One of the most severe states in neurology is a stroke. What is it, what are his consequences and how to help patients who have moved it?

What is a stroke?

Under stroke, currently understand the acute developing resulting thrombosis or narrowing of the brain vessels.

Two main forms of stroke are distinguished - hemorrhagic and ischemic.

Hemorrhagic stroke is characterized by hemorrhage in brain tissue. Develops sharply. Most often, the cause of its development is hypertensive disease. It is characterized by acute beginning, rapid loss of consciousness. The brain tissue depends on the massiveness of hemorrhage (the sooner bleeding will be stopped, the more favorable forecast).

In turn, develops gradually, against the background of atherosclerosis of the brain vessels and ischemic heart disease. It takes more favorably than hemorrhagic form.

The period of rehabilitation after the transferred stroke is quite heavy for the patient. With unwise of relevant assistance, the risk of irreversible violation of all the functions of the patient's body is high.

Rehabilitation period after stroke

As you know, no matter how heavy stroke is, with properly organized assistance, the patient has the likelihood of a complete restoration of the patient's vital activity with the return of it into the sphere of society.

The most important thing in this period is the compliance with certain rules, principles and norms in communicating with the patient.

First of all, it should be borne in mind that a stroke developed in a person and which part of the brain is damaged, because the clinic of defeats of different hemispheres differs from each other.

It should be remembered that all events and exercises must be carried out consistently according to the plan. Only then, care for patients after a stroke will be the most complete and will allow the victim as quickly as possible to stand up.

It should always be remembered that the treatment of stroke - the process is not one-day and not a week; Only persistent and proper treatment will be effective and will lead to proper recovery.

Drug therapy

Medicase treatment after a stroke is prescribed already in resuscitation. The accuracy and correctness of the administration of doses makes it possible to bring the patient from the coma and limit the lesion zone during hemorrhagic stroke (with ischemic stroke - restore brain circulation).

After the patient's transfer to the separation, supporting therapy is assigned to it, allowing to consolidate the results achieved. It should be carefully traced that the patient helps all the medicine assigned to it. If he cannot take them on his own, you need to help him in this (sometimes support my head, help swallow, crush the tablet to the powder state).

Treatment after a stroke at home begins after discharge. Help the victim should be the same as in the hospital (support the patient, tilt it, submit water). In no case can not allow the patient to miss the reception of drugs.

Food

This factor is one of the most important in the period when active rehabilitation occurs after a stroke.

It should be remembered that because of the developing disease, most patients lose the ability to independently power. It is necessary to actively help them in meals (in the initial stages to maintain a plate and spoon, prevent patients accumulation). Subsequently, when he himself can try to serve himself, it is necessary to ensure that the patient eats, and if necessary, help him.

Patients after stroke need proper healthy nutrition. The human diet should be filled with vegetables and fruits, meat. Only then ensures the most effective restoration of the affected brain areas.

From everyday use, all products that increase blood pressure should be eliminated, as well as sharp, smoked. Do not feed patients with bulk products, as it is highly risk of their breathing tracks.

Prevention of infectious diseases

As it is known, laying patients belong to the category of severe and enter the risk group for the development of infectious diseases. Such patients often appear straggle - local areas of inflammation and necrosis. Especially in the case when the patient has been lying in the same position. Because of this, in places of bone protrusions, blood and lymph occurs, which leads to maceration, infection and necrosis.

Care for patients after a stroke in this situation should include daily hygienic wipes (if possible - using a bath or soul). The sick bed is recommended to change as often as possible, do not allow formation on it. After each meal, it is desirable to shake it to remove fallen crumbs.

Another fairly frequent complication of lying patients is pneumonia. To prevent its development, it is recommended to avoid hypothermia of patients (as well as overheating). The periodic ventilation of the room is shown, careful cleaning. In order to prevent prevention, you can ask the doctor a recipe for injection or oral antibiotics.

Restoration of motor functions

This group of activities is appointed in the case when there are certain motor disorders.

Care for patients after a stroke complicated by impaired limb functions includes assistance in the development of affected hands and legs, restoring the total volume of active movements.

At the initial stages of the patient teach to keep objects. Over time, it is possible to work with shallow motility (crossing coins or keys, opening of locks).

Not always movement can be restored completely. Despite this, all efforts should be aimed at returning the patient to society.

If the lower limbs were affected, the recovery after the stroke begins with the workout of the steps. It is best to spend it lying in bed.

Start exercises with imitation steps. Over time, when the patient gets to "walk in bed", if he can not sit, then help him rise, and he spends further training in the sitting position.

Recovery of speech

Quite often in patients who have undergone strokes, speech disorders are observed. They can be as minor (light whisper or swallowing letters) and completely depriving patient speech (up to the publication of individual sounds).

On the other hand, the patient may not be aware that he is said to be written on a sheet of paper. In this case, there is a sensory aphasia, to cope with which is much more complicated than with a violation of speech.

Restoration after a stroke, accompanied by loss of speech, should begin with conversations with the patient. If the patient understands what they say, he can attempt to answer or simply reproduce the same words. However, when the sensory amphias developed, the patient needs to be learned everything again - to explain the letters of the alphabet, show how they are written.

Over time, the speech after a stroke will begin to recover. The main thing is not to drop attempts taken and stubbornly go to the end.

Psycho-emotional disorders

Unfortunately, many people who have undergone a stroke belong to the risk of data on the development of complications. After all, any disease for a person is stress, and here there is almost complete shutdown of a person from society. Against this, many patients who aware of their condition are closed in themselves, they are protected by the seemingly helping their relatives.

All this adversely affects the treatment and leads to a delay of complete cure.

In this case, the restoration after a stroke should be combined with active communication with the patient. It is necessary to periodically tell him something funny, help dispel. Only then a person stops closing in himself, seeing what else someone is needed. His mood improves, interest in life appears.

You should not try to raise your mood to a patient with medicines - there is a risk of developing severe postmedicamental depression. It is much easier to show the patient that they care about him, they love him, and then a person after a stroke will faster on the amendment.

Neurological violations

Many strokes are accompanied by a violation of the sensitivity of the affected limbs. Sometimes there is only a decrease in the painful threshold; Anesthesia (complete sensitivity violation) and paresthesia (sensation of goosebumps or chill) can be celebrated.

In this case, rehabilitation after a stroke may be useless, and with the entire remaining life will have to put up with the disorders. In order to increase the sensitivity, physiotherapy is recommended - Bioptron lamp, pulse currents. In some cases, the restoration of sensitivity was observed (if the lesion focus in the brain was not extensive).

Sometimes there may be the appearance of pathological reflexes (for example, a grabbing reflex, which is present in newborns to 4-5 months, should not appear in an adult). If you have noticed that the patient's hand after a stroke began to shrink down when touched on it, it should either wait for a while (as the reflex treatment can disappear) or seek advice to the neurologist. Sometimes this reflex can remain for life.

Physiotherapy

To restore muscle activity immediately after the sharp period has passed and the patient has already started to get up and sit down independently, special exercises should be carried out after a stroke.

Therapeutic physical culture includes gymnastics (flexing and extension of hands and legs, to warm up the fingers, attempts by weaving or folding small mosaics) and massage.

Regenerating massage has a special action. It is recommended to spend daily, starting with the periphery of the limb and climbing to the body. It allows you to restore blood circulation in the affected limb, return the past muscular tone.

It is best together with patients to exercise in the pool. Water helps to reduce the load entering the affected limbs, as a result of which the motor rehabilitation after a stroke occurs much faster.

Treatment in rehabilitation centers

Whatever a good treatment in hospitals, and at home - care, patients are best restored after a stroke in specialized centers.

Many neurologists recommend immediately after discharge from the hospital to send the patient to the rehabilitation center. After the stroke is extremely important for the first month, since it is in this period that the patient's activity is possible with properly selected therapy.

