Organizing training for relatives in special skills for caring for patients at home. Caring for the elderly and bedridden patients

The disease is named after the German scientist A. Alzheimer, who in 1906 described changes in the brain tissue of a 55-year-old woman who died, as was then believed, from an unusual mental illness. It is known that the disease is based on the gradual destruction of brain cells and tissues, especially those parts of the brain that are responsible for memory and thinking. Symptoms usually progress slowly but steadily. The disease usually lasts 5 - 10 years. Cognitive functions (memory, judgment, abstract thinking, mathematical abilities) are gradually lost. The emotional sphere and the personality as a whole collapse, motor skills and, especially, speech are lost. The patient ceases to recognize even his family and friends, he is bedridden, and cannot take care of himself. The disease affects representatives of all social groups and is not related to belonging to a certain class of society, gender, nationality or residence in a certain geographical area. Although the disease is most often observed in people old age, it is also found among younger people.

Alzheimer's disease affects people differently different people. This largely depends on what the person was like before the illness, i.e. on his personality, physical condition, lifestyle. The disease creeps up unnoticed; it is very difficult to determine its onset and distinguish it from the so-called senile forgetfulness that affects a huge number of elderly people. Who among us has not witnessed people looking for keys or watches that just a second ago were lying before our eyes and suddenly disappeared into the ground, or engaged in such searches ourselves? It is well known that human memory weakens with age, but it is important to understand that Alzheimer's disease is not simply an age-related change in memory or the manifestation of signs of aging. Alzheimer's disease is an insidious and as yet incurable disease in which memory fails completely.

People around you need to be attentive to any signs of dementia and behavioral disorders in the elderly. The first signs of the disease can be noticed by relatives and family members of the patient when he has problems finding words in a conversation, when he has difficulty remembering recent events (what he did last night, what he ate for breakfast, etc.), loses interest in favorite activities, loses habitual skills. Timely contact with medical specialists for early stage disease can help establish an accurate diagnosis, increase the effectiveness of treatment, properly organize patient care, improve the quality of his life, and preserve his labor, professional and creative potential for as long as possible.

Main symptoms and signs of Alzheimer's disease

Early stage

The early stage usually goes unnoticed. Relatives, friends and often specialists incorrectly attribute symptoms to a patient's old age, believing them to be a normal part of the aging process. Because the disease develops gradually, it is often difficult to determine exact time started it. Gradually a person:

difficulties arise when choosing words in a conversation;
short-term memory deteriorates;
serious difficulties arise when making independent decisions;
perception is disrupted environment, recognition of objects, a person is easily lost, especially in an unusual environment;
there is disorientation in time;
understanding of complex and abstract thoughts is impaired;
initiative and motivation to act disappear, indifference and isolation are noted;
depression may develop, signs of aggression appear;
difficulties arise when performing complex homework(for example, cooking);
Loss of interest in your hobbies and other previously favorite activities.

Middle stage

As the disease progresses, the problems become more obvious and significantly limit the patient’s activities. The patient experiences difficulties in Everyday life, For example:

becomes extremely forgetful, especially often forgetting recent events and names of people;
may become lost in familiar surroundings, at home or in society;
cannot continue to live alone without assistance;
cannot cook food, do house cleaning, or go to the store;
needs help when going to the toilet, washing, dressing, etc.;
ceases to be aware of his illness;
experiences increasing difficulties in communication;
exhibits abnormal behavior (eg, wandering);
may suffer from visual hallucinations.

Late stage

But at this stage the patient is completely dependent on those caring for him. Memory impairment is extremely serious, and the physical side of the disease becomes noticeable.

loses the ability to speak and understand speech;
loses the ability to move, his limbs become rigid;
has difficulty eating and has to be fed;
does not recognize relatives, acquaintances, friends and familiar objects;
unable to control natural functions;
behaves inappropriately in the presence of other persons;
bedridden or wheelchair bound.

When the disease begins to progress, every opportunity must be used to support the patient’s ability to self-care, reduce his internal discomfort and isolation from others. New, better-fitting glasses, better hearing aids, an easy-to-use radio, and books with pictures and large letters can help. It is necessary to find a useful and accessible activity for the patient, taking into account his needs and the capabilities of the caring staff. A sick person constantly needs consolation and encouragement; you cannot scold him or make offensive remarks.

Factors that increase symptoms of dementia

When providing care, it is necessary to know the factors that worsen the patient’s functional abilities and, if possible, eliminate them. TO known factors, which increase symptoms of dementia include:

unfamiliar places;
being alone for a long time;
excessive amount of external stimuli and irritants (for example, meetings with a large number strangers);
darkness (suitable lighting is necessary even at night);
all infectious diseases (most often - infections urinary tract);
surgical interventions and anesthesia are used only for absolute indications;
hot weather (overheating, loss of fluid);
taking a large number of medications.

Activities for caring for the patient at home deserve special attention. It is important for families and others involved in caring for the person to know the basic signs and symptoms of Alzheimer's disease, understand how the disease progresses, be aware of factors that increase symptoms of dementia, and be familiar with basic caregiving techniques.

Hospitalization for Alzheimer's disease is an expensive undertaking, which sometimes only has a negative effect (accelerates the progression of the disease). With any change in the environment, caring personnel, changes in drug treatment the course of the disease usually becomes more severe. Hospitalization is indicated for the selection of therapy, which is dangerous to carry out on an outpatient basis, in the absence of careful medical supervision of the patient, as well as in cases of confusion, psychotic manifestations and antisocial behavior.

