Care and rehabilitation of cerebrovascular disease
Nursing care for cerebrovascular patients focuses on observation of consciousness, observation of cerebral herniation and prevention of complications. The observation of cerebral herniation is mainly to
Observation of pupil changes and reaction to light; prevention of complications mainly requires diligent turning and back tapping, attention to sputum aspiration to prevent pulmonary complications, observation of vomitus.
and color of stool to prevent gastrointestinal complications and to prevent decubitus ulcers. Acute care of cerebrovascular disease mainly includes.
(1) Create a good indoor environment, keep quiet and make them feel comfortable.
(2) Closely observe changes in the condition, pay attention to changes in consciousness and pupils, and monitor vital signs.
(3) Change the patient’s position regularly to prevent decubitus ulcers.
(4) Pay attention to the patient’s cleanliness and hygiene.
(5) Eat and drink reasonably.
(6) Prevent disuse syndrome and perform more passive movements of all joints. Cerebrovascular patients have reduced salivary secretion and sticky saliva or because the residue of facial paralysis tends to stay in the cheek on the side of the lesion, which often leads to bacterial or mycotic infection and complications such as oral ulcers, mumps, and upper respiratory tract infections, so oral hygiene should be paid attention to and oral care should be strengthened.
How should cerebrovascular patients take care of themselves at home?
The home care of cerebrovascular patients includes.
(1) Family members should take care of the patient patiently and actively help the patient to build up confidence to overcome the disease.
(2) Pay attention to diet and ensure adequate calorie supply.
(3) Changing positions frequently to prevent complications such as bedsores and pneumonia.
(4) Strengthen language training and passive movement of the affected limbs to promote functional recovery.
(5) Carefully observe changes in the condition, and when you find that the patient’s consciousness, language or the function of the affected limb is getting heavier, promptly ask the doctor for treatment.
How to care for and treat bed sores in patients who are bedridden for a long time?
Decubitus ulcers are a common complication in cerebrovascular patients due to long-term pressure on local tissues, impaired blood circulation, persistent local tissue ischemia, and tissue necrosis formed by malnutrition. The treatment care methods often adopted clinically are as follows.
(1) First, keep the bed dry, flat, and free of crumbs, and pay attention to not contaminating the sore surface with urine or stool to prevent decubitus ulcer infection.
(2) Try to keep the sore side of the bed as little as possible to avoid aggravating the pressure on the sore surface again.
(3) Treatment should be given according to the specific conditions of the sore.
Why is psychological rehabilitation treatment important for cerebrovascular patients?
Some cerebrovascular patients are treated and their lives are out of danger, but they are left with sequelae such as hemiplegia and aphasia, and psychological changes may occur. Some are afraid that the disease will not be cured and death will come at any time; some are pessimistic and disappointed, thinking that they have become cripples and the meaning of life is over, losing confidence in life and even the idea of light life; others think that they cannot take care of their own clothes, food, housing and transportation and have become redundant people and burdens in the society and family.
All these psychological barriers will not only affect the effect of drug treatment, but also not conducive to the implementation of rehabilitation training, therefore, psychological rehabilitation treatment should be actively carried out.
What are the possible sequelae of cerebrovascular patients?
The sequelae of cerebrovascular patients are mainly hemiplegia and aphasia (loss of language function), with hemiplegia being the most important and common sequelae, which has a great impact on patients’ lives. In addition, hemiplegia, swallowing difficulties, choking and coughing, gait disorders, slurred speech, epilepsy, incontinence, mental and memory loss, dementia, personality changes, etc. are also sequelae of hemiplegia.
Why do hemiplegic patients need rehabilitation treatment?
Patients with hemiplegia can promote functional recovery and give full play to their residual functions through appropriate rehabilitation therapy in order to strive for self-care and return to society. Rehabilitation training can help establish the lateral circulation of the brain and improve the blood circulation and oxygen supply of the brain, and promote the normal recovery of self-regulation function. It has been proved that those who can adhere to rehabilitation training can not only prevent muscle and joint atrophy, but also enhance the patient’s responsiveness to the outside world, which is important to improve the patient’s quality of life.
How to perform passive exercise for cerebrovascular patients?
