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ุจุณู… ุงู„ู„ู‡ ูˆุงู„ุตู„ุงุฉ ูˆุงู„ุณู„ุงู… ุนู„ู‰ ุฑุณูˆู„ ุงู„ู„ู‡ ุฃู‡ู„ุง ูˆุณู‡ู„ุง
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ุจูƒู… ุงู„ูŠูˆู… ู‡ู†ุชูƒู„ู… ุนู† ุงู„ bit source or pressure
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ulcers ู‡ุฏู‡ ู‡ุชูƒูˆู† ุทุจุนุง two presentations ูŠุนู†ูŠ two
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video will be sent for you ูˆุฃุทู…ู†ูƒู… ูƒู„ presentation
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ุญุตู„ุช ุฌูˆุงุชู‡ ููŠุฏูŠูˆ I hope that you will like it ูƒู…ุง
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ุชุนูˆุฏู†ุงุฃูˆู„ ุดูŠ ู†ู‚ูˆู„ ุงู„ topics ุงู„ู„ูŠ ู‡ู†ุชุญุฏุซ ุนู†ู‡ุง ุงู„ุงุตุฑ
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ุงู„ definitionุŒ ุงู„ epidemiologyุŒ battle physiologyุŒ
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risk factorsุŒ ุงู„ sizeุŒ ุงู„ stagesุŒ ุงู„
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classificationุŒ ุงู„ complicationsุŒ ุงู„ test if
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needed for diagnosisุŒ ุงู„ treatment ูˆ ุงู„ prevention
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ูƒุงู„ุนุงุฏุฉ ู‡ู†ุจุฏุฃ ุจุงู„ุณุคุงู„ู‡ุฐู‡ ุงู„ุณูŠุฏุฉ ูƒุงู†ุช 88 ุณู†ุฉ ููŠ
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ู…ู†ุฒู„ ุบุงู…ุถ ุงู„ู…ุฏุฑุณุฉ ุฃุฎุจุฑุชูƒ ุฃู†ู‡ุง ูƒุงู†ุช ููŠ ู…ุฏุฑุณุฉ
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ูƒูˆู…ุจูŠูˆุชุฑ ูˆูƒุงู†ุช ููŠ ู…ุฏุฑุณุฉ ูƒูˆู…ุจูŠูˆุชุฑ ูˆูƒุงู†ุช ููŠ ู…ุฏุฑุณุฉ
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ูƒูˆู…ุจูŠูˆุชุฑ ูˆูƒุงู†ุช ููŠ ู…ุฏุฑุณุฉ ูƒูˆู…ุจูŠูˆุชุฑ ูˆูƒุงู†ุช ููŠ ู…ุฏุฑุณุฉ
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ูƒูˆู…ุจูŠูˆุชุฑ ูˆูƒุงู†ุช ููŠ ู…ุฏุฑุณุฉ ูƒูˆู…ุจูŠูˆุชุฑ ูˆูƒุงู†ุช ููŠ ู…ุฏุฑุณุฉ
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ูƒูˆู…ุจูŠูˆุชุฑ ูˆูƒุงู†ุช ููŠ ู…ุฏุฑุณุฉ ูƒูˆู…ุจูŠูˆุชุฑ ูˆูƒุงู†ุช ููŠ ู…ุฏุฑุณุฉ
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ูƒูˆู…ุจูŠูˆุชุฑ ูˆูƒุงู†ุช ููŠ ู…ุฏุฑุณุฉ ูƒูˆู…ุจูŠูˆุชุฑ ูˆูƒุงู†ุช ููŠ ู…ุฏุฑุณุฉ
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ูƒูˆู…ุจูŠูˆุชุฑ ูˆูƒุงู†ุช
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ููŠ ู…ุฏุฑุณุฉ ูƒูˆู…ุจูŠูˆุช
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ุฅูŠู‡ ู‚ู„ุชู‡ุŸ ุทูŠุจุŒ ู†ุงุฏู‰ ุณุคุงู„ ุชุงู†ู‰ุŸ ุฌูˆุงุจ No ู„ุฃู†ู‡ ู…ู…ูƒู†
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other causes causing incontinence ู…ู…ูƒู† ูŠูƒูˆู† ุงู„ู€
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UTI ู…ุซู„ุง ู„ุฃู† ู…ุด ูƒู„ ูˆุงุญุฏ ุนู†ุฏู‡ UTI ู…ู† ุฎู„ุงู„ ุทู„ุงุจ ูƒุซุฑ
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ููŠ ู†ูุณ ุงู„ูˆู‚ุช ู…ู…ูƒู† ุชู‚ูˆู„ ุงู†ูƒ ุงู†ุช ูƒุงุฏุช ู‡ู†ุง
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ุณุคุงู„ ุชุงู†ูŠ ุงู„ู€ ยซุงู„ุฏุฑุฏูŠู†ยป ู‡ู… ููŠ ุฎุทุฑ ู„ู€ pressure
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ulcer ยซู‡ู„ ู†ู‚ูˆู… ุจุฅุตู„ุงุญ ุงู„ูƒู„ูุฉ ู„ู‡ ุฃูˆ ู„ุงุŸยป ุฅูŠุด
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ุงู„ุฌูˆุงุจุŸ Yes ุฃูˆ NoุŸ ุทุจุนุงู‹ุŒ No ุฃู†ุง ุฃุชุญุฏุซ ุนู† ู‡ุฐุง
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ุงู„ูƒู„ุงู… ุณูˆุงุก ุงู„ุขู† ุฃูˆ later on ุทูŠุจุŒ
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ูƒูŠูุŸุงู„ู€ pressure ulcer developed ุฃูˆ ุงู„ู€ definition
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ู‡ู†ุง ุดุงูŠููŠู† ู‡ุฐุง ุงู„ู€ mattress ู‡ุฐุง ุงู„ู€ bone ู‡ุฐุง ุงู„ู€
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weight of the patient ุงูŠุด ุจูŠุญุตู„ ู‡ู†ุง weight ู…ุนุจูˆู†ุฉ
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ุจ
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ูˆู‡ู†ุง ุจูŠุญุตู„ pressure ุนู„ู‰ ุงู„ู€ mattress ูˆู‡ุฐุง ุทุจุนุง
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ุจุงุนุชู…ุฏ ุนู„ู‰ ุงู„ mattress ุงู„ู„ูŠ ู…ุณุชุนู…ู„ู‡ุง ูˆุญู†ุชุญุฏุซ ุนู†ู‡ุง
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ุจูŠุญุตู„ pressure ุจูŠุตูŠุฑ ู‡ู†ุง ุงู„ blood supply less ูˆ
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later on ุงู„ู„ูŠ ู‡ูˆ ุงู„ bed source ูŠุนู†ูŠ ู‡ู†ุง mattress
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ู‡ู†ุง ููŠ ุนู†ุฏู†ุงarea of pressure ู‡ู†ุง opposite to bone
