Also in the sanatorium you can get advice from a dentist, surgeon, dermatologist and psychotherapist. Recently, the material and technical base of the sanatorium has significantly improved. Complex rehabilitation treatment is carried out here, the most modern physiotherapeutic methods of treatment are used (mud and hydrotherapy, exercise therapy, massage, phototherapy, ultrasound therapy, magnetic and UHF therapy, hydromassage, darsonvalization, electrophoresis, electrosleep, inhalations, etc.). It also has its own caving complex, where specially selected music, light and soft chairs make the atmosphere ideal for simultaneous relaxation.

3. ROLE OF THE NURSE IN REHABILITATION AND SANATORIUM TREATMENT OF PATIENTS WITH CARDIOVASCULAR DISEASES

The International Council of Nurses has defined four components of the professional role of the nurse:

health promotion

· disease prevention

· rehabilitation

· alleviating the suffering of patients.

Health care workers perform these roles at different levels of prevention, which are presented as the continuity of different processes. At the primary level of prevention, nurses promote the social adaptation of patients, encouraging them to lead a healthy lifestyle and actively involving the public. At the secondary level, nurse managers plan and implement programs for patient education, adaptation of people with disabilities, and conduct health promotion and disease prevention activities. At the tertiary level, as the disease progresses, the emphasis of medical and social care is on rehabilitation and health education work with relatives and the patient. The nurse is responsible for coordinating the plan of care.

It is now becoming obvious that the achievements of modern medicine cannot be put into practice in cases where there is no partnership and true cooperation between doctor and patient. Ultimately, only the patient himself chooses what and how to do: whether to follow the doctor’s recommendations for taking medications, whether to change his diet towards health, whether to increase physical activity, whether to give up unhealthy habits, etc. In this mutual process, the role of a nurse with higher nursing education is inseparable. Only a partnership between a nurse manager and a patient gives a positive result and ensures patient adherence to treatment, which leads to an improved prognosis of the disease and prolongation of the working life of patients. One way to form a nurse-patient partnership is through education.

When developing educational technologies, it is important to understand why and what needs to be taught to patients with cardiovascular diseases, since informed consent and patient participation in both the treatment and preventive processes are the basis for successful control of health and disease. It is necessary to understand that the doctor or nurse giving advice to the patient must not only be well informed about the content of the advice, but also must know the form of presenting the information, clearly knowing the goal that they must achieve as a result of the training. It is necessary to understand that patients are adults with their own formed life principles and habits that have become their way of life, and any interference in this way of life causes a reaction of rejection that is natural in such a situation, at least at first. Therefore, incorrectly given advice or an insufficiently substantiated need for change will most likely not be accepted or implemented. It is for this reason that patients, when anonymously surveyed about the reasons for their failure to follow the nurse’s recommendations (for example, giving up bad habits), answer that the nurse’s advice is unconvincing.

One of the promising forms of preventive counseling is the “Health School for Patients.” The goal of the school is to provide relevant knowledge, teach the necessary skills and abilities, create motivation to change unhealthy habits and support the patient’s desire to improve and follow the doctor’s recommendations and prescriptions. In each specific case, the individual psychological and behavioral characteristics of the patient and his readiness to follow the advice of a doctor or nurse are determined.

In addition to clinical knowledge, to effectively teach patients, a nurse needs a number of additional knowledge and skills:

knowledge of the basics of the communication process (the process of effective communication), mastery of feedback techniques;

knowledge and consideration of psychological principles of behavior formation and their changes;

mastery of active forms of learning to increase its effectiveness.

Successful learning is facilitated by a trusting atmosphere of communication between the nurse manager and the patient, mutual understanding and a sense of empathy, as well as effective feedback (the ability to listen, discuss, clearly explain learning goals, etc.). Advice is perceived better and is more convincing if it is given with an emphasis on positive associations, does not contain recommendations that are difficult to follow, and is not perceived by patients as something unnatural for them, requiring effort and additional resources. It is advisable to accompany the advice with the issuance of written recommendations, memos, brochures, illustrated tables and diagrams. The basis of the process of forming motivation for improving behavior is an understanding of the benefits and importance of certain preventive measures (pros and cons, efforts and benefits) for a specific individual studying at the School.

The process of changing the behavior of any person is complex and not always progressive. Particular difficulties arise when the question arises about the need to “artificially” change life habits and behavior, which are almost always not felt by the patient as discomfort or inconvenience. On the contrary, sometimes unhealthy habits are perceived by the patient as satisfying a need (smoke - relax, socialize; eat - relieve stress, etc.).

The history of creating schools for patients with various chronic diseases in Russia goes back about 10 years. Quite a wealth of experience has been accumulated in training patients with coronary heart disease, bronchial asthma, diabetes mellitus, arterial hypertension, etc. From a formal point of view, the “School of Health” is a medical preventive technology based on a combination of individual and group effects on patients; aimed at increasing their level of knowledge, awareness and practical skills in the rational treatment of a particular disease, increasing patient adherence to treatment to prevent disease complications, improve prognosis and improve quality of life. Health school does not teach illness, but how to maintain health, reduce the manifestation of illness and reduce the risk of complications.

The development of schools for patients makes it possible to implement one of the fundamental principles of healthcare reform - ensuring the unity of the doctor (nurse) and the patient in achieving the quality and medical effectiveness of care provided to patients. Today, patient schools are not just information technologies that impart certain knowledge. Lectures on health education, faceless and often formal, are a thing of the past. School is new information and motivational technologies; they should help increase patients' adherence to treatment, motivate them to maintain their health, and increase the patient's responsibility for health as his personal property. In achieving these goals, schools provide quality preventive care to the population, which contributes to the implementation of the preventive focus of the health service and is the fundamental principle of its reform.

“Health School for Patients with Cardiovascular Pathology” is an organizational form of preventive counseling and is aimed at preventing complications, timely treatment and health improvement. Factors influencing the effectiveness and efficiency of the School are inextricably linked to the quality of nursing care as a whole. They can be divided into several groups:

relationships between nurses and patients (mutual understanding and empathy, ability to persuade and explain, etc.);

professional competence of a medical worker (knowledge of the basic concepts of risk, levels of risk factors, reasonable daily integration of treatment and long-term measures to prevent complications and improve prognosis);

organization of preventive work in general, which determines its quality (discussion with patients of health problems, not just illness, simplicity and accessibility of recommendations and their feasibility for specific patients, availability of written instructions and reminders, forms and methods of training, etc.).

The introduction of the “Health School for Patients with Cardiovascular Pathology” into real practice makes it possible to obtain significant medical and socio-economic effectiveness of this new organizational and functional model of preventive activities. As a result of patient education and the formation of a partnership between the nurse manager and the patient, patients' attitudes and attitudes towards health changed. The number of patients who consider the actions of medical personnel ineffective is gradually decreasing, and the economic factor is no longer considered the main obstacle to following the doctor’s recommendations for health improvement.

The domestic healthcare system suffers from an imbalance of medical personnel and low efficiency in the use of nursing personnel in practical healthcare, which significantly affects the quality of medical care. The potential of nurses with higher nursing education is not fully used. This fact contradicts the Industry Program for the Development of Nursing in the Russian Federation adopted in 2001, which calls for the creation of optimal conditions for increasing efficiency and strengthening the role of nursing personnel in providing medical and medical-social assistance to the population. Work on creating a healthy lifestyle and correct perception of the patient’s changed health status requires fundamentally new approaches and more modern and advanced training of specialists. It is obvious that health education work has not become a prestigious activity for doctors, since it does not contribute to career advancement, obtaining a qualification category, or financial incentives. Strengthening the preventive focus in the field of health care is impossible without reforming the organization of work of nurses with secondary and higher education, as well as without redistributing powers between nurses and doctors.

Specialists with nursing education are completely unreasonably assigned a secondary role in various organizational transformations. The potential of this category of medical workers is great and continues to grow, which is associated with the improvement of training programs for specialists with manager qualifications. The presence of such specialists makes it possible to redistribute functions in accordance with their competence and mission: doctors - to diagnose and treat diseases, specialists with secondary medical education - to provide care for patients and medical and social activities, and managers - to ensure the organization and management of the activities of medical staff for the most effective functioning of a medical institution. Each employee accepts responsibility for implementing the tasks assigned to the entire team. The main positive results of reorganization measures in nursing activities are:

1) constant monitoring of the patients’ condition

2) better implementation of medical prescriptions

3) training nursing staff in clinical thinking

4) work of doctors and nurses in a single team

5) increasing the self-esteem and status of the nurse.

Finding out the reason for the immediate deterioration of the patient’s condition, making a social diagnosis and trying to relieve fears and anxiety before the upcoming medical procedure is one of the goals of the nursing process, in which the nurse plays a key role.

In the FBU "Sanatorium "Troika" of the Federal Penitentiary Service of Russia, the medical unit is represented by ten doctors and sixteen nurses. About 75% of working doctors have more than 15 years of experience in medicine and 60% have the highest qualification category.

I conducted a survey of nurses at our institution. Using a questionnaire I developed, I interviewed 15 people (Appendix 1). The purpose of the survey was to obtain information about the incentives driving mid-level health workers in their professional activities; obtaining data on what interferes with the quality work of sanatorium employees; obtaining data about who today constitutes one of the most important links in today's healthcare - paramedical workers. This is what I received:

· 64% of respondents (and this is more than half of nurses) note the presence of a permanent job as the main reason that keeps them in this institution

· 33% of respondents are satisfied with the amount of work they do

· 27% of respondents are attracted by the good attitude of management towards them

· 22% are satisfied with convenient schedule and proximity to home

· 18% are satisfied with salaries

· 16% noted the possibility of self-realization (Diagram 3).

I would like to note that the respondents’ work experience in the sanatorium averaged 6.5 years. According to the respondents, the following factors negatively affect the desire to work effectively:

· monotonous work - noted by 1% of employees

· lack of understanding among colleagues - 2%

· unfair attitude of management - 15%

· heavy loads - 18%

· understaffed workplace - 22%

· low wages for doctors - 42% (Diagram 4).

