lateral semi prone position and the side should be changed every few hours. This precaution is essential to prevent formation of bedsores and aspiration pneumonia.
· It is necessary to take constant precaution that the patient does not get bedsores or ulcers. If the color of the skin changes or abrasions are seen the doctor and the nurse should be informed.
· If the patient is completely bed ridden for a long time due to longstanding disease, it is necessary to use a waterbed or an airbed. According to the doctor’s advice, arrangements can be made to lay the patient on a waterbed. Sometimes airbed orsponge bed can also be used.
· The patient should be given a sponge bath daily. Eau-de cologne should be applied to skin.
· The patient’s face should be cleaned twice a day by the nurse The relatives of the patient can also do this twice.
· If the patient is conscious, he should preferably be fed in a sitting position.
a) If the patient’s heartbeat or pulse becomes faster, the doctor should be, informed immediately. It i’s advantageous if the relatives of the patient learn to read the cardiac monitor.
b) If the respiration of the patient seems to be faster or the patient suddenly becomes pale or turns blue, the doctor/ nurse should be informed immediately.
c) The doctor’s/nurse’s attention should be drawn if there is high fever and cold sponging should be started. Somehow brain takes fever in a very unfavourable way.
a) There are numerous factors that play an important role in curing the patient. The care and attention given by the relatives is very important. Along with the treatment love and affection too can have magical effect. This increases the will power of the patient, which gives an inner strength to get cured.
b) In the hospital the relatives should arrange regular duty, in staying with the patient day and night and maintain a constant vigil. The patient should never be left alone. If left alone, there could be a possibility of the patient falling off the bed. If necessary a railing could be provided on the bed.
c) The patient requires calm and rest and therefore talking loudly near his bed or making noise should not be allowed.
d) The room should be kept clean.
e) Too many people should not be allowed to crowd around the patient. This can increase the possibility of the patient catching an infection. Sick relatives who come to meet the patient should be kept away with due regards.
f) Visitors should not talk about diseases, death or other shocking incidents in the vicinity of the patient. Such talks can lower the will power of the patient. Care should be taken that such people do not go near the patient.
g) Similarly, discussions about ill experiences related to disease, medicine, doctor or dispensary, superstitious beliefs, etc should not be done in the presence of the patient or relatives. Predictions about the patient’s disease, whether the medicines given to the patient are proper, whether the doctors are good- etc topics should be avoided. Due to this the patient and the relatives can become confused, which can create, a problem in patient’s treatment and health.
h) It’s most important to change the pattern and manners while visiting the patient and the environment in the hospital should be changed. Things like offering fruits, flowers, books, get well soon cards for the patient can be done to convey well wishes. Cassettes of the patient’s favorite music can be played in a low volume. Prayers for the patient can be done at a holy place or home; the patient can also be convinced to pray.
i) Prayer has ‘a tremendous strength to cure.Unfortunately, there is not much awareness amongst our people about the practice of medical insurance and on the other hand medical treatment is getting expensive day by day. In a situation where the patient is not insured and financially not in a good condition and requires financial support for the treatment, the doctor’s attention should definitely be drawn towards this. With the doctor’s guidance medicines can be obtained at subsidized- rates from various social organizations. Many such organizations work in the big cities. The social workers of the hospital can guide the patients at such a time.
j) Many diseases require special, intensive and expensive treatment like plasma exchange in AIDP, gammaglobulin in AIDP or myasthenia gravis, ventilator support etc. The cost of these therapies may range from Indian Rupees 50,000 to 4 lakhs (400 Thosunds). The doctor might be able to help in providing medicines at concessional rates. Information regarding financial help for the treatment in such cases may also be available from the doctor or medical social worker (MSW).