Hello! Nursing care of patients with cerebral infarction at different stages
The nursing and treatment measures for patients with cerebral infarction can be divided into three stages: the first is the acute attack stage, the second is the hospitalization first aid stage, and the third is the recovery and prevention stage after discharge. The focus of each stage of cerebral infarction care is different. The nursing staff masters the scientific nursing methods at different stages of cerebral infarction, which will play a multiplier role in the rehabilitation of cerebral infarction patients.
1. Nursing care during acute attack
1. Keep calm: For mild patients, they can be allowed to lie down with their head at about 30 degrees. No matter what kind of transportation method is used, they should be kept calm. Send the patient to a nearby municipal hospital within 1 to 2 hours as much as possible to avoid time delays caused by transfer to a small hospital without corresponding examination equipment. It is best for critically ill patients to call 120 for an emergency ambulance. If the patient has symptoms such as disturbance of consciousness and vomiting while waiting for the ambulance, he or she can turn his or her head to one side to prevent vomitus from being accidentally inhaled into the lungs.
2. Try to prepare enough cash or checks to avoid delays in treatment due to insufficient funds after arriving at the hospital.
2. Cooperative nursing and treatment with doctors in the hospital
1. Assisted nursing: Most patients with cerebral infarction are obese, and some also have diabetes. Now they have hemiplegia and local neurotrophic disorders. , pressing for too long can cause skin ulcers and form "bedsores." Once it occurs, cerebrovascular disease may be aggravated by infection and fever, and in severe cases, it may cause sepsis and cause death of the patient. Therefore, when accompanying the patient, family members should pay attention to turning him over regularly, patting the back, scrubbing the skin with warm water, and gently massaging the pressed parts, especially the parts with prominent bones, such as the spine, sacrococcyx, etc. The frequency of turning over is generally about 2 hours. If skin ulcers are found, report them to medical staff for early treatment. Patients with incontinence should change their diapers frequently, wash them with warm water, dry them and apply talcum powder after each defecation.
2. Dietary problems: Some patients have difficulty swallowing after illness, which is caused by paralysis of the muscles responsible for swallowing. The patient chokes and coughs when eating, especially when drinking water, and even food squirts out of the mouth and nose. At this time, care should be taken not to force the patient to drink water or medicine. For mild patients, they can be allowed to eat sticky foods, such as thick porridge, soft rice, etc. Chop vegetables, minced meat and other non-staple foods and mix them with rice. Avoid foods that are too thin or dry, which can be easily swallowed. If there are no contraindications for oral medications, they can be crushed and mixed with food. Severely ill patients need nasogastric feeding, that is, a rubber tube is inserted into the stomach through the nostrils, and food such as rice soup, milk, vegetable juice, etc. are injected into the stomach with a syringe to ensure adequate nutrition. Oral medications can also be injected through a stomach tube. Note that the food and medicine injected must not have large particles to avoid blocking the gastric tube. Nasogastric feeding is a necessary means to ensure treatment at a certain stage, and is directly related to the success or failure of patient rescue. Some patients and their families are unwilling to accept gastric tubes and force the patients to swallow. This is very dangerous. If food is accidentally inhaled into the respiratory tract, it can cause lung infection and aspiration pneumonia in mild cases; in severe cases, death may occur due to suffocation. ?
3. Pay attention to the changes in the condition, and report any abnormalities to medical staff in a timely manner: patients with cerebral infarction have a relatively slow onset, mild symptoms at the onset, and most will not have any disturbance of consciousness. But the condition may worsen over hours or days. Although medical staff take aggressive treatment measures, sometimes the progression of the disease cannot be stopped. If the blocked blood vessels are large, the area of ??brain tissue necrosis is large, and cerebral edema is obvious, the patient may gradually become drowsy, even if he wakes up, he will fall asleep immediately. Severe cases may enter coma. Family members should pay attention to observe whether the patient's paralyzed limbs gradually become less powerful or even completely unable to move, as well as their mental state. If the patient is found to be drowsy or listless, they should notify medical staff immediately. At the same time, critically ill patients should record their daily food intake, urine output, etc. for doctors’ reference.
