Njira Zothandizira Anamwino kwa Odwala Odwala Matenda a Mitsempha
Matenda a mitsempha amaphatikizapo matenda osiyanasiyana omwe amakhudza mitsempha yapakati ndi ya m'mphepete mwa thupi, kuphatikizapo sitiroko, kuvulala mutu, khunyu, meningitis, zotupa muubongo, matenda a Parkinson, multiple sclerosis, peripheral neuropathy, ndi matenda a mitsempha. Zotsatira za matendawa nthawi zambiri zimakhala zovuta, chifukwa zimatha kusintha chikumbumtima, kuyenda, kulankhula, kumeza, kumva, khalidwe, ndi ntchito zodziyimira pawokha monga kupuma ndi kuthamanga kwa magazi. Chifukwa chake, chisamaliro cha odwala a mitsempha chiyenera kukhala chokhazikika, kuyang'ana kwambiri chitetezo cha odwala, kuyang'anira bwino kusintha kwa momwe mitsempha imagwirira ntchito, kupewa zovuta, komanso kuthandizira kukonzanso thanzi komanso maphunziro a mabanja.
1. Kuwunika Kwathunthu kwa Unamwino wa Mitsempha
Gawo loyamba ndikuchita kafukufuku wathunthu pogwiritsa ntchito njira ya ABCDE (Airway, Breathing, Circulation, Disability, Exposure), makamaka kwa odwala omwe ali ndi vuto la mtima. Zizindikiro zofunika zikakhazikika, namwino amapitiliza ndi kafukufuku wa mitsempha.
Zinthu zofunika kwambiri pakuwunikaku ndi izi:
– Mlingo wa chidziwitso: Kuwunikidwa pogwiritsa ntchito Glasgow Coma Scale (GCS) kapena sikelo ina malinga ndi malo ochitira opaleshoni. Kusintha pang'ono kwa GCS kungakhale chizindikiro cha kuwonongeka.
– Zizindikiro zofunika kwambiri ndi momwe magazi amayendera: kuthamanga kwa magazi, kugunda kwa mtima, kupuma, kutentha, kuchuluka kwa mpweya m'thupi. Kusakhazikika bwino kungasonyeze kuwonjezeka kwa kuthamanga kwa magazi m'mutu, matenda, kapena kusagwira bwino ntchito kwa thupi.
– Kuyang'ana maso a ana: kukula, kufanana, ndi kuwala kowala. Maso a ana otambasuka komanso osachitapo kanthu ayenera kuonedwa ngati chizindikiro cha kutsekeka kwa mafupa kapena kupanikizika kwa magazi m'mutu.
- Ntchito ya minofu ndi minyewa: mphamvu ya minofu, kamvekedwe, kugwirizana, kukhalapo kwa kufooka kwa mbali imodzi, kunjenjemera, spasticity, paresthesia, kapena kuchepa kwa kumverera.
- Ntchito za chilankhulo ndi chidziwitso: kuwongolera, luso lolankhula, kumvetsetsa malamulo, aphasia, dysarthria, kusintha kwa khalidwe.
- Ululu ndi mutu: khalidwe, mphamvu, zinthu zomwe zimayambitsa, limodzi ndi nseru, kusanza kapena phobia yochokera ku projectile.
– Mbiri ya matenda: kuyamba kwa zizindikiro, zinthu zomwe zingawopseze (kuthamanga kwa magazi, matenda a shuga, kusuta fodya), mbiri ya khunyu, kugwiritsa ntchito mankhwala oletsa magazi kuundana, mbiri ya kuvulala, ndi ziwengo.
Kuwunika kumachitika nthawi ndi nthawi ndipo nthawi zambiri kumatsimikiziridwa ndi momwe wodwalayo alili (monga mphindi 15-60 zilizonse mu gawo loopsa).
2. Kusamalira Mpweya ndi Kupuma
Mu matenda amitsempha, chiopsezo cha kutulutsa mpweya m'thupi ndi kulephera kupuma bwino chimawonjezeka, makamaka kwa odwala omwe ali ndi vuto la kusazindikira kapena kumeza. Njira zofunika zoyamwitsira ndi izi:
- Yesani momwe mpweya umayendera, kupezeka kwa madzi otuluka m'thupi, phokoso la mpweya, ndi momwe mpweya umapumira.
- Ikani wodwalayo mutu wa bedi pamalo otentha madigiri 30 (pokhapokha ngati palibe chifukwa chochitira zimenezi) kuti athandize kupuma bwino komanso kuchepetsa chiopsezo cha kuthamanga kwa magazi m'mutu.
- Chitani kuyamwa ngati pakufunika pogwiritsa ntchito njira yosapha tizilombo toyambitsa matenda komanso nthawi yochepa kuti mupewe hypoxia.
- Yang'anirani kuchuluka kwa mpweya m'thupi ndikupereka chithandizo cha mpweya motsatira malangizo a dokotala.
- Dziwani zizindikiro za kupuma movutikira: kukhosomola mukudya, phokoso lofuula, kupuma movutikira, kapena kuchepa kwa madzi m'thupi.
