The convenience, comfort and safety of bedridden patients should be considered as much as possible. The width of the bed depends on the patient's condition and living habits. The width of the bed is generally 10 ~ 30cm, and there should be places for daily necessities (such as glasses, watches, radios, combs, small mirrors, sputum cups, etc.) beside the bed. ). bedside items, such as small mirrors, can be placed.
2. Basic nursing care
(1) morning care: it can promote patients' blood circulation and maintain oral hygiene, make patients feel clean and comfortable, and help prevent complications; By observing the progress of the disease, it can provide basis for diagnosis, treatment and nursing plan. The contents include: cleaning of mouth, face, hands, feet, skin and bed units, as well as combing hair (shaving for male patients) and massaging compressed parts.
(2) Night care: it can make patients comfortable, clean and promote sleep. Give the patient an evening care after supper. The contents include: in addition to repeating morning care, wiping the patient's back and buttocks and soaking his feet with hot water; Female patients should clean the perineum, cut their nails (the shape of nails should be the same as that of fingertips, and the toes should be cut flat. After cutting, they should be smoothed with a control knife) and make the bed. Keep warm.
(3) Assist the patient to eat: first urinate, wash your hands, hold the patient's waist with a quilt or a big pillow, put your hands on the dining table of the bed, assist the patient to eat, wash your hands after meals, and tidy up things.
For those who can't sit and eat, they can eat on their side.
3. Family preventive care for major complications of long-term bedridden patients.
(1) Main complications: respiratory and urinary tract infection, bedsore, venous thrombosis and secondary functional impairment.
(2) Prevention in home care
1) Posture placement to prevent functional damage
First, the prevention of foot drop: Foot drop, also known as foot drop deformity, is easy to form lower limb paralysis. Feet should be supported, such as using baseboard support and pillows. Make the feet and legs at right angles, keep back flexion and prevent calcaneal contracture. When keeping warm in winter, we should pay attention to the pressure of the quilt on our feet. We can support the quilt with brackets or clean cartons to avoid crushing the instep. Guide and help patients to exercise their ankles to avoid muscle atrophy and joint stiffness.
B, prevention of knee joint deformity: knee pad can prevent knee joint swelling and joint overstretching (knee supination), and the time should not be too long. Go to the mat and lie flat three times a day to prevent knee flexion and contracture.
C, shoulder and hip joint prevention
A, supine: put a cushion under the shoulder joint to prevent dislocation of the shoulder joint; Roll the towel on the outside of the legs and hips to prevent joint abduction and external rotation. Prevent the mattress from being too soft and the buttocks from sinking, so that the buttocks are in a flexion position for a long time and cause flexion deformity. Once the patient can get out of bed and stand, the frontal joint of the body can bend and cannot stand.
B. Hemiplegic patients lie on the healthy side: the upper limb of the affected side retracts to below the chest and elbow, and a cushion is placed; The patient's lower limbs are bent and the cushion is placed under his legs. Put a pillow on your back to prevent trunk spasm.
C. Hemiplegic patient lies on his side: the affected upper limb is straight, the healthy upper limb is bent on his chest, the affected lower limb is bent, and a cushion is placed under his feet.
D, semi-sitting position: arms leave the torso, the upper limbs are slightly flexed, and the elbow is padded to prevent shoulder adduction deformity.
D. Exercise: Preventing joint stiffness, muscle atrophy and disuse is an important condition to ensure joint activity when the rehabilitation period comes. Don't let the muscles stay in a state of inhibition for a long time in life, and make a joint exercise plan according to the patient's situation.
A, passive movement; When patients can't actively exercise, they should do passive exercise in bed.
Methods: All joints (upper limbs: shoulder, elbow, wrist and finger; Lower limbs: joints of marrow, knee, ankle and toe); All directions (back, left, right, up and down); The sequence of activities is from the big joint to the small joint; The range of motion (flexion, extension and rotation) is from small to large; Time: each joint moves in all directions 3 ~ 5 times, l ~ 2 times a day; The speed should be slow, the technique should be gentle, and the massage should be combined step by step.
B. Active exercise: If the condition permits, all parts that do not restrict exercise should keep active and exercise. Because exercise can promote blood circulation, it is the basic factor to maintain the physiological function of articular cartilage surface, and it is also an effective method to prevent articular surface degeneration.
Exercise content: upper and lower limb joints: according to the range of physiological activities, encourage patients to take active activities and do L-shaped exercises; Hand joints: make a fist and fully extend your fingers; Foot joints: ankle flexion, toe extension and flexion. And often maintain the training of fine hand movements, such as writing and eating with chopsticks.
