The conditions in which the patient is located are very important in the course and outcome of diseases. First of all, it is necessary to observe simple rules of personal hygiene and cleanliness in the ward, it is also necessary to provide the patient with proper and timely nutrition. There should be a convenient location of the patient in bed, the bed linen should be clean, and the mattress should be even, if the bed has a mesh, then it should be in a taut position. For patients with urinary incontinence and seriously ill patients, it is necessary to lay an oilcloth under the sheet on the mattress cover. Women with heavy discharge should put a diaper on an oilcloth, which must be replaced at least twice a week.
Seriously ill patients are placed on functional beds, where head restraints are applicable. The patient is given a blanket with a duvet cover and 2 pillows. The bed should be changed regularly: before going to bed and after waking up. Bed and underwear should be changed at least once a week after each bath.
It is very important to take care of the skin of a seriously ill patient.
The skin is designed to perform several functions; regulatory, analytical, protective and excretory. Uric acid, potassium, sodium, urea, water and many other substances are released through the skin and sweat glands. At normal temperature at rest, about a liter of sweat is released per day, and in patients with a fever up to 10 liters or more.
When sweat evaporates, metabolic products remain on the skin, which have a devastating effect on the skin. In this regard, the skin must be clean, and for this it is necessary to change linen frequently, wipe the skin with cologne, disinfectant wipes, and wipe the skin with a clean, dry towel.
Particular attention should be paid to the skin in the groin area, in the armpits, under the breasts in women. Daily washing is necessary for the perineum. Seriously ill patients should be washed after each emptying to avoid inflammatory processes skin. Also, in seriously ill patients, bedsores may appear, which are the necrosis of soft tissues, which occurs as a result of ischemia.
Most often, bedsores occur on the shoulder blades, elbows, heels, and sacrum. First there is soreness and redness, then blisters form. In the presence of deep bedsores, tendons and muscles appear. Ulcers are formed, sometimes reaching the bone. An infection passes through the wounds, leading to blood poisoning and suppuration.
If bedsores appear, it means that the personal hygiene of a seriously ill patient is insufficiently performed.
If redness of the skin occurs, it is necessary to wipe it twice a day with a solution of camphor, wet towel. With the formation of bedsores, you need to lubricate them with a solution of potassium permanganate, apply a bandage with Vishnevsky's ointment, etc.
It is also necessary to take care of the oral cavity, because every person needs it and there is nothing difficult about it.
It is enough to rinse your mouth with water after eating and brush your teeth twice a day, in the morning and before bed.
You need to take care of your eyes. It is necessary to wash the eyes to remove purulent formations with a solution of boric acid, potassium permanganate or rivanol with a gauze swab. In the presence of inflammatory processes in the eyes, you need to instill drugs or rub eye ointments.
Also, a seriously ill person needs to clean his ears twice or thrice a week to prevent the formation of sulfuric plugs, which reduce hearing, in such cases it is necessary to wash the auditory canal.
It is necessary to remove the crusts from the nose.
It is necessary to carefully monitor that dandruff does not form in the hair of seriously ill patients. To do this, you need to wash your hair well once a week using shampoos and toilet soap. Seriously ill people wash their hair right in bed. For this procedure, it is necessary to place the pelvis at the head of the bed, and the patient needs to throw his head back over the pelvis. He needs to wash his hair very well, lathering his head, then rinse with warm water, wipe dry and comb well. After this procedure, tie a towel or scarf around your head.
Every day you need to comb your hair, for this you need to use a personal frequent comb dipped in a solution of vinegar. Thus, dandruff is combed out wonderfully. It is necessary that the scallops are clean, it is necessary to wipe them with alcohol and rinse in hot water with soda. After that, the nurse trims the toenails and toenails.
Orenburg Institute of Communications -
branch of the State Budgetary Educational Institution of Higher Professional Education
"Samara State University of Communications"
Orenburg Medical College
PM.04, PM.07 Performance of work by profession
junior nurse
MDK 04.03, MDK 07.03
Solving patient problems through nursing care.
Specialty 060501 Nursing
By specialty 060101 General Medicine
Topic 3.4. Patient Personal Care Lecture
Prepared by the teacher
Marycheva N.A.
Agreed
at the CMC meeting
Protocol No.___
From "___" ___________2014
Chairman of the Central Committee
Tupikova N.N.
Orenburg -2014
Lesson #4 Lecture
Topic 3.4. Personal hygiene of the patient
The student must be aware of:
about the types of patient care, about the methodology for determining the degree of development of pressure sores, the prevention and treatment of pressure sores and diaper rash.
The student must know:
Principles of hygienic care;
Importance of personal hygiene of the patient;
Linen mode of the hospital (requirements for bed linen);
Rules for the assembly and transportation of dirty linen;
Care item disinfection mode
Risk factors for pressure sores;
Places of possible formation of bedsores;
Stages of formation of bedsores.
Lecture plan
Introduction.
types of patient care.
Principles of hygienic care.
Importance of personal hygiene of the patient.
Linen mode of the hospital (requirements for bed linen).
Rules for the collection and transportation of dirty linen.
The mode of disinfection of care items.
Places of possible formation of bedsores.
Risk factors for the formation of bedsores.
Method for determining the degree of development of bedsores.
Stages of formation of bedsores.
Prevention and treatment of bedsores and diaper rash.
Introduction.
Patient care is an integral part of treatment. In everyday life, care is understood as helping the patient to meet his various needs. In medicine, the concept of “care for the sick” is interpreted more broadly. Care is understood as a whole complex of therapeutic, preventive, hygienic and sanitary-hygienic measures aimed at alleviating the suffering of the patient, his speedy recovery and prevention of complications of the disease.
A sick person often needs help with personal hygiene: washing, shaving, caring for the oral cavity, hair, nails, washing, taking a bath, as well as in the implementation of waste products. In this part of care, the sister's hands become the hands of the patient. But helping the patient, you need to strive as much as possible for his independence and encourage this desire.
types of patient care.
Nursing care is divided into general and special.
General care includes activities that any patient needs, regardless of the nature of the disease. All patients need medicines, change of linen, etc.
Special Care includes measures that apply only to a certain category of patients (for example, washing the bladder for a patient with diseases of the genitourinary organs).
Care ingredients:
Patient monitoring
Patient Education
Medical procedures
General care procedures
Rehabilitation
Patient Modes
own security
Patient safety
Gymnastics
Infection control
Medication control
Care principles.
safety(prevention of patient injury);
confidentiality(details of personal life should not be known to outsiders);
respect the senses dignity(performing all procedures with the consent of the patient, providing privacy if necessary);
communication (disposition of the patient and his family members to the conversation, discussion of the course of the upcoming procedure and the care plan as a whole);
independence(encouragement of each patient to independence);
infectious safety(implementation of relevant activities).
Target help patient- implementation of personal hygiene, ensuring comfort, cleanliness and safety.
Importance of personal hygiene of the patient.
Personal hygiene patient is of great importance in the course of his treatment. First of all, it is worth understanding that the concept of cleanliness in each patient is individual. That is why medical staff need to ask them about their personal care habits, as well as to assess whether the patient is able to independently follow the rules of hygiene that will allow him to most effectively carry out his treatment.
