General recommendations for caring for seriously ill patients. Nursing care for a seriously ill patient

Care for bedridden patients can be special or general. By special we mean the general principles of carrying out activities that are necessary for all patients without exception. Special care involves special actions of the caregiver based on the specifics of the disease or pathology.

Nursing care is not a method of treatment, it is an addition to the main treatment that helps to avoid complications and difficulties.

How to provide proper care for bedridden patients

The basis of caring for bedridden and seriously ill people is the creation of a special regime that will protect the patient’s peace and protect his psyche from negative impacts and at the same time create a cozy environment around it. In such conditions, patients will feel more comfortable, they will develop an optimistic approach to the disease and a mood for speedy recovery.

People who are called upon to care for the sick must create not only comfortable living conditions, but also treat the sick with compassion. It is necessary to understand that physical suffering disturbs patients, causes a feeling of helplessness and hopelessness, they can be irritable and even aggressive.

The ability to find an approach to the patient, support him during such a period, the sensitivity and concern of the staff allow patients to be distracted from their situation, tune in to recovery and support good mood.

If care is provided by doctors, they usually undergo special training, but if they are close relatives, they need to learn something.

Caring for bedridden patients: basic rules

1. The room should be light and spacious and, if possible, isolated from noise and visitors. You need fresh air and a comfortable temperature within 20-22 degrees with a humidity of no more than 40-60%. During the day there should be soft lighting with lampshades, and at night there should be bedside lamps or bedside lamps.
2. The room must be wet cleaned at least twice a day, wiping dust from furniture, windows and doors, and rinsing the floors with a damp cloth. It is preferable to remove drapes and curtains and replace them with blinds. You need to talk in a low voice in the room, turn on the TV or radio quietly if the patient asks. It is better to ventilate the room at night, when the air is fresh, or in the morning, when the amount of dust and gases is minimal. In summer you can keep open window or a window. When ventilating, you need to make sure that the air does not get on the body, cover your head with a towel, leaving your face, and cover your body with a blanket.
3. It is very important to properly transport patients to procedures and therapeutic measures. This is done on a stretcher or gurney, while trying to avoid sudden movements, jolts and impacts. It is necessary to shift the patient together; if it is a child, it is permissible for one person to do this. If one person has to carry the patient, it is necessary to lift the patient, taking him under the shoulder blades and under the hips, while the patient’s hands should hold onto the caregiver’s neck. They transfer the patient to the bed, having previously prepared everything necessary for care.

Equipment for the care of bedridden patients

Bedridden patients need an oilcloth backing, a rubber circle, a bedpan and a urinal. The bed is made neatly and comfortably for the patient; a flat and semi-rigid bed with a mattress is used, on which an oilcloth is laid and a sheet is placed on it. If treatment of the spine is necessary, a hard shield is placed under the mattress. The bed should not be close to radiators or heaters. There should be free access to the bed from both sides.

The patient is placed in bed undressed, with or without pajamas. They help him undress, and if there is no way to do this (burns or severe injuries), the clothes are carefully cut.

Caring for bedridden patients: changing linen

Cleanliness of linen is important for the patient, so bedding and underwear are changed regularly. When changing linen, you must ensure that the procedure does not cause pain or inconvenience.

The patient is moved to the edge of the bed, part of the sheet is rolled up to his body, a clean one is laid in its place and the patient is moved onto a clean sheet, removing the dirty one and covering it completely with a clean one. Sometimes they use rolling the sheet from the legs to the lower back, and then upward, lifting the patient. The edges of the sheet are pinned to prevent it from rolling. When changing sheets, change the duvet cover and shake out the blanket.

Seriously ill patients have special underwear - these are shirts or vests, they are rolled up from the lower back to the neck, removed from one arm, then from the other and carefully removed from the head. In some cases, a shirt with a wrap around the back is worn. Linen contaminated with blood or secretions of the patient is immediately changed to clean ones.

Other principles of care are based on the regimen prescribed by the doctor. It is important how often and in what position to feed the patient, how to take medications, and how to bathe him.

Caring for bedridden patients: care and hygiene

1. Seriously ill patients carry out physiological functions in bed with the help of a urinal and bedpan. It is important to always have washed and disinfected vessels on hand to keep them warm. All patient care products should be at hand, cleanly washed and convenient for the caregiver and patient.
2. Personal hygiene is important. For seriously ill patients, wipe the body with a damp sponge or swab soaked in warm soapy water. Then wash with warm water without soap and wipe dry. Once a week, fingernails and toenails are cut short. The hair of seriously ill patients is cut short to ensure adequate hygiene.
3. Hand washing is done at every meal, feet are washed once a day before going to bed, and washing is done twice a day. If the patient is very fat, daily washing of the skin folds is indicated to avoid diaper rash.
4. Also, to prevent diaper rash, it is necessary to frequently change the position of the patient’s body, place rubber circles under the places of greatest contact with the bed, and eliminate the slightest irregularities on the bed.

Feeding the seriously ill

One of the most important points in care - the need to strictly adhere to feeding times and diet.

Seriously ill bedridden patients are given the most comfortable position so that the patient can eat and not get tired. This is usually a semi-sitting or elevated position in bed.

The neck and chest are covered with a napkin, and patients are fed crushed or pureed food from a spoon in small portions. If the patient is sleeping, wait until he wakes up. Seriously ill patients are given to drink from a sippy cup, and if they cannot swallow, they switch to artificial nutrition - by tube or intravenously.

In addition, it is important to monitor the patient’s condition and well-being, maintain his mood and contact with conversations, but not bother him.

1) If possible, place the patient in a separate room, and if not, then give him a place by the window.

2) If possible, place the bed so that it is accessible from all sides. This will help you turn the patient over, wash him, and change bed linen.

3) The bed should not be soft. If necessary, cover the mattress under the lower back with oilcloth. The sheet should be without folds; folds provoke bedsores.

4) It is better to use a lightweight woolen blanket, not a heavy cotton one.

5) Place a nightstand (stool, chair) next to the bed for medicines, drinks, books, etc.

6) Place a sconce, a table lamp, and a floor lamp at the head of the bed.

7) So that the patient can call you at any moment, purchase a bell or a soft rubber toy with a sound (or place an empty glass glass with a teaspoon inside next to the patient).