It is there that the best specialists in the field of rehabilitation are collected, which will help competently draw up a treatment program with the achievement of the best effect in treatment.

The correct combination of drug support, exercises and physioprocessor allows you to put a patient to your feet in the shortest possible time.

Care for patients after stroke in such centers is carried out around the clock. A medical sister is pressed to each patient, causing him and following his state of health.

Professional and Social Adaptation

Unfortunately, quite often after the transferred stroke in humans are lost professional skills. This state can be stopped, trying to re-train the patient of work. If it fails to restore it, a person is assigned to a person (usually third). This applies to specialized skills (for example, it is not recommended to return to the work of doctors - especially neurosurgeons, turkeys, jewelers). In this case, the ability to overall labor and self-service can be maintained.

If generaloguductural skills are lost, the patient can claim 2 group.

If the ability to self-service the ability to make a nurse to a person. In this case, rehabilitation after a stroke continues throughout life. In addition, 1 (i.e., it is believed that a person is not adapted to existence in society and he needs an assistant).

Where to treat the patient after stroke?

For many people, care for the patient who suffered a stroke is extremely difficult work. Not everyone is ready to care for a seriously ill person, because all his free time is lost. Many people who remain chained to bed is changing in nature (quite often - for the worse). Because of this, no one wants to deal with the patient (even if it is the closest relative). In this case, the best way out will send a patient at however, not every person on his pocket services of such agencies. In this case, the only way out is the recovery of the patient at home.

Some particularly irresponsible people send a patient to the boarding school, refusing him. Nevertheless, it should be remembered that in these institutions the patient does not have much care so necessary to him, because of which, in most cases it becomes disabled.

How to care for the sick?

It is known that care for a sick person requires a lot of time. However, the sick person cannot do without care, and if it happened so that the treatment should be at home, it is desirable for someone to take care of him. Careful, be it a nurse or just a friend, it is necessary to have the concept of care for a sick person.

Consider how you need to care for the sick.

Providing comfort

Comfort is the most important component in the care of a sick person. The bed on which the patient will be lying should be quite comfortable, moderately rigid, with a fresh mattress, clean linen and a warm blanket. The patient should have a comfortable pillow, no additional things on the bed should not lie. If the room is warm enough, then the patient will not need too warm blanket. He can be covered with a sheet or light coat.

Consumption of liquids

The sick person must regularly consume fluid. At a minimum, it should be clean drinking water. In the case, if the patient is permitted by hot drink, it can consume broths, hot tea with raspberries or honey. The career should know that with diseases such as a cold or flu, the patient should eat hot fluids every half hour.

Personal hygiene

Any patient a person needs to be observed personal hygiene. However, with many diseases, people are not able to provide it independently. For example, with a flu, a person often cannot get out of bed without assistance.

If the patient is able to stand on the legs, then it is possible to carry it into the bathroom and conduct water procedures there. Please note that the patient in no case cannot be immersed in the bathroom or wash his head: in this case, the virus will only increase its influence on the body. It is enough just to use the sponge moistened with water. Water should be warm and not strong hot. You can use special compositions, such as scrub. Make sure that the bathroom has a comfortable temperature, not lower than room. Water procedures must be carried out no more than 10 minutes. At the end you need to be confused by a patient with a towel. Make it to be wiped dry. Patient a patient in a towel and start cleaning the mouth.

If the patient is unable to be on the legs, then water procedures can be carried out directly in bed. To do this, prepare a bucket with warm water and a small sponge. Wash the sponge and squeeze it completely. Wet sponge neatly rub the skin of the patient. It is desirable that the water contains any soap solution, for example, you can add a little shower gel. To make it convenient to carry out water procedures, in this case, it is necessary that the patient moves the torso to the vertical position. If the patient has difficulty, be sure to help him. Remember that even in the horizontal position, its head must be maintained using a roller.

Upon completion of the water procedure, be sure to wash the patient with a towel. Watch that the water does not hit the bed.

Meals and medication

When careing for the patient, it is necessary to remember that the human body needs calories to combat the disease, if it comes to viral infection. If a person suffers from diseases of the gastrointestinal tract, food intake should be limited and follow the prescribed instructions of the doctor. At high temperatures, the patient is urgent not recommended to consume fatty foods. With almost any diseases, it is not recommended to use sharp, smoked and strongly saved food.

The best power for the patient will be soups, various porridge, boiled chicken meat or beef. It will also be useful to use vegetables and fruits. At a temperature, it is impossible to eat cold food: salads, ice cream, use cold drinks.

Reception of drugs must be carried out on the prescription of the doctor. Caring for the sick person must be remembered that if the sick forgot to take a medicine on time, then you should not use it a double dose, especially if we are talking about mixing drugs.

Among other things, the patient must be observed to comply with bed rest, go to bed on time, not spend a lot of time at the computer or abandon him at all. Keep calm and physical passivity.

Rehabilitation of lying patients after stroke - the process is long and hard. The physical aspect of care for an incompetent person is complicated by its negative emotional state, which often goes into a protracted depression. The stroke of the underlying patient perceives as the collapse of his familiar life, when unexpectedly of a full-fledged person, he sharply turns into helpless burden for his relatives. In order to overcome all the difficulties and return the lost functions of the body, you need to know the basic rules for full care for such a category of patients.

Medical principles of care

The restoration of a lying patient at home includes a complex of care measures aimed at preventing the threat of re-stroke and the emergence of serious complications associated with the permanent stay of the patient in bed.

Proleside

First of all, it is preventing sores, striking soft tissues and capable of leading to tragic consequences.

Provide normal blood flow in problem places forced to experience constant pressure, the following care measures are designed:

• periodic change in the position of the patient's body (every 2-3 hours);
• daily inspection and skin hygiene;
• regular change of bed linen;
• skin sanitary treatment with antiseptics, anti-inflammatory ointments;
• conducting a qualified massage.

In the fight against illness, technical means of rehabilitation of lying patients after stroke are reactive: functional beds, orthopedic pillows, absorbent underwear absorbing sheets. Special medical products facilitate not only the physical and psychological state of a lying person after a stroke, but also to care.

Pneumonia and venous thrombosis

The result of insufficient blood circulation in laying patients after stroke may become such serious pathologies as hypostatic (stagnant) pneumonia and thromboembolism. With pneumonia in bronchi, thick and viscous sputum accumulates, lungs swell and inflamed, breaking the respiratory functions of the patient. Warning the disease and improve the ventilation of the lungs. Simple breathing exercises (air balloon inflation, blowing air bubbles from water with a tubule), vibration and drainage of chest.

Stagnation of venous blood in the lower extremities creates a risk of blockage a broken pulmonary artery thrombus, which often ends with an instant fatal outcome. Care for lying patients after a stroke at home obliges to prevent thrombosis to use compression knitted stockings or elastic bandages, normalizing blood flow in the legs. Reception of drugs that reduce blood viscosity is carried out only by appointing the attending physician.

The danger of stagnant pneumonia lies in the sluggish character and low-rise symptoms at the initial stages of the disease. Pathology is difficult to diagnose and poorly treatable, in 70% of cases leads to the death of the patient.

Food

- This is the most important side of the process of rehabilitation measures aimed at recovering the patrol. The limited motor activity of the lying patient violates and complicates the process of digestion. In many paralyzed people after a stroke, swallowing and chewing function is broken, as well as the ability to independently welcome food. Therapeutic diet and leaving is feeding the patient at the beginning of the disease with a soft, semi-liquid food, enriched with fiber. Such food in aggregate with choleretic drugs is well activated and helps to avoid constipation. The fiber is contained not only in natural products, but also sold in pharmacies in the form of a powder, which can be mixed with any liquid to the desired consistency.

The underlying patient after stroke should receive a daily calorie diet not higher than 2000 kcal. The emphasis is placed on boiled vegetables, low-fat varieties of meat and fish, dairy products. It is advisable to eliminate fatty, salty, acute food, sweets, sdob.