4. Oral care and prevention of respiratory infection
Patients in bed are weak, their immunity is weakened, their resistance is reduced, and their respiratory and lung defense functions are reduced or decreased, which is prone to aspiration and pneumonia. Patients with chronic diseases who stay in bed for a long time have a high proportion of oral bacteria. The carrying rate of conditional pathogens in the oral cavity of ordinary people is also higher than that of normal people. Oral cavity is one of the ways that pathogenic microorganisms invade the body, and the inhalation of bacteria in oral cavity and pharynx is the main way to produce bacterial pneumonia.
In oral care, we should pay attention to the relationship between brushing teeth and gargling. For bedridden patients, sometimes gargling is more important than brushing your teeth. Therefore, bedridden patients need to rinse their mouths after eating (or drinking milk or drinks); Patients with severe illness or dysphagia (stroke, cerebral palsy, postoperative oral tumor), etc. And patients who cannot gargle by themselves due to illness or other reasons can use drinking water instead of gargling after meals. When necessary, community soil protection needs to be done by yourself or guide family members to do oral care. The method of gargling is to rinse the upper and lower teeth and the left and right sides of the mouth with a mouthful (about 10ml) of warm boiled water. Brush your teeth after gargling and clean up the residue on your teeth and between your teeth. Rinse your mouth after brushing your teeth. The purpose is to rinse the residue on the tooth surface and between the teeth and remove your mouth (after thoroughly cleaning the toothbrush, put it on and keep it dry). Rinse your mouth. After brushing your teeth and gargling, you should drink one or two mouthwashes of warm water. Its purpose is to reduce the total number of bacteria in this part, that is, dilute the bacteria and swallow them into your stomach to be killed by gastric acid. It is best to drink one or two mouthfuls of warm water after urinating at night. Children and the elderly who are susceptible to going out for too long should gargle first and then drink L ~ 2 mouthfuls of water after returning home. Same purpose as above. In case of patients with limited drinking water due to diseases, the total amount of drinking water can be controlled all day, and a small amount of drinking water can be carried out several times to achieve the purpose of cleaning the mouth and preventing respiratory tract infection.
5, skin care to prevent bedsore
For patients who are paralyzed or have trouble moving in bed, they should turn over regularly and have a specific turn-over plan, once every 2 hours during the day and no more than 3 hours at night. The plan can be written on paper, hung on the wall, and a form can be submitted to the executor for filing to ensure the implementation of the plan. Turning over at night can be arranged according to the sleeping habits of family members or caregivers. If the family members 1 1 go to bed, they can turn over the patient before going to bed. Whoever gets up before 2 am will turn over the patient again, and turn over the patient before 5 am until dawn. Before turning over, pat his back and tell him to cough, then let the patient drink 1 ~ 2 mouthfuls of warm water before turning over. Every time you turn over, you should check the oppressed bony process, so as to know the skin condition in time and deal with the problems in time. For the compressed bony process, local massage or air cushion should be used to prevent bedsore.
For patients who can move in bed, according to the condition and tolerance, formulate and guide the nursing plan of turning over on their own. Plan realistically and train step by step. Methods; During the day, use the urination time in the morning, early, middle and late, before and after a nap, and before going to bed at night to turn over. Nocturnal leaves increase by 1 ~ 2 times according to sleep habits and urination times.
6. Nursing countermeasures for patients with urinary incontinence.
Long-term bedridden and incontinent, family care should be given timely anti-infection treatment for infectious diseases, psychological care is essential (patients and their families), and basic nursing skills are also very important. First of all, we should analyze the patient's age, condition, causes of urinary incontinence, time (morning and evening) and so on. And make a personalized nursing plan according to the analysis.
If the patient is awake, but weak, and involuntarily excretes urine and feces, you can notify the family handler. In this case, we can observe the patient's defecation law, and then make a defecation nursing plan according to the law, so as to achieve purposeful and prepared active nursing and reduce the number of bedridden defecation. If the patient has dementia, the treatment of urinary incontinence can also refer to the above methods. If the effect is not good, you can put an absorbent pad on the bed (those who don't wear underwear) or on the perineum of underwear. The material can be a sponge-like article with strong water absorption, wrapped in pure cotton cloth, and absorbed urine for external use. The pads should be replaced in time to avoid dermatitis or other infectious diseases caused by urine irritation to the skin.
If the patient's upper limbs can move, and he is conscious and can cooperate with nursing, positive language guidance can be applied in psychological nursing to encourage patients to take care of themselves and reduce the care of family members or others. Specific methods: A special toilet (small and convenient) that can be reached by patients can be placed beside the bed. Completing self-care will make patients feel confident and improve their quality of life and psychological state. Second, other issues can refer to home care and intestinal care.