One of the important parts personal hygiene of the patient is skin care. In order to keep the skin clean, it is necessary to wash your face every morning and evening and take a hygienic bath once a week. Of course, this applies to those patients who, for health reasons, can carry out hygiene procedures themselves. Do not forget about caring for the oral cavity, you need to brush your teeth twice a day, while paying attention to the cleanliness of the tongue and gums.
Personal hygiene of a seriously ill patient
Since with a number of diseases a person cannot take care of himself, personal hygiene of a seriously ill patient the nurse is doing. It is worth noting that the reason for the inability to carry out personal hygiene procedures can be not only a severe physical, but also a mental condition, such as depression. Skin care in critically ill patients with bed rest in a hospital has a number of features. In order to avoid the risk of infection due to contamination of the skin, daily wiping with soapy water using a sponge or napkins should be carried out. Particular attention should be paid to places where secretions of sweat glands accumulate. These patients should brush their teeth twice a day. In addition, the oral cavity is treated with a cotton ball dipped in a solution of potassium permanganate or boric acid. Also, the duties of the medical staff include caring for the eyes, ears and nasal cavity of seriously ill patients.
Personal hygiene of the patient in the hospital
The place where the patient spends most of his time while being treated in medical institution, is his bed. That is why, in addition to the basic rules personal hygiene of the patient in the hospital you need to take care of the cleanliness of bed linen. It needs to be changed as it gets dirty, and in bedridden patients, carefully straighten all the folds, since even the smallest of them can cause skin damage. The sheets on the beds of such patients should be very soft, without scars and seams, as they are often sensitive due to illness.
Linen mode of the hospital (requirements for bed linen).
Medical organizations should be adequately provided with linen.
Collection, transportation and storage of linen
In hospitals and clinics, central pantries are equipped for clean and dirty linen. In low-power medical organizations, clean and dirty linen can be stored in separate cabinets, including built-in ones. The pantry for clean linen is equipped with racks with a moisture-resistant surface for wet cleaning and disinfection.
In "dirty" rooms (rooms for disassembling and storing dirty linen), finishing means ensuring moisture resistance to their entire height. Floors should be covered with waterproof materials. It is allowed to install suspended, stretch, hemmed and other types of ceilings that ensure the smoothness of the surface and the possibility of carrying out their wet cleaning and disinfection.
Transportation of clean linen from the laundry and dirty linen to the laundry should be carried out in a packaged form (in containers) by specially designated vehicles. It is impossible to transport dirty and clean linen in the same container. Washing of fabric containers (bags) is carried out simultaneously with linen.
Dirty linen is collected in closed containers (oilcloth or polyethylene bags, specially equipped and marked linen trolleys or other similar devices) and transferred to the central pantry for dirty linen. Temporary storage of dirty linen in compartments (no more than 12 hours) is allowed in rooms for dirty linen with a waterproof surface finish, equipped with a sink and an air disinfection device.
Laundry closets should have shelves with a hygienic coating, accessible for wet cleaning and disinfection.
Issuance and change of linen to patients
Upon admission to the hospital, the patient is given a set of clean underwear, pajamas / bathrobe, slippers. Patients leave personal clothes and shoes in a special package with hangers (polyethylene bags, covers made of dense fabric) in the storage room for patients' belongings or give them to relatives (acquaintances). Patients are allowed to stay in hospitals in home clothes. Personal clothing of patients with an infectious profile, in cases provided for by sanitary rules, is subjected to chamber disinfection. Change of linen for patients is carried out as it gets dirty, regularly, but at least 1 time in 7 days. Before the patient enters, bedding (mattress, pillow, blanket) is changed and the bed is covered with a clean set of bed linen (sheet, pillowcase, duvet cover). Soiled linen must be replaced immediately. Bed linen for postpartum women should be changed once every 3 days, underwear and towels daily, diapers at least 4-5 times a day and as needed. It is allowed to use gaskets of industrial production.
Before the patient returns to the ward after surgery, a mandatory change of underwear is carried out. In the postoperative period, the change of linen for patients should be carried out systematically until the discharge from the wounds stops.
In operating rooms, obstetric hospitals (maternity units, as well as wards for newborns), sterile underwear is used. For newborns, the use of diapers is allowed.
When carrying out medical and diagnostic manipulations, in particular in an outpatient clinic, the patient is provided with an individual set of linen (sheet, diaper, napkin, shoe covers), including one-time.
Medical staff clothing
Medical personnel should be provided with sets of changeable clothes, gowns, caps and changeable shoes. The change of clothing for personnel in the surgical and obstetric departments is carried out daily and as it gets dirty. In institutions of a therapeutic profile, it is carried out 2 times a week and as it gets dirty. Reusable wipes, if it is impossible to use disposable cloth ones, are subject to washing.
Laundry of staff clothes is carried out centrally and separately from patients' linen. Laundry is washed in special laundries or laundry as part of a medical organization. The laundry regimen must comply with current hygiene standards. Do not wash clothes at home.
Disinfection of linen
Disinfection of products made of textile materials contaminated with secretions and biological fluids (underwear, bed linen, towels, overalls of medical personnel, etc.) is carried out in laundries, soaking in disinfectant solutions before washing, or during washing using disinfectants approved for these purposes. means in washing machines of the through-type type according to program No. 10 (90 ° C) according to the technology of processing linen in medical organizations. Linen of newborns is treated in the same way as infected.
After discharge of patients, as well as as they become dirty, mattresses, pillows, blankets should be subjected to disinfection chamber treatment. In the case of using covers made of a material that allows wet disinfection to cover mattresses, chamber processing is not required. If there are covers on mattresses and pillows made of moisture-proof materials, they are disinfected with a disinfectant solution by wiping. In a medical organization there should be an exchange fund of bedding, for the storage of which a special room is provided.
Premises and inventory for cleaning laundries, pantries for temporary storage of linen are washed and disinfected daily. Cleaning equipment (trolleys, mops, containers, rags, mops) must be clearly marked or color-coded according to their functional purpose and stored in a room allocated for this purpose. The color coding scheme is placed in the inventory storage area.
Washing machines for washing mops and other rags are installed at the picking points of cleaning carts. Used cleaning equipment is disinfected in a disinfectant solution, then rinsed in water and dried.
Washing of linen in medical organizations is carried out in accordance with SanPiN 2.1.3.2630-10 "Sanitary and epidemiological requirements for organizations engaged in medical activities" and MU 3.5.736-99 "Technology for processing linen in medical institutions".
The mode of disinfection of care items.
Equipment: overalls, used item of care; a disinfectant approved for use in the Russian Federation (a list of the main disinfectants and their characteristics is given in the "Guidelines for disinfection, pre-sterilization cleaning and sterilization of medical supplies", approved by the Ministry of Health of Russia on December 30, 1998, No. MU-287-113) ( the concentration of the solution, the exposure and the method of processing are selected depending on the presence of blood and biological secretions of the patient on the care items); rags - 2 pcs.; container for disinfection with a lid and markings. Required condition: care items are disinfected immediately after use.
