物理治疗师和医生培训教程卧床患者标准操作规程Training

TRAININGMATERIAL–PTPROTOCLFORBEDRIDDENPATIENTSPage-1PageTRAININGOFPHYSIOTHERAPISTSANDDOCTORSINHOSPITALSPTPROTOCOLFORBEDRIDDENPATIENTS1.Generalinformationonbedriddenpatients1.1.DefinitionAbedriddenpatientisapatientthat,forsomereason,astostayinbedforalongperiodoftime.Suchpatientmightquicklydevelopseriouscomplicationsthatarenotdirectlylinkedwiththereasonwhyhehastostayinbed.Someofthosecomplicationsmightbelifethreatening,mostofthemmightbedisabling(leadingtoadisabilityevenifthefirstproblemwouldn’thaveleadtodisability),andallofthemwillmakethetreatmentmoredifficult(thepatientwillneedmoretimetorecover–becausethecomplicationswillalsohavetobeaddressedduringthetreatment-and/orhemightnotrecoveraswellashewouldhavewithoutcomplications).Mostofthosecomplicationscanbeveryeasilypreventedusingsimpleexercisesandteachingthepatientorthecaretaker.Therefore,adaptedexerciseshavetobedonetopreventthecomplicationsfromappearing1.2.ReasonsforwhichapatienthastostayinbedThereasonwhyapatienthastostayinbedcanbevarious:multipletrauma,fractureofthespine,paralysis,severedisease,coma,surgery,headinjury…1.3.CommoncomplicationsThemostcommoncomplicationsofbedriddenpatientsare:Musclesweakness/atrophy(a)Muscleshortness(b)Pressuresores(bedulcerations)(c)Respiratoryproblems(lunginfection)(d)Bloodcirculationproblems(e)Bonedemineralization(f)Physiotherapyexerciseswillaimtopreventtocomplicationsfromappearing.TRAININGMATERIAL–PTPROTOCLFORBEDRIDDENPATIENTSPage-2Page(a)Muscleweakness/atrophyDescription:Apatientthathastostayinbedwon’tusemuch(orwon’tuseatall)hismuscles.Musclesthatarenotusedregularlywillquicklybecomeweaker.Indeed,regularuseofthemuscleisneededtomaintainproperandfunctionalmusclestrength.Thisweakeningprocessisduetothefactthat,whennotusd,muscleswillloosepartoftheircells(thelesscellthereis,theweakerthemusclebecomes)andtheremainingcellwillbecomethinnerand,therefore,lessstrong.Theresultisathinnerandweakermuscle(thisprocessisalsocalledmuscleatrophy).Consequences:Muscleweaknesswouldmakeitmoredifficultlateronforthepatienttostand(weaknessinthemusclesofthelegs)oreventosit(weaknessofthemusclesofthetrunk)ortousethehands(weaknessofthemusclesoftheupperlimbs).(b)MuscleshortnessDescription:Ifthepatientalwaysremainsinthesameposition(lyingorsitting),someofhismuscleswillstayinashortposition(apositioninwhichthosemusclesarerelaxed).Themusclesquicklyadapttheirlengthtothepositioninwhichtheyremain.Thismeansthatifamuscleremainsinashortpositionforacertaintime,itwillbecomeshorter.Oncethemuscleisshorter,itcannotbestretchedasusual.Thiswillresultindecreasedpossibilitiesofmovementsinthejoint(decreaseofRangeOfMotion–orROM).Aclassicalexampleisthekneeandhipflexorsthatbecomeshorterwhenthepatentremainsinsittingposition.Ortheplantarflexors(calfmuscle)thatbecomesshorterwhenthepatientisinlyingposition(withdropfoot).Consequences:ShortmusclesandconsequentdecreasedROMwillleadtofunctionaldifficultiessuchasstanding,walkingorusingtheupperlimbs.Indeed,ifthekneeflexorsbecameshorter,thepatientwon’tbeabletoextendtheknee.Withoutkneeextension,standingandwalkingisveryhard.TRAININGMATERIAL–PTPROTOCLFORBEDRIDDENPATIENTSPage-3Page(c)PressuresoresDescription:Pressuresoresarewoundsthatwillappearonpartsofthebodywherethereispressureontheskinclosetoaboneprominence.Thisis,forexamplethecaseonthesideofthehipwherethegreatertrochanter(ofthefemur)comesoutandthere’snotmuchmusclearoundit.Whenthepatientislyingontheside,thegreatertrochantercreatesapointofpressureontheskinandstopsthebloodsupplyfromreachingtheskinonthatparticulararea.Withoutbloodsupply,theskindiesandanulcer(awound)appear.Suchwoundisgenerallyquitehardtoheal.Classiclocationsofpressuresores:•Iliaccrest(a)•Greatertrochanter(b)•Patellaandheadoffibula(c)•Externalmalleolus(d)•Internalcondyleoffemur(e)•Internalmalleolusandbaseof1sttoe(f)•Backofthehead(g)•Shoulder(h)•Elbow(i)•Insideoftheknees(j)•Heel(k)•Ischialtuberosity(l)•Lowerback(posteriorpartofsacrum)(m)•Shoulderblades(scapula)(n)Pressuresorescanappearwithanypatientthatstaysinbed(orinawheelchair),butpatientswithsensoryproblems(patientsthatcannotfeel),areevenmorelikelytohavepressuresores(patientthatcanfeelwillfeelthepainbeforethepressuresoreappearandtheywillchangepositionautomatically;buthecannotfeelthepain,thepatientwon’tchangeposition).Consequences:Pressuresoresaredifficulttohealandrequireheavymedicalattention.Thiswillgenerallyincreasethelengthofthetreatment(thepatientwillhavetostayevenlongerIbed).Mostimportant,pressuresorescaneasilygetinfectedandsuchinfectioncanbelifethreatening(thepatientcandiefromsuchinfectionifitspreadstotherestofthebody).TRAININGMATERIAL–PTPROTOCLFORBEDRIDDENPATIENTSPage-4Page(d)RespiratoryproblemsDescription:Respiratoryproblemsmeansthattherespiratorysystemwillgetinfected(lunginfectionsuchaspneumonia).Withbedriddenpatients,lunginfectionwilloccurbecausethepatient,whenstayinginbed,asalowerbreathingmagnitudethanusual(hewilldo“smaller”breathingmovements).Consequences:Thelowerbreathingresultsinalowerfluxofairintherespiratorytracts(trachea,bronchiiandbronchioles).Thelowerfluxofairi