Retrospective registration

Study for clinical effect of rehabilitation nursing program for patients with novel coronavirus pneumonia (COVID-19)

Study for clinical effect of rehabilitation nursing program for patients with novel coronavirus pneumonia (COVID-19)

Huang Di 

Jiang ZhiXia 

149 Dalian Road, Huichuan District, Zunyi, Guizhou, China

149 Dalian Road, Huichuan District, Zunyi, Guizhou, China

Affiliated Hospital of Zunyi Medical University

Affiliated Hospital of Zunyi Medical University

No

Affiliated Hospital of Zunyi Medical University

149 Dalian Road, Huichuan District, Zunyi, Guizhou, China

Not

Novel Coronavirus Pneumonia (COVID-19)

Interventional study

1

Case-Control study 

To improve the symptoms of dyspnea and dysfunction of patients with new coronary pneumonia discharged from hospital, reduce complications, relieve anxiety and depression, reduce disability, maximize the ability of daily living and improve the quality of life.

Respiratory function exercise Reducing lip breathing training, abdominal breathing training and whole body breathing exercises. (1) Light and ordinary: Training items: Reducing lip breathing training, abdominal breathing training, whole body breathing exercises. 1) Lip-reduction breathing training and abdominal breathing training, 4 groups daily, 8-10 times per group; 7: 00-7: 15, 9: 00-9: 15, 16: 00-16: 15 22: 30-23: 00, guided by medical staff or completed by the patient. 2) Whole body breathing exercises: 2 groups daily, each group completes neck exercise, chest expansion exercise, turning exercise, waist rotation exercise, side flexion exercise, squat exercise, and in-situ stepping twice. It will be completed at 9: 00-9: 15, 16: 00-16: 15 under the guidance of medical staff. (2) Heavy / critical: 1) Training method: follow the order from lying position, sitting position, leaving bed position, standing position. Medical staff monitor the changes of patients' heart rate, blood pressure, and blood oxygen saturation, maintain blood oxygen saturation ≥93%, and heart rate ≤120 beats / min. Decide whether to proceed based on the patient's symptoms and signs. The time is controlled within 10-15 minutes. 2) Training items: Reducing lip breathing training, abdominal breathing training, whole body breathing exercises. ① Lip-reducing breathing training and abdominal breathing training: 3 groups daily, 8-10 times each; in the medical service at 9: 00-9: 15, 16: 00-16: 15, 22: 30-22: 45 respectively Under the guidance of personnel monitoring. ② Whole body breathing exercises: The patient can complete neck movement, chest expansion exercise, turning exercise, waist rotation exercise, and side flexion exercise when the patient is seated; neck movement, chest expansion exercise, turning exercise, waist rotation exercise, side curvature exercise, in situ when standing Stepping and squatting exercise; 2 groups daily, 9: 00-9: 15, 16: 00-16: 15, completed by medical staff monitoring and guidance. 2. Physical function training (1) Aerobic exercise: formulate aerobic exercise prescriptions for patients with combined basic diseases and residual dysfunction. Light and ordinary types, including stepping, jogging, brisk walking, jogging, Taijiquan, Baduanjin and other sports; heavy / critical heavy, for patients who are prone to fatigue can take intermittent exercise. 1. Light and common patients: Training items: Baduanjin, Taijiquan, radio gymnastics, choose optional items according to the patient's sports habits and hobbies (slow walking, fast walking, jogging, badminton, table tennis, skipping rope, etc.) Specific arrangements for each training item: Baduanjin: 2 times a day, 15 minutes each time; Taijiquan: 2 times a day, 10 minutes each time; Broadcast gymnastics: 2 times a day, 1 time each time; Optional items: Patients can choose one of jogging, brisk walking, jogging, badminton, table tennis, and rope skipping, etc., twice a day for 10 minutes each time. Each project is completed daily from 09: 00-11: 00 and 15: 00-17: 00 with the guidance of medical staff. 