Ama-Bedsores

I-Bedsores (izilonda zokucindezela) zithinta izigidi emhlabeni wonke, ikakhulukazi lezo ezihlala zikhawulelwe emibhedeni noma ngezihlalo zabakhubazekile isikhathi eside. Lo mhlahlandlela obanzi uchaza yonke into mayelana nokwelashwa kwezilonda embhedeni, kusukela ezimpawini eziyisixwayiso zakuqala kuya ezindleleni zokunakekela ekhaya ezisebenzayo. Uzofunda ngezinhlobo zezilonda zokulala, amasu okuvimbela izilonda embhedeni, ukunakekelwa okufanele kwenxeba, nezimpawu eziyisixwayiso ezidinga ukunakekelwa kwezokwelapha. Ibhulogi futhi ihlanganisa izinhlobo ezahlukene zokwelapha izilonda zokulala kanye nokuthi udinga nini usizo lochwepheshe, okuyenza ibe insiza ebalulekile kubanakekeli neziguli ngokufanayo.

Yini ama-Bedsores?

Izilonda zomfutho, ngokuvamile ezaziwa ngokuthi ama-bedsores, yizindawo zesikhumba ezilimele kanye nezicubu ezingaphansi ezikhula lapho umfutho omude wehlisa ukugeleza kwegazi ezingxenyeni ezithile zomzimba. Lamanxeba angakheka phakathi namahora amabili nje lapho umfutho ongapheli unqamula ukutholakala kwegazi okubalulekile emangqamuzaneni esikhumba, kubangele ukuba afe.

Ama-bedsores avame ukuvela ezingxenyeni zomzimba lapho amathambo asondelene kakhulu nesikhumba, okuhlanganisa:

• Izithende 
• Amaqakala
• izindololwane 
• Amahlombe
• okhalweni 
• Umsila
• Emuva 
• Izintambo
• Emuva kwekhanda

Izimbangela kanye Nezici Zobungozi Bedsores

Ukuthuthukiswa kwezilonda zengcindezi kubangelwa amandla amathathu ayinhloko alimaza izicubu zesikhumba. Ukuqonda la mandla kanye nezici zobungozi ezihambisana nazo kubalulekile ekuvimbeleni nasekulapheni.

Izimbangela Eziyinhloko ze-Bedsore

• Ingcindezi Eqhubekayo: Amandla aqhubekayo avimbela ukugeleza kwegazi ezicutshini
• Ukungqubuzana: Ukuhlikihla isikhumba ezintweni zokulala noma ezingutsheni
• I-Shear Force: Isikhumba sihamba siye ohlangothini oluphambene nezicubu ezingaphansi

Ziningana izici ezikhulisa kakhulu amathuba okukhula kwama-bedsores:

• Imibandela Yezokwelapha
  • Diabetes- okuthinta ukuhamba kwegazi
  • Izifo ze-Vascular- ukunciphisa ukugeleza kwegazi
  • Ukulimala komgogodla- ukwehlisa ukuzwa
  • Ukuphazamiseka kwemizwa- ezithinta ukuhamba
• Izici Ezingokomzimba
  • Ubudala obungaphezu kweminyaka engama-70
  • Isimo sesisindo esiphansi
  • Isikhumba esintekenteke noma esibucayi
  • Ukudla okungenamsoco kanye nokuphelelwa amanzi emzimbeni
  • Izinkinga ze-Incontinence
  • Abantu abasezigunjini zabagula kakhulu 
  • Abantu abalulama ekuhlinzweni kwakamuva
  • Abantu abangakwazi ukuhamba, ikakhulukazi labo abahamba ngezihlalo ezinamasondo noma imibhede
  • Umswakama wokujuluka noma ukungakwazi ukuzithiba 
  • Ukungondleki kahle, ikakhulukazi ukungondleki kahle kwamaprotheni, amavithamini namaminerali

Izimpawu

Izimpawu zokuqala ziyahlukahluka futhi zincike esikhumbeni sesikhumba kanye nesigaba sokukhula. Izimpawu eziyisixwayiso zakuqala zihlanganisa:

