| Objective:(1)To investigate thestatus of Incontinence-Associated Dermatitis(IAD)in acute stroke patients with incontinence;(2)Analysis the IAD related factors in acute stroke patients with incontinence,and provide evidence for further nursing measures;(3)According to the IAD best nursing practice guidelines,combined with clinical practice experience and conditions of the hospital to establish a tree-graphic incontinence care process;(4)To explore the impact of the tree-graphic incontinence care process on IAD in acute stroke patients with incontinence.Methods:A total of 150 acute stroke patients with incontinence who were admitted to the Department of Neurology,the First Affiliated Hospital of Guangxi Medical University from April 2017 to October 2017 were enrolled.Through Univariate analysis and multivariate logistic regression to analysis of IAD-related factors and risk factors in acute stroke patients with incontinence.A total of 141 acute stroke patients with incontinence who were admitted to the Department of Neurology,the First Affiliated Hospital of Guangxi Medical University from November 2017 to November 2018 were selected as subjects.73patients who met the inclusion criteria from November 2017 to April 2018 were used as a control group for routine care;68 patients from May 2018 to November 2018 were selected as the intervention group,and the nursing was conducted according to the tree-graphic incontinence nursing process.To compare between the two groups of incidence of IAD,the severity of IAD,the onset time of IAD,the time of IAD healing,the incidence of skin stress injury and the implementation of IAD care measures.Result:1.The status of IAD in acute stroke patients with incontinence.There are 52 patients with IAD,the incidence rate was 32.7%,including 30(57.7%)in grade 1,22(42.3%)in grade 2,and 7(13.4%)with fungal infection.2.Factors affecting IAD in acute stroke patients with incontinence.(1)Univariate analysis showed that IAD was associated with incontinence type(c~2=26.740,P<0.01);state of consciousness(c~2=27.766,P<0.01);eating mode(c~2=8.096),P<0.01);Braden score(c~2=17.646,P<0.01);Bathel index score(c~2=8.213,P<0.05);hypoproteinemia(c~2=16.792,P<0.01);use of antibiotics(c~2=6.268,P<0.05);diabetes(c~2=6.358,P<0.05);intestinal flora imbalance(c~2=12.890,P<0.01);temperature≥38.5℃(c~2=5.657,P<0.05)and IAD prevention measures are not standardized(c~2=19.756,P<0.01).There was no significant correlation between the incidence of IAD and age,stroke type,and gender(P>0.05).(2)Multivariate analysis showed double incontinence(OR=5.489,95%CI2.220-13.575),IAD preventive measures were not standardized(OR=4.183,95%CI 1.718-10.185),enteral nutrition(OR=2.844,95%CI 1.174-6.891),diabetes(OR=3.391,95%CI1.369-8.399),dysbacteriosis(OR=2.948,95%CI1.176-7.391)is the risk factor in patients with acute stroke incontinence.3.The effect of tree-graphic incontinence care process on IAD in acute stroke patients with incontinence.(1)In the control group,25 cases of IAD occurred,the incidence rate was34.2%;12 cases of IAD occurred in the intervention group,the incidence rate was 17.6%.The incidence of IAD in the two patients was statistically significant(P<0.05).(2)There were 21 cases of grade 2 IAD in the control group and 4 cases in grade 1;4 cases of grade 2 IAD and 8 cases of grade 1 occurred in the intervention group.There was a statistically significant difference in the severity of IAD between the two groups(P<0.05).(3)The onset time of IAD in the control group was 2-8 days,and the median time to onset was 3.5 days;the onset time of IAD in the intervention group was 2-8 days,and the median time to onset was 5.5 days.There was a statistically significant difference in the onset time of IAD between the two groups(P<0.05).The IAD healing time was 2-11 days in the control group and the median healing time was 5.5 days.The IAD healing time was 3-7 days in the intervention group and the median healing time was 3 days.There was a statistically significant difference in the time of IAD healing between the two groups(P<0.05).(4)There were 12 cases of stress skin injury in the control group,the incidence rate was 16.4%;4 cases of stress skin injury occurred in the intervention group,the incidence rate was 5.9%.The incidence of stress skin injury was statistically significant between the two groups(P<0.05)(5)The standard rate of incontinence treatment was 69.9%in the control group and 92.6%in the intervention group.The difference between the two groups in the incontinence treatment was statistically significant(P<0.01).The standard rate of fecal collection in the control group was 64.4%and the intervention group was 89.7%.There was statistically significant different in the fecal collection rate between two groups(P<0.01).The skin cleansing standard rate of the control group was 67.7%,and the intervention group was 95.6.The difference in skin cleanliness rate of the two groups was statistically significant(P<0.01);the skin protection standard rate of the control group was 72.6%,and the intervention group was 88.2%.The difference in skin protection standard rate between the two groups was statistically significant(P<0.01).Conclusions:(1)The incidence of IAD in acute stroke patients with incontinence is relatively high,which needs medical staff to pay attention.(2)The occurrence of IAD in acute stroke patients with incontinence is related to incontinence type,conscious state,eating pattern,Braden score,Bathel index score,hypoproteinemia,antibiotic use,diabetes,intestinal flora disorders,elevated body temperature,and irregular measures to prevent IAD.Both incontinence,enteral nutrition,diabetes,dysbacteriosis,and inadequate IAD care are risk factors for IAD in acute stroke patients with incontinence.(3)Implementation of tree-graphic incontinence care processes can reduce the incidence rate of IAD and stress skin damage,shorten the healing time,and improve the standardization rate of IAD prevention and treatment measures for nurses.It has certain clinical application value. |
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