Restorative events

Furning a lying patient after a stroke is necessary for feeding and massage. It is important that the pose of a patient on the bed is not static, did not give him discomfort and painful sensations. All paralyzed parts of the body must take a natural position, and the process of flexing the limbs alternate with the relaxation periods. Such "passive" exercises will help preserve the mobility of the joints in the immobilized limbs. To create a gap between the body and limbs, dense rollers are used, small pillows, which not only fix the position of the patient, but also improve the blood flow, preventing the appearance of the Pader.

Physiotherapy

All recommendations regarding how to care for laying patients after a stroke at home, gives your doctor on the basis of the gravity of the patient's condition and the type of violation. He also coordinates the procedure and a set of exercises of therapeutic gymnastics, the purpose of which is:

• improve muscle tone;
• normalize blood circulation process;
• establish the work of the internal organs;
• prevent the limb contracting.

Uncomplicated movements on bending, extension, rotation of hands and feet, warm-up of fingers, brushes, stops are performed after the acute phase of the disease, when the patient is trying to sit on their own or stand. LFK must be supplemented with respiratory gymnastics and reducing massage.

The main condition for therapeutic gymnastics is the regularity and gradual increase in the load. Help good results help the exercises started in the first 2-3 months after the transferred stroke.

Organization of life

General requirements for the room in which the patient is located: cleanliness, fresh air, no extra items that scatter approach to bed and make it difficult to care for stroke. The remaining factors, how to care for lying patients at home after a stroke are determined by those from which hemisphere of the brain there was a violation of blood supply.

Violation	The area of \u200b\u200blesion	Act
Left-sided paralysis	The right side of the brain is affected: violation of motor functions, perception, coordination of movements, partial paralysis of the left side of the body.	All items in the room necessary for the patient and care for it are located to the right of the bed. The patient needs to re-learn to talk, explain the letters, show how they are written.
Right-sided paralysis	The left hemisphere is affected: violation of speech, memory, information perception, emotional passivity.	In conversation, simple words are used, tactile touch, facial expressions and gestures. It is advisable to touch on pleasant, familiar topics, to use the written form of communication.

Psychological component

The effectiveness of all rehabilitation measures directly depends on the emotional state of the lying patient. 24-hour leaving should include active communication with a family member chained to bed, patient attitude towards his fears, insults and irritability.

A weakened illness is useful to know what he needs and love. The manifestation of care and confidence in the speedy recovery, careful care helps to overcome depression, give strength and desire to return the lost health.

From how much a close person is aware of how to care for lying patients after a stroke, a favorable outcome of rehabilitation at home is depeted. High-quality care is half success and a high chance of full restoration in the struggle for a full, active life.

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After the underwent attack of acute cerebral ischemia, doctors managed to stabilize the state and partially restore disturbed functions. Now the patient is discharged, and relatives are interested in: what care for patients after stroke. Indeed, late post-thesal rehabilitation depends on how care for a person. Consider the basic rules for caring for strokes.

General rules

Before the discharge, the doctor explains in detail what should be the departure after a stroke and gives recommendations: how at home to provide a person to a normal standard of living, to help restore disturbed functions and prevent possible complications.

Despite the fact that the condition of patients with extracts is different: some can move and even partially retained self-service skills, while others are devoid of mobility and need permanent assistance, there are general rules for care for patients after a stroke at home:

• ensuring full nutrition;
• prevent possible complications (stagnant pneumonia, thrombosis, etc.);
• help in post-primer rehabilitation (massage, gymnastics, etc.);
• psychological support.

Stroy patients require constant attention, and close to distribute duties in advance: who will cook, wash, engage in patients.

It should be remembered that post-stroke restoration lasts for several years. From how to care for stroke after discharge, largely depends: whether a person will be able to learn how to go and speak again, or will remain forever chained to bed.

Premises need to cook in advance

To avoid unnecessary unrest, urgent purchase of necessary trifles and other troubles that accompany the arrival of the patient home from the hospital, it is worth preparation in advance.

First of all, you need to talk to a doctor about the peculiarities of care for patients after stroke and learn an alleged date of discharge. It will help without a rush to prepare for the arrival of the patient home.

What should be the room

The ideal option will be a separate room. This will help create comfortable conditions for a person and do not interfere with the rest of the family members to lead the usual way of life.

Basic requirements for the premises:

• Good ventilation. Windows must open to ensure full-fledged ventilation.
• Illumination. Too bright light will be annoying stroke, and the lack of lighting will negatively affect the emotional state. Good option: hang blinds on the windows to reduce the illumination slightly.
• Providing peace. Loud sharp sounds are annoying on the patient's brain, so the sources of loud sounds should be removed. You can only leave the radio and TV so that a person does not feel torn off from life.

It should be taken out of the room all too much, leaving only the bed, a table, chairs and a wardrobe, where you should place the necessary things, bed linen and hygiene products. This will facilitate the cleaning of the room and will allow you to constantly maintain purity.

What may be required

Even in the hospital, when medical staff is caught by the patient, you can decide: the relative will be able to move at the time of the statement or it will have to be transported lying.

If there is a second case, it should be facilitated by the care of paralyzed patients, should be purchased:

• Special bed with raising sections. Such a bed for patients after a stroke allows you to be close to not strain, but to change the position of the body by lifting and lowering the sections.
• Anti-Rubber mattress. This will reduce the risk of slandering.

If a person can move independently, then it is not necessary to acquire special devices. Mattress for strokes should be moderately tough, without sale and tubercles.

You should take care of bedding. Sleeping facilities must be of "breathable" fabrics. Special attention should be paid to the sheet - the presence of seams often provokes rubbing the skin and the development of laying out.

In addition to the bed, you should prepare in advance:

• circle cream:
• cream from bedside;
• anti-Rubber circle;
• diapers.

From diapers should not be refused, even if the grandmother or grandfather owns itself into the restroom. The strokes often weakened sphincters and "annoying surprise" may happen in a dream or during a nightlift from bed.

If man is paralyzed

Care for lying patients after stroke is not so complicated, as it seems from the side. Consider the basic rules.

Position in bed

This item care for patients who suffered a stroke one of the lungs. Requirements few:

• convenient position;
• the ability to reach the circle with water, the console from the television or radio (if the mobility of the hands is stored);
• good review (the opportunity to watch TV, see who enters the room and others).

Convenience is one of the components of rehabilitation.

Anti-Rubber events

Prolesidery after stroke - a frequent problem in laying patients. They occur with a long-term contact of the bodies with the surface of the mattress. To avoid this at home, it is recommended:

• often change the position of the patient in bed;
• use anti-fire circles (they can be purchased at the pharmacy or make it with their own hands by making a circle of foam rubber and having trimmed with its cloth);
• conduct skin care with hygiene and anti-infrase ointment treatments);
• to regularly inspect the skin to detect redness and scuffs in a timely manner;
• conduct damage at an early stage.

If it is not treated, they increase, and increases the risk of pathogenic microorganisms. Prevention of layers - one of the main events under the bed after a stroke.

Fighting thrombosis

• provide passive mobility (bending and blending legs and sick hands);
• making massage limbs;
• use compression linen;
• give bloodborne drugs.

Caring for limb after stroke will help prevent thrombosis.

Stagnant pneumonia

Caring for paralyzed patients is not only the satisfaction of the needs and compliance with purity. Limiting mobility negatively affects the functions of the lungs: the respiratory volume decreases, the mucus accumulates in bronchi. To avoid this, it is necessary:

• regularly change the position in bed (plant or turn it over);
• do vibromassage (turn over the person on the belly and tapping on the chest);
• give expectorant means.

