Lying patient. Problems and solutions. Prolonged bed rest: is it useful for the patient

Great success is made up of many
foreseen and considered trifles.
IN. Klyuchevsky

What words can I find to describe what I experienced on the 97th day after the injury? What comparisons to choose? Perhaps, on that day, I experienced what a person experiences who has escaped from execution, or escaped from the hands of bandits who are about to kill him, or who has escaped from a shipwreck - in a word, who has escaped death. For to remain forever bedridden was tantamount to death for me.

So, on that unforgettable day on May 25, I got on my feet for the first time since the disaster. Against all the predictions of doctors, contrary to what was said about my injury in medical books, contrary to all logic.

True, this event could have happened much earlier - I had long been ready for it, but by the grace of the attending physician, it was too late. It is now written in textbooks that spinal patients need to be put on their feet without delay. And at that time, doctors were afraid to do this and everyone delayed such an important moment for the patient.

The ward was full of people - the patients of our department, all the nurses and orderlies who were free from work, gathered. Still, such an event does not happen often in hospital life. Then they will get used to me, and my figure with a bulky iron arena, marching along the corridors, will become a common everyday occurrence. And now...

The process of dressing was very long and resembled the ceremony of dressing the bride. The whole complexity of this "rite" was that I could not be planted, bent, turned sharply.

Simple women's stockings were pulled over my legs to protect my paralyzed skin and protect it from scuffs. Obtained with difficulty (at that time they were not on sale), they turned out to be very short and covered the legs only up to the knees, so they had to be bandaged higher. The ankle joints were then reinforced with elastic bandages to prevent sagging and twisting of the feet.

After that, rather primitive gypsum splints weighing about a pood were bandaged to the back surface of the entire leg. Until they make special orthopedic devices, I will use these ... Their purpose is to keep paralyzed legs straight at the knees so that they do not break under the weight of the body.

Finally, they put on hospital slippers, bandaged them so that they would not lose them (now it will take half an hour to roll up all the bandages). In conclusion, this bandaged doll was put on new pajamas. It turned out something like a mannequin, which is displayed in store windows (in this case, to demonstrate hospital pajamas).

Now the most difficult thing was to put my body in a vertical position, because a torso with a broken spine can neither be twisted, nor bent, nor tilted to the sides. They turned me over on my stomach, dragged me to the edge of the bed, lowered my legs to the floor and slowly and carefully, like a high-voltage mast, supporting me from all sides with my hands, put me in a vertical position.

And for the first time in three months, I'm standing. I'm standing on new artificial legs and I can't feel my legs under me. No, not in a figurative sense, but literally - it was as if there had never been legs under me: I did not feel the support, the usual hardness of the floor, as if hovering over it. It's even funny: the head, arms and torso are devoid of legs, hovering in the air.

Well, let it be, I'm still happy, because I'm back on my feet, although they are made of clay, and I can now look at the world standing, from top to bottom. So, let's go. I'm starting to walk!

Oh, how loud it is said - in fact, everything looked like this: three of them dragged me, and the fourth rearranged my legs, which completely disobeyed me and dangled like lashes hanging from the body. The spine also did not hold, and the body all the time tried to fold in half, like a folding penknife.

It was only thanks to the dexterity of many strong hands that I did not fall and was passively kept upright. Not a man, but a real puppet.

Finally, two meters to the window were overcome, but what was there outside the window - I could no longer see; everything around me staggered, spun, my eyes were covered with a translucent film. My head fell to one side, I lost consciousness. This ended the epic with getting up. I was dragged to the bed completely lifeless, like a log, and they began to expose me. Disappointed spectators began to disperse - the performance ended. My joy (finally put on my feet!) passed, tired, exhausted, I lay on the bed. And then everything fell apart...

Sudden short-term loss of consciousness - fainting - happens when a paralyzed person is first put on their feet. After lying in bed for a long time, the transition from a horizontal to an upright position causes a condition characterized by weakness, profuse sweat, pallor, a sharp drop in blood pressure and loss of pulse. The reason for this is a decrease in the tone of blood vessels and a sharp outflow of blood from the brain (now there are special orthostatic tables for appropriate preparation and training).

On that day, I was no longer capable of anything. All I wanted was for everyone to leave me alone. But the next morning there was a deceptive sense of improvement, and I was itching to get back on my feet. After I was raised from my usual (and deadly bored) horizontal state to my feet, it was already impossible to lie down. But how can I learn to walk, to control my legs, to keep my body upright?

Of course, for this it is necessary first of all to ensure that the arms become strong, the muscles of the body are well trained and that there are true friends nearby. There are long months of daily training (and in general I will have to train my body now all my life) in order to re-learn elementary movements that healthy people do not even think about, performing them unconsciously. And I jump into training with new energy.

After I got to my feet, it was already impossible to keep me in bed - I was torn to the floor. My friends, led by Slava, made me a comfortable playpen - a design in the form of the letter P. Standing inside the playpen and leaning on the handrails, I began to move around the ward with its help. One day he went out into the corridor and, accompanied by a walking patient (for insurance, since it is still impossible to fall - the "armor" of the muscles is not yet strong enough), he reached the office of his classmates working at the institute, where he was met with thunderous applause.

And then the walks with the arena in the park began. For the first time, he covered 400 meters in two hours, and most recently he covered this distance at the stadium in 53 seconds.

