Proper patient care. Home care for bedridden patients: means and items of care, rules

When close person is seriously ill, his family faces a difficult task: to alleviate his condition as much as possible, to support, to surround him with care. It is important to know the basic rules for caring for a bedridden patient so as not to harm him.

Professional nurses and caregivers receive extensive training in the care of bedridden patients, but everyone who comes into contact with a bedridden patient should know the basic life hacks.

Basic rules for care

At home, the patient needs to provide comfortable conditions. You should give him a spacious, bright and noise-protected room.

Lighting is preferably moderate: not twilight, but not too much bright light. The optimum air temperature is about 20 degrees.

The bed is placed with its head against the wall, so that it has access from all sides. This will facilitate turning, hygiene procedures, changing clothes and other manipulations necessary to care for a bedridden patient. It is better to purchase a special functional bed that supports all modern technological methods.

Bed where the patient is to lie most time, and even constantly, should not be too soft. It includes:

• head pillow,
• light blanket,
• a sheet (preferably with an elastic band so that it does not wrinkle),
• special pillows for fixing the patient in the position on the side.

If necessary, the mattress is sealed with oilcloth.

It is necessary to regularly carry out the prevention of bedsores.

Next to the bed, a small table or bedside table, a wardrobe with things will come in handy. On the bedside table you can put drinking water, a lamp, a TV remote control, glasses, books and everything that the patient needs at hand. There will be no superfluous bell with which he can call for help. You can put medical and cosmetic preparations, hygiene products, a thermometer, a tonometer and other necessary devices in the drawer.

Life hacks for caring for a bedridden patient

Do not be afraid to use modern technological methods of caring for a bedridden patient: they will greatly facilitate care. The following tips will help you.

• Regularly measure pressure, temperature, watch for the slightest changes in facial expression, voice, skin condition, body odor, quantity and quality of bowel movements.
• Food should be homemade, complete, easily digestible, easy to chew and swallow. You need to feed in a semi-sitting position.
• Purchase a cup or use a straw if the patient has difficulty drinking from a cup.
• If the patient cannot go to the toilet on his own, stock up on adult diapers and disposable diapers. They are more comfortable and hygienic than the usual rags.
• Use cotton clothing with a minimum of fasteners.
• Ventilate the room regularly, use a humidifier if necessary.
• Dust and mop daily.
• Provide leisure: TV, radio, books.
• Another tip - always listen to the desires of your ward: what he wants to do, who he wants to see, what he would like to eat, etc.

An important rule is that the performance of all manipulations should be thought out to the smallest detail and be as convenient as possible for both the patient and the one who cares for him.

Nursing education

A professional nurse can teach you how to look after and care for a bedridden patient. It is not difficult, and does not require compulsory medical education. But it is not enough to get trained and learn the basic techniques, tips and technologies. You need to have truly unlimited patience and a big heart in order to truly make life easier for your sick or elderly relative, without falling into despair in his presence, without getting annoyed at his whims.

What is better: to undergo training yourself or to entrust care to a professional - it's up to you. In both cases, there are advantages and disadvantages. Of course, it is more pleasant for the patient to see a loved one next to him. But not everyone has such an opportunity, both physical and moral. In this case, contacting a nurse is the best choice.

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A person with limited mobility needs care and attention from loved ones. This article will tell you what care products will help improve the comfort of a bedridden patient, protect him from the complications associated with prolonged lying down and make it easier for people caring for him.

Even if the main care of the patient is entrusted to the nurse, his relatives must also be familiar with care products in order to choose things with the best combination of price and quality. After all, the well-being and mood of a sick person, and hence the prospect of recovery, largely depend on the participation of his household. Modern technologies have made available many means for the care of immobilized patients, which can significantly make life easier for both the sick themselves and their relatives and friends who care for them.

While a bedridden patient is undergoing treatment in a hospital under the supervision of medical personnel, relatives have the opportunity to prepare a comfortable space for him and choose the necessary means and accessories for daily care.

Bed for the patient and cleaning of the room

The room should be freed from unnecessary furniture and other items, so that it is more convenient to clean. Wet cleaning should be carried out regularly, preferably every day, since the accumulation of dust can provoke complications from respiratory system sick. Of the products for regular cleaning, give preference to those that have the least pungent odors.

The bed should not be narrow. Big square bed will not only increase the comfort of a bedridden patient, but will also make it easier for you to carry out all care procedures (diaper and bed linen change, skin hygiene and much more). A wide bed reduces the risk that the patient may fall off the bed and be injured while sleeping or actively trying to move.

If it was not possible to find a specialized medical bed with an adjustable height of the back section, the desired height of the patient's back and head in the bed can be achieved using mattresses and pillows. Means (pillows and rollers) to ensure the elevated position of the patient's body are necessary so that a person can safely eat while in bed. Drinking and eating lying down is dangerous for the patient, especially if he has even minimal swallowing disorders, which often occur with limited mobility. In the semi-sitting position, the patient can also read or watch TV.

The bed must be placed in the room so that it has free access from at least three sides. This will allow you to freely change bedding, turn the patient from side to side, work with him therapeutic gymnastics to carry out hygiene procedures.

The bedside table next to the bed should be a place for the essentials that the patient uses. Each person has their own list of such items: it can be glasses, a lamp, a TV remote control or a book.

Means for monitoring the condition and improving the comfort of a bedridden patient

A special drinker mug (“non-spill”) will help a person with limited or impaired mobility to drink liquid without spilling it.

A bell or baby monitor is needed to call relatives or a nurse. These items must be placed next to the bed.

Devices for measuring pressure (tonometer), temperature, etc. A person who has had a stroke needs daily pressure control (at least twice a day). Other health problems may require regular temperature or blood glucose measurements.

Thermometer for air temperature control. For most bedridden patients, the air temperature in the room is considered to be optimal from 19 to 21 C. Blinds and ventilation at least twice a day at any time of the year will help to ensure the desired temperature during the hot period. A properly placed thermometer will ensure that the air temperature remains within the recommended limits.

Hygiene products for bedridden patients

When caring for a patient with limited mobility, it is important to remember that the protective (immunity) and regenerative (tissue regeneration) capabilities of his body are reduced. Therefore, care procedures should be aimed at maintaining hygiene and preventing bedsores.

Especially heavily bedridden patients experience the inability to go to the toilet on their own. As soon as mobility improves a little, they try to go to the toilet themselves. In this case, it will not be superfluous to put a ship next to the bed or place a special toilet chair.

If there is a problem of incontinence, special absorbent products will help protect the patient from a constant feeling of discomfort and protect his skin from diaper rash and bedsores. The trophism of the tissues of a bedridden patient, especially in the folds of the skin and places subject to prolonged compression, is often disturbed. Microcirculation disorders, together with poor ventilation, exposure to moisture and reduced immunity create conditions conducive to the accumulation harmful microorganisms. All this is accompanied by redness, inflammation, sometimes a feeling of itching, and later - irreversible damage and tissue death.

