The disability rate and recurrence rate of cerebral infarction are high, reaching 20-40%. In order to reduce the disability rate and recurrence rate, it is very important to guide the family members to do well the rehabilitation nursing after discharge, mainly through the nurses before discharge to assist the family members to draw up the family nursing plan.
Family nursing guidance
1 dietary guidance
2. 1. 1 Based on the principle of low fat, low cholesterol, low salt (hypercholesterolemia), moderate carbohydrate and rich vitamins, eat less fat, lard, cream, egg yolk, hairtail, animal offal, candy and sweets, and eat more lean meat, fish and shrimp, bean products, fresh fruits and vegetables and iodine-containing foods, and advocate the consumption of vegetable oil.
2. 1.2 control total calories, prevent overeating, eat regularly, and avoid overeating or excessive hunger.
2. 1.3 Drink tea properly, because tea contains catecholamine, theophylline and vitamins, which can increase vascular toughness and improve blood circulation.
2.2 Safety Guide
2.2. 1 Establish a comfortable and safe environment, pay attention to the safety of patients, and have soft indoor lighting and no dangerous goods. It is advisable to place items for the convenience of patients.
2.2.2 During walking training, attention should be paid to prevent fractures caused by falls and keep the ground flat and dry. Bathrooms and toilets should be equipped with handrails, and patients should wear soft-soled shoes that are light, non-slip and suitable for feet. Patients should be given enough time when cooking in their daily lives, and should not be urged to leave the safe environment without authorization to prevent accidents.
2.3 life care guidance
2.3. 1 Family members should be patient when taking care of patients, and make daily life schedules according to patients' living habits to encourage patients to take care of themselves.
2.3.2 For patients who stay in bed for a long time, they should turn over regularly, massage, carry out limb function activities, keep the mattress flat and dry, and prevent bedsores and complications. When bedridden, add a bed rail to prevent the bed from falling off.
2.3.3 Family members can provide care, supervision and help in daily life and personal hygiene according to the patient's self-care ability, such as washing face, brushing teeth, changing clothes, taking a bath and eating, having a haircut, shaving and manicure.
2.3.4 Family members should try their best to meet patients' hobbies and reasonable requirements, arrange activities appropriately, encourage patients to participate in group activities, and let patients go out appropriately, but they must be accompanied by someone, pay attention to safety and prevent accidents, and wear identification cards (name, address, contact person, telephone number, etc.). ) give it to patients so that they can easily find it once they lose it.
2.3.5 Functional exercise is moderate. Patients should pay attention to the symptoms of hyperactivity when they are active. If there are signs of hypoxia such as general weakness, pale face or uncoordinated exercise, rapid heartbeat and breathing, or even difficulty breathing, you should immediately stop your activities and seek medical attention if necessary.
2.3.6 Develop good living habits, such as good sleeping habits, try not to stay in bed except for taking a nap during the day, and the nap time should not be too long. Eat moderately. Dinner should not be too full. It is not advisable to drink more tea or stimulating drinks after meals. Soaking your feet with warm water helps you fall asleep.
2.4 Rehabilitation Training Guidance
2.4. 1 Walking training instruction: the stride is even, the frequency is moderate, the hips and knees are extended, the heel part is lifted first, and the center of gravity is shifted smoothly. Don't rush it. One heel also lands first, and then the center of gravity shifts to the heel to start the next gait cycle.
2.4.2 Action training in daily life: (1) hitting the ball can teach patients to clap the ball or hit the balloon alternately with both hands, so as to train patients' coordinated actions and promote patients' unconscious self-activity. (2) Knitting a sweater belongs to fine motor training, which is not only conducive to training patients' eye-hand coordination ability, but also conducive to the cultivation of senses such as feelings and senses, and is conducive to the functional recovery of the brain and nerves.
2.5 Language Training Guidance
Oral practice: teach patients to do 5- 10 times/unit, such as pouting, bulging cheeks, knocking teeth, etc. And teach patients to learn pronunciation. Send a single tone first, and then the difficulty can gradually deepen. You can use pictures, word cards, objects, etc. Strengthen patients' memory and ask patients to read aloud to stimulate their memory.
2.6 Psychological nursing guidance
2.6. 1 respect patients, listen to patients patiently, speak loudly and slowly when talking with patients, use short and clear words, repeat key points, and use auxiliary equipment, such as hearing AIDS and literacy cards, if necessary, in order to communicate better.
2.6.2 Patients may feel inferior and negative because of hemiplegia or aphasia, or they may be impatient because they can't take care of themselves. Family members should pay attention to patients, communicate with patients more, give spiritual and material support, relieve their worries and stabilize their emotions, which is conducive to their recovery.