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ู‡ุฐุง ุงู„ weight ูุจุญุตู„ ู‡ู†ุง ู…ุน ุงู„ pressure ู‡ุฐุง ุงู„
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weight ุจูŠุญุตู„ drop in the blood supply in pavement
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ูุจุญุตู„ ู†ูƒุฑูˆุณูŠุฒ ู‡ุฐุง ุทุจุนุง ู„ูˆ ูƒุงู† especially for a
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long time ุทูŠุจ ู‡ุฐู‡ ู†ูุณ ุงู„ูƒู„ุงู… ุชุงู†ูŠ
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ุงู„ู€ Epidemiology ูŠู‚ุงู„ ุฅู† ูˆุงุญุฏ ู„ุชู„ุงุชุฉ ู…ู„ูŠูˆู†
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ุฃู…ุฑูŠูƒูŠูŠู† ูŠุชุฃุซุฑูˆู† ุจุงู„ู€ AIDS ุทุจุนุงู‹ ุฃู…ุงูƒู† ุงู„ุฏุงุฑู„ูŠุŒ
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ุจุดุฑ ุฃุฑุซู„ุฒ ูˆุงุญุฏ ููŠ ูƒู„ ุฃุฑุจุน ุดุฎุต ููŠ ุงู„ู€ USA ู‚ุฏ ู…ุงุช ู…ู†
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ุงู„ู€ Health Study ููŠ ุนุงู… 1987 ู‚ุฏ ู…ุงุช ู…ู† ุงู„ู€ Pit
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cells ุทุจุนุงู‹
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ู‡ุฐุง ุฎุตูˆุตู‹ุง ุจูŠู† ุงู„ุดุจุงุจ ูˆุงู„ุนุฒูŠุฒูŠ ูƒู…ุงู†
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ุงู„ุฅุญุตุงุฆูŠุงุช ุจุชู‚ูˆู„ ุงู„ุจูŠุช ุณุฑูˆุฑ ุฏูŠ ุจู„ูˆุจ in 60% of
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hospital patients ุงู„ nursing house ุงุชูŠู† ูˆ ุงู„ home
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ุงุชูŠู† one third of patients underwent surgery for
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hip fracture ู„ุฃู†ู‡ ู‡ูŠูƒูˆู† ุงู„ุจูŠุช ู„ุฏู† ุจุนุฏ ู‡ูŠูƒุจูŠุญุตู„
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ุนู†ุฏู‡ ุนูŠุด ุจุดุฑ ู‚ู„ุตุฉ longer
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stay bedridden more to develop bed ulcers ุฃูˆ bed
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sores ููŠู‡ ุฃู†ู‡ุง ุดูˆูŠุฉ series ูŠุนู†ูŠ thermodynamic
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factors
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surface interface ุงู„ู„ูŠ ู‡ูŠ ุจูŠุตู„ ู„ุฅู† ู„ูˆ ุฌู„ุฏู†ุง ู…ุฏุฉ
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ุทูˆูŠู„ุฉ ู…ุซู„ุง ุจู†ู„ุงู‚ูŠ ุญุงู„ู†ุง ูˆ ู…ู† ุงู„ุชุญุช ุจูŠูƒูˆู† few ูŠุนู†ูŠ
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ุจูŠุตูŠุฑ ูˆุงุญุฏ warm ุญุชู‰ ูˆ ุฃู†ุช ู†ุงุฆู… ู…ุฏุฉ ุทูˆูŠู„ุฉ ุจุชุญุณ ุงู†
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under you ููŠ heat and temperature ู‡ุฐู‡ ุงู„ heat ูˆ ุงู„
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temperature ู…ุงุจูŠู‡ุด antifragile ู…ู…ูƒู† ุชุชุณุงุจู‚ุดูŠุนู†ูŠ
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ุชุณุงุนุฏ ุงู†ูุฏุฑูˆู…ูŠ ุงู†ูุฏุฑูˆู…ูŠ ุงู†ูุฏุฑูˆู…ูŠ ุงู†ูุฏุฑูˆู…ูŠ ุงู†ูุฏุฑูˆู…ูŠ
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ุงู†ูุฏุฑูˆู…ูŠ ุงู†ูุฏุฑูˆู…ูŠ ุงู†ูุฏุฑูˆู…ูŠ ุงู†ูุฏุฑูˆู…ูŠ ุงู†ูุฏุฑูˆู…ูŠ
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ุงู†ูุฏุฑูˆู…ูŠ ุงู†ูุฏุฑูˆู…ูŠ
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ุงู†ูุฏุฑูˆู…ูŠ ุงู†ูุฏุฑูˆู…ูŠ ุงู†ูุฏุฑูˆู…ูŠ ุงู†ูุฏุฑูˆู…ูŠ ุงู†ูุฏุฑูˆู…ูŠ
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ุงู†ูุฏุฑูˆู…ูŠ ุงู†ูุฏุฑูˆู…ูŠ ุงู†ูุฏุฑูˆู…ูŠ ุงู†ูุฏุฑูˆู…ูŠ ุงู†ูุฏุฑูˆู…ูŠ
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ุงู†ูุฏุฑูˆู…ูŠ ุงู†ูุฏุฑูˆู…ูŠ ุงู†ูุฏุฑูˆู…ูŠ ุงู†ูุฏุฑูˆู…ูŠ
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ุงู†ู
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ูˆุงู†ุง ุงุญู†ุง ูƒู…ุงู† ุงู„ skin ุจุชุงุน ุงู„ learning ุฒูŠ ู…ุง
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ุงุชูƒู„ู…ู†ุง ุจูŠูƒูˆู† ุฑุฌุงู„ูŠ ูˆ manufacturers ูŠุนู†ูŠ ุจุฏู„ุง ู…ู†
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ุงู„ fin ุงู„ blood supply is less ุงู„ glands ุจุชูƒูˆู†
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less ููŠ ุนู†ุฏู†ุง ูƒู…ุงู† ุงู„ pressure ุทุจุนุง increased ูู‡ู†ุง
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ุจูŠูƒูˆู† ู‡ู†ุง more susceptible voltage ู„ู„ blow
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ู‡ู†ุง ุงู„ู€ forces ุงู„ู…ูˆุฌูˆุฏุฉ ุงู„ pressure ูˆุงุชูƒู„ู…ู†ุง ุนู†ู‡ุง
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ุงู†ุชูˆุง ุนุงุฑููŠู† ุงู„ pressure in the capillaries ูŠู…ูƒู†
