The main direction of therapy:
- Suppression of the inflammatory process
- Neutralization of infection
- Brain Edema Prevention
- Restoring the drainage function of the bronchi
- Resuming normal lung function
- Increased immunity
- Prevention or treatment of complications.
To suppress the inflammatory process, drugs with an antibacterial effect are primarily prescribed. The appointment is made based on the patient’s condition, determining the type of pathogen, its resistance to drugs, the presence or absence of an allergic reaction in the patient, concomitant diseases.
Unfortunately, even with well-equipped laboratories, it is only possible to establish the exact cause of the disease immediately in only 50-60% of cases. The situation is complicated not only by the presence of several pathogens, but also by their resistance to drugs that developed in a hospital setting. But in order to prevent aggravation of the disease and the development of complications, the correct and timely administration of drugs is extremely important.
The effectiveness of the treatment is checked after 1-5 days using laboratory or microbiological studies, and if necessary, adjust the treatment regimen. Performance indicators are:
- Temperature reduction
- Decreased sputum with pus
- Leukocytosis reduction
- Slowing or stopping the inflammatory process.
Further appointment is made on the basis of data from previous treatment. The duration of antibiotic use can take from 5 days to one and a half months – depending on the type of pathogen, the severity of the patient’s condition.
To improve the patient’s condition, it is of great importance to carry out measures to improve the drainage function of the lungs. To do this, medicines with an expectorant and mucolytic effect are prescribed, physiotherapy is carried out: massage, breathing exercises.
In a severe form of the disease, patients undergo a plasma transfusion, detoxification therapy is prescribed.
Provide fresh air: more often ventilate the room, observing the necessary precautions to prevent overcooling of the patient.
Carry out oral hygiene. This will prevent the development of infection. If the patient is not able to independently carry out the procedures, you will need to help him in this.
Frequent change of position: the patient will need to be turned over every two hours to ensure normal air movement and reduce stagnation.
If the patient’s condition allows, he needs to ensure a semi-recumbent position (at an angle of 45 °) – it will improve lung ventilation.
Therapeutic massage is necessary to improve the separation and release of sputum. The session is held three times a day.
Breathing exercises. To restore the functions of the respiratory system, inflation of balloons or children’s toys helps a lot. The procedure is recommended to be carried out as often as possible, one and a half hours after a meal.
Early activation of the victim. Doctors recommend stimulating the patient to do breathing exercises, and, if possible, to turn over on their own and take a sitting position. The beginning of the rehabilitation exercises is determined by the doctor, based on the patient’s condition.
The prognosis for treating pneumonia in people with or after a stroke depends on many factors. Of great importance is the prevention of the disease, timely diagnosis, proper treatment.
Inflammation of the lungs is the most common complication of a severe stroke. According to various literature data, pneumonia accompanies from 30% to 50% of all patients with stroke, and in 10% -15% it causes death.
Risk factors for the development of this complication include:
- old age over 65 years;
- chronic pulmonary and heart disease;
- sharp depression of consciousness after a stroke (below 9 points on the Glazko coma scale);
- prolonged mechanical ventilation for more than 7 days;
- prolonged hospitalization and adynamia;
- taking a number of drugs (H2 blockers).
The pathophysiological causes of pneumonia after a stroke include:
- depression of consciousness;
- central respiratory failure;
- hypodynamic changes in blood flow in the pulmonary circulation.
Massive damage to the brain causes damage to the mechanisms of self-regulation and self-defense of the body. The drainage function of the lungs is impaired, the cough reflex is reduced, the normal microflora is replaced by highly virulent strains of nosocomial infection, which contributes to the rapid development of the disease.
Prolonged mechanical ventilation after stroke or aspiration are also direct causes of pathogenic flora entering the respiratory tract.
The most common causative agents of pneumonia after a stroke:
- Staphylococcus aureus;
- pneumonia streptococcus;
- blue pus bacillus;
- E. coli and other gram-negative pathogens characteristic of nosocomial pneumonia.
There are early and late pneumonia, which differ in the mechanism of development. In the pathogenesis of early pneumonia, which occurs in the first 2-3 days of hospitalization, a decisive role belongs to the dysregulation of the central nervous system. The speed of the complication depends on the area of the brain in which the focus of ischemic or hemorrhagic changes arose. In the lungs, edema and foci of plethora are detected.
At a later date – 2-6 weeks, the main reason for the development of pathological inflammatory changes in the lungs is hypostatic processes.
Even at the current level of medical development, the diagnosis of pneumonia against the background of a stroke remains an unresolved problem. Delayed correct diagnosis contributes to the development of a number of complications that lead to death.
Symptoms of early pneumonia are veiled by manifestations of the underlying disease and are often nonspecific:
- increased body temperature;
- respiratory disorders – shortness of breath, pathological Cheyne-Stokes and Kussmaul;
- cough is rarely observed due to inhibition of the central cough reflex;
- with the development of pulmonary edema, bubbling breathing, small bubbling rales are added.
Late pneumonia develops already against the background of positive dynamics in neurological status and does not present such difficulties.
The main clinical and laboratory indicators of pneumonia are:
- Fever above 38 ° C and a decrease in temperature below 36 ° C;
- Severe blood leukocytosis, less often leukopenia with a shift of the leukocyte formula to the left;
- Purulent discharge from the trachea;
- Focal changes in the lungs are detected by x-ray studies;
- Violation of the gas composition of the blood.
Suspicion of the development of pneumonia is exposed in the presence of three of the above criteria, and a combination of four signs allows you to establish a diagnosis of pneumonia.
Therapeutic measures are aimed at suppressing infection, stopping cerebral edema, and fighting pulmonary edema.
Empirically prescribe antibacterial drugs immediately after diagnosis and in large doses, often combining drugs from different groups. After 72 hours, the choice of antibiotic is adjusted depending on:
- identified in the future type of pathogen;
- the sensitivity of the strain to chemotherapy;
- response of the body.
In addition, diuretics, cardiotonics, expectorant drugs, mucolytics are administered, oxygenation, physiotherapy, and respiratory gymnastics are used.
Preventive measures are as follows:
- Reducing the amount of pathogenic flora in the upper respiratory tract – elevated head end of the patient, daily sanitation of the nasopharynx and physiotherapy;
- Compliance with the hygiene of therapeutic measures, the rules of asepsis and antiseptics;
- The use of modern tracheostomy tubes and close monitoring of the patient.
The appointment of antibacterial drugs as a prevention of pneumonia is not recommended.
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It is necessary to ensure that the diseased leg never hangs and is always suspended;
If the patient is sitting, then a pillow should be put on the armrest, on which to lay the sick hand. And for a sore leg, use a stand that should provide the maximum horizontal position of the limb. Keep your back straight while sitting. It is advisable to put a small pillow on the stand, it will increase the area of support and reduce swelling;
To normalize blood circulation, you often need to change the position of the swollen legs.
- Massage with ice cubes.
It is best to make ice from medicinal plants. Prepare an infusion of mountain arnica, yarrow, eucalyptus or peppermint and freeze it. Before going to bed, massage your sore leg with such a piece of ice.
- Cold compress.
At night, soak a cotton cloth in cold water, wrap the affected leg with it, and wrap cellophane on top. In the morning, remove the compress and massage your legs with movements that are directed from top to bottom.
You can wear not ordinary socks or tights, but special stockings – medical. It is also recommended to drink as little as possible liquid after seven in the evening.
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