Means that will help reduce the risk of diaper rash and bedsores are seamless underwear, smooth bedding without additional seams, made from hypoallergenic materials that provide good ventilation.

Use of quality adult diapers incontinence also helps prevent pressure sores. Made from dermatologically tested materials, these adult diapers prevent chafing and irritation, are leak-proof, have a comfortable elasticated waistband and reusable Velcro fasteners to adjust the fit. They not only absorb liquid, but also block the smell, and a special filling indicator reminds you of the timely change of the diaper. The sizes of products vary from 50 to 170 centimeters at the waist, so you can choose the right size for an adult of any age and build.

The patient should be washed soft means with neutral pH. After the end of the procedure, the skin is wiped dry. Gentle massage of areas with a high risk of bedsores, their treatment with a special anti-decubitus, moisturizing or protective cream, and regular changes in the position of the patient in bed are also an important tool for prevention.

To protect bedding and mattress from getting wet and save yourself from unnecessary washing, it is recommended to apply disposable absorbent diapers during hygiene procedures. These products will also be useful in the restless behavior of a bedridden patient, when the diaper can move.

Dedicated bedside care products help prevent the complications of immobility and incontinence, as well as improve comfort and psychological condition person dear to you.

old age, accidents, chronic diseases, post-surgery recovery many of us are bedridden. Habitual activities become difficult. Such people need help. How to provide it correctly, says a specialist with five years of experience Irina Prudnikova.

Irina Prudnikova
critical care specialist rehabilitation center"Eleos"

Conditions in the room

— Optimum indoor climate — important condition for the comfort of bedridden patients. There are several rules.

• Temperature- about 20 degrees, humidity - 30-60%.

• Airing the room in autumn and winter - short-term, but frequent. In warm weather, the window can be left open all the time.

• It is not recommended to spray scented products and essential oils. And here humidifiers and air ionizers with increased dryness will come in handy. The ability to breathe freely is a paramount need for bedridden patients. Daily wet cleaning also prevents dust from entering the respiratory tract.

Change of linen

- The procedure should be carried out weekly and as needed. Ideally, a person should be moved to another place for a while. The movement must be handled by two people. One puts his hand under the patient's head and shoulder blades, the second puts his hands under the pelvis and takes the person by the legs. On command, the patient is moved.

If this is not possible, the following method is used:

• turn the person on their side

• we roll the old sheet into a roll and tuck it under the back;

• at the same time, we slowly roll out a roll of a clean sheet in the same direction as a roll of an old sheet;

• turn the patient over to the other side;

• remove the old sheet and roll out the clean one to the end.

If the patient does not control urination and is in a diaper, an oilcloth is laid on the sheet under the buttocks, and another narrow fabric is placed on top across the bed for skin comfort.

Change of clothes

- As a rule, this is a T-shirt (or shirt) and shorts (or diapers). This is the most convenient option. It is advisable to change clothes daily.

Raise the person slightly. Place a pillow under your back. From the sacrum we pull the T-shirt / shirt to the shoulders. Raise your hands slightly. We release the head through the cutout. We take off our clothes.

If it is seriously ill, then it must be rolled onto its side. Also from the sacrum we pull the T-shirt / shirt to the neck. We move the hand closer to the head. We release it through the cutout. Next, lower the sleeve. We turn the patient on the other side and release the other hand.

The person must be dressed in reverse order. First, hands, head through the cutout. Further (if a person can sit down) - we stretch the clothes to the sacrum or complete the process by turning the person from side to side.

The dressing process begins with a sore arm or leg. Otherwise, every extra movement is discomfort for the patient.

Skin care

- The skin is wiped daily with water at room temperature using tampons and sponges. There are times when doctors advise doing this with camphor alcohol. This is an antiseptic skin treatment. All procedures must be performed with disposable gloves.

The back, sides and sacrum should be wiped using the same technique of turning from side to side. It is important not to ignore the armpits and the place under the breasts (in women).

If the skin is dry, it must be moisturized with creams. Check with your doctor.

For the skin of the hands, lotions without alcohol are used. They have a softening and soothing effect. Washing foam is also great. It works especially well when changing diapers.

All these funds can be found in pharmacies and even in ordinary stores. Special moisturizing wipes are also sold - a very convenient solution.

Oral treatment

- Rinse your mouth after every meal. If the patient cannot do this, then with a napkin (do not forget about gloves) we grab the tip of the tongue with one hand and bring it forward. With the other hand, wipe the tongue with a swab dipped in a 0.5% soda solution and release it.

We take the second swab and wipe the inside and outside of the dentition.

It is impossible to process the inner side of the cheeks in this way. So you can damage the mucous membrane and bring the infection into the ducts of the salivary glands.

Eye treatment

- This must be done in the morning. Soak a cotton pad in a 3% solution boric acid and wipe the eyes of the patient from the inner corner to the outer from the top and from the bottom.

Ear Care

- It is important to rid them of accumulated sulfur on a weekly basis. Turn the person on their side. Place a few drops of 3% hydrogen peroxide in your ear. Wait five minutes, place cotton swab to the begining ear canal and moving along auricle(you can slightly twist the stick), pull the sulfur out.

Nose treatment

- Usually a daily routine. The patient is in a sitting position, the head is slightly thrown back. Wet the cotton swab vaseline oil or glycerin and wipe the nasal passages. We wait a couple of minutes. Then we remove the separated crusts with rotating movements.

Nail care

- It is carried out as needed, but at least once a week with the help of special scissors with blunt ends.

Hair care

- Hair should be combed daily with an individual comb, washed - at least once a week.

This procedure for seriously ill patients is carried out in bed. The person lies on their back with their head hanging off one end of the bed. Under the shoulders - a cushion or pillow. We put a basin under the head on the floor.

We wash our hair with the help of special products and a jug of warm water. It is important that water does not get into the ears. Dry your hair with a towel.

After the procedure, it is just convenient to change bed linen.

Bathing

- If a person moves minimally, you can carry out the procedure in the bath, seating the patient on a special seat. Even more convenient - in the shower, while the patient should sit on a chair.

Keep the water temperature at 36-37 degrees (you can just test the water with your elbow).

If seriously ill - wash in bed. You should have: one bowl of soap and one bowl of clean water, disposable gloves and washcloth. Often such people have increased skin sensitivity, so towels are not always suitable. It is more convenient to use a clean sheet.

Lather your body from top to bottom, starting at the shoulders and moving towards the feet. It is advisable to immediately rinse the treated area with clean water and dry the area. Then proceed to the sides and back, gently turning the person.

Don't skip the space between your fingers and toes.

Washing and changing diapers

- Disposable gloves are used for washing (you can also purchase special disposable gloves at the pharmacy) and a basin of warm water.

The patient lies on his side. We're taking diapers. We remove stool. We moisten the mitten in water, wring it out and wipe the body, starting with inguinal region and ending with the buttocks. Dry the skin with a tissue. We apply a diaper, turn the person on his back, spread his legs, bend at the knees, fix the diaper with Velcro.

You can also use a special washing vessel.

Apply if necessary special means care.

How to choose a diaper for an adult?

