(A) the actual ability of daily activities training and self-care.
According to the patient's condition, he gradually transited from light activity to heavy activity, and finally resumed normal functional activities to achieve self-care of daily activities, including self-care of life and housework.
1. Self-care
Everyone has different requirements and standards for self-cleaning. The content and degree of treatment and training should be determined according to the patient's wishes and goals. Maintaining good personal appearance can improve self-image and self-esteem and promote the improvement of activity ability. Self-care includes:
(1) Wash your face: Washing your face in a sitting position can reduce the anxiety and fatigue of patients. Put the washbasin beside the bed with a bracket, or place a high stool beside the washbasin to help patients wash their faces in a sitting position.
(2) Bathing: It consumes a lot of energy and requires patients to have a certain ability to balance, coordinate and tolerate temperature. Excessive temperature in the bathroom should be avoided and patients should be encouraged to take a bath and get dressed. If there are chairs and stools in the bathroom, the patient had better take a seat to bathe and dress. Foam bath or soap bath and bathrobe can save patients' physical strength. The biggest problem in taking a bath is the transfer inside and outside the bathtub. Electric lifting chair (figure 13-4- 1) can be used to help patients take the bathtub (or sit in the toilet), and the bathtub can be modified if necessary, such as installing armrest seat plates and anti-skid pads in the bathtub to facilitate bathing, or allowing patients to take a shower under the seat without using the bathtub. You can ask for help if you don't have the conditions to take a bath or if you have difficulty taking a bath yourself.
(3) Hair care: It is suggested that patients choose a hairstyle that is easy to clean and care, and invite a barber to come to the house for service when necessary, which can also be regarded as a social activity.
(4) Dressing: Try to encourage patients to dress themselves and choose clothes that are warm, light and easy to put on and take off. For example, wearing sweaters instead of vest shirts and pullovers can save physical strength. If the dressing process is laborious and time-consuming, patients need help.
Figure 13-4-0 Figure 13-4-2
2. housework
Patients should adjust housework activities according to their own physical strength, make reasonable arrangements and plans, conserve physical strength and reduce energy consumption. For example, kitchen work is tedious and time-consuming, and many activities need to be repeated many times. The design and layout of the kitchen should be reasonable, and the utensils and articles commonly used in the kitchen should be placed as conveniently as possible. Reduce excessive bending, squatting and turning. The appropriate height is 0.6~ 1.4m (Figure 13-4-2). Common utensils and articles should be put together as much as possible to reduce walking back and forth in the kitchen (Figure 13-4-3). For example, in the kitchen, there is a pool in turn, and there is a refrigerator on the left side of the pool, and a kettle can be placed on the refrigerator. Next to the stove is a locker for storing cooking condiments, chopsticks and other utensils, and opposite the stove is a dining table. When working in the kitchen, patients can sit on the movable high stool, which is convenient for moving and avoids standing for a long time. Try to use labor-saving and time-saving processing appliances, such as food processors, microwave ovens, rice cookers and other fully prepared finished and semi-finished foods (canned frozen food instant noodles, etc.). ), so that it can be eaten at any time. When going out shopping, they should plan ahead and shop as close as possible. You can also shop during exercise and on your way to work. When shopping, you can use a cart to reduce the load. Online shopping or asking a housekeeping company to deliver goods to your door can greatly reduce the physical consumption of patients. Try to choose clothes that are easy to iron and dry, and use the washing machine and dryer to handle them together. For some heavy clothes that are difficult to wash, you can send them to the laundry or ask someone to help clean the room, such as washing dishes, making the bed, mopping the floor, cleaning kitchen utensils and cleaning the bathtub. Don't do it together It is easy to make patients tired, so they should participate in outdoor courtyard layout at different times according to their own abilities, including cleaning, weeding and planting flowers in the courtyard. Don't consume too much physical strength, just consider it as mental adjustment, so as not to cause fatigue.