Family nursing guidance has become an indispensable part of health education. Before leaving the hospital, the nurse assisted the family to make a home care plan. Regular telephone follow-up after discharge, giving guidance when necessary, inviting follow-up time, etc. According to the situation, the scheme was adjusted in time, and countermeasures were taken to solve the existing problems, which achieved good results in helping patients recover as soon as possible, and the self-care rate reached 73.2%.
Experience in differentiation and treatment of cerebral infarction in convalescence
Ge July 24, 2004 17: 12: 00 China Journal of Modern Clinical Medicine Volume 2 1
Document ID B, ItemNo.1726-7587 (2003) 04-0343-02
Cerebral infarction is the name of modern medicine, which belongs to the category of "stroke" and is a common and frequently-occurring disease in middle-aged and elderly people. The acute stage of this disease is mostly treated in general hospitals, but the recovery in the later stage often depends on Chinese medicine, acupuncture, massage and other treatments. If patients with cerebral infarction can seek medical treatment in time and be treated properly, it can promote rehabilitation and greatly reduce or alleviate sequelae. In many years of convalescence, the author has treated many such diseases with traditional Chinese medicine, and now his experience is introduced as follows.
1 etiology and pathogenesis
Most patients with cerebral infarction are middle-aged and elderly people. The clinical manifestations of cerebral infarction in convalescence are different. Those with mild illness are generally conscious, while those with serious illness are indifferent and slow-witted, but most of them are accompanied by dizziness, mouth and eyes to varying degrees. Strabismus, aphasia, or clumsy speech, or choking when drinking or eating, or showing hemiplegia, and so on. This is all due to old age, weak kidney-qi, deficiency of qi and blood, wind deficiency moving internally, phlegm and blood stasis blocking the machine, forming the syndrome of deficiency in the essence and excess in the exterior, deficiency in the upper solid and deficiency in the lower.
2 principles of treatment
The pathogenesis of this disease is deficiency of qi and blood, imbalance of yin and yang, endogenous wind deficiency, phlegm and blood stasis, obstruction of collaterals and ignorance of machine. Treatment should be based on invigorating qi and nourishing blood, promoting blood circulation and removing blood stasis, balancing yin and yang, resolving phlegm and inducing resuscitation.
2. 1 Buyanghuanwu decoction plus Zheng Qian powder as the basic prescription. Medicine: Angelica sinensis, Ligusticum Chuanxiong, Astragalus membranaceus, Peach kernel, Carthamus tinctorius, Bombyx Batryticatus, Rhizoma Typhonii and Acorus gramineus.
2.2 The syndrome differentiation and treatment of vertigo belongs to hyperactivity of liver yang, so it is advisable to calm the liver and suppress yang, and gastrodia elata, Uncaria, Prunella vulgaris and Concha Haliotidis are added to the basic prescription; For those with excessive phlegm and dampness, phlegm and dampness should be eliminated, and Poria, Jiang Banxia, Pericarpium Citri Tangerinae and Radix Puerariae should be added to the basic prescription; Mouth and eyes? Oblique, due to wind deficiency and phlegm blocking collaterals, it is appropriate to eliminate phlegm and dredge collaterals, and Pinellia ternata, Scorpio and Rhizoma Arisaematis Preparata are added to the basic prescription; Aphasia or speech disorder can be divided into two types: deficiency and excess. The empirical results show that wind and phlegm hinder the connection of springs, and it is appropriate to dispel wind and phlegm and dredge collaterals, and add Saposhnikovia divaricata, Polygalae, Tianzhu Huang and Scorpio to the basic prescription. Deficiency syndrome belongs to kidney deficiency and essence cannot be inherited, so it should nourish kidney and yin. Radix Rehmanniae Preparata, Fructus Corni, Herba Dendrobii, Radix Ophiopogonis and Fructus Schisandrae Chinensis should be added to the basic prescription. Cough when drinking or eating is due to the obstruction of collaterals, so it is advisable to promote blood circulation and resolve phlegm. Radix Paeoniae Rubra, Scorpio, Rhizoma Pinelliae and Pericarpium Citri Reticulatae should be added to the basic prescription; Numbness or swelling of limbs is phlegm-dampness blocking collaterals, so it is advisable to remove dampness and unblock collaterals. Ramulus Mori, Radix Angelicae Pubescentis, Ramulus Cinnamomi and Ramulus Cinnamomi should be added as the basic prescription. Weeds and papaya; Hemiplegia is caused by deficiency of qi and blood and blood stasis, so it is advisable to replenish qi and nourish blood, remove blood stasis and dredge collaterals. The dosage of Radix Astragali was increased in the basic prescription, and Radix Angelicae Pubescentis, dried earthworm, Radix Cyathulae, Hirudo and Caulis Spatholobi were added.