Caring for patients with Alzheimer's disease can be very challenging. At home, caring for such patients, as a rule, falls on relatives who are subjected to severe emotional stress, constantly watching how their loved one is deteriorating. The unpreparedness and helplessness of relatives in a situation of chronic stress will not only not help the patient, but can also have a very negative impact on their condition. own health. Nurses and doctors need to provide psychological support to those caring for patients at home, teaching them special techniques that can help cope with problems. Thus, medical personnel are given important tasks in training and counseling the patient’s relatives and providing them with effective psychological support.

Below are various teaching materials that we hope will be useful not only to professional nurses, but also to those simply caring for sick people.

How to provide care for the sick at home

First of all, it is necessary to establish a certain daily routine for the patient, which will allow him to organize and streamline his confusing life and help him get rid of the need to make difficult decisions. The patient's daily routine should include his usual activities, this will help him maintain a feeling of confidence and security. It is important to try to help the patient maintain a sense of self-worth. In the presence of a patient, you should refrain from discussing his condition, as the words and actions of others can cause anxiety and resentment.

In many cases, physical exercises allow you to maintain the patient’s functional abilities for some time, although it is better to consult a specialist for recommendations on the nature and complexity of the exercises. If before illness a person liked to work in the garden or in the country, he may enjoy using the remaining skills. However, we must not forget that as the disease progresses, the abilities and interests of a dementia patient may change. Therefore, when providing care, it is important to carefully monitor the patient and make the necessary changes in the nature and content of his activities.

It is unacceptable to draw the patient's attention to his failures. Any conflict only leads to unnecessary stress for both the patient and those caring for him. Showing anger, bitterness, or resentment will only make the situation worse and make the problem worse. Try to remain calm, try to laugh with (but not at) the patient. Humor is often a great stress reliever!

Provide a safe environment

Memory loss and poor coordination of movements in the patient increase the risk of injury. Try to make your home as safe as possible.

Remove sharp and cutting objects, household poisons and medicines.
Hide dangerous electrical devices away.
Shut off the gas supply when the patient is alone.
Install patient safety devices (for example, a microwave oven for cooking).
Check the operation of door locks, install locks on windows.
Use locks that cannot be opened by a sick person.
Keep a close eye on smokers.
Do not change the patient’s usual arrangement of furniture.
Provide adequate general lighting, staircase lights, and nightlights in the bedroom and closet.
Control temperature regime indoors, avoid drafts, hypothermia or overheating, help select and put on clothing appropriate to the temperature conditions.
Monitor the quality of food, do not eat poor quality or spoiled food.
Install grab bars in the bathtub and toilet, the bathtub bottom and floors should not be slippery, and door locks should also open from the outside.
The material underfoot in all areas must be non-slip.
Furniture should be stable, chairs and bed should be high enough.

Keep in touch

As the disease progresses, communication between caregivers and the patient may become increasingly difficult. The patient's vision and hearing should be checked, if necessary, order stronger glasses, and replace the hearing aid. When communicating, it is recommended:

respectfully address the patient by name (patronymic);
speak clearly, slowly, face to face with the patient, while keeping your head at eye level;
show love and warmth by hugging the patient, if this does not bother him;
listen carefully to the patient;
pay attention to non-verbal means communication;
try to establish what gestures and combinations of words, hint words are necessary for effective maintenance communication with the patient;
avoid negative criticism, disputes, conflicts;
Before speaking, check whether the patient is listening to you.

Bathing and personal hygiene

The patient may forget to wash, not see the need to wash, or not remember how to do it. When offering your help to the patient, try to preserve his personal dignity.

When washing, try to adhere to the patient’s previous habits.
Try to make washing as pleasant as possible and help the patient relax.
Taking a shower may be easier than taking a bath, but if a person is not used to showering, it may bother them.
If the patient refuses to bathe or shower, wait a while - the mood may change.
Let the patient do everything possible himself.
If the patient is embarrassed when bathing or showering, certain areas of the body can be left covered.
Don't forget about safety - securely fastened objects, handles or railings that you can grab onto, a mat that you can't slip on, and an extra stable chair.
If, while helping a sick person wash, you encounter problems every time, ask someone to help you.

Dressing

The patient may forget the dressing procedure and may not see the need to change clothes. Sometimes patients appear inappropriately dressed in the presence of people.

Place the patient's clothes in the order in which they need to be worn.
Avoid clothing with complex fasteners; use clothing with elastic bands, Velcro, zippers, etc.
Do not rush the patient when dressing; encourage him to act independently.
Shoes should be comfortable, non-slip, with rubber soles, loose, but not slipping off the foot.

Toileting and incontinence

Patients may forget where the toilet is and what to do in it, and they stop feeling when to go to the toilet.

Encourage the patient to go to the toilet.
Establish a specific visiting routine.
Mark the door to the restroom with large, colored letters.
Leave the toilet door open to make it easier to find.
Make sure the patient's clothing is easy to remove.
Within reason, limit your fluid intake before bed.
You can place a chamber pot next to the bed.
Use diapers if necessary.

Nutrition and cooking

People with dementia often forget to eat and may not remember how to use a fork or spoon. In the later stages of the disease, the patient needs to be fed. There may also appear physical problems- lack of ability to chew and swallow food normally.

Remind the patient to eat.
Give him food that he can eat with his hands.
Cut food into small pieces to prevent the patient from choking.
In the later stages of the disease, prepare pureed and liquid foods.
Remind them to eat slowly.
Do not forget that the patient may lose the sensation of cold and hot and get burned, so the food should be warm.
Do not give the patient more than one serving at once.
If you have problems with swallowing, seek advice from your doctor, he will introduce you to techniques that stimulate swallowing.
Make sure the patient gets enough nutrients.