Figure 13-4-3 Walking Path and Frequency of Patients in the Kitchen
move
For patients with cardiovascular disease, the degree of recovery of activity depends on the patient's heart function, and some patients can recover their activity before illness. For patients with cardiac function II ~ III, their mobility is affected to varying degrees, and even moving beds and chairs to climb mountains and stairs will be very laborious. Therefore, handrails can be installed in the kitchen and bathroom to facilitate the patient's movement and reduce the physical consumption and the increase of heart load when the patient walks with the help of a wheelchair. Take a car or an electric car instead of walking and cycling. According to the energy consumption in work activities (Table 13-4-4), determine the walking speed, distance and times of going up and down stairs of patients, so as to ensure the patient's moving safety. As for how to improve patients' activity ability, it is mainly through exercise therapy and aerobic training (2) to restore normal activity function.
The required exercise capacity is 4~6METs, the activity intensity is 40%~50% of the maximum heart rate, the subjective fatigue degree is not greater than 13~ 15, and the sexual activity intensity is about 5METs. Restorative activity
Talking with some heart patients about the loss of sexual desire and sexual ability will make them feel embarrassed and even lead to anxiety and fear. Therapists need to take cautious measures to make patients feel comfortable by eliminating fear and anxiety. Generally speaking, the degree of physical exertion in sexual life is equivalent to the time to resume sexual life on the second floor four weeks after myocardial infarction or surgery. At this time, patients need to have the ability to go to the second floor. The comfort of sexual life is the most important thing for patients. First of all, avoid excessive isometric posture. The intimate contact and touch of the body is beneficial to the establishment of patients' sexual self-confidence. Diuretics and beta blockers can hinder the recovery of sexual activity. Patients need to find a doctor to adjust and observe drugs in time.
2. Restore driving ability
It takes at least 65,438+0 months to recover driving ability after myocardial infarction or heart surgery. It is recommended to drive in a relaxed and safe lane, avoid downtown areas and rush hours, and avoid cars being insured by insurance companies with doctors' driving licenses. If you don't fully recover or have angina pectoris while driving, you'd better not drive. Patients with myocardial infarction who used to drive professionally have to change jobs.
3. Holidays and travel
Vacation is beneficial to the recovery of patients, but we should choose the appropriate place and method of vacation.
The height of the resort should be lower than 2000 meters above sea level to avoid hyperventilation and altitude physiological reaction. The climate should neither be too cold nor too hot. Note that patients who drink moderately are suitable for traveling by train or bus, so as to avoid fatigue caused by long-distance travel and travel by night train, but don't make careful plans before hyperventilating to ensure that they can travel in a relaxed mood without consuming too much physical strength. If patients with myocardial infarction fly within 8 weeks, they need to show a doctor's certificate, and the crew should give it to them as much as possible.
4. Resume recreational and sports activities
Choosing appropriate entertainment and sports activities is conducive to the healthy recovery of patients and improving their physical strength and activity ability. Walking is an ideal exercise for patients with cardiovascular diseases. The walking distance varies from person to person, and the purpose is to increase the walking distance and improve physical strength. It does not emphasize that fatigue should not occur during speed exercise, and generally take 60%~70% of the maximum activity of the human body (which can be limited by symptoms) for exercise. Make patients have enough potential to deal with emergencies. When patients are in a bad mood, tired or in bad weather, they should reduce their activities or even stay at home, and should not exercise after meals. When you go out to exercise in cold season, you should keep warm and keep your head and face cold. They should put on scarves and gloves to prepare for sports. The exercise of patients with myocardial infarction can be monitored by pulse, that is, 220- (age +40), and the number obtained is the heart rate reached during exercise, which is also commonly known as the "bull's-eye rate". Patients who want to keep the bull's-eye rate three times a week should be regularly evaluated by doctors to see whether the target heart rate adopted by patients is safe and effective, which will not cause myocardial ischemia and sudden increase of left ventricular pressure, or it is not recommended to engage in recreational activities and activities that require the same exertion time and exercise to suddenly cool down. In recent years, the exercise plan of patients with coronary heart disease should be individualized according to their clinical conditions (including risk factors, age and functional status) (Table 18).