Ngati wodwalayo ali ndi vuto la dysphagia, chithandizo cha zakudya chiyenera kutengera kuyesedwa kwa kumeza. Kudyetsa kungachitike kudzera mu chubu cha nasogastric (NGT) kapena njira zina, ngati n'koyenera.
3. Kuyang'anira Momwe Mitsempha Ilili ndi Kupewa Kupanikizika Kwambiri M'mutu
Anamwino amachita gawo lofunika kwambiri pozindikira msanga kuwonongeka kwa mitsempha. Zochita zazikulu ndi izi:
- Yang'anirani GCS, maso, mphamvu ya thupi, ndi zizindikiro za moyo nthawi zonse.
- Pewani zinthu zomwe zimawonjezera kuthamanga kwa magazi m'mutu: hypercapnia, hypoxia, malungo, kupweteka kwambiri, komanso kukwiya kwambiri.
- Khalani mutu wopanda mbali, pewani kupindika khosi kapena kuzungulira komwe kumalepheretsa kuyenda kwa mitsempha.
– Chepetsani njira ya Valsalva: langizani njira zoyenera zokokera, pewani kudzimbidwa pogwiritsa ntchito njira zochotsera (zamadzimadzi zokwanira, ulusi, mankhwala otsekula m'mimba malinga ndi pulogalamuyo).
– Lamulirani kutentha kwa thupi, chifukwa malungo amawonjezera kufunikira kwa mpweya mu ubongo.
– Yang'anirani ngati zizindikiro za ICP zikuwonjezeka: mutu ukupitirira, kusanza, kusazindikira bwino, kusintha kwa ana aang'ono, bradycardia ndi kuthamanga kwa magazi (Cushing's triad).
Ngati chipatalacho chikugwiritsa ntchito zida zowunikira ICP, anamwino amawunika kuchuluka kwa madzi m'thupi, kuonetsetsa kuti makinawo sakutuluka madzi, komanso amasungabe kuti madziwo asatuluke.
4. Kusamalira Kugwidwa ndi Khunyu ndi Chitetezo cha Odwala
Odwala matenda a mitsempha, makamaka omwe ali ndi khunyu kapena kuvulala kwa ubongo, ali pachiwopsezo cha khunyu. Njira zochiritsira zimaphatikizapo:
– Konzani malo otetezeka: zitsulo zomangira bedi zimakwezedwa ndi kutetezedwa ngati zilipo, zinthu zakuthwa zimachotsedwa.
- Perekani mpweya ndi kuyamwa pafupi ndi wodwalayo.
– Ngati khunyu lachitika: musaletse mayendedwe a wodwalayo, musaike zinthu pakamwa, ikani wodwalayo chammbali kuti mpweya ugwire bwino, lembani nthawi ndi mtundu wa khunyu.
– Pambuyo pa khunyu: fufuzani kupuma, kuchuluka kwa chidziwitso, kuvulala, ndikuchita zizindikiro zofunika komanso kuyezetsa mitsempha.
- Kugwirizana pakupereka mankhwala oletsa kupweteka kwa mutu monga momwe adalangizidwira komanso kuyang'anira zotsatirapo zake monga kupumitsa kwambiri kapena kuvutika maganizo popuma.
5. Kupewa Mavuto Okhudza Kusayenda Bwino
Kufooka kwa minofu, hemiparesis, kapena ziwalo zopuwala zimawonjezera chiopsezo cha zilonda zamagazi, thrombosis ya mitsempha yakuya, ndi kukokana kwa minofu. Njira zoyamwitsa zimaphatikizapo:
- Sinthani malo osachepera maola awiri aliwonse, gwiritsani ntchito matiresi oletsa kutsekeka ngati pakufunika kutero.
- Kufufuza ngati khungu lili bwino, makamaka m'malo omwe mafupa ali ofooka.
- Maseŵero olimbitsa thupi oyenda pang'onopang'ono komanso molimbika monga momwe amaloledwera.
- Kugwiritsa ntchito masokisi opondereza kapena zipangizo zopewera thrombosis malinga ndi pulogalamuyo.
- Kuyamba msanga ndi katswiri wa zamaganizo ngati zinthu zilola.
Anamwino ayeneranso kuyang'anira zizindikiro za DVT monga kutupa mbali imodzi, kupweteka kwa mwana wa ng'ombe, kapena kufiira, ndi kuzinena nthawi yomweyo.
6. Kusamalira Zakudya, Kumeza, ndi Kuchotsa Matenda
Matenda a mitsempha nthawi zambiri amasokoneza zakudya chifukwa cha dysphagia, nseru, kapena kuchepa kwa chidziwitso.
- Yesani kudya zakudya zomwe mumadya, kulemera kwa thupi lanu, komanso zomwe mumadya tsiku ndi tsiku.
- Yesani kuyezetsa matenda a dysphagia; ngati mukukayikira, siyani kumwa mpaka mutayang'anitsitsanso.
- Perekani chakudya chili choyimirira, pang'ono, ndi mawonekedwe ake motsatira malangizo.
- Sungani ukhondo wa pakamwa kuti mupewe matenda komanso kuti mukhale omasuka.
