February 11, 2008 · 1 Comment
1. Isolation of the patient
2. To relieve pan and promote comfort
-Apply moist hot packs to the affected muscle and to relieve muscle shortening.
-maintain good body alignment by using board, sandbags, etc.
-Make bed with cotton or woolen blanket both under and over the patient
-Change position frequently
-Daily bath if necessary and change wet clothes.
3. To avoid spread of microorganisms
-isolation; secretions should be properly disposed
-avoid contact with person having known cases
-Nasal and oral hygiene such as mouth and teeth must be clean, nose should be cleansed for easily passage of air; moisten the mucus membrane with some prescribed lubricant.
4. When a case of poliomyelitis or endemic occurs in a community, panic and tension should be minimized
5. Children’s activities should be reduced to avoid physical exertion and fatigue and chilling should not be overlooked.
6. Sanitation of the premises and proper food handling to avoid contamination by flies should be overlooked.
7. Unvaccinated children and susceptible may be immunized.
8. Anyone who presents a minor febrile illness should be put to bed.
- Golden period of polio is 6 MONTHS, this is where the greatest return of motor function is evident
- But recovery will continue up to 2 years
- Mortality is 1 to 4 % but may increase to 10% if bulbar in from
- Extent of neurologic recovery and functional depends on:
- no. of motor neurons that survived unimpaired
- no. of motor neurons that recover and resume normal function, spontaneous improvement in 3 – 4 mos.
- no. of motor neurons that develop terminal axon sprouting, responsible for slow recovery even up to 1 year or more
2. Rate of recovery fastest in children
3. 90% of muscle that are still completely paralyzed after 6 mos would remain permanently paralyzed.
Medical and Nursing Management
a. medication and treatment
1. Analgesic- for relieving pain
2. Antipyretic- to relieve fever
1. Salk Vaccine- developed by an American researcher Jonas E. Salk. It was declared safe and effective in 1955. it is given by means of infection in 2 doses monthly interval, followed by booster at 6 mos. The vaccine contains dead (formalin inactivated) poliovirus that stimulates production of stimulating antibodies in the human body. It prevents CNS invasion but does not stop viremia.
2. Sabin Vaccine- the more recently developed vaccine by Albert B. Sabin. It consist of attenuated life virus. It is taken by mouth or orally in 3 doses, 2 months apart followed by booster at 1 year of age and before starting school. It was approved in U.S. in 1961. It is more than 90% effective, available in trivalent and monovalent forms.
a. Muscle and tendon transplantation
Operation of Tendons
- tenotomy- division of tendon
- myotomy- division of muscle
- fasciotomy- operation on deep fascia the most useful procedure in the surgical treatment of poliomyelitis are operations that restore stability to failed joints.
b. Arthrodesis- fusion of bones across a joint space by surgical means, which eliminates movement, usually performed to eliminate pain over a joint.
c. Osteotomy- cutting of bone into 2 parts followed by realignment of ends to allow healing
d. Operation to equalized the leg length discrepancy After poliomyelitis, growth affected leg is slowed down as much 6 to 7 cm by disuse, atrophy and diminished blood flow to the limb. The degree of shortening depends of the severity of the paralysis and the age at which paralysis begins.
- Hook’s corset
2. Long leg brace
To provide needed support
3. Oppenens Splints
Prevent weakening of muscles
4. Mobile arm support
To increase hand function