How to treat and recover hemiplegic patients?

How to nurse stroke patients with hemiplegia in acute stage?

Acute nursing care of stroke patients with hemiplegia is very important for the success of disease rescue, which is described as follows:

(1) Rest and avoid unnecessary moving: Patients with stroke and hemiplegia, especially those with cerebral hemorrhage, should try to reduce medical visits and avoid unnecessary examination and moving. Patients with irritability should choose a quiet room to avoid light to reduce irritation; If necessary, add a bed stop to prevent falling and bumping.

(2) Oxygen inhalation in time: All patients with stroke and hemiplegia have cerebral hypoxia, and nasal catheter is often used to provide oxygen in clinic. Pay attention to whether the patient's nasal cavity is unobstructed and whether the nasal cavity is clean and hygienic during operation.

(3) Closely observe the illness, such as consciousness, breathing, pupil, blood pressure, pulse and temperature.

(4) Pay attention to diet and nutrition: generally, it is not advisable to eat 3 days before onset, because new patients may have coma and vomiting. Reluctantly eating may cause food to be inhaled into the lungs and cause infection, but you must have an appropriate amount of intravenous fluids. Those who still can't eat after 3 days should ensure nutritional supply through nasal feeding.

(5) Change body position regularly to prevent bedsore; Maintain functional posture to prevent paralysis and limb deformity.

(6) Maintain oral hygiene: help patients brush their teeth in the morning and evening and rinse their mouths after meals to prevent diseases from entering the mouth.

(7) Nursing of defecation: Stroke patients often have difficulty in defecation. Patients can eat more fruits and vegetables, drink more water, and use mild laxatives and massage the abdomen to make them defecate regularly. For patients with urinary incontinence, they can be trained to urinate on time and establish conditioned reflex; For patients with urinary retention, if abdominal hot compress or acupuncture is ineffective, catheterization can be retained, but the catheterization time should be shortened as much as possible to prevent urinary tract infection.

How to prevent and care for bedsore?

Stroke patients often have limb paralysis, unable to turn over and change their posture, local body compression, decreased nutritional function of paralyzed limb skin, and are most prone to bedsore. Bedsore is also called pressure ulcer. At the beginning, local redness and blisters can be seen on the skin, and then it turns purple and begins to rupture. At the beginning of the outbreak, the sore surface was bright red with exudate, and then deepened, and the color became darker and darker. Common in the chest and back, hips, hip joints, heels, lateral ankles. For bedsores, prevention is the most important, and the following points should be done:

(1) Turn over and massage the patient regularly for at least 2 hours, 1 time.

(2) Add cushions, balloons, sponge pads, etc. The prone parts of bedsore.

(3) Keep the skin clean and dry. When incontinence or vomiting occurs, scrub it in time. Don't let the patient sleep directly on the rubber mat.

(4) Keep the bed clean and dry, and change the bedding when it is wet. For patients with incontinence, it is inconvenient to put the bedpan under the patient all the time. Patients with sensory impairment should try not to use hot water bottles to prevent burns.

(5) Strengthen nutrition in diet, ensure the supply of protein, and increase patients' skin resistance.

(6) For bedsore that has occurred, keep the wound dry, apply anti-inflammatory and granulation cream, and adopt physical therapy.

In short, the prevention of bedsore is to turn over frequently and check whether the skin, clothes and sheets are flat and dry when turning over; When the oppressed skin is red, it should be rubbed with the palm of your hand to promote the blood circulation of the skin and achieve the purpose of early prevention, early detection and early treatment.

How to care for paralyzed limbs?

Paralysis caused by stroke is mostly hemiplegia or single limb paralysis, and two attacks involve bilateral limb paralysis. Patients are often accompanied by language disorders, often choking due to bulbar palsy, or have a certain degree of mental decline. In order to strengthen the care of patients, we should do the following:

(1) Do a good job in psychological care: pay attention to the ideological work of patients. Paralysis has brought a heavy ideological burden to patients. Family members should encourage patients to be optimistic and open-minded and establish confidence in overcoming the disease. So that it can cooperate with medical staff and their families to exercise the function of paralyzed limbs as soon as possible to prevent joint deformity and muscle atrophy.

(2) Maintain the functional position of the limb: the knuckles of the paralyzed limb should be straight and slightly flexed, and a sponge ball can be placed in the patient's hand; Elbow joint slightly flexes, upper limb shoulder joint slightly abducts, avoiding joint adduction, hip extension and knee extension; In order to prevent foot drop, the ankle joint should be slightly dorsiflexed; To prevent external rotation of lower limbs, sandbags or other supports should be placed outside.

(3) Strengthen the activities of paralyzed limbs, including physical massage, passive activities, sitting up, standing and walking exercises. , can prevent limb contracture and deformity.