But for the first time they decided to put me on crutches. In the arena I move quite confidently. And how will it be without him? But sometimes you need to switch to crutches. You won’t walk all your life in an iron arena, like a walking excavator.

Honestly, it's scary to break away from the arena, it will take a lot of courage not only for me, but also for my assistants.

And here I am standing in the park on my plaster legs, spreading them wide. Lowered shoulders rest on crutches, the back is hunched. With all my appearance, I show a person ruthlessly crushed by the burden of life.

I'm being held tight on all sides. They tell you how to take the first step. But I don't move. Everything is not as simple as it seemed before. The former lightness has disappeared in my legs, instead of them I now have some kind of bulky clumsy stilts. I try to give orders to my legs - each separately and both together. Nothing works! I forgot how to walk, for three months I forgot how to do it, I don’t remember my walk at all. It was much easier to move in the arena: there I walked on six legs (my two, four arenas) with a good emphasis on my hands (they are now the most reliable “legs”).

I try to extinguish the panic that has seized me and calmly say to myself: "Do not rush, first get used to your new state and gain confidence." The main thing now is to learn how to maintain balance, and for this you need strong muscles. While they are gone, it is absolutely impossible to leave me alone, without support - I immediately fall, like a cut tree, in one direction or another. They even began to whisper around, apparently afraid that a loud conversation would shake the air and I would lose my balance. As they say, both laughter and sin.

But you have to move, you can't stand like this forever on crutches, swaying like a pendulum. And I, supported from all sides, take one, second step, no longer on a smooth tile, and even with the help of an arena, but on the ground. What is it uneven, bumpy, with pits!

Despite all my powerful efforts and great desire, I was able to walk only five or six unthinkably clumsy steps, as a result, I moved from strength to one meter. It turns out that to overcome this distance, with all the preparations, you need to spend more than an hour and a half. What a difficult and difficult path awaits me, how much time and effort it will take to learn how to move with the help of crutches...

In the meantime, I slowly continue on my way with timid steps, leaning forward strongly on crutches and supported by several hands. Left crutch - right leg forward, right crutch - left leg forward. What unreasonably long clumsy legs I have turned out to be, they are endlessly tangled when walking! I am constantly in danger of tripping over my own leg, which is wearing a bulky orthopedic apparatus, over a crutch, or over the treacherous unevenness of the ground.

In order not to hurt my legs, I turn my feet outward and follow my every step very carefully. I move according to the principle: you go quieter - you will continue. And this is me, who liked to walk a lot and quickly, to run.

After a few meters of snail-like movement forward, I felt so tired that it seemed that I could no longer take a single step. “No, you shouldn’t give up,” I say to myself. “There were also moments in sports when you ran out of strength and you were ready to give up the fight, quit the race. But you didn’t quit!” And I gather all the remnants of my strength, strain all my will and force myself to take one more step. Only in this way, doing the impossible, and come to victory. Do not feel sorry for yourself, do not complain about fatigue and believe in success. It is difficult, very difficult, but there is no other way out. Nobody will do this for me. Rest, rest and move forward again.

From the strongest tension, the fingers go numb, the veins that swell on them seem to be about to burst, the heart is pounding not only in the chest, but also in the head, temples, and ears. There is nausea, dizziness, I start hallucinations. It is unreasonable to torture yourself further, but it is already difficult to stop me. I walk, walk, breathing heavily and almost losing consciousness.

But then the limit came, when the forces finally dried up, I can no longer take a single step. It's dark in my eyes, I can't see anything. A wheelchair is rolled up to me (I myself can’t return to it, besides, I still don’t know how to turn on crutches), I clutch at it convulsively and, immediately limp, fall heavily on my side.

I was immediately doused with cold water from a bucket, washing off the sweat and removing the heat from my hot body. Then they vigorously rubbed the whole body with a towel, stretched the tired muscles of the arms and back, encouraging me in every possible way and admiring my successes.

I myself was amazed at what I did, for I did not imagine that such a vital force existed in me. Some unthinkable superpowers of my body moved my naughty legs, stubbornly forcing me to do it step by step.

These superpowers, these hidden powers are in every person. But people do not even know about them, they do not know that in their entire life they use no more than ten percent of their body's reserves. And if they knew, if they knew how to use them, how many ailments would be cured, how many lives would be saved! But, having fallen ill, a person does not connect the reserves of his body for a cure, but drinks medicines, swallows pills, supports himself with injections, that is, he does not heal the whole body, but puts only patches on the sore spot. I gave up all this very soon, because I realized that the medicines (patches) would not lift me up. Therefore, I got out of the abyss only with the help of the body's defenses, so now I know about them not from literature, but from my own experience.

That is why I can say with confidence to anyone who has fallen into a seemingly hopeless situation similar to mine: being even in the most difficult physical condition, a person should not give up and lose hope, but fight for his recovery. Fight hard day after day, and the body will not let you down - it will respond to your efforts. And you will definitely win if you become brave and persistent. Although the recovery may be incomplete, you will be able to live, work, love and be loved. The strong are loved even when fate is merciless to them, when their health is lost.