Three typical cases
Patient, female, 67 years old, cadre. 1997165438+10 month 18 was admitted to hospital, suffering from high blood pressure for 40 years, with the highest of 240/ 120mmHg. After taking antihypertensive drugs for many years, the blood pressure was usually 150/90mmHg. 1976 was diagnosed as "coronary heart disease" due to chest tightness, precordial discomfort, high blood lipid and low ST-T of electrocardiogram. 1996 ECG showed "old anterior septal myocardial infarction", and he denied having a history of acute attack. 1992 The elevated blood sugar during physical examination was diagnosed as diabetes (type 2). All the above syndromes were treated with drugs. 1995 65438+2 months, due to dizziness and weakness of the left limb, the brain CT showed "right cerebral infarction", and the limb function recovered quickly after treatment. 65438+1June 2, 19971day, the patient developed weakness of the right limb, accompanied by hoarseness, which gradually became aphonia, dysphagia, choking cough and oral salivation. Then brain CT showed "low density lacuna of anterior branch of left internal capsule". After hospitalization, he was treated with western medicine such as anticoagulation and vasodilation for 5 months. After his symptoms stabilized, he gradually recovered.
When admitted to the hospital, the patient was conscious, but his expression was indifferent. His blood pressure was185/110mmhg. He speaks clumsily, his voice is hoarse and low, and he complains of dizziness, poor sleep, occasional coughing, salivation, chest tightness, numbness in his left middle finger and slight weakness in his right limb, but he walks freely. The pulse is subtle and the tongue coating is thin and greasy. Physical examination showed that the nasolabial groove was symmetrical, the tongue extended to the middle, the muscle strength of the right upper and lower limbs was V, the muscle strength of the left upper and lower limbs was IV, the lower limbs were depressed and swollen, and there were no positive signs in the nervous system. After admission, total cholesterol and triglyceride were normal, and fasting blood glucose was normal. The blood glucose was 10.4mmol/L 2 hours after meal. Doppler ultrasound examination of the head showed: (1) cerebral arteriosclerosis; (2) The blood supply of the left internal carotid artery is insufficient; (3) Right posterior inferior cerebellar artery stenosis? Syndrome differentiation of traditional Chinese medicine belongs to hyperactivity of liver yang, obstruction of collaterals by phlegm and blood stasis, and obstruction of fu-organs and qi.
Treatment includes calming the liver and resolving phlegm, inducing resuscitation and dredging collaterals, dredging fu organs and regulating qi. Medicinal purposes: Gastrodia elata 10g, Uncaria rhynchophylla 12g (lower back), Acorus gramineus 10g, Bombyx batryticatus 10g, Rhizoma Typhonii 10g, Radix Angelicae Sinensis 10g, and Rhizoma Chuanxiong/kloc-. Weeds 15g. After taking more than 20 doses, the patient's blood pressure dropped to about 150/90mmHg, dizziness improved, and viscera were ventilated. Remove gastrodia elata, Uncaria rhynchophylla, Trichosanthes kirilowii and Trichosanthes kirilowii from the top. Weeds are removed, and 6g of Scorpio, 0/0g of polygala tenuifolia, 0/0g of Jiang Banxia, 0/0g of Rhizoma arisaematis preparata and 0/0g of kloc are added. After more than 30 doses, the patient's dizziness and salivation basically disappeared, his facial expression was rich, his reaction was sensitive, his language was basically clear, his fur was greasy, but his voice was still hoarse. Then the basic prescription was changed to Astragalus 30g, Ramulus Mori 10g, Ramulus Cinnamomi 10g, Radix Paeoniae Rubra 10g, and Lumbricus 65438. The patient came to the hospital for recuperation in1March 1999 and1February 1999, respectively. During the period, his condition was stable and his limb function returned to normal, leaving only hoarseness.
4 discussion
The syndrome differentiation and treatment of cerebral infarction need to pay close attention to all stages of disease development and clinical syndromes. Acute cerebral infarction belongs to deficiency in substance and excess in substance, which is prominent and urgent. If it is urgent, it will treat the symptoms and should be treated according to the syndrome. In the recovery period of cerebral infarction, kidney deficiency and essence deficiency, brain dystrophy or deficiency of qi and blood, deficiency of collaterals, deficiency of wind, phlegm and blood stasis, obstruction of collaterals and ignorance of machine are more common. Treatment should address both the symptoms and root causes, or focus on nourishing liver and kidney, benefiting qi and nourishing blood, promoting blood circulation and dredging collaterals, resolving phlegm and inducing resuscitation; Or resolving phlegm and promoting blood circulation, calming the liver and suppressing yang, tonifying deficiency and strengthening the body resistance. In a word, patients with cerebral infarction in convalescence are complicated and stubborn, so they need careful clinical identification and patient treatment to achieve ideal results.