• Ukushintsha umbala wesikhumba (obomvu esikhumbeni esikhanyayo, onsomi noma oluhlaza okwesibhakabhaka esikhumbeni esimnyama)
• Izindawo ezizizwa zifudumele noma zipholile kunesikhumba esizungezile
• Amapeshi ahlala eshintshile ngemva kokukhishwa kwengcindezi
• Amathenda noma izindawo ezibuhlungu
• Ukuqina okungajwayelekile noma ukuqina kwesikhumba
• Ukuluma noma ukuvutha

Njengoba izilonda zengcindezi ziqhubeka, ziba nezimpawu ezihlukile esigabeni ngasinye sombhede:

• Isigaba sokuqala: Amapheshana afudumele, ashintshe umbala angacwayizi lapho ecindezelwa
• Isiteji Esimaphakathi: Amanxeba angashoni noma amabhamuza agcwele uketshezi
• Isiteji Esithuthukisiwe: Amanxeba afana neCrater anezicubu ezinamafutha abonakalayo
• Isiteji esinzima: Amanxeba ajulile okungenzeka avele emathanjeni noma emisipha

Izimpawu Eziyisixwayiso Zokutheleleka 

Lezi zihlanganisa: 

• Ukukhipha ubovu
• Iphunga elibi
• Ukwanda kobuhlungu endaweni ethintekile
• Fever, amakhaza, noma ukudideka uma isifo sibhebhetheka. 

Izinkinga

Lapho izilonda zokulala zidlula izigaba zazo zokuqala, zibeka engcupheni enkulu empilweni nasekululameni kwesiguli.

Izinkinga ezinkulu ze-bedsores ezingalashwa zihlanganisa:

• I-Cellulitis (ukutheleleka kwesikhumba nezicubu ezithambile)
• Ukutheleleka kwamathambo namalunga
• Ukuthuthukiswa komdlavuza (Marjolin ulcer)
• Sepsis 
• Ukulimala kwezicubu ezisongela ukuphila
• I-Gangrene
• Inkinga enzima kakhulu ukushaqeka kwe-septic, okwenzeka lapho ukutheleleka kusakazeka kuwo wonke umzimba ngegazi. Lesi simo singaba yingozi empilweni futhi sidinga ukungenelela kwezokwelapha ngokushesha.

Sifo

Odokotela basebenzisa amathuluzi amaningana aqinisekisiwe okuhlola ubungozi ukuze bahlole iziguli: 

• Isikali saseNorton: Ihlola ingozi yezilonda zengcindezi ezigulini ezikhulile. Isilinganiso sihlanganisa izinto ezinhlanu, okuhlanganisa isimo somzimba wesiguli, isimo sengqondo, umsebenzi, ukuhamba, kanye nokungakwazi ukuzithiba. 
• Ithuluzi le-Waterlow: Leli thuluzi lokuhlola ubungozi be-bedsore lihlanganisa izingxenye ezimbalwa, ezifana nokwakheka, uhlobo lwesikhumba, izici zokuhamba, ubudala, nezici zobungozi ngazinye. 
• Ithuluzi le-Braden: Leli thuluzi libikezela ingozi yezilonda zengcindezi ezigulini. Ihlanganisa ama-subscales ambalwa, okuhlanganisa ukubona kwezinzwa, umswakama, namazinga omsebenzi.

Phakathi nenqubo yokuxilonga, odokotela ngokuvamile benza:

• Ukuhlolwa ngokomzimba kwendawo ethintekile
• Ukuhlolwa kwegazi ukuhlola isimo sempilo sisonke
• Amasiko ezicubu uma kusolwa ukutheleleka
• Ukuhlolwa kwesithombe njengama-X-ray noma ama-MRIs lapho ukulimala kwezicubu ezijulile kungenzeka

Ngokusekelwe ekuhlolweni, odokotela babela isiteji esilonda sokucindezela, esiza ekunqumeni uhlelo olufanele kakhulu lokwelashwa kwezilonda ze-bedsore. Le nqubo yesiteji ibalulekile ekubhekeni ukuqhubeka kwesilonda kanye nokulungisa amasu okunakekela njengoba kudingeka.