In the later stages of the disease, the patient may lose the ability to prepare food. This can be a serious problem if a person lives alone. Poor coordination of movements leads to increased danger injuries such as burns and cuts from cooking. Try to provide the patient with ready-made food.

The patient does not sleep well

The patient may stay awake at night and disturb the entire family's sleep. For caregivers, this can be the most debilitating problem. What can be done?

Try not to let the patient sleep during the day.
Taking a long walk every day may help. Let's do more physical activities during the daytime.
Make sure that the patient can feel comfortable and comfortable when going to bed.

The patient often loses things and accuses you of stealing

The patient may often forget where he put this or that object. Often he accuses you or other people of stealing lost items.

Find out if the patient has a secluded place where he hides things.
Keep replacements of important items with you, such as a spare set of keys or glasses.
Check trash cans and baskets before emptying them.
Answer the patient’s accusations calmly, do not get irritated.
Agree that the item is lost and help find it.

Vagrancy

Sometimes patients show a tendency to wander, which causes a lot of anxiety and worry to relatives and caring staff. The patient may leave home and wander around the surrounding area, go to an unknown direction and get lost, or even end up in another city. If the patient leaves home alone, care must be taken to ensure his safety.

Make sure that he always has some form of identification document with him,
Make sure that the person with dementia has a note in their pocket with an address and telephone number where they can contact the person's next of kin or caregivers.
Make sure that all exits from the house are well locked, that the patient is safe in the house/apartment and cannot leave the house without your knowledge.
If the patient gets lost, control your emotions, speak calmly, do not scold the patient, try to express your support to him when he is found.
It is useful to have a recent photograph of the patient in case he gets lost and you need help from others in finding him.
To combat vagrancy, you can attach unbreakable mirrors to all doors: your own reflection in the mirror distracts the patient from the intention of opening the door.

Delusions and hallucinations

Patients may experience delusions and hallucinations. Delusional ideas are characterized by the appearance of false beliefs in the patient. For example, the patient feels that they are pursuing him, want to poison him, cause harm, etc. Delusional ideas are perceived by him as a reality that causes fear. The patient may have visual and auditory hallucinations, he may see or hear things that do not actually exist, such as figures or voices of people talking in the room.

Do not argue with the patient about the reality of what he saw or heard, since if he feels that he must defend his own views, this may lead to increased delusion.
If the patient is frightened, try to calm him down: take him gently by the hand, speak in a soft, calm voice.
Distract the patient's attention from the hallucination by drawing his attention to a real object in the room.
Consult a doctor: the patient’s condition may be due to the use of medications.

Aggressive behavior

A serious problem for caregivers can be the manifestation of aggressiveness and violence on the part of the patient. In such cases, the following tips may be helpful:

Try to remain calm and do not show your own fear or anxiety.
Retaliatory aggressiveness should be avoided by all possible means; An accusing, threatening or judgmental tone of voice can increase the patient's aggression.
You should not be too close to the patient, he may perceive this as a threat.
Try to switch the patient's attention to a calmer activity.
Try to determine what caused the patient’s reaction and make sure that these conditions are not repeated.
If aggressive behavior the patient often recurs, it is necessary to seek help from a specialist.

How to cope with the stress of caring for a patient

Alzheimer's disease affects not only the patient, but also the entire family. The heaviest burden is borne by those who directly care for the sick. Constantly exposed to stress, these people need to know how to help themselves.

Family

For some caregivers, family is the most best assistant, for others, it only brings grief. Do not reject the help of other family members if they have enough time, and do not try to shoulder the entire burden of caring for the patient. Contact special services for help.

Don't keep your problems to yourself

You need to share your experiences caring for the patient with others. Keeping them with you makes your job more difficult. Feeling that your emotions are a natural reaction in your situation, it will be easier for you to cope with your problems. Do not reject the help and support of others, even if it seems to you that you are burdening them with it.

Leave time for yourself

You need to have time for yourself too. This way you can see others, do what you love, and most importantly, enjoy life. If you need to be away for a while, try to find someone who can replace you so that you can take a break.

Consider your limits

How much can you endure before the work becomes too much for you? Most people are able to set their own limits before caring becomes overwhelming. If you feel that you are overworked and that work is beyond your strength, seek help to prevent a crisis.

Don't blame yourself

Don't blame yourself or the patient for the difficulties you have to face. Remember, it is only their illness that is to blame. If you feel like you are losing touch with family and friends, don’t blame them or yourself. Try to determine what exactly is disconnecting you and discuss this problem with them. Don't forget that your relationships with other people can be an irreplaceable source of support for you, which is beneficial for both you and the patient.

It can be very useful for you to seek advice from a specialist about the changes occurring with the patient.

Don't forget how important you are

Your condition is extremely important both for you and for the patient. You are irreplaceable in his life; the patient could not live without you. This is an additional reason to take care of yourself.

Professor Perfilyeva G.M.
Nurse, 2002, № 1.
The article is published with abbreviations.

Care for dementia caused by cerebrovascular disease

With this condition, patients suffer from memory loss, and their mental disorders worsen. Unlike people with Alzheimer's disease, they are aware of their situation, their personality remains relatively intact. Caring for patients is difficult, but there are techniques that can make the situation easier:

establish a routine that makes the patient’s life more organized;
When following the regime, try to maintain the previously established habitual routine for as long as possible;
maintain the patient’s independence for as long as possible;
help the patient maintain self-esteem;
refrain from discussing his condition with other people in his presence;
avoid conflicts; remember: the disease is to blame, not the person;
take care to create conditions for the maximum manifestation of the patient’s capabilities;
monitor changes in vision and hearing, determine whether the patient needs to change glasses, purchase hearing aid;
speak to him clearly, slowly, do not shout, communicate face to face;
watch the patient’s facial expressions, gestures, and postures; all this serves as a means of communication for him.

