Clinical data of 1
All the 39 patients met the diagnostic criteria of hypertensive cerebral hemorrhage [1], including 22 males and 7 females 17, aged 45-76 years, with an average of 56.2 years, of which 24 were 5 1-60 years old, accounting for 6 1.5%, and under 50 years old. Among them, there were 35 cases of first stroke, accounting for 89.7%, and 4 cases of second stroke, accounting for 10.3%. Treatment results: 365,438+0 cases basically recovered (conscious and paraplegia basically recovered), 6 cases partially recovered, and 2 cases died of cerebral hernia.
2 nursing experience
2. 1 psychological nursing All the patients in this group are middle-aged and elderly patients, and they often feel anxious, fearful and lonely because they lose their ability to take care of themselves after onset. Because of the long course of the disease, patients are often depressed or irritable, and these unfavorable factors hinder the recovery of the disease. Nurses must be compassionate, on the one hand, actively treat and carefully care, and take the initiative to care for and considerate patients. On the other hand, do a good job in the explanation and publicity of diseases, often comfort and encourage patients to correctly understand diseases, answer all questions raised by patients realistically and appropriately, grasp patients' psychological needs in time, encourage patients to establish confidence in overcoming diseases, mobilize potential strength, and make all nursing work go smoothly.
2.2 Professional nursing
2.2. 1 Nursing of limbs and skin Patients' wrists and ankles should be placed in joint functional positions, and the compressed parts of each joint should be supported by cotton pads, and low-amplitude and slow-motion posture changes and skin massage should be given regularly; When turning to the healthy side, support the affected limb with a pillow to prevent joint stiffness. However, you can only move your shoulders and hips in a small range within 24 hours of onset, so as not to affect your head due to turning over.
2.2.2 Observation of illness When using dehydrating agent, we should maintain rapid intravenous drip or push injection to ensure hypertonic dehydration in the body, observe the changes of blood pressure and urine volume at any time, record the 24-hour fluid inflow and outflow, regularly measure T, P, R and BP, closely observe the changes of illness, and closely observe the degree of patients' consciousness disturbance, such as drowsiness, drowsiness, coma and deep coma. Pay attention to the changes of vital signs, consciousness and pupils. Conscious state is an important basis for judging the therapeutic effect. Prevent intracranial hypertension and brain edema.
2.2.3 Patients with unobstructed defecation often have constipation, urinary retention or urinary incontinence, especially when using dehydrating agent and without catheter, which is more likely to cause patients to be restless and even induce rebleeding, and should be given corresponding care. When defecation is not smooth, senna decoction can be given to promote intestinal peristalsis, eliminate intestinal gas accumulation, and clean enema can be carried out when necessary. In case of urinary incontinence, catheterization and indwelling should be carried out strictly under aseptic operation, and the color, quality and quantity of urine should be observed at the same time to prevent the catheter from falling off, so as to avoid urinary tract infection caused by repeated intubation.
2.2.4 Strengthen Oral Care Coma patients should be given oral care as usual, 2-3 times a day, while sober patients can gargle with physiological saline or Dobbin solution through straws, 3 times a day to prevent coughing.
2.3 Diet Care Most patients have difficulty chewing or swallowing. Eat and drink slowly to prevent choking. When vomiting, the vomit should be removed quickly. Nasal feeding should be carried out when necessary. The food should be a fruit juice diet with high calorie, high protein and high vitamins. Before eating, check whether the gastric tube is in the stomach, eat a little more, and the interval is less than 200ml at 38℃. At the same time, the intake of sodium salt should be strictly restricted.
2.4 recuperation nursing recuperation is mainly to promote the functional recovery of paralyzed limbs, starting with massage and passive exercise, three times a day, each time 15min, and then gradually increase the activity. When the patient actively moves, obstacles should be removed from the activity area, and bed bars should be added at night to prevent him from falling off the bed. Go out with someone. If the condition permits, patients can be encouraged to take a walk, play Tai Ji Chuan and other appropriate physical exercises. Aphasia patients should actively carry out speech training, language stimulation should be carried out in daily activities as much as possible, and patients should be encouraged to actively find the most effective communication methods, such as gestures, pictures, words or words. Training enlivens the atmosphere, patients get emotional support and encouragement through mutual help, which promotes language communication and ensures the continuity of patients' recovery after returning home. Adhere to/kloc-0 twice a day, each time 1 hour.
3 abstract
The nursing work of hypertensive cerebral hemorrhage is meticulous and arduous, which is related to the life and death of patients. Nursing work should have a high sense of responsibility and skilled skills, closely observe the changes of illness and pay attention to the observation of vital signs. Careful nursing, preventing complications and promoting the recovery of body function are of great significance to improve the treatment effect and reduce disability. Reasonable diet, combination of work and rest, relaxed and happy mood, reasonable oral antihypertensive drugs and regular blood pressure measurement can greatly reduce the occurrence of cerebral hemorrhage.