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maximum is 32 millimeter mercury ูู‡ุฐุง ุงู„ pressure
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ุงู„ู„ูŠ ูŠimpair the blood supply to the tissue ููŠ
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ุญุงุฌุฉ ุงุณู…ู‡ุง ุงู„ refreshing ูˆุงู†ุง ุงุฌู‡ุฒูƒู… ู‡ูŠุด ู„ู‡ุง ููŠุฏูŠูˆ
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ุงู„ู„ูŠ ู‡ูŠ ุจูŠุณู…ูˆู‡ุง sliding or rolling ูˆููŠ ุนู†ุฏู†ุง ุญุงุฌุฉ
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ุงุณู…ู‡ุง static pressure ู‡ุชุดูˆูู‡ุง ุน ุดูƒู„ ููŠุฏูŠูˆ ูˆููŠ
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ุนู†ุฏู†ุง ู‡ุฐุง ููŠุฏูŠูˆ ุจุณ ุฃู†ุง ุฎุงูŠู ุงู†ู‡ ู…ุงูŠุดู‡ุฑุด ุงู„ link
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ูุงู†ุง ู†ุฒู„ุชู‡ ุน ุดูƒู„ ููŠุฏูŠูˆ and I will show it to you
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in the next slide ููŠ ุญุงุฌุฉ ุงุณู…ู‡ุง sphere ูŠุนู†ูŠ ุงูŠุด ุงู„
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sphere ุงู†ุช ููŠ ุนู†ุฏู†ุงู‡ู†ุง skin moving against hard
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thing ุงู„ู„ูŠ ู‡ูˆ ุงู„ู€ ball ูู‡ุฐุง ุงู„ู€ movement ุฅูŠุด can
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cause injuryุŸ ู†ุดูˆู ุงู„ู€ static friction ุฃู†ุชูˆุง
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ุฃูŠุงู…ู†ุง ูƒุงู† ููŠ ุญุงุฌุฉ ุฅุณู…ู‡ุง static static ูˆ dynamic
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ููŠ ุงู„ุณู†ูˆูŠุฉ ุงู„ุนุงู…ุฉ ุงู„ู„ูŠ ูƒู†ุง ู†ุฏุฑุณู‡ุง ู‡ุฐุง ูŠู…ูƒู† ุงู„ุฃู† ู…ุด
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ู…ูˆุฌูˆุฏุฉู‡ุฐู‡ ุทุจุนุง ู‚ุจู„ ู…ุง ุชู‚ูˆู„ูˆุง ุงู†ุชูˆุง ู„ู…ุง ูƒู†ุง ุงุญู†ุง ููŠ
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ุณู†ุฉ ุฃูˆ ุชุณุนุฉ ูˆ ู…ุฆุฉ ูˆ ุณุจุนูŠู† ุทุจุนุง
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ุงูˆู„ ุดูŠ before you ูŠุนู†ูŠ show you the slide ู‡ุฐุง
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static pressure ู‡ู†ุง once you have mattress ุณูˆุงุก it
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is
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ู‡ุฐุง ุงู„ููŠุฏูŠูˆ ุณูˆู ูŠุดุงุฑูƒูƒ ูƒูŠู ูŠุชุทูˆุฑุฃู†ุง ู…ุด ู‡ุนู…ู„
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comment I ended the previous lesson with a
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question I asked you if the force of friction
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comes into play only when the two things are in
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relative motion let's discuss this in detail let's
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say you want to move a stationary sofa in your
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living room and the sofa is really heavy what
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happens when you give it an initial push yes I'm
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right nothing happens the sofa doesn't move even
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though you're applying a lot of forceWhy do you
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think the sofa doesn't moveุŸ Well, the answer is
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static friction The force that you apply is
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balanced by a frictional force by the floor And
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this force is applied in the direction opposite to
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your push This force is nothing but static
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friction The concept of static friction is really
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amazing Why do I say thatุŸ The reason why I say
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that is because it is a self-adjusting forceAs you
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increase your force of push, the force of static
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friction increases too and the forces are still
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balanced Now I know what you must be thinking,
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after a few seconds the sofa begins to move right?
