This friend, home-based care for the aged can include the following aspects:
1. Health evaluation of elderly nurses In the process of home care, the health status of the elderly should be comprehensively evaluated according to the patient's condition and needs. Observe the change of illness, measure and record vital signs as needed, and work out a feasible nursing plan that can ensure the health and safety of patients.
2. Nursing work in the treatment of senile diseases Nurses in home care should understand the condition of the elderly, be familiar with the treatment methods, and understand the uses, methods and precautions of therapeutic instruments and drugs. Proficient in all basic nursing operation techniques, cooperate and assist doctors to complete nursing work in the treatment of senile diseases.
3. Care for the daily life of the elderly should pay attention to: ① meet the needs of the daily life of the elderly; (2) prevent accidents; ③ Enhance the ability of self-protection; ④ Family basic nursing requires "six cleanness" (cleanness of mouth, face, hair, hands and feet, skin, perineum and bed sheets), "five prevention" (prevention of pressure sore, postural hypotension, urinary system infection, respiratory system infection and cross infection) and "three noes" (no feces, no falling bed and no burns).
4. Mental and psychological care for the elderly The elderly are generally stubborn, often pessimistic and afraid of loneliness. Nurses should be "smiling, thoughtful, considerate, easy-going and enthusiastic" when giving psychological care to elderly patients. Nurses should pay special attention to maintaining their self-esteem in family care, and at the same time, they should patiently give psychological care guidance to family caregivers and other family members, so that the elderly can feel the respect and concern of others everywhere and better cooperate with the treatment.
5. Rehabilitation nursing for the elderly According to the characteristics that elderly patients are ill and should not be overloaded, besides the treatment and nursing methods, exercise therapy and occupational therapy closely related to daily life activities are also adopted to encourage patients to do activities within their power, such as radio exercises, Tai Ji Chuan, qigong and walking. And pay attention to the combination of work and rest to keep the limbs in good functional condition. Through evaluation and adjustment, gradually restore and improve the ability of daily living.
6. Health education and guidance for the elderly. Family nursing faces all people in the family, including not only patients with various diseases, but also a large number of elderly people who are basically healthy or completely healthy. Therefore, nurses should not only complete the basic nursing work for patients, but also carry out targeted health education for the elderly. Guide the physical and intellectual activities of the elderly and delay the aging process. Such as prevention of essential hypertension, diabetes and cerebrovascular diseases, nutrition and health promotion, environment and health, exercise and the quality of life of the elderly. Cultivate the self-care consciousness of the elderly.
2. Nursing knowledge of the elderly
The health and longevity of the elderly have a great relationship with the quality of family basic care. It is not the primary disease that eventually leads to the death of some elderly people, but the complications caused by lack of nursing knowledge and improper nursing. It can be seen that basic nursing plays a very important role in the health of the elderly.
Rest environment for the elderly
The factors of family rest environment are:
Maintaining an appropriate indoor temperature not only makes the elderly feel comfortable and stable, but also helps the body to carry out metabolism and prevent diseases. The indoor temperature should be 18 ~ 20℃, and it can be relatively high (22 ~ 24℃) in summer to reduce the indoor and outdoor temperature difference. If the room temperature is too low, the elderly are prone to catch a cold; If the room temperature is too high, it is easy to make people tired and depressed. It should be pointed out that for the elderly with chronic respiratory diseases, too high room temperature is likely to make the elderly feel stuffy, have poor breathing and aggravate dyspnea. Cool room temperature and circulating air will make it easy for the elderly to exchange gases, increase blood oxygen concentration and improve breathing.
Humidity generally refers to the content of water in the air. The air humidity is high, and the evaporation of human body is weak, which inhibits sweating and makes people feel humid and sultry, and the elderly with cardiac insufficiency will feel suffocated. Because the evaporation of skin and breathing water decreases, the amount of urination increases, which increases the burden on the kidneys. When the air is too dry, the human body will evaporate a lot of water, causing discomfort such as dry skin, dry mouth and sore throat. In the elderly with respiratory diseases, dry air makes respiratory mucosa dry, and sputum is not easy to cough up, which increases the chance of lung infection and aggravates the condition. The optimum indoor humidity should be 50%~60%. Proper humidity will make people feel refreshed and relaxed. In recent years, it is a good way for air humidifiers to enter the home. It is also effective to increase humidity by soil methods, such as sprinkling water on the ground, putting a sink on the heater, or putting wet towels. I suggest you buy a thermometer, master the temperature and humidity scientifically, and let it serve your health.