8) If it is difficult for the patient to drink from a cup, then purchase a sippy cup or use a straw for cocktails.

9) If the patient cannot retain urine and feces, and you have the means to buy adult diapers or adult diapers, then purchase them. And if not, then make a lot of rags from old clothes for changing.

10) Use only thin (even old) cotton underwear for the patient: fasteners and ties should be in the front. Have a few of these shirts ready for a change.

11) Ventilate the patient’s room 5-6 times a day in any weather for 15-20 minutes, covering the patient warmly if it’s cold outside. Wipe dust and do wet cleaning every day.

12) If the patient likes to watch TV, listen to the radio, or read, provide this for him.

13) Always ask what the patient wants and do what he asks. He knows better than you what is comfortable for him and what he needs. Do not impose your will, always respect the wishes of the patient.

14) If the patient gets worse, do not leave him alone, especially at night. Make yourself a bed next to him. Turn on a night light to keep the room dark.

15) Ask the patient who he would like to see and call these particular people to him, but do not bore him with visits from friends and acquaintances.

16) Nutrition should be easily digestible and complete. It is advisable to feed the patient in small portions 5-6 times a day. Prepare food so that it is convenient for chewing and swallowing: meat in the form of cutlets or souffles, vegetables in the form of salads or purees. Of course, you need soups, broths, porridges, cottage cheese, eggs. Important daily use vegetables and fruits, as well as rye bread And fermented milk products. Do not try to give all food only pureed, otherwise the intestines will work worse. During feeding, it is advisable for the patient to be in a semi-sitting position (to avoid choking). Don't put him down immediately after eating. Do not forget to give the patient juices and mineral water.

LEATHER requires the closest attention, since more than that healthy person needs cleanliness. A bedridden patient should be wiped with a damp, warm towel, followed by wiping dry. It is better to moisten the towel with body lotion diluted with water. One of the most common problems Bedridden patients have bedsores. They arise as a result of circulatory problems. Usually this is the area of ​​the sacrum, coccyx, vertebral processes, shoulder blades, heels and buttocks. Treating bedsores is difficult and takes a long time, so you need to make every effort to prevent their occurrence: change the patient’s position in bed up to 10 times a day, turn him. The sheet should be taut, without folds. The seams of underwear should not be in areas that come into closest contact with the bed. A rubber circle, slightly inflated and covered with a soft diaper or a towel rolled into a tourniquet, is placed under the sacrum and coccyx. Change wet, dirty laundry immediately (if you do not hoard it, but soak it and wash it immediately, you can avoid the characteristic smell of a seriously ill person in the apartment). Places highest pressure The skin must be wiped with camphor, ammonia or salicylic alcohol, as well as diluted table vinegar at least 3-4 times a day. Every day, lubricate the entire surface of the body with any nourishing creams, especially the legs. If reddened areas appear, after light massage, cauterize them with a strong dark purple solution of manganese. Use talc, zinc oxide and streptocide in the form of powders; baby powders are also suitable. If the bedsore becomes wet, do not apply any ointments, stick plasters or bandages yourself: you will only make it worse. The bedsore must “breathe.” Invite appropriate medical professionals.

HAIR They are washed at least once a week and should be combed daily. Trim your fingernails and toenails as they grow. Don't forget to shave men. Do this carefully, avoiding cuts.

EYES AND ORAL CAVITYalso need care. Rinse your eyes daily with infusions of chamomile, sage or tea leaves using a pipette and a cotton ball. Wipe your tongue, gums and teeth with a weak solution of potassium permanganate or furatsilin, chamomile, sage, also daily. To prevent stomatitis, lubricate the oral cavity with a solution of borax in glycerin, honey or vegetable oil. If the patient can, then let him brush his teeth with a toothbrush.

CHAIR needs to be regulated. If the patient is constipated, use laxatives and enemas. If constipation is prolonged (more than 5-6 days) and even an enema does not help, consult a doctor, as well as in a situation where the patient does not urinate for more than a day.

Bed

To prevent complications associated with prolonged bed rest, it is necessary to place the patient on a medical functional bed with a special bed, divided into sections. The angle of inclination of these sections can be adjusted, changing the patient’s position and improving his well-being. The main thing is that the headboard (head section) rises.

Bed side rails and over-bed table

Side rails are installed on the bed for the safety and comfort of the patient. You can place an over-bed table on the railings (across the bed), at which it is convenient to have lunch, work at the computer, read, take notes, etc. The side rails fold easily to provide access to the patient.

Bed wheels

A bed on wheels is more functional than a bed with legs. This is especially important if the patient is prescribed many procedures. The wheels of the medical bed must be made of a material that does not leave marks on the floor. At least two wheels must be equipped with brakes.

Bed sanitary equipment

If the patient does not get out of bed, then it is most convenient to place him on a bed with sanitary equipment. The sanitary equipment is a plastic bucket (vessel) with a lid. The bucket is installed under a special hole in the mattress, which opens as needed. In the most functional models of beds with sanitary equipment, the hole in the mattress opens and closes using an electric drive. This organization of a “delicate issue” smooths out the patient’s negative feelings from being in a helpless position and makes caring for him easier.

Anti-bedsore mattress

If the patient cannot change body position on his own (with paralysis, paresis, severe injury), care must be taken to ensure that constant stay in bed does not affect the condition of the skin. In the absence of proper care, bedsores - areas of dead skin - may appear on the skin of a bedridden patient. An important role in the complex of anti-decubitus measures is played by an anti-decubitus mattress, the cylinders or cells of which are alternately inflated and deflated, avoiding excess pressure on risk areas.

Orthopedic pillow

It is advisable to place an orthopedic pillow on the bed while you sleep. What if a person suffers from illness? cervical region spine, then the presence of an orthopedic pillow is mandatory. To stay awake, you need a special pillow under your back or a regular pillow with synthetic filling. The shape of the pillow should be such that the patient is comfortable.

Hair washing device

Bedside table/bedside table

The ideal bedside table for a bedridden patient is equipped with drawers, a compartment with a door and a folding tabletop that can be used as a table. The bedside table should be 20-30 cm higher than the bed. It is necessary to place an extension cord on it, to which you can connect a charger from a phone, laptop, tablet, kettle, etc.