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What happens to this static force then? Let's
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discuss this with the help of a simple graphWe
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assume that the force you apply is the horizontal
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force represented by the X-axis and the frictional
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force applied by the floor is represented by the Y
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-axisุงู„ุฃู†ุŒ ุจู…ุฒูŠุฌ ุนู„ู‰ ุงู„ู‚ูˆุฉ ุงู„ู‡ูˆุฑูŠุฒูˆู†ูŠุฉ ุงู„ุชูŠ ุชู…
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ุชุทุจูŠู‚ู‡ุงุŒ ูุฅู† ุงู„ู‚ูˆุฉ ุงู„ุชุถุบุทูŠุฉ ุฃูŠุถู‹ุง ุชุฒุฏุงุฏ ุจุดูƒู„ ู…ู†ุงุณุจ
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ู„ุฅุจู‚ุงุก ุงู„ุตูˆูุฉ ู…ุฑุชุงุญุฉุŒ ูˆู‡ุฐุง ูŠุณุชู…ุฑ ุฅู„ู‰ ู†ู‚ุทุฉ ุญุชู‰ ุชุจุฏุฃ
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ุงู„ุตูˆูุฉ ุชุชุญุฑูƒ ูู‚ุทุŒ ูˆู‡ู†ุงูƒ ูŠู†ุชู‡ูŠ ุงู„ุชุถุบุท ุงู„ุณุชุงุชูŠูƒูŠุŒ
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ูˆูŠุจุฏุฃ ุงู„ุชุถุบุท ุงู„ุชุณู„ู‚ูŠ. ุงู„ุชุถุบุท ุงู„ุชุณู„ู‚ูŠ ู‡ูˆ ุฃูƒุซุฑ ุฃูˆ
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ุฃู‚ู„ ู…ุณุชู…ุฑ ุฅุฐุง ุชู„ุงุญุธูŠู†ู‡ุฐุง ุงู„ุฌุฒุก ู…ู† ุงู„ู…ู‚ุงุฑู†ุฉ ู‡ูˆ
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ุงู„ุถุบุท ุงู„ุงู†ุฌู„ูŠุฒูŠ ุฅู†ู‡ ุนู†ุฏู…ุง ู„ุง ูŠุชุญุฑูƒ ุงู„ุตูˆูุง ููŠ ุญุงู„ุฉ
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ู…ุง ูŠุชู… ุฅุณุชุฎุฏุงู…ู‡ ุงู„ู‚ูˆุฉ ูˆู‡ุฐุง ุงู„ุฌุฒุก ู…ู† ุงู„ู…ู‚ุงุฑู†ุฉ ู‡ูˆ
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ุงู„ู…ุณู„ุญุฉ ุฃูˆ ุงู„ุถุบุท ุงู„ุงู†ุฌู„ูŠุฒูŠ ุนู†ุฏู…ุง ูŠุจุฏุฃ ุงู„ุตูˆูุง ูŠุชุญุฑูƒ
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ุงู„ู…ู‚ุงุฑู†ุฉ ุญูˆู„ ู…ุง ูŠุจุฏุฃ ุงู„ุตูˆูุง ุชุชุญุฑูƒ ู‡ูˆ ู…ุง ูŠุณู…ู‰ ุจู€
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break way point ู‡ู„ ู‡ู†ุงูƒ ุฃูŠ ุดูŠุก ุขุฎุฑ ุฑุฃูŠุชู‡ ููŠ
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ุงู„ู…ู‚ุงุฑู†ุฉุŸWhy is this line at a lower level than
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the maximum static frictional forceุŸ The reason is
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simple If you've ever pushed a sofa or some heavy
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object on the floor You would've realized that
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pushing it is a little easier when it's in motion
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Yes, it's because the sliding friction is lesser
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than the static friction that's offered by the
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floor That was the concept of static friction for
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you ุทุจุนุง ุฃู†ุง ุญุงุจูŠุช ุฃู‚ูˆู„ูƒู… ุงู„ูƒู„ุงู… ู‡ุฐุงุนุดุงู† ุชู‚ููˆุง ุงู†ู‡
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ุงู„ู€ patient when he stays for a long time on the
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bed ูŠูƒูˆู† ููŠู‡ static friction ุฒูŠ ู…ุง ุจูŠู‚ูˆู„ ุงู„ุจู†ูŠ ุขุฏู…
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ุชุฌูŠู„ ุทุจุนุง ุงุญู†ุง ู„ู…ุง ุจู†ุญุฑูƒู‡ ููŠ ุงู„ุฃูˆู„ ุจูŠูƒูˆู† ุญุชู‰ ุชุฌูŠู„
