CARING OF BEDRIDDEN PATIENTS

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Compiled by
DR KANHU CHAARN PATRO
TAKING CARE OF
NEUROLOGICAL/BEDRIDDEN PATIENTS
A GUIDE TO CARETAKERS

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By
Dr Kanhu Charan Patro
MD, DNB (Radiation Oncology), MBA, PDCR, FAROI, FICRO, CEPC
(Brain Tumor Specialist)
drkcpatro@gmail.com
www.drkanhupatro.com
M +91 9160470564

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Preface
The prevalence rates of various neurological disorders in different
regions of the country range from 967 to 4,070 cases per 100,000
population, with a mean of 2,394. This provides a rough estimate of over
30 million people living with neurological disorders, excluding neuro-
infections and traumatic injuries. These individuals require special care
and attention. Unfortunately, not everyone has access to all medical
benefits. My father has been battling Progressive Supranuclear Palsy
(PSP), and I have personally witnessed the immense suffering he endures.
My mother tirelessly stands by his side 24 hours a day, and I constantly
feel the weight of the situation on my shoulders. In my journey, I've
accumulated valuable experience in managing neurological issues and
have outlined effective solutions. I've documented these problems and
their best possible remedies, complemented by images sourced from
reputable online platforms. My intention is to assist not only my patients
but also yours, as well as family members, in navigating these challenges.
You can access the book for free by scanning the provided QR code using
a QR code scanner app like Paytm, ensuring widespread accessibility to
this resource. This is my inaugural edition, presented in straightforward,
everyday language. I welcome your valuable suggestions for
improvements. This book is a heartfelt dedication to my dear parents. My
future goals include translating it into numerous other languages. Please
don't hesitate to reach out with any recommendations or corrections; your
input is greatly appreciated.it will also reduce the counselling time of busy
consultants. I have taken some lines and pictures from google for guide
the patients. My apologies.

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INDEX
TOPIC PAGE
Who is a neuro patient? 5
How to make them sleep? 6
How to prevent head injury? 7
How to prevent bed sores? 8
How to take care of swallowing issues? 9
How to take care of speech in a neurological patient? 10
How to take care of nutrition in a neurological patient? 11
How to take care of oral health in a neurological patient? 12
How to take care of genital health in a neurological patient? 13
How to manage motion in neurological patients? 14
How to manage vomiting in neurological patients? 15
How to handle seizures in neurological patients? 16
Support staff for neurological patients 17
Palm and sole care for neurological patients 18
Ocular care in neurological patients 19
Urinary issues in neurological patients 20
Medication handling in neurological patients 21
Taking the help of alarm bell 22
Choosing of bed and wheelchair 23
Using of GPS system 24
Handling the memory loss 25
Use of suction machine 26
Physiotherapy in neurological patients 27
Sunlight exposure in neurological patients 28
Handling an emergency 29
Support services 30

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Chapter-1
Who is a neuro patient?
 In simpler terms, a neuro patient is someone dealing with a brain-
related issue.
 These conditions often result from brain injuries caused by strokes,
accidents, tumors, and various other factors.
 Patients facing these challenges require increased attention in their
daily lives and rely on the kindness and support of their loved ones.
 Within this book, I've outlined some practical preventive measures for
everyday life.
 The collaborative efforts of neurologists, neurosurgeons, nurses,
physiotherapists, caregivers, and researchers are indispensable in
providing comprehensive assistance.
 My aspiration is that this resource will be beneficial to your close
friends and family.
 Please feel free to share it as you see fit.

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Chapter-2
How to make them sleep?
 Neurological patients often face a heightened risk of aspiration.
 Aspiration can lead to chest infections and choking issues.
 It's important to avoid letting them sleep flat on their back or face
down.
 Instead, encourage them to sleep on their left or right side.
 This position allows any saliva secretion to naturally flow down rather
than accumulate in the throat.

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Chapter -3
How to prevent head injury?
● Neurological patients often tend to fall.
● Falling can result in head injuries and an increased risk of blood clots
within the head, potentially leading to emergency situations.
● If there's a significant risk of falling, help when they need to walk and
avoid sending them alone to places like the bathroom.
● It's advisable to wear a thick woolen monkey cap as often as possible.
● Even in the event of a fall, wearing a cap can reduce the likelihood of
head injuries.
● Do not make them suddenly sit or get up from bed.
● Some people having head reeling sensation requires extra care.