2) Heavy / critical ① Training method: follow the order from lying position, sitting position, out of bed sitting position, standing position. Medical staff monitor the patient's heart rate, blood pressure, and blood oxygen saturation changes, maintain blood oxygen saturation ≥93%, heart rate ≤130 beats / min, and decide whether to continue according to the patient's conscious symptoms and signs, and control the time within 10-15 minutes. ② Training items: A. Bed movements Extremities joint muscle exercise (carpal and knuckle grasping training, wrist flexion and extension, elbow flexion and extension, upper limb lifting and back rotation, ankle pump training, knee flexion training, aerial cycling training), raising the bed head- Sitting training, bed sitting, upper and lower extremity stepper training; 2 eight beats per exercise, twice a day, completed at 9:30 and 16:30 under the guidance of medical staff. B. Out of bed exercises Upper and lower limb stepper training, standing, stepping in place, walking slowly, Baduanjin, etc. a. Upper and lower extremity stepper training: Complete four eight beats for each of the upper and lower extremities without resistance, twice a day; b. Standing / Standing / Walking slowly: Alternately, the total activity time is controlled within 10-15 minutes; c. Baduanjin: 2 times a day, each exercise time is determined by the medical staff to not exceed the patient's basic heart rate by 20% in real time; The out-of-bed exercise is performed twice a day at 09: 00-11: 00, 15: 00-17: 00, accompanied by medical staff, under the guidance and supervision, and is mainly in the form of intermittent exercise. The medical staff evaluates and evaluates the patient's symptoms. The patient's heart rate, blood pressure, blood oxygen saturation, and physical condition determine whether to continue. The remaining items such as Tai Chi and radio gymnastics can be compared with light and general patients. After assessing vital signs and patient's subjective symptoms, they can choose according to the patient's personal preference. (2) Strength training Training equipment: dumbbells. 1) Dumbbell weight selection: The patient uses dumbbells for the first time to exercise, and the maximum weight that can be completed for 12 consecutive curls is the basic weight of the patient's choice of dumbbell weights. After that, the above method is used to evaluate the dumbbells every two weeks to adjust the patient training dumbbell weight. 2) Training items: 2 sets of dumbbell curls, 12 times in each group, 1 minute rest between groups; dumbbells alternately lift 2 sets of 12 times in each group, 1 minute rest between groups, 3-5 minutes rest between different items; , The patient can choose 1-2 other training items according to his own situation; record the time spent for each item at the end of the training. 3) Training time: 3 times a week, the total time of each training does not exceed 30 minutes; the time is arranged on Monday and week Wednesday and Friday 15: 00-16: 00. 4) Patient evaluation: Evaluate the patient's heart rate, blood pressure, blood oxygen saturation, and physical condition before exercise. After completing the two items of dumbbell curl, alternate dumbbell lifting, evaluate the patient's heart rate, blood pressure, blood oxygen saturation, and physical condition again. . 3. Activities of daily living ability training Encourage patients to participate in self-life care and gradually return to normal according to their living ability. Guide daily activities for patients. Light and general, including self-care ability, communication, daily household chores, etc .; heavy and critical, mainly energy-saving technical guidance, breaking down daily life activities such as wearing clothes, using the toilet, bathing, etc. into intermittent intervals. 1) Light and ordinary Use the guidance and inspection methods to complete the following living activity ability training A. Self-care: changing, eating, going to the toilet, washing, grooming (comb hair, shave, make-up, trim nails, etc.). B. Communication: identifying environmental marks, using electronic information equipment to communicate with the outside world, etc. C. Housework: ordering meals, doing laundry, taking care of children, using household appliances and environmental controllers such as power switches, faucets and keys, to do a good job of checking fire safety hazards. 