Preparation for the procedure
Put on overalls, gloves.
Prepare equipment.
Pour the disinfectant solution of the desired concentration into the container.
Perform the procedure using the item of care.
Performing disinfection by full immersion:
Immerse the item of care completely, filling its cavities with a disinfectant solution).
Remove gloves.
Record the start time for disinfection.
hold for 60 minutes (or required time disinfection process with this agent).
Put on gloves.
End of procedure
Pour the disinfectant solution into the sink (sewer).
Store the item of care in a specially designated place.
Double wipe method:
Wipe the object of care twice in succession with a disinfectant solution with an interval of 15 minutes (see "Guidelines for the use of a disinfectant").
Make sure that there are no untreated gaps on the subject of care.
Let dry.
Wash the care item under running water, using detergents, dry.
End of procedure
Pour the disinfectant solution down the sink (sewer).
Store the item of care in a specially designated place.
Remove overalls, wash and dry hands.
Risk factors for the formation of bedsores.
Skin must be clean to function properly. Contamination of the skin with the secret of the sebaceous and sweat glands, dust and microbes that settle on the skin can lead to the appearance of a pustular rash, peeling, diaper rash, ulceration, bedsores.
Intertrigo - inflammation of the skin in the folds that occurs when rubbing wet surfaces. They develop under the mammary glands, in the intergluteal fold, armpits, between the toes with excessive sweating, in the inguinal folds. Their appearance is facilitated by excessive secretion of sebum, urinary incontinence, discharge from the genitals. More often occur in the hot season in obese people, in infants with improper care. With diaper rash, the skin turns red, its stratum corneum, as it were, soaks and is torn off, weeping areas with uneven contours appear, cracks can form in the depths of the skin fold. Often, diaper rash is complicated by pustular infection or pustular diseases. To prevent the development of diaper rash, regular hygienic skin care and treatment of sweating are necessary.
With a predisposition to diaper rash, after washing and thoroughly drying, it is recommended to wipe the skin folds with boiled vegetable oil (or baby cream) and powder with talcum powder.
bedsores- this is soft tissue necrosis, which develops as a result of their prolonged compression, shift or friction due to impaired local blood circulation and nervous trophism.
Prolonged (more than 1 - 2 hours) action of pressure leads to vascular obstruction, compression of nerves and soft tissues. In the tissues above the bone protrusions, microcirculation and trophism are disturbed, hypoxia develops, followed by the development of bedsores.
Friction damage to soft tissues occurs when the patient is moved, when the skin is in close contact with a rough surface. Friction causes injury to both the skin and deeper soft tissues.
Shear injury occurs when the skin is immobile, and there is a displacement of tissues lying deeper. This leads to impaired microcirculation, ischemia and skin damage, most often against the background of the action of additional risk factors for the development of bedsores.
Places of possible occurrence of bedsores.
Depending on the position of the patient (on the back, on the side, sitting in a chair), the pressure points change. The figures show the most and least vulnerable areas of the patient's skin. (6)
In the supine position - in the region of the tubercles of the calcaneus, sacrum and coccyx, shoulder blades, on the posterior surface of the elbow joints, less often above the spinous processes of the thoracic vertebrae and in the region of the external occipital protrusion.
In the position on the "belly" - on the anterior surface of the legs, especially above the anterior edges of the tibia, in the region of the patella, upper anterior iliac spines, at the edge of the costal arches.
When positioned on the side - in the region of the lateral malleolus, condyle and greater trochanter of the femur, on the inner surface of the lower extremities in places of their close contact with each other.
In a forced sitting position - in the area of the ischial tubercles. In order to determine whether a patient is at risk of developing pressure ulcers, all risk factors must be identified.
Risk factors for the formation of bedsores.
Risk factors for developing pressure ulcers can be reversible (eg, dehydration, hypotension) or irreversible (eg, age), intrinsic or extrinsic.
8.1.1. Carrying out a hygienic shower
Contraindications: serious condition of the patient.
Equipment: bath bench or seat, brush, soap, washcloth, gloves, bath treatment products.
Performing manipulation:
- put on gloves;
- wash the bath with a brush and soap, rinse with 0.5% bleach solution or 2% chloramine solution, rinse the bath hot water(you can use cleaning and disinfecting household products);
- put a bench in the bath and seat the patient;
- help the patient dry himself with a towel and get dressed;
- remove gloves;
8.1.2. Carrying out a hygienic bath
Indications: skin pollution, pediculosis.
Contraindications: serious condition sick.
Equipment: brush, soap, washcloth-mitt, gloves, footrest, bath treatment products.
Performing manipulation:
- put on gloves;
- wash the bath (Fig. 73) with a brush and soap, rinse with a 0.5% bleach solution or 2% chloramine solution, rinse the bath with hot water (household cleaners and disinfectants can be used);
- fill the bath warm water(water temperature 35-37 ° C);
- help the patient to take a comfortable position in the bathroom (the water level should reach the xiphoid process);
- wash the patient with a washcloth: first the head, then the torso, upper and lower limbs, groin and perineum;
- help the patient get out of the bath, dry himself with a towel and get dressed;
- remove gloves;
- Escort the patient to the room.
The duration of the bath is not more than 25 minutes.
Possible complications: deterioration of health - pain in the heart, palpitations, dizziness, discoloration of the skin. If such signs appear, it is necessary to stop taking a bath, transport the patient on a gurney to the ward, and provide the necessary assistance.
To facilitate the work of staff, there are special devices that make it easy to place the patient in the bath (Fig. 74).
8.1.3. Seriously ill skin care
Patients who are indicated for bed rest or strict bed rest should not use a hygienic bath or shower due to the severity of the condition and high risk the development of complications. However, compliance with skin hygiene in this category of patients is also necessary. Such patients wipe the skin at least twice a day with a swab or the end of a towel moistened with warm water or an antiseptic solution (10% camphor alcohol solution, vinegar solution - 1 tablespoon per glass of water, 70% ethyl alcohol mixed with water, 1% salicylic alcohol). Then the rubbed places are wiped dry.
The nurse washes the patient (face, neck, hands) with a sponge moistened with warm water. Then dries the skin with a towel. The patient's legs are washed 2-3 times a week, placing a basin on the bed, after which, if necessary, the nails are cut short. With poor skin care, diaper rash, bedsores and other complications can occur that worsen their condition.
It is especially necessary to wash and dry the skin folds under the mammary glands in women (especially in obese women), armpits, inguinal folds, as otherwise there is a high risk of developing diaper rash. At the same time, the protective properties of the skin are reduced, and microorganisms are able to penetrate through damaged skin. In order to prevent diaper rash, it is necessary to examine the skin folds under the mammary glands, armpits, and inguinal folds daily. After washing and drying, these areas of the skin must be powdered with powder.
8.1.4. Washing feet in bed
Equipment: rubber oilcloth, basin, warm water at a temperature of 34-37 ° C, washcloth, soap, towel, vaseline or softening cream.
