#株洲头条 ##湖南省直中医医院#
A stroke, also known as a stroke, is a serious medical emergency that is usually caused by a blocked or ruptured blood vessel in the brain.
Rehabilitation and care for early stroke are crucial as they can significantly impact the speed and extent of recovery. Below, experts from Hunan Provincial Hospital of Traditional Chinese Medicine will discuss in detail the rehabilitation and nursing strategies of patients with early stroke.
1. Good limb positioning
Correct positioning is one of the important measures to prevent joint contracture deformation, because the loose connective tissue around the surrounding joints will become dense connective tissue after braking more than 3 times, which can easily lead to joint contracture deformation [1].
(1) Supine position
This position is rarely used because it is affected by the cervical tension reflex and labyrinthine reflex, with the strongest abnormal reflex activity.
In the supine position, the shoulders are raised and raised, the upper arm is externally rotated and slightly abducted, the elbow and wrist are straightened, the palms are up, the fingers are straight and separated, and a pillow is placed under the upper limb and shoulder blades on the affected side for support; the lower limbs are flexed, the pelvis and hips are pushed forward, the thighs are slightly clamped inward and slightly internally rotated, and a pillow is placed under the hip joint on the affected side for support, and the feet are flat on the bed.
(2) Decubitus on the affected side
The shoulders of the affected side are forward, the elbows are straight, the fingers are open, the palms are up, the unaffected side is glued in front, supported by a pillow, and the lower limbs of the affected side are bent back and the soles of the knees and calves are kept as vertical as possible.
(3) Unaffected lateral decubitus position
The upper limb on the affected side is relaxed and stretched forward on two to three overlapping soft pillows above the level of the heart, the shoulders are extended forward, the elbows are straightened, the wrists are dorsiflexed, and the five fingers are extended, and the lower limbs of the affected side are slightly flexed anteriorly on the soft pillows, with the soles of the feet remaining perpendicular to the calf, and the healthy leg flexed naturally posteriorly [2].
2. Skin care - prevention of pressure ulcers
(1) Turning over: Most patients with hemiplegia cannot turn over on their own, and long-term bed rest will affect the blood circulation of the compressed part, resulting in ischemia and necrosis of local tissues in the bone protrusion site. Changing the patient's position regularly is the best and easiest way to prevent pressure ulcers. According to the patient's condition, it can be turned over once every 2-3 hours, and the methods of turning over include passive turning and self-turning.
(2) Passive turning method: The patient is unable to turn over on his own and is completely dependent on the help of others. Specific method: Move the patient to the side of the bed, so that the patient's legs are flexed, the family members put one hand on the proximal side of the patient's buttocks, and the other hand on the proximal patient's shoulder joint, the legs are lunged, and gently pushed forward to the distal side. This method is comfortable for patients, and it saves effort, time and control for family members.
(3) Self-turning method: In the early rehabilitation stage at home, self-turning method plays a vital role in the patient's recovery.
There are two specific methods, one is the elbow extension swing turning method, which is used for patients who can extend their elbows, and the steps are: (1) make the patient extend the elbows, (2) hold the hands crossed, and the thumb of the affected hand must be placed above the thumb of the healthy hand, (3) bend the knees, (4) first swing the stretched hands to the unaffected side, and then swing to the affected side in the opposite direction, and turn to the affected side by the inertia of the swing.
The second method is the healthy leg turning method, which is used in patients who cannot extend their elbows or their elbows cannot be straightened, by (1) bending the elbow and supporting the affected elbow with the forearm of the healthy hand, (2) inserting the healthy leg under the affected leg, and (3) moving the affected leg to the unaffected side while the body is rotating [2].
3. Passive activity training
It is suitable for hemiplegic patients who are unable to move their limbs, or who have limited limb movement due to muscle spasms.
(1) Objective: (1) To promote the recovery of paralyzed limbs, (2) to prevent limb stiffness and maintain joint mobility.
(2) Precautions: (1) Avoid severe pain; (2) Gentle and slow movement
(3) Next, we will introduce some simple passive activity training
a. Passive activity of shoulder joint forward flexion: During the operation, the patient takes the supine position, the operator stands on the affected side, fixes the palm of the affected side with one hand, makes the patient's thumb extended, the palm is inward, avoid touching the patient's palm, and holds the upper arm with one hand to do forward bending, and the shoulder of the patient in the soft paralysis stage does not bend forward more than 90 degrees to prevent shoulder dislocation.
b. Passive activity of elbow flexion and extension: the patient takes the supine position, the operator stands on the affected side, fixes the upper arm with one hand, fixes the palm with the other hand, extends the thumb, and the palm is upward, avoiding touching the patient's palm, and does passive activity of flexion and extension. The operation is gentle to avoid causing pain.
c. Passive activity of hip flexion and knee flexion: the operator stands on the affected side, supports the knee joint with one hand, and supports the heel with the other hand, and does hip flexion and knee flexion, hip extension and knee extension activities, and each action is repeated 3-5 times.
d. Ankle joint passive activity: During ankle joint passive activity training, fix the ankle with one hand and support the heel with the other hand to keep the ankle joint in a neutral position, and do dorsiflexion and toe flexion.
4. Psychological nursing
The patient's mental health is equally important during the recovery process. Psychological support can help people cope with frustration, anxiety and depression, and increase their determination and confidence to face challenges.
5. Conclusion
The rehabilitation of hemiplegic patients is a long-term and complex process that requires the joint efforts of the patient, the family and the medical team. Through scientific rehabilitation training and treatment, many hemiplegic patients are able to regain their ability to take care of themselves and even return to society. The important thing is to maintain a positive mindset and the motivation to persevere.
bibliography
[1] Huang Renjian, Tian Li, "Nurse Handbook" [M].Beijing:Jindun Publishing House,1999.634-635.
[2] Xie Jiaxing, "Family Rehabilitation Nursing for Stroke Hemiplegia Patients" [J].China Rehabilitation Theory and Practice,2002.8(2):116-119.
Source: Rehabilitation Treatment Center, Hunan Provincial Hospital of Traditional Chinese Medicine
Follow @Hunan Medical Chat to get more health science information!
(Editor YH)