A sociological survey is one of the most revealing methods for assessing quality. Based on the research and comparative analysis of the quality and professionalism of nurses at the Troika Sanatorium of the Federal Penitentiary Service of Russia, I made the following conclusions:

The majority of respondents are satisfied with the quality of the work they perform and cope well with their professional duties, which has a positive effect on the entire work of the sanatorium. However, the same majority (42%) considers their wages to be inconsistent with the quality of their work (lower than what is necessary for the normal functioning and ability of a health worker to work today).

And this, in turn, may in the future prevent the sanatorium from providing quality medical care to patients due to the loss of qualified personnel: due to low wages, employees working today will be forced to leave, and the younger generation is in no hurry to get a job for pennies.

Almost a third of respondents are attracted by the good attitude of the administration towards them, which positively characterizes the entire management staff of the sanatorium. But almost a quarter of respondents are dissatisfied with the staffing of their workplaces, which, in turn, cannot qualitatively improve the ability of employees to work and improve the quality of medical care provided to patients in need.

The lack of unity in the level of knowledge of the studied employees confirms the need to develop a general training program for medical personnel on site at all levels of training of nursing specialists, including advanced training courses, seminars and conferences at various levels.

QUESTION: What primarily attracts you to this institution?

16% - opportunity for self-realization

% - decent salary

% - solving personal problems

% - good management attitude

% - satisfaction with the quality of work

% - having a permanent job

QUESTION: What, in your opinion, negatively affects the desire to work?

1% - monotonous work

% - no understanding among colleagues

% - injustice of the administration

% - heavy loads

% - poorly equipped workplace

4. FEATURES OF MONITORING PATIENTS WITH CARDIOVASCULAR DISEASES IN A SANATORIUM AND RESORT INSTITUTION

Among diseases of the cardiovascular system, one of the most common is coronary heart disease (or ischemic heart disease, ischemia, coronary heart disease, coronary sclerosis). Coronary heart disease is common in all economically developed countries; one might say that the whole world is facing the threat of its epidemic. What is coronary heart disease? This term is commonly used to describe a group of cardiovascular diseases, which are based on impaired circulation in the arteries that supply blood to the heart muscle (myocardium). These arteries are called coronary arteries, hence the name of coronary artery disease - coronary heart disease. IHD gets its name from the process that causes it, which is called ischemia. Ischemia is insufficient blood access to an organ, which is caused by a narrowing or complete closure of the lumen in the artery. So-called transient ischemia can also occur in a healthy person as a result of physiological regulation of blood supply. This happens, for example, with a reflex spasm of the artery, which can be caused by the influence of pain, cold, hormonal changes, such as the release of adrenaline into the blood during stress.

Longer ischemia, that is, already leading to pathological processes, can be provoked by biological irritants (bacteria, toxins), it can be a consequence of blockage of the artery by a blood clot, narrowing of the vessel due to atherosclerosis or an inflammatory process, compression of the artery by a tumor, scar, foreign body, etc. . Depending on the degree of disruption of blood flow, on the rate of development and duration of ischemia, on the sensitivity of tissues to lack of oxygen, on the general condition of the body, ischemia can result in complete restoration of the affected organ or tissue, but can also lead to their necrosis, that is, partial or complete necrosis .

Ischemia develops not only in the heart arteries; there is, for example, cerebral ischemia (cerebrovascular accident), ischemia of the upper and lower extremities. But the central nervous system and heart muscle are the most sensitive to ischemia. Cardiac ischemia is most often caused by atherosclerosis, in which narrowing of blood vessels occurs due to the accumulation of cholesterol deposits, so-called cholesterol plaques, on their walls. Actually, IHD is one of the particular variants of atherosclerosis that affects the coronary artery. This is where another name for ischemic heart disease comes from - coronary sclerosis. In most cases, IHD occurs in waves; exacerbations of the disease alternate with periods of relative well-being, when there may be no subjective manifestations of the disease. The main symptom of IHD is angina pectoris, that is, paroxysmal pain in the heart area. At the initial stage of coronary artery disease, angina attacks occur during physical or psychological stress. The further course of the disease is usually long-term: IHD can develop over decades. In typical cases, after some time, angina attacks occur not only during exercise, but also at rest. During periods of exacerbation in its later stages, the threat of developing myocardial infarction is real.

Myocardial infarction is necrosis (death) of the heart muscle caused by an acute violation of the coronary circulation as a result of a discrepancy between the need of the heart muscle for oxygen and its delivery to the heart. Over the past twenty years, mortality from myocardial infarction in men has increased by 60%. The heart attack made me look much younger. Nowadays it is no longer uncommon to see this diagnosis in thirty-year-olds. So far it spares women up to the age of fifty, but then the incidence of heart attacks in women is compared with the incidence in men. Heart attack is one of the main causes of disability, and the mortality rate among all patients is 10-12%. In 95% of cases of acute myocardial infarction, it is caused by thrombosis of the coronary artery in the area of ​​atherosclerotic plaque. When an atherosclerotic plaque ruptures, erodes (forms an ulcer on the surface of the plaque), or cracks the inner lining of the vessel underneath, platelets and other blood cells adhere to the site of damage. A so-called “platelet plug” is formed. It thickens and quickly grows in volume and eventually blocks the lumen of the artery. This is called occlusion. The supply of oxygen to the cells of the heart muscle, which was fed by the blocked artery, will be enough for ten seconds. The heart muscle remains viable for about thirty minutes. Then the process of irreversible changes in the heart muscle begins, and by the third to sixth hour from the onset of occlusion, the heart muscle in this area dies. There are five periods of development of myocardial infarction:

1. Pre-infarction period. It lasts from a few minutes to 1.5 months. Typically, during this period, attacks of unstable angina become more frequent and their intensity increases. If treatment is started on time, a heart attack can be avoided.

2. The most acute period. Often occurs suddenly. During this period, a variant of the course of a heart attack is formed. The options may be the following:

· anginal (painful) - this is the most common variant, which accounts for 90% of heart attacks. It begins with severe pain, pressing, burning, squeezing or bursting behind the sternum. The pain intensifies, radiating to the left shoulder, arm, collarbone, scapula, lower jaw on the left. The duration of a painful attack is from several minutes to two to three days. Patients often experience a feeling of fear and vegetative reactions (cold sweat, paleness or redness of the face).

Asthmatic - when a heart attack begins with shortness of breath, cardiac asthma or pulmonary edema. This option is more common in elderly patients and in patients with repeated myocardial infarction.

Abdominal - a heart attack begins with abdominal pain. The patient may have nausea and vomiting, and bloating.

· arrhythmic - can begin with a sharp increase in heart rate or, conversely, complete atrioventricular block, when the heart rate sharply decreases and the patient loses consciousness.

· cerebral (cerebral) - occurs if there is no pain in the heart and headaches, dizziness, and visual disturbances appear due to a decrease in blood supply to the brain. Sometimes paralysis and paresis may occur.

Acute period. Lasts about ten days. During this period, the zone of dead heart muscle is finally formed and a scar begins to form at the site of necrosis. During this period, body temperature may increase.

Subacute period. Lasts about eight weeks. During this time, the scar is fully formed and thickened.

Post-infarction period. Lasts for six months. The patient's condition is stabilized. In the same period, repeated myocardial infarction, exertional angina or heart failure are possible.

The diagnosis of myocardial infarction is established by the presence of three criteria:

typical pain syndrome

changes on the electrocardiogram

changes in biochemical blood test indicators, indicating damage to heart muscle cells.

Treatment must be carried out in a hospital. After hospitalization, a long period of rehabilitation begins, which lasts up to six months.

Half of deaths due to cardiovascular diseases are due to coronary heart disease. In Russia, the problem is especially acute: in our country, the prevalence of IHD and mortality from IHD is one of the highest in Europe. According to WHO, at the end of the twentieth century, in European countries with well-developed medicine, the annual mortality rate from coronary heart disease among older patients is 745 cases per 100 thousand population, and in the CIS countries this figure is almost 4 times higher. The saddest thing is that the difference between mortality rates is much greater among young patients: if in Europe 23 people die from ischemic heart disease per 100 thousand people, then the figure for the CIS countries is more than 120 cases per 100 thousand. In addition, among patients with coronary artery disease, cases of disability and, accordingly, partial or complete loss of ability to work. All this turns the prevalence of IHD from a purely medical problem into a socio-economic problem, which, moreover, can affect any of us. Therefore, every person needs to have at least basic information about the causes of coronary heart disease, what the risk factors for the development of ischemic heart disease are, and what preventive measures need to be taken to reduce the likelihood of developing ischemia or its complications.

The nurse determines the patient’s needs for this pathology, the satisfaction of which is impaired and formulates the patient’s problems (the satisfaction of the needs to breathe, eat, drink, move, sleep, communicate, etc. is impaired). It identifies real problems: weakness, interruptions in heart function, shortness of breath with little physical exertion. Identifies the priority problem - attacks of chest pain and potential problems (risk of developing myocardial infarction (or re-infarction)).

The nurse sets short-term and long-term goals and implements necessary nursing interventions:

1) for effective treatment and prevention of complications, ensures compliance with the prescribed regimen and diet with limited salt and liquid

2) to restore heart function, ensures the implementation of the exercise therapy program

3) to monitor the patient’s condition, monitors appearance, pulse, blood pressure, respiratory rate

4) to prevent complications, conducts conversations about the need to follow a diet, control daily diuresis, constantly take medications, control blood pressure, give up bad habits, etc.

Over the past four years, the number of cardiologist consultations at the Troika sanatorium has been steadily growing. Thus, in 2005, 211 people were forced to seek advice; in 2006 this figure increased to 243 people. In 2007, consultations with a cardiologist were scheduled for 649 patients, and already in 2008, 798 patients visited the cardiologist’s office (Table 4).

Table 4. Consultations with a cardiologist at the Troika sanatorium in 2005-2008.