Ventilation Patients with pulmonary heart disease and respiratory failure must put their beds in the center of a ventilated room to feel that breathing is labor-saving. Similarly, fresh air is particularly important for elderly patients. Opening the window in the morning for ventilation can discharge indoor exhaust gas and make fresh air supplement. Generally, it takes 20~3 0 minutes to open the window to update the indoor air. For the frail old people, when they are ventilated, they can temporarily go to other rooms to avoid cold air. This can keep the indoor air fresh and not catch a cold.
Noise research shows that when the noise is 50~60 decibels, the average person will feel noisy. Most of the noise at home is caused by loud noise and excessive volume. Generally, old people like to be quiet. For the elderly with heart disease, quietness is a kind of treatment, and creating a quiet and elegant environment in the family is conducive to the elderly to recuperate.
Daylighting is the best room for the elderly, and indoor sunshine is particularly important for the elderly. When the sun shines, infrared rays are absorbed by the skin, which warms the deep tissues, dilates blood vessels, accelerates blood flow, improves the nutritional status of skin tissues and makes people feel comfortable. If you open the glass window and let the sun shine directly into the room, the ultraviolet rays in the sun also have disinfection and sterilization effects.
Old people should choose a hard bed, and it is best to sleep on a bed without a mattress. The height of the bed should be below the knee and the length of the calf. Too high or too low will bring inconvenience to the elderly and increase the chance of falling.
Family morning and evening care
Morning and evening care can make the elderly feel comfortable, happy and relaxed, which is conducive to the rehabilitation of diseases.
Exercise in bed: wake up in the morning, don't get up in a hurry, lie still in bed for more than ten minutes, and do necessary exercise in bed; Stretch one's limbs; Rub each other with your hands and move your knuckles; Then do "dry face washing" 20~30 times. These actions can make the elderly adapt to the physiological changes from sleep to awakening, so that the body has a relatively transitional stage, so that it will not fall down because of sudden dizziness, and it can also gradually change the frequency of breathing and heartbeat to avoid the recurrence of heart disease.
Toilet exercise: brushing teeth, gargling, washing face and combing hair are also very beneficial exercises for the elderly. When brushing your teeth, your upper limbs are active, so you should do it carefully. Cough exercise should be carried out after gargling to cough up phlegm in the respiratory tract. Cough without phlegm itself (even a few dry coughs) is beneficial to the expansion of alveoli and reduces the chance of lung infection. When washing your face, you can smooth your face and increase blood circulation. On the one hand, combing hair can increase the blood circulation of scalp, improve scalp nutrition and prevent hair loss; On the other hand, combing the hair also exercises the lifting action of the upper limbs. Comb your hair with a blunt wooden comb 100 times every morning and evening, and alternate your hands, which is very beneficial to the health of the elderly.
Outdoor sports: Appropriate outdoor sports, such as walking, jogging, doing exercises and practicing all kinds of boxing are the means for the elderly to enhance their own quality and improve their resistance. Morning exercise also laid the foundation for a day's life and work.
Bath at night: Besides repeating a set of activities in the bathroom in the morning, conditional elderly people can also take a bath before going to bed, which can dilate blood vessels in the whole body, relax muscles, reduce blood supply to the head and help them fall asleep. For most elderly people who are physically inconvenient or have no bathing conditions, soaking their feet with warm water is also very beneficial to promoting health and sleep. Old people's families should prepare a plastic bucket, fill it with warm water to their knees, and soak it for 15~20 minutes before going to bed. People who can move should rub their lower limbs with their hands, so that the blood vessels in the lower limbs will expand, the muscles will relax, and the blood circulation in the whole body will be accelerated, which can relieve fatigue. That warm and relaxed feeling can promote rest and sleep.
3. Daily nursing knowledge of the elderly
(a) How to clean and disinfect the air?
1. Always open the window for ventilation, let the air circulate, and let germs out of the room. Ventilation should not be less than 30 minutes at a time.
2. Fumigation method: use 5 5- 10/0ml vinegar per square meter indoors, add 1-2 times of water, or add 60ml formalin to 40ml, and heat and evaporate until the doors and windows are closed.
(2) How to clean and disinfect articles
1. Brush with soap and washing powder and rinse with clean water.
2. Sunlight method: Sunlight contains ultraviolet rays, which can be disinfected after 3 to 6 hours of irradiation.
3. Boiling method: Boiling can rapidly coagulate and denature the protein of bacteria. 15 to 20 minutes later, it can kill common bacteria. Disinfection time should be calculated after the water is boiled, and all items should be soaked in water. If possible, it can be disinfected with a domestic pressure cooker. Disinfection for 20 minutes can kill all pathogenic microorganisms from the time the control valve starts to steam, which is suitable for articles that are not afraid of damp heat and high temperature.