For example, I am amazed at how many women around me now who sincerely want to help. Moreover, some of them directly say that they are ready to link their fate with me. Embarrassed by such offers, I try to convince them that in my position a nanny is needed, not a wife. But my "brides" continue to persist and in response they say such words, which it is even immodest of me to mention here. Nothing like this happened to me in that former life, while I was healthy, strong and looked quite decent. Moreover, I was often alone then.

The most difficult hours of training and getting on your feet took place in the park. I was tired to death from this hard work and at the same time I was happy that I was back on my feet and moving. Let it be for the time being in special apparatuses, let it walk only a few meters on its own, but now I knew for sure that this was only the beginning. The park was for me a place of physical and spiritual rebirth. A beautiful quiet corner of the earth, which we dream of to tears when trouble overtakes us.

Here, outside the ward, I was not affected by the hospital regime and internal routine. I had a lot of time and complete freedom of action and tried not to waste this wealth, but to engage in exercises, self-education: I read a lot, made notes in my diary, continued to study English. I don’t know how my life will turn out now, whether I will be able to return to my former profession of a doctor again or I will have to acquire a new one, but I am sure that extra knowledge has not bothered anyone yet.

In the park, I can receive as many visitors as I like, sometimes the most unexpected ones. Particularly touching were the visits to my former patients, who had been cured by me in the past or who had not been cured and who were waiting for detailed recommendations from me.

Luda's visit was also unexpected. I saw her for the first time three years ago. After receiving patients at the clinic, I received a house call. I was met by an anxious woman, who, as I later learned, was the foster mother of my patient, and led me into a large room full of flowers. On the couch lay a girl of 17-18 years old with an attractive face, painted with a healthy blush. There was no one else in the room. So it's a challenge to her.

“What is this?” I thought with annoyance, “such a blooming girl could not come to the clinic herself.” Apparently, the hostess of the room read the displeasure on my face, because she immediately silently and angrily threw back the blanket covering her. And I see that the girl does not have one leg, instead of it there is a very short stump. The bandage was soaked with blood - it can be seen that the wound is fresh.

Having met the patient’s heavy gaze, I feel confused, but immediately I pull myself together and proceed to examine the wound. Having provided the necessary assistance, I say goodbye and go out into the corridor. Here my mother stops me and briefly tells the story of the accident: a motorcycle accident, I was traveling with my uncle, who did not even get a scratch. Crying, the mother begs to support her daughter, to breathe hope into her, the desire to live.

From that day on, I visited the girl almost every day. He brought books, told 6 of his patients, among whom were those with similar injuries, but recovered, found themselves in life. My patient listened with eager attention.

When the stump was ready for prosthetics, the girl began to learn to walk: first around the house, then went outside, began to go to the cinema, and think about further studies. She didn’t need me anymore, she walked on in life on her own.

Later I found out that the girl got married, gave birth to a child, and is happy.

And now Luda is standing by my bed - the roles have changed. Now she tries in every possible way to encourage and support me. I am very glad to see her, because she is in good shape, and I listen to her encouraging, kind words with pleasure. But I really do not want to look miserable and weak in front of the former patient, and I transfer the conversation to another topic, asking how she is doing at home.

Luda takes out her mother's x-rays and hands them to me. On them I see advanced inoperable cancer of the esophagus. The patient remained to live no more than 4-5 months. It's hard to talk about this Luda. The joy of rendezvous is overshadowed.

And one day I see an old man turning onto my path and waving his hand from afar. Fits.

Hello, Doctor! You do not remember me?

I'm straining my memory, but I can't remember it. And only when he began to talk about our meetings, I finally remembered.

He came to see me with his wife. He is 84 years old, she is 60 years old. It was felt that his young wife really loves her brave old man and takes great care of him. The patient showed me his right arm, which was strongly bent at the elbow joint, and could not be straightened by any means. There was a tumor under the bandage. Within a month I managed to eliminate it, but I did not hope to develop ankylosis (immobility) of the joint and stretch chronic muscle tendon contractures at his age. However, he nevertheless gave appropriate recommendations: special compresses, heat massage and energetic therapeutic exercises.

The patient turned out to be a man of character, he persistently and accurately began to follow my recommendations and advice. And now I see that both his hands are straight, one leans on a stick, the other holds a cake.

Frankly, I was very surprised: after all, then I almost did not believe in the success of therapeutic exercises: the elbow joint, being inactive, is especially susceptible to bone changes and violent salt deposits. And if someone told me about such a case, I would simply not believe it. But then I saw the healed hand with my own eyes.

This visit was especially useful for me: the case of a former patient once again confirmed how great the power of movements is, which, combined with perseverance, work wonders. So you have to work, work and work without stopping. I have no other choice.

Prolonged stay of the patient in bed is a forced consequence of the severe course of many acute and chronic diseases. Prolonged lying or immobility of the patient is not as it seems at first glance. Immobility gives rise to many very serious complications. These complications significantly worsen the outcome of the underlying disease, are in themselves formidable diseases that contribute to the disability of the patient. The following are the main problems that occur with prolonged lying down and how to prevent them.

Skin related problems

When lying down, the skin is significantly affected by friction against linen, from squeezing between the tissues of the human body (muscles, bones, etc.) and the surface of the mattress, from crumbs, folds of linen, from sweat, urine, and much more. Patients may develop diaper rash, bedsores, scratching, excessive dryness or moisture in the skin. The skin becomes more sensitive to ambient temperature, bedridden patients often feel cold, they do not tolerate ventilation in the room, change of underwear and bed linen.

