Stroke rehabilitation nursing plan (1): body position

Stroke, also known as cerebrovascular accident, is a neurological deficit syndrome caused by local or overall brain dysfunction caused by acute cerebral vascular rupture or occlusion. Duration >; 24 hours or death. 73%~86% of stroke patients have hemiplegia for a week, and stroke patients account for a considerable proportion of patients who need rehabilitation at present.

In stroke rehabilitation nursing, body position is the first and runs through.

The first is to put the limbs and posture transfer.

An English word: BObath (neurodevelopmental therapy) will appear repeatedly here. Bobath handshake is the most commonly used posture in rehabilitation self-help exercise: palms facing each other, fingers clenched, the thumb of the affected hand above the thumb of the healthy hand, straightening and lifting the elbow with the help of the healthy side.

First of all, good body posture

The good limb position of the healthy side is: the affected shoulder is extended forward, the upper arm is raised and the elbow joint is straight 180 degrees, the palm is down and the fingers are straight; The affected lower limb is slightly flexed and placed in front of the healthy leg, and the healthy leg naturally flexes to the back.

The good limb position of the affected side is: the affected shoulder is forward, the shoulder joint is 90 degrees, the elbow joint is 180 degrees straight, the palm is up, the fingers are straight, the healthy lower limb is in front, and the affected lower limb is slightly bent back.

The good limb positions in supine position are: shoulder joint forward, upper arm slightly abduction, elbow and wrist straight, palm up, fingers straight apart. The pelvis and hips are forward, and the thighs are slightly inside, slightly inside.

Second, posture change: In order to prevent pressure ulcers and lung infections, patients should learn to change their posture as soon as possible. Supine position will strengthen the advantages of extensor, healthy lateral position will strengthen the advantages of flexor and affected lateral position will strengthen the advantages of extensor. Constantly changing body position can balance the extensor tension of limbs and prevent the occurrence of spasm mode. Usually change your posture every 2 hours. Turn over on the healthy side first, then turn over on the affected side.

Passive turn-over training: rotate the upper body first, then the lower body. The nurse put one hand under the patient's neck and the other hand around the patient's scapula, turning the patient's head and upper torso into a lateral position, then put one hand on the affected pelvis to turn it forward, and put the other hand behind the affected joint, and rotate the affected lower limb to make it in a natural semi-flexion position.

Passive turn-over training: first, put the affected upper limb in the booth 90 degrees away, and then let the patient turn to the affected side by himself. If the patient is in a coma or poor physical strength, the method of turning over to the healthy side can be used to help the patient turn over.

Active turn-over training: shake hands with Bobath, straighten the elbow joint, bend the shoulder joint 90 degrees, turn your head to the healthy side, and the upper limbs and trunk of the healthy side will drive the epithelium and trunk of the affected side to the healthy side. At the same time, the healthy side will hook the leg of the affected side, and the bone and the affected side will turn to the healthy side under the drive of the healthy side.

Active turn-over training: shake hands with Bobath, straighten the elbow joint, bend the shoulder joint 90 degrees, and turn your head to the affected side. On the healthy side, the lower limb flexes, the foot steps on the bed surface, and the center of gravity is on the outside, exerting force on the affected side, and turning to the affected side with the cooperation of beard and upper limb hand.

Secondly, three periods are mentioned: flaccid paralysis period, spastic period and recovery period.

Paralysis: The patient's consciousness is clear or slightly disordered, and the vital signs are stable, but the muscle strength and tendon reflex of the affected limb are very low.

Spastic period: the patient has hyperreflexia of tendon, and the patient's muscle strength and tension increase, resulting in joint reaction.

Recovery period: in the early stage, the affected limb and trunk do not have enough balance ability.

First, sitting and sitting balance training (spastic period and recovery period)

1. Sit up in bed

Sit up from the healthy side: take the healthy side to lie down, the nurse stands on the healthy side, instruct the patient to extend the healthy leg under the affected leg, use the healthy leg to drive the affected leg to move the calf to the edge of the bed, shake hands with Bobath, support the bed surface with the healthy forearm, and then sit up. The nurse held the patient's head up with one hand and sat down along the bed with the other hand.

Sit up from the affected side: take the affected side to lie down, the nurse stands on the affected side, instruct the patient to put the healthy leg under the affected side leg, use the healthy side leg to drive the affected side leg to move the calf to the edge of the bed, shake hands with Bobath, and support the bed surface with the affected side forearm before sitting up. The nurse held the patient's head up with one hand and sat down along the bed with the other hand.

2. Sitting posture balance training

The patient's upper limbs support the body, the fingertips are outward and backward, and the center of gravity is biased towards the affected side. The lateral limb helps the elbow joint of the affected side to stretch for a period of time, and then the center of gravity is biased towards the healthy side, and it is repeated.

Second, the movement from bed to wheelchair:

① Exercise: Place the wheelchair obliquely on the patient's healthy side, with the nurse standing on the patient's affected side, fully supported by the healthy upper limb, and move the trunk with the healthy lower limb as the axis, so that the buttocks face the wheelchair. Sit down slowly after the torso is fully flexed forward. Nurses ensure the safety of movement and the adjustment of wheelchair sitting posture.

2 Maintaining a correct sitting posture is the same as sitting in bed.

Standing: In bed and wheelchair.

① Standing: The nurse stands in front of the patient and asks the patient to put his healthy hand on the nurse's waist. Then the nurse fixed the hand of the affected side to one side of the waist with her forearm, and the other hand of the nurse stood under the armpit of the affected side. The patient looks up and faces forward, and stands up by the strength of the waist. After the nurse helps to maintain the correct standing posture, stand on the patient's affected side to ensure his safety and prepare for walking.

② Maintain a correct standing posture: the nurse stands on the patient's affected side, with her feet against the patient's affected feet, her hip joint against the patient's hip joint, and her hand reaches into the patient's affected side and lifts her shoulder joint to maintain a correct anatomical position.