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Chapter - 4
How to prevent bed sores?
 Bed sores frequently occur in patients who are bedridden.
 They develop because of prolonged immobility in bed.
 It's crucial to change their position at least every half an hour.
 Encourage them to sit in a wheelchair or with a backrest for short
periods.
 Consider using air beds or water beds to help prevent the development
of bed sores.

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Chapter - 5
How to take care of swallowing issues?
● Swallowing difficulties are common among some neurological
patients.
● Swallowing involves the process of food passing through the throat.
● Coughing during swallowing often indicates a swallowing issue.
● Always ensure that the patient is in a seated position while eating; if
bedridden, prop them up.
● Exploring various swallowing exercises, which can be found on
platforms like YouTube, may be beneficial.
● Consider offering a diet consisting of semi-solid and liquid foods rather
than solids.
● In cases where a patient is unable to swallow or unconscious, the
nasogastric tube, inserted through the nose to the stomach, can be
considered.
● Liquid foods like milk can be administered through this tube.
● Another option to explore is PEG (percutaneous endoscopic
gastrostomy), which involves the permanent placement of a feeding
tube directly into the stomach.

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Chapter 6
Taking care of speech in neurological patient?
 Maintain regular communication with them.
 Seek assistance from a speech therapist.
 For those who cannot verbally communicate, encourage the use of hand
signals, and provide appropriate training.
 Encourage them to speak louder or shout by gently prompting or
teasing.
 Utilize self-speaking toys, digital toys, or television sets to aid in
communication.
 Recognize that the type and severity of speech difficulties can vary
widely depending on the underlying neurological condition,
necessitating tailored treatment plans.
 Speech therapists will evaluate the patient's specific speech challenges
and design a targeted therapy program.
 Sign language training can be valuable in communication
development.

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Chapter 7
How to take care of nutrition in neurological patient?
 Maintaining a well-balanced diet is crucial.
 Neurological patients may not always express their hunger, so it's
important to follow a set meal schedule with alarms.
 Plan meals according to the scheduled times.
 Aim to incorporate enough protein, such as 3-6 eggs, to meet their
protein requirements.
 Given that some patients may have diabetes or renal issues, consulting
with a professional nutritionist or dietitian is advisable.
 These experts can evaluate the patient's nutritional status and devise a
personalized dietary plan.
 Collaborate with the healthcare team to address specific nutritional
needs based on the patient's condition.
 Keep in mind that individualized care is essential since the nutritional
requirements of neurological patients can vary significantly.

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Chapter 8
How to take care of oral health in neurological patient?
 Maintaining excellent oral hygiene is vital for preventing dental issues
and enhancing overall quality of life.
 After every meal, it's important to clean the mouth thoroughly.
 In cases where self-care is not possible, please provide the necessary
assistance.
 You can aid in cleaning by using sprays and syringes.
 Always conduct a thorough examination for any injuries or infections
inside the mouth using a mirror.
 If necessary, opt for a children's toothbrush for gentler cleaning.
 It's advisable to refrain from regular use of mouthwashes.

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Chapter 9
How to take care of genital health in neurological patient?
 Caring for the genitals is a crucial aspect of daily care for neurological
patients.
 Male patients are best attended to by a male caregiver or their life
partner.
 Female patients benefit from the care of a female attendant or their life
partner.
 For male patients, cleaning the glans daily during bathing is essential.
This can be done through self-care or with assistance. Ensure the
prepuce (foreskin) is retracted and cleaned.
 Female patients typically require gentle care without the need for deep
cleaning. Using normal or lukewarm water is sufficient.
 Vigilance for any white patches in the genital area is important, and it
should be reported to the doctor promptly.

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Chapter 10
Motion management in neurological patients?
● Constipation is a prevalent issue among neurological patients.
● This problem often arises from reduced mobility and, in many cases,
as a side effect of medications.
● Smooth laxatives can be employed as needed to alleviate constipation.
● If the patient is unable to have a bowel movement, consider using
enema procedures and rectal medications as per the doctor's guidance.
● Encourage the patient to consume an ample amount of water, ideally
3-4 liters per day.
● Incorporate a higher proportion of vegetables and fruits into their diet
to promote regular bowel movements.

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Chapter 11
Managing vomiting in neurological patients?
 Vomiting can be indicative of various neurological conditions or may
result from factors like medications, infections, or gastrointestinal
issues.
 When vomiting occurs, it's crucial to provide care and attention.
 While the patient is vomiting, assist them by allowing them to sit.
 In cases of persistent vomiting, it's advisable to let the patient sleep in
a lateral position.
 Consider the use of mouth-dissolving anti-vomiting tablets, but always
consult with your local doctor for proper guidance and medication.

