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Communication with a sick person of any age (and even more so, care) requires special skills and methods. First of all, you need faith in recovery. Or at least not to deteriorate the patient’s health...
The emotional tone of the nurse is naturally, like that of a healthy person, subject to aggravation. Try not to sympathize and not react to the groans, or even just the weakness of the bedridden patient...
Emotional tone is significantly reduced towards fatigue, a joyless feeling from daily physical stress. The nurse has to constantly use physical force: for washing, drying, massage, to help the patient move around the apartment.
The motives for seeking help from caregivers are varied: for a few hours, coming and providing assistance according to a specific service regimen: in a hospital or at home, with medical skills, sometimes without them...
Today there is also such a request from customers as inviting a nurse-companion. It is in such a nurse that the employer sees an opportunity to help the patient’s experiences, an opportunity to provide him with full communication and warmth. It is this kind of nurse who is singled out as a conductor of kindness, courage and cheerfulness of spirit. And the facets of her sociability are represented in the ability to present the patient with interesting information, to protect him from unnecessary, unnecessarily disturbing information. When communicating with a patient, she should not just be talkative, but psychologically sensitive and delicate.
Let's turn to an interesting psychological test. Does this test help identify the inevitable loss of mental and physical energy?
Do you know how to care for the sick?
- I fulfill all the whims of the patient
- I'm saying that I shouldn't have put myself in that state.
- I suffer with the patient
- I don't pay any attention to his suffering
- I take care of the patient day and night
- I tell you not to pretend
- Pampering the patient
- I arrange luxurious leisure time for any money
If the condition worsens:
- I call a doctor from the clinic (the doctor on duty at the hospital)
- I think, does he really need such serious care?
- I joke with him about his illness
- I am taking all necessary measures to help.
Is it even possible to measure the inevitable losses of giving one’s own optimism to a sick or infirm person?
Complaints
For example, the complaints of a patient or the complaints of his relatives who are tired of caring for him. You have to listen to them endlessly. Well, don’t interrupt a person mid-sentence!
Try to casually tell an even more pitiful story, remembering it, either from your life, or drawn from a movie, literary work, etc.
No matter what scenario of life’s ups and downs the patient sets out in his monologue, there were undoubtedly more joyful things in life than sad ones!
You can also use distracting information. Use anything: something you recently heard, saw on the street, read... fantasize! In this way, you can delay or completely prevent the loss of your own mental vigor, as well as at least for a while neutralize the negative emotional state of the patient and his relatives.
Habits
Everyone has good habits and bad ones. But not always even a healthy person can recognize stereotypical, outdated habits that interfere with self-development. And here a sick person, limited to a minimum circle of contacts, falls into captivity of habits...
Most often, patients are hampered by the habit of excessively capricious behavior. It is hardly worth “re-educating” such people. This is a very difficult task. But you can deftly delay such a manifestation.
Let's say, as it was in my experience of caring for a 90-year-old aunt. Out of long-standing habit, she loved to educate me. Aunt Vera didn’t let me sit down for a minute: bring this to her, give it to her, find her, don’t leave. Or - “Sit further away!”... “Peel the potatoes nearby”... Either she’s hot - open the window, or there’s a draft - close the door.
“Well, flutter, flutter,” I said to myself and began to easily write down her whims, unpredictable at first.
And then she began to recall vivid episodes of her childhood with her. This fascinated her extremely and put her in a good-natured mood.
This simple method of remembering, starting with the words: “Do you remember?” helped me enormously.
For two months, in the summer, I had to be a “visiting guest” in the house of my once director, mentor, inspiration in life. He turned 89 this year. I found out that it turns out that two years ago he was struck down by paralysis. The right arm remained paralyzed. He stopped talking. It would seem that not long ago he was a brilliant speaker, lecturer, scientist, philosopher!
I had to use both “Auntie’s appointment” and add “counseling.” For example, it’s like I’m preparing a video about my working methods. I ask my teacher to criticize me, clarify me, give me some advice. And one day I asked him to listen to the songs I had selected for a circle of friends - a tea party with older people. So we sang all the songs with him! He waved his left hand in time with our performance. I saw the same sparkle in his eyes!
