RESPIRATORY FUNCTION
Although acute pulmonary problems may not be as frequent during rehabilitation as during the initial phase after SCI, close attention should be paid to pulmonary status, especially in children who are younger and less able to communicate and in those with tetraplegia, high paraplegia, or more complete lesions.
Though children with lower cervical and thoracic lesions have full diaphragmatic innervation, complete or partial paralysis of the abdominal wall and accessory respiratory muscles will weaken the cough and clearance of pulmonary secretions. Clinical symptoms of respiratory problems often develop long before radiologic or laboratory evidence is present. The child should be carefully watched for changes in secretions or cough, shortness of breath, headache, changes in mental status, sleepiness, and snoring. Presence of morning headache should be assumed to be a sign of hypercarbia and promptly investigated. Routine monitoring of pulmonary status during rehabilitation should, at the least, include daily auscultation, measurement of end-tidal carbon dioxide tension and transcutaneous oxygen saturation, and measurement of vital capacity and maximal inspiratory and expiratory forces in all children with quadriplegia and infants and young children with high paraplegia. Consideration should be given to monitoring oxygen saturation overnight in children with complete quadriplegia because some studies have found that a high percentage of adults with complete quadriplegia have frequent nocturnal desaturations (31-33). Prevention of problems may include percussion and postural drainage, assisted cough techniques, respiratory muscle training, pneumococcal immunization and yearly influenza vaccines, adequate nutritional status, and a cardiopulmonary fitness program. An abdominal binder or thoracolumbro- sacral orthosis may be beneficial by providing support to the abdominal muscles.11.3
Bowel Medications
| MEDICATION | EFFECTS | NEGATIVE EFFECTS |
| Bulk-forming agents | Absorb water to keep stool formed and prevent | Bloating, flatulence |
| Psyllium (Metamucil, Fibercon, Citrucel, Perdiem) | dry, hard stool | |
| Stool softeners | Allows water to enter stool | Diarrhea, liquid form tastes bitter and is |
| Docusate (Colace, Surfak) | poorly tolerated | |
| Mineral oil | Lubricant | Interferes with absorption of fat-soluble vitamins, causes lipid pneumonia after aspiration |
| Stimulants | Increases intestinal motility, takes 6-12 hours | Diarrhea, cramping |
| Senna (Senokot) | to work | Diarrhea, cramping (less with rectal |
| Bisacodyl (Duicolax) | Increases intestinal motility | suppositories) |
| Saline laxatives | Draws water into gut to stimulate colonic | Diarrhea |
| Milk of Magnesia | motility | |
| Magnesium citrate | Stimulates colonic motility, used for complete | Large volume, tastes bad, may cause |
| Saline enemas (Fleet’s) | bowel evacuation | electrolyte imbalance |
| Acts to evacuate distal colon | Cramping, may cause electrolyte disturbance | |
| Hyperosmolar | Draws fluid into intestine | Diarrhea, cramping, flatulence |
| Lactulose, sorbitol | Draws fluid into intestine, used for complete | Cramping, diarrhea |
| Polyethylene glycol (Miralax) | bowel emptying | |
| Glycerine suppositories | Irritant | |
| Prokinetic agents | Affects neurotransmitters to increase | Interacts with many drugs, cardiac |
| Metaclopramide (Reglan) | gastrointestinal motility, including gastric emptying antiemetic | arrhythmia |
| Promotes gastric emptying | Behavior problems | |
| Rectal agents Therevac m ini-enemas | Triggers colonic peristalsis | |
| Carbon dioxide suppositories (Ceo-Two) | Causes rectal distention |
More medical literature on Medic.Studio
More on the topic RESPIRATORY FUNCTION:
-
Infectious diseases -
Internal diseases -
Obstetrics and Gynaecology -
Pediatrics -
Veterinary medicine -
-
Conflictology -
Ecology -
Economy -
Finance -
History -
Law -
Medicine -
Philosophy -
Religious studies -