Prevention consists in frequent and regular hygienic treatment of the skin of the human body, in the selection of warm, light, well-breathable clothing that does not cause sweating.

Vascular problems

When lying down, part of the vessels, especially in the lower extremities, is subjected to partial or complete compression. The absence of active movements and muscle contractions, as a result of which blood is squeezed out of the venous bed, reduces the rate of blood flow. Paralysis and paresis also contribute to a decrease in blood flow. This can lead to the formation of a blood clot in the vessel.

A thrombus is a blood clot that partially or completely clogs the lumen of a vessel. Usually, blood clots form in the deep vein system of the lower extremities, this can be manifested by pain, swelling, and most importantly, the blood clot can break off and reach the lungs with blood flow and clog the lumen of the pulmonary arteries. Often this ends for patients with death or severe disability.

Thrombosis prevention consists in creating an elevated position for the lower extremities and bandaging the legs with elastic bandages. It is necessary in cases where there are no contraindications, to apply gymnastics for the legs. Exercises are especially effective when the patient, lying on his back with his legs up, makes circular movements in the manner of riding a bicycle.

With prolonged lying, the vascular tone weakens significantly. This leads to the fact that when the patient's position changes, for example, from lying down to semi-sitting or sitting, his blood pressure may drop sharply. And when the patient tries to stand up, fainting may occur. The so-called orthostatic collapse develops.

Respiratory problems

In the horizontal position, the volume of the lungs during inhalation of air decreases, compared with the vertical position. The lack of active movements and a decrease in the volume of pulmonary ventilation leads to a decrease in blood flow and congestion in the lung tissue. The sputum becomes viscous and is difficult to cough up. It accumulates in the airways and increases congestion in the lungs. All this leads to the development of an infectious-inflammatory process in the pulmonary system.

Prevention consists in active movements of the patient in bed and breathing exercises (See Components of care/exercises).

Problems associated with the organs of the gastrointestinal tract

The lack of active movements when lying down leads to a decrease in the tone of the gastrointestinal tract, especially the colon, which in turn leads to constipation or difficult defecation. Bedridden patients are forced to defecate in an unusual and difficult position, often in the presence of strangers. This helps suppress the urge to defecate. Some patients arbitrarily delay bowel movements, as they are embarrassed to seek help from strangers. Constipation and lethargy of the gastrointestinal tract can lead to indigestion, which is usually expressed initially in furred tongue, halitosis, lack of appetite, mild nausea. Fecal intoxication develops. Often constipation is replaced by diarrhea. After a few months of lying down, the gastrointestinal tract becomes very susceptible to changes in diet and to infection, i.e., such people develop digestive disorders faster than an active person.

Prevention complications consists in creating comfortable conditions for physiological functions, in gymnastics of the anterior abdominal wall of the abdomen, in observing an appropriate diet (See Problems / Constipation).

Problems related to muscle activity

It has been experimentally established that the absence of movements, as a result of which the muscles contract and relax, leads to a loss of muscle mass (muscle atrophy), and this loss can be up to 3% of the total muscle mass per day with complete immobility. This means that in a little more than a month of constant immobile lying, the patient will experience complete muscle atrophy, and even if it becomes possible to move, he will not be able to do this without outside help.

Prevention consists in the regular performance of a complex of gymnastics, physical exercises.

Joint problems

contractures

Contractures - restriction of active and passive movements in the joints as a result of a long immobile state of the limb. Such restriction of movements leads to severe functional disorders, expressed in the fact that the patient cannot move (if his knee or hip joints are affected), serve himself and work (if his wrist and elbow joints are affected). The loss of muscle activity entails a limitation of joint mobility, which is called contracture. So, the foot of a bedridden patient rather quickly falls forward (the position of a lying person, as it were, on tiptoe) under the weight of a blanket, and a contracture of the ankle joint occurs, which is called the horse foot. To prevent this complication, you can use a stand under the blanket that does not allow the blanket to put pressure on the patient's foot. The patient's hand clenched into a fist eventually takes the form of a bird's paw, the knee joint does not bend and straighten well, etc.

Prevention of contractures. Contracture is easier to prevent than to cure. To prevent the development of contractures, it is necessary:

as early as possible, start doing gymnastics in the form of active and passive exercises, affecting, if possible, all joints, especially those that are in a sedentary state. In this case, rough violent passive movements that cause pain and reflex muscle spasm should be avoided. (See Components of care/gymnastics);
ensure the correct position of the limb (in the position corresponding to the average physiological) in case of muscle paralysis or in case of immobilization of the limb with a plaster bandage;
carry out activities aimed at reducing pain in the joints and adjacent parts of the limb.

To prevent contact of the joints of the hand, you can use a special cone sheathed with a soft cloth, preferably sheep's wool.

ankylosis

If patients lie motionless for a very long time and prevention of contractures is not carried out, then a complete loss of joint mobility as a result of bone fusion of the articular ends of the bones is not excluded. This complete loss of the ability to move the joint is called ankylosis.

Joint pain

Joint stiffness causes pain when trying to use the joint. The patient begins to additionally spare the diseased joint and thereby enhances its immobility. It is necessary to combine physical exercises with taking painkillers.