2) Heavy / critical: Use the guidance and assistance methods to break down the movements into sections to complete the following life activity ability training, and then complete it as the physical strength recovers. A. Self-care: changing clothes: choosing styles according to personal preferences, teaching hedging and button / zipper dressing methods, eating: matching nutritional meals according to the patient's basic illness and diet preferences, entering the toilet: installing safety handrails and toilets in the toilet, constipation To help patients laxative, wash and wash can be used in sitting and standing positions, grooming (comb hair, shave, trim nails, etc.). B. Communication: Elderly patients are taught to use their mobile phones to call, video, chat, and watch news with their families. Encourage patients to express their ideas. C. In the field of housework: assist the patient in organizing the environment, categorizing and placing the articles, and instruct the patient to wash small pieces of clothing and pantyhose. Teach patients to use TVs, air-conditioning remotes, and more. 4. Psychological rehabilitation intervention (1) Psychological assessment: understand the mental health status of discharged patients, focus on key populations, and screen based on psychological assessment As a result, high-risk groups are identified in a timely manner. (2) Psychological intervention: use professional methods for psychological crisis intervention to avoid adverse events. Carry out psychological health education, body scanning exercises, work and recreation therapy, expressive art therapy, and conduct psychological intervention through self-experience, lectures, radio reading, and remote fish psychotherapy. (3) Psychological support: Using the mutual help group platform of the spiritual gas station, peers help each other and go hand in hand. 5. Meal Management (1) Ensure sufficient energy and intake of high-quality protein foods, such as lean meat, eggs, soybeans, milk, fish, shrimp, etc. (2) Increase the intake of fresh vegetables and fruits, and eat as many dark vegetables as possible. (3) Properly increasing the intake of tea oil, olive oil, and rapeseed oil rich in monounsaturated fatty acids is good for inflammation and rehabilitation. (4) To ensure sufficient drinking water, you can choose boiling water or light tea, vegetable soup, fish soup, chicken soup, etc. Water is the carrier of nutrients transportation and necessary for keeping the internal environment stable. It also has the function of lubricating the respiratory organs. (5) Eat well for three meals, work regularly to ensure sleep. (6) If you do nt eat enough, consider using nutrient supplements, nutritionally fortified foods, and milk powder as supplements. 6. Sleep Management (1) Sleep assessment: Use the Pittsburgh Sleep Quality Index (PSQI) scale to assess the sleep of patients. Evaluation frequency: once a week until discharged. (2) Sleep intervention 1) Behavioral interventions: Perform reasonable rehabilitation exercises during the day, such as "Ba Duan Jin", "Respiratory Exercises" and "Broadcast Gymnastics" to ensure the patient's daytime activity; practice "music exercises" before bedtime; instruct less before bedtime Drink water, urinate, and keep your feet warm; do not do the mental work that is likely to cause excitement or look at mobile phones, tablets, etc. 1 h before going to bed. 2) Physical intervention: Chinese herbal aromatherapy (sachet) therapy, acupoint tapping, Chinese herbal foot bath, acupuncture, etc. Combined with sleep music, bedtime meditation, and abdominal breathing to help patients sleep. 3) Diet intervention: Do not overeating or eating foods that are not suitable for digestion before going to bed, avoid drinking coffee, strong tea, etc. to avoid insomnia 4 to 6 hours before going to bed; drink hot milk, and soak your feet before going to bed, which will help improve sleep quality; 4) Environmental intervention: Keep the room quiet before falling asleep, reduce noise as much as possible, and close the curtains to create a good sleeping environment. 5) Psychological intervention: Provide health education for patients with psychological support and psychological sleep knowledge to help them improve sleep quality. (3) Termination criteria: Patient PSQI ≤ 7 points or patient discharged. 

1. Heart rate> 120 beats / min or <40 beats / min;
2. Blood pressure <90/60 mmHg or> 140/90 mmHg;
3. Blood oxygen saturation is <=90% or the change from baseline value is decreased by> 4%;
4. Respiratory frequency> 40 times / minute;
5. Pregnant women or other special groups.

Computer generated randomly

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After the test is completed, it will be published in the CNKI as a paper.

The data collection was uniformly performed by a special person. After the patients were uniformly evaluated using a paper form, the data was checked by two persons. After the data was correct, they were registered in the EXCEl form for management.