Nursing care

Pressure ulcers or bed sore:  are ulcers occurring as a result  of  skin  and  subcutaneous  tissue  injury  due  to  poor circulation in the pressure area that come into contact with the bed. 

 

 

Common locations of pressure ulcers:

Hips, elbows, heels, shoulder blades, knees, protruding areas of the ankle and head, ears and sacrum.  The selection  of  appropriate  clothes,  active-passive exercise,  personal  hygiene,  and  massage  can  be applied  to  protect  the  patient.

Hygiene:  Infection is one of the most common complications, especially after stroke.  One of the problems of rehabilitation patients is difficulty in swallowing as well as poor oral hygiene. Difficulty in emptying the bladder following a stroke leads to the accumulation of urine and bacterial infection.

Inadequate fluid intake is one of the causes of the accumulation of urine. Therefore, it  is important for post-stroke  patients  to  take  plenty  of  fluids  and  to have  their  catheters  changed  within  twenty  days.  If  the patient  is using  a cloth  wipe,  it  is also  very important to replace these cloth wipes at two to three hours intervals. This will both relieve the patient and ventilate the back of the patient.  During  the replacement of the cloth wipes, the urinary region and the  areas  that  are  in  contact  with  the  cloth  wipes should be cleaned with  wet wipes  or a  cotton cloth moistened with water. The perineum and the back of

The patients should be checked at certain intervals if the patients are able to maintain their own hygiene.

Bathing: After returning home, it would be beneficial for  the  patient  to  take  a  bath  at  frequent  intervals (depending  on  the  person’s  health  status).  This stimulates blood circulation and allows the opening of skin pores. The patient can spend one to two hours in the bath each day.  Bath time should be a relaxing time.  The healthy hand can rub and massage the opposite side.  Individuals  are  able  to  regain  some function  of  the  hemiplegic  hand  with  time. It is important to set the temperature of the water to prevent burn injuries. It may be convenient automatic, touch less sensor sink.  Showering should be preferred to a bathtub. It is beneficial to apply body massage with baby oil or lanolin cream after bathing

Bed Bath: Water-repellent products should be placed under the patient to protect the bed. Gloves must be used during the post-toilet cleaning of the patient. The cleaning procedure must be performed from top to bottom and from interior to exterior. After controlling the room temperature, up to two thirds  of the hand bath  should  be  filled  with  water  up  to  43  to  46 degrees.  The  patient’s  body  should  be  rinsed  with soapy water from top  to bottom,  and from  distal to proximal,  and  dried.  The genital area should be cleaned from front to back.  It is important to use a moisturizing lotion for moistening the skin.

Toilet: Toilet grip handles can be used to facilitate the ability to sit and stand. Sometimes, raising the toilet seat height can be of critical value.  

Eating:  Eating  with  other  family  members  at  the same  table at  home  can improve  the  morale of  the patient.  In this regard, caregivers should encourage the patient.  Non-functional body, sensory problems, difficulty swallowing and relaxed facial muscles can make it hard to eat. To divide the food into the small pieces, to use mixers when necessary, to wipe the patient’s mouth with a wet wipe, and to use a smock would be useful. Oral care is an important component of eating and appetite.

Exercise:  The  aim  of  exercise  is  to  regulate  the distribution  of  oxygen  and  metabolic  processes enhance strength and endurance, reduce body fat, and improve  muscle-joint  movements.  All of these benefits are necessary for good health and everyone should undertake a routine exercise program in daily life. There is no distinction between young and old people; however, strenuous exercise might have so risks. Exercising for 20 minutes or more, three times a week is sufficient.  Fifteen – 25 minutes of daily exercise five or more days a week provides high level of benefits. The exercise period can be started with light warm-ups and completed with stretching exercise.

The Family of the Rehabilitation Patient

The patient’s family plays an important role in rehabilitation.  To  have  a  relevant  and  resourceful family  that  can provide  care  is  an important  factor affecting  the  rehabilitation  process  positively.  What kind of problems the patient may experience and how these problems affect the patient should be explained to family members.  In this way, it will be easier for the family to find solutions after the discharge. 

If  you  are  a  relative  of  someone  in  need  of  rehabilitation, you should support and encourage him.

You should not leave the patient alone in hospital or the  rehabilitation  centre,  and  should  make  him/her feel  that  you  are  with  them.  Watching  television, listening  to  the radio,  playing  chess or  card  games with  family  members  may  make  the  patient  more comfortable.  This is a good way to learn how rehabilitation works and how you can help the patient.