Bone Problems

In the absence of movements and physical exertion, strong bones become, as it were, unnecessary to the body. The calcium content in the bones decreases, the bones gradually become brittle. Osteoporosis develops. It is known that tubular bones contain red bone marrow, in which blood cells are formed, in particular platelets, which are responsible for blood clotting. With a decrease in physical activity, the production of platelets and other blood cells decreases. On the one hand, this is good, because the blood flow slows down when lying down and the risk of blood clots increases, as we talked about above, and the "thinning" of the blood reduces this risk. But another problem arises. Due to the fact that the blood contains few platelets, the patient may experience spontaneous bleeding, for example, from the nose, gums and other mucous membranes. These bleedings are minor but prolonged, further debilitating the patient.

Problems associated with the urinary organs

Prolonged horizontal position can lead to changes in the urinary system. In a horizontal position, urine lingers longer in the pelvis, which contributes to the occurrence of an infectious process, and then the formation of kidney stones. Prolonged "under the blanket" heat makes a person vulnerable to cool air, this can affect any organs and systems, including the kidneys. And inflammation can contribute to the formation of salts, and then - sand and stones. Using a boat and/or a duck, seeking help with physiological functions, and being in an uncomfortable position all create discomfort, irritability, depression, and such conditions only hasten the onset of problems.

The most formidable problem, of course, is the formation of kidney stones, and this is not the only problem. Over time, the patient may develop urinary incontinence, which in turn leads to skin problems, as well as the appearance or worsening of depression, because. unexpected urination in bed, for a conscious person, a big trouble, stress that is hard to experience. It must also be remembered that it is harder to hold urine in a horizontal position than in a vertical position.

Urinary incontinence, which we are now talking about, as a rule, is not functional, but is associated only with physical and psychological inconveniences, as well as with sluggishness or lack of attendants. There is such a thing as "psychology of expectation". You can often hear that if a person falls ill, and even an elderly one, then expect urinary incontinence. Such a psychology is not justified in any way, and its sad consequences are such that caregivers lose precious time waiting for incontinence, instead of actively carrying out prevention.

Problems related to the nervous system and psyche

One of the rapidly emerging problems is insomnia at night. The idea of resorting to sleeping pills comes very quickly and is often realized by the patient even without consulting a doctor. The use of sleeping pills generally does not result in good, deep sleep. A person, although sleeping, does not rest, becomes "sluggish", tired, which, in turn, leads to irritability and further to depression. Manifestations of diseases of the nervous system are aggravated if the patient is forced to spend some time in a supine position. For example, Parkinson's disease. One of the manifestations of this disease is stiffness in movements. So, if the patient breaks his leg and stays in bed for a month for this reason, then the stiffness will be even greater. The time for rehabilitation after a long stay in bed in patients with diseases of the nervous system increases by 4-5 times. Let's go back to the fracture case. Usually a patient with a relatively healthy nervous system spends the same amount of time in a cast and is rehabilitated. For example, 1 month in a cast means it will take approximately 1 month for him to walk again without crutches or canes. A patient with a disease of the nervous system will need 4-5 months. Short but frequent bed rest for patients with nervous system disease can lead to early bed rest.

Long-term patients often suffer from social "wildness", i.e. loss of social behavior skills, especially for the elderly and people with manifestations of mental retardation, which always tends to progress against the background of immobility.

Older people who have been on prolonged bed rest fall more often. Their falls often lead to fractures.

Prevention insomnia consists in fulfilling the requirements for the normalization of sleep (See Sleep Problems/Disturbance). It is necessary to organize the patient's leisure time, create conditions for active mental work (See Components of Care/Leisure). It is necessary to encourage any independent activity of the patient. Try to make it as active as possible. Elderly and debilitated patients during the recovery period of independent walking should use devices for additional support: handrails, walkers, canes, etc.

Hearing problems

Communication with a bedridden patient always takes place "at different levels": the patient lies, and the one who communicates with him either sits or stands. This position strains the ear. The bedridden patient, of course, is also interested in what is happening around, and since he cannot see everything, he often listens, which means he strains his hearing. These two causes lead to tension and even overstrain of hearing, and in the future - to hearing loss. We must not forget that if your patient has a hearing aid, then it is necessary to put it on before communication, as well as check the health of the batteries and cleanliness, because. discharge from the ear may reduce its effectiveness.

Patient Dignity

Concepts of the dignity of the patient are very different in different societies and depend on very many factors.

However, in most societies it is customary to be clean, dressed in clean, covering the nakedness of the body, not torn clothes, combed, with neat nails, etc. And also, according to moral standards, it is customary not to expose the body and not to touch it, not to talk about the personal characteristics of the patient and what is happening in his house, if this does not concern patient care.

Often, when such simple rules of treatment are violated, caregivers contribute to the humiliation of human dignity. The weaker and more vulnerable the person, the faster this happens.

Man is the greatest value that no one has the right to destroy. On the conscience of the one who serves the sick, lies a great responsibility for his soul and body. Therefore, try to acquire the skills not only of good care, but also of proper, professional communication. Professional communication is communication according to the profession or, in other words, the chosen ministry. You can talk a lot about the features of communication with the patient and caring for him, but there is a golden rule that is easy to remember: as you want people to do to you, so do you to them!

