1, the bed unit settings
Bed unit settings for bedridden patients should try to consider the patient’s convenience, comfort, safety and other conditions, the width of the bed, depending on the needs of the patient’s condition, living habits, etc., usually wider than the general bed 10 to 30cm, the bed should be left next to put daily objects (such as glasses, watches, radios, combs, small mirrors, spittoon cups, etc.) Placement of bedside objects: such as small mirrors, can improve the interest of bedridden patients, see The environment around the room, expand the field of vision, through the mirror to see the outside “world” and into the room guests, so that the patient to build confidence in life, through the difficulties brought about by bed rest.
2.Basic care
(1) Morning care: It can promote the patient’s blood circulation and maintain oral hygiene, make the patient feel clean and comfortable, and help prevent complications; it can provide the basis for diagnosis, treatment and care plan by observing the progress of the disease. Contents include: cleaning of the mouth, face, hands, feet, skin, bed units, as well as hair combing (male patients shaving) and massage of pressure areas.
(2) Evening care: It can make the patient comfortable, clean and promote sleep. Make an evening care for the patient after dinner. Contents include: in addition to repeat the morning care content, give the patient back and buttocks, soak feet with hot water; female patients rinse perineum, cut finger (toe) nail (trimming nail shape should be the same as the fingertips, toes should be flat cut, cut after the application of control knife smoothing), make the bed. Pay attention to keep warm.
(3) assist the patient to eat: first urinate, wash hands, use a quilt or large pillow to note the patient’s waist, hands on the bed table, assist the patient to eat, wash hands after the meal and organize the supplies.
For those who can not take a sitting position to eat, can use the lateral recumbent feeding method.
3, the main comorbidities of long-term bedridden patients home preventive care
(1) Major comorbidities: respiratory and urinary tract infections, decubitus ulcers, venous thrombosis and secondary functional impairment.
(2) Prevention in home care
1) Placement of positions to prevent functional impairment
A. Prevention of foot drop: foot drop, also known as drooping foot deformity, is very easy to form in people with lower limb paralysis. The foot should be given support, such as the use of foot plate support, pillows and other things, so that the foot is at right angles to the leg and keep the dorsiflexion position to prevent heel bile contracture. When keeping the foot warm in winter, it should be noted that the quilt presses against the foot, and a brace or clean cardboard box can be used to support the quilt to avoid compressing the dorsum of the foot. Instruct and help the patient to exercise the ankle joint to avoid muscle atrophy and joint stiffness.
B. Prevention of knee deformity: Put a pad under the knee joint to prevent knee swelling and joint hyperextension (knee anteversion) for not too long. Daily, the pads should be removed to prevent knee flexion contracture.
C. Prevention of shoulder and hip joints
a. Lie flat: put a pad under the shoulder joint to prevent shoulder joint dislocation; put a towel roll on the outside of the leg and hip to prevent enough joint abduction and external rotation. Prevent the mattress from being too soft and the hip from sinking, which makes the hip in a flexion position for a long time and the flexion medullary deformity occurs. Once the patient can leave the bed and stand, the frontal joint of the body is flexed and cannot stand.
b. Hemiplegic patients lying on the healthy side: the upper limb of the affected side is inwardly folded and a mat is placed under the chest and elbow; the lower limb of the affected case is flexed and a mat is placed under the leg; a pillow is placed behind the back to prevent trunk spasm.
c. Hemiplegic patient lying on the affected side: the upper limb on the affected side is in the extended position, the upper limb on the healthy side is flexed in the chest, the lower limb on the affected side is flexed, and a mat is placed under the foot.
d. Semi-sitting position: both arms leave the trunk, upper limbs are slightly flexed, and a cushion is placed under the elbow to prevent shoulder joint inversion deformity8).
D. Exercise: Preventing joint stiffness, muscle atrophy, and disuse is an important condition to ensure joint movement when the rehabilitation period comes. It is important not to keep the muscles in a state of prolonged inhibition and to set up a joint exercise program according to the patient’s condition.
a. Passive exercise; when the patient is unable to perform active exercise, passive exercises in bed are performed.
Methods: each joint (upper limb: shoulder, elbow, wrist, finger joints; lower limb: pulp, knee, ankle, toe joints); each direction (back, left, right, up, down); the order of activities from large joints to small joints; movement amplitude (flexion, extension, rotation) from small to large; time: each joint movement in each direction 3 to 5 times, 1 to 2 times a day; speed should be slow, gentle, step by step and with massage.
b, active exercise: in the case of the condition allows, the parts that do not restrict the activity should be kept active, forging. Because activity can promote blood circulation, is the basic factor to maintain the physiological function of the articular cartilage surface, is an effective way to prevent degenerative changes in the joint surface.