- There are Velcro diapers and panties. The former are shown to the seriously ill, the latter to those who remain independent.

The size depends on the fullness of the person (the most small size designated as 1 or S, the largest - 4 or XL). Measure the waist and pelvic volume, it is by these indicators that it will be possible to determine the appropriate option (more detailed instructions are indicated on the packages).

bedsores

Pressure sores are the death of tissues as a result of constant pressure, local circulatory disorders and nervous trophism. The most problematic place is the sacrum, then - the area of ​​​​the shoulder blades, buttocks, heels and the back of the head!

If the patient is not able to roll over himself from time to time, he needs help to change the position of the body.

The rate of development of bedsores

1. Redness of the skin in places of compression. Often accompanied by swelling. The structure of the skin is not disturbed.

What to do? It is often necessary to change the position of the body (we turn at least every 2 hours). Timely change of underwear and bed linen, straightening of all folds on clothes and linen. The use of an anti-decubitus mattress and care products for bedridden patients is shown.

2. Damage to the upper layer of the skin (cracks, peeling of the skin).

What to do? Primary measures to combat bedsores are applied. Hydrogel dressings and disinfectants are used.

3. Complete death of skin areas, pus appears in the wounds.

What to do? It is necessary to consult a surgeon who will prescribe medication. Bandages are applied, special pastes, gels, powders are used, and primary measures are taken to combat pressure sores.

4. Becomes visible bone, tendons and even the bone itself, the wound is completely filled with pus.

What to do? Medical treatment is required. Physiotherapy procedures are prescribed. Consultation and supervision of a surgeon is necessary. It is important not to allow the extent of the problem to progress. Once the process has started, it is not easy to stop it.

P.S. Do not forget that the most important thing is the emotional state of the patient. As the saying goes: "The doctor heals, but the caregiver cures."

If a person is still able to adequately perceive reality, divert his attention from sad thoughts, invite people close to him to visit, try to please him more often. Do not leave a person alone with his problem.

People who care for the seriously ill every day face certain difficulties, but this task can be made a little easier if everything is organized correctly. Caring for a bedridden patient is no easy task. Relatives and friends are dear to us, even if the disease does not allow them to move independently and serve themselves. In such a situation, you can invite a nurse, but often relatives take care of all the care for their sick relatives.

It is important for them to know how to properly perform all the procedures for caring for a bedridden patient.

Medical care for bedridden patients in medical institutions is carried out by staff. When patients are discharged home, care responsibilities are shifted to the patient's relatives. Creation comfortable conditions for these patients can improve their quality of life. Home care for bedridden patients is hard work requiring organization, patience and a lot of time. First, let's talk about what requirements a room for bedridden patients should meet.

What should be the room of the bed patient?

For a bedridden patient at home, it is desirable to allocate a separate room. It should be spacious enough and light. If this is the south side, then in the summer on hot days it is necessary to make shading in it. Well, if the windows have blinds. They protect from the sun when needed and are easy to clean.

It is good if the room is protected from outsiders loud sounds, but the patient should not feel isolated from society.

The room in which the patient is located should not be cluttered, but everything you need should be placed at hand. The room should contain the following furniture: a table, a wardrobe or a chest of drawers with linen, a chair, if necessary, there may be a TV or a portable radio (the patient should be aware of all the latest events and not feel like an outcast). Extra items from the room must be removed, because they make it difficult to clean.

The means of care for bedridden patients should be right there, nearby.

The rug by the bed should not slip. You can use a bathroom rug, they are usually made with a rubberized bottom, which prevents them from sliding on the floor.

Air the room should be in any weather at least twice a day for 15-20 minutes. Wet cleaning is done daily. Bedridden patients are very sensitive to dust and various infections, since they usually have reduced immunity.

bed of a bedridden patient

If the patient spends a lot of time in bed, it is desirable that his bed be special, functional. Its height is easy to adjust, the head and foot parts are raised and lowered if necessary. On such a bed there are special side racks that do not allow the patient to fall off it. A functional bed will facilitate the care of bedridden patients. Bedsores are best prevented and difficult to treat. The possibility of bedsores with such a bed is much less.

But if it is not possible to purchase such a bed, then the usual one can be somewhat transformed. The desired height can be achieved by placing several mattresses on top of each other. Chairs inserted into the bed frame will prevent the patient from accidentally falling.

The bed should be wide enough, because bedridden patients spend most of their time in it. They should be comfortable. Approach must be provided from all sides. It is so easy to change bed and underwear and turn the patient to another position.

Items needed by the patient

Patient care items should be nearby. On the nightstand by the bed, there should always be fresh drinking water and a glass (mug or drinking bowl), a TV remote control, the patient's glasses (if he reads in them), a table lamp (floor lamp or wall sconce). It is convenient if the patient has a bell on the table or bedside table, with which, if necessary, he can call a nurse or a relative caring for a bed patient. All these items must be arranged in such a way that the patient can easily reach them on their own.

In the drawer of the bedside table there should be a tonometer, a thermometer, cotton pads and sticks, as well as special cosmetical tools, talcum powder, cream and remedies for bedsores and necessary medicines. The drawer below can accommodate disposable diapers, diapers and garbage bags. Care items for bedridden patients should be arranged in such a way that, if necessary, the patient himself can reach them. The toilet chair, if used by the patient, should also be located next to the bed.

Basic rules of care

A bed patient requires a lot of attention and time. The rules for caring for him are as follows:

• patients who have had a heart attack or stroke, it is necessary to measure daily in the morning and evening arterial pressure, write it down, and show these records to the attending physician;
• body temperature is measured daily;
• it is necessary to monitor the nature and quantity of bowel movements, and if they become pathological (loose stools, streaks of blood, little urine, dark or red urine, etc.), report this to the doctor;
• skin condition should be assessed daily (appearance of bedsores, rash or redness);
• all the necessary medicines must be given to the patient according to the schedule or make sure that he does not forget to take them on his own.

If it is difficult for the patient to drink from an ordinary cup, you need to purchase a drinking cup for him.

In case of incontinence of patients with urine or feces, it is necessary to stock up on disposable diapers and diapers.

Underwear for the patient should be soft and only made of natural fabric, it is desirable that it be seamless, but if it has fasteners or ties, then they should be only in front.

It is always necessary to ask the patient about what he wants, and, if possible, fulfill his requests. It is not worth arguing, the patient understands better what exactly he needs at the moment.

Ask whom he would like to see, and invite only these people, but visits should not tire.

If the patient becomes worse, he should not be left alone, especially at night. Leave the lights dimmed in the room. If you yourself cannot constantly be present in the room with the patient in case of deterioration of his health, then you can hire a nurse or a nurse. Nursing care for bedridden patients medical education perform better. You can hire them through an agency or look for them in medical institutions.

Hygienic care for bedridden patients

Hygiene is especially important for the seriously ill. Immunity in such people is weakened, so any infection can worsen the condition or provoke comorbidity such as congestive pneumonia.

