Chizindikiro Chachikulu kwa Ambiri Ndi Moyo Woperewera Kudwala
Kutenga ndi chizindikiro chofala kwa odwala pafupi mapeto a moyo. Kugonana kungakhudzidwe kwambiri pa umoyo wa moyo kotero kupewa ndi kuchiza n'kofunika.
Kuletsa Kutseka
Ndi bwino kuteteza kudzimbidwa ngati kuli kotheka. Kusamalira odwala ndi odwala opaleshoni amaphunzitsidwa kufunsa za kayendedwe kambirimbiri ndipo ndi kofunika, kukhala woona mtima ndi mayankho anu.
Kupewa kudzimbidwa kumadalira chiopsezo chokhala wobvomerezeka. Mwachitsanzo, wodwala yemwe ali ndi kansa ya m'mimba, shuga komanso akumwa mankhwala opweteka opioid nthawi zonse amakhala pachiopsezo chachikulu. Ndichifukwa chakuti ziwalo za m'mimba zimatha kupweteka kapena kuchepetsa chifuwa, matenda a shuga amaletsa ululu komanso amachepetsa m'mimba, komanso amachititsa kuti phokoso likhale lopanda pang'onopang'ono. Kupewa kwa wodwala uyu kungakhale koopsa kwambiri kuposa wodwala amene ali ndi, kunena, dementia.
Kupewa kumayang'ana pa kudya kokwanira kwa madzi, chakudya choyenera, ndi ntchito (kukhala yogwira ntchito kumakhudza matumbo).
Zakudya, Chakudya Choyenera ndi Kuchita Zopewera Ndi Zida Zothandizira
Izi nthawi zambiri zimakhala zovuta kuwonjezeka kwa munthu amene akudwala, komabe ngakhale kuwonjezeka kwakung'ono kwa madzi okwanira kungakhale kopindulitsa. Kuwonjezeka kwa zakudya zowonjezera kungawononge kwambiri ndipo sikuyenera kukakamizidwa, koma mofatsa kulimbikitsa chakudya chaching'ono kangapo kungakhale kothandiza.
Ntchito yowonjezereka, ngakhale ngati ili ndi mawonekedwe osiyanasiyana othamanga ndi thandizo laumoyo kapena wodwalayo, ingakhale yothandiza kwambiri.
Zosungira zida zimagwiritsidwa ntchito kusunga malowo mosavuta, kuwapangitsa kukhala kosavuta kudutsa. Ochepetsa zida, monga senna, ndi ofunika kwambiri kwa odwala opaleshoni ya opioid.
Kuchiza Kugonjetsedwa
Pamene kupewa sikukwanira ndipo wodwalayo amadzimbidwa, ndikofunika kuyamba mankhwala mwamsanga. Mankhwalawa amagwiritsidwa ntchito pochiritsa ndipo amagawidwa ndi zochita zawo.
Laxative Zambiri. Mankhwalawa amachititsa kuti matumbo awonjezere kuchuluka kwa chinsalu, zomwe zimapangitsa matumbo kusuntha. Zakudya za zakudya ndi chitsanzo cha mankhwala ambirimbiri odzola. Mankhwala odzaza kwambiri sangakhale yankho kwa odwala ambiri odwala matenda opatsirana komanso odwala matendawa chifukwa amafuna kuti madzi aziwathandiza kwambiri. Ngati wodwalayo sangathe kusunga madzi okwanira, mavitamini ambiri amatha kupweteka kwambiri ndikuwonjezera vutoli. Mankhwala obiriwira amatha kupangitsanso mpweya komanso kuphulika.
Laxatives zamakina. Mankhwalawa amafewetsa pansi ndipo amawotcha pamwamba pa chitsimecho, kuti chikhale chosavuta kudutsa. Mafuta a mchere ndiwo mtundu wambiri wa mafuta onunkhira. Mafuta a mineral sali ovomerezeka kwa odwala omwe ali pangozi ya aspiration , kapena omwe amatenga docusate (Colace).
Mankhwala osakaniza / osakaniza. Mankhwalawa, omwe amadziwika kuti otchedwa softolers, amachititsa kuchepetsa kutentha kwa madzi, motero kumatulutsa madzi ndi mafuta mu zitsulo zouma. Docusate, senna, ndi mafuta okwera ndi zitsanzo.
Osmotic Laxatives. Mafinya a Osmotic ndiwo shuga omwe sungathe kudetsedwa ndi thupi ndipo amakhala ndi matumbo osokonezeka m'matumbo.