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ูˆ ุจุนุฏูŠู† ุงู„ู„ูŠ ุจูŠุญุตู„ ุจุชุฌูŠู„ ู„ู„ static friction ุนุดุงู†
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ู‡ูŠูƒ ุจู†ุญุท ูƒู…ุงู† mattress ุจุชูƒูˆู† air ุงูˆ air foam
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ุทุจุนุง ุงุญู†ุง ู†ุญู† ู†ุญุถุฑ ุงู„ู…ุณุชุฎุฏู… 15 ุฏู‚ูŠู‚ุฉ ูƒู„ 2 ุณุงุนุงุช
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00:12:18,350 --> 00:12:22,690
ุนุดุงู† ู†ุฌู„ู„ ุงู„ static friction ุจุณ ู…ุงู„ูŠุด ู†ุณุญุจู‡ ุฒูŠ ู…ุง
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ู‚ู„ู†ุง ููŠ ุงู„ูƒู†ุจุงู† ู†ุณุญุจู‡ ู…ู† his legs ูŠุนู†ูŠ ุฎุฏูˆุง ุจุงู„ูƒู…
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ูŠุนู†ูŠ ู‡ุฐู‡ ุงู„ matrices ุจุชุฌู„ู„ ุงูŠุด ุงู„ static friction
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ุงู„ู€ pathophysiology ู†ู‚ูˆู„ ู„ูƒู… ูƒุงู…ูŠุฑุง
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ุฑุดู‡ุฑ 32 ู…ู„ูŠ ู…ุชุฑ ู…ุฑุชุฑ ู‡ู†ุง ู…ุนู†ุงู‡ุง while he is lying
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down he may occlude these cameras ู…ุนู†ุงู‡ุง ุงู„ blood
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profusion ู‡ูŠูƒูˆู† ู‡ุฐุง ูˆ ู‡ู†ุง ู…ู…ูƒู† ูŠุญุตู„ bit source
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00:13:12,310 --> 00:13:16,330
ุฃุญู†ุง ู‚ู„ู†ุง ููŠู‡ ุงู†ูƒุงุฐุฉ factor ูƒู…ุงู† ู„ risk factor ุฃูˆู„
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ุดูŠุก ุงุญู†ุง ู‚ู„ู†ุง ุงู„ุงู„ุฏุงุฑ ุงู„ู„ูŠ ุจูŠูƒูˆู† skin is thin ู‡ุฐุง
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ุจูŠุฎู„ูŠู‡ susceptible for injury ุจุนุฏูŠู† less natural
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cushions on the balls ุจูŠูƒูˆู† ุทุจุนุง ู†ู‚ุตุฉ ููŠ cutaneous
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tissue ูˆุฏ ุฅูŠุด ุจุชูƒูˆู† less ุงู„ muscles ุจุชูƒูˆู† maybe
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ุงู„ุฃุดุฎุงุต ุงู„ู„ูŠ ู‡ูŠุจู‚ู‰ ุจุฑุฒุฉ ู‡ุชูƒูˆู† ุจุฑุถู‡ ุจูŠูˆุณู… ููŠู‡ุง ูˆุงู„ู€
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nutrition ุจุชุงุนุชู‡ู… ุจุชูƒูˆู† ุบุงู„ุจุง ุงู„ daily ูŠุนู†ูŠ ู‡ุชุจู‚ู‰
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ุจุชุงุนุชู‡ู… ุจุชุงุนุชู‡ู… ุจุชุงุนุชู‡ู… ุจุชุงุนุชู‡ู… ุจุชุงุนุชู‡ู… ุจุชุงุนุชู‡ู…
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ุจุชุงุนุชู‡ู… ุจุชุงุนุชู‡ู… ุจุชุงุนุชู‡ู… ุจุชุงุนุชู‡ู… ุจุชุงุนุชู‡ู… ุจุชุงุนุชู‡ู…
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ุจุชุงุนุชู‡ู… ุจุชุงุนุชู‡ู… ุจุชุงุนุชู‡ู… ุจุชุงุนุชู‡ู… ุจุชุงุนุชู‡ู… ุจุชุงุนุชู‡ู…
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ุจุชุงุนุชู‡ู… ุจุชุงุนุชู‡ู… ุจุชุงุนุชู‡ู… ุจุชุงุนุชู‡ู… ุจุชุงุนุชู‡ู… ุจุชุงุนุชู‡ู…
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ุจุชุงุนุชู‡ู… ุจุชุงุนุชู‡ู… ุจุชุงุนุชู‡ู… ุจุชุงุนุชู‡ู… ุจุชุงุนุชู‡ู… ุจุชุงุนุชู‡ู…
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ุจุชุงุนุชู‡ู… ุจุชุงุนุชู‡ู… ุจุชุงุนุชู‡ู… ุจุชุงุนุชู‡ู… ุจุชุงุนุชู‡ู… ุจุชุงุนุชู‡ู…
165
00:13:56,220 --> 00:13:58,960
ุจุชุงุนุชู‡ู… ุจุชุงุนุชู‡ู… ุจุชุงุนุชู‡ู… ุจุชุงุนุชู‡ู… ุจุชุงุนุชู‡ู… ุจุชุงุนุชู‡ู…
166
00:13:58,960 --> 00:14:06,860
ุจุชุงุนุชู‡ู…
167
00:14:06,860 --> 00:14:11,080