Hygiene care consists of daily washing, washing hands, brushing teeth and hygiene intimate places. To do this, it is better to use neutral liquid shampoos and detergents for bedridden care with a pH of 5.5. The body also needs regular washing. Special treatment should be carried out where there are skin folds - these are the back and buttocks (places where bedsores are most often formed).

To wash the body, use a sponge and a hard towel, which rub and massage the skin of the patient after washing. After the hygiene procedure, the body must be thoroughly wiped. Growth occurs on a moist body bacterial infection which can lead to inflammation. After hygiene procedures, skin folds and places of contact with the bed (where bedsores can form) must be treated with talc or baby cream.

After changing the diaper, the genital area must be washed using gentle detergents, wiped dry and treated with a protective cream (there are special creams for diapers).

When changing bed linen and diapers, they should not be dragged from under the patient, this can damage the skin and provoke the formation of bedsores.

Care of bedridden patients. Bedsores and their prevention

Pressure sores are areas of necrosis (necrosis) of the soft tissues of the body. They can form in bedridden patients as a result of compression of the tissue of the protruding areas, these are places above the bone protrusions. Usually bedsores appear in immobilized patients. typical places their manifestations are the buttocks, heels, the back of the head, elbows, less often the back and hips. Skin care for bedridden patients, in addition to the usual hygiene procedures, is to prevent bedsores.

It is needed by both bedridden patients and patients who use a wheelchair for movement, partially immobilized (for example, an arm or leg does not work after a stroke), as well as obese, diabetes severe form or incontinence of urine or feces.

Bedridden care involves the prevention of bedsores. It would be nice to lightly massage the back area after each body wash. This will increase blood circulation and thereby help improve tissue trophism, which will serve as a prevention of bedsores.

To prevent the formation of bedsores, you must:

• exclude risk factors for the formation of bedsores;
• use the necessary devices for the prevention of bedsores (rollers, soft pillows, a rubber circle);
• careful hygiene of the patient's skin;
• performance exercise if the patient is immobilized, but these should be passive exercises (that is, the person caring for the patient independently bends and unbends his limbs);
• massage, it can be done on your own, it can be an unprofessional massage, the main task is to increase blood flow to places that experience the greatest pressure (perform the most common movements - stroking, lightly patting);
• complete nutrition.

How to eliminate risk factors for pressure sores?

1. Carefully inspect the patient's body daily for redness and changes skin, Special attention give places of bone protrusions.
2. Every 2 hours it is necessary to change the position of the patient's body. So, for example, to turn it on its left side, you need to cross the patient's arms on the chest and put it right leg to the left. Then go up to him on the right and slip your one hand under the thigh, and put the other on his shoulder, and then turn the bed patient with one movement. Turn patients from side to side as carefully as possible to avoid excessive tension or friction of the skin. A soft pillow can be placed between the legs, especially for malnourished patients (for obese patients, this measure will be redundant).
3. The temperature in the room must be maintained optimal (19-20 degrees) so as not to provoke excessive sweating of the patient and the formation of diaper rash.
4. Bed linen should always be clean and changed in a timely manner. Linen should be soft and only made from natural fabrics. It is best to put a disposable absorbent diaper on top of it, this will prevent the formation of diaper rash and facilitate the care of a bedridden patient.

Nutrition for bedridden patients

Since a bedridden person does not move much, his nutrition should be moderate, because such an organism does not experience large energy costs. The calorie content of food is reduced, but the diet is well balanced. The amount of protein and minerals should be sufficient. Protein is a building material for cells; if it is lacking, tissue repair and wound healing will go badly.

The diet must contain meat, fish, dairy products (cheese, cottage cheese), fruits, nuts. The daily calorie content of products for bedridden patients should be in the region of 1500 kcal.

Treatment of bedsores

If nevertheless preventive measures was not enough or they did not help and bedsores appeared, then their treatment should be started immediately. It consists of three main areas:

1. Improve blood supply to bedsores (do not lie on the wound, use a rubber circle, anti-decubitus mattress, often turn the patient).
2. Cleanse the wound of pus, dirt and necrotic tissue and treat it with chlorhexidine. Do not touch the wound with your hands, carry out all manipulations with gloves and use aids (sterile wipes, tweezers), apply the medicine directly from the vial (do not use hydrogen peroxide, iodine, brilliant green - they dry the skin and interfere with healing).
3. Take measures to heal the wound as soon as possible (completely clean the wound from necrotic tissues, since they are a breeding ground for the development of infection), change the bandage once a day.

Features of patient care after a stroke

Often, after a stroke, the patient is cared for by his relatives. Regardless of the severity of the disease, the patient should be in bed for the first time. Ischemic stroke often leads to partial immobilization of a person. The care of a bedridden patient after discharge from the hospital is carried out by his relatives. In such patients, the right or left side of the body is paralyzed, and certain rules should be observed when caring for them.

Such patients need to change the position of the body every 2 hours, carry out a complex of physiotherapy exercises and massage. These activities are necessary to restore nerve impulses and return the mobility of paralyzed limbs. The more often exercise therapy and massage are carried out, the better the dynamics of recovery will be. Ideally, these complexes should be repeated every 3-4 hours. Patients can perform some elementary exercises on their own.

When caring for such a patient, it is very important to ensure that the paralyzed limbs are not in weight. To do this, place rollers, pillows or use garters, and mobility in shoulder joint must be maintained, and some distance must be maintained between the hand and the body.

If the patient is turned on the paralyzed side, then the diseased arm is placed 90 degrees relative to the body, placing a small pillow under it, and the healthy arm is pulled back.

Sometimes the recovery period lasts a long time, for all this time you need to be patient and consistently follow all the doctor's recommendations. The patient will have to learn to hold objects on their own and move around again.

Support when walking such a patient should always be from the side of the affected limbs.

Update: October 2018

Everyone can face a situation when a previously healthy relative has an injury to his legs or spine or a disease that prevents him from walking and serving himself. And if you are one of those who cannot hire a professional nurse or nurse for round-the-clock care who knows all the intricacies of dealing with bedridden patients, as well as male orderlies who will change his position in bed several times a day, our article is for you.

We will describe in detail how home care bedridden patients. Describe feeding, watering, exercising hygiene measures and assistance in the implementation of physiological functions. We will also consider in detail the prevention and treatment of bedsores, prevention and therapy. congestion occurring in the internal organs. We will tell you how professional care for bedridden patients is carried out - in a hospital.

The Dangers of Prolonged Lying

Staying in a supine position for more than 3 days is due to many diseases. This:

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

and many others.

At its core, caring for bedridden patients at home is a much greater effort than that required for baby who has not yet learned to change the position of the body. And it's not about body weight, but about pathological reactions that start very quickly, even if a previously healthy person has to lie down for more than 3 days. Let's talk a little about these processes.

metabolic processes

Without oxygen, the internal organs do not function: it is a kind of "bargaining chip" that makes it possible to carry out any metabolic processes. Its delivery should be adequate to the needs of the body. For this:

1. those parts of the lungs (alveoli) in which oxygen directly penetrates into the blood must be continuously ventilated, and carbon dioxide- in the exhaled air;
2. the membrane of the alveoli, through which diffusion of oxygen takes place in one direction, and carbon dioxide in the other, should not be edematous (this is typical for pneumonia of any nature);
3. the blood must be sufficiently fluid. This is ensured by sufficient fluid intake, timely treatment inflammatory processes in the body (proteins formed during inflammation increase blood viscosity), as well as enough proteins from food;
4. blood circulation should be sufficient, "reaching" to each cell;
5. the nervous and endocrine systems involved in the regulation of the respiratory muscles should also not be damaged.