Stagnation pneumonia is more common in older people or in individuals suffering from chronic diseases of the respiratory system. Care for elderly patients after a stroke should be carried out, taking into account the fact that old people have an age attenuation of the respiratory function.

How to change linen

The bed must be changed regularly and often the change of the sheet seems to be an unsolvable problem. Relatives in confusion: how to flip a lying patient and pull out a sheet? But the laundry change algorithm is simple:

• turn a person to the right side;
• roll into a neat roller from the liberated part of the sheet;
• turn a person to the left side;
• remove sheets;
• clean sheet to twist in the roller;
• to be closed out the free part of the mattress so that the twisted part adjacent to the back of the storing;
• turn a person on the other side;
• slide the sheet and fill the remaining part of the bed.

It is important to take into account: a paralyzed patient has increased risk of forming bedding, so there should be no folds on the sheet.

Morning Toilet and Disguise

Explaining how to care for patients after a stroke, doctors pay little attention to the rules of hygienic procedures, but maintaining body cleanliness is important.

Consider how at home to spend the morning toilet:

• put a person;
• put on your knees a basin with warm water;
• wash or give the opportunity to wash yourself.

Often, after the patient was taken from the hospital, and the relatives have not yet learned how to care for a storing at home, confusion arises: how to put a lying patient in bed. There are 2 ways:

• if the bed is purchased after a stroke for the house, it is enough to change the position of the sections in order to give the body a sedentary position;
• when a person lies on a conventional bed, then to hold the body in the sitting position it is necessary to make a soft focus for the back (pillows or rollers).

The special bed after stroke not only facilitates the possibility of care for the patient, it makes it easier to rehabilitate. Stroy patients are gradually recovering, and the bed for rehabilitation will allow a person to start to sit on their own faster.

And one more problem: how to redeem the lying patient after stroke. The best option is to score a little water in a bathroom and carry out hygienic procedures. If this is not possible (no conditions or a person weighs a lot), then skin treatment is carried out.

To facilitate the care of patients, it is recommended to abandon clothes and do not wear anything except diapers. But for stroke patients, the lack of clothing can be a reason for depression. What to do in this case? Choose a T-shirt or shirts made of natural fabrics and, disguised, put on the sleeve first on a paralyzed hand, then cover your head into the neckline on a T-shirt and after you wear a second sleeve on a healthy limb.

Care for patients in a coma after a stroke is also carried out, as in people in consciousness, but such patients need to control the breath and pressure in order to notice possible complications in a timely manner.

The rules of care for older people are slightly different. Caring for the elderly, it should be remembered that this group the risk has a tendency to appear on the appearance and development of stagnant pneumonia.

Features of feeding

The nutrition of a lying patient after a stroke should be gentle and at the same time to ensure the needs of the body. Food for lying patients should include:

• meat;
• fish;
• porridge;
• vegetables;
• fruits.

Insulter feeding is carried out often and small portions.

If a person can chew and swallow to fully, then it is allowed to give fish fillet, bokings, chopped meat or vegetable salads. With violation of the swallowing function, all dishes are shared to a semi-liquid puree consistency.

How and how to feed after a stroke is indicated in a memo, which is given when discharge. Patients can not eat sharp, smoked or fatty food.

Control of defecation

Problems with intestines after stroke arise for the following reasons:

• powered for lying patients is incorrect;
• long-term immobility violated intestinal motility.

After the stroke, most appears a tendency to constipate. Normalize the chair will help the correction of the edible diet and the frequent change of the position.

Home rehabilitation

Care for patients after ischemic stroke and care after hemorrhagic stroke are the same, but the consequences of brain hemorrhages pass longer. How to help a relative is faster to recover at home?

LFK

Therapeutic gymnastics after a stroke helps:

• improve blood circulation;
• restore the sensitivity of nerve receptors;
• strengthen weakened muscles.

In addition, the LFC is a good prevention of pneumonia at stroke. With physical effort, breathing becomes deeper, the lung ventilation improves.

It is not necessary to be limited only by classes with a doctor who are held several times a week. When leaving for a person follows several times a day to make 2-3 healing exercises.

How to get up

The disease slowly retreats and the person begins to sit on his own, and then tries to stand on his feet.

How to help faster start walking? Here you need to be careful and the first steps should occur with the help of supports:

• walkers;
• crutches.

What supporting tool to choose depends on the state of the vestibular apparatus and on the degree of restoration of the mobility of the legs.

Problems with speech

What kind of help can be to help restore speech?

At home it can be done:

• repeating the occupation, which was held at the speech therapist;
• learning children's speech therapy rhymes;
• often talking to man.

Restoring the ability to speak normally improves psychological state, and the treatment prediction becomes more favorable.

How to avoid depression

A common mistake of relatives is that under the concept of "how to care for", they understand only the maintenance of purity, timely giving medication and the prevention of complications, but at the same time do not pay attention to the psychological problems of the patient.

Depression after a stroke develops if a person feels superfluous and unnecessary due to illness. Depressive state negatively affects the quality of rehabilitation. Here are some tips, how to defeat depression:

• • Communication. The patient must communicate. No need to prevent colleagues and friends visits.

\u003e Hobbies. It may be knitting, embroidery, gluing models from matches and others. Similar hobbies are not only good psychological rehabilitation, but also a way to improve your fingertips motility.

• Encourage independence. If a person wants to eat or wash himself, then it is not necessary to prevent this, even if the bed is dirty. Faith in its independence accelerates psychological recovery.
• Communication on equal. Despite the fact that the stroke is limited in movements, it is impossible to emphasize this state of unnecessary pity - it makes patients with naughty and increases the tendency to depression. It is worth listening to the wishes of the patient and tell about your problems. Such communication will help to find a compromise and will not allow a person to feel flawed.
• Newspapers and TV. The lack of information adversely affects the psychological state. Let him read books, newspapers and watching TV - it will help to recover faster.

Well, if the depressive state came and a person refuses food, does not want to engage in gymnastics, then about how to get out of depression, you need to consult with your doctor. Psychologists have psychocorrection programs that will help to cope with depression.

When you need a doctor

Despite the violation of speech and motor centers, the overall condition of patients at the discharge of patients is stable and does not threaten life. Urgently consult a doctor, if at home appeared:

• dyspnea;
• hypertensive crisis that is not borne by hypotensive means;
• weakness in the limbs;
• worsening speech;
• fever;
• myiospazms or convulsions.

Timely appeal for medical help will help avoid serious complications.

The success of rehabilitation depends on how correctly under stroke care and is a psychological assistance. It is important to all: food, hygiene, physical and speech therapy classes, as well as the creation of a comfortable psychological situation for storing.

Update: October 2018

With the situation, when a healthy, previously relative was injured in a feet or spine or a disease that does not give him to walk and serve himself, everyone may face. And if you are from those who can't hire a professional career or nurse for round-the-clock care, which knows all the subtleties of treatment with lying sick, as well as man's sanitation, who will change his position several times a day, our article is for you.

We will tell you in detail how home care is underlying patients. We describe feeding, water giving, exercise hygienic measures and assistance in the implementation of physiological shipments. We will also consider in detail the prevention and treatment of laying out, the prevention and therapy of stagnant phenomena arising in the internal organs. Tell how professional care for lying patients is carried out - in the hospital.

Danger of long lying

Stay in the lying position for longer than 3 days due to many diseases. It:

• acute pathology of the nervous system (stroke, encephalitis, disorder of the integrity of the spinal cord);
• chronic diseases of the nervous system (Parkinson's disease, amyotrophic sclerosis, dementia);
• pathology of the joints, bones;
• heart disease and vessels;
• ailments accompanied by equilibrium disorder

and many others.

In essence, care for laying patients at home is much greater efforts than those required for an infant child who has not yet learned to change the position of the body. And it's not a matter of mass of the body, but in pathological reactions that are very quickly launched, it is even healthy to go for more than 3 days. Tell me a little about these processes.