Ukwelashwa kwe-Bedsores

Ukwelashwa kwezilonda ezicindezelayo kudinga indlela ebanzi ehlanganisa ukunakekelwa okufanele kwesilonda, ukukhululeka kwengcindezi, nokusekelwa kokudla okunomsoco. 
Izindlela zokwelapha ngokuvamile zihlanganisa:

• Ukunakekelwa Kwenxeba Okusebenzayo: Odokotela batusa:
  • Ukuhlanza amanxeba ngesisombululo saline ukususa izicubu ezifile
  • Ukusebenzisa izingubo ezifanele (amafilimu, ama-gauze, ama-gel, noma amagwebu)
  • Kusetshenziswa omatilasi abakhethekile nama-cushions ukukhulula ingcindezi
  • Ukushintsha indawo njalo emahoreni angama-2-4 kuye ngezinga lengozi
• Ukunakekelwa Kwezokwelapha Okuchwepheshile: Kungase kuhlanganise ukuchithwa kokuhlinzwa ukuze kukhishwe izicubu ezifile, izingubo eziyisipesheli, nemithi yokwelapha ethuthukisiwe. Ezimweni ezimbi kakhulu, kungase kudingeke ukuhlinzwa ukuze kufakwe ama-muscle flaps noma ama-grafts esikhumba.
• Ukudla Okufanelekile: Idlala indima ebalulekile ekwelapheni izilonda zengcindezi. Umzimba udinga ama-calories anele, amaprotheni, uvithamini C, kanye ne-zinc ukusekela ukulungiswa kwezicubu. Odokotela bangase batuse izithasiselo zokukhuthaza ukuphulukiswa ngokushesha.
• Ukuqapha Okuvamile Kwezimpawu Zokutheleleka: Qaphela izimpawu ze-bedsore infection, ezihlanganisa iphunga elibi noma ubuhlungu obandayo. 

Uzoyibona Nini Udokotela

Abantu kufanele bathinte ngokushesha odokotela babo abelaphayo uma beqaphela:

• Isikhumba esishisayo, esivuvukele, noma esibomvu (sibonakala sinsomi noma siluhlaza okwesibhakabhaka esikhumbeni esimnyama)
• Ukuphuma kobovu esilonda
• Izinga lokushisa eliphezulu noma imfiva
• Ubuhlungu obukhulu noma ukungakhululeki okwandayo
• Izinguquko kumbala wesikhumba noma ukuthungwa
• Ubumnene noma ukufudumala okungajwayelekile endaweni ethintekile

Prevention

Izinyathelo ezibalulekile zokuvimbela zihlanganisa izinguquko ezivamile zesimo nokunakekelwa okufanele kwesikhumba:

• Hlola isikhumba nsuku zonke ukuze uthole izimpawu eziyisixwayiso zakuqala
• Gcina isikhumba sihlanzekile futhi siswakeme
• Shintsha indawo njalo emahoreni angu-4-6 ngenkathi ulele
• Shift isisindo njalo ngemizuzu eyi-15-20 ngesihlalo sabakhubazekile
• Gcina ukudla okunomsoco kanye ne-hydration
• Sebenzisa izinto ezifanele zokudambisa ingcindezi; ukukhethwa kwemishini efanele kudlala indima ebalulekile ekuvimbeleni. Odokotela batusa izindawo eziqondile ezisekelayo ezisekelwe kuzici zobungozi ngazinye, njengomatilasi begwebu, amakhushini ejeli, noma omatilasi bomoya.
• Iziqondiso zokunakekelwa kwesikhumba kufanele zilandelwe ngokucophelela. Lezi izi:
  • Gcina isikhumba sihlanzekile futhi somile, ikakhulukazi ezindaweni ezithanda umswakama. 
  • Gcoba ama-moisturizing creams nsuku zonke. 
  • Kubantu abangakwazi ukuzithiba, ukuhlanzwa ngokushesha kanye namakhilimu okuvimbela asiza ukuvikela izindawo ezisengozini.
  • A Ukudla okunazo zonke ecebile amaprotheni, amavithamini namaminerali kusiza ukugcina ubuqotho besikhumba. 
• Izinyathelo zokuqapha ngesihlalo sabakhubazekile:
  • Kubasebenzisi bezihlalo zabakhubazekile, ukulinganisa okufanelekile kanye ne-cushion kubalulekile. 
  • Ukuhlolwa okuvamile kokulingana kwesihlalo sabakhubazekile kanye nesimo se-cushion kusiza ukuvimbela amaphuzu okucindezela ukuthi angathuthuki. 
  • Ama-cushions akhethekile kufanele ahlolwe nsuku zonke ukuze athole ukwehla kwamandla emali nokuma ngendlela efanele.