With forced prolonged immobilization, each of the points suffers:

Lungs

The air that we breathe does not all go "to work" even under conditions full health and normal physical activity. Part of it remains in the dense “tubules” of the trachea and bronchi (otherwise they would “collapse”), another part is a reserve volume in case you have to breathe deeply (for example, during exercise or running from danger).

The expansion of the lungs, in which chest negative pressure is created, and the air is "sucked" into the incompressible airways, occurs with the help of the respiratory muscles. Most of them are localized between the ribs in several layers, if necessary, additional muscles are connected to the work: neck, sub- and supraclavicular muscles, abdominals. The main respiratory muscle is the diaphragm, stretched like a dome under the ribs. It provides 2/3 ventilation, increasing volume chest cavity where the lungs are, vertically.

Because the respiratory muscles controlled as involuntarily, by commands from medulla oblongata, and arbitrarily, that is, by an effort of will, a person can use the chest or abdominal type of breathing. In the first case, only the intercostal muscles work, while the diaphragm moves passively along the intrathoracic pressure gradient. Abdominal breathing, which mainly uses the diaphragm, can simultaneously lower intrathoracic and increase intra-abdominal pressure, improving blood flow from abdominal cavity to the heart and reducing blood congestion in the lungs.

Therefore, in order to prevent congestion in the chest cavity, if a person is forced to lie down for a long time or move very little, he needs to master abdominal (diaphragmatic) breathing. Periodically, you will also need to perform exercises to improve ventilation: inflating balloons, exhaling air with effort through a tube into the water.

Whatever muscles are involved in breathing, ventilation depends on the position of the body. IN vertical position the right lung is better ventilated, the upper sections are worse than the lower ones. If a person lies, then those areas that lie below are better ventilated. In order to avoid stagnation, the body must move - first to one side, then to the other side, then to the back. Optimally, the lungs are “breathed”, and the mucus formed in the bronchi (it also becomes more viscous in immobilized people) is better coughed up when the person lies on his stomach. Also, this mucus, in which there are already microbes at the time of lying, is easier to cough up if you tap on the back of a person lying on his stomach in a special way - to conduct a vibration massage.

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

Vessels

Human vessels are elastic tubes in which the muscular layer is more or less developed. The blood flowing through the vessels is not quite an ordinary liquid, however, it obeys gravity. This means that in those areas where it must move against gravity, when lying down, stagnation occurs, like a swamp in which there are no fresh currents.

By "those areas" is meant the lower limbs, where the blood must always overcome gravity, moving through the veins to reach the heart. Only in a healthy person, blood flow is provided by the "second heart" - the muscles of the lower leg. When the patient lies, the muscles of the lower leg and thighs lose their tone, there is nothing to ensure the outflow of blood from lower extremities, as a result of such a "swamp" blood clots form in the veins of the legs. In this case, some attempt to stand up or strain (for example, when going to the toilet) can lead to the separation of a blood clot, which is able to quickly reach the lungs through the vein system and clog the vessels there. This is how a condition called "pulmonary embolism" arises, in the majority ending in death.

This can be avoided in bedridden patients by bandaging the legs. elastic bandages, especially before getting up to use the toilet or to perform hygiene measures, as well as massage them, move them to the extent that the disease allows (optimally, perform a “bike”).

In addition to thromboembolism, with stagnation of blood in the lower extremities, a large volume of blood is turned off from the general circulation. Therefore, an attempt to stand up (especially abruptly) may result in loss of consciousness. This is called orthostatic collapse.

The work of the digestive system in bedridden patients

The functioning of the gastrointestinal tract depends in part on the work of the muscles of the body: with forced immobilization, the peristalsis of the stomach and intestines becomes lethargic. In addition, now a person who is conscious, with more or less preserved criticism of what is happening, is forced to walk more in an uncomfortable lying position, and at the same time resort to the help of other people. All this leads to constipation, and they, in turn, cause fecal intoxication (absorption of decay products into the blood). This is how bad breath, furred tongue, loss of appetite, constant slight nausea appear.

Constipation alternates with diarrhea. The latter are caused by violations of the diet, a decrease in the acidity of gastric juice, which makes it easier for various bacteria that cause intestinal infection to enter the gastrointestinal tract.

The solution to the problem lies in fractional nutrition, following a diet, when dishes are served warm, they are made from boiled or baked vegetables, meat, fish. The patient is fed soups without "frying", cooked on the second or third broth or without it at all, cereals. Smoked meats, fast food, salty and fried foods should not be given to a recumbent.

Muscle problems

The lack of full-fledged movements leads to relaxation of the skeletal muscles, a decrease in their mass (up to 3% of the volume of all muscles can be lost per day with complete immobility). This means that even if after a while it becomes possible to get up, it will not be possible to do this without outside help.

To prevent muscular atrophy, it is necessary to perform muscle massage, passive gymnastics, when a relative moves the hands and feet of the patient.

Immobility and joints

As a result of prolonged immobility, the joints “wedge”: neither active nor passive movements become possible in them, the limb freezes in some position (this is called contracture). So, the foot is extended to the “on tiptoe” position, the hand becomes like a “bird's paw”, the knee practically stops bending and unbending. When contracture has developed, when the damaged joint is involved, strong pain, which is why many refuse further studies. Then, between the bones of the bone joint, bone unions are formed, and it becomes immobile. This is called ankylosis.

In order not to develop either contractures or ankylosis, you need:

• perform passive and / or active gymnastics in all joints, while there should be no violent movements and pain;
• lay the limbs in the correct physiological position on the bed;
• when a contracture begins to form or the limb is paralyzed, a plaster splint is temporarily applied to it so that the limb is forcibly in a physiological position.

Immobilization and the skeletal system

In bedridden patients, not only the blood supply to the skin and internal organs worsens, but the supply of nutrients to the bones also worsens. This is how osteoporosis develops - rarefaction of the main parts from which tubular bones are built - bone beams. This increases the risk of spontaneous fractures. In addition, red suffers Bone marrow located inside the bone. Because of this, the production of platelets decreases (this leads to spontaneous bleeding), leukocytes (due to this, immunity decreases) and red blood cells (anemia occurs).

Urinary tract in bedridden patients

Due to horizontal position urine stagnates in the kidneys, contributing to the formation of stones and their infection. It is also more difficult to hold urine while lying down, partly due to a reluctance to ask for help from others. The outflow of urine on the bed leads to the formation of bedsores.