Exchange processes

Without oxygen, internal organs do not function: it is a peculiar "exchangeable coin", which gives the possibility of any exchange processes. His delivery must be adequate to the needs of the body. For this:

1. those sections of the lungs (alveoli) should be continuously ventilated, in which the oxygen penetration into the blood, and carbon dioxide - in exhaled air;
2. the alveol membrane, through which the diffusion of oxygen is performed in one direction, and carbon dioxide to another, should not be echo (this is characteristic of pneumonia of any character);
3. blood should be sufficiently liquid. This is ensured by sufficient liquid use, timely treatment of inflammatory processes in the body (proteins formed during inflammation increase blood viscosity), as well as a sufficient amount of proteins coming from food;
4. blood circulation should be sufficient, "getting" to each cell;
5. nervous and endocrine systems involved in the regulation of the operation of the respiratory muscles should also not be damaged.

With a long-term immobilization, each of the items suffers:

Lungs

The air that we breathe, not all goes to work even in complete health and normal motor activity. Part of it remains in the dense "tubes" of the trachea and bronchi (otherwise they would be "collapsed"), another part is a reserve volume in case it is necessary to breathe deeply (for example, during exercise or hazard).

The lighting of the lungs, in which a negative pressure is created in the chest, and the air is "absorbed" into incompressible respiratory tract, occurs with the help of respiratory muscles. Most of them are localized between the ribs in several layers, if necessary, additional muscles are connected: neck, under-and-screw muscles, abdominal press. The main respiratory muscle is a diaphragm, stretched like a dome, under the ribs. It provides 2/3 ventilation, increasing the amount of the breastside, where there are lungs, vertically.

Since the breathing muscles are managed both involuntarily, teams from the oblong brain, and arbitrarily, that is, the effort of will, a person can use a chest or abdominal type of breathing. In the first case, only intercostal muscles work, the diaphragm is shifted passively, according to the gradient of the intragenic pressure. The abdominal breathing, involved, mainly aperture, is able to simultaneously lower the domestic and increasing intra-abdominal pressure, improving blood flow from the abdominal cavity to the heart and reducing stagnation of blood in the lungs.

Therefore, for the prevention of stagnant phenomena in the chest, if a person is forced to continuously lie or move very little, he needs to master the abdominal (diaphragmal) breathing. Periodically, you will also need to perform exercises to improve ventilation: inflation balls, exhalation of air with an effort through the tube into the water.

Whatever the muscles do not participate in breathing, ventilation depends on the body position. In a vertical position, the right light is better ventilated, the upper departments are worse than the lower. If a person lies, then those sites that lie below are ventilated better. In order not to be stagnant phenomena, the body should move - then one, then on the other side, then on the back. Optimally, the lungs are "extended", and the mucus formed in the bronchi (it also becomes a bang of the immobilized people), it is better to fade when a person lies on his stomach. Also, this mucus, in which the microbes are already located at the time of lying, it is easier to appear if the person lying on the abdomen of a person tapping a special way - to conduct a vibratory massage.

If not to take into account these features, then a decrease in the volume of ventilation, a more viscous mucus and the deterioration of blood circulation will lead to the fact that in the underverted areas that are constantly at the top, the inflammation will develop - pneumonia.

Vessels

Human vessels are elastic tubes, in which the muscular layer is more or less developed. Blood, current vessels - not quite ordinary liquid, however, it obeys gravity. This means that in those areas where it should move against the strength of gravity, when it is stagnant, like a swamp in which there are no fresh flows.

Under the "Tempets" implies the lower limbs in which the blood should always overcome gravity, moving along the veins to reach the heart. Only a healthy person is ensured by the "second heart" - the leg muscles. When the patient lies, the muscles of the lower leg and the thighs loses the tone, there is nothing to ensure the outflow of blood from the lower extremities, as a result of such a "swamp" in the veins of the feet, thrombus are formed. In this case, some attempt to get up or fit (for example, when you hike in the toilet) can lead to a tomb of a thrombus that is able to quickly reach the lungs and clog the local vessels. So there is a condition called "pulmonary artery thromboembolism", in most ending deathly.

You can avoid this in laying patients, if you bint the legs with elastic bandages, especially before getting up to the toilet or to make hygienic events, as well as perform their massage, moving them to the extent that the disease allows (optimally - to perform a "bike").

In addition to thromboembolism, with a stag of blood in the lower limbs, a large amount of blood turns off from the overall blood flow. Therefore, an attempt to get up (especially sharply) can end the loss of consciousness. This is called an orthostatic collapse.

Work of the digestive system in lying patients

The functioning of the gastrointestinal tract depends partly from the work of the muscles of the body: with a forced immobilization of the peristalistic of the stomach and intestines becomes sluggish. In addition, now a person who is in consciousness, with a more or less saved criticism to what is happening, is forced to walk in a large position in an inconvenient position lying, and at the same time resort to the help of other people. All this leads to constipation, and they, in turn, cause capital intoxication (suction of products of rotting in blood). So there is an unpleasant smell of mouth, the cased language, the decrease in appetite, constant light nausea.

Popps alternate with diary. The latter are caused by diet impairment, a decrease in the acidity of the gastric juice, which is why various bacteria causing intestinal infection fall into the gastrointestinal tract.

The solution to the problem is in frequent fractional nutrition, observance of the diet when the dishes are fed in warm form, they are cooked from boiled or baked vegetables, meat, fish. The patient is fed with soups without "grip" prepared on the second-third broth or in general without it, porridge. Smoked, fast food, salted and fried dishes are impossible to give.

Muscle problems

The absence of full-fledged movements leads to relaxation of skeletal muscles, reduce their mass (per day with completely immobility, up to 3% of all muscles may be lost). This means that even if it becomes possible to get up, without helping it will not work.

In order to prevent muscle atrophy, you need to perform muscle massage, passive gymnastics, when a relative moves with hands and legs of the patient.

Immiding and joint

As a result of long-term immobility, the joints "encourages": neither active nor passive movements become impossible in them, the limb is frozen in some position (this is called contracture). So, the stop is pulled out to the position "on tiptoe", the brush becomes similar to the "bird paw", the knee almost ceases to bend-blending. When the contracture developed, with a strong pain of damaged joint, there is a strong pain, because of which many refuse to further occupy. Then bone fragments are formed between the bones of bone articulation, and it becomes motionless. This is called ankylosis.

In order not to develop neither contractures or ankyloses, you need:

• perform passive and / or active gymnastics in all joints, with the violent movements and pain should not be;
• put the limbs in the right physiological position on the bed;
• when the contracture or limb is being taken to form a paralyzed, the plaster glitter is imposed on it - so that the limb is forcibly in the physiological position.

Immiding and bone system

In lying patients, blood supply to not only skin and internal organs deteriorates, but the supply of nutrients and to the bones will also deteriorate. This develops osteoporosis - the vacation partitions from which tubular bones are being built. Because of this, the risk of spontaneous fractures increases. In addition, the red bone marrow is suffering inside the bone. Because of this, platelet production decreases (it leads to spontaneous bleeding), leukocytes (due to this, immunity decreases) and red blood cells (anemia arises).

Urinary Ways in lying patients

Due to the horizontal position, urine is stored in the kidneys, contributing to the formation of stones and their infection. In addition, lying urine to keep harder that partly due to the reluctance to ask for help from others. The expiration of urin on the bed leads to the formation of laying out.

Changing the psyche and nervous system in lying patients

If before the disease, which led to the fact that a man run, he was already old and sick, then forced immobilization would not lead to a violation of the relationship to life, to himself and relatives. But if the disease was actively preserved before the moving person, as a result of immobilization, it comprehends:

• depression;
• insomnia, when even the reception of sleeping pills does not give a feeling of rest;
• irritability;
• loss of behavior skills in society;
• the deterioration of hearing (this is due to the fact that the patient now lies, and those who communicate with him, sitting or standing);
• deterioration of mental activity;
• violations by the peripheral nervous system, because of which the person makes it easier to freeze, it feels significant discomfort when changing, ventilating, and so on.

