Health education of cerebral hemorrhage

1. Avoid emotional excitement, get rid of anxiety, fear and anger, and keep a good mood. 2. Eat a light diet, eat more foods containing water and cellulose, eat more vegetables and fruits, and avoid irritating foods such as tobacco, alcohol and spicy food. 3. Life should be regular, develop the habit of regular defecation, and avoid overexertion and suffocation when defecating. 4. Avoid heavy physical labor, insist on doing health gymnastics, playing Tai Ji Chuan and other appropriate sports, and pay attention to the combination of work and rest. 5. The process of rehabilitation training is arduous and slow (usually 1-3 years, accompanying the elderly for life), which requires confidence, patience and perseverance, and should be gradual and persistent under the guidance of rehabilitation doctors. 6. Measure blood pressure regularly, review the condition, and treat atherosclerosis, hyperlipidemia and coronary heart disease that may coexist in time. Publicity and education on health knowledge of cerebrovascular disease rehabilitation exercise [psychological guidance] (1) should first explain clearly to family members and patients that rehabilitation is not synonymous with eating well, dressing well and having a good rest after illness. In order to give full play to the residual function of patients, rehabilitation work runs through. (2) When carrying out rehabilitation training, especially walking training, patients should not be too confident, and they should not stand or move on their own without being accompanied or cared for, so as to avoid accidents such as falling. (3) For patients with language disorders, in order to improve their training enthusiasm, reduce interference and facilitate patients' concentration, outsiders are forbidden to visit during the training process. When strengthening training, we should give priority to supervision according to the requirements of rehabilitation doctors. When patients still want to train after language training meets the requirements, the training content can be expanded according to their requirements. (4) When the patient is emotional and refuses to train, it may be due to the following reasons:. 1. Lack of self-confidence and shyness. It is necessary to understand the patient's ideological trends, explain the importance, necessity and gradual progress of exercise, and give affirmation and encouragement to the patient's every progress. 2. Pressure from family or society. You can talk with relevant personnel, win their support, explain the positive significance of rehabilitation training and its impact on the quality of life of patients, and strive to gain the trust and cooperation of family members. (5) Rehabilitation training should be evaluated regularly to understand the patient's rehabilitation progress, modify the training plan in time, and tell patients not to be upset by some repeated examinations, and should try their best to cooperate. According to the patient's condition, an assessment can be arranged once a week, once a month or even once every six months. [Guidance of bed training] Most patients with acute cerebrovascular disease are paralyzed in bed and have disturbance of consciousness. While saving patients' lives, we should also pay attention to the rehabilitation of limb functions. In order to reduce neurological dysfunction such as joint spasm and muscle atrophy caused by long-term bed rest, patients and their families should be instructed to do the following work in the early stage: (1) Good limb position: 1. Supine position, shoulder flexion 45, abduction 60, no internal and external rotation; Elbow extension position; Wrist extension, palm up; Fingers and joints are slightly flexed, and soft towels can be held. Pay attention to keep your thumb in the middle position; Straighten the hip joint to prevent internal and external rotation; Joint flexion 20-30 (about one punch high), padded with soft towel or pillow; The ankle joint is in the middle position. When placing, the heel should be lifted easily to prevent the foot from sagging. Don't tuck the quilt at the end of the bed or pile things on your feet to press your feet, and put soft pillows on your feet. 2. When lying on the healthy side: the healthy hand flexes and abducts, the healthy limb flexes, the back is cushioned, the affected hand is placed on the chest and the palm is straight down to the elbow joint and wrist joint; The affected limb is placed on the soft pillow, and the joint is straight or flexed for 20-30 degrees. 3. When the patient lies on his side, it is advisable to put a soft pillow on his back and tilt it at 60-80 degrees. Excessive lateral lying is not allowed to avoid suffocation; The affected hand can bend 90 degrees on the pillow, and the healthy hand can be placed on the chest or body; The healthy limb flexes, the affected limb is stepped or flexed, and a soft pillow is placed between the lower limbs to avoid oppressing the affected limb and affecting blood circulation. (2) Passive exercise: After the patient's condition is stable, in addition to paying attention to the placement of limbs, both consciously and unconsciously, passive exercise should be carried out as soon as possible. 