With the continuous improvement of people's living standards in China, the incidence of cerebrovascular diseases is increasing year by year, and its sudden onset and critical condition are one of the main causes of human death and disability. Timely, effective and systematic nursing care of cerebrovascular patients is the key to reduce complications and mortality, which is discussed as follows.
Keywords cerebral hemorrhage; nurse
Clinical data of 1
From June 2004 to August 2005, 43 patients with cerebral hemorrhage were admitted to our hospital, including 30 males and 65,438 03 females, aged 40-83 years. At the time of admission, there were 5 cases of consciousness disorder, 38 cases of consciousness disorder, 5 cases of aphasia, 8 cases of unclear speech/kloc-0, and the remaining 20 cases of language disorder. All 43 patients have different degrees of hemiplegia of one limb.
2 nursing
2. 1 ordinary care
Keep the indoor air fresh, clean and quiet. In the acute phase, you should stay in bed absolutely and avoid carrying. Closely observe the changes of consciousness, pupil, vital signs, headache and vomiting, report to the doctor in time if any abnormality is found, and actively cooperate with the rescue. If the disturbance of consciousness deepens, the blood pressure rises, the brain beats slowly, the breathing is deep, slow and irregular, and the central high fever indicates continuous bleeding; Such as severe headache, frequent vomiting, irritability, slight breathing, accelerated deepening, rapid pulse, elevated blood pressure and body temperature, consider the precursor symptoms of encephalopathy; If one pupil is dilated, the light reflection slows down or disappears, suggesting the formation of encephalopathy; Needle-shaped size of bilateral pupils and eyeball fixation suggest pons cerebral hemorrhage. The coma patient's head leans to one side to keep the respiratory tract unobstructed. After fasting for 72 h, acute severe cerebral hemorrhage can be treated with gastric tube, low-fat and high-protein liquid and part of water, and those without dysphagia can be treated with low-fat and high-protein liquid diet. Arrange the use of dehydrating agent reasonably according to the doctor's advice, keep the vein unobstructed, and it is forbidden to overflow. The dehydrating agent should be given quickly, and the dripping speed of the rest intravenous administration should be controlled to prevent intracranial enlargement.
2.2 Nursing care to prevent complications
2.2. 1 Prevention and nursing of pulmonary infection Keep the patient's head tilted to one side, turn over and pat his back regularly after his condition is stable, and suck out respiratory secretions or contents by mistake with an aspirator. If the sputum is sticky and difficult to suck out, it can be inhaled by atomization. Keep warm to avoid catching a cold.
2.2.2 Prevention and nursing of urinary system For patients with urinary incontinence and urinary retention, indwelling catheterization should be carried out under strict aseptic operation, and the catheter should be kept unobstructed. Urine should be released every 4 hours 1 time, and the disposable urine bag should be replaced every day. The urethral orifice and perineum should be disinfected every day to keep the catheter unobstructed. The color, nature and quantity of urine should be observed and recorded, and urine culture should be done if necessary. After 7~ 14 days, the catheter was gradually clamped regularly to guide urination and exercise its bladder function.
2.2.3 Prevention and nursing of constipation People with a clear consciousness told him to eat more crude fiber food, vegetables and fruits, and to ensure that he drank 2000ml of water every day and defecated 1 time for three days. Constipation can be given circular massage of colon or laxative, and enema if necessary. At the same time, rinse around the anus with water after each defecation.
2.2.4 Prevention and nursing of bedsore Let patients stay in supine position, sleep on an air cushion bed, and put a soft pillow in the body gap. The bed should be soft, clean, dry, flat and free of sundries. Patients should turn over every 2 ~ 3 hours 1 time. When helping to turn over, the movements should be gentle, avoiding taking off, pulling, pushing and other actions to prevent scratching the skin. Regular warm water massage or 50% alcohol massage should be performed on the compressed and red parts of the body, and antibiotics should be applied locally to the damaged parts. Infrared radiation twice a day.
2.2.5 Prevention and nursing of central high fever When the temperature fluctuation of patients with cerebral hemorrhage is about 40℃, it is central high fever. In clinical nursing, we should use 50% alcohol or warm water to repeatedly scrub the large blood vessels on the forehead, top of the head or neck, armpit, groin and armpit, or put ice packs in these parts, or take medicine according to the doctor's advice, but we should pay attention to the life changes before and after cooling, strengthen basic nursing and prevent complications.
