Paralysis is the diminution or loss of casual motor function in patients and is a sequela caused by a disease that seriously affects the quality of life of patients. Since the recovery of neurological function is extremely slow and paralyzed patients often need to be bedridden for long periods of time, it becomes especially important to prevent complications. The following is an introduction to four common complications in patients with long-term paralysis and their preventive care methods. Pressure sore prevention For patients with long-term paralysis and their caregivers, pressure sores are undoubtedly the first problem in front of them. I have met several paralyzed patients who came for follow-up visits, and the first question their caregivers asked me was: “He is fine with everything, but he has a sore on the back of his buttocks, what good medicine can you recommend to apply?” Every time I hear this, I can’t help but shake my head in my heart. It’s not that there’s no medicine for it, but the cause of pressure sores is the prolonged pressure on local tissues, which leads to continuous ischemia and hypoxia, eventually causing necrosis of the soft tissues. Therefore, ulceration is the result of pressure, and if the pressure problem is not solved, the wound will not necessarily heal or stop ulcerating even if good medicine is used. Therefore, pressure sores are more about prevention than treatment! In fact, it is not difficult to prevent pressure sores, so keep the word “diligence” in mind. 1. “Diligent work” of “turning over”. As a caregiver of a long-term paralyzed patient, you should change the patient’s position every two hours during the day and every three hours at night. In order to maintain an effective lying position, a pillow can be placed behind the patient’s back when he or she is in the lateral position, which can help relax the back muscles and make the patient comfortable. When lying on the side, the leg on the top side should be bent and a soft pillow should be placed between both knees and under both feet. Turning should avoid dragging, pulling, tugging and pulling to prevent skin abrasion. Families who have the conditions can also go to a rehabilitation store and buy an air mattress. By adjusting the softness of the mattress and regular turning, the occurrence of pressure sores can be effectively reduced. 2. “Diligent work” and “diligent finishing”. Since pressure sores are caused by pressure, it is important to tidy up the clothes and sheets under the patient’s body regularly while turning over diligently to keep the sheets and clothes clean, wrinkle-free, and free of debris to avoid local skin indentation. For patients with indwelling catheters, it is also important to check the correct position of the catheter to prevent the patient from being pressed under the body due to improper placement of the catheter, which may aggravate the local skin pressure. The skin should be cleaned and kept dry to increase the skin’s resistance. It should be noted that when changing bed sheets and clothes or using the bedpan for the patient, the patient must be lifted off the bed to reduce friction and damage to the skin. 3, “diligent” of “diligent observation”. In the turn over at the same time to strengthen the observation of the skin of the easily pressed parts. Since we need to strengthen the observation of the skin of the parts under pressure, which are the parts susceptible to pressure? The easily pressurized parts are mostly at the bony prominence, and the pressurized parts are different according to the position. In the horizontal position, the pressure-prone areas are sacrococcygeal, scapula, spinous process of the spine, elbow joint and posterior occiput; in the lateral position, the pressure-prone areas are auricle, acromion, elbow joint, anterior superior iliac spine, lateral knee joint and external ankle of the foot. After each change of position for the patient, the corresponding area should be examined, and if a local skin change of red or dark red is found, the skin should be given more attention and the time of pressure should be minimized. If possible, massage the area with a liquid dressing for pressure sores such as Cytomel. Prevention of pulmonary infections Patients with long-term paralysis are prone to pulmonary infections due to factors such as impaired consciousness, reduced immunity, and weakened coughing and swallowing functions. 1. Pat the back. The caregiver should pat the patient’s back while turning the patient at regular intervals. The purpose is to assist the respiratory tract to clear secretions and promote the discharge of phlegm through the vibration of the thorax. The method of patting the back: tap the patient’s back from bottom to top and from outside to inside with the arch of the hand in a hollow shape, with the strength to feel the vibration of the patient’s chest cavity. If the patient is conscious, encourage the patient to cough while patting the back to help expel sputum. If the patient is conscious, the patient can be given sputum with the help of suction device and suction tube behind the pat if necessary. 2.Keep the oral cavity clean. The patient should be given oral cleaning twice a day in the morning and evening. If the patient is impaired in consciousness, the caregiver can help the patient brush his teeth with a soft brush. If the patient has hemiplegic symptoms, place the food ball on the healthy side of the patient’s mouth every time he eats to facilitate chewing. 