Lactulose ndi sorbitol ndi mitundu ya osmotic laxatives ndipo nthawi zambiri imakhala yogwira mtima. Mankhwalawa ndi othandiza kwambiri odwala ambiri ndipo amachititsa kuti maluwa ndi magetsi aziphulika. Zikhoza kuphatikiza ndi madzi, tiyi, madzi, kapena madzi ena kuti achepetse kukoma.
Glycerin suppositories ndi chitsanzo china cha osmotic laxatives. Glycerin suppositories mwina sangakhale yothandiza monga njira zina mu wodwalayo kapena wodwala wodwala.
Saline Laxatives: Mkaka wa magnesia mwina ndiwo mtundu wambiri wa mankhwalawa. Saline laxatives kuwonjezera chapamimba, pancreatic, ndi zobisika za m'mimba zamkati ndi m'mimba motility.
Mankhwalawa amatha kupweteka kwambiri komanso kumagwiritsidwa ntchito ngati njira yomaliza yopatsira odwala matenda opatsirana.
Suppositories ndi Enemas: Zamadzimadzi ena amapezeka mu fomu yodzitetezera, kutanthauza kuti amaikidwa mwachindunji mu rectum. Ngakhale kuti kugwiritsira ntchito mankhwala a rectal kungakhale kosasangalatsa kwa odwala ndi osamalidwa angagwedezeke kuti ayambe kuwaika, ma suppositories kawirikawiri amakhala ofulumira komanso ogwira mtima. Bisacodyl (Dulcolax) ndi mankhwala omwe amagwira ntchito mwachindunji pa colon kuti apangitse osowa. Chifukwa chochititsa chidwi, kupweteka ndi njira yowonekera. Dulcolax sikuti nthawi zonse amalimbikitsidwa kwa odwala khansa ndi odwala matenda a chiwindi chifukwa cha kufunika kokhala ndi kagayidwe kabwino ka magazi, kapena kuwonongeka, m'chiwindi.
Enemas ikuyenera kugwiritsidwa ntchito mosalekeza komanso ngati njira yomalizira odwala odwala kwambiri. Saline enemas (Fleet Enema) amamasula chithunzithunzi ndipo amachititsa kuti thupi liziyenda . Ngati zimagwiritsidwa ntchito nthawi zambiri, zimatha kuyambitsa kusamvana kwapadera monga hypocalcemia (kuchepa m'magazi a calcium) ndi hyperphosphatemia (kuchuluka kwa magazi ndi phosphate levels).
Mafuta osungirako mafuta amatha kukhala othandiza kwa odwala amene amakhudzidwa, kutanthauza kuti chophimba ndi chachikulu komanso chovuta kwambiri kuti chizimitsekanso. Ngati wodwalayo angathe kusunga maema a mafuta usiku womwewo, izi zingayesedwe pamaso pa namwino kuti asatengere. Chitsanzo cha enema ya kusungirako mafuta ndi enema ya milk-and-molasses.
Kusiyanitsa: Ngati wodwalayo ali ndi vuto ndi mankhwala ophera mankhwala, suppositories, ndi enemas sakugwira ntchito kapena sakuvomerezedwa, namwino angafunikire kuwasokoneza. Iyi ndi njira yosasangalatsa pamene namwino ayenera kuika chala chake mu rectum kuti amasule ndi kuchotsa chotupa. Mutha kuwerengera ngakhale kuwerenga za njira yake. Dziwani kuti kusagwirizana ndizochitika pokhapokha ngati mukufunikira kuchipatala. Chifukwa chosamvetsetseka komanso chokhumudwitsa kwambiri, odwala ayenera kukonzekera ndi opioid analgesic ndipo mwina nkhawa, monga lorazepam.
Kutenga ndi chizindikiro chovutitsa chimene chimakhudza kwambiri khalidwe la moyo. Ndikofunika kuti wothandizira zaumoyo adziwe za kusuntha kwa thupi lanu kapena wodwalayo ndi kuwachenjeza kusintha kulikonse kwa kayendedwe kake.
Zotsatira:
> Bleser S, Brunton S, Carmichael B, Okalamba K, Rasch R, Steele J. Kugonjera kwachikhalire: Malangizo ochokera ku mgwirizanowu. J Fam Pract. 2005 Aug, 54 (8): 691-8.
> Ferrell, > BR >, ndi Coyle, N; Buku la Palliative Nursing, Oxford University Press, 2006.