4. Soaking method: Soak the articles in 2% Lysol, 70% alcohol or]% bromogeramine solution for 30 minutes.
5. The vomit and excrement of the elderly can be sprinkled with twice as much lime and stirred, and poured into the toilet after 2 hours; The sputum of the elderly with pulmonary tuberculosis can be vomited in a paper box or wrapped in paper for burning.
6. Wipe method: wipe with 1%-3% bleaching powder supernatant (that is, clear water precipitated on bleaching powder) to inactivate the enzymes in bacteria and die.
In addition, wash your hands with soap after contact with the elderly, before and after meals; Old people's bowls, chopsticks, cups and utensils should be dedicated, washed, disinfected and placed separately.
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4. How to carry out home care for the elderly who have been bedridden for a long time?
2。
Help the old man turn over to the opposite side, loosen the bed sheets, and sweep the debris on the bed sheets from the head of the bed to the end of the bed with a bed brush. Pay attention to thoroughly sweep all the layers under the pillow and the old man's body, then flatten the sheets to help the old man turn over and lie on the swept side. Turn to the reverse side and clean it layer by layer according to the above method, and press the sheets flat.
3。 Tidy up the quilt, flatten it and cover it for the old man.
4。 Take the pillow down, rub it loosely and put it under the old man's head.
3。 Roll up the dirty sheets, put them under the old man and clean the crumbs on the mattress.
4。 Spread clean sheets on one side (including the front) of the bed, and the center line of the sheets is aligned with the center line of the bed. Roll up the upper part and stuff it under the old man's body. Spread the half near the side from the head of the bed, the end of the bed and the middle, and put it under the mattress one after another, so as to help the elderly lie on the clean sheets, face the caregivers, turn to the opposite side, pull out the dirty sheets from the head of the bed to the end of the bed, and then flatten the clean sheets. Spread them out like above and help the old man pick up his back.
5。 Cover the quilt so that the old man can lie down comfortably.
6。 Hold the old man's head and neck with one hand, and quickly take out the pillow with the other hand, put it back in the pillowcase and pad the pillow for the old man.
2。 Lift the old man's head and shoulders, turn to the opposite side, put a soft pillow on the old man's back to maintain * * *, and put a soft pillow on the old man's chest to support the forearm to make the old man comfortable.
3。 Bend the old man's thigh forward and his calf slightly, and put a soft pillow between his knees to prevent the two legs from squeezing and rubbing each other.
(4) The temperature, humidity and food residue of the oral caregivers of the elderly in bed are all suitable for microbial growth and reproduction. Healthy people seldom get sick because of their body resistance and the bactericidal effect of lysozyme in saliva. Mechanical actions such as brushing teeth, gargling, drinking water and eating have certain effects on bacteria. The body resistance of the elderly is weakened, saliva secretion is reduced, and the bactericidal effect of lysozyme is reduced, which creates favorable conditions for the reproduction of bacteria in the oral cavity.
At this time, bacteria increase, and the functions of sugar decomposition, fermentation and acid production are enhanced. If you don't pay attention to oral hygiene, it will not only lead to bad breath and stomatitis, but also affect appetite and digestive function, and even lead to complications such as mumps due to oral infection, so oral care is very important. 1。
Instruments: a pair of tweezers, a cotton ball, tongue depressor (or bamboo chopsticks instead), mouthwash (ordinary physiological saline, 1:5000 furacilin or 3% boric acid solution). 2。
Methods: Let the elderly lie on their side, facing the caregivers, gently spread their cheeks with a tongue depressor, take a cotton ball soaked in mouthwash with tweezers, and wipe the occlusal surface, tongue, oral mucosa and hard palate on both sides of the teeth from inside to outside along the longitudinal direction of the teeth. After washing, help the old man rinse his mouth and dry his face. If the oral mucosa has ulcers, you can sprinkle tin powder or indigo powder.
If there are false teeth, help the elderly to take them off, rinse them with cold water, and let them wear them after gargling. 2。
Methods: Close the doors and windows, remove the desks and chairs, fill three quarters of the pots with hot water, loosen the lid, and put a large towel with half a pad and half a cover on the area scrubbed by the elderly, first wipe it with a wet towel, then scrub it with a soap towel, then wipe it repeatedly with a wet towel, and finally dry it with a large towel. The sequence of scrubbing parts is as follows: ① Untie the neckline, wash the eyes, nose, face, ears and neck for the elderly, and pay attention to after washing the ears.
② Take off the old man's coat (wash the healthy side first, then the affected side) and scrub the arm. Pay attention to cleaning armpits.