If the patient is forced to lie not at dozens of years, but for several months (for example, as a result of a fracture), when it is rolling, it will be long to lie, which will require the use of crutches, handrails or walkers.

All these problems are especially aging the care of a relative for laying patients: if earlier he was willing to contact, he was benevolent and agreed, then in immobilization, a person becomes a demanding, capricious, flexible, accuses to be in disbelief to his person. Nevertheless, in order to improve the condition of loved ones and stop attempts to suicide, relatives will have to pay attention to him, as well as to establish radionan in his bed, so that the patient could call for the rescue or could he be heard if he wonders to get up or not to use, for example, Cutting devices.

What happens to the skin

The coating fabric of a person forced to lie long, thinning. It is also due to the lack of load on it, which in this case is to stretch it and compressing. More severe atrophy are subject to skin areas that are subjected to transmitting. After 2 hours of stay in the same position lying or sitting, in those places that are above bone protrusions or turn out to be pressed bones to the bed, those that are localized over the fold on the underwear or directly on the solid bed, ischemia begins. Particularities of the skin are especially affected, between which there is very little fatty tissue, which is a kind of shock absorber. It:

• in the position on the back: the crushes, heels, sedanized bumps, blades, elbows, headings;
• lying on the back: on the hip on the side, knees, on the sides of the ankles, on the bottom shoulder, on the temple;
• lying on the stomach: on the pubis, cheeks;
• on a rigid bed or in a sitting cattle: the area of \u200b\u200bthe tailbone and blades, heels, and when they are supported on the entire foot - socks.

Ischemia is enhanced if the skin is shifted relative to its usual position if it is wet from sweat, urine or not dried after swimming. Then, in places of friction, diameters appear very quickly, then the macerations, and in their place are formed.

The task of relatives who had misfortune with a close person - to maximize attention to each of the pathological factors, without giving them to "lift their heads". And then even a month to spend such huge amounts for treating a relative, then, no matter how it would not want, you will have to start care from the hospital. It is necessary to do this with the help of medical personnel intensive therapy, and then, according to the discharge, continue at home. Step-by-step instructions for laying patients in the hospital and at home you will find below.

Hospital care features

When with relatives, it happens in misfortune, as a result of which they are for a short time or for life - are chained to bed, the first stage of assistance is usually the hospital. To have less problems with the health of your lying close in the future, you need to start care for your native person already at this stage, especially since now you can even be in the resuscitation and intensive therapy.

In this position, there are not only minuses for cauting, which will have to (not everyone wants to do it) now spend time, money and strength. There are advantages that are as follows:

• you will be prompted to pay attention to how to properly wipe, bathe and feed a relative. This will further save funds to buy unnecessary preparations and accessories; The time will also save to read the desired information on the Internet or the waiting time of the precipitated nurse / physician;
• you will see and begin to navigate with the feeding of a relative: when he can only eat liquid food, and when it is already possible to perturb it or allow the presence of pieces. This will help with a deterioration in the state of a person at home not to feed it inappropriate food, which is why there may be blockage of the respiratory tract of food and death;
• you have time to get used to the thought that a relative stopped being so independent as before, and you can figure out, you will handle your own care or you have to hire a nurse;
• you do not see the suffering of a relative around the clock, there is a time to relax morally;
• the underlying patient sees and feels the care of relatives, to his depression due to the current situation, the feeling is not added that it has become a burden.

Of course, the medical staff does not force a relative who came to a lying patient in the hospital, care for him. Given the poor medication of hospitals and high cost of drugs, preference is given to the patient to bring the necessary medicines. But the middle and junior medical personnel, careering for your relative, is actually extremely busy. Nurses and care sisters should care immediately after several people, as well as to fill a huge amount of documentation. This will not allow you to perform the necessary leaving procedures in the required volume. Then the patient will discharge, and all the consequences of poor care will be slandering on your shoulders. To avoid this, it is better to allocate at least 1-2 hours a day (optimally - in the morning and in the evening) to provide a stay of the patient necessary procedures.

A feature of the hospital care is the presence of auxiliary means to ensure the physiological needs of the patient. This is a probe for feeding and a blade catheter for urine isolation. You most likely will not be such a means: they will be deleted in the hospital, so as not to create an opportunity for an additional (on these tubes) infection in and so weakened organism.

In addition, in the hospital, the patient has venous access, where the necessary drugs are introduced. Before discharge, for the same reason as the probe with the blade of the blade, will delete it. All the necessary drugs, already in coordination with the profile specialist (neurologist - if a person suffered a stroke, a cardiologist - if the heart attack) is a patient to introduce a nurse coming to the house.

Home care - where to start

Care for lying patients after a stroke or any other states depends on how people are immobilized, what social skills it has lost, as far as they did not work. However, there are a lot of general rules by reading which you will understand what to do you.

Accommodations

Whatever moral discomfort, if you cannot afford a few shifts of round-the-clock nurses with medical education, with a lying relative will need to live in the same apartment / house. For him, it is necessary to highlight a separate room, it is desirable, on the sunny side, while the windows should be closed using the blinds, so that the light shines the light.

Furniture in the room should not be much to be, but also to look completely like a hospital chamber (only a bed and bedside table next to it) - an incorrect, causing nervous stress solution. Imagine yourself in forced to an inactive position, on the bed, when the rest of the family members are active and are engaged in their affairs, and think about what you like.

If we no longer have it, that a person will be able to get up soon, makes sense to immediately purchase a special bed. These are two- and three-section functional beds: the first option allows you to raise the head restraint or legs, while the three-section design also allows you to bend the legs in your knees or give a person a half-way position without its help. The second form of the design of the bed is optimal with a pronounced person's paralysis, especially when he also has overweight or notes urinary incontinence.

Next to the bed put the bedside table. If the patient moves a little, on the bedside table, put "non-breaking" with water, wet wipes, put the phone or (for the older generation) radio. Nearby there can be a remote control or a book, a glass, which will be stored for removable dentures. Also on the bedside table should be a radion man or a walkie-talkie, allowing careful to hear what is happening in the room, and so that the sick person could call.

The room needs to be tired three times a day, for 15-20 minutes; At this time, the patient needs to be covered with a blanket or a duvet cover (last - in summer). On the wall it is worth hanging a bactericidal emitter (it is desirable that you can quartzinate in the presence of a person, without covering it with a cover with his head). Wet cleaning in the room - obligatory.

If the patient can get up, even with an extraneous help, in the bed, put the chair-toilet.

Put the nightstand:

• thermometer;
• tonometer;
• antiseptics that are processed by leather;
• cotton swabs;
• wool;
• alcohol;
• talc;
• camphor alcohol;
• diapers - if a person does not control his feces.

Accepted preparations can be put on the bedside table or in it only if you are confident in the mental health of your relative: that it will not exceed the dosage of drugs intentionally or not.

A vessel or duck can stand under the bed, if the patient feels when he wants to the toilet, and can call. Duck, that is, a device for men, where they can urinate, you can hang (most have a special hook) on the comfort of the bed, if it is (from the side where the patient does not get up).

If the patient became not quite adequate, lost the orientation in space, place or time, drink legs by the bed or constantly raise her the ram. In addition, remove all the attendant items (sharp, cutting, stuck) from his room.

It is very important to maintain a decent moral condition of the patient. To do this, it is necessary to go to him more often and talk gently at the time while you are working. At night, leave a nightlight with a light light, if a relative is not asked to fully extinguish the light: he should not feel abandoned.

Terms of Lying

The patient must be dressed in soft clothes from natural materials that will not have buttons, ties, fasteners or lightning - all the fact that when it is lying on it, it will be forced extra squeezing of the skin. Optimally, if the seams on the night shirt / T-shirt and shorts will not or they will be located only in front.