Bedside rug

A bedside rug in the case of a bedridden patient is a completely unnecessary thing. He will only interfere with those caring for the patient. And if the patient suffers from neurological foot drop, then a rug on the floor can cause injury. However, if the patient insists on having a mat near the bed, place one, but choose one that does not slip.

Lift

If the patient is completely immobile, a lift with a hydraulic and electric drive will be a good help for those caring for him. It allows you to change the patient's position without effort. The caregiver does not strain his back, the patient does not feel discomfort from moving.

Room interior

The floor in the patient's room should be smooth, level and non-slip. Ideally - laminate or linoleum. If a person gets out of bed and leaves the room, there should not be a carpet in his way. It is generally better to avoid carpets, especially if the patient is prescribed many procedures. However, to “domesticate” the environment, you can place a small rug by the window, within the patient’s line of sight.

You also need to hide all the wires, especially those that are in the space between front door and a bed. Excess chairs must be removed from the room. There should be no obstacles on the way to the patient's bed - nothing that would make it difficult for emergency doctors, caregivers and the patient himself.

Window

You should not place the patient’s bed directly next to the window, since it may blow from the window, and when the room is ventilated, the patient will be in a draft. However, there should be enough light from the window for comfortable reading in daytime days. It is advisable to position the bed so that the light does not hit the patient’s face in the morning at dawn and in the evening at sunset.

Room lighting

The main lighting in the room should be bright enough for doctors to comfortably and efficiently examine the patient and for caregivers to carry out procedures. It is better to equip the switch with a brightness control so that the patient can independently adjust the lighting.

Ideally, the maximum possible brightness of lighting in a patient’s room should be greater than in a healthy person’s room, however, if it is impossible to regulate or at least turn off the light on their own, the patient will experience discomfort and feel like in an operating room.

It is better to provide additional lighting in the patient’s room - a night light or a table lamp that can be placed on the bedside table. The ideal option is a lamp with the ability to change the direction of light.

Plants and flowers on the windowsill

Items on shelves

Only those items that please the patient, evoke pleasant memories, and lift his spirits should be left on the shelves. It's better to remove everything else. It is necessary that the room is free of useless objects that accumulate dust and are easily broken. If a person gets out of bed, but his coordination is impaired, he may accidentally drop something and break something. After this, the patient’s emotional state may worsen and a fear of movement may appear.

Books, TV, stereo system

A bedridden patient should have access to all types of leisure activities that he is able to engage in. You cannot leave a person alone with his thoughts and the feeling of his own helplessness. At a sufficient distance from the patient, you need to install the TV, if possible observing the “rule of five diagonals” (the gap between the bed and the TV = TV diagonal X 5). The TV remote control should be on the bedside table. If possible, install a DVD player and a floor rack with discs directly next to the patient. The patient's access area may also include a laptop, tablet, music player, electronic and paper books.

Door

It is advisable that the door to the patient's room be wooden, not glass, so that the patient feels protected. A situation where the door constantly slams, hitting a cabinet or door frame, is unacceptable. The patient experiences information hunger (lack of events and sensations) and therefore notices all the sounds and movements around him. A slamming door will put pressure on the psyche and worsen the emotional state of the patient.

Door knob

Push-type door handles are more suitable than ball handles, since with general weakness of the body, spasticity and other ailments, it is quite difficult to turn a ball handle.

Handrails

If possible, handrails must be installed on all walls free of furniture. So that the patient can move around the room fearlessly and safely. The handrails should be located at the level of the patient's wrist. If it is not possible to install handrails everywhere, then you need to install them at least along the patient’s main routes (bed-toilet, toilet-bathroom, bathroom-bed, bed-kitchen, etc.)

Bathroom and toilet

If the patient moves independently, then you can install a chair, stool or seat in the bath. This will allow the patient to wash while sitting. If the patient cannot support his back, then a high-back lift can be installed in the bathtub to bathe him. It smoothly sinks to the bottom of the bath, and after the end of the water procedures it smoothly rises up to its original position. The lift gives the patient the opportunity to fully take a bath even with significant limitation of motor functions.

Bathroom handrails

For the safety of the patient and to facilitate his movement around the bathroom, it is advisable to install handrails in the following places:

Above the bathtub (one or two) so that the patient can lean over them when getting up and sitting in the bathtub
- above the sink
- next to the toilet
- on a free wall

Toilet nozzles

Sitting on a standard-height toilet and getting up from it can be quite difficult in case of certain diseases, pathologies, as well as in old age. To make it easier for a sick person to discharge his natural needs, you need to install a nozzle on the toilet that increases the height of the seat. The nozzle can be standard, with handrails, with handrails and a lid. No special tools are required to install the attachment.

Bath mat

A rug must be in the bathtub. And it’s not only about comfort and aesthetics, but also about safety. A wet tiled floor is the worst thing you can think of for a weakened body with poor coordination of movements. It is important that the rug has a non-slip base and not too thick pile.

The real problems of the immobile patient

Violation of indicators various functions organs and systems (heart rhythm disturbances, shortness of breath, edema, headache due to high blood pressure, chest pain, vomiting, pain and swelling in the joints, etc.)

· Limitation of mobility

Self-care deficit

· Lack of communication

· Violation of natural nutrition

· Psychological discomfort

Priority problems of unconscious patients

· Lack of consciousness

· Inability to self-care

· Inability to eat adequately

· Urinary incontinence

· Fecal incontinence

Breathing disorders

Cardiac dysfunction

Potential problems of seriously ill and immobile patients

The category of patients with impaired satisfaction of the need to “move” especially needs intensive nursing care, because cannot satisfy most of their needs on their own. Satisfaction of the need to “move” may be impaired as a result of illness. In some cases, the patient is limited in motor activity by a doctor in order to prevent the deterioration of his condition - strict bed rest. Bed rest is more physiological if the patient can turn around, take a comfortable position and sit down in bed. Impaired motor activity can lead to serious consequences for the patient, up to fatal outcome!