ุจุชุงูŠุนู†ูŠ ุงู„ patient while he is dying downุŒ ูˆุนู†ุฏู‡
168
00:14:11,080 --> 00:14:16,860
ู…ุซู„ุง spinal injuryุŒ ูŠูƒูˆู† ููŠู‡ุดูŠ ุนู†ุฏู‡ sensation ูŠุนู†ูŠ
169
00:14:16,860 --> 00:14:20,660
he may develop the ulcer and doesn't feel anything
170
00:14:20,660 --> 00:14:26,300
ูˆู‡ุฐู‡ ุฎุงุตุฉ ูŠุนู†ูŠ ู…ู…ูƒู† ูŠุชูุญุตูˆู‡ุง ุงู„ health education
171
00:14:26,300 --> 00:14:32,640
ุงู„ diabetic patient especially ู„ูˆ ุนู†ุฏู‡ู… neuropathy
172
00:14:38,040 --> 00:14:43,020
ููŠู‡ ู‚ูˆู„ู†ุง Natural thinning ุงูˆ weight loss ุงุญู†ุง
173
00:14:43,020 --> 00:14:47,400
ู‚ูˆู„ู†ุง ููŠู‡ atrophy ุณูˆุงุก ููŠ subcutaneous ุงูˆ ููŠ ุงู„
174
00:14:47,400 --> 00:14:56,220
muscles ุงู„ man nutrition ูˆุงุตู„ ุงู„ condition
175
00:14:56,220 --> 00:15:03,760
of its source ุนุดุงู† ูŠูƒูˆู† ููŠู‡ุง
176
00:15:03,760 --> 00:15:10,510
protein, zinc and vitamin Cุฃุฎุฑ ู…ุดูƒู„ุฉ ุงู„ู„ูŠ ู‡ูŠ
177
00:15:10,510 --> 00:15:17,550
culinary ู‡ูŠ ุงู„ู€ feed culp incontinence ู‡ุฐุง
178
00:15:17,550 --> 00:15:23,130
ุงู„ู…ุดูƒู„ุฉ ุทุจุนุงู‹ ุณุชุณุงุนุฏ ููŠ ุชุตู ุงู„ุฃู„ุซุงุฑ ู„ุฃู† ุงู„ู…ุดูƒู„ุฉ
179
00:15:23,130 --> 00:15:30,510
ุณุชูƒูˆู† ู…ุญููˆุธุฉ ูˆ ู…ุญููˆุธุฉ ูˆู‡ุฐุง ุณูŠุฌุนู„ ุงู„ุจูƒุชูŠุฑูŠุง ุชุทูˆุฑ
180
00:15:36,110 --> 00:15:40,890
ุทุจุนุง ู„ูˆ ูƒุงู† ุงู„ุจูŠุดูŠุฑ ุนู†ุฏู‡ ุจูŠู†ุณ ุงูˆ ุจุงุณูƒูˆู„ุงุช ุงูˆ
181
00:15:40,890 --> 00:15:41,770
ุจุงุณูƒูˆู„ุงุช ุงูˆ ุจุงุณูƒูˆู„ุงุช
182
00:15:41,770 --> 00:15:59,610
ุฏูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒูŠุฒ
183
00:16:00,290 --> 00:16:04,570
ูˆุจุชุฒูŠุฏ ููŠ ุญุงู„ุงุช ุงู„ diseases ูˆ ุงู„ trauma ูˆ ุงู„
184
00:16:04,570 --> 00:16:09,250
medication ูุงู„ู†ุงุณ ูŠุฌุจ ุฃู† ุชูƒูˆู† aware about these
185
00:16:09,250 --> 00:16:14,070
problems ูˆ ุชุชุนุงู…ู„ ู…ุน ุงู„ู…ุณุชุฎุฏู… ู‡ุฐู‡ ุงู„ risk factors
186
00:16:14,070 --> 00:16:19,870
ุฒูŠ ู…ุง ู‚ู„ู†ุง ุฃูˆ ู…ู† ุงู„ุณู…ุงุฑูŠ ู„ู‡ุง spinal cord injury
187
00:16:19,870 --> 00:16:26,010
traumatic brain injury neuromuscular disorders
188
00:16:26,010 --> 00:16:31,040
immobility malnutritionFecal and urinary
189
00:16:31,040 --> 00:16:39,400
incontinence Altered consciousness Systemic
190
00:16:39,400 --> 00:16:47,880
diseases ููŠู‡ ุฏุจูŠุชุณ ู…ุซู„ุง ูุฑุนูƒุดุงู„ Ageing skin ูˆู‡ู†ุง
191
00:16:47,880 --> 00:16:53,760
ุงุชูƒู„ู…ู†ุง decrease ููŠ ุงู„ุงุจุฏุฑู…ุณ ูˆุงุจุฏุฑู… ุงู„ layer ุจูŠูƒูˆู†
192
00:16:53,760 --> 00:16:56,860
flat ูˆ ุงู„ blood supply ุจูŠูƒูˆู†
193
00:16:59,690 --> 00:17:08,150
decrease pain perception ุงู„ู€
194
00:17:08,150 --> 00:17:14,670
sites ุทุจุนุง according to the position ูŠุนู†ูŠ ู‡ู†ุง ุงุญู†ุง
195
00:17:14,670 --> 00:17:21,790
ู‚ู„ู†ุง ููŠู‡ ุจูŠูƒูˆู† ู‡ู†ุง pressure ู‡ู†ุง ูˆ ู‡ู†ุง bone and
196
00:17:21,790 --> 00:17:26,930
this is a patient ูŠุนู†ูŠู‡ุฐู‡ ุงู„ู…ู†ุทู‚ุฉ ู…ู…ูƒู† ุชุทูˆูŠุฑู‡ุง
197
00:17:26,930 --> 00:17:32,230
ุชุทูˆูŠุฑ ุฃุฑุตุงุต ุชุทูˆูŠุฑ
198
00:17:32,230 --> 00:17:36,890
ุฃุฑุตุงุต
199
00:17:36,890 --> 00:17:41,790
ุชุทูˆูŠุฑ ุฃุฑุตุงุต ุชุทูˆูŠุฑ ุฃุฑุตุงุต ุชุทูˆูŠุฑ ุฃุฑุตุงุต ุชุทูˆูŠุฑ ุฃุฑุตุงุต
200
00:17:41,790 --> 00:17:42,430
ุชุทูˆูŠุฑ ุฃุฑุตุงุต ุชุทูˆูŠุฑ ุฃุฑุตุงุต ุชุทูˆูŠุฑ ุฃุฑุตุงุต ุชุทูˆูŠุฑ ุฃุฑุตุงุต
201
00:17:42,430 --> 00:17:42,710
ุชุทูˆูŠุฑ ุฃุฑุตุงุต ุชุทูˆูŠุฑ ุฃุฑุตุงุต ุชุทูˆูŠุฑ ุฃุฑุตุงุต ุชุทูˆูŠุฑ ุฃุฑุตุงุต
202
00:17:42,710 --> 00:17:42,730