Lying the patient should be in bed linen from natural fabrics. At the same time, it is necessary to ensure that he has no folds under his back, and so that he does not slip on the bodied bed. It is a straight path to breakdown. If the sheets often comes, you can buy or sew this, on the edges of which there will be an elastic band. So the sheets put on the mattress. If a person has urine incontinence, you can put it on the oilcloth, but it should not lie on the "bare" glue. It is better to wear a diaper on a person (he also needs to be stripped) and periodically give him to prew from absorbing the urine of matter. Then it is better to lay it on a moisture-taking one-time diaper measuring 90 * 60 cm.

For the prevention of the patient, the patient must be rotated every 2 hours, or remind him to make it himself. If a relative is paralyzed, and you have to turn it over to you, lay it - whether it is on the stomach, on the side or back - so that he lay comfortable. Benging, if a person is lying on his back or honey knees, if he lies on the side, you need to lay a pillow. If you laid a relative on the side, put a pillow under your back or a few so that he can rely on them. In the position lying on the back under the elbows and heels, put rubber small circles (like circular expander). Under the crushes can also be putting a special circle. You can use anti-Rubber mattresses that we will talk later.

Every few days or in case the sheet has become wet, it needs to be changed. In paralyzed patients, it is necessary to do this according to the algorithm:

1. turn the person on the side;
2. roll off the sheet behind it in the "tube";
3. at the site of the rolled sheet of bed, the plot of a clean sheet, also rolled by the "tube" or folded "accordion", deploy it;
4. turn the patient on the other side so that it, turning over, rolled through the roller of two sheets;
5. then you will only remain pulling out dirty and straighten clean sheets.

You can use another method:

• grasp the edge of the changing sheet, on which the patient lies, on the one hand the bed, pull it out, so that the patient turns over with a sheet with his back to you;
• the released floors are tightened on the patient from above;
• spread a new sheet exactly on the released surface of the bed, and its end designed for the busy space to fold the non-searched (centimeters 20-25) by the harmonica so that the opposite edge of the sheets watched from you, i.e. in the patient's back;
• return the dirty end and patient on the back;
• turn the patient to the other side by pulling the end of the sheet. It, as well as last time, put on top of the patient;
• remove the harmonica. If the harmonica turned out to be partially under the sick, then by pulling out the protruding edge, you can dissolve the harmonica and free up without effort;
• purify clean sheets, and the end of the dirty fold the harmonica;
• turn the patient from one side to another and pull the dirty sheet.

Do not forget all the time to hold the patient, the position on the side is unstable.

Hygienic events

Lying patient necessarily bathe every day, wash, comb hair. If he can move around himself, he is in the bath, where they bathe under the shower, better if baby soap and children's shampoo use for washing. Be sure to then wash the body with a marlevary napkin or a soft terry towel, as it is fraught into a bed with a wet body fraught with the development of bedding.

Body washing

If the patient can not get up, wash it right in bed. For this, two pelvis for water are used, the stand under the pelvis, the container for heated water, lotions, gels or wash foams. Under the washed part of the body of the patient, the oil washes, wash it with a soft sponge, without excess friction; After washing, it is carefully dried, moisturizing creams are applied:

Seni Care Body Gel	Seni Care Body Protective Cream with Arginine
Cream Menalind Professional Protective, With Zinc	Body Cream Protective Seni Care Zinc and Others

The places that are subjected to friction - camphor alcohol. Only after drying the means you can put a person on the bed, but it must necessarily be dry.

Places that are subjected to friction or a little reddened, are processed not by ordinary soap, but a foam for lesing care, for example, Tena Wash Mousse or Seni Care foam.

TENA WASH MOUSSE.

Washing head

For head wash, a special inflatable bath with a pipe for draining water in a bucket is used. The head is lifted, placed in a special hole of this bath, carefully watered with warm water and soap. After washing the head, the soap water merges through the tube, and the head is washed with clean water, which is also poured through the tube. Hair must be wiped with a towel and dry the hairdryer before putting a man on the bed.

Shaving

Shaving is done like this: the shave foam is applied to the face, there are pelvis with warm water, where will be time from time to the razor. After removal of excess hair on the skin, a moisturizing cream or lotion is applied.

Teeth cleaning

The teeth are cleaning or brushed or, if the patient is not in a clear consciousness, it is used by a latex pad with a brush that they wear on the finger (they are sold in the department of children's goods, to care for infants). The brush is applied to the paste, in which there are hemostatic and antiseptic substances. This is a paste Lacalut Active, Silca Complete Sensitive, Periotherapy Healthy Gums Toothpaste, President Sensitive. Brush teeth from all sides, language, the inner surface of the cheek. It is possible to rinse the mouth with water, soda solution (1 tsp for 1 liter of water), decoction of chamomile, calendula or oak bark. In unconscious patients, this is done using a rubber fringe.

To wash the face of the patient use:

• washing cream TENA WASH CREAM
• seni Care cream
• menalind Professional Lotion

Make it in the morning and in the evening with the help of a soft sponge. After washing off the detergent solution, the eyes wipe with clean cotton disks: from the outer edge of the eye to the internal (so that there was no accusation of the eyelids).

Hand washing

Hands wash the same detergents as the body. Before washing, every hand is immersed in a basin with a detergent solution and processed with a sponge or foaming gloves. Especially purified by interdigital space - a large number of pathogens microorganisms accumulate here. After washing, the hands are dried with a towel and on the zone of elbows (as a rule, they are often observed with the root of the skin) cause a special caring agent - Seni Care cream for dry and coarse leather. After that, cut the nails of the patient and squeeze them with a special saw. Next, nail care is carried out as they are growing.

Intimate zone hygiene

It is held in the following sequence:

• under the pelvis of the patient, the moisture-taking diaper;
• the diaper is removed;
• a hand takes a soft sponge in the glove, plowing into the water with detergent. It can be a Tena Wash Mousse or Seni Care foam;
• the patient's legs are moved, bended in the knees;
• crotch, genitals, and then the anus are washed towards the pubic to the anus;
• the detergent solution is washed off;
• specially selected soft towel, the oblast area is dried;
• the patient turns on the side, its buttocks are also dried by floring movements;
• bepanten-cream or ship is applied on the skin.

After each urination, women need to wipe the crotch with wet Seni Care napkins.

Hygiene foot

Feet wash in a basin with warm water. A sponge or verge of caring must "go through" from the heels to the legs, washed away all the dirt, especially between your fingers. Next, the legs need to be dried by a towel, apply (especially on the heels) children's cream, children's cream, mixed with oil vitamin A, bepangen ointment.

Feeding, nutrition

The diet is appointed by the attending physician and depends on the general disease and how much chewing and swallowing skills were injured. If the consciousness of the patient is unclear, he does not answer questions or makes it a nepouquate, he needs or liquid, or boiled and flew through a sieve or a blender. If he is in a clear consciousness and adequate, it is fed by porridge, soups on the second broth, in which there are small pieces of vegetables. The daily diet is divided into 5-6 meals, it is necessary to issue it strictly according to the schedule. Squelts in the form of a souffle, meat puree or steam kitlet must be sure, otherwise there will be shrinking edema, over which the skin will rush, forming bleeding and poorly healing wounds. Water, compote, tea and non-acidic juices must necessarily limit the fluid only in cardiac, renal failure, cirrhosis and liver cancer.

Feed as follows. If the patient is not completely paralyzed, then with the help of pillows or lifting the head restraint of a functional bed for 30 degrees, it gives a semi-dying position. The chest is a rack diaper and feed from a spoon (you can put a special table, which often comes complete with functional beds and, if a person is able to serve himself, it is imposed on a meal in the plates (you can - with suction cups) that should be stable to stand on the table.