Potential problems for seriously ill and immobile patients:

· risk of violations of skin integrity: bedsores, diaper rash, wound infection;

· risk of developing inflammatory changes in the oral cavity;

· risk of changes in the musculoskeletal system: muscle wasting and joint contractures;

· risk of respiratory disorders: congestion in the lungs with the possible development of pneumonia;

· risk of changes in the cardiovascular system: hypotension, orthostatic collapse;

· risk of disorders of the urinary system: urinary infection, stone formation;

risk of atonic constipation and flatulence;

· risk of dehydration;

· risk of falls and injuries when moving;

· risk of sleep disturbance;

· risk of communication deficit.

Basic principles of caring for seriously ill and immobile patients

· safety: injury prevention;

· confidentiality;

· respect for dignity: all procedures are performed with the consent of the patient, privacy is ensured if necessary;

· communication: the patient and his family members are willing to talk, discuss the care plan and all procedures;

· independence: encouraging the patient to be independent;

· infection safety: implementation of appropriate measures.

Features of skin care for seriously ill patients

The skin is contaminated by secretions of sweat and sebaceous glands, desquamated epidermis, transient microflora, and in the perineal area - urine and feces. Skin care provides:

· its cleaning;

· stimulation of blood circulation;

· hygienic and emotional comfort.

Bed and underwear for a seriously ill patient are changed as soon as they become dirty. Wash your face at least 2 times a day - morning and evening. Wash your hair, shower or bath (if possible) – once a week. Wet rubbing of the skin - daily at least 3 times a day. Hand washing - before every meal. Wash your feet at least once every 3 days.

Prevention of the development of joint contractures and muscle wasting

K. s. – change in shape and decrease in joint mobility

G. m. - gradual thinning and reduction of muscle fibers.

Nursing interventions:

1. Encourage the patient to make movements, change position in bed, using special devices.

2. Change the position of the patient’s body in bed every 2 hours, taking into account the biodynamics of the human body, eliminating sagging joints.

3. Within the limits of joint mobility, perform passive movements with patients, gradually moving to active ones. Start at the top knuckles on one side, work your way down, then move to the other side. Do not tire the patient, the amount of exercise is minimal - shoulder joint– 4, elbow – 2, wrist – 3, fingers and toes – 4, hip and knee – 3, ankle – 2, foot joints – 2.

4. Massage.

5. Use a footrest perpendicular to the surface of the bed to avoid sagging feet

6. Maintain hands in a comfortable functional position (rollers, pillows)

7. Encourage relatives to participate in exercises and movements of patients.

Prevention of congestion in the lungs

Due to being in one position for a long time, the drainage system is disrupted. function lungs and bronchi, there is a risk of developing congestive pneumonia.

Nursing interventions:

1. Carry out daily thermometry, assessment of general condition and breathing.

2. Ensure optimal temperature in the room, regularly quartz, ventilate to avoid drafts.

3. Monitor the patient’s free nasal breathing.

4. Encourage the patient to change body position and simultaneously perform breathing exercises.

5. Use drainage positions to stimulate sputum discharge.

6. Teach the patient coughing techniques: take a deep breath, hold your breath for 2 seconds, clear your throat.

7. If there are no contraindications, use vibration massage of the chest.

8. As prescribed by the doctor, oxygen therapy, mustard plasters and cupping on the chest.

9. Prevent flatulence, monitor regular bowel movements.

Risk of developing fractures due to osteoporosis

Nursing interventions:

1. Achieve maximum limb alignment

2. Perform resistance movements with caution.

3. Teach patients the rules of biomechanics

4. Warn of danger sharp turns and tilts

5. Use canes and handrails when moving

6. Control over nutrition with the addition of protein, calcium and phosphorus: meat, liver, legumes, eggs, fish, dairy products

Development risk cardiovascular complications(orthostatic collapse, Valsalva effect)

Ø Dizziness when going from horizontal position to vertical

Ø Violation of the rhythm of the heart when straining at the height of inspiration

1. Teach the technique of active and passive movements

2. Help change the patient’s position, following the rules of movement, raising the corner of the bed or sitting with legs down, excluding sudden movements, performing movements only while exhaling

3. When changing the position from horizontal on the back to vertical: turn to one side, then lower the legs, only then, while exhaling, transfer the patient to vertical position

4. Warn about the danger of holding your breath when moving.

5. Avoid overtiring the patient

Risk of developing constipation

Prevention of sleep disorders

Nursing interventions:

1. Provide fresh air and optimal temperature in the room.

2. Ensure comfortable bed and clothing.

3. Ensure silence and dim lighting.

4. Eliminate generous reception food and liquid before bed, drinking coffee and strong tea.

5. Ensure bowel movements and Bladder.

6. Follow a daily routine.

7. Provide pain relief.

Bedsores

Bedsores- dystrophic, ulcerative-necrotic changes in the skin, subcutaneous tissue and other soft tissues that develop as a result of their prolonged compression, shear or friction due to disruption of local blood circulation and nervous trophism.

Squeezing– under the influence of the patient’s own weight, circulatory and innervation disorders, tissue ischemia, and subsequently necrosis (death) are caused. In the elderly - after 2 hours of continuous compression.

Displacement, tissue shift– when pulling the patient to the head of the bed, when pulling the sheet from under him, when moving the patient incorrectly and applying plasters (when removed, the skin becomes thinner and injured).

Friction– urinary incontinence, profuse sweating, wet underwear or bed linen.

Places of formation of bedsores:

· in a supine position – sacrum, back of the head, shoulder blades, elbows, heels;

· in the prone position – ribs, ridges iliac bones, knees, toes;

· in a side lying position – area hip joint(greater trochanter), knees, ankles;

· in a sitting position – ischial tuberosities, shoulder blades, feet.

Diaper rash

Diaper rash- inflammation of the skin in the area of ​​skin folds due to contamination with the secretions of the sweat, sebaceous glands and secretions of the patient.

Risk factors:

Increased sweating of the patient;

hot indoor microclimate;

· the patient has urinary and/or fecal incontinence;

· poor quality hygiene care on the patient's skin.

Places where diaper rash may form:

· under the mammary glands in women;

· inguinal folds;

· armpits;

· inguinal folds

interdigital spaces;

Prevention of diaper rash

1. Maintaining optimal temperature in the room - no higher than +22 0 C, ventilation.

2. Use clean, dry cotton linen.

3. Regular skin toilet warm water with inspection, washing after each urination and defecation.

4. Air baths for skin folds, pads between toes or hands.

5. For urinary and/or fecal incontinence, use diapers - change regularly.

Lecture No. 5. Problems of a seriously ill patient. Care and rehabilitation products.