This technique allowed me to invite his housekeeper, who also acts as a live-in nurse, to sing him his favorite songs in Georgian. By the way, she had a good voice.
Common dying symptoms
General pre-mortem signs can only be considered in old people or in bedridden patients. Sudden death is not accompanied by any signs, because they simply cannot exist.
Changing your daily routine
As has already been said, a dying person sleeps most of the time. When he wakes up, he is in an alert state for a short time, after which he falls asleep again.
This phenomenon may be due not only to the general exhaustion of the patient, but also to the fact that he does not want his loved ones to see his suffering. Short intervals between sleep become increasingly rare, and death may occur in sleep.
Swelling and skin changes
Progressive renal or heart failure provokes the appearance of edema - that is, the accumulation of fluid in the human body. Most often, it accumulates at a considerable distance from the heart - in the feet and hands. As a rule, such a symptom no longer requires any specific measures, since it is not the cause of dying, but only part of this process.
The skin becomes dry and pale. Sometimes blue venous spots may appear on them, for example, on the legs, this is due to a decrease in the functionality of the blood vessels. See what venous spots look like in the photo below:
Problems with the senses
If we talk about natural death from old age, then people in old age often have problems with hearing and vision. Signs of death appear not only in the deterioration of the functioning of the senses, but in a change in the appearance of a person. “Cat's eye” is the name given to a visual change in the eye of a dying person, which is associated with a sharp drop in ocular pressure.
Decreased or complete loss of appetite. Since the dying person spends most of his time sleeping, the need for food decreases. The closer the end of life is, the more likely it is that the swallowing reflex is lost, and then the person receives nutrition through a tube or IV. It is quite difficult to say how long this condition can last in an elderly person.
Violation of thermoregulation. The body spends all its remaining energy to maintain the functioning of vital organs; as a result, the blood circulation decreases, which leads to paresis and paralysis.
General weakness
This symptom is directly related to the lack of nutrition of the body.
Depression from inactivity
I think that every person, being active, healthy and energetic in his life, quickly begins to “give up” from constant lying down or restrictions on movement.
Today you can find videos with a variety of low-amplitude exercises for different body segments. There are mini-Pilates complexes, coordination gymnastics for the combination and development of small movements. They are very helpful. It's never boring with them. Massages and gentle rubbing are also useful here.
Such “inhibition” of a weakened body, work with the restoration of sensitivity points, activation of muscle tone allows you to distract the patient from unhappy thoughts. And they inevitably spin around in your head due to the lack of new sources of surprise, admiration, and inspiration.
And I also believe that the most important condition for successful, reliable care for a sick child, adult, or elderly person is to turn to his inner world. Only in this way does the interaction between a healthy person and a sick or weakened person begin to have magical healing powers.
About mental hygiene
And finally, about mental hygiene. Naturally, this is important for the patient, his relatives, and the nurse. We wash our hands every day when we come home from the street, and brush our teeth after eating. Healthy emotional tone also requires systemic cleansing and restoration.
Write on a piece of paper what pissed you off today, or what painful thoughts haunt you and haunt you. Now replace them with positive, even fantastic, statements and definitions and post them for open review for the patient. If there are no objections on his part, we can hope that his strength for recovery will begin to accumulate. If the patient objects and grumbles about the uselessness of striving for a cheerful mood, be patient, but watch yourself and your thoughts carefully. Save your lines, draw conclusions and don’t lose heart!
And another observation from my own experience. Patients with different types of diseases are often called victims: “stroke victim”, “heart attack victim”, etc. Do not surrender yourself and your patient to these attitudes. Reach out with the patient to the divinity of the body. After all, he is trying so hard to get better. You need to learn not to disturb him, hear him, talk to him and listen to signals of recovery or at least not worsening of the condition. And creating a prayer for recovery can be a very necessary procedure! Church officials know that a created prayer has a stronger effect than one read or learned by heart.
Lyubov Bogomolova
The trouble of bedridden patients
In addition to the main illness, bedridden patients face another, no less serious danger. These are bedsores. Rehabilitation doctor Oksana MUKHARLAMOVA told our correspondent how to solve this problem .
