The rapid changes in social life, the pollution of the environment horse clothes wasted scale aging, increased the incidence of cerebrovascular disease, people are increasingly threatened by this type of disease. Stroke is the world’s leading cause of death among people, according to research data in China, the number of new cerebrovascular disease is 1.5 million people each year, the number of people who die from cerebrovascular disease is 800,000 to 1 million people each year, second only to heart disease and tumor mortality, and for the number of more survivors of cerebrovascular disease, they rub 3/4 of the mouth to varying degrees of loss of life and labor capacity, to patients, the They bring great mental suffering and economic burden to patients, families and society. Cerebrovascular disease often causes paralysis of the patient’s limbs, resulting in deficits in the patient’s ability to care for themselves and affecting the patient’s quality of life; the patient’s aphasia causes communication barriers; the patient’s depression leads to a prolonged course of the disease; and the seriousness of the disease can lead to complications and even threaten the patient’s life.
The goal of our care is to enable patients to live independently. Help them, but don’t replace them. Remember, if the patient can do something by himself, no matter how much time it takes, let him do it by himself.
1. Patients with aphasia communicate
According to the literature, 57% to 69% of stroke patients are accompanied by language disorders. In daily life, language impairment seriously affects interpersonal communication between patients and others, making them lose their ability to work and live their daily lives, and requiring dedicated care for even the most basic living, which greatly affects the physical and mental health of patients and their families. The first step in caring for aphasic patients is to determine the severity of the aphasia and pay attention to the most effective means of communication that the patient still retains; secondly, the body caregiver teaches effective methods of communication with the patient.
Patients with aphasia and their families understand their needs through gestures and expressions. You can use objects, pictures, body language, writing, etc., combined with daily living habits to communicate and communicate.
(1) Gesture method: Agree with the patient on the intent of the gesture, for example, the upper thumb indicates stool, the lower thumb indicates urine; opening the mouth is eating, and turning the palm up and down is turning over. The hand behind the forehead indicates headache, and the hand moving in the abdomen indicates abdominal discomfort. Except for those with hemiplegia or bilateral limb paralysis and patients with auditory comprehension disorder, other aphasia can be applied.
(2) Physical picture method: Use some physical pictures to communicate simple thoughts to meet physical needs and solve practical difficulties. Use common objects such as teacups, toilets, bowls, human heads, hospital beds, etc., and teach patients to use them repeatedly. For example, a teacup means to drink water, a portrait of a human head means a headache, and a hospital bed means to turn over. This method is most suitable for communication of hearing impairment.
(3) Text writing method: It is suitable for patients with high cultural quality, no mechanical writing disorder and visual-spatial writing disorder. After recognizing the characteristics of the disease, medical staff and caregivers can express what they want in words, and teach health knowledge according to the condition and need.
2.How to help patients through frustration and depression
Stroke patients often have many doubts and thoughts; Is the stroke recurring? Is it going to die? Can they return to their original job? Certification is taking over their work or taking care of things? Are they disliked by others? All these worries can lead to anxiety, which is a normal reaction after a stroke. The changes in the stroke hand can be difficult at first, but then most patients and family members will gradually adapt. Each person will learn to relieve stress in ways such as listening to light music, taking a walk, or other leisure activities. Some specialists, such as psychotherapists, will also help you master appropriate relaxation methods.
Almost all people who have had a stroke have varying degrees of depression. Depression can stem directly from brain damage, or it can be a normal response to a major illness. Stroke patients feel sad about the loss of many functions, such as difficulty walking and speaking, and have impaired self-esteem and self-image. Patients feel they have lost control of their destiny and have difficulty doing DD for things they previously did not care about. It takes weeks or even months to adjust to this change. Therefore a period of depression is inevitable. Patients should be encouraged to talk about their emotions, such as fear, anger, sadness, and disappointment. Such emotions are not right or wrong, they are objective. Merely urging the patient not to be sad and upset is not very helpful to the patient. If the depression lasts for a long time, you can consult your doctor, ask for help from an experienced psychologist, or take antidepressants.
3.Stroke patient’s daily life arrangement
For patients with mild to moderate stroke, you can use the following techniques to achieve the goal of using your residual functions to perform daily life independently and to be able to do household chores, go for walks, and engage in appropriate social and recreational activities.
(1) Environment and dressing
Environment: clean → clean, clean → neat and simple, bright → bright light, fresh → fresh air; environment is clean, clean, simple, spacious and bright. Ventilation and ventilation.
Clothing: clothing should be wide, loose, smooth, easy for patients to put on and take off, comfortable to wear. In particular, the sleeves and trouser legs are fat, the front of the clothes open body, with Velcro instead of buttons and zippers. Add a small ornament to the end of the zipper on the pants for easy pulling. The waist belt and shoelaces should be replaced with elastic belts. Patients with clubfoot should choose to use leather shoes, the sole of the rear outer country to another reinforcement to avoid wear and tear.
(2) assistive devices: patients walking, choose a three-legged or four-legged cane is a more ideal tool to support walking. The cane handle should be wide and easy to grasp. The length is measured from the vertical distance from the small wrist transverse line to the ground with the patient upright and the upper limb naturally hanging down at the side of the body.