The importance of nursing cannot be overstated. Often, the success of treatment and the prognosis of the disease are entirely determined by the quality of care. IN Everyday life Nursing usually refers to helping patients meet their various needs. These include: eating, drinking, washing, moving, emptying the intestines and bladder. Care also implies creating optimal conditions for the patient to stay in a hospital or at home - peace and quiet, a comfortable and clean bed, fresh underwear and bed linen, and sanitary and hygienic treatment of patients.

Today we’ll talk about the patient’s problems related to with long stay in bed. We are accustomed to thinking that when a person is admitted to a hospital, he should literally lie in bed. We say: “My grandmother is in the hospital receiving treatment,” or we ask: “Where did you stay before?” And indeed, once in the hospital, the patient automatically ends up in a bed, where he often spends most of his time. A very dangerous and completely incorrect opinion has developed that lying in bed for a patient is harmless or even has a healing effect. It has long been proven that this is not so .

Physical inactivity influences negatively affects the functioning of the entire body . Every day of strict bed rest takes away 3 percent physical strength. To return to normal condition after 3-4 weeks of lying down, 4-6 weeks are required active recovery. Sister's tasks: firstly, determine together with the attending physician how long the patient can stay in bed in order to “not lie too long,” and, secondly, how much the patient who is forced to stay in bed should be activated. For example, with a hip fracture or coma, this is inevitable, but with the help of a nurse, the patient can actively or passively engage in physical and other exercises while lying down. Keeping in mind the possible complications of bed rest, the nurse must organize the patient’s life with maximum activation within the limits of clinical reasonableness. Let's consider possible complications bed rest for the functioning of various body systems and methods for their prevention.

Respiratory system. Lying still is dangerous for the respiratory system. decreased tidal volume , resulting in breath becomes superficial. Mucus accumulates in the bronchi, which often leads, especially in older people, to the development congestive pneumonia . To prevent this kind of complications, it is necessary to force patients inflate rubber toys, air balloons, after making sure that the toy is inflated quite easily, without much effort. It is interesting to note that older people are more likely to inflate large, brightly colored toys or balls. Fine change body position frequently patient on the bed, raised with pillows top part body, if possible, seat patients using shallow chest massage. Useful simple physical exercises for arms and legs using a rubber bandage (the bandage should stretch easily). Hygienic and diagnostic procedures in cold rooms or on cold, especially iron, tables and gurneys. We must not forget that in winter time The coldest place in the room is under the open window, where cold air descends.

Vessels. One of the most serious complications of long-term bed rest is thrombosis and thromboembolism. Immobile state of the limb compressed by its own weight or by pressing objects, for example a pillow placed under the knee, leads to stagnation of venous blood, because no active muscle contractions, involved in pushing blood through the veins . A bent position contributes to blood stagnation. or tense position limbs placed awkwardly. Useful for purposes prevention apply physical exercises for the legs for flexion and extension in the joints, shallow foot massage, periodic elevation of them using pillows or Beler splints, as well as frequent change body position . Frequently ask the patient if he is comfortable, and try to give the limbs a comfortable position.

Changes affecting work musculoskeletal system, lead to failure in activities of cardio-vascular system. Decline general muscle tone promotes decrease in circulating blood volume and venous outflow. The movements of the diaphragm promote the origin of blood flow into the vena cava. Contraction of the muscles of the lower extremities pushes blood through the veins, thus aiding the functions of venous drainage. Immobility due to splinting or bed rest is a cause of loss normal contractions. Violation of venous outflow , dehydration electrolyte balance lead to increased blood viscosity And increased risk of blood clots. Due to impaired venous outflow, the stroke and total volume of circulating blood decreases, which, in turn, leads to an increase in heart rate and vasoconstriction, and peripheral blood supply is disrupted. Initially, all these factors cause an increase in the stroke volume of the heart, the frequency and strength of heart contractions at rest and during exercise. Subsequently there is danger sharp decline cardiac activity, when compensatory mechanisms cease to function. Particular attention must be paid to monitoring blood pressure. It has been noted that patients with immobility problems most often become hypotensive.

Leather. The skin suffers significantly from the patient's prolonged stay in bed, especially when he has a large body weight. Additional problems arise in older people, since their skin is thinner and more vulnerable, in patients with excessive sweating, urinary and fecal incontinence, as well as improper care for the sick, when, while making a bed or putting him on a bedpan, the patient is not lifted, but dragged, injuring the surface layer of the skin. Problems can be alleviated by shifting the patient to different parts of the body, sitting him in bed, carrying out hygienic procedures, straightening wrinkles in linen, and correctly moving the patient in bed. Nourishing creams are useful, especially in areas of possible future bedsores: Where the skin is especially sweaty, it is possible to use a drying powder and ointment like “Lines”.

Joints and muscles. With forced inactivity while lying in bed, it develops stiffness or even immobility With statutes, which is especially often observed among elderly people left without proper care. The brush takes the form "bird's paw" and the person stops using such a hand. The same problem can occur in young patients, for example, for a long time who are in a comatose state in the intensive care unit or have suffered acute disorder cerebral circulation. Over time, consciousness and the ability to move may return, but the function of movement will be lost. This problem can affect any joints.

The cartilage tissue located in the joints receives all the necessary substances to maintain its structure due to synovial fluid. During joint movement, synovial fluid interacts with the surface layer of articular cartilage, and when immobilized, this process is disrupted due to a change in the flow of synovial fluid, which makes it difficult to penetrate into the cartilage tissue. The cartilaginous extracellular fluid stagnates; the nutrition of the cartilage tissue becomes insufficient, as a result of which a process of degeneration develops, becoming permanent. Changes begin to affect the joint capsule with the tendons and muscles attached to it. Connective tissue inside the joint cavity becomes excessive and limits the movement of the joint. Muscle paralysis, in turn, contributes to joint immobility. Correct position The joints are supported by ligaments that are tightly pulled together by muscle tension. Increased mobility (mobility) of the joint, or its unstable position, is determined by stretching of the ligaments. Joint laxity is caused by a pulled muscle or decreased muscle tone. All this can lead to discomfort and pain in the joint area.