– Oksana Filippovna, please tell us what bedsores are and why they occur?
– Bedsores –
These are areas of the skin to which access to oxygen is stopped, nutrition in the tissues is disrupted and there is no outflow of metabolic products.
In other words, these are areas of ischemia (bleeding) and necrosis (death) of skin tissue, resulting from prolonged compression
,
shearing
or
displacement
between the human skeleton and the surface of the bed.
If the patient lies in one position for a long time, the microscopic vessels through which blood flows are compressed. This also happens when a person is pulled across the bed, wet clothes are pulled out from under him, or they try to push a bedpan under him. In this case, there is a significant displacement of the superficial layers of soft tissue in relation to the deep layers, as a result of which small blood vessels are torn and the blood supply to these parts is disrupted.
In a similar way, bedsores can also form in weakened patients who, without support in their legs, begin to slowly slide down a chair or bed from a sitting or half-sitting position (their muscle activity is not enough to remain in the original position).
In addition, as we know, the work of blood vessels is controlled by the nervous system, and any serious illness –
This is stress for the whole body. All its functions weaken, and this is also a direct road to bedsores. It happens that a person is so depressed by his condition that bedsores begin to appear literally before his eyes - on the second or third day after he was put to bed.
– Where do bedsores most often form?
– These can be all the places over bony protrusions on the body that are compressed when lying or sitting. In these places, as a rule, there is little subcutaneous fat, and the pressure of the bony protrusions on the skin tissue is strong. If the patient lies on his back, such places will be the sacrum, heels, ischial tuberosities, elbows, shoulder blades, and the back of the head. If on the side, then this is the hip on the side (the greater trochanter area), on the sides of the ankles and knees. If a person is lying on his stomach –
pubic area and cheekbones.
– How dangerous are bedsores?
- So much so that you can even die from them. If at first it is only redness, then later (if nothing is done) the skin may be subject to erosion. The affected area becomes moist, which makes it easier for infection to enter, and sepsis may even develop. There is a term “bedsore sepsis”, that is, blood poisoning. And this form of the disease, if left untreated, often leads to the death of a person.
Dead skin leads to local suppuration. Purulent toxicosis may occur, which is also deadly. Just don't think that I'm intimidating. I just want to emphasize that bedsores –
It's a serious matter. And we must take them seriously too.
– Could you name the categories of patients who are especially prone to bedsores?
– Mostly these are very obese people. Or, on the contrary, very thin and emaciated. This also includes people who use a wheelchair, suffer from diabetes, urinary and/or fecal incontinence, bedridden patients who have suffered, for example, a stroke, heart attack, and patients with various types of fractures.
It’s a disaster if a sick person lives alone and has no one to care for him. –
then bedsores cannot be avoided. And with good care, you don’t have to be afraid of them.
– What can be done at home to prevent bedsores from occurring?
The main principles of prevention include the following:
♦ reducing compression, friction or shear of tissues;
♦ keeping leather and bedding clean;
♦ good nutrition;
♦ regularity and correctness of bowel movements (bladder and intestines).
Since the most vulnerable to bedsores –
This is the back part of the body, it is important not to let the patient lie on his back all the time. It is necessary to change its position frequently so that the skin experiences minimal friction and soft tissue experiences minimal displacement. This must be done every 2-3 hours, including at night.
The bed should be flat, and the sheets should be well stretched, without bumps or hard seams, and most importantly, dry. The skin must also be dry. It is important to examine it daily, especially in areas of bone protrusions, and treat it 2-3 times a day for preventive purposes with some means, such as camphor alcohol.
You can additionally place foam rollers under bone protrusions, and under immobile limbs –
bags filled with round grains, such as millet. Pharmacies sell special inflatable rubber rings. They are usually placed under the sacrum or back. All these means increase the area of contact between the body and the surface on which the patient lies, which means that the pressure on each area of the skin decreases. As a result, blood circulation improves and thus reduces the risk of bedsores.
You can purchase a special anti-decubitus air mattress. It creates more comfortable conditions for the patient, but remember that it is not a panacea; other preventive measures are also necessary. The doctor can suggest medications that improve blood circulation and thereby prevent the occurrence of bedsores.