T.G.Dasko, O.P.Ivanova.
Nurse, 2000, No. 6.
Printed with abbreviations.

Life is unpredictable and circumstances may develop such that one of the people close to you becomes seriously ill or, even worse, becomes bedridden. But in such cases, the desire to help is often not enough; certain skills and knowledge are needed to provide competent care for a sick person. Even with this knowledge and free time, it is very difficult to cope with such a task on your own, since a bedridden patient often requires round-the-clock care. The best option is to use a live-in caregiver or a caregiver with a work schedule convenient for you. Of course, this will require certain costs. However, you will very soon see that the costs are worth it.

Caring for a patient with limited mobility is, first of all, taking care of his personal hygiene, because... an unpleasant body odor or neglected appearance can aggravate the patient’s depressed state. If it is not possible to bathe the patient in the bathroom, then this should be done in bed, wiping his body with a damp towel, and wash his hands, feet and head separately, placing oilcloth under them. Caring for the patient's oral cavity should be performed at least twice a day.

At first glance, hygienic care, feeding, prevention of bedsores, therapeutic massage, washing the patient, changing linen, etc. seem to be simple and straightforward procedures. In fact, they require certain knowledge and skills that are possessed by professional, experienced caregivers.

Nurses provide constant round-the-clock care for the patient and perform various medical manipulations(droppers, injections, dressings) and other procedures prescribed by the doctor, assist in the management household. To prevent diseases resulting from inactivity, caregivers carry out a whole range of measures, including:

regularly shifting (turning over) the patient (at least every two hours) to prevent the formation of bedsores;
doing exercises with the patient therapeutic exercises, helping to increase joint mobility, strengthen ligaments and muscles of the body.
conducting therapeutic massage sessions.

Such care for bedridden patients is mandatory and requires a professional approach, which can only be provided by a qualified nurse.

An indisputable fact is that the most necessary thing for a person, and especially for a sick person, is attention and communication. Of course, it is very difficult after spending sleepless night at the patient’s bedside, feeling tired and lack of strength, maintain good mood and a friendly tone. However, in no case should you show your irritation, lose your composure and lash out at a sick person, because he is not able to move freely and take care of himself.

Do not forget that the most traumatic psychogenic factor that can lead to somatic complications is a formal and indifferent attitude towards the duties you perform, which can develop due to a long stay near the patient. Such situations do not happen rarely, since one person, even one who loves the patient very much, gets tired of the constant workload and needs rest. That's why the best option in this case, the hiring of a professional nurse for whom caring for the sick is her job is recognized. The nurse can come to you as needed or will care for the patient around the clock.

And here the question arises: where to find a nurse who could successfully cope with these difficult responsibilities? The LAVENDA-med patronage service will help resolve this issue very quickly. The services of our company are in great demand, and not without reason, since we specialize in providing only such services.

A huge advantage of the LAVANDA-med patronage service is the availability sufficient quantity qualified experienced caregivers with medical education and related nursing skills. By using our services, you will be convinced of the professionalism and reliability of the company’s management and the chosen nurse.

Cope with the responsibilities of caring for the patient yourself or seek help - it’s up to you to decide. But most importantly: take care of your health and that of your loved ones!

When a person gets sick, he needs medical supervision, help from loved ones in caring for him and following medical orders. In many cases, it is the patient’s relatives themselves who have to take on the responsibilities of a nurse and caregiver. When the patient’s condition is not so serious, he tries not to bother his relatives, independently fulfilling all the doctor’s prescriptions and following the regime. Such actions require special knowledge that will allow competent care. In the most condensed form, in this part of the book the reader will receive the necessary information on caring for the patient.

It is during illness that a person most needs your participation, psychological support and physical care. And if you yourself are sick, then you will really want your loved ones to support you.

In more severe cases, when a person has become bedridden, he cannot do without the care of loved ones. And with good care, the patient often recovers faster, his health returns, and he again becomes completely independent.

Most diseases are curable. And only very severe diseases in neglected form may become incurable. Good care and home procedures will help most patients overcome their illness, and in the case of an incurable illness, make the rest of the patient’s days easier. Care and procedures can be performed by medical professionals, but relatives must still come to their aid. And even more often, this hard work falls entirely on loved ones. That is why you should have basic medical knowledge and skills and be able to carry out doctor’s orders at home. And the departure of loved ones can give best result, because the love of loved ones helps the healing of the patient.

To ensure effective care, follow all medical instructions and procedures with love for the patient. He will feel your love and get better faster.

Be patient and never get irritated in the presence of a sick person, because this will push him into illness.

A long-term ill person is depressed by his illness and his infirmity, which leads to a depressed state of mind and uncertainty about the prescribed treatment. Thoughts about the worst illness and the worst possible outcome appear.

Many patients become dissatisfied and irritable, so it is necessary to take this feature of the disease into account, be patient and be patient with the patient. The illness will pass, and this person will become the same as always.

The caregiver should be calm and friendly towards the patient. You should not argue with the patient, but gently, in a friendly manner, convince him of faith in his own strength, choosing a time for this when the patient is ready to enter into psychological contact.

Do not let despair and fear settle in the patient’s soul, which always aggravate the disease and aggravate its course.

It is necessary for the patient to experience confident optimism that his painful condition is temporary and healing powers the body will prevail over the disease.

This is quite possible, because most patients believe in a better outcome and have hope for recovery. We need to delicately and confidently convince them of this. Hope and optimism - best medicines.

However, psychological pressure and pressure from any of the relatives when trying to psychologically support the patient is unacceptable.