4. Help the patient move the paralyzed limbs early and promote recovery: If the condition is stable on the second day of the onset, you can start passive movement of the limbs, that is, help the patient with the paralyzed limbs to stretch and bend. This will help promote blood circulation in paralyzed limbs, prevent the formation of deep vein thrombosis, promote muscle strength and joint mobility, and prevent limb contracture and deformation. When inactive, the patient's paralyzed limb should be in an anti-spasmodic position, that is, when lying on his back, place the affected upper limb on a pillow so that it is slightly abducted and externally rotated, the elbow joint is slightly flexed, the wrist joint is slightly dorsiflexed, and the hand is held in an appropriate position. sized cylindrical objects, such as toilet paper rolls.
Pad the back so that it moves forward and upward; pad the outer buttocks of the lower limbs to make the hip joints adduct and push the pelvis forward. Place a soft pillow under the knee joints to flex the knee joints. The ankle joints should be kept at 90° to prevent foot drop. The patient's feet can be placed on the bed or wall or a homemade splint can be used. When lying on your back, the head height is 30°, but not too high. When in the lateral position, the paralyzed limb should be placed on top as much as possible. A pillow should be placed in front of the chest and in front of the lower limb. The upper limb should be extended and the lower limb should be flexed and placed on the pillow.
5. Pay attention to the patient's emotional changes: The patient suddenly loses mobility and language skills from a normal person, to losing the ability to take care of himself and work. It is emotionally unbearable, so depression, anxiety and other emotional changes often occur. Moodiness and even personality changes. Family members should actively cooperate with medical staff, comfort and encourage patients to cooperate with treatment and rehabilitation exercises. Try to avoid making the patient emotional.
3. Home nursing treatment during the recovery period after discharge from hospital
Brain cells die due to ischemia and hypoxia when blood vessels are occluded. The later treatment is started, the larger the blocked blood vessels will be. The more brain cells die, and brain cells cannot regenerate after death. Therefore, despite many proactive measures taken by doctors, patients will inevitably be left with varying degrees of disability, also known as "sequelae". These sequelae cannot be solved in hospitals, especially general hospitals whose main purpose is to save lives. They need to be treated in rehabilitation hospitals. In our country, they are still mainly sent home for further care and treatment. ?
1. Use medication scientifically and accurately to prevent recurrence of cerebral infarction
Cerebral infarction is a chronic cerebrovascular accident with high recurrence and irreversibility. After discharge, patients still need to take medication regularly according to the doctor’s instructions to control it. Treat basic diseases of arteriosclerosis such as high blood pressure, hyperlipidemia, and diabetes, and go to the hospital for regular check-ups. Commonly used effective drugs for the treatment of cerebral infarction include anti-platelet aggregation drugs, such as aspirin; brain-protecting nutritional drugs, such as cerebrolysin tablets; modern traditional Chinese medicine that promotes blood circulation and removes blood stasis, aromatic resuscitation, lipid-lowering and anticoagulant dual-effect drugs, such as Xueshuan Xinmaining piece. The rational combination of Western medicine's advantages of strong targeting and rapid onset of action and the advantages of modern Chinese medicine's long-lasting effect, safety, reliability, and lack of drug tolerance can achieve therapeutic effects of enhanced efficacy and reduced toxicity. It is the main clinical drug and also Secondary prevention for patients with cerebral infarction during the recovery period - an ideal combination of drugs that can effectively improve symptoms while preventing recurrence.
If the patient has the conditions, it is possible to take some health products to increase the body's resistance and help improve it, but it is not necessary. Health supplements have no therapeutic effect and should never be used as a substitute for regular drug treatment. There are also patients who need regular infusion to prevent and treat cerebral infarction, especially in northern patients. Infusion is only suitable for acute treatment. Some patients are superstitious about advertised drugs, but the promises in the advertisements are often far less effective than their efficacy. It is not uncommon for people to be exposed for false advertising. If you choose the wrong drug, you will lose not only money, but also the best chance of recovery. Therefore, if we want to truly effectively treat the disease and reduce the high recurrence rate of cerebral infarction, we should make scientific selection of drugs through multi-faceted comparisons and select first-line drugs that are clinically effective.