Due to the prevalence and constant growth of cardiovascular pathology among people of different age categories, the unpredictability of the variety of manifestations and outcomes at a young age, this topic aroused my interest and the need for more in-depth study. In particular, I carried out research work among patients with cardiovascular pathology undergoing rehabilitation after illnesses at the Troika Sanatorium of the Federal Penitentiary Service of Russia. 30 patients were interviewed: 20 women and 10 men, who were under constant supervision during their treatment cardiologist of the sanatorium. The age of the respondents ranged from 18 to 70 years. The group from 18 to 25 years old included 4 people, which made up 13% of the total number of patients from 26 to 40 years old - 8 people or 26%. made up half of the respondents, that is, 50%, and the group from 56 to 70 years old included 3 patients or 11% of respondents.

Diagram 5. Age limits of respondents

To the question “Do you take medications and how often?” 11 respondents gave a positive answer, which amounted to 36% of the total number of respondents. 9 people or 30% of respondents answered negatively to this question. And the answer “rarely” was given by 10 people - 34% of patients

Diagram 6. Taking medications

Analyzing the data obtained, I came to the conclusion that taking medications does not cause any problems for almost half of the respondents, regardless of whether the medications were prescribed by the attending physician or taken independently. It’s no secret that most of us systematically self-medicate without ever reaching a specialist. And this, in turn, has negative consequences both for the patients themselves and for the therapists, surgeons, cardiologists and other specialists treating them. And only when we have brought ourselves to the last point, to an extremely difficult condition with a bunch of complications that have arisen, do we become ready to go to the doctor. This is especially true for medical practitioners.

To the survey question “Do you have problems with blood pressure?” I received the following answers:

l 15 people, which is 50% of the patients surveyed, have problems with blood pressure (!). This is a scary figure, considering that the lower age limit of respondents was 18 years.

l 14 people never had any problems with blood pressure, this amounted to 44%.

It should also be noted that only half of the surveyed patients know how to measure blood pressure.

The study made it possible to establish that the majority of patients with coronary heart disease equally need both physical care, which is one of the most important sections of nursing care and is aimed at creating the most favorable conditions for the patient’s stay in a sanatorium by replenishing his self-care deficit, and education patient to perform simple nursing procedures, such as measuring temperature, taking medications, measuring blood pressure, etc. The choice of these questions to explore with patients is determined by the nursing specialist on a case-by-case basis. The scientific literature notes that working with patients is effective under the following conditions: the presence of a clear goal, motivation to learn and mandatory practice of developed skills.

Analysis of the results obtained showed the presence of a direct, reliable connection on such aspects of therapeutic training as its effectiveness, purpose, method, and the main meaning of training, that is, the restoration of health indicators in patients during the training process.

The point of application for both primary and secondary prevention of coronary artery disease is the risk factors known to us. Of these factors, there are four lifestyle factors that are of greatest importance and can influence the occurrence and progression of coronary heart disease. These factors are smoking, diet, namely the content of fats and unsaturated fatty acids in food, such as omega-3 fatty acids, lack of physical activity and chronic, and especially occupational stress. Therefore, lifestyle changes can be identified here, which include smoking cessation, a coronary-protective diet, regular physical activity and reducing chronic stress. Numerous studies have long proven that the decisive therapeutic method for the prevention of coronary artery disease is a combination of a diet with minimal fat, quitting smoking, stress management and regular physical activity, which can lead to the reverse development of coronary stenosis within a year.

In the 1990s, the so-called "Mediterranean diet" was studied in France. We were talking about a diet that is relatively rich in unsaturated and polyunsaturated fatty acids and omega-3 fatty acids. This study involved 605 patients who had suffered a myocardial infarction. The diet of the patients in the study group included a large amount of bread, vegetables, fruits, fish, olive oil, some meat and margarine fortified with alpha-linolenic acid. After a four-year follow-up period, the reduction in recurrent heart attacks and mortality was 12 percent.

Also, based on the results of epidemiological studies, it has been known for many years that regular moderate-intensity physical activity (for example, leisurely walks, housework) has a beneficial effect in the primary prevention of CHD. The absolute risk for overall mortality was shown to be reduced by 2.2 percent.

The most effective measure, comparable in its effect to the effect of combination therapy with platelet aggregation inhibitors, beta blockers and statins, is smoking cessation. A low-fat diet is also very effective. The effectiveness of regular physical activity and the reduction of chronic stress using stress management techniques is comparable to the effectiveness of statin therapy. It is likely that the total contribution of lifestyle changes to the secondary prevention of coronary artery disease may be many times greater than the contribution of combination drug therapy. After analyzing the data obtained through the survey, I received the following:

l 20 people out of 30 respondents, which is about 65% of the total number, report periodic pain in the chest or pain in the heart area;

l 12 people - 18%, report arrhythmias or interruptions in heart function;

l -heart murmurs were observed in 6 people or 9% of respondents

Table 5. Common complaints of patients with cardiovascular pathology

To the questions of the “Patient Questionnaire” about whether the patients of the sanatorium are provided with proper nursing care in the therapeutic department, whether advisory nursing care is provided and whether the nursing staff of the department supports the patients psychologically, I received the following answers: almost 80-85% of respondents answered the data questions positively. Negative answers were given by 15 to 20% of respondents.

In the first seven days of their stay in the sanatorium, the patients who received a course of treatment after consulting a cardiologist and the patients I interviewed assessed the quality of work of the nurses in the therapeutic department of the FBU "Sanatorium "Troika" of the Federal Penitentiary Service of Russia:

9 people out of 30 (28%) rated “excellent”

14 people out of 30 (47%) rated “good”

7 people out of 30 (25%) rated it as “satisfactory”

There was never a single “unsatisfactory” rating.

In general, patients were satisfied with the attitude of the nursing staff.

There were virtually no comments or complaints from patients. Within 14 days after the survey, the nurses of our department and myself in particular carried out a lot of work with patients undergoing rehabilitation after suffering coronary heart disease and myocardial infarction. It included the following activities:

1) regular conversations were held with patients about their diseases

2) familiarize patients with risk factors for coronary heart disease

3) talk about the dangers of smoking

4) design of the stand "Cardiovascular diseases. What do we know about them?"

6) daily monitoring of blood pressure in study patients (morning and evening)

7) 15 people were trained in the technique of measuring blood pressure

8) 15 people trained in pulse measurement techniques

9) patients were consulted on taking medications and using medications.

Training is a complex two-way process of interaction between the student and the teacher, on which the achievement of agreement between the patient and the medical professional depends. I studied the opinions of 30 patients regarding the qualities that a nursing professional should have. The results of the study are shown in Table 6:

Table 6. The most important personal qualities of a medical worker today

As a result of the work carried out by the nurses of the therapeutic department of the Troika sanatorium with patients with cardiovascular pathology in the third week of their stay, blood pressure normalized in 18 patients, and shortness of breath decreased (in some cases disappeared). In 85% of those observed, general health improved, dizziness and headaches disappeared, and the number of patients visiting the doctor decreased. After the course of sanatorium-resort treatment, I interviewed the same 30 people to assess the communication style of the nursing staff with the patients of our sanatorium. I combined all the answers and showed them in Table 7:

Table 7. Answers to the questions “Questionnaires for the patient after treatment.”

In personal conversations with patients, it was also revealed that in almost 50% of cases of patients being treated at the Troika sanatorium, a healthy psychological atmosphere in the therapeutic department and the friendly, tactful and responsive attitude of nurses towards patients give only positive results. Love for the patient, politeness, respect and tolerance - these are the qualities that are fully possessed by the doctors and nurses of the sanatorium, who surround each newly arrived patient with care and attention. By their behavior, they create confidence in the patient that his health is under the control of professionals who can be safely entrusted with health and life. And the patient begins to switch from his problem to communication with the medical workers around him, and a miracle happens - the patient gets better. Of course, constant medical supervision and drug therapy also play an important role here. But with high-quality nursing care, the patient’s recovery occurs much faster. Nurses reduce all problems to a minimum, strive to reduce all the inconveniences that the patient faces, without impinging on his initiative in matters of self-care.

We all know well that conflict situations or negative emotions received as a result of communication with medical workers aggravate the already unstable condition of the patient, cause his irritation, reduce his interest in life and desire for recovery. In addition to existing complaints, complaints about poor sleep and loss of appetite, constant headache, fatigue, etc. are added. From the above we can conclude that the health of our patients is in our hands and directly depends on the professional, high-quality and successful work of the nurse.

Good health and improved health are promoted not only by compliance with all medical prescriptions and fulfillment of medical prescriptions, but also by care, kindness, mercy, selfless and conscientious performance of one’s professional duty by a nurse who is ready to help at any moment.

CONCLUSION

The observed stratification of society and the increase in the number of socially vulnerable groups of the population negatively affect the availability of medical care. In the context of a shortage of budgetary funds and human resources, it is difficult to provide the population with generally accessible, safe and high-quality medical care. But public health is one of the main indicators of state security. That is why we need to improve the quality of the medical care we already have and the professional status of the nurse.

Therefore, I consider it necessary to create so-called “Health Schools” on the basis of medical institutions, which, in turn, will free up time for medical appointments in order to carry out diagnostic and therapeutic activities and improve the quality of care provided.

At the “Health School” it is necessary to teach patients to consciously observe a healthy lifestyle, the basic principles of rational nutrition, drug and non-drug therapy, prevention of exacerbations of various diseases, as well as methods of self-control and self-care, massage and gymnastics techniques.

The theme of the “Health School” must be developed based on an analysis of morbidity indicators and take into account the interest of the patients themselves. For this purpose, you can periodically conduct patient surveys, organize recordings on various topics, or set up a cell to collect suggestions on issues of interest. Visual information about the work of the School of Health should be available.

The Health School program should include various forms of education: conversations, lectures, practical exercises, discussions, educational games; Conduct both individual and group lessons. Efforts to educate patients and their families need to be systematically evaluated.