Each disease is accompanied by a set of different symptoms that affect the general condition of the patient in different ways. Bed rest is prescribed mainly in cases where the disease is severe, there are risks of serious consequences. To avoid or minimize them, the patient is recommended bed rest, because during the movement of forces more is spent, and these forces are important for fighting the disease.

What diseases require bed rest?

It is most important when a person experiences general weakness, dizziness, has a high body temperature, loses concentration in space.

It can be:

high blood pressure, especially during a crisis;
vascular crisis;
flu or cold with complications;
traumatic brain injury;
the threat of miscarriage, the risk of placental abruption, symphysiopathy in pregnant women;
heart attack;
a sharp increase or decrease in blood sugar;

This is not a complete list of diseases and conditions in which bed rest is indicated. If necessary, it is prescribed by the attending physician. Such an appointment is advisable depending on the state of human health. For example, after an operation and anesthesia, a person may feel dizzy for a long time and a person may add bruises to himself by getting out of bed early. And after an attack of ischemia of the heart, the lying position will provide the patient with a better supply of oxygen to the cells than when moving. During movement, the need for cells in oxygen increases significantly.

Forms of bed rest

Strict bed rest. With strict bed rest, the patient is strictly forbidden to get out of bed at all. The care of the needs of such a person falls entirely on the medical staff if he is in the hospital, or on his relatives if the patient is at home. This is feeding, all hygiene procedures, timely delivery of the vessel, change of linen, etc.
Bed rest. The patient is allowed to get up to use the toilet and to wash, but the rest of the time must be spent in bed, including eating.
Half bed mode. The patient can serve himself, walk quietly into the dining room, periodically sit on a chair or in bed. However, he is shown to spend the rest of the time in bed.

The purpose of the form of bed rest depends on the severity of the patient's condition, the type of disease, complications and other factors.

Bed rest results

The results vary and are due to the factors due to which such a regimen was prescribed. For example, at a high temperature during the flu, a large amount of energy and strength is expended to overcome the disease. When a person lies, these forces go to fight viruses, a person recovers faster.

With the threat of miscarriage, bed rest is also important for pregnant women, and such patients are placed in a hospital under full supervision. The cause of a threatened miscarriage may be uterine hypertonicity or isthmic-cervical insufficiency, and mechanical impact on the uterus can accelerate fetal loss. The prescribed procedures and bed rest make it possible for a woman to still be able to bear a child. Once the threat has passed, she will be allowed to get up and lead the lifestyle prescribed by the gynecologist.

If the pressure has risen sharply, there is a vascular crisis, bed rest is extremely important. During such a condition, severe dizziness and loss of consciousness are not excluded, which will lead to serious complications and even injuries. A calm, relaxed state in bed and a long sleep will help to quickly relieve the crisis and normalize blood pressure.

Possible problems after prolonged bed rest

If strict bed rest is necessary, when a person is forced to lie in the same position, not moving, not being able to turn himself around and even more so to stand up, some problems often appear. First of all, these are bedsores, which look on the skin in the form of ulcers and severe irritations of a reddish color.

It is the duty of the service personnel to prevent such complications. To do this, it is necessary to turn the patient on the other side in a timely manner, if possible, wipe well or wash the patient's body with a clean napkin to wash off sweat. After hygiene procedures, it is necessary to apply special products to the skin that promote the healing of bedsores and prevent the occurrence of new ones. The most vulnerable places for bedsores are the shoulder blades, sacrum, leg muscles, buttocks.

These procedures are required to be carried out by ward nurses. It is also their responsibility to change bed linen in a timely manner, which may contain crumbs after eating. The crumbs can also irritate the skin, causing sores and bedsores. This is especially true for delicate children's skin and the skin of women.

Also, during prolonged forced lying down, muscle atrophy, congestion in the lungs, blood clots in the vessels, and kidney stones can develop. In order to avoid these negative phenomena, special therapeutic massages are performed, physiotherapy exercises for that part of the body that can be moved.

For example, after a serious fracture of one leg, a patient can and should gradually perform therapeutic exercises on the other, healthy leg, as well as arms and neck. A physical rehabilitation specialist or exercise therapy instructor helps to perform such exercises. Thanks to exercise therapy, blood circulation in tissues and blood vessels improves, blood flow increases and the transfer of useful substances, oxygen to the cells of the body; the stool is normalized (especially for constipation), hypodynamia decreases. Stagnation is eliminated, muscle tone improves, the general condition of the patient, his mood. Respiratory gymnastics, which can be performed even by the most immobile patients, has also justified itself well.

The attending physician prescribes all additional procedures and therapeutic exercises.

Rehabilitation after bed rest

Sometimes recovery from prolonged lying is long and difficult. Immediately after getting out of bed, you may feel dizzy and nauseous, your legs may not obey. Therefore, you need to know some simple rules:

Before you try to get out of bed, you need to stretch quietly in bed: arms up, toes down. Sipping should be done at least three times.
Carefully sit on the bed and try to bring your breathing back to normal. Sit quietly for 3 minutes and try to do a little exercise: raise both hands up, then put them behind your back. Run 3 times.
It is important to get out of bed slowly, not abruptly, preferably with the help of someone.
Take the first steps around the room while holding onto someone or surrounding objects.

