a stroke patient. After treatment, she still has sequelae such as language barriers, sensory barriers, and motor barriers. It is difficult to recover and increases family pressure. So, how to scientifically care for patients with stroke sequelae like Aunt Zhao?
Most patients with post-stroke sequelae are prone to negative emotions due to dysfunction, inconvenient physical activities, and even inability to take care of themselves, which have adverse effects on organs and bodies. Therefore, it is necessary to understand the emotional fluctuations of patients and carry out psychological counseling as soon as possible. However, some patients have self-abandonment emotions, especially those who are difficult to take care of themselves, and are prone to fear, anxiety, and even suicidal tendencies, which is not conducive to medical institutions to carry out rehabilitation care. At this time, the nursing staff should change the traditional nursing concept, be friends with the patient, and maintain a good relationship between nurses and patients; deeply analyze the patient’s thinking, show respect and understanding for the patient’s emotional fluctuations, encourage them to deal with life with a positive, tolerant, and open-minded attitude, and help Solve practical difficulties. In addition, it is necessary to carry out exercises for specific symptoms of patients with stroke sequelae, which can help improve mood.
intervention Prepare fresh fruits and vegetables and high-protein foods for patients with stroke sequelae. For patients with swallowing reflex disorder, prepare semi-liquid food for them to avoid choking, and help patients rinse their mouth after meals to avoid residual food in the mouth; for patients with constipation, ask their family members to prepare high-fiber food; Families prepare low-salt food. No smoking and alcohol.
Physical exercise It is extremely important for patients
with stroke sequelae to carry out functional exercise. The initial movement is mainly passive movement, and then gradually transitions to active movement. When assisting patients to carry out passive movements, focus on exercising large joints such as shoulders, elbows, hips, and knees, and exercising the affected limb from bottom to top. After helping patients to carry out knee flexion and extension exercises, instruct them to do leg raising, hip raising, and knee bending exercises; carry out fine movements of large joints, such as wrist rotation, fist clenching, and ankle dorsiflexion and other distal movements.
Generally speaking, when the upper limbs are passively moved, the shoulder movement is carried out first, and the family members are instructed to hold the patient’s shoulder with one hand and the patient’s elbow with the other hand, and perform upper arm abduction, adduction, and up and down movements. Attention should be paid to gentle movements to avoid muscle relaxation in the area adjacent to the shoulder joint, resulting in joint dislocation and damage. When passively moving the forearm, the family members support the patient’s wrist with the palm of one hand upward, and support the patient’s elbow joint with the other hand, flex and extend the forearm, and perform internal rotation movements at the same time. Next, carry out passive hand movements. Instruct the patient’s family members to hold the patient’s wrist area with one hand and the patient’s fingers with the other hand, and carry out wrist joint and finger flexion and extension exercises. When the lower limbs are passively moved, first carry out the hip joint movement, flex the hip joint of the affected limb, then instruct the family members to place one hand on the knee joint of the affected side, and place the other hand on the hip to assist the patient to rotate left and right; On the patient’s ankle, pinch the toes with one hand to assist the patient in the movement of the dorsum of the foot and rotation. Note that during the passive movement of the patient, massage care should be done to restore the function of the affected limb.
Assist the patient in active movement. It can not only prevent complications such as pulmonary infection and decubitus, but also maintain the balance of extensor and flexor muscle tension in the patient’s limbs, which is beneficial to the prevention of limb spasms. The active exercise program is as follows: First, carry out sitting balance training. Note that postural hypotension may occur when you sit up for the first time. At this time, you can slowly raise the head of the bed and gradually transition to sitting exercises; after you can adapt to active sitting exercises, start balance exercises and endurance exercises. The patient can complete the dynamic standing balance exercise independently, and the weight of the affected leg is more than half of the body weight, and the walking exercise can be carried out after the patient can move forward. Encourage the patient to step forward alternately with both legs, and pay attention to controlling the transfer of the body’s center of gravity. After completing the above exercises, carry out exercises such as turning around and going up and down stairs.
language function training
Patients with post-stroke sequelae may have language barriers, that is, slurred speech, slurred pronunciation, and abnormal expressions. At this time, in order to avoid being teased by others, the patient often subconsciously overcomes the language barrier, which instead aggravates the tension and forms a vicious circle. Over time, patients may develop a sense of inferiority complex. Therefore, it is extremely important to carry out language function training for patients with stroke sequelae. You can use short words to communicate with patients, leave enough time for them to answer relevant questions, and ask whether there is a willingness to speak. For patients who are impatient because they are difficult to express their intentions fluently, they should be comforted and instructed how to answer, and writing and body language can also be used to make up for language defects. Some patients with language impairments have inaccurate intonation. At this time, family members should be encouraged to guess and correct their pronunciation, and take practical actions to tell the patient that his words can be understood and improve their confidence in recovery. Rehabilitation care for stroke sequelae takes a long time, and patients and their families are prone to lose confidence. Therefore, we should tell them the importance of rehabilitation care.
Nursing of complications
(1) The patient may suffer from secondary limb paralysis, difficulty in defecation and defecation, and needs to be taken care of by family members, often accompanied by pessimistic and world-weary emotions. A quiet and comfortable recuperation environment can be arranged for such patients to alleviate their physical and mental fatigue; at the same time, family members should pay more attention to and enlighten patients, and carry out life care such as scrubbing, eating, washing, and defecation, so as to enhance patients’ awareness of recovering their ability to take care of themselves . Help patients move their toes more, because the toes are the end of the lower limb movement, as long as the toe movement sensation can be restored, the recovery of the lower limb movement sensation can be promoted. During exercise, family members can be instructed to hold the patient’s toes, so that the patient can feel the dorsiflexion and stretching of the toes, 2 to 3 times a day. After the patient can feel the dorsiflexion and extension of the toes, he can gradually increase the exercise intensity with the assistance of his family members; after he can complete the ankle joint and toe exercises, he can carry out the entire ankle dorsiflexion exercise and persist every day. In addition, patients with hemiplegia do not only carry out toe and ankle exercises, but also carry out internal and external rotation exercises of knee joints and hip joints, as well as upper limb joint exercises when conditions are ripe, so as to shorten the recovery time. (2) The patient may develop decubitus ulcers, which is related to the long-term pressure on the local tissues during the paralyzed bed rest, resulting in obstruction of blood supply. The nursing plan for such complications is as follows: keep the bed surface flat and dry, assist the patient to turn over once every 2 hours, prepare a sponge pad and place it on the bony prominence of the patient, so that the compressed position is suspended in the air. (3) The patient may develop secondary urinary tract infection. At this time, the perineum should be cleaned well and the patient should be given adequate water.
Precautions for rehabilitation exercise
Due to the slow recovery of various dysfunctions in patients with stroke sequelae, they are prone to negative emotions such as depression and anxiety, and even lose confidence in life. Therefore, during the rehabilitation nursing period, it is necessary to obtain family support and cooperation, and to improve the rehabilitation exercise program in combination with the actual situation of the patient, so as to improve the patient’s tolerance and enhance the rehabilitation effect. In addition, stroke patients should pay close attention to fluctuations in their condition during functional exercise to avoid overwork; family members should accompany them throughout the exercise to prevent accidental risk events such as falls; patients should be encouraged to persevere and not to give up or stop exercising at will.