The use of a training system in the form of a “Health School” for patients and people close to them is a low-cost and very effective method of preventive work, which will increase the motivation of patients to consciously adhere to a healthy lifestyle and create appropriate conditions for the further growth and development of the nation.

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Healthcare in Russia 2005./Statistics. collection. M.: Rosstat, 2006.390p.

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T.P. Obukhovets, T.A. Sklyarova, O.V. Chernova. Fundamentals of nursing./Rostov-on-Don: Phoenix, 2006. 512 p.

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procedures./http://www.pozvonok.ru/med/page-21-1-9.html

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www American clinic com articles /55

Annex 1

Questionnaire for a mid-level medical worker of the Federal Budgetary Institution "Sanatorium "Troika" of the Federal Penitentiary Service of Russia

1. What primarily attracts you to this institution?

(Underline whatever applicable)

Wage

Management attitude

Possibility of self-realization

Ability to solve personal problems (emphasize: convenient schedule, proximity to home, amount of work).

Possibility of additional income

Confidence in having a permanent job

Possible incentives (bonuses, etc.)

Satisfaction with completed work

What do you think negatively affects the desire to work effectively? (Underline whatever applicable)

great physical and emotional stress

low wages

poorly adapted workplace

inconvenient work schedule

monotonous work

lack of understanding among work colleagues

1. Do you think about career growth (yes; no; sometimes)

2. Work experience in this position………………………………

3. Do you read special medical literature (yes; no; sometimes)

Appendix 2

Patient Questionnaire

1. Age (underline as appropriate):

From 18 to 25 years old; - from 41 to 55 years old;

from 26 to 40 years old; - from 56 to 70 years;

over 70 years;

Gender (underline): male, female.

Do you take medications and how often?....................................

Do you have problems with blood pressure? ………………

Do you know how to measure blood pressure? ...

Do you smoke? If yes, how often? ………………….

Your weight? Height? ……………………………....

Have you ever had a heart murmur?.................................................

Have you ever had arrhythmias or heart failure?....................................

Have you ever had pain behind the sternum or in the heart area?....................

Are you provided with the necessary care in the department?

Do you receive nursing advisory assistance?

Does the nursing staff support you psychologically?

Do you have conversations about a healthy lifestyle?

Please evaluate the work of the department nurses (underline):

Great; - Fine; - satisfactory; - unsatisfactory.

Appendix 3

Questionnaire for interviewing the patient after treatment:

1. You were provided with the necessary nursing care (underline as appropriate):

Fully;

no effect;

it got worse.

2. You were provided with advisory nursing care (underline as appropriate):

Fully;

friendly;

indifferent;

indifferent;

another opinion.

What qualities, in your opinion, should a nurse have in caring for patients (underline as appropriate):

professionalism;

compassion;

goodwill;

Your special opinion (specify which one).

fully; - partially; - not given at all.

Similar works to - The role of the nurse in the rehabilitation and spa treatment of patients with cardiovascular diseases

The term “rehabilitation” comes from the Latin “habilis” - ability and “rehabilis” - restoration of ability.

Rehabilitation is a complex of coordinated measures of a medical, physical, psychological, pedagogical, social nature aimed at the most complete restoration of health, mental status and ability to work of persons who have lost these abilities as a result of illness.

Based on the diversity of rehabilitation tasks, it is conventionally divided into so-called types or aspects of rehabilitation: medical, physical, psychological, socio-economic and professional.

Medical aspect of rehabilitation is a set of therapeutic measures aimed at restoring and developing the patient’s physiological functions, identifying his compensatory capabilities in order to provide further conditions for his return to an active independent life. This aspect of rehabilitation is associated with therapeutic measures throughout the entire period of observation of the patient and includes issues of early hospitalization, prescription of medications, and later - after the patient returns to work - the organization of active clinical observation and systematic preventive treatment, including secondary prevention measures.

Physical aspect of rehabilitation is aimed at restoring the physical performance of patients, which is ensured by timely and adequate activation of patients, early prescription of therapeutic exercises, then exercise therapy, dosed walking, and in a later period – physical training.

Psychological aspect of rehabilitation. Studying the nature and severity of mental disorders, which often develop in various diseases, and their timely correction is one of the tasks of this aspect of rehabilitation.

Professional aspect of rehabilitation. Issues of employment, vocational training and retraining, and determining the ability of patients to work form the subject of the professional aspect of rehabilitation.

Socio-economic aspect of rehabilitation includes issues of relationships between the patient and society, the patient and family, and pension provision.

Rehabilitation phases.

In accordance with WHO recommendations, the rehabilitation process is divided into three phases: hospital (inpatient), recovery and maintenance. Within each of these phases, the tasks of each type of rehabilitation are solved to one degree or another.

Hospital (inpatient) phase of rehabilitation. The goal of this phase of rehabilitation is to restore the patient’s physical and psychological condition so that he is prepared to carry out the second phase of rehabilitation in a sanatorium or, if there are contraindications, at home. The tasks of the hospital phase of rehabilitation, implemented in the conditions of a cardiological or therapeutic, or other hospital department, are solved within the framework of each type of rehabilitation.

Sanatorium (second) phase rehabilitation . Upon completion of the hospital phase of rehabilitation, the patient is prepared to complete the recovery phase program, which is usually carried out in rehabilitation centers. This phase of rehabilitation is essentially the boundary between the period when a person is in sick status and his return to the family, to active work, to life’s troubles and difficulties.

The main goal of this phase of rehabilitation is to prepare the patient for an active life - returning to the family, for a rational restructuring of the lifestyle, changing some habits, for the systematic implementation of preventive measures, including secondary prevention. The tasks of physical, mental and other aspects of rehabilitation are solved in this phase at a new level compared to the hospital stage.

Maintenance (third) phase of rehabilitation. Upon completion of the recovery phase, the patient enters the third phase of rehabilitation, the purpose of which is to maintain the level of physical performance achieved in the sanatorium with some increase in some patients, and to complete the psychological rehabilitation of the patient already in the conditions of the resumption of his social life.

A possible factor ensuring the effectiveness of rehabilitation as a whole is the implementation of the principle of continuity between phases, which is achieved by entering complete information about the clinical, physical and psychological status of the patient at each stage of rehabilitation into a staged epicrisis.

The leader in the rehabilitation of therapeutic patients is physical therapy (PT).

Features of the physical therapy method:

impact on a person by physical exercise;

the patient himself actively participates in the process of his treatment and rehabilitation.

Physical education means used in exercise therapy:

physical exercise;

motor modes;

1. natural factors;

   occupational therapy.

Classification of physical exercises:

a) gymnastics: general developmental and respiratory, active and passive, without apparatus and on apparatus;

b) applied sports: walking, running, throwing balls, grenades, etc., jumping, swimming, rowing, skiing, skating, etc.;

c) sedentary, active and sports games. Of the latter, in the practice of physical therapy, mainly in sanatoriums, they use towns, volleyball, tennis, and elements of basketball.

Rehabilitation is a direction of modern medicine, which in its various methods relies primarily on the patient’s personality, actively trying to restore the person’s functions impaired by the disease, as well as his social connections.

The impetus for the development of rehabilitation as a science was the First World War and the Second World War. Due to advances in medicine, sanitation, and hygiene, morbidity and mortality from acute infectious diseases have significantly decreased. At the same time, the acceleration of scientific and technological progress, rapid industrialization and urbanization, environmental pollution, and an increase in stressful situations have led to an increase in severe non-infectious diseases. Principles of medical and physical rehabilitation.

The patient’s medical rehabilitation program includes:

* physical methods of rehabilitation (electrotherapy, electrical stimulation, laser therapy, barotherapy, balneotherapy, etc.), physical therapy,

* mechanical methods of rehabilitation (mechanotherapy, kinesiotherapy),

* traditional methods of treatment (acupuncture, herbal therapy, manual therapy, etc.),

* speech therapy assistance,

* reconstructive surgery,

* prosthetic and orthopedic care (prosthetics, orthotics, complex orthopedic shoes),

* sanatorium-resort laziness,

* information and consultation on medical rehabilitation issues,

* other events, services, technical means.

Stages of the nursing process.

Professional and social rehabilitation programs include issues of informing the patient about the programs, creating conditions most favorable for achieving their goals, teaching the patient self-care, and the use of special rehabilitation devices.

The nursing process is the systematic identification of patient and nurse situations and emerging problems in order to implement a plan of care that is acceptable to both parties. The goal of the nursing process is to maintain and restore the patient's independence in meeting the basic needs of the patient's body.

Achieving the goal of the nursing process is carried out by solving the following tasks:

* creation of a patient information database;

* determining the patient's need for nursing care;

* designation of nursing service priorities;

* providing nursing care;

* assessing the effectiveness of the care process.

First stage nursing process - nursing examination. It involves assessing the patient's condition, collecting and analyzing subjective and objective health data before implementing nursing interventions.

At this stage, the nurse should: obtain an understanding of the patient's condition before performing any interventions; determine the patient’s self-care options;

establish effective communication with the patient; discuss nursing needs and expected outcomes with the patient; complete nursing documentation.

The nurse receives subjective data about the patient’s health during a conversation. These data depend on the patient’s condition and his reaction to the environment. Objective data does not depend on environmental factors. The quality of the examination and information obtained determines the success of subsequent stages of the nursing process.

Second phase nursing process - identifying nursing problems.

A nursing diagnosis is a description of a patient's condition as determined by a nursing assessment and requiring intervention by the nurse.

Nursing diagnosis is aimed at identifying the patient’s body’s reactions in connection with the disease, can often change depending on the body’s response to the disease, and is associated with the patient’s ideas about his state of health. The main methods of nursing diagnosis are observation and conversation. Particular attention in nursing diagnostics is paid to establishing psychological contact. After formulating all nursing diagnoses, the nurse establishes their priority, based on the patient's opinion about the priority of providing him with care.

Third stage nursing process - setting goals, drawing up a plan for nursing interventions.

The patient actively participates in the planning process, the nurse motivates the goals, and determines, together with the patient, ways to achieve these goals. At the same time, all goals must be realistic and achievable, and have specific deadlines for achievement. When planning goals, it is necessary to consider the priority of each nursing diagnosis, which may be primary, intermediate or secondary.

Based on completion time, all goals are divided into:

short-term (their implementation is carried out within one week, for example, lowering body temperature, normalizing intestinal function);

long-term (it takes longer than a week to achieve these goals).

Goals may correspond to expectations from the treatment received, for example, freedom from dyspnea on exertion, stabilization of blood pressure.

Based on the volume of nursing care, the following types of nursing interventions are distinguished:

dependent - actions of a nurse performed as prescribed by a doctor (written instructions or instructions from a doctor) or under his supervision; independent - actions of a nurse that she can perform without a doctor’s prescription, to the best of her competence, i.e. measuring body temperature, monitoring the response to treatment, patient care manipulations, advice, training;

interdependent - the actions of a nurse performed in collaboration with other health care workers, exercise therapy doctor, physiotherapist, psychologist, and patient’s relatives.

Fourth stage nursing process - implementation of the nursing care plan.

The main requirements for this stage are systematicity; coordination of planned actions; involving the patient and his family in the process of care; provision of pre-hospital care according to the standards of nursing practice, taking into account the individual characteristics of the patient; maintaining documentation, recording care provided.

Fifth stage nursing process - assessing the effectiveness of planned care.

The nurse collects and analyzes information, draws conclusions about the patient’s response to care, the possibility of implementing the care plan, and the emergence of new problems. If the goals are achieved, the nurse notes this in the plan about achieving the goal for this problem. If the goal of the nursing process for this problem is not achieved and the patient continues to need care, it is necessary to reassess and identify the reason that prevented the goal from being achieved.

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STATE BUDGET EDUCATIONAL

INSTITUTION OF SECONDARY VOCATIONAL

EDUCATION OF THE CITY OF MOSCOW

"MEDICAL COLLEGE No. 5

DEPARTMENT OF HEALTH OF THE CITY OF MOSCOW"

BRANCH No. 3

Course work

Specialty: 060501 Nursing

Subject: "The role of the nurse in the rehabilitation of a patient after a stroke in a hospital setting»

Completed by: 4th year student, group 42

Izzatova G.G.

Head: Turakhanova N.V. PM teacher

Candidate of Medical Sciences

Introduction

Today, about 9 million people in the world suffer from cerebrovascular diseases. The main place among them is stroke.

Every year, cerebral stroke affects from 5.6 to 6.6 million people and claims 4.6 million lives; mortality from cerebrovascular diseases is second only to mortality from heart disease and tumors of all localizations and reaches 11-12% in economically developed countries. The annual mortality rate from strokes in the Russian Federation is one of the highest in the world (175 per 100 thousand population).

There is a rejuvenation of stroke with an increase in its prevalence in people of working age - up to 65 years. Morbidity and mortality rates from stroke among people of working age in Russia have increased over the past 10 years by more than 30%.

The early 30-day mortality rate after a stroke is 34.6%, and approximately half of those affected die within a year. Another disaster associated with stroke is that it is the leading cause of serious loss of functional capacity, regardless of age, gender, ethnic origin, or country. Stroke turns out to be the leading cause of disability in the Russian population, 31% of patients who have suffered it need outside help, another 20% cannot walk independently, only 8% of surviving patients are able to return to their previous work. Stroke imposes special obligations on the patient’s family members, significantly reducing their work potential, and places a heavy socio-economic burden on society.

Cerebrovascular diseases cause enormous damage to the economy, taking into account the costs of treatment, medical rehabilitation, and losses in production.

Thus, stroke is a national medical and social problem, which is why real efforts to organize effective preventive measures and improve the system of providing medical care to patients with a stroke are so significant and important.

Purpose of the study:

Study of nursing activities in caring for patients with stroke.

Object of study:

Nursing process in the treatment of patients with stroke in a hospital setting.

Subject of study:

The effectiveness of nurse participation in the treatment of patients with stroke in a hospital setting.

Research objectives:

1. Based on a theoretical study of literature sources, identify and study risk factors for stroke, classification, variants of the clinical course of the disease, main treatment methods and possible complications.

2. Explore the role of the nurse in ensuring the quality of life of patients who have suffered a stroke.

3. Conduct a practical study of nursing participation in the treatment of patients with stroke in a hospital setting.

4. Analyze the research results.

Research methods:

1. Analysis of literary sources.

2. Observation from practice of two patients with stroke.

stroke cerebral circulation sister

Chapter 1. Stroke

Stroke is an acute cerebrovascular accident (CVA), characterized by the sudden (within minutes, hours) appearance of focal and/or cerebral neurological symptoms that persist for more than 24 hours or lead to the death of the patient in a shorter period of time due to cerebrovascular pathology. Stroke includes cerebral infarction, cerebral hemorrhage and subarachnoid hemorrhage, which have etiopathogenetic and clinical differences. Taking into account the time of regression of neurological deficit, transient cerebrovascular accidents (neurological deficit regresses within 24 hours, unlike the stroke itself) and minor stroke (neurological deficit regresses within three weeks after the onset of the disease) are especially distinguished. Vascular diseases of the brain occupy second place in the structure of mortality from diseases of the circulatory system after coronary heart disease.

Risk factors.

b genetic predisposition;

b increased levels of lipids in the blood, obesity;

b age;

b arterial hypertension;

b heart disease;

b diabetes mellitus;

ь smoking;

b stress;

1.1 Etiology

Ischemic stroke (cerebral infarction)

Ischemic strokes are divided into:

1) thrombotic

2) non-thrombotic.

With ischemic stroke, there is an integration of hemodynamic and metabolic disorders that occur at a certain stage of circulatory failure. Chemical cascade reactions that occur in all areas of the brain (especially damaged ones) lead to changes in neurons, astrocytosis and activation of glia, and disruption of the trophic supply of the brain. The outcome of cascade reactions is the formation of a cerebral infarction. The severity of ischemic stroke is primarily determined by the depth of the decrease in cerebral blood flow, the duration of the preperfusion period and the extent of ischemia. The area of ​​the brain with the most pronounced decrease in blood flow (less than 10 ml/100 g/min) becomes irreversibly damaged within 6-8 minutes from the onset of the first clinical symptoms. The formation of most of the cerebral infarction zone ends within 3-6 hours from the moment the first symptoms of a stroke appear.

Hemorrhagic stroke

Hemorrhagic strokes are divided into the following types of hemorrhages:

a) parenchymal;

b) meningeal (subarachnoid, subdural, epidural);

c) parenchymal-meningeal.

Parenchymal hemorrhages most often occur with hypertension, as well as with secondary hypertension associated with disease of the kidneys or endocrine glands. Less commonly, they develop with vasculitis, connective tissue disease (lupus erythematosus), sepsis, after traumatic brain injury, with hemorrhagic diathesis, uremia. Hemorrhage in the brain develops more often as a result of rupture of a vessel and much less often due to increased permeability of the vascular wall. There are hematomas and hemorrhagic impregnation of brain tissue.

The cause of subarachnoid hemorrhage is most often the rupture of an intracranial aneurysm, less often - the rupture of vessels altered by an atherosclerotic or hypertensive process.

1.2 Classification.

By nature they distinguish:

Ischemic stroke - occurs due to a blood clot or atherosclerotic plaque in the arteries.

· hemorrhagic stroke - occurs as a result of hemorrhage into the substance of the brain or under the meninges during a hypertensive crisis, rupture of a modified vessel.

Along the flow they distinguish:

progressive stroke

completed stroke

According to severity they are distinguished:

b Mild to moderate severity - without disorders of consciousness with a predominance

focal neurological symptoms.

b Severe - with depression of consciousness, signs of cerebral edema, disruption of the activity of other organs and systems.

There is also a separate form of stroke - small stroke (in which neurological symptoms completely disappear after 3 weeks).

Intracerebral hemorrhage.

Most often occurring at the age of 45-60 years. A persistent increase in blood pressure contributes to the weakening of the walls of small cerebral vessels and the development of microaneurysms, the rupture of which leads to hemorrhage into the brain substance. The spilled blood forms a hematoma, which can increase in size over several minutes or hours until a blood clot forms at the site of the rupture of the vessel. In hemorrhage associated with arterial hypertension, hematomas are often localized in the deep parts of the brain, mainly in the area of ​​the internal capsule, where nerve fibers pass that connect the motor and sensory zones of the cerebral cortex with the trunk and spinal cord.

Symptoms of intracerebral hemorrhage:

· The patient may fall and lose consciousness;

· The patient's face becomes purple-red or bluish;

· breathing rare, deep;

involuntary urination

Parenchymal hemorrhage is characterized by:

· intense pain in the head;

· nausea, vomiting;

· depression of consciousness (up to coma);

Subarachnoid hemorrhage (SAH)

Hemorrhage into the intrathecal space of the brain. In 80% of cases, spontaneous subarachnoid hemorrhage is caused by rupture of an intracranial aneurysm. More rare causes of the phenomenon. trauma, intracranial artery dissection, hemorrhagic diathesis. SAH manifests itself as sudden, intense pain in the head.

At the moment of rupture of an aneurysm, the following is observed:

· loss of consciousness;

repeated vomiting;

Half of the patients experience transient headaches within 2-3 weeks associated with compression of adjacent structures by the aneurysm, for example, dilated pupils caused by compression of the oculomotor nerve.

1.3 Clinical picture

A stroke can manifest itself with general cerebral and focal neurological symptoms. General cerebral symptoms of stroke vary. This symptom may occur in the form of impaired consciousness, stupor, drowsiness, or, conversely, agitation; a short-term loss of consciousness may also occur for several minutes. A severe headache may be accompanied by nausea or vomiting. Sometimes dizziness occurs. A person may feel a loss of orientation in time and space. Possible vegetative symptoms: feeling of heat, sweating, palpitations, dry mouth.

Against the background of general cerebral symptoms of stroke, focal symptoms of brain damage appear. The clinical picture is determined by which part of the brain is affected due to damage to the blood vessel supplying it.

If a part of the brain provides the function of movement, then weakness in the arm or leg develops, including paralysis. Loss of strength in the limbs may be accompanied by a decrease in sensitivity in them, impaired speech, and vision. These focal stroke symptoms are mainly associated with damage to the area of ​​the brain supplied by the carotid artery. Muscle weakness (hemiparesis), speech and pronunciation disorders, decreased vision in one eye and pulsation of the carotid artery in the neck on the affected side are characteristic. Sometimes there is unsteadiness of gait, loss of balance, uncontrollable vomiting, dizziness, especially in cases where the blood vessels supplying the areas of the brain responsible for coordinating movements and a sense of body position in space are affected. “Spotty ischemia” occurs in the cerebellum, occipital lobes and deep structures and brain stem. Attacks of dizziness in any direction are observed when objects rotate around a person. Against this background, there may be visual and oculomotor disturbances (strabismus, double vision, decreased visual fields), unsteadiness and instability, deterioration in speech, movements and sensitivity.

1.4 Diagnostics

1. MRI - allows you to see changes in brain tissue, as well as the amount of damaged cells caused by a stroke.

2. Doppler examination of the carotid arteries - The study allows you to see the condition of the arteries, namely, to see the damage to the vessels by atherosclerotic plaques, if any.

3. Transcranial Doppler study - ultrasound examination of cerebral vessels, which provides information about the blood flow in these vessels, as well as about their damage to fatty plaques, if any.

4. Magnetic resonance angiography - similar to an MRI study, only in this study more attention is paid to the vessels of the brain. This study provides information about the presence and location of a blood clot, if any, and also provides information about the blood flow in these vessels.

5. Cerebral angiography - this procedure involves injecting a special contrast agent into the vessels of the brain, and then using X-rays we obtain images of the vessels. This study provides data on the presence and location of blood clots, aneurysms and any vascular defects. This study is more difficult to perform, unlike CT and MRI, but is more informative.

6.ECG - Used in this case to detect any disturbances in heart rhythm (cardiac arrhythmias), which may cause the development of a stroke.

7. Cardiac echocardiogram (Echo-CG) - ultrasound examination of the heart. Allows you to detect any abnormalities in the functioning of the heart, as well as detect defects in the heart valves, which can cause blood clots or blood clots, which in turn can cause a stroke.

8. Biochemical blood test - this analysis is necessary to determine two main indicators:

1. Blood glucose - necessary to establish an accurate diagnosis, since very high or very low levels of glucose in the blood can provoke the development of symptoms similar to a stroke. And also for diagnosing diabetes mellitus.

2. Blood lipids - this test is necessary to determine the content of cholesterol and high-density lipoproteins, which can be one of the causes of stroke.

On-site diagnostics:

It is possible to recognize a stroke on the spot, immediately; For this, three main techniques for recognizing stroke symptoms, the so-called “USP” are used. To do this, ask the victim:

· U - smile. With a stroke, the smile may be crooked, the corner of the lips on one side may be directed downward rather than upward.

· Z - to speak. Say a simple sentence, for example: “The sun is shining outside the window.” With a stroke, pronunciation is often (but not always!) impaired.

· P - raise both hands. If your arms don't rise at the same rate, this could be a sign of a stroke.

Additional diagnostic methods:

· Ask the victim to stick out his tongue. If the tongue is curved or irregular in shape and falls to one side or the other, then this is also a sign of a stroke.

· Ask the victim to stretch his arms forward, palms up, and close his eyes. If one of them begins to involuntarily “move” sideways and downward, this is a sign of a stroke.

If the victim finds it difficult to complete any of these tasks, you must immediately call an ambulance and describe the symptoms to the doctors who arrived at the scene. Even if the symptoms have stopped (transient cerebrovascular accident), there should be one tactic - emergency hospitalization; old age and coma are not contraindications for hospitalization.

There is another mnemonic rule for diagnosing a stroke: U.D.A.R.:

· U - Smile After a stroke, the smile becomes crooked and asymmetrical;

· D - Movement Raise both arms and both legs up at the same time - one of the paired limbs will rise slower and lower;

· A - Articulation Say the word “articulation” or several phrases - after a stroke, diction is impaired, speech sounds inhibited or simply strange;

· R - Decision If you find violations in at least one of the points (compared to the normal state), it’s time to make a decision and call an ambulance. Tell the dispatcher what signs of a stroke (STROKE) you have found and a special resuscitation team will arrive quickly.

1.5 Complications

b Bedsores;

b Vascular thrombosis;

b Pneumonia;

b Paralysis;

ь Death;

Bedsores - Necrosis of soft tissues, which is accompanied by poor circulation.

Vascular thrombosis is a blockage of a blood vessel by a blood clot. As a result, blood does not flow to certain parts of the body. Thrombosis often goes unnoticed.

Inflammation of the lungs - Appears due to a violation of the function of expectoration of sputum accumulating in the lungs.

Paralysis - The patient is unable to move the limbs of the arms and legs;

Coma - Manifests itself in a prolonged loss of consciousness. The person does not respond to the stimulus, breathing is impaired, loses the ability to brain activity, and loses some brain functions.

Death - after hemorrhagic - mortality exceeds 80% of all cases, after ischemic - up to 40%, after subarachnoid hemorrhage - from 30% to 60%.

1.6 First aid for stroke

1) In case of a stroke, the most important thing is to take the person to a specialized hospital as quickly as possible, preferably within the first hour after symptoms are detected. It should be borne in mind that not all hospitals, but only a number of specialized centers are equipped to provide proper modern stroke care. Therefore, attempts to independently transport a patient to the nearest hospital during a stroke are often ineffective, and the first action is to call emergency services for medical transport.

2) Before the ambulance arrives, it is important not to let the patient eat or drink, since the swallowing organs may be paralyzed, and then food entering the respiratory tract can cause suffocation. At the first signs of vomiting, the patient's head is turned to the side so that the vomit does not enter the respiratory tract. It is better to lay the patient down with pillows under his head and shoulders, so that the neck and head form a single line, and this line makes an angle of about 30° to the horizontal. The patient should avoid sudden and intense movements. The patient is unbuttoned from tight, obstructive clothing, his tie is loosened, and his comfort is taken care of.

3) In case of loss of consciousness with absent or agonal breathing, cardiopulmonary resuscitation is started immediately. Its use greatly increases the patient's chances of survival. Determining the absence of a pulse is no longer a necessary condition for starting resuscitation; loss of consciousness and absence of rhythmic breathing are sufficient. The use of portable defibrillators further increases survivability: when in a public place (cafe, airport, etc.), first aid providers need to ask the staff if they have a defibrillator or nearby.

1.7 Treatment

Basic therapy for stroke

Normalization of external respiration and oxygenation function

· Sanitation of the respiratory tract, installation of an air duct. In case of severe disturbances in gas exchange and level of consciousness, endotracheal intubation is performed to ensure patency of the upper respiratory tract for the following indications:

· Patients with acute stroke should be under pulse oximetry monitoring (blood saturation O 2 not lower than 95%). It should be taken into account that ventilation can be significantly disrupted during sleep.

· If hypoxia is detected, oxygen therapy should be prescribed.

· In patients with dysphagia, reduced pharyngeal and cough reflexes, an oro- or nasogastric tube is immediately installed and the need for intubation is decided due to the high risk of aspiration.

Antihypertensive therapy for ischemic stroke.

Blood pressure control in a patient with ischemic stroke, during and after reperfusion therapy (thrombolysis), is achieved with the following drugs:

§ labetalol

§ nicardipine

§ sodium nitroprusside

It is also possible to use the following drugs to lower blood pressure: captopril (Capoten, Captopril tablet), or enalapril (Renitek, Ednit, Enap) orally or sublingually, IV slowly over 5 minutes.

It is also possible to use the following drugs: bendazole (Dibazol) - i.v. clonidine (Clonidine) IV or IM.

Reducing cerebral edema

· Stabilization of systolic blood pressure at the level of 140-150 mm. rt. Art. Maintaining optimal levels of normoglycemia (3.3-6.3 mmol/liter), normonatremia (130-145 mmol/liter), plasma osmolality (280-290 mOsm), hourly diuresis (more than 60 ml per hour). Maintaining normothermia.

· Raising the head end of the bed by 20-30%, eliminating compression of the neck veins, avoiding turning and tilting the head, relieving pain and psychomotor agitation.

· Prescription of osmodiuretics is carried out with increasing cerebral edema and the threat of herniation (i.e. with increasing headache, increasing depression of consciousness, neurological symptoms, development of bradycardia, anisocoria (inequality in the size of the pupils of the right and left eyes)), and is not indicated in a stable condition sick. Glycerin or glycerol, mannitol are prescribed. To maintain the osmotic gradient, it is necessary to replace fluid losses.

· If osmodiuretics are ineffective, it is possible to use 10-25% albumin (1.8-2.0 g/kg body weight), 7.5-10% NaCl (100.0 2-3 times a day) in combination with hypertonic solutions of hydroxyethyl starches (Refortan 10% 500-1000 ml/day).

· Tracheal intubation and artificial ventilation in hyperventilation mode. Moderate hyperventilation (normally, tidal volume is 12-14 ml/kg of ideal body weight; respiratory rate is 16-18 per minute) leads to a rapid and significant decrease in intracranial pressure, its effectiveness remains for 6-12 hours. However, prolonged hyperventilation (more than 6 hours) is rarely used, since the resulting decrease in cerebral blood flow can lead to secondary ischemic damage to the brain substance.

· If the above measures are ineffective, non-depolarizing muscle relaxants (vecuronium, pancuronium), sedatives (diazepam, thiopental, opiates, propofol), lidocaine (Lidocaine hydrochloride solution for injection) are used.

· Drainage of cerebrospinal fluid through a ventriculostomy (a drain placed in the anterior horn of the lateral ventricle), especially in the setting of hydrocephalus, is an effective method of reducing intracranial pressure, but is usually used in cases where intracranial pressure is monitored through the ventricular system. Complications of ventriculostomy include the risk of infection and hemorrhage into the ventricles of the brain.

Symptomatic therapy

Anticonvulsant therapy

For single convulsive seizures, diazepam is prescribed (IV 10 mg in 20 ml of isotonic sodium chloride solution), and again, if necessary, after 15 - 20 minutes. When stopping status epilepticus, diazepam (Relanium), or midazolam 0.2-0.4 mg/kg IV, or lorazepam 0.03-0.07 mg/kg IV is prescribed, and again, if necessary, after 15 - 20 min.

If ineffective: valproic acid 6-10 mg/kg IV for 3-5 minutes, then 0.6 mg/kg IV drip up to 2500 mg/day, or sodium hydroxybutyrate (70 mg/kg on isotonic solution). re at a rate of 1 - 2 ml/min).

If ineffective, thiopental IV bolus 250-350 mg, then IV drip at a rate of 5-8 mg/kg/hour, or hexenal IV bolus 6-8 mg/kg, then IV drip at a rate of 8-8 10 mg/kg/hour.

If these drugs are ineffective, stage 1-2 surgical anesthesia is performed with nitrous oxide mixed with oxygen in a 1:2 ratio for 1.5-2 hours after the end of the convulsions.

Nausea and vomiting

For persistent nausea and vomiting, metoclopramide (Cerucal), or domperidone, or thiethylperazine (Torekan), or perphenazine, or vitamin B 6 (pyridoxine) is prescribed intravenously.

Psychomotor agitation.

For psychomotor agitation, diazepam (Relanium) 10 - 20 mg IM or IV, or sodium hydroxybutyrate 30 - 50 mg/kg IV, or magnesium sulfate (Magnesium sulfate) 2 - 4 mg/hour IV, or haloperidol 5 - 10 mg IV or IM. In severe cases, barbiturates.

For short-term sedation, it is preferable to use fentanyl 50-100 mcg, or sodium thiopental 100-200 mg or propofol 10-20 mg. For procedures of medium duration and transportation to MRI, morphine 2-7 mg or droperidol 1-5 mg is recommended. For long-term sedation, along with opiates, you can use sodium thiopental (bolus 0.75-1.5 mg/kg and infusion 2-3 mg/kg/hour), or diazepam, or droperidol (boluses 0.01-0.1 mg/hour). kg), or propofol (bolus 0.1-0.3 mg/kg; infusion 0.6-6 mg/kg/hour), to which analgesics are usually added.

Adequate nutrition of the patient

Should be started no later than 2 days from the onset of the disease. Self-feeding is prescribed in the absence of impaired consciousness and the ability to swallow. In case of depression of consciousness or impaired swallowing, tube feeding is performed with special nutritional mixtures, the total energy value of which should be 1800-2400 kcal/day, the daily amount of protein 1.5 g/kg, fat 1 g/kg, carbohydrates 2-3 g/kg , water 35 ml/kg, daily amount of administered fluid is at least 1800-2000 ml. Tube feeding is carried out if the patient has uncontrollable vomiting, shock, intestinal obstruction or intestinal ischemia.

Change in muscle tone

After the development of a stroke, the muscle tone in the arms and legs changes, with higher tone in the flexors in the arms, and in the extensors in the legs. If you do not start movement in the spastic limbs in time and do not give them a functionally advantageous position, then contractures may develop leading to the formation of a posture Wernicke-Mann.

The correct position of the limb begins to be given 2-3 days after the stroke.

In the supine position: the arm is straightened at the elbow and wrist joints, supinated, the shoulder is laid to the side, the fingers are straightened, the first finger is laid to the side, the leg is slightly bent at the knee, the foot should be extended at an angle of 90 degrees and placed in a special boot or resting into the headboard.

In the position on the healthy side: the paralyzed limbs should be bent on the floor and laid on a pillow, the healthy leg should be slightly bent and set back, the hand of the paralyzed arm should be extended and laid on the pillow. To avoid rolling down the patient, 1-2 pillows should be placed under the back.

1.8 Stroke prevention

Prevention of strokes consists of maintaining a healthy lifestyle, timely detection of concomitant diseases (especially arterial hypertension, heart rhythm disturbances, diabetes mellitus, hyperlipidemia) and their adequate treatment.

1. Prevention of the development of atherosclerosis. It is necessary to follow a diet, regularly monitor blood cholesterol levels, and take lipid-lowering medications as prescribed by a doctor if lipid metabolism disorders are detected.

2. Regular physical activity is necessary to prevent the development of obesity, type 2 diabetes and hypertension.

3. Stop smoking. Smoking increases the risk of developing cardiovascular disease and atherosclerosis, which leads to stroke

4. Reduction of hyperlipidemia.

5. Fight stress. Unfavorable factors worsen the patient's condition.

To reduce the irritating effect of the drug on the stomach, use aspirin in a coating that does not dissolve in the stomach (thrombo-ASS) or prescribe antacids.

If doses of aspirin are ineffective, anticoagulants (warfarin, neodicoumarin) are prescribed.

1.9 Forecast

Depends on the etiology and course of the underlying vascular disease, on the nature and rate of development of the pathological process in the brain, on the localization and extent of the lesion, as well as on complications.

A poor prognostic sign for hemorrhagic stroke is a deep degree of impairment of consciousness, especially the early development of coma. The appearance of oculomotor disturbances, hormetonia, decerebrate rigidity or diffuse muscle hypotonia, the presence of a disorder of vital functions, pharyngeal paralysis, and hiccups is unfavorable. The prognosis worsens with poor physical condition of patients, especially due to cardiovascular insufficiency.

The prognosis of ischemic stroke is more severe with extensive hemispheric infarctions that developed as a result of acute blockage of the intracranial part of the internal carotid artery, accompanied by disconnection of the arterial circle of the brain, and blockage of the middle cerebral artery, as well as with extensive infarctions of the brain stem due to acute occlusion of the vertebral and basilar arteries. Signs of general cerebral edema and secondary damage to the brain stem, and general circulatory disorders are unfavorable prognostically. The prognosis is more favorable for limited brainstem infarctions, in young people and in satisfactory general condition of the cardiovascular system.

Complete restoration of lost functions is not always achieved. Currently, stroke is the leading cause of disability.

Chapter 2. Practical part

2.1 Nursing process plan for stroke in a hospital setting

The goal of the nursing process for stroke is to create for the patient the conditions necessary for recovery, prevent complications, alleviate suffering, and also provide assistance in fulfilling needs that he cannot fulfill himself at the time of illness.

· Conduct subjective and objective examinations of the patient.

· Identify the violated needs, real and potential problems of the patient.

The nurse carries out:

b Primary assessment of the patient’s condition and risk factors for complications;

b Training the patient and relatives in care and self-care;

b selection of patients and their formation into groups (for example, by duration of stroke, by neurological defect, etc.);

ь conducts practical classes in physical therapy, teaches the patient to monitor his condition, together with the patients draws up a personal card for the post-stroke patient, including information about the duration of the stroke, medications taken, existing other diseases, usual blood pressure levels, contact numbers;

ь gives lectures on combating the main risk factors for stroke, rules of conduct for patients who have suffered a stroke, nutritional therapy;

ь if necessary, refers patients for consultation to a psychotherapist, psychologist, or physiotherapist;

ь calls patients for routine examinations with a neurologist

ь maintains medical documentation;

Nursing Diagnosis Syndrome:

b Syndrome of movement disorders (paralysis, paresis, loss of coordination).

b Sensory impairment syndrome (numbness of the face, arms, legs).

b Speech impairment syndrome (difficulty pronouncing words, impairment of one’s own speech and understanding of others).

b Asthenia (increased fatigue, weakness, irritability, sleep disturbance).

Nursing intervention plan:

Ш Monitor blood pressure, pulse

Ш Carry out ECG monitoring.

Ш Check the patient's observation diary of his condition.

Ш Help the patient understand the medication regimen

Ш Draw up a memo for the patient, write down the medications that the patient takes without a doctor’s prescription;

Ш monitor the timely delivery of tests, if necessary, write out a referral for tests or independently collect samples,

Ш to assess the ability to self-service over time

Ш Conduct control of transferred products by relatives or other close people to inpatients

Ш Teach the patient relaxation techniques to relieve tension and anxiety

Ш Conduct a conversation with the patient/family.

Observation from practice:

A 75-year-old patient is hospitalized in the neurological department with a diagnosis of cerebral infarction in the territory of the right middle cerebral artery. Left-sided hemiparesis. The patient is conscious, there is weakness in the left extremities. He is inactive independently, needs outside help and care.

The patient underwent the following examinations

Laboratory:

· General blood analysis

· Coagulogram

· Blood test for RW

Instrumental:

MRI of the brain

· Chest X-ray

· Ultrasound of neck vessels

Specialist consultations:

· Therapist

· Ophthalmologist

The patient is on bed rest. The nurse helps in meeting physiological needs (if necessary, carries out catheterization of the bladder) and carrying out hygienic measures. Carries out the prevention of bedsores, the development of pneumonia, and transports the patient for examinations.

A gentle diet was prescribed with the exception of animal fat, carbohydrates and table salt. The nurse helps the patient eat.

If necessary, provides tube feeding

Drug therapy:

Infusion therapy is carried out

intravenous drip (Cavinton 4.0 NaCl 200.0)

Intramuscular injections (ethamsylate 2.0; piracetam 5.0; combilipen)

Tablet drugs (Enap 10 mg x 2 times; thrombo ACC 50 mg)

The role of the nurse in this case is to set up a drip system and intramuscular injections. Help with taking pills. Monitors the patient’s condition after taking medications and promptly informs the doctor about the patient’s adverse reactions to the drug.

Algorithms of manipulations performed by a nurse

Algorithm of actions when installing an intravenous system

drip infusions

1. Wear gloves

2. Treat the area of ​​the elbow bend measuring 10*10 cm with a sterile ball of alcohol

3. Treat the area of ​​the punctured vein with a second ball of alcohol

4. Remove excess alcohol with a dry ball

5. Apply a tourniquet and ask the patient to use his fist

6. Puncture with a sterile needle from the system into the vein; if blood appears, place a sterile napkin under the needle

7. Remove the tourniquet and ask the patient to unclench his fist.

8. Connect the system to the needle cannula and open the clamp on the system

9. Secure the needle coupling to the skin with adhesive tape

10.Adjust the flow rate of drops (as prescribed by the doctor)

11. Cover the venipuncture site with a sterile napkin.

12. Apply a clamp to the system or close the valve on the system at the end of infusion therapy

13.Apply a sterile ball to the puncture site and remove the needle from the vein

14.Ask the patient to bend the arm at the elbow joint for 3-5 minutes

15. Throw the used syringe, needle, balls, gloves into a safe disposal box (KBU)

Technique for performing intramuscular injection:

Equipment:

1. soap, individual towel

2. gloves

3. ampoule with medicine

4. file for opening the ampoule

5. sterile tray

6. tray for waste material

7. disposable syringe with a volume of 5 -- 10 ml

8. cotton balls in 70% alcohol

9. skin antiseptic (Lizanin, AHD-200 Special)

10. Covered with a sterile napkin, a sterile patch with sterile tweezers

12. first aid kit “Anti-HIV”

13. containers with disinfectant. solutions (3% chloramine solution, 5% chloramine solution)

14. rags

Preparation for manipulation:

1. Explain to the patient the purpose and course of the upcoming manipulation, obtain the patient’s consent to perform the manipulation.

2. Treat your hands at a hygienic level.

3. Assist the patient into the desired position.

Intramuscular injection technique:

1. Check the expiration date and tightness of the syringe packaging. Open the package, assemble the syringe and place it in a sterile patch.

2. Check the expiration date, name, physical properties and dosage of the drug. Check with the assignment sheet.

3. Take 2 cotton balls with alcohol with sterile tweezers, process and open the ampoule.

4. Fill the syringe with the required amount of the drug, release the air and place the syringe in a sterile patch.

5. Put on gloves and treat the ball with 70% alcohol, throw the balls into a waste tray.

6. Use sterile tweezers to place 3 cotton balls.

7. Treat a large area of ​​skin with the first ball in alcohol centrifugally (or in the direction from bottom to top), treat the puncture site directly with the second ball, wait until the skin dries from the alcohol.

8. Throw the balls into the waste tray.

9. Insert the needle into the muscle at an angle of 90 degrees, leaving 2-3 mm of the needle above the skin.

10. Place your left hand on the piston and inject the medicinal substance.

11. Press a sterile ball to the injection site and quickly remove the needle.

12. Check with the patient how he is feeling.

13. Take the 3rd ball from the patient and escort the patient.

Patients with movement disorders

When serving patients, it is worth remembering to perform the manipulations competently and accurately.

Depending on the severity of the paresis, the patient will need partial support or full movement for him.

The nurse should prevent possible trauma to the patient:

· Ensure unhindered movement.

· Teach the patient the correct use of mobility aids

· Train balance and walking skills

· To prevent the patient from falling out of the bed, it must be equipped with side backrests.

Important to remember

· Do not hold the patient by the neck - this can lead to injury

· Do not pull on the sore arm - this can lead to dislocation of the shoulder joint

· Do not lift the patient by the armpits - this will injure the shoulder of the affected arm and cause pain

Observation from practice:

A patient aged 60 years was admitted to the neurological department. Diagnosed with stroke.

Anamnesis of life:

Sakh has been suffering for 10 years. diabetes

Objectively:

Upon examination, the patient is conscious. Complaints of dizziness, nausea. He tries to pronounce words with difficulty, but understands spoken speech. Movement in the right arm and right leg is impaired. The patient has difficulty remembering current events. There is visual impairment in both eyes. Blood pressure 180/140, pulse 80, t37.1C.

Patient problems:

· dizziness

· Nausea, vomiting

· Movement of arms and legs is impaired

Difficulty with current events

· Visual impairment

Priority problem: dizziness, nausea, vomiting, impaired movement of arms and legs

Goal: To alleviate the patient’s condition, ensure proper discharge of vomit, restore limb movement, perception of events and visual function

Nursing care plan

Conclusion

The tasks of neurological practice at the end of the 20th and beginning of the 21st centuries require higher accuracy of topical diagnostics and a deeper understanding of the pathogenesis of disorders of higher mental functions in focal brain lesions.

According to studies, in patients who have just suffered a cerebral stroke, cerebral blood flow in the stroke area is reduced from the first minutes. A decrease of 20% leads to impaired brain function, and above this figure, changes may be irreversible. This is followed by the destruction of the VPF.

In case of violations of higher mental functions, human activity is observed that returns to the primitive inseparability of the sensory and motor spheres: direct motor manifestation of impulses with the inability to delay their action and form a delayed intention, inability to transform an image that has once arisen by moving attention, complete inability to reason and action to distract from meaningful and familiar structures; a return to primitive forms of reflective imitation are the deepest consequences that are associated with the defeat of higher symbolic systems.

Conclusions: Stroke is much easier to prevent than to treat.

Scientists around the world are looking for methods to prevent and prevent stroke. For example, research work by Harvard University scientists conducted in 2006 showed that it is possible to reduce the risk of disease by 40% with very simple means.

To do this, it is enough to regularly eat vegetables and fruits rich in beta-carotene at least 5 times a week, 200 g each.

Such products were recognized as carrots, sweet potatoes, sweet potatoes and spinach leaves. Spinach can be added to soups, salads, and sandwiches.

The secret of these products is their antioxidant properties; they heal blood vessels, cells and even genes.

Also, constant consumption of food rich in beta-carotenes and vitamin A helps in the fight against the consequences of stroke

In addition to carrots and spinach, pumpkin, tomatoes, oranges, papaya, mango, melon and many other products are also very useful.

Another element for stroke prevention is potassium.

Eating potassium-rich foods every day can also reduce the risk of stroke by 40%.

The required daily dose is 400 mg. This amount of potassium is contained in 200 g of vegetables or fruits eaten daily. Bananas are especially rich in potassium.

In addition to proper nutrition, you should not neglect walks in the fresh air - to actively saturate the brain with oxygen, as well as physical exercise.

Fast walking, running, cycling, skiing, and swimming are encouraged.

Let's not forget about the strength of the load; for some, this may include movements in pastels. The main thing is regularity.

Again, let’s not mention the wonderful exercises of Chinese gymnastics Qigong, because they are suitable for absolutely any age and are aimed at healing and strengthening various human organs.

You should also not neglect the advice - force your brain to work - reading, solving crossword puzzles greatly contribute to increasing brain activity.

Main literature

1. Abbyasov I.Kh., Dvoinikov S.I., Karaseva L.A. and others. Fundamentals of nursing. Edited by Dvoinikov S.I. M.: Academy, 2007. - 336 p.

5. Kadykov A.S., Chernikova L.A., Shvedkov V.V. Life after a stroke (Popular practical guide to the rehabilitation of patients who have suffered a stroke) // Miklos, 2010. - 46 p.

6. Manvelov L.S., Kadykov A.S. Stroke: how to prevent, how to treat, how to restore functions // Institute of General Humanitarian Research, 2007. - 192 p.

10. Organization of specialized nursing care. textbook allowance / N.Yu. Koryagina [and others]; edited by Z.E. Sopina. M.: GEOTAR-Media, 2009. - 464 p.

11. Public health and healthcare: Textbook for medical students. Universities / Ed. V.A. Minyaeva, N.I. Vishnyakova. - 4th ed. - M.: MEDpress-inform, 2006. - P. 340 - 363.

12. Fundamentals of nursing: a reference book / M.Yu. Aleshkina, N.A. Guskova, O.P. Ivanova, S.V. Naumenko, A.M. Sprinz, I.N. Filippova, E.P. Shatova, Z.M. Yudakova; under. ed. A.M. Spritz. -SPb.: SpetsLit, 2009. - 463 p.

Internet resources: http://www.ordodeus.ru/Ordo_Deus12_Insult.html.

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“Rehabilitation” is a term that comes from the French rehabilitation and from the Latin prefix ge- (again), translated as restoration, adaptation.
MR in a broad sense is considered as a system of measures aimed at recovery, compensation and restoration of functions impaired as a result of illness or injury, at the prevention of complications, chronic course and relapses of the disease, at the patient’s adaptation to self-care and work activity in new conditions that have arisen as a result of the disease. At the same time, the task of restoring the patient as an individual and returning him to an active life in society is solved.
In the modern concept, rehabilitation is a system of medical, governmental, socio-economic, professional, pedagogical and legal measures aimed at restoring lost morphophysiological, psychological, and social functions of the body, the ability to work of sick and disabled people.
Medical rehabilitation is impossible without the participation of nursing staff.
The nursing process in medical rehabilitation solves the following problems:
· improving the quality of rehabilitation measures
· reduction of rehabilitation time
· reducing the need for medical personnel
· increasing the role of the nurse in the rehabilitation process;
There are 3 types of rehabilitation - medical, professional and social. Their implementation requires the efforts of specialists of various profiles.
MR begins from the moment of the acute phase of the disease and continues until the maximum possible elimination of physical, mental and occupational
Working with patients with long-term and persistent disability requires special delicacy, warmth, attention and professional training of nurses. The main means of rehabilitation - exercise therapy, massage, physiotherapy - are performed mainly by nurses, or with their participation and control. The quality and timeliness of rehabilitation measures will follow from the organization, creativity, and implementation of set goals and objectives; this will determine the further outcome.
The nurse is the main organizational and treatment position at all or at the most critical stages of the rehabilitation process.
Thus, the nurse is not only a creative organizer of the nursing process, but also a subtle psychologist who creates a favorable microclimate in the department, able to help the patient switch from his illness to the interests of the group, and helps communication and mutual understanding between patients. The nurse must instill faith in the patient, in the possibility of returning to work and his family responsibilities.