Performing manipulation:
- put on gloves;
- put oilcloth on the mattress;
- put the basin on the oilcloth;
- pour water up to half of the basin;
- lower the patient's legs into the pelvis with minimal physical exertion for the patient;
- lather your feet well, especially the interdigital spaces;
- rinse the patient's legs clean water, lifting them above the pelvis;
- wipe your feet dry with a towel;
- lubricate the soles and heels with cream;
- take out the oilcloth;
- it is convenient to lay your legs on the bed and cover them with a blanket;
- Wash the hands.
8.1.5. Washing away the sick
Patients who can take care of themselves, wash with boiled water and soap every day, preferably in the morning and evening.
Seriously ill patients who are in bed for a long time and are not able to take regular hygienic bath should be washed after each act of defecation and urination. Patients suffering from incontinence should be washed several times a day, as the accumulation of urine and feces in the perineum and inguinal folds can cause diaper rash, bedsores or infection.
Indications: perineal hygiene.
Equipment: 8-16 cotton swabs, oilcloth, vessel, forceps, jug, Esmarch's mug with a rubber tube, a clamp and a tip, an antiseptic solution (a weak pink solution of potassium permanganate or a solution of furacilin 1: 5000).
Performing manipulation:
- put on gloves;
- lay the patient on his back, his legs should be bent at the knees and divorced;
- lay an oilcloth under the patient and put the vessel;
- take a forceps with a napkin or cotton swab in your right hand, and a jug with a warm antiseptic solution or water at a temperature of 30-35 ° C in your left hand. Instead of a jug, you can use an Esmarch mug with a rubber tube, clip and tip;
- pour the solution on the genitals, and with a napkin (tampon) make movements from the genitals to the anus (from top to bottom).
First, the labia minora are washed (with two different tampons or one large, but different sides), then the labia majora, inguinal folds, and the anus area is washed last, changing the tampons each time;
- dry in the same sequence, constantly changing tampons;
- at the end of the procedure, remove the vessel and oilcloth;
- Wash the hands.
8.2. oral care
Oral care is a necessary procedure for all patients, as microorganisms accumulate there, causing bad breath and causing inflammatory changes in the teeth, mucous membranes of the oral cavity, and excretory ducts. salivary glands. Assistance in such care should be given to patients who are not able to do it themselves.
Patients should thoroughly brush their teeth, especially near the gums, 2-3 times a day, preferably after each meal. If this is not possible, rinse your mouth after eating with lightly salted water (*/4 teaspoon table salt per glass of water) or a solution of baking soda (U2 teaspoon per glass of water). This procedure is also necessary for people who do not have teeth.
For seriously ill patients who cannot brush their own teeth, after each meal, the nurse should treat the oral cavity. Patients rinse their mouths. After that, the gums are gently and thoroughly wiped with a cotton ball or gauze, fixed with a clamp or forceps and moistened with an antiseptic solution.
Application- this is the imposition on the mucous membrane of sterile gauze wipes soaked in any disinfectant solution (0.1% solution of furacilin) for 3-5 minutes. This procedure is repeated several times a day. You can make applications with painkillers.
Patients who have impaired nasal breathing and who breathe almost completely through the mouth often suffer from dry lips and mouth. After some time, they develop cracks in the corners of the mouth, which can be painful, especially when talking, yawning, eating. The patient must be taught not to touch these wounds with his hands and not to open his mouth wide. The lips are gently wiped with a swab moistened with a 1:4000 solution of furacilin, and then lubricated with vegetable, olive or vaseline oil, sea buckthorn oil.
To prevent the formation of cracks and drying of the lips, patients in a coma with artificial ventilation of the lungs are given a gauze pad moderately moistened with a solution of furacilin, which is replaced as it dries.
In patients with high fever, viral infection or severe violation blood circulation, sometimes develops aphthous stomatitis, in which there is a sharp smell from the mouth. To get rid of this smell, it is necessary to treat, first of all, the underlying disease. Be sure to rinse your mouth with disinfectants (0.2% sodium bicarbonate solution, 1% sodium chloride solution or dental elixir).
If the patient has removable dentures at night, they are removed, thoroughly washed with running water and stored in a dry glass. Wash again before wearing.
8.2.1. Oral treatment
Oral Care Algorithm
Indications: Regular oral care.
Equipment: spatula, cotton balls, clip or tweezers, tray, solutions of the previously listed antiseptics, gloves.
Preparation for the procedure:
- introduce yourself to the patient, explain the course of the upcoming procedure (if he is conscious);
- prepare everything necessary equipment;
- position the patient in one of the following positions:
- on the back at an angle of more than 45°, unless contraindicated,
- lying on the side
- lying on your stomach (or back), turning your head to the side;
- put on gloves;
Wrap a towel around the patient's neck.
Performing manipulation:
Prepare a soft toothbrush (no toothpaste) for brushing your teeth. Ask the patient to open their mouth wide. Soak the brush in the prepared antiseptic solution. In the absence of a toothbrush, you can use a gauze pad attached to a clip or tweezers;
- clean the teeth, starting from the back teeth, sequentially clean the inner, upper and outer surfaces, performing up and down movements in the direction from the back teeth to the front teeth. Repeat the same steps on the other side of the mouth. The procedure is repeated at least two times;
- wet the patient's oral cavity with dry swabs to remove residual fluid and secretions from the oral cavity;
- ask the patient to stick out his tongue. If he cannot do this, then it is necessary to wrap the tongue with a sterile gauze napkin and carefully pull it out of the mouth with the left hand;
- Wipe the tongue with a cloth soaked in an antiseptic solution, removing plaque, in the direction from the root of the tongue to its tip. Release the tongue, change the napkin;
- wipe the inner surface of the cheeks, the space under the tongue, the gums of the patient with a napkin dipped in an antiseptic solution;
- if the tongue is dry, lubricate it with sterile glycerin;
- sequentially process the top and lower lip a thin layer of petroleum jelly (for the prevention of cracks in the lips).
Finishing the procedure:
- remove the towel. It is convenient to lay the patient;
- collect care accessories and deliver to a special room for further processing;
- remove gloves, place them in a container for disinfection;
- wash your hands, treat them with an antiseptic or soap;
- make an appropriate record of the procedure performed in the medical records.
During this manipulation, the mouth, tongue, and gums are carefully examined. If inflammatory changes occur in the oral cavity, rinsing is carried out, the gums are treated with a solution of furacilin 1; 5000, 2% boric acid solution. Sometimes they apply applications with the same solutions, removing them after 1-2 hours. Treatment is carried out under the guidance of a dentist.
As a first aid, the site of inflammation of the mucous membranes can be treated with a solution of brilliant green. This procedure is repeated 2-3 times a day. In the early stages, it sometimes allows the patient to be completely cured before the arrival of a dental consultant.
Patients who are on bed rest for a long time and consume few vitamins may develop stomatitis: round sores appear on the red mucosa. Then they turn yellow, and there are pains in the oral cavity. Sometimes sores appear along the edge of the tongue, on the gums, the inside of the lips and cheeks. Local treatment - applications or irrigation of the oral cavity with the previously listed antiseptic solutions are used. Sores are lubricated with specially prepared ointments or vegetable oil.
8.2.2. Oral irrigation
Indications: phenomena of stomatitis.