2.2.6 Nursing care of stomatitis Those with mild illness can brush their teeth before going to bed after meals; Patients with removable dentures should be removed and kept clean, and patients with coma and dysphagia should be given oral care twice a day; Breathers who open their mouths should cover their mouths with saline gauze and remove oral secretions in time.
2.2.7 Prevention and nursing of stress ulcer and bleeding in digestive tract. Coma and dysphagia patients can be indwelling nasal feeding tube and fed with liquid diet for 24 hours. When stress ulcer bleeding occurs, you should immediately tilt your head to one side, keep the respiratory tract unobstructed, and closely observe the changes of vital signs, especially blood pressure, to prevent bleeding. At the same time, people who have only a small amount of tar-like stool can eat liquid food, check their blood type and prepare their blood. Take norepinephrine orally when necessary, replenish blood volume in time, keep the balance of water and electrolyte, and cooperate with doctors to do corresponding treatment.
2.3 Functional exercise
2.3. 1 In the acute phase, prevention should be given priority (1) to maintain limb function. When taking the supine position, the upper limb pad on the paralyzed side is higher than the shoulder, the elbow is slightly flexed, the wrist and fingers are slightly extended, a gauze roll is held in hand, a small pillow is placed under the knee, and a sandbag is placed on the outside of the leg to prevent abduction and external rotation of the leg; Place pedals on the soles of feet to prevent feet from drooping and everting; The body positions that change with turning over are semi-lying position, lateral position and semi-lying position. (2) Passive posture: Carry out passive movement according to the range of joint activities, from the healthy side to the affected side, from the big joint to the small joint step by step, and pay special attention to the activities of elbows, fingers and ankles, because these parts are prone to stiffness, so do more exercise. Every time, each joint moves 5~6 times in each direction, 3~5 times a day. (3) Massage the affected limb gently and rhythmically to relax it, massage the extensor muscle combined with kneading, and massage the pectoralis major muscle to reduce its spasmodic contraction, so as not to interfere with the shoulder joint movement, twice a day, each time 15~20 min.
2.3.2 During the rehabilitation period, the affected limb should be trained in sitting, standing, walking and all kinds of daily training. When the patient can turn over on his own, he will change the training position to sitting position, hold the bed steady and droop his legs, thus increasing the muscle and ligament functions of the spine and hip joint and the ability of sitting balance. Standing training: first assist standing training, then bedside standing training, and stick to it step by step to prevent limb atrophy. Walking training: When the patient stands still 10~ 15 min without fatigue, walking exercise can be started.
2.3.3 Daily life training includes training for patients in diet, dressing, washing, going to the toilet and outdoor activities, so as to help patients build up confidence in their new life.
2.4 Psychological care of patients The sudden onset of cerebral hemorrhage and its sequelae have caused great psychological trauma to patients. In the acute stage, patients showed psychological problems such as anxiety and powerlessness, and the patients changed from health to paralysis. This change made the patient feel heartbroken and even had the idea of suicide. Some patients have strange personalities due to cerebral hemorrhage, which is difficult for their families to accept. In view of patients' various emotional reactions, we can fully understand their needs through talking notes and gestures, tell patients that dysfunction can be recovered after active exercise, and enhance patients' confidence in overcoming diseases.
2.5 Discharge Guidance Patients with cerebral hemorrhage have a long course of disease, and most patients are often discharged without full recovery. Nursing staff should teach their families to master certain nursing knowledge, such as the rest environment should be ventilated, transparent and quiet, the ground should not be too slippery, they should not live alone, their personality should be cheerful and optimistic, and their life should be regular; Diet should be low in fat, high in protein and rich in cellulose; Strengthen physical or language training; Family members should encourage and urge patients to take medicine, control blood pressure and prevent recurrence.
3 nursing experience
Cerebral hemorrhage, as a common nervous system disease that threatens the health of middle-aged and elderly people, causes sequelae such as limb paralysis, aphasia and psychological disorder. Through the active treatment of doctors, systematic nursing of nurses and close cooperation of patients and their families, the limb muscle strength, language function, defecation function and psychological state of the above 43 patients have been obviously improved. 32 patients can take care of themselves, 8 patients can return to work, 3 patients need life help, and none of them has complications. The healing of the disease directly affects the quality of life of patients. Drug therapy can only achieve a certain effect on patients with cerebral hemorrhage, and systematic nursing often has an ideal improvement effect on disease observation, prevention of complications and rehabilitation of diseases.