风湿病的护理

发布时间:2019-09-26 22:15

(一)情志护理
       中医讲究情志护理的渊源已久,《内经》中即有:恬淡虚无,真气从之,精神内守,病从安来、精神不进,志意不治,帮病不可愈,说明精神情志的调节在人类防病、治病、延年益寿中起了很大作用,也为情志护理奠定了理论基础,后世医家在《内经》的基础上又有了不同程度的充实发展。
       由于风湿病的病程长,病情反复大,患者的思想活动、情志变化更为复杂,如疾病急性发作,或病情加重,行动不便,生活不能自理时,就感到悲观失望,甚至产生轻生的念头;有的对疾病缺乏正确的认识,又产生了急于治愈、心情急燥、要求
医疗效果过高的情绪等等精神状态,都严重影响了治病的疗效,此时虽有灵丹妙药也难奏效,所以对风湿病人的护理道德要做好情志护理。
        具体做法如下:1)指导和帮助患者正确对待疾病,减轻病人心理上的压力;2)争取亲属积极配合,使能达到预期疗效。
        (二)生活护理
       1、一般护理:风湿病患者最怕风冷、潮湿、因此居住的房屋最好向阳、通风、干燥,保持室内空气新鲜,床铺要平整,被褥轻暖干燥,经常洗晒,尤其是对强直性脊柱炎病人最好睡木板床,床铺不能安放在风口处,防睡中受凉。洗脸洗手宜用温水,晚上洗脚,热水以能浸至踝关节以上为好,时间在一刻钟左右,可促进下肢血液流畅。
       对四肢功能基本消失长期卧床者,应注意帮助经常更换体位,防止发生褥疮。对手指关节畸形,或肘关节屈伸不利,或两膝关节及踝关节变形、行走不便者,要及时照顾、处处帮助。
       2、饮食护理:1)饮食要根据具体病情而有所选择。风湿病患者的饮食,一般应进高蛋白、高热量、易消化的食物,少吃辛辣刺激性的食物以及生冷、油腻之物。2)饮食不可片面,正确对待药补、食补问题。瓜果、蔬菜、鱼肉、鸡、鸭均有营养,不可偏食。3)注意饮食宜忌。有关饮食护理的详细方面可参见前面风湿病的膳食文化。
      (三)姿态护理(亦称体位护理)
       风湿病人的姿势动态异常,往往会影响病人今后的活动功能和今后的生活与工作。姿态护理的目的是时时注意纠正病人不良的姿态、体位有利于今后恢复
健康,正常进行工作。
       风湿病患者由于肢体麻木、酸痛、屈伸不利、僵硬等情况,常常采取种种不正确的姿态和体位,以图减轻疼痛。因此在护理时患者的坐、立、站、行走、
睡眠等姿态均须注意,及时纠正,防止遗害终生。
       护理时还要注意生理姿态的保持。如为预防强直性脊柱炎患者脊柱、髋、膝关节发生畸形、僵直,一般要示病人站立时应尽量挺胸、收腹和两手叉腰,避免懒散松弛的驼背姿态,床铺不可太软,以木板床为佳,睡眠时忌用高枕,卧姿采取以俯卧姿势为佳等。
       (四)功能锻炼护理
       风湿类风湿性关节炎病人必须进行功能锻炼,目的是通过活动关节,避免出现僵直挛缩,防止
肌肉萎缩,恢复关节功能,即所谓以动防残。通过锻炼还能促进机体血液循环,改善局部营养状态,振奋精神,增强体质,促进早日康复。因此如何指导风湿病患者适当休息和进行必要的锻炼也是风湿病护理工作中的重要一环。
       1、有病时的功能锻炼与无病时的体育锻炼要求不能一律。
       对于风湿病人,锻炼是为了维持和恢复关节的功能,但锻炼的要求与方法应根据体质、年龄、性别不同而各异,如风湿病人在急性发作期全身症状明显或关节严重肿胀,此时应卧床休息,严重者可休息1-2个星期,中度的休息5-7天,注意手足关节的功能位置,一俟病情缓解,即可做一些床上的功能锻炼,如关节屈伸运动、按摩肿痛关节等。可做山东谷岱峰老人密传的按摩
保健法床上八段锦。
      (1)干沐浴(自我按摩):浴手、浴臂、浴头、浴眼、浴鼻、浴胸、浴膝。
      (2)鸣天鼓:用两手掌心紧按两耳孔,两手中间二指轻击后头枕骨十几次。
      (3)旋眼睛:两眼向上左右旋转各5-6次。
      (4)叩齿:上下牙齿互相轻叩击30多次。
      (5)鼓颐:闭口咬牙,口内如含物,用两腮和舌做漱口动作30次。漱口时,口内多生津液,等津液满口时再分三口慢慢下咽。
      (6)搓腰眼:两手心搓热,紧按后腰部用力向下尾闾部上下30次。
      (7)揉腹:用两手心揉腹,在脐孔周围自左至右、自右至左做圈状揉按。
      (8)搓脚心:搓脚心涌泉穴各80次。
       病情稳定后,可开始下床活动,慢步行下床活动,缓步行走,又可做床下六段锦,即:用两手前伸如关门状;两手平举耸肩10次;两手平侧下按;俯身两手掌向下,左右交叉向下摸10多次;两手心向上托动10多次;两手左右交叉向前抓10多次。
       关节肿痛消除后,必须将功能锻炼放在恢复关节功能方面,按照病变关节的生理功能进行锻炼,开始时先从被动活动逐步转为主动活动,或两者结合进行,以主动活动为入促进关节功能恢复。亦可借助于各种简单的工具与器械,如手捏核桃、弹力健身圈锻炼手指功能;两手握转环练习旋转功能锻炼手腕功能;脚步踏自行车锻炼关节;滚圆木、踏空缝纫机以锻炼踝关节;滑轮拉绳活动锻炼肩关节等。
        2、功能锻炼的场所、形式与时间。
        风湿病人功能锻炼的场所、形式与时间也应因人因病制宜,可按《内经、素问、四气调神大论》所要求的春三月、、、、、、夜卧早起,广步于庭,被发缓行,以使志生、、、、、、夏三月、、、、、、夜卧早起,无厌于日、、、、、、。秋三月、、、、、、早卧早起,与鸡俱兴、、、、、、。冬三月、、、、、早卧晚起,必待日光、、、、、、去寒就暖,无泄皮肤、、、、、、。
       (五)辅助治疗护理
       风湿病是一种比较难治的顽固性疾病,有时单纯服药治疗,效果尚不够满意,目前有很多研究风湿病的专家主张要用综合疗法,即用各种辅助性的治疗方法与药物疗法结合治疗,可以提高治疗效果。目前常用的辅助疗法主要有:传导热疗法,矿泉疗法,运动疗法,敷贴疗法,热熨疗法,外搽疗法,薰蒸疗法,药液穴位注射,针灸、推拿、按摩疗法及激光、微波电疗法等。
       (六)并发症的护理
       风湿病患者在漫长的疾病过程中,常易合并其它病症,尤其是在气候突变或梅雨季节及台风、暴雨、严冬、酷暑时,更易感受风寒、湿邪及
中暑等,对此应予以重视。对于合并肺炎心衰、高烧不退等严重并发症时应早上医院对证治疗


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