Equipment: spatula, cotton balls, clip or tweezers, tray, antiseptic solutions, gloves, oilcloth, pear-shaped balloon or Jeanne's syringe. Performing manipulation:
- put on gloves;
- draw a warm antiseptic solution into a pear-shaped balloon or Jeanne's syringe;
- so that the solution does not get into Airways, the patient's head must be turned on its side (if possible, seat the patient);
- put an oilcloth (or diaper) on the chest and neck of the patient, put a tray under the chin;
- pull the corner of the mouth with a spatula, insert the tip into the vestibule of the mouth;
- alternately rinse the left and right buccal space with a jet of liquid under moderate pressure.
Manipulation of irrigation of the oral cavity is not used in seriously ill patients because of the danger of fluid entering the respiratory tract, which can cause irreversible consequences.
8.3. Ear care
Patients who are on a general regimen wash their ears on their own during the morning daily toilet. Patients on bed rest should periodically toilet the external auditory canals.
8.3.1. Removing dirt and sulfur plug
Performing manipulation:
- put on gloves;
- seat the patient;
- drip a few drops of a 3% hydrogen peroxide solution into the ear (the solution should be warm);
- pull back auricle back and up and with rotational movements, insert a cotton turunda into the external auditory canal;
- changing the turunda, repeat the manipulation.
To remove wax from the ears, do not use hard objects to avoid damage to the eardrum.
8.3.2. Putting ointment in the ear
Performing manipulation:
- put on gloves;
- seat the patient;
- tilt the patient's head in the opposite direction;
- apply the required amount of ointment to a sterile cotton turunda;
- pull the auricle back and up and with rotational movements insert the turunda with ointment into the external auditory canal.
8.3.3. Drops in the ears
Performing manipulation:
- put on gloves;
- seat the patient;
- tilt the patient's head in the opposite direction;
- draw the required number of drops into the pipette (they should be warm);
- pull the auricle back and up and introduce drops into the external auditory canal;
- at the end of the procedure, put a cotton swab into the external auditory canal.
8.4. Nose care
Walking patients during the morning toilet take care of the nose on their own. Seriously ill patients who are not able to monitor the hygiene of the nose, it is necessary to free the nasal passages daily from secretions and crusts that form. The nurse should do this daily.
8.4.1. Nasal processing
Performing a manipulation
- put on gloves;
- in a lying or sitting position (depending on the patient's condition), slightly tilt the patient's head;
- moisten cotton turundas with vaseline or vegetable oil or glycerin;
- insert the turunda into the nasal passage with rotational movements and leave it there for 2-3 minutes;
- remove the turunda and repeat the manipulation.
8.4.2. Instillation of drops in the nose
Another way to clear the patient's nose is to instill drops. In this case, a sterile pipette is used. Patients are in a sitting or lying position (depending on the condition), the head is tilted to the opposite shoulder and slightly tilted back. The nurse must check the compliance of the drops with the doctor's prescription, seat the patient and draw the required number of drops into the pipette. Drops are first instilled into one, and then, after 2-3 minutes, into the other nasal passage, after changing the position of the head.
8.4.3. Help with nosebleeds
The causes of nosebleeds are varied. They can be the result of local changes (injuries, scratching, ulcers of the nasal septum, skull fracture), as well as appear in various diseases (blood diseases, infectious diseases, influenza, hypertension, etc.).
With nosebleeds, blood flows not only outside, through the nasal openings, but also into the pharynx and into the oral cavity. This causes coughing, often vomiting (when blood is swallowed). The patient becomes restless, which increases bleeding.
Performing manipulation:
- seat or lay the patient down and calm;
- it is not recommended to throw back the head in order to avoid swallowing blood and its entry into the nasopharynx;
- press the wings of the nose to the nasal septum;
- put a cold compress or ice pack on the partition;
- if the bleeding does not stop, insert cotton balls (dry or moistened with 3% hydrogen peroxide) into the nasal passages;
- if nosebleeds recur or bleeding is massive, consultation of an otorhinolaryngologist is indicated.
8.5. Eye Care
Walking patients during the morning toilet take care of their eyes on their own. Seriously ill patients often develop discharge from the eyes, sticking together the eyelashes and making it difficult to look. Such patients need to wipe their eyes daily with sterile gauze or cotton swabs moistened with disinfectant solutions. It must be remembered that a separate sterile swab is taken for each eye. After manipulating the treatment of the patient's eyes, the sister should thoroughly wash her hands with soap and wipe them with alcohol.
8.5.1. Rubbing eyes
Indications: eye hygiene.
Equipment: sterile tray, sterile gauze balls, antiseptic solutions, gloves.
Performing manipulation:
- put on gloves;
- put 8-10 sterile balls in a sterile tray, and moisten them with an antiseptic solution (furatsilin solution 1: 5000, 2% solution
soda, 2% solution of boric acid, 0.5% solution of potassium permanganate), 0.9% solution of sodium chloride or boiled water;
- slightly squeeze the swab and wipe the eyelashes with it in the direction from the outer corner of the eye to the inner one;
- repeat wiping 3-4 times;
- blot the remaining solution with dry swabs;
- Wash the hands.
8.5.2. Eye wash
Indications: disinfection of the conjunctival sac, removal of mucus, pus from it, first aid in case of eye burns with chemicals. Equipment:
- tray;
- sterile rubber can;
- solutions of antiseptics, gloves.
Performing manipulation:
- put on gloves;
- lay down the patient;
- tilt the patient's head slightly back;
- from the side of the temple to substitute the tray;
- collect an antiseptic solution in a rubber can;
- push both eyelids with the thumb and forefinger of the left hand;
- rinse the eye with a jet from a can, directing from the temple to the nose;
- Wash the hands.
Seriously ill patients who, for one reason or another, do not close their eyelids during sleep, need to apply gauze napkins moistened with warm saline on the eyes (to avoid drying of the conjunctiva).
Performing manipulation:
- put on gloves;
- seat or lay down the patient;
- draw ointment on a sterile glass rod so that it covers the entire shoulder blade;
- throw back the patient's head;
- lay the spatula with ointment behind the lower eyelid so that the ointment is directed towards eyeball, and the free surface to the eyelid;
- lower the lower eyelid and ask the patient to close the eyelids;
- remove the spatula from under the closed eyelids and then lightly press the ointment to the eyeball;
- remove excess ointment with a cotton ball;
- Wash the hands.
8.5.3. Other eye care procedures
8.5.3.1. Eversion of the upper eyelid
Indications:
- diseases of the conjunctiva of various etiologies (bacterial, viral, allergic) (Fig. 75);
Availability foreign body;
- wearing contact lenses. Contraindications:
- pronounced cicatricial adhesions of the conjunctiva of the eyelids with the conjunctiva of the eyeball;
- consequences of injuries;
- Consequences of burns.
Equipment:
- desk lamp;
- glass rod;
- magnifying glass 20x;
- binocular loupe (if necessary). Recommendations to the patient before the procedure: when eversion and examination of the conjunctiva of the upper eyelid, it is necessary to look down at the knees.