Isiphetho

Ukuvimbela kuseyisu eliphumelela kakhulu ngokumelene nezilonda zokulala ngokuhlolwa kwesikhumba nsuku zonke, ukuma ngendlela efanele, kanye nokusetshenziswa kwezinto ezikhulula ukucindezela. Ukuqapha njalo kusiza ukubamba izimpawu eziyisixwayiso kusenesikhathi ngaphambi kokuba zibe izinkinga ezinkulu. Abanakekeli kanye neziguli ezibuqondayo ubungozi futhi zilandele imihlahlandlela yokunakekela efanele bathola imiphumela engcono ekulawuleni izilonda ezicindezelayo. Inhlanganisela yokuvimbela okuqaphile, ukwelashwa okufanele, nokungenelela kwezokwelapha okufika ngesikhathi kusiza ukuqinisekisa imiphumela engcono kakhulu kubantu abasengozini yokuthuthukisa izilonda zokulala.

Imibuzo Evame Ukubuzwa

1. Zingelashwa futhi zilawuleke kanjani izilonda zokulala kubantu abadala?

Ukwelashwa kweziguli esezikhulile kudinga ukunakwa okukhethekile ekuzweleni kwesikhumba kanye nezimo zempilo zizonke. Odokotela batusa izinguquko ezivamile zesikhundla njalo ngamahora angu-2-4 nokunakekelwa kwesikhumba okufanele. Izinyathelo zokwelashwa ezibalulekile zihlanganisa:

• Ukugcina isilonda sihlanzekile ngesisombululo saline
• Ukusebenzisa izigqoko ezinqunyiwe ezifanele isiteji sesilonda
• Ukuqinisekisa ukudla okufanele ngokudla okwanele kwamaprotheni
• Ukugcina ibhalansi yomswakama wesikhumba esihle

2. Ingabe izilonda zokulala zingelashwa ekhaya?

Ukwelashwa ekhaya kungenzeka ngezilonda zengcindezi yesigaba sokuqala ngaphansi kokuqondisa kukadokotela. Ukuhlanzwa kwamanxeba ngendlela efanele, izinguquko ezivamile zokugqoka, nokuqapha ngokucophelela kwakha isisekelo sokunakekela ekhaya. Kodwa-ke, isiteji sesi-3 kanye nesesi-4 sezilonda zokulala zidinga ukunakekelwa kochwepheshe.

3. Ingabe isifo sombhede siyelapheka?

Izilonda eziningi ezicindezelayo ziyaphola ngokwelashwa okufanele, ikakhulukazi lezo ezisesigabeni soku-1 nesesi-2. Isikhathi sokululama siyahlukahluka futhi sincike esigabeni sesilonda, impilo iyonke, kanye nokubambelela ezimisweni zokwelapha. Ezinye izimo ezinzima zingadinga ukungenelela kokuhlinzwa ukuze kuphole ngokuphelele.

4. Ingabe i-antibiotic cream ilungele izilonda?

Okhilimu bemithi elwa namagciwane bangaba nenzuzo lapho odokotela benikeza izilonda zengcindezi ethelelekile. Nokho, akuzona zonke izilonda ezidinga ukwelashwa ngama-antibiotic. Odokotela banquma isidingo ngokusekelwe ekuhlolweni kwesilonda kanye nezimpawu zokutheleleka.

5. Yiziphi izindawo ezijwayelekile zezilonda zengcindezi?

Amaphoyinti okucindezela ajwayelekile ayahluka kuye ngokuma komzimba nokuhamba, okufana nalokhu:

• Isikhundla sokuqamba amanga: Izithende, ithambo lomsila, amahlombe
• Ukuhlala: Izinqe, umgogodla, amahlombe
• Ukuqamba amanga: Izinqe, amaqakala, izindlebe

UDkt. Sandeep Borphalkar

I-MBBS, DNB (Imithi Yangaphakathi)
CARE Hospitals, Banjara Hills, Hyderabad

Ukuze Ubhukhe Isikhathi, shayela:

+ 91 40-68106529

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