Changes in the psyche and nervous system in bedridden patients

If before the illness that led to the fact that a person fell ill, he was already old and sick, then forced immobilization will not lead to a violation of his attitude to life, himself and relatives. But if the disease has laid down actively before that moving person, as a result of immobilization it comprehends:

• depression;
• insomnia, when even taking sleeping pills does not give a feeling of rest;
• irritability;
• loss of social behavior skills;
• hearing impairment (this is due to the fact that the patient is now lying, and those who communicate with him are sitting or standing);
• deterioration of mental activity;
• violations of the peripheral nervous system, because of which a person freezes more easily, feels significant discomfort when changing clothes, airing, and so on.

If the patient is forced to lie not for decades, but for several months (for example, as a result of a fracture), when getting up, he will stagger for a long time, which will require the use of crutches, handrails or walkers.

All these problems are especially aggravated by the care of a relative for a bedridden patient: if earlier he was willing to make contact, was friendly and accommodating, then during immobilization a person becomes demanding, capricious, whiny, accuses of inattention to his person. However, in order to improve the condition of a loved one and stop suicide attempts, relatives will have to pay attention to him, as well as install a baby monitor at his bedside so that the patient can call for help or can be heard if he decides to get up or use it for other purposes, for example, cutlery.

What happens to the skin

The integumentary tissue of a person forced to lie down for a long time becomes thinner. This also happens due to the lack of load on it, which in this case consists in stretching it and compressing it. More pronounced atrophy are those areas of the skin that are subjected to squeezing. Already after 2 hours of being in the same position lying or sitting, in those places that are above the bone protrusions or are pressed against the bed by the bones, those that are localized above the fold on the linen or directly on a hard bed, ischemia begins. Particularly affected areas of the skin, between which and the muscles there is very little fatty tissue, which is a kind of shock absorber. This:

• in the supine position: sacrum, heels, ischial tubercles, shoulder blades, elbows, occiput;
• lying on the back: on the side of the thigh, knees, on the sides of the ankles, on the lower shoulder, on the temple;
• lying on the stomach: on the pubis, cheekbones;
• on a hard bed or in a seated wheelchair: the area of ​​​​the coccyx and shoulder blades, heels, and when relying on the entire foot - socks.

Ischemia is aggravated if the skin is displaced from its normal position, if it is wet from sweat, urine, or not dried after bathing. Then diaper rash appears very quickly in the places of friction, then macerations, and pressure sores form in their place.

The task of relatives who have had a misfortune with a loved one is to pay maximum attention to each of the pathological factors, not allowing them to “raise their heads”. And in order to spend not so huge amounts on the treatment of a relative every month, then, no matter how much you would like to, you will have to start leaving even from the hospital. This should be done with the help of the medical staff of the intensive care unit, and then, upon discharge, continue at home. step by step instructions care for bedridden patients in the hospital and at home you will find below.

Features of inpatient care

When an accident occurs to relatives, as a result of which they - for a short time or for life - are bedridden, the first stage of care is usually a hospital. In order to have fewer health problems with your recumbent loved one in the future, you need to start caring for your loved one already at this stage, especially since now you can even be in the intensive care unit.

In this situation, there are not only disadvantages for caregivers, that they will have to (not everyone wants to do this) already now spend time, money and effort. There are also advantages, which are as follows:

• they will tell you what you need to pay attention to, how to properly wipe, bathe and feed a relative. This will further save money on the purchase of unnecessary drugs and accessories; time will also be saved for reading the necessary information on the Internet or waiting time for the district nurse / doctor;
• you will see and begin to navigate with the feeding of a relative: when he can only eat liquid food, and when it is already possible to grind it or allow the presence of pieces. This will help, if a person’s condition worsens at home, not to feed him with unsuitable food, which may cause blockage of the respiratory tract with food and death;
• you have time to get used to the idea that a relative has ceased to be as independent as before, and you can figure out whether you can handle the care on your own or have to hire a nurse;
• you do not see the suffering of a relative around the clock, there is time to relax mentally;
• a bedridden patient sees and feels the care of relatives; his depression due to the current situation does not add the feeling that he has become a burden.

Of course, the medical staff does not force a relative who has come to a bed patient to a hospital to take care of him. Given the poor medical supply of hospitals and the high cost of drugs, preference is given to bringing the necessary medicines to the patient. But middle and junior medical staff caring for your relative is actually extremely busy. Nurses and caregivers have to care for several people at once, as well as fill out a huge amount of paperwork. This will not allow you to perform the necessary care procedures for your loved one in the required amount. Then the patient will be discharged, and all the consequences of the lost care will fall on your shoulders. To avoid this, it is better to allocate at least 1-2 hours a day (optimally - in the morning and in the evening) to provide the bed patient with the necessary procedures.

A feature of hospital care is the presence of aids to meet the physiological needs of the patient. This is a feeding tube and a urinary catheter for urination. Most likely, you will not have such funds at home: they will be removed in a hospital so as not to create an opportunity for additional (through these tubes) penetration of infection into an already weakened body.

In addition, in the hospital, the patient has venous access, where necessary drugs. Before discharge, for the same reason as the probe with urinary catheter, it will be removed. All the necessary drugs, already in agreement with a specialist (a neurologist - if a person has had a stroke, a cardiologist - if a heart attack), the patient will be administered by a nurse who comes to the house.

Home care - where to start

Caring for bedridden patients after a stroke or any other condition depends on how immobilized a person is, what social skills he has lost, how long he has not been engaged in them. However, there are many general rules, after reading which, you will understand what to do for you.

Accommodations

No matter how uncomfortable it may be, if you cannot afford several shifts of round-the-clock nurses with medical education, you will need to live in the same apartment / house with a bedridden relative. For him, you need to allocate a separate room, preferably on the sunny side, while the windows should be closed with blinds so that the light does not shine into the eyes.

There should not be a lot of furniture in the room, but it should also look like a hospital ward (only a bed and a bedside table next to it) - wrong, defiant nervous stress solution. Imagine yourself in a forced inactive position, on the bed, when the rest of the family is active and going about their business, and think about what you like.

If you do not expect that a person will be able to get up in the near future, it makes sense to immediately purchase a special bed. These are two- and three-section functional beds: the first option allows you to raise the headrest or legs, while the three-section design also allows you to bend your knees or give a person a semi-sitting position without his help. The second type of bed design is optimal for severe paralysis of a person, especially when he also has excess weight or urinary incontinence.

Place a nightstand next to the bed. If the patient moves a little, put a “spill-proof” with water, wet wipes, put the phone or (for the older generation) radio on the bedside table. Nearby may be a TV remote control or a book, a glass in which his removable dentures will be stored. Also on the nightstand should be a baby monitor or walkie-talkie, allowing caregivers to hear what is happening in the room, and so that a sick person can call.

The room should be ventilated three times a day, for 15-20 minutes; at this time, the patient should be covered with a blanket or duvet cover (the latter in the summer). A bactericidal emitter should be hung on the wall (preferably one that can be quartzed in the presence of a person without covering him with a blanket with his head). Wet cleaning in the room is a must.

