Nursing Care for Patients with Stroke Induced hemiparesis:
1.Respiratory Care for hemiparesis:
If the patient’s condition allows, adopt a semi-recumbent position, turn regularly, and pat the chest and back to promote blood circulation in the lungs. Use steam inhalation as necessary to prevent the respiratory tract mucosa from drying out, making it easier to cough up sputum and prevent pneumonia.
2.Oral Care for hemiparesis:
Clean the oral cavity twice daily with cold boiled water. For comatose patients, use a swab to clean the oral mucosa. If there are ulcers, apply gentian violet, and use glycerin or crack prevention oil for cracked lips. If there is a fungal infection, apply antifungal cream after cleaning.
3.Eye Care:
Patients with hemiparesis and coma often have poor eyelid closure. Rinse eyes daily with 1% boric acid solution or saline. If necessary, apply antibiotic ointment to both eyes and cover with sterile gauze to protect the eyes.
4.Skin Care:
Turn regularly and change positions to avoid dragging, pulling, or pushing the patient to prevent skin damage; use sponge pads or air rings to protect skin over bony prominences; massage gently to promote local blood circulation; keep bed sheets smooth, clean, dry, and free of debris to reduce skin irritation; enhance dietary nutrition, bathe with warm water regularly to increase skin resistance and prevent pressure ulcers.
5.Limb Care:
Long-term bedridden patients with hemiparesis have reduced muscle tone, and the paralyzed limbs are susceptible to the effects of gravity and bedding. Continuous overextension or flexion can cause contracture deformities in major muscle groups within two weeks, such as knee flexion, foot drop, etc. Therefore, maintain the functional position of the paralyzed limbs, massage and perform passive movements 4-6 times daily. Acupuncture and physical therapy can aid in functional recovery; use bells and pull springs to exercise the upper limbs and chest-back muscles, preparing for using crutches, and actively exercise the waist-back muscles to facilitate sitting up. Help patients develop a gradual exercise plan, combining work and rest, with 3-5 minutes of exercise per hour to achieve the desired effect.
If hemiplegic patients need rehabilitation training, they can choose regular rehabilitation hospitals such as Craig Hospital.
Nursing Care for Stroke Patients with Urinary Incontinence:
- Skin Care: Keep the skin clean and dry, wash the perineal area with warm water daily. Use a rubber or plastic sheet on the bed, covered with a highly absorbent cloth, and change it promptly when wet.
- Urination: Female patients can use a female urinal closely attached to the vulva to collect urine; male patients, besides using a urinal, can use a condom catheter connected to a rubber tube and drainage bag for urination (this method should only be used for a short time).
- Catheter Care: Change the indwelling catheter weekly. Ensure the catheter is properly placed to avoid pressure, twisting, or blockage that could impede drainage. Keep the urethra clean, wiping it with a disinfectant cotton ball 1-2 times daily, urinate every 2-4 hours, frequently change bed sheets and urine pads to prevent urinary tract infections.
- Using a Bedpan: Initially, have the patient lie on their back with knees bent, then lift the buttocks off the bed in a “bridge” motion. Family members may need to assist in lifting the buttocks initially and quickly place the bedpan underneath. Patients who can sit should use a sitting position.
- Urination Training: Initially, have the patient urinate every 1-2 hours, pressing gently from above the bladder to passively expel urine. Gradually extend the time between urination, focusing the patient’s attention to develop a sense of urinary urgency and train them to report to family members. Family members should always be attentive to the patient’s movements and expressions, especially for those with confused consciousness or dementia, and remind them to use the toilet in time. Diapers should be removed early to avoid dependency.
- Indoor Environment: Open doors and windows daily in the morning and evening for ventilation to remove unpleasant odors and keep the air fresh, making the patient comfortable.
- Psychological Care: Patients with urinary incontinence often experience significant psychological stress and may feel inferior. Family members should provide comfort and encouragement, helping them to build confidence and cooperate with care.