Passive exercise should be performed in sequence, with large joints moving first, followed by small joints. The amplitude of movement should be from small to large, trying to extend straight and flex fully, and should do flexion, extension, adduction, abduction, rotation and other movements according to the normal mobility of each joint. For example, the shoulder joint should be forward flexion, backward extension, abduction, adduction, rotation and supination. The forearm should be internally and externally rotated; the elbow joint should be flexed, extended, rotated forward and backward; the hand and fingers should be flexed and extended, and the fingers and thumbs should be used for finger-to-finger and finger-to-finger movements; the hip should be internally rotated, externally rotated, internally rotated and externally rotated; the knee joint should be flexed and extended; the ankle joint should be dorsiflexed, internally and externally rotated; the toes should be flexed and extended, etc.
At the same time, attention should also be paid to slow and gentle movement, to be rhythmic, to avoid forceful pulling with violence and do strenuous exercise, so as not to cause joint and muscle damage and cause pain. If pain occurs, the amount of exercise or range of motion is too large and should be controlled appropriately.
How to perform active exercise for cerebrovascular patients?
In patients with incomplete paralysis or complete hemiplegia, as the condition stabilizes and muscle strength progresses, the patient should be encouraged to take the initiative to do functional exercises to restore muscle strength, increase the range of motion of joints, and improve the coordination of limbs and muscles. Active exercise should be done in different ways according to the patient’s muscle strength. The general principle is to train movements from simple to complex, and gradually expand the range of activities.
From a single joint to the overall activity, from short to long time, strength from weak to strong, step by step, do not be too hasty. And should be well protected to avoid joint and muscle damage. Patients who cannot get out of bed should abduct the shoulder joint by themselves, and also do backward movements, flex and extend the elbow and wrist joints, and do fist clenching and palm stretching exercises. The lower limbs should insist on abduction and internal rotation exercises and flexion of the lower limbs to exercise the muscle strength of the lower limbs and the function of the joints. Patients with hemiplegia generally recover the function of the lower limbs faster than the upper limbs, so it is more important to carry out functional exercises of the lower limbs as early as possible. When practicing walking, the patient can first step in place, and then practice stepping.
If the patient has difficulty in lifting the foot, tie a rope on the patient’s foot and let the supporter help to lift the foot and step, and gradually transition to supporting the object by oneself. As the condition improves and muscle strength progresses, the patient can eventually walk on foot. In addition to the necessary extension and flexion movements, the patient’s upper limbs should also be exercised to push, pull and grasp objects. When the elbow joint is flexed, the patient’s upper limb can be used to hold round objects, pull and stretch the upper limb, or frequently shrug the shoulder, rotate the shoulder joint and pat the object with the affected hand.
How to give massage to hemiplegic patients?
Massage parts and scope: Generally speaking, massage should be given to the affected limb wherever it can be massaged. The order can be started from the head, using the thumb to knead the patient’s head 5 times, using the hand to knead the patient’s upper limbs 5 times, and then using the fingers to do the popping method in the tendon area 1 to 2 times. At the same time, twist and knead and move the finger joints. Lower limb flexion several times, and use the thumb to rub the back of the foot between the toes several times.
Massage time and power, should vary from person to person. The power of massage should be light and the duration should be short for those who are older and weaker, on the contrary, for younger and heavier hemiplegic patients, the intensity of massage should be large and the duration should be long, while each massage generally lasts 20-30 minutes, once a day, 15 days as a course of treatment. If the patient has dizziness, heartbeat, cold sweat and shortness of breath during massage, stop the massage and rest in bed.
What should I pay attention to when walking training for hemiplegic patients?
When walking training for hemiplegic patients, attention should be paid to.
(1) The preparation work should be done before walking, including psychological preparation and balance training. Psychological preparation: For patients who are seriously ill or bedridden for a long time, they should prepare themselves mentally before walking to avoid mental tension. Balance training: start sitting in bed, later sit with legs down on the side of the bed, then later sit in a chair, each time can insist on 10min, then practice standing balance, and finally walking practice.
(2) Walking training includes standing training, stepping exercises and up and down steps exercises, pay attention to each step should be gradual, not too hasty, the beginning have to have an assistant to assist, strictly prevent falls. If the patient’s blood pressure is more than 200/120mmHg or less than 80/50mmHg, accompanied by headache and dizziness, the exercise should not be carried out.