Such rules are important so that after a long lying down, breathing and heart rate return to normal. At first, palpitations and weakness may be felt, but as movements increase, the blood supply will improve, and the general condition of the person will return to normal.

In the early days, you should not immediately overload yourself with walking and other household chores. Everything should be gradual. After a week, it will be possible to do short walks in the fresh air, which start from 15 minutes, increase as the general condition of the person, by about 10 minutes a day.

Important for a speedy recovery and proper nutrition. If there are no special medical instructions, it is important to consume as many fresh juices, vegetables, dairy products, legumes, cereals as possible.

The most effective for health will be that which brings moral and spiritual pleasure to a person. Alcohol and smoking are prohibited.

Galina Vladimirovna

Diseases come unexpectedly and significantly complicate human life. But they can be treated not only with the help of medicines. Often, in order for therapy to contribute to the full recovery of the body, bed rest is necessary.

General understanding of the restriction of motor activity

Each disease is individual and affects the body differently. But there is a generally accepted set of measures and rules that should be followed for various ailments. In particular, this is the need for bed rest. Depending on the diagnosis, the type of motor limitation may differ. The decision on its obligation and duration is made by the doctor. The specialist does this on the basis of medical prescriptions applicable to this ailment. It must be realized that such a measure is as important as taking medications, and ignoring it can lead to a deterioration in the condition and unpredictable consequences. Therefore, bed rest is mandatory for patients to whom it is prescribed.

The feasibility of this measure

Like everything in medicine, this restriction has a clearly defined meaning and expediency. First of all, the following goals are pursued:

To a certain extent, limit the activity of the patient's movements (in some cases, practically immobilize him) in order to reduce the need for cells in oxygen, which will reduce the effects of hypoxia and allow adequate adaptation to the conditions that have arisen.
The horizontal position and the state of rest will inevitably reduce pain, for example after surgery. And this, in turn, will lead to a decrease in the dosage of painkillers.
Provide the body with a good rest and restore the strength of a person exhausted by the disease.

It is worth noting that the physiology of bed rest can only be discussed when the patient is able to move at least a little. Otherwise, over time, complete immobilization will lead to a number of problems, and the task of the medical staff is to carry out a set of measures to avoid possible complications.

Types of bed rest

What is a mode? It is the fulfillment of rules or well-defined conditions. There are different types of it: the daily routine and others. This article discusses the hospital regime, due to which the patient recovers.

Types of restriction of motor activity include the following items:

Strict bed rest. This type involves almost complete immobilization and is the most difficult in terms of physiology and psyche. The patient is categorically not allowed to rise, sit down, and sometimes a person is prescribed complete immobilization.
Regular bed. Limited physical activity within the bed is allowed. Further, when the patient begins to recover, he is allowed to sit down and even do gymnastic exercises under the supervision of a specialist.
Ward. This type of regimen is called semi-bed. The patient usually goes to the toilet and dining room, partially serves himself, but his main life activity is limited to the hospital ward.
General. Unlimited movement and walks are allowed. The patient is completely self-serving.

Strict bed rest: duties of medical staff

With the appointment of this type of regimen, all work on servicing the patient falls on the shoulders of medical personnel. This category of employees is responsible not only for ensuring the physiological needs of a seriously ill patient, but also for supporting his morale. Therefore, sensitivity and mutual understanding between a health worker and a sick person is very important. The most time-consuming in terms of care is the strict restriction of activity. In such cases, the duties of the nurse include:

Feeding. Food should be warm, attractive to look at and served at the same time.
Vessel supply (diaper change). This is a special moment. In life, there are intimate situations in which a person tends to retire. Considering that the patient cannot fulfill a physiological need on his own, but is forced to ask strangers for help, this often brings moral suffering to the patient. This must be understood by a health worker and provide a person with at least a screen separating him from others.
hygiene measures. With strict bed rest, they are especially important. It is necessary to provide the patient with diapers and wet wipes to save him from feelings of inferiority. But the treatment of the inguinal folds and genital organs after each act of defecation or urination is mandatory.
Change of bed linen.
Transferring to a wheelchair.
Necessary medical procedures: setting a gas outlet tube, enemas, etc.

The fight against bedsores

In addition, if there is prolonged bed rest, the health worker should monitor the possible formation of bedsores and avoid it in a timely manner. In order to prevent the appearance of irritations and ulcers on the skin, it should be regularly treated in vulnerable places (shoulder blades, sacrum) and periodically turn the patient over. You also need to ensure that the linen is cotton and without hard seams, and that there are no crumbs left after dinner in the bed. For a helpless person, these are not trifles at all.

As for other movement restrictions, partial assistance from a nurse may be needed during bed rest. It can be expressed in the participation of the ward nurse in hygiene measures and feeding the patient. In addition, the health worker must ensure peace and quiet on the territory of the department.

At what diseases the motive mode is limited?

Bed rest of varying degrees can be prescribed for many diseases. First of all, of course, these are injuries, postoperative conditions, concussions and other craniocerebral disorders, infectious diseases, difficult pregnancy, all ailments that are treated in intensive care units and intensive care units. In general, as already mentioned, the bed rest of the patient is important for the recovery process to the same extent as drug therapy.