If the patient feels the psychological violence of a healthy and energetic person who will harshly insist that his illness is nonsense, then such support will give reverse effect- the patient will be offended and morally depressed because his loved ones do not understand him. We must understand that during an illness, a person’s mental state becomes uncertain and weak, and the most unpleasant thoughts about the outcome of the illness enter his head. All this is explained by the low energy of the sick body, because the disease takes away the strength of the patient. It is necessary to prepare the patient’s psyche for recovery. The patient's confidence in recovery will give him additional strength in the fight against the disease.

Sometimes patients look for special illnesses: statements from a doctor or one of their relatives that it is common illness, like everyone else, which many have suffered from and successfully recovered from, they really don’t like it. They believe that their illness has a special course and that the illness itself is special. There is no need to argue in this case, trying to convince the patient that his illness is mild and everything is like everyone else’s. It’s better to say that the patient really has a special case, that you understand that the pain is very strong, and the cough is very severe, and so on. But gradually everything will get better, the disease will recede, the body will recover.

And in fact, the same disease occurs in each person in its own way, because each organism is unique and is able to resist the disease to a greater or lesser extent.

The patient really needs to be understood and not argued with.

The patient may become suspicious of the doctor and the prescribed treatment. You should patiently convince him that the treatment is correct, paying attention to the progress made, and correction is only a matter of time.

You should communicate with the patient in accordance with his condition.

At in serious condition the patient cannot communicate with you, so you should carry out the procedures prescribed by the doctor without actually communicating with the patient, but mentally or in a very quiet voice wish to a loved one get well soon.

If the patient’s condition is relatively mild, you should communicate with him as he wishes, supporting his spirit and will to recover.

Excessive communication with the patient is difficult for him.

Such intrusive attention on the part of the caregiver can take away from him vitality.

You need to communicate with the patient as naturally as with healthy person.

Never cooze with a patient, do not change your voice, do not speak in a whisper in front of him, do not resort to excessive gestures, do not think out loud about your problems or the patient’s condition, do not change your usual gait by walking on tiptoes. You should also not make excessive noise and move, making knocks, or slam doors. It is better to lubricate the door hinges so that they do not creak. At the patient's request, curtains should be drawn or curtains should be opened. The patient’s nervous system is tense, so one must be sensitive to his increased sensitivity.

The patient's personal area is his bed.

Therefore, it is better not to touch it unless necessary and not to sit on it. The patient usually does not like this. There should be a stool near the bed, on which the caring relative should sit.

You need to sit at some distance from the bed and the patient’s head so that he can clearly see you, especially your face, without turning his head.

You can entertain the patient only at the stage of active recovery, and he himself will ask for what he needs to distract himself from the disease (often this is a good book).

We must try to understand the patient and identify his desires, which will strengthen his spirit and improve his mood.

In case of a protracted illness, when a person has the strength to read, spiritual literature helps well in recovery.

It is also useful to develop the patient’s optimism and love of life. Appropriate literature that can improve the patient’s mood should be specifically selected taking into account his condition and personality characteristics.

It is better not to watch TV - it takes away the patient’s vitality and depresses his psyche.

Quiet music, specially selected for a given patient, can also contribute to his recovery. Such music sessions do not have to be intimate.

Properly selected melodies can help the body recover by adjusting biorhythms energy fields person, having a beneficial effect on emotional sphere and strengthening the psyche.

Often patients want to watch flowers blooming in a vase houseplants, look at paintings with a cheerful landscape. You should find out the patient’s wishes and improve the interior of his room.

Caring for a bedridden patient is a difficult task, not only from a physical but also from a psychological point of view. Not every person can cope with this task. It is difficult to remain calm while watching a loved one suffer every day. In addition, caring for a patient requires a lot of time, physical strength and special skills.

How to organize care for a bedridden patient

Therefore, especially if we are talking about a terminally ill person, the best option may be another specialized nursing facility. In this case, specially trained personnel will help the patient live the rest of his days as comfortably as possible, saving him from suffering and loneliness.

Hospices do everything to make life easier seriously ill people: apply effective techniques pain relief, psychological support is provided, complications are prevented, and medical supervision is provided.

Hospice accepts people of different ages who need care, and not only with cancer, but with any serious illness that limits life.

This best way solving the problem, especially if relatives do not have the opportunity to provide their loved one with full care and supervision at home.

Hospices can be either state-owned, where you can get a referral, or paid. You can go to a paid hospice without a doctor’s referral; in addition, the level of comfort in such institutions is usually higher.

But, nevertheless, often a bedridden patient remains at home, especially in cases where the illness is temporary nature. In this case, it is important to organize the whole process in such a way that it would be good not only for the patient, but also for those who care for him.

The ideal option is to select a separate room and leave in it only the necessary furniture and care items that should be at hand. In addition, the room should have a TV, books, a computer - everything a sick person needs to feel connected to the world.

If there is no separate room, it is better to place the bed closer to the window, provide access to it from all sides and place all care items nearby.

It is better to purchase a special functional bed, but if you don’t have one, you can modify a regular one. It is necessary to add height and rigidity to the bed with the help of additional mattresses and create a fence.

The toilet chair and the items needed by the patient should be next to the bed.

You should definitely learn basic nursing techniques: how to make a bed, feed and change a patient, prevent bedsores, do massage and therapeutic exercises.

These useful skills can be acquired in an inpatient setting. Nurses and hospice staff also teach how to care for the sick.

It is necessary to draw up a schedule for caring for the patient, a daily routine and nutrition.

It is necessary to find out from the doctor in which cases it is necessary to urgently call an ambulance.

All instructions from doctors regarding care and taking medications must be followed exactly.

