|
|
|
 |
TREATMENT OF
PARAPLEGIA |
|
|
|
|
|
|
| |
| |
Nowadays, with the growing number of injuries, those of the
spine and spinal cord continue to take up a more significant
place. This, and the cause of injuries in general, lie in
the modern pace of living growth in mechanization and
industrialization, and especially in the fast growth of
traffic.
Every injury of the spine or spinal cord causes nerve damage
to the urinary bladder. Depending on the level and extent of
the injury, there is also deformation of the urinary
bladder.
The urinary bladder suffering of nervous damage, or
neurogenic dysfunction of the urinary bladder is the
morphologic basis which is the source of every urinary
complication. Insufficient discharge of the urinary bladder
and residium present provide a favorable environment for
infections, while the inability of the urinary bladder to
contract leads to its dilatation. This then spreads to the
urethras causing reflux. A paraplegic's good neurogenic
urinary bladder in a functional sense is the only boundary
to retaining the function of the upper urinary tract.
Having had perceived the seriousness of this problem, in
1980 the hospital staff opened the Centre for Paraplegics,
which offered complete nursing of these patients. This
centre treats paraplegics with paralyzed lower extremities.
Broken spines are treated surgically with the aim of
stabilizing the spine so that the patient is enabled to sit
in a chair independent of another person.
The establishment of this Centre for Paraplegics gave the
Republic of Macedonia a medical institution which offers
complete assistance and treatment to paraplegics, and
patients with injuries of the spine and spinal cord.
This team consists of: an orthopedist, urologist,
neurosurgeon, plastic surgeon, anesthesiologist,
physiatrist, neurologist, internist, transfusion specialist,
biochemist, radiologist, physiotherapists, nurses, trained
male nurses and other assisting personnel.
|
|
| |
Nursing of the
paraplegics
Treatment
of the decubitus
Methods for drainage of urine
Presentation - part of the job of the centre for paraplegia
|
|
| |
Nursing of the paraplegics |
|
| |
The team working with the paraplegics devotes particular
attention to their care. The nursing plan must be closely
related and coordi¬nated to the general aims of
rehabilitation of the paraplegics. Therefore, whether fully
or partially, the nursing of the paraplegics contributes to
treatment of the following problems:
|
|
| |
medical treatment of the illness or injury that
caused paraplegia;
adapting the paraplegic to invalidity;
prevention and therapy of stiffness deformities, and
decubitusi;
regulation of discharging of urinary bladder and
intestines;
prevention and therapy of urinary infection and
calculuses;
providing hygienic sanitary and other conditions for
maintaining the good health of he paraplegic;
taking appropriate measures as fast as possible for
enabling the paraplegic to move as much as possible with the
use of adequate appliances (wheel chair, crutches, walking
devices, etc.);
training of the paraplegic to take care of
themselves and become independent in everyday activities;
preparing the family to accept the paraplegic after
his return from the hospital;
cooperation with appropriate team members in
creating work habits and consistence in their work for
achievement of professional orientation of the paraplegic,
etc.
|
 |
|
|
|
| |
Treatment of the decubitus |
|
| |
The prevention, or treatment of decubitus is a permanent
problem of the rehabilitation of the paraplegic. There is
danger that decubitus (an illness which is most common in
the first 6 to 8 months) could appear and it practically
remains throughout their entire life despite the relative
adaptation of the skin to the variable conditions.
The level of success of the efforts and measures taken at
the hospital for prevention and treatment of the decubitusi
depends on the precisely designed and consistently carried
out nursing plan, which is based on the conscientious and
correct gathering of information regarding the form and
degree of injury, and the form, scale, and duration of the
existing complications. Therefore, the problem of decubitus
is a specific and complicated task within the framework of
the general rehabilitation plan.
At the hospital the main aims of the nursing and treating
the decubitus are the following:
|
|
| |
maintenance of a clean body and increasing immunity
of the body;
regular examination of the skin, especially the
paralyzed parts of the body;
removal of local and general conditions and reasons
that lead to decubitus and other pathologic skin changes;
assistance through local and general means for
curing the decubitus and other pathologic skin changes.
