2. 1 Psychological nursing patients are pessimistic and disappointed because some organs of cerebral infarction have lost their normal functions. Therefore, it is very necessary to do a good job in patients' health education and eliminate patients' anxiety, which shows the importance, necessity and progressiveness of rehabilitation nursing. While carrying out psychotherapy, we should strive to create a clean, quiet and comfortable environment for patients. Every progress of patients should be affirmed and encouraged in time to increase confidence.
2.2 Prevention of Bedsore ① Reduce the pressure and friction at the compression site, change positions frequently, and turn over every 2 hours 1 time. In the process of turning over, the movement should be slow and gentle, and it is forbidden to drag, pull or push. (2) Keep the patient's bed clean, flat and dry, clean the wet bed, soft bedding and underwear. ③ Promote local and systemic blood circulation, scrub locally on the bed on time, and sleep in an air cushion bed or sponge bed.
2.3 Prevention of pulmonary complications Long-term paralysis patients are bedridden, with low resistance and prone to respiratory complications. Therefore, we should do a good job in respiratory care, encourage deep cough, often turn over and pat the back, promote sputum discharge and prevent lung infection.
2.4 Pay attention to nutrition and food hygiene. Diet should be light and easy to digest. Eat more foods with low salt, low fat and high protein and rich in vitamins and crude fiber, eat more fruits and vegetables and drink more water to prevent constipation. Chew slowly, give full play to the mechanical function of teeth and the digestive function of saliva, which is beneficial to the digestion and absorption of gastrointestinal tract.
2.5 Strengthen physical function exercise. After the condition is stable, you can exercise your limbs. On the basis of supine position, first, assist the paralyzed limbs to do extension and flexion exercises, 3-4 times d ~, 3-5 min each time, which not only moves the major joints such as shoulders, elbows, hips and knees, but also moves the minor joints such as fingers and toes. At the same time, acupuncture, physical therapy and massage are supplemented. Encourage patients to take the initiative to move: turn over in bed, lift legs, move arms, move toes and so on. Encourage patients to sit up in bed, assist them first, and then sit up independently, so that they can sit on the bed and droop their lower limbs and practice lower limb activities. Exercise standing and walking. At first, two people helped, then one walked against the wall or stood alone. El daily life function exercise: let patients practice buttoning, changing clothes, washing, urinating and walking. Pay attention to exercise and take care of it step by step.
2.6 Patients who suddenly become speechless or slurred speech in early language training are unable to communicate with the outside world and are prone to pessimism and depression. Nurses and their families should communicate frequently with patients according to their illness, starting with written communication, and then talking to patients slowly and clearly in a language that patients can easily understand. Sick
When people are frustrated in training, we should guide the patients step by step, in an orderly way, and don't rush for success.
2.7 do a good job in discharge education, guide patients to scientific living habits, quit smoking and drinking, and strengthen nutrition. Maintain emotional stability. Avoid fatigue and take appropriate activities, such as walking, doing exercises and hitting Tai Ji Chuan. Insist on taking medicine, do not stop or reduce it at will, and review it regularly. Introduce the importance and methods of rehabilitation training to patients and their families, so as to promote patients' early recovery and return to society.
Supplementary health education part:
Health education for patients with cerebral infarction
Under the guidance of modern medical model, health education is one of the important contents of holistic nursing for patients in both physical and mental aspects. In China, the incidence and mortality of cerebrovascular diseases are very high. Strengthening the propaganda and education of cerebrovascular disease knowledge can effectively control its occurrence and development. Taking cerebral infarction as an example, this paper briefly introduces the main contents of health education. Patients with cerebral infarction often have sudden onset and severe symptoms, and often suffer from unilateral or systemic convulsions, paralysis and loss of self-care ability due to the decline or disappearance of motor, sensory and reflex functions.
Therefore, it is very important for nurses to strengthen health education for patients and their families, which can guide patients to establish confidence, actively cooperate with treatment, prevent complications and promote the recovery of body function.
1 mental health guidance
Patients are often depressed and troubled because of language barriers, limb paralysis, incontinence, and inability to take care of themselves, and their psychological burden is heavy. Nurses should pay more attention to patients and actively introduce the hospitalization environment to make them adapt as soon as possible. And introduce the etiology, clinical manifestations, treatment and nursing measures and ideal prognosis of the disease to patients and their families to gain their trust. Make it relieve or eliminate tension and fear, and get up the courage to actively cooperate with the treatment.
2 Dietary guidance
Instruct patients to eat moderately and not to be too full. Choose a diet with low salt, low cholesterol, moderate carbohydrates and rich vitamins. Limit the intake of salt, with an average of no more than 6g per day; Eat less animal fat, cream, egg yolk, animal offal and other foods to prevent obesity and hypercholesterolemia; Increase the intake of high-quality protein, especially fish protein and soybean protein, and eat more fish and shrimp, lean meat, bean products, fresh vegetables and fruits; Drinking tea properly increases vascular toughness and improves blood circulation; Avoiding spicy food, quitting smoking and drinking will help reduce the incidence of cerebral infarction. People with dysphagia should take a sitting position or a lateral position with their heads held high, and give a liquid or semi-liquid digestible diet, chew slowly to prevent coughing; Those who are conscious or unable to eat should be given a nasal feeding diet as soon as possible to ensure nutritional supply.
3 life guidance
3. 1 Strengthening skin care Patients with cerebral infarction often have severe limb paralysis and stay in bed for a long time. It is particularly important to strengthen skin care. The patient should take the supine position with his head tilted to one side or lateral position. People with disturbance of consciousness and irritability should add a bed stall, and if necessary, they can be protected by restraint belts. Turn over regularly every 2 hours, gently massage the pressed parts and apply talcum powder. Mattress should be kept flat, dry and free of slag. When moving the patient, the patient should be lifted off the bed surface, and no dragging is allowed to avoid scratching the skin.
3.2 The nursing of defecation guides patients to keep defecation unobstructed and form a good habit of defecation every day. For constipation, laxatives can be given appropriately to avoid excessive exertion during defecation and increase the burden on the heart and brain.
3.3 Nursing patients who promote the recovery of limb function during bed rest can pad the affected limb to promote venous blood return in order to prevent limb swelling; In order to prevent foot drop, limbs should be kept in functional position. After 2 weeks of onset, the condition improved, and you can do limb function exercise and give passive exercise and massage to paralyzed limbs. From15 to 20min, twice a day. After that, gradually increase the number and time of exercise, and after the function is restored, then carry out active movement of limbs, activities in bed and under bed.
Activities, etc. , and gradually promote the recovery of limb function. Aphasia patients should be trained in language rehabilitation to gradually restore their language function.
4 discharge guidance
4. 1 Pay attention to the regular ventilation of the bedroom after discharge, keep the air fresh, live a regular life and pay attention to the combination of work and rest. We should insist on physical and language rehabilitation exercises.
4.2 After discharge, strictly follow the doctor's advice, such as oral enteric-coated aspirin and dipyridamole, to prevent recurrence. Maintain a low-salt, low-fat and low-sugar diet on weekdays, avoid spicy food, and quit smoking and drinking. Come to the hospital regularly for reexamination, recheck the indexes such as blood sugar, blood pressure and blood lipid, observe the changes of the disease, and adjust the treatment plan at any time.
4.3 If you feel unwell, seek medical advice in time. If you find symptoms such as dizziness, unsteady gait, elevated blood pressure, numbness and weakness of limbs, vague speech or aphasia, you should see a doctor in time and deal with them in time to prevent further development of the disease.