2. Start rehabilitation treatment as early as possible and actively? Cerebral infarction will leave many sequelae, such as monoplegia, hemiplegia, aphasia, etc. The effect of drugs on these sequelae is very limited, and through active rehabilitation , with formal rehabilitation treatment, most patients can take care of themselves, and some can return to work. Those who have the conditions are best to go to a regular rehabilitation hospital for systematic rehabilitation. If you are unable to go to a rehabilitation hospital for treatment due to various reasons, you can purchase some relevant books and videos and perform the treatment at home. Rehabilitation should begin as early as possible. 3 to 6 months after the illness is the best time for recovery. After half a year, due to muscle atrophy and joint contracture, recovery will be more difficult, but it will also be helpful?
3. Daily life training? After illness, many previous living habits are broken. In addition to training the affected limb as early as possible and formally, attention should also be paid to developing the potential of the healthy limb. Patients with right-sided hemiplegia who are usually right-handed (right-handed) need to train their left hand to do things. The clothes should be loose and soft, and can be sewn into special styles according to special needs. For example, zippers can be installed on the sleeves of the affected limb to measure blood pressure when going to the doctor. When dressing, put on the paralyzed side first, then the healthy side; when taking off clothes, take off the healthy side first, then the affected side. ?
4. Face reality and adjust your emotions. As the saying goes: "Sickness comes like a mountain falling, and sickness goes like a thread." This statement is more appropriate for cerebrovascular patients. Facing the fait accompli, we should adjust our emotions and actively carry out rehabilitation in order to return to society as soon as possible.
Patients with severe mood disorders can seek help from a doctor and use antidepressants, such as Prozac, which have a good effect on depression and anxiety after cerebrovascular disease.
5. Functional recovery care for sequelae
(1) Language impairment Patients with language impairment are often anxious and painful. Medical staff should have more contact with patients, understand their pain, keep patients comfortable and eliminate tension. The patient must be induced and encouraged to speak as early as possible, and the pronunciation must be corrected patiently, from simple to complex, such as "e", "ah", "ge", etc., and practice repeatedly and persistently. In conjunction with acupuncture at Yamen, Tongli, Lianquan and other points, this will help improve and restore language function.
(2) Limb dysfunction In acute care, attention should be paid to placing paralyzed limbs in functional positions to prevent contracture deformity of the limbs. Supine and lateral decubitus positions are often used. When the patient's condition is stable, guide and assist him in functional exercises, starting with simple flexion and extension, requiring adequate and reasonable activities to avoid damaging muscles and joints, 2 to 4 times a day, 5 to 30 minutes each time. In conjunction with drug treatment, massage of the affected limbs, and acupuncture at Quchi, Hegu, Zusanli, etc. Instruct the patient to soak the affected limb in hot water frequently to promote blood circulation.
(3) Deviation of the corners of the mouth. Clinically, common symptoms include incomplete eyelid closure on the affected side, drooping of the corners of the mouth, inability to wrinkle the forehead, closing eyes, bulging cheeks, and whistling. Patients often develop negative emotions and lose confidence in treatment. Nurses should sympathize with and care for patients and provide spiritual encouragement in order to gain trust and soothe their emotions. It is advisable to provide a liquid or semi-liquid diet that is easy to digest and rich in nutrients. Combined with acupuncture cheek car, Dicang, Yingxiang, Sibai. Encourage patients to do more eye, mouth, and facial exercises, and massage the area frequently.
Cerebral infarction is a chronic disease caused by multiple causes. In addition to diet, exercise and scientific care, only by adhering to reliable medication can we truly start from the cause, prevent and treat thrombosis and arteriosclerosis, and improve symptoms. At the same time, it is possible to effectively prevent recurrence. Precautions for patients with cerebral infarction
(1) Dietary care. Patients should be given high-calorie, digestible liquid food; those who cannot swallow should be given nasogastric feeding. Nasal feeding food can be milk, rice soup, vegetable soup, broth, juice, etc. In addition, milk, eggs, starch, vegetable juice, etc. can also be mixed together to make a gruel-like mixed milk, which can be fed to the patient through the nose. The amount of nasogastric feeding is 200 to 350 ml each time, 4 to 5 times a day. During nasogastric feeding, cleaning and disinfection of the patient's meals should be strengthened.