If the patient can get up, even with outside help, put a chair-toilet by the bed.

Put in the nightstand:

• thermometer;
• tonometer;
• antiseptics that treat the skin;
• cotton buds;
• cotton wool;
• alcohol;
• talc;
• camphor alcohol;
• diapers - if a person does not control his bowel movements.

The drugs you are taking can be put on or in the nightstand only if you are sure of mental health his relative: that he will not exceed the dosage of drugs intentionally or not.

A ship or a duck can stand under the bed, if the patient feels when he wants to go to the toilet, and can call. A duck, that is, a device for men where they can urinate, can be hung (most have a special hook) on the old bed, if there is one (on the side where the patient does not get up).

If the patient has become not quite adequate, has lost his orientation in space, place or time, file the legs by the bed or constantly raise her former. In addition, remove all traumatic objects (sharp, cutting, piercing) from his room.

It is very important to maintain a decent moral condition of the patient. To do this, you need to go to him as often as possible and talk affectionately while you are taking care of yourself. At night, leave a night light that shines with a faint light, unless a relative asks to turn off the light completely: he should not feel abandoned.

Lying conditions

The patient should be dressed in soft clothes made of natural materials that will not have buttons, ties, fasteners or zippers - all that, when lying on it, will form unnecessary squeezing of the skin. It is optimal if there are no seams on the nightgown / T-shirt and shorts or they are located only in front.

The patient should lie on bed linen made of natural fabrics. At the same time, you need to make sure that there are no wrinkles under his back, and that he does not slide onto an uncovered bed. This is a direct path to bedsores. If the sheet often crumples, you can buy or sew one with an elastic band around the edges. So the sheet is put on the mattress. If a person has urinary incontinence, it is possible to lay him on an oilcloth, but he should not lie on a “naked” oilcloth. It is better to put a diaper on a person (it should also be straightened) and periodically give him a break from the urine-absorbing matter. Then it is better to lay it with the buttocks on a moisture-absorbing disposable diaper measuring 90 * 60 cm.

To prevent bedsores, the patient should be turned every 2 hours, or reminded to do it himself. If a relative is paralyzed and you have to turn him over, lay him down - whether on his stomach, on his side or on his back - so that he lies comfortably. Under the knees, if a person is lying on his back or under his knees, if he is lying on his side, you need to lay a pillow. If you have a relative laid on his side, place a pillow or several under his back so that he can lean on them. In the supine position, under the elbows and heels, put rubber small circles (such as circular expanders). You can also put a special circle under the sacrum. You can use anti-decubitus mattresses, which we will talk about later.

Every few days, or if the sheet becomes wet, it needs to be changed. In paralyzed patients, this should be done according to the algorithm:

1. turn the person on their side;
2. roll the sheet behind his back into a “tube”;
3. in place of the rolled sheet, lay a section of a clean sheet, also rolled up with a “tube” or folded “accordion”, unfold it;
4. turn the patient on the other side so that he, turning over, rolls over the roller of two sheets;
5. then you just have to pull out the dirty and straighten the clean sheet.

You can use another method:

• grasp the edge of the changeable sheet on which the patient lies, on one side of the bed, pull it so that the patient turns over on the sheet with his back to you;
• Throw the freed half-sheet over the patient from above;
• spread the new sheet evenly on the freed surface of the bed, and fold its end, intended for the occupied space, with a narrow (20-25 centimeters) accordion so that the opposite edge of the sheet looks away from you, i.e. into the back of the patient;
• return the dirty end and the patient to his back;
• turn the patient over to the other side by pulling on the other end of the sheet. She, like last time, lay on top of the patient;
• straighten the accordion. If the accordion was partially under the patient, then by pulling the protruding edge, you can dissolve the accordion and release the sheet without effort;
• straighten a clean sheet, and fold the end of a dirty sheet with an accordion;
• turn the patient from one side to the other and pull out the dirty sheet.

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

Hygiene measures

A bedridden patient must bathe, wash, comb his hair every day. If he can move on his own, he is taken to the bath, where they bathe in the shower, it is better if they use baby soap and baby shampoo. After that, be sure to thoroughly blot the body with a gauze napkin or a soft terry towel, since going to bed with a wet body is fraught with the development of bedsores.

body wash

If the patient cannot get up, they wash him right in bed. For this, two basins for water, a support under the basin, a container for heated water, lotions, gels or foams for washing are used. An oilcloth is laid under the washed part of the patient's body, washed with a soft sponge, without unnecessary friction; after washing, dry thoroughly, apply moisturizers:

On places that are subject to friction - camphor alcohol. Only after the funds have dried, you can put a person on the bed, but it must also be dry.

Places that are rubbed or slightly reddened are treated not with ordinary soap, but with a bed care foam, for example, TENA Wash Mousse or Seni Care foam.

Washing head

To wash the head, a special inflatable tub with a pipe for draining water into a bucket is used. The head is raised, placed in a special hole in this bath, gently poured over with warm water and soaped. After washing the head soapy water is drained through the tube, and the head is washed with clean water, which is also poured out through the tube. Be sure to dry your hair with a towel and dry it with a hair dryer before laying the person on the bed.

Shaving

Shaving is performed as follows: shaving foam is applied to the face, a basin with warm water is placed nearby, where they will dip the razor from time to time. After removal extra hair A moisturizer or lotion is applied to the skin.

Teeth cleaning

The teeth are brushed or brushed or, if the patient is unconscious, a latex pad with a brush is used, which is put on the finger (they are sold in the department of children's goods, for the care of babies). A paste is applied to the brush, which contains hemostatic and antiseptic substances. These are LACALUT active, SILCA Complete Sensitive, PerioTherapy Healthy Gums Toothpaste, PRESIDENT Sensitive pastes. They clean their teeth from all sides, tongue, inner surface of the cheeks. You can rinse your mouth with water, a solution of soda (1 tsp per 1 liter of water), a decoction of chamomile, calendula or oak bark. In unconscious patients, this is done with a rubber douche.

To wash the face of the patient use:

• TENA Wash Cream
• Seni care cream
• menalind professional care lotion

Do this morning and evening with a soft sponge. After washing off the washing solution, wipe the eyes with clean cotton pads: from the outer edge of the eye to the inner (so that there is no sagging of the eyelids).

hand washing

Hands are washed with the same detergents as the body. Before washing, each hand is immersed in a basin of detergent solution and treated with a sponge or foaming gloves. They especially clean the interdigital space - it accumulates here a large number of microorganism pathogens. After washing, the hands are dried with a towel and a special care product is applied to the elbow area (as a rule, roughening of the skin is often observed on them) - Seni Care cream for dry and rough skin. After that, the patient's nails are trimmed and filed with a special nail file. Further, nail care is carried out as they grow.

