Author: Adu
Stroke is a group of diseases characterized by cerebral ischemia and hemorrhagic injury, also known as stroke or cerebrovascular accident. Because of its sudden onset, fierce strength, rapid change of illness and windy nature, it was likened to "stroke" by ancient doctors. The mortality and disability rate of this disease is very high, which is life-threatening and often leaves sequelae. After surviving in hospital, patients often leave some obstacles such as movement, feeling and language, and the recovery period is long. Therefore, family rehabilitation after discharge is a necessary means to promote functional improvement.
Common sequelae and corresponding rehabilitation nursing;
1. Three deviations: Stroke often has functional disorders such as hemiplegia, hemiplegia (referring to pain, temperature and proprioception on one side of the patient) and hemianopia. Because stroke leads to the decline of limb function and some joint muscles are in a state of disuse, most patients are lazy to exercise. At this time, family members should urge and assist patients to carry out functional exercise to prevent limb contracture deformity, and often adopt supine position and lateral position, starting from simple flexion and extension. Exercise fully, reasonably and moderately to avoid injury to muscles and joints, and massage the affected limbs with drugs. Massage can regulate the excitement and inhibition of the central nervous system, promote local blood and lymphatic circulation, thus preventing or alleviating disuse atrophy of musculoskeletal, 2 ~ 4 times a day, 30 minutes each time. There are three commonly used massage methods: ① Moxibustion: gently stroking the affected part from the far end to the heart (that is, from the far end to the near end) with the palm or fingertips along the direction of lymphatic reflux, which can help venous and lymphatic reflux. ② Moxibustion method: Rub the palm, thenar, palm root or finger pulp on the skin, the direction is still, the force is large and even, and the action is coherent, which makes the local skin feel burning, so that the blood supply between the skin and subcutaneous tissue is rich and the nutrition is improved. (3) Kneading method: Make a relatively constant forced rotation with fingers or palms to improve the nutrition of muscle ligaments.
2. Language disadvantage: More than half of stroke patients are slow-thinking, have difficulty in association, have poor memory, can't speak or can't speak clearly, or although they can speak spontaneously, they answer irrelevant questions and can't understand what others are saying. These are the sequelae of stroke, and patients are more anxious and painful. Patients should be induced and encouraged to speak as soon as possible, and the earlier the rehabilitation treatment of language disorders, the better. Recover quickly within 3 months after illness, and it is difficult to recover after one year. Functional rehabilitation training includes pronunciation training, phrase training, conversation training, reading training, sentence retelling training, character recognition, pointing out the name of an article, executing commands, matching pictures with objects, etc. Rehabilitation training for patients with complete aphasia should start with learning pronunciation, just like teaching children to speak. Patiently correct pronunciation, from simple to complex, such as "e", "ah" and "song", and keep practicing. Encourage more in training, stimulate confidence, make patients feel comfortable and eliminate tension.
3. Oblique mouth and dysphagia: the affected side has incomplete eyelids, drooping mouth, drooling, unable to bulge cheeks, wrinkled forehead and closed eyes. Patients often have negative emotions and lose confidence. They should sympathize with and care for patients, give spiritual encouragement, relax their emotions, encourage them to do more eye, mouth and face exercises, and often massage the affected areas. Give a liquid or semi-liquid diet, which is easy to digest and nutritious.
4. Others: Patients who stay in bed for a long time are prone to bedsore, lung infection, urinary system infection and deep vein thrombosis. Nursing should pay attention to these aspects:
① Bedsore: It is tissue necrosis caused by long-term compression of local tissues, blood circulation disorder, persistent ischemia of local tissues and malnutrition. Serious consequences, focusing on prevention. First of all, the bed should be kept dry, flat and slag-free; Turn every 2 ~ 3h 1 time; Place a balloon, sponge pad or cotton pad on the bony process, so that the easily compressible part is suspended; Keep the skin dry and clean, scrub the pressed parts with clear water 2 ~ 3 times a day, and change clothes and bedding in time after they get wet; Keep buttocks and perineum clean and dry; Massage the compressed part regularly, 2 ~ 4 times a day, and massage the bone protuberance part for at least 3 ~ 5 minutes each time to promote blood circulation and dredge the meridians.
② Prevention of lung infection: You should turn over and pat your back to expectorate, keep indoor air circulation, pay attention to oral hygiene, and prevent food and water from being inhaled into trachea by mistake.
(3) Prevention of urinary tract infection: Pay attention to keeping the perineum of patients clean, so that patients can get enough water. The diet should be light, nutritious, digestible and less salt to reduce the burden on the kidneys.
(4) Regular physical massage to raise the affected limb and prevent deep vein thrombosis.
In addition, patients should eat light, low-fat, low-salt, low-cholesterol and multivitamin foods. Avoid overeating, alcohol and tobacco, especially dinner. Keep the stool unobstructed, keep warm, prevent colds, pay attention to regular supervision and help monitor blood pressure, and take antihypertensive drugs according to the doctor's advice.
Stroke patients can't take care of themselves in daily life because of hemiplegia or aphasia. Rehabilitation nursing of stroke sequelae is a long process, which easily makes patients and their families lose confidence. Most patients and their families are willing to receive medication and despise the concept of rehabilitation. Only reasonable functional exercise, successful psychological care and perfect diet care can make patients recover their limb functions to the maximum extent, reduce the disability rate and effectively shorten the rehabilitation period.