1. Shoulder flexion, extension, abduction, internal rotation, external rotation, etc. According to the patient's tolerance, the coma patient can reach the functional position to the maximum extent, from small to large, ***2-3 minutes to prevent dislocation. 2. Elbow flexion and extension, internal rotation and external rotation. , appropriate force, the frequency should not be too fast, ***2-3 minutes. 3. Wrist flexion, extension and encircling. Move 3-4 times in all directions. Don't use too much force to avoid fracture. 4. Finger joint flexion and extension, thumb abduction, around and pointing to the other four fingers, each activity lasts about 5 minutes. 5. The abduction, adduction and internal and external rotation of hip joint should be based on the patient's patience. The abduction of coma patients 15-30, adduction, internal rotation and external rotation are all around 5. Don't push too hard, the speed is appropriate, ***2-3 minutes, and it is appropriate to move in all directions for 2-3 times. 6. Knee abduction, internal rotation, external rotation, etc. , see the patient's patience, ***2-3 minutes. 7. Ankle flexion, extension, encircling posture, etc. ***3 minutes, don't push too hard to prevent sprain. 8. Flexion, extension and rotation of the toes of the toe joint, ***4-5 minutes. You can do passive exercise 2-3 times a day and massage the soles of your feet, palms, Hegu points and Quchi points. , help patients massage the whole body muscles to prevent muscle atrophy. (3) Active exercise: When the patient is conscious and his vital signs are stable, he can take active exercise in bed to facilitate the recovery of limb function. 1.bobath handshake method: help the patient to separate the five fingers of the affected hand, press the thumb of the healthy hand under the thumb of the affected side, cross the other four fingers accordingly, straighten the elbow joint as far as possible, and insist on the healthy hand to drive the affected hand to lift. At 30, 60, 90 and 120, the patient may be required to be 5- 120 according to the patient's condition. 2. Bridge exercise: Let the patient lie on his back, put his hands flat on his sides, and put his feet on the bed. The assistant will press the patient's knees, try to lift the patient's hips off the bed, keep them from shaking, and try to keep his knees together. When doing so, raise the height to the maximum capacity of the patient and instruct the patient to keep calm breathing. The time starts from 5 seconds, and gradually increases to 1-2 minutes, 2-3 times a day, 5 times each time, which is of exercise significance to the back muscles, arm muscles and quadriceps femoris, and helps to prevent bad gait such as hip-throwing and foot-dragging. 3. Exercise in bed: Teach patients to exercise up and down in bed with healthy hands as the focus and healthy limbs as the fulcrum. Healthy hands hold the railing of the bed tightly, and healthy limbs help the affected limb to stand upright on the bed surface, such as crossing the bridge. When the arm is lifted off the bed surface, it is convenient to move up and down, and the bed can be moved by itself. If the strength of healthy hands reaches level 5, patients can be taught to grasp the bedside guardrail with their hands and insert healthy feet under the knee joint of the affected limb to turn over. [Bedside activity guidance] (1) Get up: 1. Starting from the healthy side, ask the patient to shake hands with BOBARTH to move the upper body as close as possible to the bedside, drive the affected limb to move out and put it down near the bedside, and support the bed surface with the elbow joint of the healthy hand to support the affected shoulder and help the patient get up. From the affected side, prepare the same healthy side. When you get up, hold it up with your palm to help you get up. These two methods of getting up are labor-saving and safe, and patients can get up by themselves after getting used to it. (2) Balance training of the affected limb: help the patient to take the booth outside the affected shoulder joint: elbow joint extension and external rotation; The wrist passively bends back 90; Five fingers are respectively supported on the bed surface. If the patient does not stretch enough, press the arm on the patient's hand, close to the patient's elbow joint, and keep the shoulders opposite to help the patient straighten the elbow joint. The patient's lower limbs are close together, and his trunk leans as far as possible to the affected side when his feet touch the ground. After a period of time, sit up straight and practice repeatedly. When it is difficult to move, patients can touch objects or hands placed in front of the affected side with healthy hands to help training. (3) Standing: Help the patient to lay his feet flat on the ground, with his legs shoulder width apart. Shake hands with Bobarth to make his hands stretch forward as far as possible, bow his head, bend over and tuck in his abdomen, and gradually shift his weight to the lower limbs, and assist the staff to pull the patient's shoulder joint with both hands to help him get up. If the patient's limbs are weak and can't land, the helper can put his knee against the knee joint of the patient's limbs and clamp the affected foot with his foot. The patient puts his hands on the