Table 13-4-7: Make an activity plan according to the characteristics of patients.
(3) Employment ability training
Employment gives patients the opportunity to get in touch with society, with status, self-esteem, economic income and job satisfaction. Therapists analyze and evaluate patients' working ability, psychological state and time demand according to their physical condition and work needs, and provide suggestions for patients to choose jobs. They may keep their original jobs, but the work intensity will be reduced. If the original job is not suitable for patients, you can adjust or change jobs appropriately. If not, you can work at home or retire early.
Before employment, patients can adopt the following treatment schemes: ① continuous standing and simple activities of upper limbs and hands; (2) Intermittent arm flexion and extension, with a certain rhythm; (3) the body is fixed and stands continuously; Activities of upper limbs in different directions and at different heights.
In addition, homework activities are divided into light activities and heavy activities. Common light activities are as follows: ① Walking indoors with a basket in one arm for 2 laps (changing hands in the second lap), * * * 55m; ② Walking with things in both hands for 55m, then picking up objects on the ground and repeating for 4 times.
③ Heavy objects move repeatedly from left to right on the table ④ Steps alternate repeatedly up and down on the table ⑤ Heavy objects activities include: ① Carrying baskets up and down stairs with one arm ② Heavy objects move up and down on the shelf. For example, someone's occupation is washing dishes. His job is to clean up the piled dishes for 2 hours every day (low-intensity activities of standing hands continuously). Generally, he cleans tables and mops the floor, cleans tables and chairs for 2 hours (intermittent flexion and extension of arms) and washes dishes for 3 hours (frequently picking them up and stacking them in a standing position for 5-60 hours).
These simulated activities not only help therapists master the cardiovascular response during activities, effectively control the intensity of activities, but also help patients recover their work intensity and endurance as soon as possible under the premise of safety.
(D) Psychological and emotional adjustment
Therapists should help patients and their families through this period, inspire them to express their worries and worries, listen to their expressions, solve various problems they have raised, help them face up to their diseases, strengthen mutual communication and understanding between patients and their families, encourage patients to participate in various social activities, and gain the understanding and support of relatives and friends. Hospitals and society can set up cardiovascular psychological counseling services, sex counseling clinics, clubs for cardiovascular patients and self-organized domestic service centers, which can play a bridge to regulate family and social relations in hospitals.
(5) adjustment of lifestyle and personal habits
The purpose of occupational therapy is to help patients recover and maintain their original lifestyle (such as work habits, social activities and entertainment) as much as possible. After illness, the patient's mobility may be limited to varying degrees. Therapists should help patients adapt and adjust their lifestyle appropriately. Personal hobbies and habits should also be adjusted according to the functional state of the body after illness, such as planting flowers, enjoying music, keeping pets, exercising, walking, painting and traveling, with less pressure. Safe and reliable activities will not increase the cardiovascular burden. For example, patients who like bowling and table tennis can change from gardening to bonsai, and those who like music can change from playing musical instruments to enjoying music.
Rest should be arranged in the middle of a long walk, and someone needs to accompany you when traveling. In order to save energy, you can use a wheelchair instead of walking.
(6) Energy saving technology
Energy-saving technology involves various activities, such as letting patients sit on high chairs to cook or iron clothes in the kitchen, and transporting things indoors with trolleys instead of taking things from trays (isometric contraction). Bathing chairs can reduce the cardiovascular response of patients standing in the shower, which is easy to produce strong cardiovascular response when their upper limbs move above their heads. When taking a bath, the water temperature and room temperature should not be high and the time should not be long. Patients are encouraged to get help in washing clothes, making beds and shopping. But the amount of help should be appropriate, both to save energy and avoid excessive dependence. Reasonable time arrangement is one of the main methods of energy-saving technology, which can enable patients to fully arrange activities without causing fatigue and excessive energy consumption.