If the patient is paralyzed and give it an exalted position will not work, then the side of the side turn his head, the diaper is proseted on his shoulder and feed it.

After feeding, they wipe the face with wet wipes, be sure to shake the chips from the bed.

The liquid is made of drinkers or from a glass, in which a cocktail tube is located.

Physiological departures

If the patient is able to get up and feels a call for urination and defecation, a chair-toilet is put near his bed, where he helps to cross if necessary.

If a person is unable to get up, but feels a call for urination and defecation, it is served by a ship (for women - for both types of physiological shipments, for men - only for defecation) or duck (for emptying the bladder in men.

If the patient suffers from incontinence of urine or feces, he needs a diaper for adults

Massage

In order to avoid muscle atrophy, Massage must be carried out - classic and vibration. Muscles of the back and limbs are being worked out by stroking and rubbing movements so that it is not painful. You need to do it after massage oil is applied on the skin.

Vibrating massage is carried out after the patient is turned on the side. A camphor alcohol is applied on his back on two sides of the spine. Further, starting from the lower departments, the palm is put on each site, according to which the fist of the other hand is slightly tapping. So every day the lungs are being worked out for the prevention of pneumonia.

Physiotherapy

It lies in passive and active movements in each joint. Thus, there are circular movements with brush, compressing and connecting fists, flexing the neck and turns of the head, move foot, knees, hips - for the prevention of contractures and treatment of paralysis.

In those joints in which a person cannot make movements, he helps a careful, the rest of the patient should move himself. The main task of the caring is to encourage and remind of the need for medical physical education.

If the contractures developed, after the massage and exercises, removable gypsum flares are superimposed on the limbs (how to do them, any rehabilitologist will tell). Legs after that are covered with elastic bandages. In varicosely extended veins, the leather of the lower extremities is treated with Lioton or Heparin gel in combination with the Trokevazine gel.

Medical problems

A lying patient must measure the temperature and blood pressure daily. If the temperature is increased, it is necessary to give "paracetamol" or "ibuprofen", after which cause a doctor. If the pressure is increased (above 140/99 mm Hg), give 10 mg of "Enalapril" or the previously designated preparations "from pressure".

Also, relatives are forced to fix on paper:

• the amount of drilled liquid;
• volume of daily urine;
• frequency and character of feces.

If there is a liquid chair, blood is found in the urine or felling, the amount of urine decreases or it changes the color and smell, and a rash or non-heaven wound appeared on the body, you need to call a doctor.

Proleside

This is the name of the ulcer-necrotic defects of the skin and the fiber to be subject to fiber, which occurs mainly in defects in the care of laying patients. They also appear if he has been lying for a long time, and his psycho-emotional state has changed so much that he interferes with relatives in the implementation of leaving procedures. Prolesidery - Problem number 1 in lying patients. She takes not only time, strength and money from relatives, but may complicate the suppuration, as a result of which blood infection (sepsis) is rather rapidly developing with the defeat of most internal organs.

The risk of developing ulcer-necrotic defects is significantly increased in cases:

• existence of excess weight;
• if a person is heavily exhausted, not enough and drank;
• diabetes;
• smoking;
• heart and vessel pathology;
• urinary incontinence and feces;
• high body temperature;
• diseases or injuries of the head or spinal cord;
• if there is an allergy to lesing care products;

and also with such care disorders, when there are buttons, seams or folds on bed or tight linen, on the body - dirt (or body sweaty or wet), crumbs or small particles come to bed. Such patients in particular need prevention of layers, and with the slightest redness on:

• sacrum;
• knees;
• head;
• whiskey;
• blades;
• heels and bones in front of the legs;
• elbows;
• shoulder joints

you need to immediately begin treatment of laying out (about it below).

To prevent the development of necrotic skin changes

For the prevention of laying down care, underlying patients should include, mainly those activities that were considered in detail below. It:

• compulsory laying for bedwear under the sick;
• nutrition, rich in proteins, iron, zinc and ascorbic acid: chicken boiled meat, chicken broth, dairy products, vegetables, fruits;
• seamless and without buttons and underwear;
• changing the position in bed every 2 hours;
• paving under the bone protrusions that rub about the skin, rings, tissue bags filled, for example, luzga buckwheat or sand;
• timely change of diapers;
• daily bathing, after which the moisturizing cream is applied to the skin, and in places where redness has been laughed - drying agents (for example, "shipmach");
• massage;
• wiping back and limbs camphor alcohol;
• careful wiping of the skin before putting the patient on the bed;
• periodic finding without diaper.

Treatment breakdown

The optimal situation is to inspect the skin of the whole body, especially in those places that come into contact with the bed or with each other, and with the slightest appearance of redness to take appropriate measures. But this is not always possible, so below we will look at what the stages are lying and what to do on each of them.

Stage	What looks like	What to do
0	Easy redness disappearing with a finger	Camphoring alcohol
I.	Redness that does not disappear when pressing a finger from above may be accompanied by an edema, but no skin integrity disorders	The extremity of the patient is placed on the anti-face cushion with the memorization of the shape or anti-face mattress of a cellular type. The wound is washed with chlorhexidine, powder is powder "Baneocin", and it alternates with the overlapping of the Grid "Bronglind" with a Peruvian balm, which can be cut in size to the bed and deposit to the skin hypoallergenic plaster. Alternate these events with the overlapping of the Aktovegin or SalkoSeril gel, the "leveometall" or "flat". Inside: Polyvitamins.
II.	Even skin, bubbles are formed on it, which are partially peeling. The process involves subcutaneous fiber	Events are the same as in the previous stage The patient should lie on the counter-type counterprocepted mattress Antibiotics - in the form of tablets or intramuscular injections In addition, it is necessary to disintellation, which is in intravenous administration of solutions.
III	Deep wound, in the depths of which can be seen fatty tissue and muscle	Removal of dead tissues surgically with subsequent drainage of the wound. After that, bandages with such drugs as "Collagenzine", "Dnza, Himotrypsin", "Vulnusan", "Argosulfan", "Sulfargin," Iruksol "or" Intrasayt "are superimposed on the wound The patient must lie on a balloon type anti-face mattress Intravenous introduction of a combination of 2 antibiotics, which are selected at the beginning of a wide spectrum ("Ceftriaxone", Ceftazidim with Metronidazole), then change to those to which there is a microflora sensitivity from the wound (it turns out with the help of Bakposhev) Disinfection - intravenous administration of solutions
IV.	Inflammation of "corrosive" tendon, can go to the bone, the wound is filled with pus	The same as in the previous stage. Prior to surgical treatment, the proteoks-TM, Biathen AG, hydrocoleloids can be applied. In addition, not only ointments, but also physioproads: ultrasound, phonophoresis of antiseptics, darsonval, should be used to stimulate the healing here. After healing the pathological process, autoderoplasty can be carried out

For the treatment of layers 2 stages, you can also use such an algorithm:

1. Stop breathing into the wound fluid. This is done with the help of a bath with Powder "Deckin" or "Baneocin". After such a bath, it is not necessary to wash the skin, wait for its independent drying.
2. After 2 days, local antimicrobial therapy is connected: "Fusicutan", "Levsin", "Levomekol", "Iruksol".
3. For 9 days from the beginning of therapy, the means that improve the restoration of fabrics are connected: "Vulcymulin", "Aktovegin", "Salkosryl".

Thus, after stroke, care for lying patients will require acquisition, at least:

Wet napkins
Ducks or ship
Diapers
Tooth cleaning overlays
Anti-Rubber Mattres
Circles under the protruding parts of the body
Special detergents
Elastic bandages - for the binting of paralyzed limbs
Moisturizers - for dry skin sites, for heels, sacrum, hands
Means to improve blood circulation on rubbing sites, and also - in the lung area
Drinking means - if some kind of body surface relating to the bed or other part of the body began to blush