I. Prevention and care of lung infection
1. Help and encourage the patient to cough up sputum: teach the patient the correct and effective way to cough. Regularly instruct patients to cough hard to promote lung expansion and sputum discharge. For those who dare to cough because of pain, use painkillers appropriately; for those with chest injury, use both hands to fix the chest; for those with intercostal muscle paralysis and weak cough, use both hands to press the upper abdomen to assist breathing. Lightly clap the back, also conducive to discharge of secretions. The method of patting the back: five fingers together and bend, from the top down, from both sides to the central row of the patient’s back.
2, position: long-term supine prone to secretion accumulation, is not conducive to drainage, should often change position. If you find that one side of the lung infection or lung expansion has a full, should make the affected side on top, in order to facilitate the expansion of the lung and drainage.
3, nebulized inhalation: can make the secretions dilute to facilitate the discharge. The inhalation solution is saline plus antibiotics, dexamethasone, chymotrypsin and other drugs as appropriate.
Second, skin care, prevention of decubitus ulcers
Patients with spinal cord injury are prone to decubitus ulcers and related factors.
1.The paralyzed part cannot be moved
2, loss of skin sensation, without the pain signal stimulation after the lower often skin pressure
3, local ischemia due to plant nerve dysfunction.
Prevalent sites of decubitus ulcers: common in the sacrococcygeal region and heel, followed by the external ankle, peroneal head, elbow and posterior occipital region in those with high spinal cord injury (those who perform cranial traction) can also occur. The depth of tissue necrosis can be from skin, subcutaneous tissue, muscle to bone. Decubitus ulcers are difficult to heal, and large and deep ones often suffer from malnutrition, high body temperature, decreased plasma protein, toxicity, and hyperemesis. Decubitus ulcers can be a cause of death and prevention should be emphasized.
Preventive measures.
1. Turning regularly and changing positions. Turn the patient once every 1-2 hours according to his condition. Precautions for turning.
(1) master the correct method of turning: patients with cervical fractures should pay attention to the head, neck and shoulders in a straight line to prevent spinal distortion and aggravation of spinal cord injury: those who perform cranial traction should also pay attention to maintaining the effectiveness of traction and preventing the traction arch from falling off: the chest and waist in a straight line; patients with lumbar spine should pay attention to the chest and waist and hip in a straight line.
(2) turn the patient gently lift the patient to move and turn, prohibit dragging the patient in bed.
2. Keep the bed neat and dry.
3.Guide the companion to eat a high nutrition multivitamin diet for the patient to increase skin resistance.
4. And strict shift handover.
Treatment of decubitus ulcers.
Early signs of decubitus ulcers are dark red skin under pressure, reduced elasticity, followed by blisters. At this time, strengthen care so that local pressure is no longer applied, evacuate the blisters, keep the skin dry and massage gently around the blisters, and recovery can be expected. If skin and subcutaneous tissue necrosis and ulceration occur, the medicine should be changed, the necrotic tissue should be removed, and Oriental One should be applied locally (with the effect of decay and muscle growth). After the trauma surface is fresh, apply Beifu agent twice a day, and pay attention to increase the nutrition of the whole body at the same time.
Prevent urinary system infection
Urinary system infection is very common in paraplegic patients, and its related factor is the long-term use of catheters. Therefore, in the process of nursing, strict requirements for aseptic operation should be made to prevent aggravating infection. Measures.
1.Explain to the patient the hazards of long-term indwelling urinary catheters in order to obtain the patient’s cooperation in the implementation of nursing measures.
2.Assist the patient to drink 2500ml of water daily.
3.Perineal scrubbing for the patient daily.
4.Properly fix the urinary catheter bag, always positioned below the level of the bladder, when the patient changed to the lateral position, the urinary catheter should not cross the side of the body, but should pass between the legs.
5.The urine bag should be changed twice a week and the urinary catheter should be changed once every two weeks, and the operation should be strictly aseptic. In case of infection and clinical symptoms such as high fever, the water intake should be increased, the urinary catheter should be held open for drainage, and broad-spectrum antibiotics should be used to prevent retrograde infection and pus accumulation in the renal pelvis.
The use of broad-spectrum antibiotics to prevent retrograde infection and pelvic pus.
Fourth, high fever
Patients with high spinal cord injury often have hyperthermia up to 40 degrees or more, but clinical examination did not find pneumonia or urinary tract infection, which is due to the loss of most sympathetic nerves after cervical cord injury, no sweating function below the plane of injury, so that the ability of thermoregulation is greatly reduced, resulting in hyperthermia. Therefore, the room temperature should be kept not too high, and ventilation and cooling measures should be taken in summer. Once the body temperature rises, you can use physical cooling methods, such as warm water baths, ice bags, fans and other cooling.
V. Bowel care
Defecation dysfunction is mainly manifested as a decrease in the number of times, often for several days without defecation. Measures to deal with.
1, adjust the diet. Eat more food containing more fiber, such as green vegetables and fruits, to stimulate intestinal peristalsis and promote defecation.
2, massage. Massage from the lower right to the left downward in the direction of the colon.
3.Use laxative and slow laxative, such as laxative, fruit seeking, and corkage.
The requirements for patients with spinal cord injury are generally kept once every 2-3 days. If there is fecal incontinence, feces soaking around the anus can easily cause erosion and induce bedsores. At this time, the skin around the anus should be treated promptly, washed and oiled with water, and if necessary, the area should be baked dry with an infrared lamp.
Six, prevention of disuse syndrome
1. Lung: the same measures to prevent lung infection. During the recovery period, if the patient’s condition allows, assist the patient to take a semi-sitting position and instruct the patient to do deep breathing exercises several times a day to exercise the lung function and increase the lung capacity.
2, urinary system: If the patient does not have symptoms of urinary tract infection, the ureter should be changed to open regularly, so that the bladder has expansion and contraction. This physiological stimulation helps to establish a reflex bladder and also prevents the formation of a contracted bladder due to long-term non-distension. After a few weeks, the urinary catheter is removed and the voiding function is trained. This can be done by applying gentle pressure to the lower abdomen with the palm of the hand to assist in urination. Through training try to achieve that the patient can urinate on his own when he is discharged.
3.Limb deformity: The most frequent parts of deformity are hip, knee, ankle and toe. The hip joint is prone to flexion, inversion and internal rotation deformity, which can be caused by posture and long-term inattention to passive movement of the hip joint in the early stage. Therefore, the hip joint should be moved to the maximum extent every day, paying attention to full extension and abduction to prevent joint stiffness, and later develop into contracture paralysis. The ankle and toes are prone to plantar flexion deformity, namely horseshoe foot and hammer toe, which becomes a great obstacle when moving down to the ground, and even requires surgery.
4, muscle atrophy: strengthen functional exercise, including the activities of paralyzed and non-paralyzed muscles and joints, with special emphasis on the active movement of non-paralyzed parts, such as using dumbbells or pulling springs to exercise the upper limbs and chest and back muscles, so as to prepare for crutches on the ground: at the same time, you can actively exercise the low back muscles in the supine or prone position. Start to sit up and leave the bed as early as possible after the disease is stabilized. With the help of the upper limbs and the upper body, practice standing and walking on the floor with the help of auxiliary tools, such as double bars, braces, four-legged crutches, etc. Through practice to enhance the ability of self-care, the patient can build up confidence.
Seven, pay attention to the patient’s psychological state, and do a good job of psychological care.