ุชุทูˆูŠุฑ ุฃุฑุตุงุต ุชุทูˆูŠุฑ ุฃุฑุตุงุต ุชุทูˆูŠุฑ ุฃุฑุตุงุต ุชุทูˆูŠุฑ ุฃุฑุตุงุต
203
00:17:42,730 --> 00:17:50,230
ุชุทูˆูŠุฑ ุฃุฑุตุงุต ุชุทูˆูŠุฑ ุฃุฑุตุงุต ุชุทูˆูŠุฑ ุฃุฑุตุงุต ุชุทูˆูŠุฑ ุฃุฑุตุงุต
204
00:17:50,230 --> 00:18:06,380
ุชุทูˆุจุงู„ุนูƒุณ ู…ู† ุงู„ู€ bone ุจุณ ูˆูู‚ู‹ุง ู„ู„ู…ูˆุถูˆุน ุทุจุนู‹ุง ู„ูˆ
205
00:18:06,380 --> 00:18:10,220
ูƒุงู† ู„ูŠุด ู‡ุชุงู†ูˆูŠ ุงู„ู€ chair ุทุจุนู‹ุง ุงู„ pressure ู‡ูŠูƒูˆู†
206
00:18:10,220 --> 00:18:17,620
ู‡ู†ุง ููู‚ู‹ุง ู„ู„ู…ูˆุถูˆุน ุฃูŠุถู‹ุง tail bone ุงู„ู„ูŠ ู‡ูŠ ุงุณู…
207
00:18:17,620 --> 00:18:26,270
ูŠุณู…ูˆู†ู‡ุง ุงู„ุนุตูˆุณุฉู…ุซู„ู‹ุง ุงู„ู€ Shoulders Back Arms ู„ุฃู†
208
00:18:26,270 --> 00:18:29,510
ุงู„ู…ุณุจูˆู† ู‡ู†ุง Leaning on the wheelchair
209
00:18:38,540 --> 00:18:45,920
ู‡ุฐุง ูŠุนู†ูŠ ุงู†ูƒ
210
00:18:45,920 --> 00:18:50,120
ุชู‚ูˆู… ุจุชุญุฑูŠูƒู‡ ูˆ ุชุญุฑูŠุฑู‡ ูˆ ุชุญุฑูŠุฑู‡ ูˆ ุชุญุฑูŠุฑู‡ ูˆ ุชุญุฑูŠุฑู‡ ูˆ
211
00:18:50,120 --> 00:18:50,420
ุชุญุฑูŠุฑู‡ ูˆ ุชุญุฑูŠุฑู‡ ูˆ ุชุญุฑูŠุฑู‡ ูˆ ุชุญุฑูŠุฑู‡ ูˆ ุชุญุฑูŠุฑู‡ ูˆ
212
00:18:50,420 --> 00:18:50,860
ุชุญุฑูŠุฑู‡ ูˆ ุชุญุฑูŠุฑู‡ ูˆ ุชุญุฑูŠุฑู‡ ูˆ ุชุญุฑูŠุฑู‡ ูˆ ุชุญุฑูŠุฑู‡ ูˆ
213
00:18:50,860 --> 00:18:51,320
ุชุญุฑูŠุฑู‡ ูˆ ุชุญุฑูŠุฑู‡ ูˆ ุชุญุฑูŠุฑู‡ ูˆ ุชุญุฑูŠุฑู‡ ูˆ ุชุญุฑูŠุฑู‡ ูˆ
214
00:18:51,320 --> 00:18:51,600
ุชุญุฑูŠุฑู‡ ูˆ ุชุญุฑูŠุฑู‡ ูˆ ุชุญุฑูŠุฑู‡ ูˆ ุชุญุฑูŠุฑู‡ ูˆ ุชุญุฑูŠุฑู‡ ูˆ
215
00:18:51,600 --> 00:18:52,660
ุชุญุฑูŠุฑู‡ ูˆ ุชุญุฑูŠุฑู‡ ูˆ ุชุญุฑูŠุฑู‡ ูˆ ุชุญุฑูŠุฑู‡ ูˆ ุชุญุฑูŠุฑู‡ ูˆ
216
00:18:52,660 --> 00:18:58,480
ุชุญุฑูŠุฑู‡ ูˆ ุชุญุฑูŠุฑู‡ ูˆ ุชุญุฑูŠุฑู‡ ูˆ ุชุญุฑูŠุฑู‡ ูˆ ุชุญุฑูŠุฑู‡ ูˆ
217
00:18:58,480 --> 00:18:59,580
ุชุญุฑูŠุฑู‡
218
00:19:09,740 --> 00:19:19,140
ู‡ู†ุง ู‡ู†ุง ู‡ู†ุชูƒู„ู… ุนู† ุงู„ู€ Stages of Petsaws ูŠู…ูƒู† ุฃุฎุฏุชู‡
219
00:19:19,140 --> 00:19:25,180
ุงู†ุชูˆุง ููŠ ุงู„ู€ Surgery ุงู„ู€ Stages of Bears ุชู‚ุฑูŠุจุง ู‡ูŠ
220
00:19:25,180 --> 00:19:35,160
ู†ูุณู‡ุง Stage 1 Stage 2 Stage 3 Stage 4 ู†ุงุฎุฏ
221
00:19:35,160 --> 00:19:41,550
Stage 1ู…ุง ูŠุนู†ูŠ ุจู„ุงุชุดุงุจูˆุชุŒ ู…ุงูŠุนู†ูŠ ุจู„ุงุชุดุงุจูˆุชุŸ
222
00:19:41,550 --> 00:19:46,790
ุจู„ุงุชุดุงุจูˆุช
223
00:19:46,790 --> 00:19:55,930
ุจุชูƒูˆู† ุฑุฏุŒ ูˆุฅุฐุง ู‚ู…ุช ุจุงู„ุถุจุท ุนู„ูŠู‡ุŒ ู‡ุฐุง ู„ู† ูŠุชูุฌุฑุŒ ูŠุนู†ูŠ
224
00:19:55,930 --> 00:19:57,290
ู‡ุถู„ู‡ุง ู‚ุงุด ุฑุฏ
225
00:20:04,350 --> 00:20:08,030
ุจุณ ูƒุงู† maybe hotter ูˆู…ู…ูƒู† ูŠูƒูˆู† cold ุนุดุงู† ุงู„ blood
226
00:20:08,030 --> 00:20:16,070
supply ูŠูƒูˆู† less ุจูŠูƒูˆู† ุงู„ sensation ู‡ู†ุง odd ูŠุนู†ูŠ
227
00:20:16,070 --> 00:20:23,610
ุญุงุฌุฉ ุฎุดู†ุฉ ูˆู…ู…ูƒู† ูŠูƒูˆู† painful ู„ุฃู†ู‡ ุฒูŠ ุงู„ fifth
228
00:20:23,610 --> 00:20:28,410
degree of pain ุจูŠูƒูˆู† ููŠู‡ exposure ู„ุฅูŠุด ู„ู€ nerve
229
00:20:28,410 --> 00:20:29,550
endings
230
00:20:33,410 --> 00:20:41,030
ู‡ุฐุง ู‡ูˆ ู‡ุฐุง ุฅูŠุด ุงู„ุจุฏุงูŠุฉ ุฅูŠุณุง intact ุจุณ ุฅูŠู‡ ุดุฏ ุฒูŠ ู…ุง
231
00:20:41,030 --> 00:20:50,210
ู‚ู„ู†ุง first degree of ulcers ุดุงูŠููŠู†ู‡ ู‡ู†ุง ู‡ุฐู‡ ุงู„
232
00:20:50,210 --> 00:20:57,610
ulcers first degree ุงู„
233
00:20:57,610 --> 00:21:02,640
second degree ุชุฎุชููŠู‡ู†ุง ุงู„ู€ epidermis will be
234
00:21:02,640 --> 00:21:07,440
involved ูˆุจูŠูƒูˆู†
235
00:21:07,440 --> 00:21:12,500
ุงูŠุดุŸ ุนู„ู‰ ุดูƒู„ blisters ุงูˆ abrasions ูŠุนู†ูŠ ุงู„
236
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epidermis ุญุตู„ู‡ ุดุฏ ู‚ุจู„ ุนูƒุณ