Performing manipulation:
1st way. Turning the upper eyelid with fingers. The subject looks down. Doctor:
- thumb the left hand raises the upper eyelid (Fig. 76A);
- fixes the eyelid by the edge and eyelashes with the thumb and forefinger of the right hand, pulling it down and forward (Fig. 76B);
- with the thumb or forefinger of the left hand shifts the upper edge of the cartilage down (Fig. 76B);
- the everted eyelid is pressed by the eyelashes to the upper edge of the orbit and held in this position until the end of the examination (Fig. 76d).
2nd way. Inversion of the upper eyelid with a glass rod.
All steps are performed in the same way as in the first method, only when performing point “B”, a glass rod is used, on which the upper eyelid is turned out. To study the conjunctiva of the upper transitional fold with the everted upper eyelid, it is necessary to slightly press on the eyeball through the lower eyelid. At the same time, the conjunctiva of the upper transitional fold, loosely connected with the underlying tissues, becomes available for inspection. Recommendations to the patient after the procedure: no.
Possible complications:
- infection of the conjunctival cavity;
- if the procedure is performed roughly, corneal erosion is possible.
8.5.3.2. Instillation (instillation) of eye drops
Indications:
- treatment;
- diagnostics;
- Anesthesia during various manipulations. Contraindications: drug intolerance.
Methods of anesthesia: not required.
Equipment:
- instilled solution;
- pipette;
- cotton or gauze ball.
Advice to the patient before the procedure:
- raise the chin;
- fix the look up and inside.
Performing manipulation:
Put on gloves. Seating or laying down the patient. Immediately before the procedure, check the correctness of the administered medication. Ask the patient to tilt their head back slightly and look up. Take a cotton ball with your left hand, put it on the skin of the lower eyelid and, holding the cotton wool with your thumb, pull the lower eyelid down, and hold the upper eyelid with the index finger of the same hand. Without touching the tip of the pipette to the eyelashes and the edges of the eyelids, inject one drop of the solution into the space between the eyelids and the eyeball, closer to the inner corner of the palpebral fissure (Fig. 77). Remove the part of the medicine flowing from the eyes with a cotton ball. You can also instill drops on the upper half of the eyeball - with the upper eyelid pulled back and when the patient looks down. When instilled into the eyes of potent drugs (for example, atropine) in Fig. 77. Instillation to avoid getting them into the nasal cavity and for reducing eye drops. General actions are followed by the index finger
press the lacrimal ducts for 1 minute. Wash your hands at the end of the procedure.
Recommendations for the patient after the procedure: close your eyes and gently press on the inner corner of the eye for 3-5 minutes.
Possible complications:
- an allergic reaction to the drug;
- damage to the conjunctiva;
- damage to the cornea due to careless manipulation.
8.5.3.3. Applying eye ointment
Indications: the introduction of a soft drug into the conjunctival sac in inflammatory diseases of the anterior segment of the eye of various etiologies.
Contraindications:
- drug intolerance;
- Suspicion of a penetrating injury to the eyeball.
Methods of anesthesia: not required.
Equipment:
- used ointment;
- sterile glass rod;
- cotton ball.
Advice to the patient before the procedure:
- raise the chin;
- Fix your eyes up.
Performing manipulation:
Put on gloves. Seating or laying down the patient. Dial the ointment on a sterile glass rod so that it covers the entire shoulder blade and, holding it parallel to the eyelids, place the tip of the stick behind the lower eyelid with ointment to the eyeball, and with the free surface to the eyelid. After the patient closes his eyes, remove the stick from the palpebral fissure. Next, perform circular stroking with a cotton ball of closed eyelids to evenly distribute the ointment over the eye. Remove excess ointment with a cotton ball. The ointment can be administered directly from a specially produced tube. At the end of the procedure (Fig. 78), wash your hands.
Possible complications: see point 8.5.3.2.
8.5.3.4. Removal of superficial foreign bodies from the conjunctiva
Indications: foreign body of the cornea or conjunctiva.
Contraindications: no.
Anesthesia methods:
- when removing a foreign body from the conjunctiva, anesthesia is not required;
- when removed from the cornea - installation anesthesia with a 0.25% solution of dicaine (or other anesthetic).
Equipment:
- anesthetic solution;
- cotton swab;
- injection needle or spear;
- slit lamp or binocular loupe.
Recommendations to the patient before the procedure: fix the gaze at the request of the doctor. Performing manipulation:
Removal of foreign bodies from the conjunctiva is performed using a small cotton "bannichka" moistened with some kind of disinfectant eye drops.
To remove foreign bodies located on the conjunctiva of the upper eyelid, you must first turn it out. After removal of the foreign body, a 0.25% solution of levomycetin is instilled into the conjunctival sac. With a foreign body of the cornea, a local anesthetic solution is instilled into the eye. Superficially lying foreign bodies are removed with a damp cotton swab. Foreign bodies that have penetrated into the superficial layers of the cornea are removed with an injection needle or spear (the procedure is performed by a doctor).
Possible complications: see point 8.5.3.2 and reaction to the anesthetic.
8.5.3.5. Foreign body in the conjunctival sac
The search for a foreign body should begin with pulling back the lower eyelid. If found, it can be removed with a cotton "bannichka". If there is no foreign body behind the lower eyelid, then you need to look for it on the inner surface of the upper eyelid; to do this, it must first be unscrewed. It is important to remember that a foreign body in the conjunctival sac should be looked for without prior anesthesia. After removing the foreign body, drops containing an antibiotic are instilled into the affected eye.
8.5.4. Chemical burns to the eyes
If a powdered chemical gets behind the eyelids, it is necessary to remove it with a dry “bannichka” and only after that proceed with washing the eye. For liquid chemical burns, eye rinsing should begin as soon as possible. Washing is best done with a weak stream of water for 10-15 minutes. If the burn is caused by alkali, a 2% solution of boric acid or a 0.1% solution is used for washing. acetic acid. For acid burns, a 2% sodium bicarbonate solution or an isotonic sodium chloride solution is used. In no case should you limit yourself to a 1-2 minute rinse, especially for burns with powdered chemicals. After irrigation, the burned skin of the eyelids and face is lubricated with an antibiotic-containing ointment: 1% tetracycline ointment, 1% erythromycin ointment, 10-20% sulfacyl sodium ointment. A 0.25% dicaine solution or a 3% trimecaine solution is instilled into the conjunctival sac and an antibiotic-containing ointment is applied. 1500-3000 IU of tetanus toxoid is injected subcutaneously. For burns of the 2nd, 3rd and 4th degree, urgent hospitalization is necessary.
Specific antidotes:
- lime, cement - 3% solution of disodium salt of ethylenediaminete-raacetic acid (EDTA);
- iodine - 5% sodium hyposulfite solution:
- potassium permanganate - 10% sodium thiosulfate solution or 5% solution ascorbic acid:
- aniline dyes - 5% solution of tonin;
- phosphorus - 0.25-1% solution of copper sulfate:
- resins - fish fat, vegetable oil.