(2) Keep the respiratory tract open and prevent colds. Patients who have been comatose for a long time have low body resistance. Care should be taken to keep the patient warm and prevent colds and colds. No matter what lying position the patient takes, the face should be turned to one side to facilitate the drainage of respiratory secretions; when the patient has phlegm or secretions and vomitus in the mouth, they should be sucked out or dug out in time; the patient should be changed every time he turns over. When positioning, gently buckle the patient's back to prevent the occurrence of aspiration or accumulation pneumonia.
(3) Prevent bedsores. The most fundamental way to prevent bedsores in comatose patients is to turn over regularly, usually every 2 to 3 hours. In addition, wet sheets, bedding and clothes should be replaced in time. Here is the introduction: The method of turning the patient over (taking the patient in the left lateral decubitus position as an example): In the first step, the family member stands on the right side of the patient, first makes the patient lie down, and then bends the patient's lower limbs; in the second step, the family member puts the left arm Place it under the patient's waist, place your right arm under the patient's thigh, then lift the patient and move it to the right side (family side), then place your left hand under the patient's shoulder, your right hand under the waist, lift and move to The third step is to turn the patient's head, neck, and trunk to the left side at the same time, that is, to the left side. Finally, place a pillow on the patient's back and head to support his turning position and make the patient comfortable.
(4) Prevent burns. Patients in long-term coma have poor peripheral circulation, and their hands and feet become colder in winter. When family members use hot water hoses to warm patients, they must pay attention to the temperature not being too high, generally below 50 degrees Celsius, to avoid burns.
(5) Prevent constipation. Patients who are bedridden for a long time are prone to constipation. In order to prevent constipation, the patient can eat some bananas, honey and foods rich in fiber every day, and massage the patient's abdomen every morning and evening. Those who have not had a bowel movement for 3 days should take laxatives such as Maren Runchang Pills or Rhubarb Soda Tablets. If necessary, Kaiselu can be used to help defecate.
(6) Prevent urinary tract infections. If the patient is able to urinate on his own, he must change wet clothes, sheets, and bedding in a timely manner. If the patient needs a urinary catheter to help urinate, pay attention to aseptic operation every time you clean the patient's urine bag, and the urinary catheter should be replaced regularly.
When helping the patient to turn over, do not lift the urine bag higher than the patient's lying position to avoid urine reflux causing urinary tract infection.
(7) Prevent falling from the bed. Restless patients should install bed stops and use protective belts when necessary to prevent patients from falling from the bed or falling.
(8) Prevent conjunctiva and keratitis. For those whose eyes cannot be closed, antibiotic eye ointment can be applied to the patient and covered with wet gauze to prevent the occurrence of knots and keratitis.
(9) General care. The patient's mouth should be cleaned with salt water every morning and evening and after meals, bathed 1 to 2 times a week, the vulva should be cleaned once a day, and the feet should be washed every other day.
Patients with cerebral infarction should pay attention to the following in their daily diet: (1) Limit fat intake. The total amount of fat in the daily diet should be reduced, and animal fat should be reduced. When cooking, do not use animal oil, but use vegetable oil, such as soybean oil, peanut oil, corn oil, etc., and limit the cholesterol in the diet. It should be within 300 mg per day, which is equivalent to You can eat 3 egg yolks per week. (2) Control the total heat. If total fat intake is controlled in the diet, blood lipids will decrease. (3) Increase protein appropriately. As the amount of fat in the diet decreases, it is necessary to increase protein appropriately. It can be provided by lean meat and skinless poultry. You can eat more fish, especially sea fish. You should eat a certain amount of soy products every day, such as tofu and dried beans, which are beneficial to lowering blood cholesterol and blood viscosity. (4) Limit the intake of refined sugar and sugary sweets, including snacks, candies and drinks. (5) Patients with cerebral infarction should use less salt and adopt a low-salt diet, with 3 grams of salt per day. You can add salt and mix well after cooking. (6) Pay attention to the cooking ingredients. In order to increase appetite, you can add some vinegar, tomato sauce, and sesame sauce when cooking. In addition to being a seasoning, vinegar can also accelerate the dissolution of fat and promote digestion and absorption. Tahini has high calcium content. Regular consumption can supplement calcium and has certain benefits in preventing cerebral hemorrhage. (7) Patients with cerebral infarction should drink water frequently, especially in the early morning and evening. This can dilute the blood and prevent the formation of blood clots