You need to find out from the attending physician what the patient can do on his own and what he needs help with. There is no need to do absolutely everything for the patient; on the contrary, it is important to support and encourage his activity and independence.

Special items for the care of bedridden patients make life much easier, so they are worth purchasing. This can be done inexpensively or even for free via the Internet, from friends or with the help of charitable foundations.

Who can help care for the sick?

It is very difficult for those who directly care for a sick person. Sometimes this ends in moral and physical exhaustion, or even serious illness. To prevent this from happening, you need to determine in advance the circle of people who can provide at least some help and do not hesitate to ask for it.

Close people: someone can help with money, someone can take the patient to the doctor, sit with him for several hours or cook food.

Social workers can provide free help with shopping.

The nursing service of the Sisters of Mercy can come to your home for advice on care.
Charitable organizations can help you purchase expensive care items or medications.

Carers are a good way to significantly ease the situation and provide qualified assistance to a loved one. If it is not possible to hire a nurse for permanent term, you can do this at least sometimes to give yourself a rest.

Tell your friends about it!

In the generally accepted interpretation, care is a set of activities that provide comprehensive care for a person, including the creation of optimal conditions and environment for him, the implementation of procedures prescribed by the doctor, which, in turn, contributes to a more comfortable state of health for the patient and a faster recovery.

Nursing and its basic principles

Care is divided into special and general - subtypes, which, in turn, have their own characteristics.

Let's look at each subtype separately:

General care. This subtype includes responsibilities for maintaining the hygienic condition of the patient, as well as maintaining the ideal cleanliness of the room in which he is located, organizing meals for the patient and properly performing all procedures prescribed by the doctor. Also, general care involves providing assistance to the patient with physical activities, eating, and toileting. In addition, this also includes monitoring the dynamics of the patient’s condition and his well-being.
Special care is usually associated with the specifics of a particular diagnosis.

It is worth noting that care is not an alternative to treatment: it is part of a complex therapeutic measures. One of the main purposes of caring for a sick person is to maintain a comfortable psychological and domestic environment at each stage of treatment.

How is proper care built?

The basis of proper patient care can be called protective regime, which is designed to protect and spare the patient’s psyche:
- elimination of excessive irritants,
- ensuring peace/quiet,
- creating comfort.
When all these components are completed, the patient feels comfortable, has an optimistic attitude and confidence in the successful outcome of the disease.
It is especially worth noting that the effectiveness of caring for a sick person requires not only certain skills, but also a compassionate attitude. After all, physical suffering and illness create feelings of anxiety in a person, often hopelessness, irritability towards medical staff and even relatives. Tact, the ability to support a person during this difficult period for him, a sensitive and attentive attitude towards him, will allow the patient to escape from his painful situation and tune in to an optimistic mood. That is why care is one of the mandatory sections of the activities of medical personnel. If the patient is treated at home, care is provided by his relatives or medical staff, after consultation with your doctor.

Basic principles of care

1. Room. It should be bright, spacious, and, if possible, insulated and protected from noise. For any disease, an abundance of light, fresh air and a comfortable temperature in the room where the patient is located will have a beneficial effect on the person. Separately, it is worth mentioning about the light: its strength should be reduced if there is a patient with an ophthalmological disease or a disease of the nervous system in the room. During the day, electric lamps should be covered with a frosted lampshade, and at night only nightlights or other low-heat devices can be turned on.

2. Temperature. The optimal microclimate in the patient's room should be as follows: temperature within 18-20°, air humidity no more than 30-60%. It is very important that the room does not cool down in the morning. If the air is too dry, you can put a moistened rag on the radiator to increase the humidity, or place a vessel with water next to it. To reduce the humidity in the room, it is necessary to ventilate it. In city conditions, it is better to ventilate at night, since during the day the city air is much more polluted with dust and gases. In other conditions in summer time You can ventilate the room around the clock, but in winter, ventilation should be done no more than 3-5 times a day. To protect the patient from the cold air flow during ventilation, it is necessary to cover him with a blanket and his head with a towel or scarf (the face is open). Instead of ventilation, it is unacceptable to fumigate the room with aromatizing agents!

3. Purity. The room in which the patient is located must be kept clean. So, cleaning must be done at least twice a day. Furniture, window frames and doors should be wiped with damp cloths, the floor should be washed or wiped with a brush wrapped in a damp cloth. Items on which dust can accumulate (drapes, carpets) are best removed or frequently shaken out/vacuumed. The patient's room must be isolated from street, traffic and industrial noise. It is also recommended to reduce the volume on radios, televisions, etc. You should talk in a low voice.

4. Transportation. A very important point. If a person is seriously ill, he must be transported carefully, on a special chair, stretcher or gurney, while avoiding jolts. The patient is carried on a stretcher by two or four people. It is important that they walk out of step, in short steps. Shifting and carrying the patient by hand can be carried out by one, two or three people. If the carrying is carried out by one person, then it is necessary to act in the following order: one hand is placed under the patient’s shoulder blades, the other under the hips, while the patient must hold the carrier by the neck. In order to move a seriously ill patient from a stretcher to a bed, you must proceed as follows: place the stretcher at a right angle to the bed, so that its foot end is closer to the head of the bed. Before transferring a seriously ill patient to a bed, it is necessary to first check its readiness, as well as the availability of individual care items and bedside accessories.
A seriously ill person, among other things, will need:

Lining oilcloth,
- rubber circle,
- urinal,
- bedpan.

The patient's bed should be neat, comfortable, of sufficient length and width. For a patient's bed, it is best to use a multi-sectional mattress, over which a sheet is laid. If necessary, put oilcloth under the sheet. IN special cases, for example, in case of lesions of the spine, a hard shield is placed under the mattress. It is worth remembering that the patient’s bed should not be located next to heating sources. The best location would be one in which the patient can be approached comfortably from both sides.