237
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ุนูƒุณ ุนูƒุณ ุนูƒุณ ุนูƒุณ ุนูƒุณ ุนูƒุณ ุนูƒุณ ุนูƒุณ
238
00:21:27,710 --> 00:21:34,470
ู‡ู†ุงูƒ ู…ูŠุงู‡ ูƒูŠุงุชุฑ ูุชุญุช
239
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ุจุฑูƒุงู† ุดู„ูˆู† ุดู„ูˆู† ูƒูŠุงุชุฑ ู‡ูŠุฑุฏ ู„ูƒู† ุงุจู† ูŠุงู…ุณ ุญุตู„ ุดุฏ ุฃุจ
240
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ู‡ุฐูŠ
241
00:21:50,550 --> 00:21:54,470
second degree ู†ูุณ ุงู„ุดูŠุก ุจูŠุญุตู„ ููŠ second degree ุงุฎ
242
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ุจุงู„
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00:21:59,490 --> 00:22:05,670
ุงู„ุซุงู„ุซ ุฏุฑุฌุฉ ู…ูˆุฌูˆุฏุฉ ููŠ ุงู„ู€ Top ุดุงูŠููŠู†ุŸ ุฒูŠ ุฅูŠู‡ ุฅูŠุดุŸ
244
00:22:05,670 --> 00:22:12,630
ู„ูƒู† ููŠู‡ ุฃุจูŠุฌูŠู† ู„ุณู‡ ูˆุงุถุญุŸ
245
00:22:12,630 --> 00:22:20,010
ู‡ุฐุง second degree ู„ุณู‡ ุงุญู†ุง ุจู†ุชูƒู„ู… ู…ุนุงู‡ second
246
00:22:20,010 --> 00:22:29,410
degree ุงู„ third degree ู‡ู†ุง ุจูŠุญุตู„ ุฅูŠุด ุฃุฎุฏ ุงู„ุฅูŠุดุงู„ู€
247
00:22:29,410 --> 00:22:34,830
Dermis ูˆุงู„ู€ Epidermis ูˆููŠู‡ ู…ู…ูƒู† ูŠุฃุฎุฐ ุจุงุณ of the
248
00:22:34,830 --> 00:22:39,610
subcutaneous tissue ูˆู‡ุฐุง
249
00:22:39,610 --> 00:22:45,370
ุจุชูƒูˆู† ุนู…ู„ูŠุฉ ุงู„ู€ healing ุจุชูƒูˆู† difficult ูˆู…ู…ูƒู†
250
00:22:45,370 --> 00:22:51,550
ูŠุญุชุงุฌ surgery ุงู„ูƒุซุฑุฉ
251
00:22:51,550 --> 00:22:57,860
ุจุชูƒูˆู† ุฃูˆุณุน ู‡ุดุงูŠููŠู†ุŸุฃุฎุฏ ุงู„ู€ epidermis ูˆ ุงู„ู€ dermis
252
00:22:57,860 --> 00:23:05,480
ูˆ ุฃุฎุฏ ุงู„ู€ subcutaneous tissue part of it
253
00:23:05,480 --> 00:23:08,740
ู‡ุฐุง
254
00:23:08,740 --> 00:23:13,660
ู‡ูˆ ุงู„ third degree ู‡ู†ุง
255
00:23:13,660 --> 00:23:23,440
ููŠ ุงู„ูุชุญุฉ ุนุงู…ู„ุฉ ุฒูŠ ุงู„ tunnel ูุชุญุฉ ููŠ ุงู„ู†ูู‚ ู‡ูŠูƒ ู…ุด
256
00:23:23,440 --> 00:23:24,480
ูƒุงุชุฑ ุจุณ
257
00:23:27,760 --> 00:23:33,960
ุงู„ู€ fourth way ู‡ู†ุง ู‡ุชุงุฎุฏ ูƒู„ ุดูŠุก ูŠุนู†ูŠ ู‡ุชุงุฎุฏ
258
00:23:33,960 --> 00:23:38,640
Epidermis, Dermis, Subcutaneous ู‡ุชุงุฎุฏ ุงู„ muscle ูˆ
259
00:23:38,640 --> 00:23:41,700
ุงู„ tendons ูˆ ูŠุญุตู„ ุงู„ bone ูˆ ูŠุญุตู„ ุงู„ complications
260
00:23:41,700 --> 00:23:48,960
ุจุชุงุนุฉ ุงู„ bone ู‡ุชุงุฎุฏ ูƒู„ fitness ุชุงุฎุฏ ูƒู„ ุดูŠุก ูˆ ููŠ
261
00:23:48,960 --> 00:23:54,660
ู…ูˆู‚ุน ุงู†ูƒ ุจูŠูƒูˆู† ุจุฒูŠุงุฏุฉ ุฃูˆุณุนูˆู‡ุฐุง ุจูŠุนุชู…ุฏ ุงู„ู€ depth
262
00:23:54,660 --> 00:23:57,580
ุจุชุงุนู‡ according to their size ูŠุนู†ูŠ ุงู„ู…ู†ุทู‚ุฉ ู…ุซู„ุง
263
00:23:57,580 --> 00:24:03,180
ุชูƒูˆู† ูŠุนู†ูŠ ู…ุฎุฏุฉ ุงู„ ยซุจุงุชูˆูƒุณยป ู‡ุชูƒูˆู† ุงู„ depth ู‡ุชูƒูˆู†
264
00:24:03,180 --> 00:24:08,180
ุฃุนู„ู‰ุŒ ุฃุฒูˆุฏ ู„ุฃู†ู‡ ููŠู‡ muscle ูˆsubcutaneous ุชุดูˆู ุฃุฒูˆุฏ
265
00:24:08,180 --> 00:24:11,360
ูˆู‡ู†ุง
266
00:24:11,360 --> 00:24:16,040
you can see ุงู„ bone ูˆุงู„ุชู†ุฏู†ุช ูˆู…ู…ูƒู† ูŠุญุตู„ู‡ุง ุงูŠ ุดูƒู„
267
00:24:16,040 --> 00:24:20,780
ยซshitting outยป ุชุทู„ุน ู…ู† remoteุŒ ู‡ุฐุง ู‡ูŠ
268
00:24:25,250 --> 00:24:32,170
ุจูŠุญุตู„ู‡ุง stuffing ูŠุนู†ูŠ ู‡ุฐู‡ ู‡ูŠ ุงู„ู€ Flatter ู‡ุฐู‡ ู‡ูŠ
269
00:24:32,170 --> 00:24:39,690
ุจุนุฏ ูƒู„
270
00:24:39,690 --> 00:24:43,790
ุงู„ layers ู‡ู†ุง
271
00:24:43,790 --> 00:24:49,350
ุจูŠุญุตู„ ุงู„ stuff ุฏู‡ ุงูŠุดุŸ ุฏู‡ ุงู„ tendons ูˆ ุงู„ muscles
272
00:24:49,350 --> 00:24:54,490
and so on ู‡ู†ุง
273
00:24:55,240 --> 00:24:59,240
ู‡ุฐุง ุงู„ู€ part one of build source