It is very important to begin active and passive exercises for flexion and extension of all joints free limbs and neck, as well as a light massage. Good exercises are with a hand expander, working with your fingers with plasticine or flour placed in a rubber or canvas ball, and working with foam rollers. It is advisable to warm up your hands before exercise. warm water. It is important that massage and gymnastics do not cause pain to the patient; it is necessary to explain to him the meaning of the exercises so that he can, if possible, actively help in their implementation. An unconscious state is not a contraindication for exercises and massage. However, the most important “exercise” will be the patient’s active participation in self-care: the nurse should help him with this by preparing everything necessary for the patient; had the opportunity to wash himself in bed, brush his teeth, comb his hair, eat food, etc.

When immobilized muscular system subject to the process atrophy, associated primarily with a decrease in muscle fiber size. Decline muscle mass occurs due to the lack of necessary pressure on the muscles, they lose about 3% of their normal tone per day. All this leads to loss of muscle strength. Factors? Contributing to muscle atrophy are indicators of muscle mass before a period of immobility. Insufficient weight is a risk factor, while with normal weight the recovery process proceeds faster.

Disorders occurring in the bones. Typically, in patients paralyzed as a result of neurological or orthopedic complications, as well as in patients on prolonged bed rest, detect advanced osteoporosis (loss of bone matrix and minerals). This is due, first of all, to a decrease in longitudinal pressure on the long bones of the lower extremities. For adequate functioning and formation of the bone matrix, bone cells require a certain load, which is created by movement and physical weight of the body. If there is no movement, osteoclasts destroy bones faster than osteoblasts can form them, and as a consequence of this, bone density decreases. Additional factors contributing to this process may include insufficient bone density in the period before immobility occurs, existing metabolic imbalances, and cessation of menstrual cycle among women.

One of the first complications osteoporosis - This emergence cracks in bone tissue , then the pathological process continues to develop peripherally in relation to the site of the crack. This process in a progressive stage is detected using x-ray examination. It is most clearly manifested in the cancellous bone, in the metaphyseal and epiphyseal parts. Moreover, the first signs appear in the epiphyseal and subchondral areas. It should also be noted that in the initial stage of immobility the bone structure is a short time thickens, but the situation is soon changing. Loss of calcium from bone tissue leads to complications such as the formation of kidney stones. As for hypercalcemia, it is rare. Although cases of hypercalcemia can be observed in physically active adolescent boys and in the active phase of bone growth immediately before the onset of immobility. Among adult patients, there is perhaps the only group that exhibits such an imbalance. These are people suffering from osteodystrophy deformans.

Muscles, in turn, are of great importance for the skeletal system, serving as a kind of pump. The contraction and relaxation of muscles allows blood to flow in and out of the bones (by contracting the muscles, an electrical tension is created in the bone, and when one end of the bone is under tension and the other under pressure, they can be compared to an anode and a cathode). However, it is believed that osteoporosis is a pathological process that has natural boundaries: when bone mass is reduced to a critical level, the balance between bone structure and reabsorption is restored.

With prolonged stay in bed it develops osteoporosis . The time period for bone fusion with a sedentary lifestyle is significantly prolonged. The bones become fragile, and increases threat emergence new fractures for subsequent injuries. An unusual position of a limb (located, for example, in traction) also leads to slower recovery: It is necessary to engage in physical exercises with rubber bandages or an expander, using all non-fixed parts of the body. The patient should be advised to eat more fish and cottage cheese (in the absence of contraindications).

Urinary system. Often polyuria, hypercalciuria develop . Quite often, patients who are forced to stay in bed for a long time suffer urolithiasis. It has even been noticed that in the absence of previous diseases of the urinary-digestive system due to a recumbent position, a long course of the disease, the need use "duck" resulting from this psychological discomfort disruptions in the work of this area are possible. For example, urinary incontinence may develop, especially in older people, which, in turn, makes the general state the patient and lengthens the time of his stay in the hospital. Human oppressed by feelings of annoyance, one’s own uselessness, alienation from others. Recovery seems out of reach depression develops , sharply worsening the prognosis. It is very important to engage in psychotherapeutic work with such patients. It is necessary to teach the patient how to use the “duck” correctly. It should always be at hand, in a place convenient for the patient, so that he can easily take it. Naturally, it should be empty and clean. Find out exemplary mode urination of the patient and offer him a “duck” in advance. We must encourage him and in every possible way encourage successful attempts to use it. If urine spills past or the patient does not have time to use the “duck” at all, you need to quickly change the underwear, showing with all your appearance that nothing terrible happened. In no case should you scold or reproach the patient and rearrange his bed or change his linen with disgust or irritation.

Gastrointestinal tract. When lying in bed, patients develop quite quickly dyspepsia, loss of appetite. There is a decrease in the amount of fluid you drink, which, on the one hand, is due to the fact that the patient is uncomfortable drinking, even using various devices, and on the other hand, with the desire to need outside help as little as possible (feeding and removing a vessel with urine). Developing hypovolemia increases the risk of developing bedsores. Muscle mass decreases and increases risk of developing constipation . The latter is also associated with lack of active movement, use of a bedpan, and the patient's reaction to the hospital environment. This especially applies to older people. The consequence of constipation is fecal intoxication , influencing mental activity and state of mind. This condition may be incorrectly assessed as a worsening of the underlying disease, for example, Alzheimer's disease, post-stroke syndromes, and various mental disorders.

It is necessary to teach the patient to do gymnastics for the muscles of the anterior abdominal wall. And carefully monitor your stool, periodically using enemas and laxatives in the absence of stool as prescribed by the doctor. Of course, the patient must be sure that if necessary, they will immediately give him a bed and then everything will be removed. If possible, the person should be left alone during defecation, because often patients cannot perform it in front of other people.

It is important that breakfast, lunch and dinner occur at the same time. Food should be warm (not cold!) and have an attractive appearance. It is advisable that the patient eats himself while sitting. If his condition allows, it is better to organize collective meals in the dining room with other patients. When eating in bed, it is advisable to use a table, placing it above the bed so that the patient, seated with the help of pillows, can eat the dishes offered to him; Only if his condition does not allow this, the patient should be spoon-fed. In a lying position, it is not better to serve the first dish in a homogenized form, by mashing the solid part in a plate with a fork and mixing it with the liquid. Do not forget to use a large napkin or towel when feeding the patient. Any pieces of food that fall on the bed or table should be immediately removed with a napkin, and the patient’s mouth should be wiped more often if he or she does not eat very carefully. Patients are advised to drink plenty of fluids (preferably juices) and eat fiber-rich foods. It is advisable to eat dried apricots, prunes, seaweed, fresh kefir, vegetable salads with vegetable oil.

Nervous system and mental state. For progressive neurological diseases such as multiple sclerosis even a short stay in bed sharply reduces the ability to move, and very great efforts are required to restore it. Bed rest is almost always accompanied by insomnia. Instead of deep sleep, it becomes superficial and often shifts to daytime hours. This can cause depression, disorientation, and confusion in the patient. We remind you once again that prolonged lying down leads to depression and loss of interest in life; often occurs in older people; the desire to die, which always worsens the course of the underlying disease. Individual work with the patient is required. You need to get to know him well, understanding how a person can be interested, stirred up, and amused. It is very important to distract him by all means from the feelings of his own inferiority, instilling hope for a speedy recovery. To do this, you need to find small, but positive changes in your health and tell the patient about them. For example, tell the patient: “Well, Anna Nikolaevna, you did well today, look how high you raise that hand! Can’t compare with Monday!” Such remarks instill hope and cheerfulness in patients. However, it is better to be restrained in external manifestations of optimism if we are talking about a progressive disease. Here, a softly spoken truth is often more important than a vigorous lie. This will allow you to maintain a frank relationship with the patient. Try not to let patients sleep during the day, and with the help of relatives, medical staff or volunteers, find suitable activities for them. It is very good if a bedridden patient collects mosaics, weaves or knits, draws, or looks at pictures in albums. With old people you can talk about the times when they were young, full of strength and socially significant.

The main way to combat complications arising from a patient’s prolonged stay in bed is to activate the patient as early and comprehensively as possible, within the limits not prohibited by the attending physician. During the entire period of bed rest, it is necessary to restore temporarily lost or depressed functions and skills. Compliance simple rules, diets, engaging in light and interesting physical exercises for the patient, creating physical and psychological comfort, joint hope for the success of treatment and a speedy recovery make it possible to achieve the effect of treatment.

Nurse's actions. What should you be guided by? nurse when choosing tactics for managing patients with similar problems? Having identified all of the above problems, the nurse should note the degree of changes occurring associated with immobility and relating to bone density (detected by x-ray examination), muscle density, and muscle tone. It checks how mobile the joints are and whether or not the muscles and tendons are being used sufficiently. How much is the venous outflow changed and the orthostatic load reduced, and whether the functions of the heart are weakened.

Practical actions include the following:

Maintaining proper patient load using plumb lines and/or exercises;

Monitoring fluid intake: the patient should drink as much as possible (up to three liters per day) to reduce the risk of calcium in the urine;

Detection of muscle atrophy by measuring the thickness of the limb (which, however, is not entirely effective, since the thickness of the limb can change every day) and monitoring the loss of proteins;

Carrying out various physical exercises of a dynamic and static nature with the patient to restore muscle mass and strength (carry out carefully, if possible, in a bath or swimming pool);

Motivating the patient to perform resistance exercises;

Explaining the importance of appropriate exercises;

Need to change position more often bedridden patient and, if possible, lift the patient out of bed, help him move more;

The patient's desire (to assist him) should be encouraged to increase the amplitude of movements and to self-help;

The patient's loved ones should be encouraged to participate in the exercises;

Use a footrest to avoid sagging feet, support your arms in a position comfortable for functioning;

Try to avoid overtiring the patient.

The nurse should constantly check muscle tone, examine the bones for their alignment (alignment can be done using a splint or splint if indicated), explain the causes of joint stiffness and carry out preventive measures - physical therapy to increase mobility in the joints). Blood pressure needs to be monitored. On lower limbs to maintain venous outflow, elastic bandages should be applied and a support bandage should be used abdominal cavity. To stimulate the autonomic nervous system it is necessary to change the patient’s position in bed from a lying position to a sitting position - using pillows or adjusting the position of a functional bed. Well established as a drug therapy for changes in bone density and the appearance of kidney stones in the urine. anabolic steroid. These drugs reduce the formation of kidney stones and calcium excretion.

You, of course, understand how great the importance of food and drink is for humans. The well-being of even a healthy person is largely determined by what, how much, when And How he eats and drinks. For a sick person, food and drink become especially important, often determining either recovery or progression of the disease. A frivolous attitude towards this problem, directly or indirectly, entails serious consequences. A simple example: a patient does not receive the required amount of fluid (there is simply no one to give a glass of water to an old lonely grandmother with a hip fracture), this leads to hypovolemia - a decrease total number blood, which, in turn, contributes to the formation of bedsores, and, in the end, the patient dies from sepsis. So, apparently, a trivial reason leads to catastrophic consequences. A person needs liquid for the normal course of all biochemical processes, replenishment of circulating blood volume, and detoxification. Lack of fluid leads to bedsores, constipation, urolithiasis, cystitis, etc. Poor nutrition several times increases the risk of developing bedsores, slows down recovery, contributes to the progression of the underlying disease, and the development of complications.

15.09.2016

Over the years, the responsibility of caring for elderly parents falls on the shoulders of older children. Few of us have not faced the problem of caring for an elderly relative in our lives.

A seriously ill patient needs outside help.The activity of all functional systems in his body is disrupted. It is known that competent, attentive care for a seriously ill patient significantly prolongs his life. Is this assistance properly organized? There are even special courses for this difficult craft; the services of a professional nurse with medical education if you need to perform injections or dressings.

Such patients do not require daily medical supervision and active treatment. They feel much better in their familiar home environment. The only thing they need every day- This means care, creation of favorable comfortable conditions, hygiene and, most importantly, psychological support.

