床上翻身训练

Turning Training in Bed

王爷爷，75岁，脑血栓后遗症，左侧肢体活动障碍，自主翻身困难。根据康复师的训练方案，请养老健康照护师指导王爷爷进行床上翻身的功能训练。

Mr. Wang, 75 years old, has suffered from cerebral thrombosis sequela, with a left limb movement disorder, and had a difficulty in turning actively. The caregiver shall instruct Mr. Wang to carry out function training on turning in bed according to the rehabilitation therapist's training program.

步骤1：工作准备

Step 1: Preparation

1、环境准备：干净整齐﹔温湿度适宜

1. Preparation of environment: The environment shall be clean and tidy with proper temperature and humidity

2、照护人员准备：着装整洁﹔七步洗手法洗净双手

2. Preparation of caregiver: The caregiver shall dress neatly and wash hands with the seven-step hand washing method

3、物品准备：护理车、软枕、毛巾、免洗洗手液、记录单、笔

3. Preparation of articles: Care cart, soft pillow, towel, hand sanitizer, record sheets and pen

4、老年人准备：老年人排尿后平卧于床上

4. Preparation of the elderly: The elderly shall lie supine in bed after urination

步骤2：评估与沟通

Step 2: Assessment and Communication

5、沟通：推车携物至老年人床前﹔了解老年人有无训练意愿

5. Communication: Push the cart with articles to the bedside of the elderly and understand whether the elderly are willing to participate in training

6、评估：评估老年人身体状况﹔检查肢体活动能力

6. Assessment: Assess the physical condition of the elderly and check the limb mobility

7、介绍训练目标：训练躯干旋转，缓解痉挛，提高老年人的床上生活自理能力；改善患侧肢体的运动功能，防治并发症

7. Introduction to training objectives: Train the trunk rotation, relieve spasm and improve the self-care ability of the elderly in bed; improve the motor function of the affected limbs, prevent and treat complications

8、介绍训练内容：指导老年人在床上向患侧及健侧进行自主翻身动作的训练

8. Introduction to the training content: Instruct the elderly to carry out the training of turning actively to the affected side and unaffected side in bed

9、介绍训练时间：根据老年人具体情况，确定老年人每天训练至少2-3次；每次不超过30分钟，循序渐进进行

9. Introduction to training time: According to the specific situation of the elderly, it is determined that the elderly shall be trained at least 2-3 times a day, with each time not exceeding 30 min, and the training shall be carried out step by step

步骤3：翻身训练

Step 3: Perform Turning Training

10、翻向健侧：打开床挡，协助老人仰卧位；健侧下肢屈髋屈膝，健侧脚插入患侧腿的下方钩住患肢；双手叉握，健侧手握住患侧手；患手拇指压在健侧拇指上，双上肢前伸90 度，头转向健侧方；用健侧上肢的力量借助惯性作用，带动患侧上肢来回摆动2～3 次；在身体旋转同时，利用健侧膝部的力量带动患侧身体翻向健侧，调整为健侧卧位。至少连续做2 次。

10. Turn to the unaffected side: Open the bed guardrail to assist the elderly in supine position; flex the hip and knee of the lower limb on the unaffected side, and stretch the foot on the unaffected side to the lower part of the affected leg to hook the affected limb; hold hands together; press the thumb of the affected hand on the thumb of the unaffected side, extend both upper limbs forward by 90°, and turn the head to the unaffected side; drive the affected upper limb to swing back and forth 2 - 3 times with the force of the unaffected upper limb and the help of inertia effects; while rotating the body, use the strength of the unaffected knee to drive the affected body to turn to the unaffected side and adjust it to the unaffected side lying position. At least perform twice consecutively.

11、翻向患侧：老人取仰卧位；健侧下肢屈髋屈膝；头转向患侧方；双手叉握，健侧手握住患侧手；患手拇指压在健手拇指上，双手上肢前伸90 度；用健侧上肢的力量带动患侧上肢来回摆动2～3 次后，借助惯性作用翻向患侧。同时，健侧下肢跨向患肢前方，调整为患侧卧位。至少连续做2 次。

11. Turn to the affected side: The elderly is in the supine position; flex the hip and knee of the lower limb on the unaffected side; turn head to the affected side; hold hands together; press the thumb of the affected hand on the thumb of the unaffected side, extend both upper limbs forward by 90°; drive the affected upper limb to swing back and forth 2 - 3 times with the force of the unaffected upper limb, and then turn to the affected side with the help of inertia effects. At the same time, stretch the lower limb on the unaffected side to the front of the affected limb and adjust to lie on the affected side. At least perform twice consecutively.

12.调整卧位：调整老人舒适卧位，患侧在下；患肩关节前伸稍内旋，患侧上肢伸展垫软枕；健侧上肢自然位；患侧下肢微屈，踝部功能位垫小软枕；健侧下肢呈迈步状，其小腿下垫一中软枕，颈下垫一小软枕，背后用大软枕支撑。

12. Adjust to lying position: Assist the elderly in lying on the affected side comfortably; adjust the affected shoulder joint to a medial rotation position, extend the affected upper limb and pad with a soft pillow; make the unaffected upper limb in a natural position; slightly bend the affected lower limb, and pad the ankle functional site with a small soft pillow; adjust the lower limbs on the unaffected side in a step-like position, with a middle soft pillow under the lower leg and a small soft pillow under the neck; support the back with a large soft pillow.

步骤4：观察记录

Step 4: Observe and Record

13、训练过程中应注意：照护人员随时观察老年人反应及其感受；随时擦净汗液﹔随时与老年人沟通，发现异常立即停止﹔感受老年人表现有进步时应及时给予鼓励。

13. Attention shall be paid during training: The caregiver shall observe the reactions and feelings of the elderly at any time; wipe off sweat and communicate with the elderly at any time; stop the training immediately in case of any abnormalities; encourage the elderly in time if the elderly has an improved performance.

14、洗手、记录记训练时间、内容、老年人感受、反应等。

14. Wash hands and record the training time, content, feelings and reactions of the elderly.

注意事项

Precautions

1、根据老年人肢体障碍情况选择不同的康复训练项目；

1. Choose different rehabilitation training programs according to the physical disabilities of the elderly;

2、训练中应以绶慢温和的语速告诉老年人每一项操作的步骤；把每一步具体动作加以分解，反复示范；

2. During training, the caregiver shall tell the elderly the steps of each operation at a slow and gentle speed; divide each step and demonstrate it repeatedly;

4、老年人的康复训练要有计划性、规律性，并持之以恒；

4. The rehabilitation training of the elderly shall be planned, regular and persistent;

5、照护人员要尊重、理解肢体障碍老年人，鼓励老人及家属主动参与积极配合训练。

5. The caregiver shall respect and understand the elderly with physical disabilities, and encourage the elderly and their families to actively participate in the training.