A seriously ill patient must be helped to undress, take off his shoes, and in special cases, the clothes are carefully cut.

5. Change of bed linen. With this procedure, it is impossible to create for the patient uncomfortable positions, forced muscle tension, do not cause pain. The patient should be moved to the edge of the bed, and the freed part of the sheet should be rolled up to the patient's body. Next, spread a clean sheet on this part of the bed and shift the patient. With strict bed rest, the sheet rolls down in the direction from the legs to the head - first to the lower back, then to the upper part of the body. The edges of the sheet are attached to the mattress with safety pins. Every time you change your linen, you should also shake out your blanket.

6. Change of underwear. When changing a shirt for a seriously ill person,
You should first place your hand under his back, then lift the shirt to the back of his head, remove one sleeve, then the other (in cases where one arm is injured, you should start with the healthy one). After this, the patient should put on a shirt (starting with the sore arm), then lower it over the head to the sacrum and straighten out all the folds. If a patient is prescribed strict bed rest by a doctor, he should wear a vest. If the patient's underwear has been contaminated with blood or secretions, it should first be soaked in a bleach solution, then dried, and only then sent to the laundry.

7. Mode. The doctor prescribes different regimens for the patient, depending
on the severity of the disease:
Strict bed rest, in which it is forbidden to even sit.
Bed rest, in which you can move in bed, but you are prohibited from leaving it.
Semi-bed, in which you can walk around the room.
General mode, in which, as a rule, physical activity the patient is not significantly limited.

Features of caring for a patient with bed rest

1. The patient carries out physiological functions in bed. The person is given a disinfected, cleanly washed bedpan (a specialized device for defecation), into which a little water is poured to absorb odors. The vessel is placed under the buttocks so that the patient’s perineum is above the large hole, and the tube is between the thighs. In this case, you need to place your free hand under the sacrum and lift the patient. After freeing the vessel, it must be thoroughly washed hot water, and then disinfect with a 3% chloramine or Lysol solution. The container for collecting urine - a urine bag - must also be served well washed and warm. After each patient urinates, the urinal is washed with solutions of sodium bicarbonate and potassium permanganate, or a weak solution of hydrochloric acid.

2. Tools and equipment necessary for maintenance must be stored in a strictly designated place. Everything necessary for the patient should be ready for use. Heating pads, bedpans, urine bags, rubber rings, ice packs must be washed with hot water, then rinsed with a 3% chloramine solution and stored in specialized cabinets. Probes, catheters, gas tubes, enema tips are washed in hot water and soap and then boiled for 15 minutes. Enema tips must be stored in designated, labeled containers. Beakers and sippy cups are ordered to be boiled. If possible, you should use care products designed for one-time use. Chairs, gurneys, cabinets, beds, stretchers and other medical equipment must be periodically disinfected with a 3% solution of chloramine or Lysol, and must be wiped daily wet rag or wash with soap.

3. Personal hygiene of the patient is of great importance during the rehabilitation period. Primary patients (with the exception of patients in extremely serious condition) should be subjected to sanitization, which includes a bath, shower or wet wiping, and, if necessary, a short haircut followed by disinfection treatment of the scalp. If the patient requires outside assistance during hygiene procedures, it should be lowered into the bath on a sheet, or placed on a special stool placed in the bath and washed with a hand shower. If a person is seriously ill, taking a bath is replaced by wiping the body with a swab dipped in warm water and soap. Upon completion of the procedure, it is necessary to wipe the patient’s body with a swab dipped in warm water without soap and wipe dry. Unless otherwise prescribed, the patient should take a shower or bath at least once a week. The patient's toenails and fingernails must be cut short.

4. Secondary or dispensary patients are recommended to wash their hair warm water with soap (after the procedure, the hair is carefully combed). If a person is seriously ill, then it is recommended to wash your hair in bed. As for the frequency of these hygienic procedures, it is as follows: the patient’s hands should be washed before each meal, feet - every day before going to bed. The upper body, as well as the face and neck should be washed daily. The genitals and anus should also be washed daily. In cases where a person is seriously ill, washing the genitals should be carried out at least twice a day. The procedure is as follows: a bedpan is placed under the patient’s buttocks (at this time the patient lies on his back, legs bent at the knees). For the washing procedure, it is also convenient to use an Esmarch mug, which is equipped with a special rubber tube with a tip, which, in turn, has a clamp or tap. A stream of water or a weak solution of potassium permanganate is directed into the perineum. At the same time, a cotton swab is passed in the direction from the genitals to anus. Then, using another cotton swab, the skin of the perineum is dried. This procedure can also be performed using a jug into which a warm disinfectant solution is poured. Inguinal folds, axillary areas, as well as folds of skin under the mammary glands, especially if the patient is obese or prone to excessive sweating,
It is necessary to wash frequently to avoid diaper rash.

5. Exhausted patients, as well as those patients for whom bed rest lasts a large number of time, require especially careful care of the body and skin to avoid the appearance of bedsores. As a preventative measure, in addition to skin care, it is necessary to keep the bed in perfect order: regularly smooth out the folds of the sheets and eliminate unevenness. The skin of patients at risk of developing bedsores should be wiped once or twice a day. camphor alcohol, and also powder with talcum powder. In addition, it is necessary to use rubber circles wrapped in a pillowcase, placing them under the places that are most subject to pressure (for example, the sacrum). A necessary preventive measure is also to frequently change the patient's position on the bed. Caring for the patient’s feet is no less important - with insufficient care, thick horny layers can form on the soles, which is a manifestation of epidermophytosis in a scaly form. In these cases, removal of keratinized skin followed by treatment of the skin of the legs with antifungal agents is indicated.