8.5.5. Thermal eye burns
The substance that caused the burn is carefully removed from the skin of the face, eyelids and mucous membranes of the eyes with tweezers or a stream of water. conjunctival sac washed with water, a 3% solution of trimikain, a 0.25% solution of dicain, a 20% solution of sulfacyl sodium, a 0.25% solution of levomycetin are instilled into the eye. Over the eyelids, a 1% tetracycline or erythromycin ointment is applied. If there are bubbles on the skin, they must be cut off, and the wound surface should be generously lubricated with antibiotic-containing ointments. Anti-tetanus serum (1500-3000 IU) is injected subcutaneously. An aseptic bandage is applied to the eye.
Test tasks:
1. When treating the eyes:
a. Use different tampons.
b. Movements are made from the sides to the center.
c. Swabs must be sterile.
2. Rubbing the patient is performed:
a. Warm water with soap.
b. Warm water without soap.
c. Warm solution of furacilin.
d. At least once a week or when contamination occurs.
3. Processing of the perineum is performed:
a. Movements from the genitals to the anus.
b. Movements from the anus to the genitals.
4. Treatment of the oral cavity:
a. Performed by the patient independently.
b. According to indications, it is performed by a nurse.
5. When caring for the ears, the following is instilled into the external auditory canal:
a. salicylic acid solution.
b. 70% alcohol.
c. Sterile glycerin solution.
d. 3% hydrogen peroxide solution.
6. Washing the patient in the hospital should be carried out:
a. Every day.
b. At least 1 time per week.
c. 1 time in 10 days.
d. 1 time per month.
e. Every 3 days.
7. When treating the nasal cavity, use:
a. Dry turundas.
b. Turunds moistened with a solution of furacilin.
c. Turundas moistened with sodium bicarbonate solution.
d. Turundas soaked in vaseline oil.
e. Cooking salt.
8. In case of nasal hemorrhage, it is necessary:
a. Tilt the patient's head back.
b. Lay down or seat the patient.
c. In case of recurrence of bleeding, call an otorhinolaryngologist.
d. Perform an emergency endoscopic examination of the nasal passages.
e. Put on nasal septum ice bubble.
Personal hygiene of the patient
The student must know:
Position of the patient in bed.
Modes of motor activity of the patient.
Risk factors for the formation of bedsores.
Places of possible formation of bedsores, stages of their formation.
Rules for the assembly and transportation of used linen.
Possible patient problems: violation of the integrity of the skin: diaper rash, bedsores, the risk of pressure sores; infection; pain, etc.
nursing interventions.
The student must be able to:
Determine the risk of pressure ulcers in each patient.
Treat the skin in the presence of bedsores.
Educate relatives of a seriously ill patient on the elements of preventing the occurrence of pressure ulcers at home.
Create the necessary position for the patient in bed, depending on the disease, using a functional bed and other devices.
Prepare the bed for the patient.
Change underwear and bed linen.
Take measures to prevent bed sores.
Treat natural skin folds, prevent diaper rash.
Conduct the morning toilet to the patient.
Wash the patient in bed.
Treat the patient's eyes.
Treat the patient's mouth and nose.
Clean the patient's external ear canal.
Wash your feet in bed and trim your toenails and fingernails.
Wash your hair in bed.
Submit a vessel, urinal.
Take care of the external genitalia of men and women.
Questions for self-study
Features of care for seriously ill patients.
The position that the patient can take in bed.
The main purpose of a functional bed.
Positions that can be created for the patient in bed using a functional bed and other devices.
Requirements for bed linen.
Methods for changing underwear and bed linen for a seriously ill patient.
Basic rules for changing underwear and bed linen for a seriously ill patient.
Making a bed for a seriously ill patient.
Hair care.
Delivery of the vessel and urinal to patients (man to woman).
Washing technique for patients (men and women).
Diaper rash, causes, localization, prevention of occurrence.
Washing, brushing teeth to the patient in bed.
Wiping the skin of the patient in bed.
Washing the feet of a patient in bed.
Trimming the patient's fingernails and toenails.
Shaving the patient's face.
Bedsores, risk factors, localization.
Determining the degree of risk of pressure ulcers according to the Waterlow table.
Measures for the prevention of bedsores.
Tactics in the development of bedsores.
Removal of mucus and crusts from the nasal cavity of the patient.
Care of the eyes of a seriously ill patient.
Cleansing the external auditory canal.
Oral care.
Ethical and deontological support
The nurse should, without additional reminders, carry out personal hygiene measures in bed for a seriously ill patient, as this is her direct responsibility. She must convince the patient to accept her help. After all, good care requires not only knowledge and skills, but sensitivity, tact, the ability to influence psychologically, the ability to overcome the patient's increased irritability. A restrained, even and calm attitude towards the patient helps to gain his trust and obtain consent to the implementation of certain personal hygiene measures. To do this, it is equally important to inform the patient in advance of the goal and the progress of their implementation.
Since patients are often embarrassed when carrying out manipulations of an intimate nature (washing away, giving a vessel, etc.), the nurse should:
tactfully convince the patient that there is no reason for embarrassment;
shield the patient with a screen;
ask other patients to leave the room if their condition allows - after the vessel or urinal is delivered, leave the patient alone for a while.
Glossary
term
Wording
Apathy
Painful indifference, indifference to everything
hemiplegia
Unilateral paralysis of limb muscles
Depression
oppressed mental condition
bedsore
The necrosis (necrosis) of soft tissues (skin, subcutaneous fat, muscles, tendons and other tissues).
Theoretical part
Safety rules
A nurse needs to know and be able to apply the rules of biomechanics in her work in order to prevent injuries to patients and medical staff. (See "Safe hospital environment. Mode of rational physical activity. Rules of biomechanics for the patient and medical staff).
Don't forget to wear protective clothing!
Attention! Remember the safety precautions for contact with the mucous membranes of the patient in order to prevent AIDS and hepatitis (see the topic "Prevention of HIV infection").
Purpose of hygiene care
Create maximum comfort for the patient and ensure cleanliness and safety.
Principles of hygiene care
1 . Safety (prevention of injury to the patient, both physical and psychological).
2. Compliance with the principle of infectious safety.
3. Privacy (not divulging patient secrets).
4. Communication should be inviting the patient to himself, before each manipulation to inform the patient:
1) the purpose of the manipulation;
2) how to prepare for manipulation;
3) what sensations will be during the manipulation and how to behave;
4) what to do after manipulation;
5) what sensations will be after the manipulation;
6) what undesirable sensations can be and what to do if
will appear.
5. Respect feelings dignity patient.
6. Encouragement of independence and autonomy of the patient.
Job Responsibilities guard (ward) nurse:
(depending on department profile)
apply knowledge on the system and policy of health care, the basics of legislation and law in the health care of the Russian Federation in the context of budgetary insurance medicine;
to introduce the basics of management into nursing;
maintain medical records;
monitor compliance with the sanitary and epidemic regime in the department;
supervise the work of junior medical staff;
organize nursing care for patients:
a) organize general care,
b) organize differentiated care,
c) organize intensive patient care;
provide nursing care for patients based on the nursing process:
a) assess the condition using anamnesis data, objective data of the patient,
b) formulate a nursing diagnosis,
c) identify violations patient needs,
d) develop a plan for patient care,
e) implement the plan nursing care,
f) evaluate the effectiveness of nursing care, quality standards
care, criteria for the effectiveness of nursing care;
apply the knowledge of nursing pedagogy and communication in the implementation of all stages of the nursing process;
provide palliative nursing care;
apply the methods of traditional and alternative medicine in the treatment, care and rehabilitation of patients through pharmacotherapy, medical nutrition, herbal medicine, using various types of massage, physiotherapy exercises, methods of psychotherapy.