helper's waist to help him stand easily, but don't pull his clothes hard to avoid falling. (4) Standing training; Teach patients to abdomen, chest, head up, relax shoulder and neck muscles, do not shrug or lift shoulders, straighten waist, stretch hips, and straighten both lower limbs as much as possible. Mirrors can be used to help patients correct their bad posture when standing. [wake up instruction] 1. Walking training guidance: Before walking, the muscle strength of lower limbs should reach level 4, and it is best to do it under the guidance of rehabilitation doctors to avoid misuse syndrome and leave some gait that is difficult to correct. (1) The stride is even and the frequency is moderate. (2) Stretch your hips and bend your knees. First, lift one heel and shift the center of gravity. The heel of the other foot also lands first, and the center of gravity shifts to the hind foot to start the next cycle. (3) Training of going up and down stairs: It is easy to go down stairs, and training should be conducted under the guidance of a rehabilitation doctor. The training should start gradually from the height of 10cm, and it is appropriate to use the non-slip wooden ladder with guardrail. Do not conduct training without authorization. (4) center of gravity shift training; Teach the patient to stand at the railing at the end of the bed, grab the railing with both hands and stand with both lower limbs shoulder width. If possible, put a wooden board with a 30-degree oblique angle on the sole of the affected limb to help straighten the knee joint of the affected limb, and ask the patient to squat down half-way, hold out his chest, and experience the feeling that the center of gravity gradually shifts from his hips to his lower limbs. 2-3 times a day, each time 15 minutes, can achieve the correction of bad posture. 1. daily life action training; (1) Strike: It can teach patients to play volleyball alternately with both hands, so as to train patients' coordinated movements and promote patients' unconscious self-activity. (2) wool; This belongs to fine motor training, which is not only beneficial to the coordination of patients' hands and eyes, but also beneficial to the cultivation of senses and feelings, and is of great significance to the recovery of brain nerve function. (3) If patients are interested, they can take other training. [Language Training] 1. Oral practice: teach patients to pout, drum their cheeks, knock their teeth and play their tongues. , each action 5- 10 times. 2. Tongue movement: open your mouth and do the expansion and contraction of your tongue; Stick the tip of your tongue out of your mouth as far as possible and lick your upper and lower lips and left and right corners of your mouth; And do the action of wrapping your tongue around your lips and licking your palate with your tongue. Repeat each exercise 5 times, 2-3 times a day. 3. Teach patients to learn pronunciation (pa, ta, ka), and repeat them one by one. When the patient can pronounce correctly, the three sounds are repeated together (that is, pa, ta, ka), and the training is repeated several times a day until the patient is well trained. 4. Breathing training: When the patient breathes unevenly, the patient should be trained to breathe first; Touch the patient's chest ribs with both hands and tell the patient to inhale. At the end of inhalation, tell the patient to stop for a while, press his hands gently, tell the patient to exhale evenly, and so on. Patients can also be taught to exhale through the mouth first and then through the nose to adjust the respiratory airflow and improve the language function. 5. Use pictures, word cards, objects, etc. To enhance the patient's memory. In the early stage, copying, spontaneous writing, ink writing and other methods can be used to strengthen the patient's language memory function, requiring patients to read more and read aloud to stimulate memory. 【 Guidance on dysphagia 】 1. The diet is light, with little residue and soft food. Bread and steamed bread can be eaten with juice. When the choking of drinking water is obvious, you should try to reduce drinking water and replace it with soup and juice. 2. Raise the bedside 30-45 degrees when eating. 3. Before eating, you can gargle with ice water or stimulate your throat with ice cotton swabs (because these phenomena are mostly caused by the swelling and decline of the uvula. When the throat is stimulated by cold, the swelling of the uvula can be improved and the foreign body sensation disappears), which is beneficial to the passage of food and water. Usually after 4 or 5 days to 10 days of stimulation, these symptoms can be obviously improved or even disappeared. [Discharge Guidance] 1. Conduct home visits and surveys before leaving the hospital to guide the necessary family environment transformation. 2. Try to sleep on the street before leaving the hospital. 3. Rehabilitation training is best accompanied by someone, and don't change the training at will. Go back to the hospital regularly for reexamination and work under the guidance of a rehabilitation doctor. 4. Rehabilitation training should be persistent. The recovery of neurological function is the fastest 1 year, but it is still possible to recover after a few years of long-term exercise.