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Chapter 12
How to handle seizures in neurological patients?
 Abnormal brain activity can lead to unusual body movements, ranging
from isolated body parts to the entire body.
 When a patient experiences a seizure, it's important to allow them to
lie on the floor or a cot. Seizures can occur in episodes.
 During a seizure, there's a risk of biting the tongue. To prevent this,
consider placing a cloth, like a handkerchief, between the teeth, but
avoid putting it inside the mouth.
 It's crucial never to miss a seizure medication dose. If seizures persist
despite medication, consult the doctor again.
 Place the patient in a lateral position during a seizure to aid in their
safety.
 Take precautions to prevent head injuries and maintain a diary to track
the seizures and their details.

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Chapter 13
Support staff for neurological patients?
 Family support plays a vital role in caregiving for neurological patients.
 Depending on your budget, you have the option to hire an attendant or
nurse for additional assistance.
 Investing in an attendant is a cost-effective measure compared to
potential injury and medical complications.
 Affordable support groups are accessible, but if not, consider hospice
or palliative care options.
 Hospice and palliative care services offer comfort and support to
patients with advanced neurological conditions and their families.
 They also oversee the patient's comprehensive neurological care and
treatment plan.

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Chapter 14
Palm and sole care in neurological patients
● Taking care of both the palms and soles is equally important.
● Examine the soles for any injuries daily.
● In the case of diabetic patients, pay special attention to the soles to
prevent injuries and consider using socks.
● If there is leg swelling, it's crucial to have any ulcers or wounds on the
soles assessed by a doctor.
● Regularly trim the nails of both the fingers and toes to maintain proper
hygiene and prevent complications.

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Chapter 15
Ocular care in neurological patients
 Caring for the eyes or ocular health is a crucial aspect of overall patient
care.
 Patients who cannot close their eyes may require glasses to prevent
dryness, and artificial tears or consultation with an eye specialist may
be necessary for dry eye management. Eye strapping with micropore
will help.
 Those having ptosis, not able to open the eyes, again eye with
micropore strapping will help.
 Patients unable to open their eyes should receive regular cleaning to
maintain eye health.
 Patients unable to move their eyes, restricting their upward or
downward gaze, should be closely monitored to prevent falls.
 Any unusual redness in the eyes should prompt consultation with a
doctor for proper evaluation and treatment.
Not able to close the eyes.
Not able to open the eyes.

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Chapter 16
Urinary issues in neurological patients
● Urinary issues in neurological patients often involve leakage and
retention problems.
● In cases of persistent leakage, using diapers is advisable as it reduces
the risk of infection compared to catheters.
● Patients unable to pass urine may require intermittent self-dwelling
catheters.
● Timely evacuation through urinary training can be beneficial. Some
patients may also require specific medications, so consulting a doctor
is essential.
● When using urinary catheters, take precautions to prevent infections.
Use gloves and strictly follow the doctor's instructions for proper
catheter care to minimize the risk of infections.

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Chapter 17
Medication handling in neurological patients
 It's important to maintain a medication chart.
 Educate the patient about the chart and medication details.
 After taking the medicine, encourage them to mark it with a pen.
 If the patient is unable to manage this task, continue with the same
procedure yourself.
 Consider using a pill organizer, which you can purchase online, to help
with medication management.
 Keep a separate medication chart for emergencies.
 Establish contact with a pharmacist, nurse, or local physician who can
help in case of emergencies.
 Online apps or websites can also be consulted for medication
management and information.

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Chapter 18
Using of alarm bell in neurological patients
 Implementing an alarm bell or alert system can be a valuable tool to
enhance the safety and well-being of neurological patients.
 Utilizing an alarm bell or alert system for neurological patients is
particularly beneficial for ensuring their safety, especially when they
face mobility or communication difficulties.
 Incorporate an alarm bell for neurological patients and provide training
on how and when to use it, particularly for those who cannot speak or
communicate effectively.
 Choose an alarm system that is tailored to the specific needs and
capabilities of the patient.