Exercise content: upper and lower limb joints: according to the physiological range of activity, encourage patients to actively move and do L exercises; hand joints: make a fist and fully extend the fingers; foot joints: ankle force dorsiflexion, toe extension and flexion activities. And often maintain the training of fine hand movements, such as writing, eating with chopsticks and other actions
4.Oral care and prevention of respiratory tract infection
Bedridden patients are weak, immune system is weakened, resistance is reduced, the defensive function of the respiratory tract and lungs is reduced or diminished, prone to aspiration and pneumonia. Chronic patients who are bedridden for a long time, the bacteria carriers in the oral cavity than. Wang normal people , the carriage rate of conditionally pathogenic bacteria in the oral cavity is also higher than normal people. The oral cavity is one of the ways for pathogenic microorganisms to invade the organism, and the inhalation of bacteria from the mouth and pharynx is the main way to produce bacterial pneumonia.
In oral care, it is important to note the relationship between brushing and rinsing. For bed-ridden patients, sometimes rinsing the mouth seems more important than brushing the teeth. Therefore, bedridden patients are required to rinse their mouths after meals (or after drinking milk or drinks); patients who are seriously ill or have difficulty swallowing (stroke, cerebral palsy, post-operative oral tumors), etc., and who cannot rinse their mouths themselves due to illness or other reasons, can use the method of drinking water instead of rinsing their mouths after meals, and if necessary, community nursing clays need to do it themselves or instruct their families to do oral care. The method of gargling is to take a mouthful (about 10ml) of warm water to rinse the upper and lower teeth and the left and right of the mouth with water. After rinsing, brush the teeth to clean the residue on the tooth surface and inside the teeth. After brushing still need to rinse the mouth, the purpose is to brush out the residue on the tooth surface and inside the crevice by rinsing the mouth, clear out of the mouth (after thoroughly cleaning the toothbrush, the toothbrush should be placed upward to keep dry). Gargle, brush teeth after gargling should drink one to two mouthfuls of warm water to rinse the throat, the purpose of which is to reduce the number of the total number of bacteria in the area is diluted bacteria swallowed to the stomach by gastric acid to kill. It is also best to drink one to two mouthfuls of warm water after urination at night, susceptible children and the elderly who have been out for too long, should also rinse their mouths after returning home, and then drink l to 2 mouthfuls of water, the purpose of the same. In the case of patients with diseases that restrict water intake, the total amount of water can be used throughout the day to control the total amount of water, divided into several times, a small amount of water to achieve the purpose of cleaning the mouth and preventing respiratory tract infections.
5. Skin care to prevent bedsores
For patients who are paralyzed or have difficulty moving around in bed, they should be turned regularly and have a specific turning plan, once every 2 hours during the day and no more than 3 hours at night. The plan can be written on paper and hung on the wall, and a form can be used to keep track of the implementation of the plan. Turning at night can be arranged according to the sleeping habits of family members or caregivers, such as family members go to bed at 11 pm, turn the patient before bedtime, who gets up at home before 2 am, turn the patient once again by the night riser, and turn the patient once before 5 am until dawn. Before turning over, you should pat the back and tell the patient to cough, then let the patient drink l to 2 sips of warm water, and then turn over. Every time you turn the patient, you should check the bony prominence under pressure so that you can know the skin condition in time and deal with the problem in time. For the pressurized bony prominence, local massage or air cushions should be used to prevent decubitus ulcers.
For patients who can move around in bed, a care plan for self-turning should be developed and instructed according to their condition and tolerance. The plan should be realistic and the training should be gradual. Methods; Turning is done during the day using the time for urination in the morning, before meals in the morning, midday and evening, before and after naps, and at night before bedtime. Night leaves according to sleep habits and the number of urination to increase 1 to 2 times.
6.Care measures for patients with urinary and fecal incontinence
Long-term bedridden and suffering from incontinence, home care for infectious diseases should be timely anti-infective treatment, good psychological care is essential (patients and family members), basic nursing skills are also very important. First of all, we should analyze the patient’s age, condition, reason for incontinence, time of day (morning, evening), etc., and develop a customized care plan based on the analysis.
If the patient is awake, but weak, involuntary excretion of urine and feces, the family handler can be informed that such cases can reduce the number of urine and feces in bed by observing the patient’s diaphoretic pattern and then arranging the diaphoretic care plan according to the pattern setting, to achieve purposeful and prepared active care. If the patient is demented, the treatment of urinary incontinence can also refer to the above method, if the effect is not good, can be placed in bed (for those who do not wear underwear) or underwear in the perineum absorbent pad, the material can be used sponge-type absorbent items, wrapped with pure cotton cloth outside to absorb urine. The pad should be changed promptly to avoid dermatitis or other infectious diseases caused by urine irritation of the skin.
If the patient can move his upper limbs and is conscious and can cooperate with the care, positive language guides can be applied in psychological care to encourage the patient to care for himself and reduce the care of family members or others. Specific methods: A special commode (small and convenient) can be placed next to the bed where the patient can reach. Completing self-care will give the patient confidence and improve the patient’s quality of life and psychological state. Other problems with second stools can be referred to home bladder removal care and bowel care.