6. Feeding seriously ill patients is extremely important point in care. Must be strictly observed prescribed by a doctor nutrition and diet. When eating, bedridden patients must be placed in a position that will avoid fatigue. As a rule, this is a slightly elevated or semi-sitting position. The patient's neck and chest must be covered with a napkin. Feverish and weakened patients should be fed while the temperature decreases/improves. Such patients are fed with a spoon; pureed or crushed food is given in small portions. For feeding purposes, do not interrupt nap, in cases where the patient suffers from insomnia. Seriously ill patients are given a drink from a sippy cup. If a person cannot swallow food, he is shown artificial nutrition: tube feeding.

7. One more thing necessary condition successful treatment- monitoring the patient's condition. Thus, caregivers must regularly inform the doctor about every change that occurs in the patient’s condition. It is necessary to take into account the patient’s mental state, changes in the position of his body, skin color, facial expression, the presence of a cough, breathing rate, changes in the nature and color of urine, feces, and sputum. In addition, on the instructions of the doctor, it is necessary to measure body temperature, weigh, measure the ratio of the fluid excreted and drunk by the patient, and make other prescribed observations. It is important to monitor the patient's intake of prescribed medications. For the medication administration procedure, clean beakers and a carafe of boiled water should be prepared.

Features of caring for senile and elderly patients

Care for such patients must be carried out taking into account the characteristics of the aging organism and, as a consequence, a decrease in adaptive capabilities. It is also necessary to take into account factors such as age-related changes psyche, as well as the uniqueness of the course of diseases in older people. Among these features the following can be distinguished:

Atypical sluggish course of the disease in the absence of a pronounced temperature reaction.
- relatively rapid onset of severe complications.

Elderly people are susceptible to various kinds of infectious diseases and the appearance of inflammatory processes, and this feature requires increased care of hygienic care.

In addition, it is often manifested by older people increased sensitivity to changes in diet and regime, to changes in microclimate, and the appearance of noise. Among the characteristics of the behavior and psyche of an elderly person, one can highlight slight vulnerability, emotional instability, and, if there is vascular diseases – a sharp decline memory, criticism, intelligence, helplessness, and, often, untidiness. These kinds of features require increased attention at service personnel, as well as a patient and compassionate attitude.

Strict bed rest for older people is recommended to be reduced as early as possible. And it is recommended to prescribe treatment as early as possible physical culture and massage for the fastest return to motor mode. This will avoid hypokinesia. Also, elderly patients are recommended to prescribe breathing exercises with
for the purpose of preventing congestive pneumonia.

Features of care for resuscitated patients

The peculiarity of care for resuscitated patients, as well as for patients who are in conditions intensive care, is that here care includes both general and special elements, in relation to traumatological, surgical, neurological, as well as unconscious patients.

Much attention must be paid to monitoring the patient’s condition, including monitoring, monitoring the patient’s physiological functions, including breathing, urination, and blood circulation. In addition, it is necessary to monitor the condition of perfusion tubes, catheters and conductors from systems and devices connected to a person.
Special care is required for patients undergoing artificial ventilation lungs through a tracheostomy or through an endotracheal tube. In such cases, a thorough toilet of the tracheobronchial tree is required (in some cases, every 15-20 minutes).
Without this procedure, bronchial obstruction may be impaired and, as a result, asphyxia may develop. Removal of secretions from the bronchi and trachea must be carried out wearing sterile gloves, or after the hands have been treated with a disinfectant solution. To perform the procedure, a specialized angled catheter is used, which is connected to a vacuum pump through a tee. One elbow of the tee must be left open. The patient's head must be turned, then, while inhaling, in one movement, insert the catheter into the tracheostomy or endotracheal tube and push it through the bronchi and trachea into the lung until it stops. After this, the tee hole is closed with a finger to ensure the action of vacuum suction; the catheter must then be removed by gently rotating it with your fingers. After this, the catheter is washed with isotonic sodium chloride solution or replaced and the procedure is repeated the required number of times. The effectiveness of the procedure will be doubled if you simultaneously perform a vibration massage of the chest.
In order to prevent the development of congestion in the lungs and the appearance of bedsores, the patient’s position must be changed every 2 hours. In addition, it is necessary to place ring gauze pads under bony protrusions and wipe the patient’s skin with antiseptic solutions.
It is better if the patient lies on an anti-decubitus mattress.
It is also necessary to pay great attention to feeding patients, since eating on their own is often impossible for them. The feeding process is carried out using a sippy cup, to the outlet of which a rubber tube 20 to 25 cm long is attached. The end of the tube is inserted into the posterior parts of the oral cavity. Food is introduced through a tube, portions are regulated by squeezing it. Solid food must be brought to a creamy consistency by first subjecting it to heat treatment, then crushing and diluting it with liquid. Do not give the patient spicy or hot food. During feeding, the patient must be placed in a sitting position (in severe cases, the head should be raised), covered with an oilcloth apron so as not to stain the bed linen, clothes, and bandages. The feeding procedure should be repeated an average of 4 times. If it is impossible to feed the patient through a sippy cup, feeding is carried out using a nasogastric tube.

If the patient is unconscious, it is necessary to parenteral feeding, as well as parenteral fluid administration. Before introducing the solution into the oral cavity or vascular bed, it is necessary to warm it up to the patient’s body temperature. Upon completion
feeding, the patient’s oral cavity is washed with a solution of sodium bicarbonate, and after that with a solution of potassium permanganate in a ratio of 1: 5000, or another disinfectant solution.