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Don't use folk remedies indiscriminately after stroke, pay attention to maintenance and prevention.
A few days ago, a reader wrote to ask if the prescription for stroke prescribed by her friend had scientific basis. This prescription is for bleeding the fingers of stroke patients. The reporter interviewed Wang Linpeng, director of acupuncture department of Beijing Hospital of Traditional Chinese Medicine. Director Wang said that for the treatment of stroke, time is very critical, so when patients show signs of stroke, they must contact the emergency center in time and ask professionals to send patients to the hospital for treatment, instead of superstitious remedies, otherwise it will not only delay treatment, but also aggravate the condition.
■ Drug abuse may aggravate the condition.
The remedies provided by readers say that after a stroke, the capillaries in the brain will slowly rupture. Don't panic in this case. No matter where the patient is (bathroom, bedroom or living room), don't move him. Because, if it moves, it will accelerate the rupture of microvessels. Therefore, the patient should be lifted up and sit firmly in the same place to prevent him from falling down again and then starting to bleed. If there is a needle specially used for injection at home, it is of course best. If there is no needle, take a copper needle or a needle for sewing clothes and disinfect it with fire. As long as it is stabbed at the top of the patient's ten fingers, it will bleed (in case the blood does not come out, it can be squeezed by hand). When all ten fingers bleed (one drop per finger), the patient will naturally wake up within a few minutes.
Director Wang said that everything in this prescription is very reasonable, especially saying not to touch stroke patients, otherwise it will accelerate the deterioration of the condition, which is very correct. Bloodletting with ten fingers mentioned later is also one of many ways for doctors to treat stroke, but it is not easy for family members without any medical care knowledge. Finally, it is impossible to say that the patient woke up soon after bloodletting. If the condition is serious, it is impossible to be fully awake just by bloodletting.
In addition, the folk prescription also said that if your mouth is crooked, you will pull your ears, pull your ears red, stab two needles in the earlobes of both ears, and still shed two drops of blood. After a few minutes, the mouth will return to its original state. When the patient returns to normal and feels normal, he will be sent to the hospital, which will definitely turn the corner.
Director Wang said that ear bleeding mentioned in this prescription is also a kind of treatment, but the ear should never be pulled out, because pulling out the ear will inevitably aggravate the patient's shaking head, which is likely to aggravate the condition and it is impossible to restore the oral cavity to normal. In addition, it is even more wrong to wait until the patient regains normal feeling, because it wastes valuable treatment time and is harmful to treatment and recovery.
■ The key to stroke treatment is to seize the time.
Stroke is the most common nervous system disease caused by various cerebrovascular diseases, which is characterized by acute onset and brain dysfunction. It is because the brain tissue is ischemic and hypoxic, and the root cause is brain vascular diseases, including embolism, thrombosis and insufficient blood supply. The incidence of stroke is high, the mortality rate is high and the disability rate is high. The main symptoms are hemiplegia, mild hemiplegia (numbness), language disorder and mental retardation, which all affect the quality of life of patients and their families.
An important reason why stroke is difficult to treat is that the treatment "time window" is very short, usually 3 to 6 hours, which is called as fast as the wind by Chinese medicine and western medicine. Most patients have passed the best treatment period when they are admitted to hospital, and the brain tissue has been damaged, so it is inevitable that there will be no sequelae. In addition, the mechanism of the occurrence and development of stroke is very complicated, involving many factors, and it is difficult to solve the problem with a single measure and drug. Timely and effective treatment and active prevention have become the key to prevent and treat stroke, which is called "time is the brain" internationally.
Therefore, when a stroke occurs, you should seek medical treatment in time, and go to a hospital with a certain scale or a professional neurology department. Timely and correct treatment is a necessary condition to save lives and reduce sequelae. Director Wang said that patients and their families often ask him if all kinds of remedies are really as effective as they say. He believes that it is not easy to trust doctors to treat stroke.
I believe that the folk prescription, even if it is reasonable, is likely to make mistakes in the operation, aggravating the illness and delaying the most precious treatment time.
■ Always be alert to signs of stroke.
Stroke patients usually have the following five symptoms. If people around you find it, you should contact the emergency personnel immediately. People around you should not turn the patient's head back and forth, loosen the patient's clothes and pants and let the patient lie flat on the pillow.
1. weakness, numbness or paralysis of one or both sides of the body, upper limbs, lower limbs or face.
2. One eye or both eyes suddenly blurred vision, or decreased vision, or diplopia.
3. Difficulties in verbal expression or understanding.
4. Dizziness, loss of balance, or no accidental fall, or unstable gait.
5. Headaches (usually severe and sudden) or unexpected changes in headache patterns. Director Wang stressed that it is more dangerous for someone to take blood pressure at home and find it higher than usual, and then take antihypertensive drugs on their own. Because in the event of a stroke, blood pressure will rise reflexively, which is normal protection and beneficial. Never lower your blood pressure at home.
■ Six measures to prevent stroke
1. Measure blood pressure at least once a year.
Smoking doubles the risk of stroke, so quit smoking as soon as possible.
3. Moderate drinking.
4. Hyperlipidemia will also increase the risk of stroke. Hyperlipidemia can be controlled by diet and exercise, and some people need medication.
5. Diabetic patients should control blood sugar and reduce the risk of stroke.
6. Walk briskly for at least 30 minutes every day, or do aerobic exercise, such as cycling, playing golf, swimming, dancing, playing table tennis, etc.