Hygiene of intimate areas

It is carried out in the following sequence:

• a moisture-absorbing diaper spreads under the patient's pelvis;
• the diaper is removed;
• a soft sponge is taken with a gloved hand, dipped in water with a cleaning solution. It can be TENA Wash Mousse or Seni Care;
• the patient's legs move apart, bend at the knees;
• the perineum, genitals, and then the anus are washed in the direction from the pubis to the anus;
• washing solution is washed off;
• the washed area is dried with a specially selected soft towel;
• the patient turns on his side, his buttocks are also dried with wetting movements;
• Bepanthen-cream or Sudocrem is applied to the skin.

After each urination, women need to wipe the perineum with Seni Care wet wipes.

Foot hygiene

Feet are washed in a bowl of warm water. With a sponge or mitten, the caregiver should “pass” from the heels to the lower leg, washing away all the dirt, especially between the fingers. Next, you need to dry your feet with a towel, apply (especially on the heels) baby cream, baby cream mixed with vitamin A oil, Bepanten ointment.

Feeding, nutrition

The diet is prescribed by the attending physician and depends on common disease and the extent to which chewing and swallowing skills were affected. If the consciousness of the patient is unclear, he does not answer questions or does it inappropriately, he needs either liquid, or boiled and ground food through a sieve or blender. If he is in a clear mind and adequate, he is fed with cereals, soups on the second broth, in which there are medium-sized pieces of vegetables. The daily diet is divided into 5-6 meals, it must be given strictly according to the schedule. Proteins in the form of a soufflé, meat puree or steam cutlets must be mandatory, otherwise protein-free edema will appear, over which the skin will tear, forming bleeding and poorly healing wounds. Water, compote, tea and non-acidic juices must be given, it is necessary to limit the liquid only in case of cardiac, kidney failure, cirrhosis and liver cancer.

Feed as follows. If the patient is not completely paralyzed, then with the help of pillows or raising the headrest of a functional bed by 30 degrees, he is given a semi-sitting position. A diaper is laid on the chest and fed from a spoon (you can put a special table, which often comes with functional beds, and if a person is able to serve himself, they put food in plates (possibly with suction cups), which should stand steadily on the table.

If the patient is paralyzed and give him exalted position if it doesn’t work out, then they turn his head to one side, spread a diaper over his shoulder and feed him.

After feeding, wipe the patient's face with wet wipes, be sure to shake the crumbs off the bed.

Liquid is given from a drinking bowl or from a glass in which there is a cocktail tube.

Physiological departures

If the patient is able to get up and feels the urge to urinate and defecate, a toilet chair is placed near his bed, where he is helped to transfer if necessary.

If a person is unable to get up, but feels the urge to urinate and defecate, he is served a vessel (for women - for both types of physiological functions, for men - only for defecation) or a duck (for emptying the bladder in men.

If the patient suffers from urinary or fecal incontinence, he needs an adult diaper.

Massage

In order to avoid muscle atrophy, it is imperative to carry out massage - classic and vibration. Kneading, stroking and rubbing movements work out the muscles of the back and limbs so that it does not hurt. This should be done after massage oil is applied to the skin.

Vibration massage is performed after the patient is turned on his side. Camphor alcohol is applied to his back on both sides of the spine. Next, starting from lower divisions, a palm is placed on each site, which is lightly tapped with the fist of the other hand. So every day the lungs are worked out to prevent pneumonia.

Physiotherapy

It consists of passive and active movements in each joint. Thus, circular movements of the hand are performed, clenching and unclenching fists, bending the neck and turning the head, movements of the foot, knees, hips - to prevent contractures and treat paralysis.

In those joints in which a person cannot move, the caregiver helps him, while the rest of the patient must move himself. The main task of the caregiver is to encourage and remind of the need for physiotherapy exercises.

If contractures have developed, after performing massage and exercises, removable plaster splints are applied to the limbs (any rehabilitation doctor will tell you how to do them). The legs are then wrapped with elastic bandages. With varicose veins, the skin of the lower extremities is treated with Lioton or Heparin gel in combination with Troxevasin gel.

medical problems

A bedridden patient needs to measure temperature and blood pressure daily. If the temperature is elevated, it is necessary to give "Paracetamol" or "Ibuprofen", and then call a doctor. If the pressure is increased (above 140/99 mm Hg), give 10 mg of Enalapril or previously prescribed drugs "for pressure".

Also, relatives are forced to record on paper:

• the amount of liquid drunk;
• volume of daily urine;
• frequency and nature of bowel movements.

If loose stools appear, blood is found in the urine or feces, the amount of urine decreases or it changes color and smell, and a rash appears on the body or non-healing wounds you need to call a doctor.

bedsores

This is the name of ulcerative-necrotic defects of the skin and underlying fiber, which occur mainly with defects in caring for a bedridden patient. They also appear if he is already quite long time, and his psycho-emotional state has changed so much that he interferes with relatives in the implementation of care procedures. Bedsores are the #1 problem in bedridden patients. It takes not only time, effort and money from relatives, but can be complicated by suppuration, as a result of which blood poisoning (sepsis) develops quite quickly with damage to most internal organs.

The risk of developing ulcerative-necrotic defects increases significantly in the following cases:

• the presence of excess weight;
• if a person is severely malnourished, did not eat and drink enough;
• diabetes;
• smoking;
• pathology of the heart and blood vessels;
• incontinence of urine and feces;
• high body temperature;
• diseases or injuries of the brain or spinal cord;
• if you are allergic to bed care products;

as well as with such violations of care, when there are buttons, seams or folds on the bedding or underwear, dirt on the body (or the body is sweaty or wet), crumbs or small particles come across in the bed. Such patients especially need the prevention of bedsores, and with the slightest redness on:

• sacrum;
• knees;
• back of the head;
• temples;
• shoulder blades;
• heels and bones in front of the toes;
• elbows;
• shoulder joints,

you need to immediately begin treatment of bedsores (about him - below).

To prevent the development of necrotic changes in the skin

For the prevention of bedsores, care for bedridden patients should mainly include those activities that have been discussed in detail below. This:

• obligatory straightening of bed linen under the patient;
• nutrition, rich in proteins, iron, zinc and ascorbic acid: chicken boiled meat, chicken broth, dairy products, vegetables, fruits;
• seamless and buttonless underwear and underwear;
• changing position in bed every 2 hours;
• laying under bony prominences that rub against the skin, rings, tissue bags filled with, for example, buckwheat husks or sand;
• timely change of diapers;
• daily bathing, after which a moisturizer is applied to the skin, and in places where there is redness - drying agents (for example, Sudocrem);
• massage;
• wiping the back and limbs with camphor alcohol;
• thorough wiping of the skin before laying the patient on the bed;
• periodically being without a diaper.

Treatment of bedsores

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

For the treatment of stage 2 bedsores, you can also use the following algorithm:

1. Stop sweating into the wound fluid. This is done using trays with Delaskin or Baneocin powder. After such baths, the skin does not need to be blotted, wait for it to dry on its own.
2. After 2 days, local antimicrobial therapy is connected: Fuzikutan, Levsin, Levomekol, Iruksol.
3. On the 9th day from the start of therapy, agents that improve tissue repair are connected: Vulstimulin, Actovegin, Solcoseryl.

Thus, after a stroke, care for bedridden patients will require the acquisition of at least: