Caring for bed-ridden patients: How to prevent complications

• Bed-ridden patients who are partially or fully paralyzed as a result of a stroke may suffer a number of potential complications, such as bed sores, urinary tract infections and lung infections.
• Caring for patients or relatives who are bed-ridden in a way that helps to prevent complications can be done by ensuring vital aspects of their health are managed according to the advice of their doctor, such as maintaining a healthy blood pressure, body temperature and blood glucose level.

Bed sores

Bed sores occur when an area of skin has been placed under pressure for an extended period, leading to blood being unable to reach the affected skin tissue properly. This lack of circulation results in a red sore that can affect the deep skin and muscle tissues in that area.

There are 4 stages regarding bed sores:

• 1st stage: A red sore that does not disappear when a finger is pressed against it.
• 2nd stage: Some areas of skin begin to peel, while the sore may begin to blister or develop into a shallow wound.
• 3rd stage: An open wound that reaches the fatty layer of skin tissue. Muscle and bone will not yet be visible.
• 4th stage: An open wound that reaches muscle, tendon and bone.

Bed sores tend to occur at areas where bones protrude. Bed sores can result in pain and infection, and those that are left untreated can lead to extremely complicated infections.

Bed sores can be prevented by moving the patient from one side to another and changing their lying position every 2 hours. This includes, for example, moving them from lying on their left side to lying on their back, right side or on their front (where suitable). Moreover, pillows, airbeds or soft blankets can be used to cushion key contact points and avoid friction.

Should a bed sore develop, it is essential that it be treated immediately by taking any weight off that area of skin.

Lung infections in bed-ridden patients usually occur as a result of swallowing their food, which is a problematic process for this group of patients. Should medical staff deem a bed-ridden patient unable to swallow independently, they will advise fitting a tube through which food can be administered, while gradually retraining the patient in how to swallow each type of food. During this time, they may be given liquid foods, such as blended rice congee, to analyze their preparedness for swallowing more solid foods. However, the position from which they eat may also be adjusted, ensuring they are sitting up at 90 degrees from their bed.

If a patient experiences coughing, shallow breathing, low blood oxygen levels or a fever it could indicate a lung infection. The patient should visit a doctor, who can diagnose the problem and prescribe the proper treatment.

• Ensure patients receive at least 3,000 cc of water per day or as advised by their doctor. They should not be given any drinks that contain caffeine or alcohol.
• In patients who rely on a catheter, caregivers should ensure their sexual organs, groin area, and skin where the catheter is inserted is cleaned at least twice per day. Cleaning should involve the use of soap, while the catheter should be replaced every two weeks.
• Urine should be emptied from the packet when the level reaches around two thirds full, or every 3 hours, and caregivers are strongly advised to wash their hands carefully after emptying the packet.
• In patients who urinate independently but cannot properly drain their urinary tract, it is advised that a catheter be fitted when urine becomes backed up.

Caregivers should seek medical attention in order to have the patient undergo a diagnosis and receive treatment if any of the following complications arise: increasingly concentrated urine color, large amounts of sediment present in urine, pus becoming apparent alongside urine leaking from the opening where the catheter is inserted, or a fever.

Bed-ridden patients who have difficulty passing solids, experience constipation, or have less than 3 bowel movements per week could be experiencing these symptoms as a result of the following issues:

• Weakening of bowel contractions due to a lack of movement
• Not getting enough fiber in their diet
• Not drinking enough water
• Repressing bowel movements Using medication, such as muscle relaxants, which causes a decrease in bowel movements

Basic treatment for these issues can take the form of laxative medication, including those that increase fiber, those that improve bowel strength, and those that encourage bowel movements. However, should you find that the patient’s stools are overly hard, blood is passed with the stools, the patient finds it difficult to pass stools, or the patient frequently experiences indigestion, it is recommended that a doctor be consulted.

Current technologies have made close monitoring of bed-ridden patients easier than ever before. Complications can now be detected at the outset, allowing for preventive measures to be put in place before conditions deteriorate. These measures can also improve the lives of the patient’s relatives, including those who may play the role of main caregiver.

Bringing a bed-ridden patient to the hospital when it is time for a hospital-based blood test or doctor’s appointment is of the utmost importance, although many hospital visits often take the better part of a day to complete.

Stroke Telecare is a service available to patients with partial or full paralysis, offering care to those who have been released home after treatment. The service includes physiotherapy through our 24-hour Telecare system. Stroke Telecare also includes physiotherapist home visits, home blood tests, and real-time vital sign monitoring services for bed-ridden patients. Moreover, for caregivers who are lacking in confidence, we offer 24-hour doctor consultations via video call, allowing caregivers to communicate with doctors who can prescribe medication that can either be bought over the counter or ordered through our medication delivery service.

Research has indicated that the most crucial time with regard to the rehabilitation of a stroke victim is the initial year following their injury. Patients receiving proper rehabilitation during this time will have the best chance at making a full and speedy recovery. Physiotherapy carried out during the initial 12 months is of the utmost importance. It is natural for relatives to worry about whether they are capable of carrying out effective physiotherapy on the patient at home. Our recommendation is to seek the advice of a doctor or physiotherapist, who will be able to teach you the correct methods involved.