(4) Prevention of complications: Due to the movement and sensory disturbance of paralyzed limbs, the local blood vessels and nerves are poorly nourished. If the compression time is long, it is easy to cause compressive ulcers-bedsores. Therefore, we should pay attention to changing body position, generally turn over every 2 hours 1 time, gently massage the pressed part, or massage with safflower alcohol to improve local blood circulation. Beds should be dry and flat, and maintain good personal hygiene. You can take a bath, but keep warm to prevent colds. When using hot water bottles or taking a bath, the water temperature should be appropriate to prevent skin burns. When turning over, pat your back properly, encourage expectoration and prevent pneumonia. You should have enough intake, especially in summer. Choose vegetables and fruits rich in cellulose and vitamins to ensure adequate nutrition. Develop the habit of defecation and prevent constipation. Give 1 cup of hot drink before breakfast (hot water, tea, milk or coffee can be used according to the habit), which can promote the increase of intestinal peristalsis and stimulate the rectal defecation reflex. In order to promote defecation, you can also massage the abdomen, from the lower right abdomen to the upper right, to the upper left abdomen, and then to the lower left abdomen, and massage it repeatedly for 5 ~ 10 times to promote peristalsis of the upper colon and help defecation. In case of constipation, glycerin suppository or traditional Chinese medicine can be used. When you still can't defecate, you should enema. Urinary catheter should be placed in patients with urinary retention or urinary incontinence, and aseptic operation should be strictly carried out to prevent urinary tract infection.

(5) Training of self-care ability and professional ability: When paralysis improves, patients should actively exercise their daily life ability; Medical staff and their families should give correct guidance and enthusiastic help, and encourage patients to do what they can, such as undressing, washing their faces and eating.

How to help hemiplegic patients build self-confidence?

Hemiplegic patients who are conscious and have no obstacle to thinking are often pessimistic, disappointed, depressed and worried because of the loss or decline of their activity ability. This negative psychology is not conducive to patients' treatment, sleep and appetite. To help patients get rid of pessimism, medical staff, patients' relatives and social service institutions have to do a lot of work.

(1) Actively treat the primary disease and carry out rehabilitation treatment as soon as possible. Rehabilitation should run through the whole process of disease treatment, strive to reduce the degree of disability and avoid complications. A large number of data prove that the timely use of exercise therapy, occupational therapy and psychological guidance has obvious effects on improving limb function, improving living ability and correcting negative psychology.

(2) Carry out meticulous life care and create a warm emotional atmosphere. In the environment that many people care about, patients are easy to get rid of loneliness, get spiritual safety and help in life, make up for the inconvenience caused by disability, and build self-confidence in life. Especially patients with progressive stroke are often depressed and need help in life at this time. Unmarried hemiplegic patients, faced with marriage and the coming, will inevitably have depression and self-abandonment, which requires the sympathy and careful care of medical staff and the tireless comfort of relatives. Only in this way can we face up to the reality and maintain a positive and optimistic mood.

(3) With the stabilization of illness or the improvement of mood, we should treat patients rationally, encourage self-realization, actively cooperate with the treatment of medical staff, put into rehabilitation training at an early stage, overcome disuse muscular atrophy and joint contracture stiffness, and minimize the degree of disability. Organize recreational activities, improve the fun of life, encourage paralyzed patients to participate in collective activities and return to society, and eliminate inferiority complex.

How to adjust the bedding and clothing of hemiplegic patients?

Hemiplegic patients had better sleep in a hospital bed with guardrails, which can prevent them from falling and is also conducive to rehabilitation exercises in the future. You can put a thick and soft mattress on the wooden bed, and you can use an air cushion bed if possible. When you are incontinent, you can put a rubber pad under the bed sheet and a diaper on the bed sheet so as to change it in time and keep it dry.

The clothes worn by hemiplegic patients should be fat and soft, and easy to put on and take off. It is best to have zippers or velcro for easy replacement. When changing clothes, first change the healthy upper limb, take off one side and put on the changed clothes immediately to avoid catching cold; When changing the affected side, protect the shoulder joint and prevent dislocation; When the temperature is low, it is necessary to raise the room temperature, cover it with a light and warm quilt, and do not place a hot water bottle to avoid burns caused by sensory impairment; When the temperature is high in summer, it is more convenient to wear pajamas on the bed. Just cover it with a thick towel, but pay attention to your shoulders.

What will happen if the hemiplegic patients at home are sent to the hospital?

Cerebrovascular diseases not only have high morbidity, disability and mortality, but also have high recurrence rate. A considerable number of patients with stroke hemiplegia have suffered from stroke hemiplegia for the second or even the third time. Therefore, patients with stroke and hemiplegia who recover at home may have another stroke and hemiplegia. Usually, the secondary stroke hemiplegia is more serious than the primary stroke hemiplegia, and the mortality rate is much higher than that of the primary stroke hemiplegia. Therefore, it is very necessary to be sent to the hospital in time and get treatment in time.

Patients who recover at home may have another stroke if they have the following conditions: paralysis and aggravated limb weakness; One limb is numb, or the other limb is numb and weak; Unclear speech or stuttering; Cough and dysphagia when drinking water; Unstable walking, dizziness with vomiting; Severe headache and vomiting, even coma and epilepsy. At this point, it must be sent to the hospital immediately.

In addition, stroke patients have fever, cough and expectoration, or abdominal pain and diarrhea, or palpitation, precordial pain, chest tightness and other symptoms, indicating that patients have other medical diseases, and should also be sent to the hospital for examination and treatment immediately.

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