To organize effective targeted home care For a seriously ill patient, you need to understand the severity of his condition. There are also situations when the patient cannot satisfy his needs on his own, so he becomes dependent on the people around him. The neighbor's task– create the most favorable and comfortable conditions for the patient. It is sometimes impossible to cope with such a task alone; a family team with a distribution of tasks is needed.

In a severely immobile patient, movement, normal breathing, eating and drinking, excretion of waste products, rest, sleep, and the ability to maintain own safety. Therefore, there is a high risk of bedsores and respiratory disorders– congestion in the lungs and pneumonia, urinary disorders - infections, constipation, difficulty moving joints and muscle wasting, injuries, sleep disturbances.

When communicating with a patient, it is important to carefully monitor his facial expressions: intonation. More often than not, body movement will say more than words.

Here are some tips that can help you when caring for a seriously ill patient.

1. To create comfort and reduce the effect of irritants, create mental and physical peace. After all, a good mood for a seriously ill patient is the key to stability in already shaky health.

2. Appearance bedsores is the first signal of insufficient patient care. Their formation is facilitated by prolonged compression of soft tissues, a damp, untidy bed with folds and crumbs. Hto relieve pressure on the skin, pThe height of the head of the bed should be no more than 30 degrees. When lying on your side, do not put pressure on the bony prominence of your hip. Regularly inspect the skin in the area of ​​the sacrum, heels, ankles, back, elbows, back of the head, femur, and knee joints. Do not expose vulnerable areas to friction. To prevent bedsores, body position must be changed every 2 hours. Clean skin also contributes to this. Expensive medications for the prevention of bedsores do not always pay off. A light massage with moisturizing cream is recommended, avoiding areas of bony prominences, at least twice a day. If a bedsore does form, do not try to cope with it yourself using potassium permanganate or brilliant green, call a doctor at home.

3. Ventilate the rooms to enrich the air with oxygen. Fresh air pleasant, because walks are already limited.

4. Control general condition of the body(temperature measurement, blood pressure, pulse, respiratory rate) - for early diagnosis complications and timely provision of emergency care.

5. Monitor physiological functions of the patient(stool, urination) to prevent constipation, edema, and the formation of kidney stones. It is possible to use urinals and a bedpan. If constipation occurs, use medicines And cleansing enema to stimulate the motility of the large intestine. Don't forget about proper nutrition, with a sufficient drinking regime and the exclusion of foods that cause constipation: fatty, hard-to-digest foods, semi-finished products, butter and yeast products, sweets, pickles, canned food, carbonated drinks, tea, coffee, food instant cooking. Saturate your diet with fruit and vegetable juices and purees. Cooked meals should have enough fiber found in vegetables and fruits. Don't forget about lactic acid products.

6. Compliance activities personal hygiene to create comfort and prevent complications.

Washing the patient;

Eye care;

Oral care;

Nose care;

Cleansing the external auditory canal;

Shaving the face;

Hair care;

Feet care;

Caring for the external genitalia and perineum.

7. Remember leather is an entry point for infection. It is necessary to wipe it with a towel moistened with warm and soapy water, and wipe it dry, lightly rubbing it, as if lightly massaging it. Wipe reddened areas daily with a disinfectant solution: camphor alcohol, vodka, cologne. Cleanliness is the key to success. Patients who are in bed for a long time and do not take a hygienic bath need to be washed several times a day, because the accumulation of urine and feces in the area of ​​​​the folds can lead to a violation of the integrity of the skin and the formation of diaper rash, cracks and subsequently bedsores, which will be much more difficult to deal with. Patients must be washed after each act of defecation. Washing is carried out with a weak solution of potassium permanganate or another disinfectant solution.

8. Change of underwear and bed linen to create skin hygiene and simply comfort, and prevent complications. Since the patient spends most of his time in bed, it is important that the bed is comfortable, with flat surface, it is advisable to purchase an orthopedic mattress and pillow. Even one week on a soft sofa can cost a patient bedsores and a broken back for you. A functional, comfortable bed can be found and ordered online. The bed must be changed regularly - in the morning, before day rest and at night. The sheets should not have scars or seams, and the pillowcases should not have knots or fasteners on the side facing the patient. Underwear should be clean and changed when dirty.

9. Feeding the patient. Nutrition must be balanced in composition nutrients and on energy balance. Remember, overeating can lead to overweight patient due to decreased physical activity. And then you will have a harder time getting up or changing clothes. And malnutrition will lead to a decrease in vital function important systems body. Such patients need to be fed 4-5 times a day, in small portions. Food must be fresh natural products, mechanically gentle, mushy, heat-treated. You can learn how to properly formulate your diet by reading the article on our website. , published July 12. Don't forget to set the table using beautiful dishes. Try to organize meals in a pleasant environment.

10. Creating an atmosphere of optimism to ensure the greatest possible comfort. It is necessary to hide the severe symptoms of the disease, and sometimes the diagnosis, during conversation. We have to use lies for good. Such patients need to occupy their leisure time with acceptable activities. Such people are especially sensitive to loneliness. Remember, the warmth of your hands and words is much more important than the TV.

11. To encourage and motivate action, try teach basic self-care techniques. Never lose hope for improvement and recovery.It is necessary to set a goal for the patient: every victory in self-care techniques is a movement towards independence from others.

12. Charger. Daily for organs that have retained movement. Rehabilitation activities no matter what! Massage, physical therapy, breathing exercises etc. Be interested in new technologies, medicine does not stand still, new devices and techniques appear to restore body functions.

The goal for relatives of such patients should be to improve the patient’s quality of life, as well as to prolong the life of their loved one. When faced with caring for a seriously ill patient, do not be left alone with the problem. You need to turn to friends and neighbors for help in advance, before your strength is exhausted. Experiences in similar situation natural. Do not hesitate to ask for help in solving a specific small task, you deserve it. Someone will help with transport, advice, money, buy medicine, cook lunch. There will probably be an assistant who can replace you at least for a few hours a week. It’s especially difficult in the first weeks, but then everything will become familiar and not so difficult. If a person cannot be cured, this does not mean that he cannot be helped.

And remember, not a single modern medical institution can replace the comfort of home, care and love of loved ones for a patient.

The article was prepared by anesthesiologist-resuscitator F.I. Mishankin and methodologist S.S. Denisova.