Making a reasonable schedule of activities and rest every week and every day, and adjusting it regularly, can gradually enhance the activity endurance and energy of patients. The following is the schedule of the day (table 13-4-8).
Table 13-4-8 list of energy-saving technologies
(7) Education for patients and their families
Education includes daily life guidance and health education. The specific contents of health education include: the purpose and methods of rehabilitation, the related factors of diseases, how to monitor the pulse, matters needing attention in life, the handling of emergencies, the guidance of daily life including food, clothing, housing and transportation, correcting bad lifestyles, changing inappropriate eating habits and the value of rehabilitation treatment.
Health education can help patients and their families understand the general knowledge of diseases, get information about how to deal with symptoms, implement treatment (such as relaxation techniques) and prevent and treat risk factors of heart disease, answer their various questions, help patients delay the course of disease, reduce the chance of disease recurrence, enhance patients' confidence in treatment, give full play to their corresponding physical fitness level with the active cooperation of family members, reduce dependence on others, and realize independence in daily life. Get a higher quality of life and guide patients to control their weight, cultivate good eating habits, have reasonable nutrition, quit smoking and drinking, arrange life, study and work reasonably and regularly, carry out aerobic fitness activities appropriately, eliminate nervousness, treat things around them with an optimistic attitude, go to the hospital for physical examination regularly, learn to monitor blood pressure, and guide patients not to blindly seek medical treatment and medication.
For patients with coronary heart disease, we should pay attention to controlling the development of the disease at an early stage, actively participate in rehabilitation treatment, and work together with medical staff to overcome the disease. It is difficult for medical staff to help patients decide which activities can be continued and which activities must be abandoned. It is very difficult for those patients who are busy with work to reduce their activities. Therapists need to talk frankly with patients and explain their interests. Active cooperative education for patients should run through the whole process of rehabilitation treatment, not only for patients, but also for their families.
In this period, we should pay attention to the principles of individuality, step by step, perseverance, interest and comprehensiveness. Patients need to understand the limitations of personal ability, and should regularly check and modify the treatment plan to avoid excessive fatigue. When medication changes, we should pay attention to adjusting the activity plan accordingly. If you find symptoms such as upper body discomfort (including chest, arms, neck, burning pain, shrinking or swelling pain), weakness, shortness of breath, joint discomfort (joint pain or back pain), you should stop your activities and seek medical advice in time.
Occupational therapy for hypertensive heart failure mainly focuses on rehabilitation treatment of stage ⅱ ~ ⅲ hypertension, and mainly focuses on exercise therapy (aerobic training, relaxation training, medical gymnastics). It should be emphasized that occupational therapy for hypertension should be carried out in a relaxed and relaxed environment, and the design of activities should avoid low-intensity static activities and long-term dynamic activities (isotonic activities) of large muscle groups, with a maximum heart rate of 40%~60% for 30~60 minutes.
In the health education of patients, we should strengthen their understanding of stress, pay attention to the adjustment of self-emotion and mentality, change the daily bad behavior pattern, and gradually learn appropriate stress handling skills (learn various relaxation skills) to avoid emotional overexcitation. Exercise training and psychological stress therapy can significantly improve patients' ability to resist external pressure, thus improving their social adaptability and quality of life. In addition, the control of other risk factors of hypertension should be strengthened. Smoking can increase blood vessel tension and hypertension. Therefore, quitting smoking is also the content of behavior correction. Because of the poor cardiac reserve function in patients with heart failure, it should be emphasized that the increase of exercise intensity should be small and slow during the treatment. The treatment process should include intermittent rest. The treatment time should start from 5~ 10 minutes, and increase at the rate of 1~2 minutes each time until 30~40 minutes to avoid dyspnea, asthma and fatigue.