Resuscitation: features of bed rest

As for the intensive care unit, only strict bed rest is applied here. This is obvious, since there are people in the wards and emergency rooms who are practically born twice. Many of them have experienced clinical death, others are in. Considering that patients are completely immobilized, the care of medical staff is especially relevant here. The specificity of such departments is that patients in them are without underwear and in general wards that are not separated by gender. As for the first, it is necessary for full access to the body in case of situations when a person needs to carry out life-saving measures. In addition, medical staff should have a round-the-clock opportunity to treat skin and wounds in order to avoid complications.

Complete peace

Complete immobilization is of particular importance here, since droppers, catheters, pacemakers and other equipment are constantly connected to patients who are in an extremely serious condition. Naturally, its disconnection due to careless movement of the patient can cause bleeding, disruption of tissue integrity, respiratory arrest and lead to death.

Bed rest for concussion

Consider several common conditions in which bed rest is vital. These diseases include craniocerebral injuries, in particular concussion of the brain. It can be of different degrees of severity, but in any case, a certain regimen is necessary (strict bed or half-bed - the doctor decides).

In severe cases, of course, hospitalization is mandatory. But if the condition allows you to stay at home, then you should remember that with such diseases you need to stay mainly in a horizontal position for about a week. In some cases, it is allowed to get out of bed to mend and eat. It is important not to forget that the patient needs complete rest: watching TV, working at a computer, reading books and the like is strictly prohibited, since this can lead to a significant deterioration in the condition.

Bed rest during pregnancy

There is another period in a person's life where bed rest may be needed - this is a difficult pregnancy. The doctor decides on hospitalization in case of a threat of miscarriage or the possibility of violations in the development of the unborn child. What kind of bed rest will be needed in each case, the gynecologist decides. But there are conditions in which a pregnant woman will have to spend almost the entire period in a horizontal position without the right to get up and sit down. This happens with the threat of placental abruption, uterine hypertonicity or cervical insufficiency. But basically, pregnant women are prescribed a ward regimen with a gradual transition to a general and sparing one (already at home).

It is worth noting that with, for example, extended bed rest, the expectant mother is allowed to sit for no more than a few minutes a day. If a ward regimen (bed) is assigned, then the woman should be in bed for half a day, and the rest of the time she should be in a semi-sitting position, sometimes slowly moving up to 200 meters. In the general mode, you can walk at a leisurely pace (up to 1 km) and use the stairs.

How to keep a sick child in bed?

All parents are familiar with the situation when a child has a high temperature, and he tries to run around the apartment. Many are perplexed, not understanding how to explain to a child that an infectious disease requires a regimen (especially bed). But, since compliance with this condition in the acute period is necessary, parents have to go to various tricks to calm the child. First of all, the mother should understand what the non-compliance with the regime is fraught with. This can lead to complications in the work of the heart, urinary system, serious vascular disorders. Therefore, bed rest in children is prescribed with an increase in body temperature, of course, only during an exacerbation of the disease. Such a measure will save the child's energy to fight the disease, help avoid complications and speed up recovery.

There are diseases in which bed rest is indispensable, for example, injuries, when strict fixation of the damaged area is necessary. In such cases, so that the forced stay without movement does not lead to whims, and in older children to depressive states, it is necessary to help the child successfully survive this period. Provide your child with toys, board games, interesting books, you can allow a short TV viewing. It will not be out of place to invite relatives or friends whom the child will be glad to see infrequently. Be sure to help the patient change position to avoid muscle numbness and numbness of the limbs. If prolonged bed rest is provided, then it is recommended to purchase special devices used to avoid bedsores. In the case of infectious diseases, you can sometimes take a sitting position, and after an acute period, begin to gradually activate the motor mode.

Gymnastics in bed

It is important to remember that exercise is recommended even when strict bed rest is prescribed. They involve passive movements of the limbs and active ones in the area of small joints. Breathing exercises and massage worked well.

For other types of movement restrictions, the following exercises are recommended:

At the initial stages of bed rest, it is important to adapt the patient to later life, so it is necessary to pay attention to the resumption of self-care skills. First of all, this is feeding, which the medical staff gradually begins to produce, subject to the patient's sitting position. These measures are designed to return the patient to a full life. In addition, daily exercises are gradually connected: active movements of the limbs at an average pace lasting no more than 15 minutes.
When appointing a ward regime, slow walking is allowed for a distance of about two hundred meters, sparing exercises at an average pace in the supine and sitting positions.
In the case of the general regimen, exercises performed at medium intensity for half an hour are necessary. They are held mainly while standing, gradually becoming more difficult, and throwing a light ball is also allowed. Often groups of such patients are engaged with a specialist in the exercise therapy room.

Complications with prolonged bed rest

Prolonged bed rest after various serious illnesses is not uncommon. But we must understand that forced long-term immobilization has extremely negative consequences for the human body. Physical inactivity causes metabolic deterioration, vascular changes, congestion in the respiratory system, skin disorders, dysfunction of the urinary system (sometimes infection) and psychological problems. In addition, it has been proven that a person without movement loses up to 3% of muscle mass every day, which can lead to complete muscle atrophy and weight loss. That is why, after a long coma, people learn to walk again. A bedridden patient, who is conscious, should at least manipulate the comb and brush his teeth on his own - this will help to avoid severe

It must be remembered that any restriction implies feasible activity. If it is followed, the recovery of a person will be significantly accelerated.