- Yang'anirani kuchotsa mkodzo: kusunga mkodzo, kusadziletsa, kudzimbidwa. Njira zothandizira zimaphatikizapo nthawi yopita kuchimbudzi, kuyika catheter ngati pakufunika, komanso kuyang'anira madzi.
Kudzimbidwa kuyenera kuchiritsidwa chifukwa kungayambitse kupanikizika kwa magazi m'mutu chifukwa cha kupsinjika.
7. Thandizo la Kulankhulana ndi Thanzi la Maganizo
Odwala omwe ali ndi aphasia, dysarthria, kapena vuto la kuzindikira amafunika njira yapadera yolankhulirana:
- Gwiritsani ntchito ziganizo zazifupi komanso zomveka bwino, perekani nthawi yoti muyankhe.
- Gwiritsani ntchito zithunzi, zolemba, kapena zizindikiro zosalankhula.
– Limbikitsani banja kuti limvetse momwe wodwalayo amalankhulirana.
- Perekani chithandizo chamaganizo chifukwa odwala ali pachiwopsezo cha nkhawa, kuvutika maganizo, kapena kukhumudwa chifukwa cha zofooka za ntchito.
Anamwino ayeneranso kuwunika chiopsezo cha misala, makamaka kwa odwala okalamba, ndikupanga malo abata komanso ogwirizana ndi zenizeni (wotchi, kalendala, kuunikira kokwanira).
8. Kugwirizana ndi Kukonzanso Maphunziro Osiyanasiyana
Chisamaliro chogwira mtima kwa odwala amitsempha chimaperekedwa ndi gulu: madokotala, anamwino, akatswiri a za thupi, akatswiri a zantchito, akatswiri olankhula, akatswiri azakudya, ndi ogwira ntchito zachitukuko. Anamwino amagwira ntchito ngati othandizira, kuonetsetsa kuti dongosolo la chithandizo likutsatiridwa ndipo zosowa za wodwalayo zikukwaniritsidwa.
Kuchira msanga kumathandiza kuti munthu ayambenso kuchita masewera olimbitsa thupi. Anamwino amalimbikitsa kuchita masewera olimbitsa thupi mosamala, kuphunzitsa mabanja chisamaliro chapadera, komanso kuyang'anira momwe wodwalayo angapiririre kuchita masewera olimbitsa thupi.
9. Maphunziro a Odwala ndi Banja ndi Kukonzekera Kutuluka M'chipatala
Maphunziro ndi ofunikira kwambiri kuti apewe kubwereranso m'mimba kapena mavuto ena akatuluka m'thupi. Zipangizo zophunzitsira zikuphatikizapo:
- Kutsatira malangizo a kumwa mankhwala (mankhwala oletsa kutsekeka kwa mtima, mankhwala ochepetsa kuthamanga kwa magazi, mankhwala oletsa kutsekeka kwa magazi) ndi ndondomeko zowongolera.
– Zizindikiro zoopsa zomwe zimafuna thandizo lachipatala mwamsanga: kusazindikira bwino, kufooka mwadzidzidzi, kugwidwa ndi khunyu mobwerezabwereza, mutu waukulu, kapena kupuma movutikira.
- Kusintha kwa moyo: kudya zakudya zopatsa thanzi, kusiya kusuta fodya, kuwongolera kuthamanga kwa magazi ndi shuga, kuchita masewera olimbitsa thupi malinga ndi luso lanu.
- Chisamaliro cha kunyumba: kupewa kugwa, masewera olimbitsa thupi a ROM, njira zosamutsira, ndi chisamaliro cha khungu.
- Thandizo la anthu ndi zinthu zothandizira anthu ammudzi ngati zilipo.
Kukonzekera kutuluka m'chipatala kuyenera kuyamba pachiyambi cha chithandizo, kuphatikizapo kuwunika kufunikira kwa zipangizo zothandizira (ma wheelchairs, zoyendera), kusintha kwa nyumba, ndi osamalira odwala.
Mapeto
Njira zochiritsira odwala omwe ali ndi matenda amitsempha zimafuna kulondola, kuwunika mobwerezabwereza, komanso kuchitapo kanthu mwachangu kuti apewe kuwonongeka kwina. Chisamaliro choyamba chikuphatikizapo kukhazikitsa ABCs, kuyang'anira momwe mitsempha ilili, kupewa kupanikizika kwambiri m'mutu, kuthana ndi khunyu, kupewa mavuto obwera chifukwa cha kulephera kuyenda, kukwaniritsa zosowa za zakudya ndi kuchotsa matenda, kuthandizira kulankhulana, komanso kugwirizana ndi kukonzanso. Ndi njira yokwanira komanso maphunziro abwino, anamwino angathandize kukonza chitetezo, moyo wabwino, komanso mwayi wochira kwa odwala amitsempha.
Ngati mukufuna, nditha kusintha nkhaniyi kuti ikhale yofanana ndi pepala lasayansi (ndi mawu oyamba - njira - kukambirana), kuwonjezera buku lofotokozera, kapena kuyang'ana kwambiri momwe zinthu zilili pa vuto linalake monga sitiroko kapena kuvulala mutu.