Help the old man lie on his side, face the nurse, put the washbasin on the big towel on the other side, and wash his hands. (3) untie the old man's belt, scrub his chest and abdomen, pay attention to the lower part and navel, help the old man turn over and scrub his back and buttocks.
④ Take off the trousers of the elderly and scrub the legs, groin and both perineum. Move the washbasin to your feet, spread a big towel on the bed, wash your feet and put on your pants.
⑤ Make the bed, change the sheets as needed, and clean up the used items. ()。
5. How to carry out home care for the elderly who have been bedridden for a long time?
Nursing care of preventing venous thrombosis of lower limbs The elderly are prone to induce venous thrombosis of lower limbs after long-term bed rest. During home care, the affected limb should be raised, centripetal or elastic bandage should be used according to the doctor's advice, and the superficial vein should be moderately compressed to increase venous reflux.
Active and passive movements of toes, ankles and knees, and contraction of calf muscles. Nursing care to reduce complications of pulmonary infection: keep indoor air circulating, disinfect indoor air regularly, quit smoking, guide the elderly to do chest expansion exercise, take deep breaths and cough exercises; Pat your back regularly 2~3 times a day to promote sputum discharge.
Cerebral infarction: the elderly are often accompanied by cerebral arteriosclerosis, refusing to move because of pain, resulting in slow blood flow, so it is easy to be complicated with cerebral embolism. On the basis of functional exercise, early application of peripheral vasodilators or antiplatelet drugs under the guidance of doctors can effectively prevent cerebral infarction.
Bedsore: The old people's subcutaneous fat and blood vessels decrease, muscle fiber atrophy, arteriosclerotic, local compression, blood circulation disorder, which is easy to cause bedsore. Home care should keep the sacrococcygeal region clean and dry, use an air cushion bed, turn over every two hours, and put an air ring or cotton ring on the bony process 2-3 times a day, and do it 3-3 times a day according to the condition.
6. What are the contents of safety care for the elderly at home?
With the increase of age, the memory and judgment of the elderly will decline, and their audio-visual ability, adaptability, self-defense ability and ability to avoid injury will also decrease significantly, thus increasing the chances of injury, fall and loss of the elderly. Therefore, we should strengthen the safety care for the elderly.
Nannies should take care of the home life of the elderly according to the following points: (1) Many elderly people have lost their teeth or installed false teeth, so their digestion and absorption function is relatively low, so their food should be rotten, soft and broken, which is convenient for digestion and absorption. At the same time, because the throat of the elderly is not sensitive and easy to choke, the elderly should be reminded to chew slowly to prevent food from entering the trachea.
(2) When the elderly are making changes, they are often told to move slowly, not too fast, such as getting up and standing up from a squatting position, in case of bumping or falling accidents due to body imbalance or upright hypotension. (3) The elderly are slow to move and slow to respond, and are often prone to falls, fractures and other injuries. Therefore, when the elderly engage in activities, they should be accompanied by someone, and they should also be properly assisted when walking.
(4) Some elderly people often have constipation, incontinence, frequent urination and urgency. And poor urination can easily lead to high blood pressure and increase heart load, so let the elderly develop the habit of urinating on time. (5) Older people often suffer from limb weakness and muscle atrophy due to reduced activities. Therefore, it is necessary to insist that older people go to bed early and get up early, and take appropriate physical exercise.
For example, walking, jogging, doing exercises, playing Tai Ji Chuan and practicing Qigong. (6) Anti-skid pads should be laid in the bathroom and bedroom, and handrails should be set at the stairs to prevent the elderly from walking and slipping on the waxed floor.
(7) There should be no wires and obstacles within the activities of the elderly, so as not to hinder the elderly from walking; Remind the elderly to avoid dangerous activities, such as climbing to get things or lifting heavy objects; The furniture of the living space for the elderly should also be relatively fixed.
7. How can the elderly stay in bed for a long time for home care?
Pay attention to turning over the old man often. If the old man can't turn over by himself and his body is heavy, he can turn over with the help of two placemats. The placemat should be harder, one foot square or slightly larger (not too big, more than 30 cm square).
Specific methods: First of all, the bed should be placed where people can stand on both sides, that is, the left and right sides of the bed should not be against the wall. If the old man lies on his side at 180 degrees and wants to turn over, then the nursing staff will stand in front of the old man (that is, in front rather than behind) and put two placemats under his shoulders and buttocks, the more stuffed the better. Then the nursing staff will hold or hold his shoulders and the back of his knees with their left and right hands respectively, and use the smoothness of the placemat to move in their own direction until they reach the extreme edge of the bed. Turn hard in the opposite direction, and then adjust to the other side of the bed. This method is more effective than nursing bed when turning over at 180 degrees.