In general, the best remedy against bedsores –
early activity of the patient. If he begins to sit down, stand up, and walk around the room on his own, then he will not be in danger of bedsores.
As for the nutrition of a bedridden patient, it should be complete, but taking into account restrictions, if any. Include dairy and fermented milk products, chicken broth, fish, cereals, herbs, vegetables, and fruits in the patient’s diet. Choose foods that are rich in minerals (especially iron and zinc) and vitamin C
. Drinking – at least 1.5 liters of liquid per day (if there are no restrictions). You should not consume sweet and carbonated drinks, as well as fast food products.
– What to do if bedsores do appear?
– Neither ointments, nor powders, nor other remedies will help get rid of bedsores if the affected area continues to be compressed and the blood does not supply it with nutrients.
Therefore, first of all, you need to restore normal blood flow to the affected area of the body. And for this you need to follow all the preventive recommendations mentioned above.
Let me make a reservation right away that if the wound festers and dead skin appears, you need to immediately contact a surgeon, who will excise the affected areas and tell you what to do to heal the wound.
At the first stage, bedsores are pink, weeping spots. They need to be lubricated with a strong solution of potassium permanganate and dried in air. It’s good if it is possible to treat these areas with ultraviolet light or expose them to sunlight for a few minutes.
To shed dead tissue as a home remedy, traditional medicine recommends using wet dressings with a cognac salt solution (30 g of table salt and 150 ml of cognac). The bandage must be applied under compress paper and changed as needed. Before applying a new dressing, be sure to wash the wound to avoid excess salt concentration.
A wide variety of ointments can be used for inexpensive wound healing: Levosin, Levomikol, Actovegin, Solcoseryl, Vulnostimulin, Desyatin and others.
The skin around the bedsore also needs to be carefully looked after: washed with soap (it’s not a big deal if soap suds get into the wound), but do not rub, just blot, dry either in air or using a 1% solution of potassium permanganate, brilliant green, ointments containing zinc. The latter means are preferable to others, since when they are used, gauze bandages do not stick to the edges of the wound.
Nowadays, pharmacies have a lot of products (in particular, for the treatment of bedsores) for the care of bedridden patients; there are even specialized stores in Moscow. You can consult a specialist and choose what is most suitable.
The main thing is to remember that prevention is always cheaper - both literally and figuratively, don’t waste time!
Folk recipes
1. Steam several handfuls of millet, pour into cotton bags and place warm under bedsores. Keep for 4 hours. Do this once a day. The wounds heal quite quickly.
2. Boil 100 g of vegetable oil and add a piece of beeswax the size of a walnut. Stir well and cool. The result will be a mass similar to Vaseline. Use this ointment to lubricate bedsores, any wounds, ulcers, or seals.
3. Cut the leaves of Kalanchoe (whose forks fall off) and apply the side where the juice is released as a sticker to the bedsore. The wound will heal overnight.
4. Mix equal amounts of olive oil and vodka. Wipe the sore spot with this mixture 2-3 times a day.
5. Lubricate the baked onion with honey and apply to the wound, covering the top with gauze and cellophane.
6. Fir oil, rosehip oil, sea buckthorn oil, and ointment based on aloe leaves are good remedies for healing wounds caused by bedsores.
7. Mix almond oil and onion juice, taken in equal quantities, and lubricate the areas of bedsores.
8. Sprinkle the wound with potato starch .
9. Recipes with calendula:
- Pour 2 teaspoons of calendula flowers into 2 cups of boiling water, leave for 15 minutes, strain. Wash the festering bedsore areas with this infusion;
- for extensive bedsores that are difficult to treat, apply crushed fresh calendula leaves directly to bedsores, ulcers and festering wounds;
- grind 1 tbsp in a coffee grinder. spoon of dried calendula flowers and mix with 50 g of Vaseline. Apply the ointment to the sore spot 1-2 times a day.
11. Pour boiling water or boiling milk over freshly picked young elderberry leaves , squeeze and apply to bedsores 2 times a day.
6.12.13 Magazine “60 years is not an age”
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September 14, 2020