Preventive measures taken are the following:
maintenance of personal hygiene of the patients and
skin care;
increasing immunity of the skin;
protection of prominent parts;
prevention of maceration and skin infection;
improving blood circulation;
passive and active exercises and adequate condition
in bed, and separation of the patient from the bed as soon
as possible.
|
|
| |
Decubitus treatment is conducted through appropriate
treatment in nursing, medical and technical procedures, and
therapeutical treatment in an adequate manner, which depends
on the localization, number, extent, and state of the
decubitus wound. Treatment is conducted in the following
manner: |
|
| |
everyday treatment of the decubitus wound, i.e.
bandaging and application of appropriate therapy;
refreshing of the edges of the decubitus wound;
drainage of matter and deep decubitusi;
removal of necrotic mass from the decubitus;
plastic surgery of decubitus wound;
adequate position of the patient in bed, which must
not interfere with treatment of decubitus wound;
passive and active exercises in bed and enabling the
patient to stand up as early as possible;
strengthening of immunity and vitality of the
patient, i.e. maintenance of a good general condition of
health;
avoiding physical effort which tire the patient.
|
|
|
|
|
| |
Methods for drainage of urine |
|
| |
As regards the problem of rehabilitation of the patients
with injuries of the spinal cord, it is of great importance
to establish the functions of the urinary bladder, and of
the lower urinary tract. The basic methods for drainage of
urine where this is prevented in patients having injured
spines only provide a passive flow, creating further
conditions for serious complications.
One of the methods for drainage of the urinary bladder that
is applied at our centre is the intermittent sterile
catheterization using the non-touch method of Gutman. This
technique demands intensive care of the doctors and good
training of the assistant personnel, and prevents
infection, although it is nevertheless present.
Discharging of the urinary bladder by the Krede
approach and ,,trigger" mechanism failed to give good
results due to the ,,rest
urine", which remained and the possibility of uroinfection,
and because of the dependence on assisting personnel.
The blockage of the pudendal nerves accompanied by impotence
in 50% to 60% discredits this procedure, while the sacral
neurotomy and risotomia treats permanently the problem of
discharging of the urinary bladder, which is most important
for full urination.
Surgical treatment, such as transurethral resection of the
neck of the urinary bladder and the sphincterotomy of the
external sphincter of the urethra do not promise much, and
makes the patients completely incontinent, constantly led.
Surgical solution by tying up the ureter into an intestine
is relatively contraindicated due to the poor control of the
intestine functions, or the anus of these patients.
Dissatisfied with the previous treatment of patients with a
neurogenic dysfunction of the lower urinary tract, and
relying on the characteristic of the impulsive path to
imitate effects of nervous impulses and to put nerve and
muscle tissue into motion, we tried to introduce a new
method, i.e. electrostimulation, and studying the elements
and details which make this treatment better than the
previous. For this reason, contacts were established with
the Sesojuzni centre for injuries of the spinal cord at the
,,Burdenko" Institute in Moscow for full treatment of these
patients, paraplegics.
In the Republic of Macedonia for the first time in our
hospital a stimulator of the urinary bladder was implanted
in 1987 with initial good results, with complete excretion
of the urinary bladder and its balanced function. Three
years later the lines broke and the receiver exited through
the abdominal fascia through the skin, with incomplete
excretion and appearance of residual urine.
During the period 1980 - 1990 the centre for paraplegics
treated 217 patients, fully analyzed where a method was determined that
gave the best results and least complications in the treatment of the neurogenic dysfunc-
tion of the lower urinary tract in paraplegics. This was the
method of intermittent clean self-catheterization, i.e. the
patient set up the catheter himself. As a
result, the rehabilitation of the urinary tract was
significantly shortened and was no longer a factor that
determined the duration of hospitalization of the
paraplegics. This method makes it possible to avoid constant
and definite catheters. It has advantages in comparison to
the intermittent catheterization because it engages no time
or personnel, decreases urinary complications, shortens
hospitalization. |
|
|
|
|
|
|
|
|
|