3.Prevent mis-aspiration. Misaspiration usually refers to patients who cannot swallow normally or whose swallowing function is weakened and inhale food or stomach contents from the mouth into the respiratory tract when eating or vomiting. There are two types of aspiration: overt aspiration and covert aspiration. Caregivers will easily sense when a patient shows manifestations of aspiration such as choking and coughing. However, when a patient presents with symptoms such as food accidentally entering the airway without coughing, it can greatly reduce the caregiver’s concern about the misaspiration, which can lead to prolonged invisible misaspiration and eventual development of a lung infection. Clinically, we often use the Puddlefield drinking test to assess whether a patient has a swallowing disorder. Test method: Have the patient sit upright and drink 30 ml of warm boiled water and observe the time required to drink and choke. grade 1: can swallow the water smoothly in 1 sitting within 5 seconds; grade 2: can swallow without choking in more than 2 parts; grade 3: can swallow in 1 sitting but with choking; grade 4: swallow in more than 2 parts but with choking; grade 5: frequent choking and cannot swallow all. Patients with abnormal swallowing function in grade 3-5 should be highly concerned about the presence of aspiration, and if necessary, a gastric tube or gastrostomy can be placed. Prevention of urinary tract infections Bedridden patients with long-term paralysis are prone to urinary tract infections, which are mainly related to long-term indwelling catheters, bladder-urethral dysfunction due to neurological damage, improper cleaning methods after defecation, and low water intake. Since the urethra of female patients is short and straight, the chance of urinary tract infection is higher than that of men. 1. Observation. Normal urine is clear and yellowish in color. When a patient’s urine changes color, becomes cloudy or appears flocculent, as a caregiver, you should be highly concerned about whether the patient has a urinary tract infection, which can be confirmed by routine urine examination or by retaining the middle section of urine for urine culture examination. 2. Cleanliness. In daily life, the first thing is to keep the perineum clean, twice a day with a special towel warm water to clean the local, for patients with indwelling catheters also twice a day with sterile saline cotton balls or gauze wipe the catheter and urethral orifice. Pay attention to the method of cleaning after each bowel movement. The order of cleaning should be from to back to reduce the pollution of the urethra; secondly, if the condition allows, the patient should be given a small amount of warm water several times a day to dilute the urine to flush the purpose of the urethra. 3.Change the catheter regularly. For patients with indwelling urinary catheters, if urinary tract infection does not occur, the catheter should be changed once a month. If urinary tract infection occurs, you should seek medical advice and shorten the time of catheter replacement as appropriate. Prevention of limb contracture and deformity 1. Patients with lower limb paralysis are very prone to foot drop symptoms due to Achilles tendon contracture, so caregivers should pay more attention to their foot form. Patients can wear functional shoes to help the feet and legs at right angles and maintain dorsiflexion, a position that can effectively prevent foot drop (functional shoes to prevent foot drop are available in rehabilitation stores). At the same time, when covering the patient to keep warm, pay attention to the foot not to be pressed, and use supports to hold up the quilt if possible. 2. Patients with upper limb paralysis may have deformities of the wrist and elbow joints if they are not positioned properly for a long time. Therefore, the patient should be checked for shoulder joint compression when lying on his or her side, and the elbow joint can be naturally flexed and the wrist joint can be placed in front of the chest. A small, neatly folded towel can also be placed in the patient’s hand to absorb sweat and keep the fingers in a functional position. 3. The caregiver can assist the patient to do passive movements in bed to help move each joint. The order of movement is from large joints to small joints, and the range of movement is from small to large. When assisting the patient with shoulder joint movement, the caregiver should hold the patient’s shoulder with one hand and the patient’s elbow with the other hand, doing inward, outward and up and down movements; when the caregiver assists with elbow joint movement, the caregiver should hold the patient’s elbow joint with one hand and the patient’s wrist with the other hand, doing flexion and extension, internal rotation and other movements. 4, to assist the hip movement, the caregiver should hold the patient’s hip joint with one hand, the other hand on the knee joint, to do left and right rotation and other movements. When assisting the patient to do knee exercises, one hand should hold the patient’s knee joint and the other hand should hold the patient’s ankle and do flexion and extension. Passive movements should be performed twice a day for 30 minutes or as long as the patient is not strained. 5, while assisting the patient to do passive exercises, the patient patient should also be encouraged to do active exercises in bed. Patients should be encouraged to strengthen the movement of the healthy side of the limb. For example: forceful fist clenching, finger extension, forceful foot dorsiflexion and other movements. Patients can be encouraged to brush their own teeth, wash their faces and eat when their condition allows. In addition to the prevention of the above four complications, paralyzed patients are prone to emotional instability, depression, and even depression and anxiety due to their long-term role as caregivers. The endless love and attentive care from family members and caregivers is an important psychological pillar to encourage patients to overcome the disease. As a caregiver of a long-term paralyzed patient, while providing careful care to the patient, he or she also needs to adjust his or her emotions and can seek necessary social support to jointly help the patient recover as soon as possible.