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Chapter 19
Choosing the bed and wheelchair in neurological patient
 Ensure the patient's safety by selecting an appropriate wheelchair and
bed based on their specific requirements.
 Decide between an automatic self-propelled electronic wheelchair and
a manual one, depending on the patient's needs.
 Explore options like all-in-one wheelchairs with sleeping modes and
attached commodes.
 Patient beds are available with manual and electric adjustments; choose
the one that suits the patient's needs.
 Conduct tests on different variants and make your selection based on
affordability and the patient's specific requirements.

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Chapter 20
Using a GPS system in neurological patient
● GPS chips or app-based GPS systems can be invaluable for supporting
neurological patients.
● In cases where a person may forget their way or home after a walk,
these systems can assist family members in tracing their location.
● Simply place a GPS tracker in the person's pocket, and you can easily
track their whereabouts.
● Many GPS tracking apps are available for free, while others may
involve a nominal fee for added features and benefits.

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Chapter 21
Handling in memory loss in neurological patient
 Memory loss is characterized by unusual forgetfulness, where one may
struggle to remember new events, recall memories, or both.
 Memory loss can be transient, resolving after a short period, or it may
persist and potentially worsen over time, depending on its underlying
cause.
 Encourage daily physical activity, as it enhances blood flow to the
entire body, including the brain.
 Keep them mentally engaged and active consistently.
 Spend quality time with them to provide emotional support.
 Consider using an alarm bell as a conditioning tool.
 Implement a GPS system if they tend to forget routes or directions,
ensuring their safety when returning home.

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Chapter 22
Use of suction machine in neurological patient
o Repeated aspiration, where food may enter the lungs during
swallowing, is a concern for some patients.
o Not all patients can effectively cough it out.
o Some individuals with coughing difficulties struggle to clear sputum.
o A suction machine can be invaluable in such situations.
o You can purchase this machine online or from a local surgical store.
o Suction machines are user-friendly and offer practical assistance in
clearing respiratory secretions.

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Chapter 23
Physiotherapy in neurological patients
 Physiotherapy is a vital component in enhancing the quality of life and
functional independence of neurological patients.
 Physiotherapists are specialists in designing exercise programs tailored
to the unique challenges presented by neurological conditions.
 A thorough assessment conducted by a physiotherapist evaluates the
patient's movement patterns, muscle strength, balance, posture, and any
neurological deficits.
 Physiotherapy can be effective in improving gait problems (walking
issues) among patients.
 If necessary, consider hiring a physiotherapist to address specific
concerns, as they play a pivotal role in rehabilitation and recovery.
Regular progress assessments help fine-tune the treatment plan as
required.

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Chapter 24
Sunlight exposure in neurological patients
 Sunlight can significantly improve the mood of patients.
 Ensure there's adequate access to natural light by opening a window or
door.
 This exposure also contributes to their intake of essential vitamin D.
 Exposure to light can have diverse effects on neurological patients,
affecting their sleep patterns, mood, and overall sense of well-being.
 While sunlight exposure is beneficial, it's advisable to avoid direct
sunlight during the morning or evening for a limited duration to ensure
its benefits.

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Chapter 25
Handling an emergency
 Note whom to call in an emergency, keep a note written beside the bed
and inform other family members.
 Keep the ambulance number with you in an emergency.
 Keep a pulse oximeter, thermometer, BP instrument, glucometer with
you and learn and teach all family members.
 If the person needs oxygen support frequently, it is better to buy an
oxygen cylinder or concentrator.
 If the patient is not responding to a call or pain suddenly just give some
glucose and see the response.
 Check the BP, pulse, oxygen saturation.
 Look for the missed medication.
 Learn how to revive called CPR, learn from you tube or ask your
doctor.
 Keep the ambulance number with you in an emergency.
 Call for help.

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NATIONAL AND INTERNATIONAL SUPPORT SERVICES
PROBLEM WEB SITE/LINK PHONE
Bedridden
care
https://www.youtube.com/watch?v=q_31qjv__Yo
Dementia www.dementia-india.org 8585990990
Parkinsonism https://www.parkinsons.org.uk/information-and-
support/our-support-services
08088000303
Brain tumor https://www.thebraintumourcharity.org/living-with-a-
brain-tumour/get-support/
08088000004
Stroke https://strokesupport.in/ 9810290988
Cerebral palsy https://www.cerebralpalsyguide.com/community/ (866) 7229617
PSP https://www.psp.org/ 8004574777
Motor neuron
disease
https://www.mndassociation.org/ 01604611860
CPR https://www.youtube.com/watch?v=Plse2FOkV4Q
Here I have collected some national and international support services for various
neurological patients according to disease wise. You can search in Google also