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Rehabilitation (Care and management during rehabilitation (Bladder care…

- - - - • Many elderly clients or people with neurological disorders have difficulty in emptying the bladder and in this case bladder care must be commenced to prevent bladder infection due to stasis and as well as for social acceptance.
      - • The flaccid bladder Is able to retain large volumes of urine, but most not be allowed to become overfull or the person will develop hydronephrosis with the ascending urinary tract infection.
      - • The recommended method for draining this type of bladder is intermittent catheterization every three to four hours.
      - • Subsequently the indwelling catheter is clamped and released at three to four hourly intervals and finally intermittent catheterization is carried out every three to four hours.
      - • The spastic bladder is unable to hold large volumes of urine and therefore leakage occurs between catheterization, which is uncomfortable and socially unacceptable. It is possible to have a permanent indwelling catheter in situ and these are changed every six weeks.
      - • Urinary tract infection is common to those who do not have the ability to empty their bladders and have residual urine in their bladders. UTI’s are also common for clients with an indwelling urinary catheter because ascending infection travels up the catheter into the bladder. Clients should at least a day drink 6-8 glasses of water, take prophylactic dose of vitamin C or cranberry juice, monitor the colour and smell of the urine- if it becomes dark it might be an indication of dehydration or that there is an infection present, note any small deposits in the urine glass or catheter bag or any sensation of pressure, lower abdominal pain, burning micturition bypassing the catheter.
      - • Care of the urinary catheter must be done daily
  - - - • The skin care and care of the pressure areas are of vital importance and must remain so for the rest of the rest of the client’s life.
      - • During the acute phase the health care worker or team gives very careful attention to the skin and to pressure areas and ensures that the client’s position is changed regularly.
      - • During the rehabilitation phase the client or caregiver must be shown how to care for the skin and pressure areas.
      - • It is important to explain how to inspect the skin for red patches, blisters or other changes in skin colour that may give warning of an impending pressure sore or decubitus ulcer.
        If the red area develops, the client must not be placed on that position.
      - • The paralyzed person must be changed the positions, turned from side to side and not positioned on his or her back as he or she will sit on his or her buttocks during the day when sitting in a wheel chair.
  - - - • It is important for the client to achieve an optimum degree of independence in the routine activities of daily life, such as dressing, eating, grooming, personal hygiene and toileting.
      - • Health care workers make use of the remaining abilities and work out ways to enable the client to achieve the goal of carrying out the activities of daily living.
      - • As a rehabilitation process, the client is encouraged to extend the range of tasks that he or she is able to carry out.
  - - - • In order to avoid faecal incontinence or constipation, and for social acceptance, the client should be advised to consume a diet high in fibre, including adequate amounts of fresh fruit, vegetables, dried fruits and nuts, whole grain, cereals and bran.
      - • Take plenty of fluids.
      - • Follow a fixed routine e.g. every day walking, take a hot drink, which will stimulate peristalsis, following a hot drink the person sits upright on the toilet to evacuate the bowel.
      - • Take care not to exceed more than 30 minutes on the toilet, as this can cause the development of haemorrhoids.
      - • Give mild bulk aperient if the person does become constipated.
  - - - • The aim is to prevent complications of immobility such as contractures and joint stiffness, which will interfere with the client’s ability to mobilise.
      - • During this early stage the limbs are positioned in a natural functional manner and muscle tone is maintained by means of a passive range of motion exercises.
      - • Passive exercise is combined with active exercise for the muscles and muscle groups that are functional. Physiotherapists are to help with this.
      - • The appropriate aids to mobility such as crutches, walking frames or a wheel chair will be determined by the strength and ability of the client and they must be taught how to use these aids.