Bathroom installation of a firmly fixed bathing chair, the chair surface is selected in the shape of a strip to facilitate drainage. Prepare a long-handled brush and special gloves for bathing and back rubbing. The gloves have a loop on the wrist that can be hung on a hook after use. Toilet installation signal equipment so that patients do not feel well call for use.
(3) Hygiene: wash the affected hand with the healthy hand first, then scrub the healthy hand with a brush fixed on the sink coated with soap. Twisting towel: hang the towel on the faucet and roll it into a twist before twisting.
(4) Protect the feet: after a stroke, the patient’s walking posture often changes. Here the brain and nerve damage leads to limb paralysis, weakened muscle strength and reduced sensation. So these eventually lead to foot problems. However most of the problems teachers can avoid. The best way to detect abnormalities early is to check your feet daily. Check your feet for cracks, blisters, soreness, swelling and changes in skin color. You will also need some other help: for example, if you feel a loss of sensation in your feet, you may not realize that you have blisters or calluses on your feet; therefore, you need to have the soles of your feet checked regularly by a friend, family member or medical professional. Any signs of infection, such as redness, swelling, or oozing, should be told to your doctor when applied.
The right shoe is important: inappropriate shoes can bring many hidden problems that can cause foot disorders, including sprains, fatigue, sweaty feet, corns, calluses; for high heels, there will also be too much tension on the gastrocnemius muscle. If the stroke affects walking, you should buy the right shoes. Shoes should be made of natural raw materials, such as coarse cloth, which can easily absorb sweat. Avoid artificial materials, which are not breathable and can easily generate sweaty feet. The following suggestions will help you choose the right shoes.
Note when buying shoes: measure your feet beforehand and buy according to the shoe size of your big feet; don’t prop up the shoes (rather, be comfortable with your feet from the beginning); in the store, try on different styles of shoes (if you feel uncomfortable don’t buy them); wear shoes with a certain gap; shoes should be suitable for slightly larger feet; shoes should be high and short, fat and thin, and the heel should feel right. The ideal shoes should have: low heel, soft sole, lacing, deep sole round Tou, coarse cloth surface.
4, the care of stroke complications
(1) respiratory tract infection: can not effectively queue excessive secretions and flow into the pe lungs causing lung infection. Flat lying, the angle of the head of the bed is too low to increase the chance of reflux to the esophagus and secretion reflux into the respiratory tract. Combined with insufficient nutritional supply and low immunity of the body, these factors often lead to lung and bronchial infections. Combined with the application of dehydrating agents, sticky sputum, misaspiration of vomit, and posterior tongue drop, complications such as asphyxia and pneumonia are very likely to occur.
(2) The occurrence of pressure ulcers, also known clinically as pressure ulcers. It is one of the serious complications of stroke patients.
Pressure ulcers can cause osteomyelitis, septic arthritis, cellulitis, and even sepsis rapidly through superficial tissues due to infection, and these complications are often serious threats to patients’ lives.
Most pressure sores occur at bony prominences that are under pressure and lack the protection of adipose tissue and are not covered by muscle or have a thin muscle layer, such as the occipital ridge, auricle, scapula, elbow, vertebral body prominence, hip, sacrococcygeal, medial and lateral knees, internal and external ankles, and heel of the foot.
Pressure sore prevention measures.
The prevention of pressure sores requires “seven diligence”: diligent turning, diligent scrubbing, diligent changing, diligent tidying, diligent inspection, diligent accounting, and diligent massage. Change position regularly and turn over once every one to two hours. Use warm towels to scrub and massage the skeletal bulges under pressure at least 2 times a day. Massage with 50% alcohol or safflower alcohol for those who are thin; if the skin is dry and flaky, apply a small amount of lubricant to avoid dry cracking and bleeding.
②If the patient is incontinent in stool and urine, vomiting and sweating, he should be scrubbed clean in time to keep dry, change clothes and bed sheets in time, and the mattress should be soft, dry and flat.
③For bedridden patients with limb paralysis, equip the bed with air mattress to achieve the purpose of overall decompression. At the place where the skeletal bulge is easily pressurized, sponge cushion or cotton ring, soft pillow, air ring, etc. are placed to prevent pressure edema, obese people should not use air ring, better with soft cushion, or soft pillow placed under the leg, and elevate the limb and change the position, which is more important.
④ Care for patients with gentle movements, do not drag the patient to prevent joint pulling, dislocation or surrounding tissue damage. After turning over, carefully observe the skin condition of the pressurized area for signs that a pressure sore is about to occur, such as dark red skin. Check whether nasal tubes, urinary catheters, infusion tubes, etc. are dislodged, bent or pressed under the body. Move more gently when removing and placing the potty to prevent damage to the skin.
5. Stroke can happen again and the recurrence rate of stroke is high
Patients who have had a stroke have an increased likelihood of having another stroke, especially within a year of a stroke attack. The likelihood of stroke recurrence increases with age, increased blood pressure (hypertension), high cholesterol, diabetes, obesity, transient ischemic attack (TIA), heart disease, smoking, and alcohol abuse. There are some risk factors (such as age) that cannot be changed, while others can be reduced by taking medication or making lifestyle changes.
Patients and their families should get guidance from their doctor or nurse about preventing stroke recurrence. Patients and their families should also be aware of the risk symptoms of TIA (e.g., numbness in one limb, slurred speech) and see a doctor immediately if they occur.