Medical documentation medical department
Journal of reception and delivery of duty.
Portion requirement.
temperature sheet.
Pharmacy requirement.
Head Nurse Requirement for Medicines.
Summary of the movement of patients.
Notebooks of medical appointments.
Journal of registration of narcotic and potent drugs.
Appointment sheets.
Appointment notebooks.
Position of the patient in bed
In diseases, the patient takes various positions in bed.
Distinguish:
active position - the patient easily and freely performs arbitrary (active) movements.
Passive position – the patient cannot perform voluntary movements, retains the position that he was given (for example, when he lost consciousness, or the doctor forbade him to perform them, for example, in the first hours after a heart attack).
forced position – the patient takes it himself in order to reduce pain, cough and other pathological symptoms.
Functional position - a position that a doctor prescribes in order to speed up recovery or so as not to harm.
The position of the patient in bed does not always coincide with the motor regimen prescribed by the doctor.forced the position of the patient in bed also does not always coincide with the functional one, for example, with pustular diseases in the lungs (lung abscess), the patient needs to lie on healthy side, as this position contributes to the outflow of pus. But the outflow of pus causes coughing, and coughing causes pain, and it is easier for the patient to lie on the sore side, and this position is harmful to him.
Mode of the patient's motor activity
General (free) - the patient stays in the department without restriction of motor activity within the hospital and
hospital area. Free walking is allowed along the corridor,
climbing stairs, walking around the hospital.
Ward (half-bed) - the patient spends a lot of time in bed, free walking around the ward is allowed, all personal hygiene measures are carried out within the ward.
Bed - the patient does not leave the bed, can turn, sit, but cannot get up. All personal hygiene activities are carried out in bed by medical staff.
Strict bed - the patient is strictly prohibited from active movements in bed, even turning from side to side is impossible.
Change of bed and underwear
There are two ways to change bed linen.
First way used if the patient compliesbed rest subject to permission to turn in bed (see algorithms).
Second way applied in case of compliancestrict bed rest provided that the patient is prohibited from performing active movements in bed (see algorithms).
Rules for changing and transporting linen.
The patient's head should not lie on a bare mattress.
Do not shake linen at the patient's bedside, especially dirty ones.
Do not place soiled linen on the floor, place immediately in a waterproof bag.
Carefully fold clean laundry so that it does not touch the floor.
Transport linen in the department only in waterproof bags.
Sort dirty laundry only in special rooms.
When changing underwear for the patient, the nurse should wear protective clothing (apron, gloves).
Remember! Change of linen in patients is carried out at least 1 time in 7-10 days, in a seriously ill patient - as far as contamination, but not less than 7 days 1 time. To change underwear for a seriously ill patient, it is necessary to invite 1 - 2 assistants.
Vessel supply
When caring for a patient who is on strict bed and bed rest, if necessary, empty the intestines and bladder, a vessel or urinal is supplied to the bed, women use the vessel more often when urinating. Enamelled metal, plastic or rubber vessels are used. When serving the vessel, infection safety rules are observed, confidentiality during urination and defecation is ensured, as well as patient independence and personal hygiene is observed (see algorithms).
Remember! The ship is always served disinfected and warm, and for taking feces or urine for analysis and for washing - dry, in other cases, a little water is poured into the vessel before serving.
Currently, diapers are used for urinary incontinence for seriously ill patients. They need to be changed every4 hours and monitor the condition of the skin, lubricate the skin with protective creams (for example, "children's").
Diaper change algorithm for a seriously ill patient
Equipment: non-sterile gloves, protective sheet (diaper), clean wipes, a container with warm water, a bag for used linen, a clean diaper, skin antiseptic.
I. Preparation for the procedure.
1. Explain the course and purpose of the procedure to the patient (if possible), obtain his consent.
2. Treat hands in a hygienic way, dry.
3. Prepare a clean diaper and protective sheet, make sure that there are no personal belongings of the patient in the bed.
4. Put on gloves.
II. Execution of a procedure.
5. Lower the handrails, assess the position and condition of the patient.
6. Turn the patient on his side, slightly bending his knees.
7. Roll up a waterproof diaper halfway along the long side and slip it under the patient's back in the same way as changing bed linen.
8.Unfasten the used diaper, remove it from under the patient. Place in a laundry bag. Take care of the intimate area of the patient.
9. Remove the clean diaper from the package, shake it and pull on the ends to fluff up the absorbent layer and bring the side protective frills to a vertical position.
10. Turn the patient on his side, slightly bending his knees, and put the diaper under his back so that the Velcro fasteners are on the side of the head, and the filling indicator (the inscription on the outside of the diaper in its central part, directed along the diaper) is along the spine .
11. Turn the patient on his back, his legs should be slightly bent at the knees.
12. Gently spread the diaper under the patient's back.
13. Stretch the front of the diaper between the patient's legs on the stomach and straighten it.
14. Lower the patient's legs.
15. Fasten the Velcro: first fasten the lower Velcro, first the right one, then the left, or vice versa, tightly covering the legs, directing the Velcro across the patient's body, slightly from the bottom up; then fasten the upper Velcro, in the direction across the body of the patient.
III. End of procedure.
16. Comfortably position the patient in bed.
17. Remove gloves, place them in a container for disinfection
18. Treat hands in a hygienic way, dry.
19. Make an appropriate record of the results of the implementation in the medical records.
Change diapers at least three times a day: morning, afternoon and before bed.
If contaminated with feces, replace the diaper immediately and carry out hygiene and treatment of the patient's skin.Change the diaper every 4 hours if you are at risk of developing pressure sores.
Washing the feet of a patient in bed
Feet in bed are washed every 3 days with warm water (see algorithms).
Washing feet in bed
bedsores
bedsore ( decubitus ) - these are deep lesions of the skin and soft tissues up to their necrosis as a result of prolonged compression. Factors contributing to the formation of bedsores include impaired local blood circulation, innervation and tissue nutrition. Bedsores can form anywhere there are bony protrusions. When the patient is on his back, this is the sacrum, heels, shoulder blades, sometimes the back of the head and elbows, rarely along the spinous processes of the vertebrae. When sitting, these are ischial tubercles, feet, and shoulder blades. When lying on the stomach, these are ribs, knees, toes with back side, iliac crests. When positioned on the side, these are the convex parts of the joints (knee, elbow, shoulder, ankle)
Most frequent places The most vulnerable places for the occurrence
localization of bedsores bedsores (marked with dots)
Distinguish the following types bedsores:
exogenous , i.e., caused by mechanical factors that led to ischemia and tissue necrosis. In these cases, the elimination of the causes that caused the bedsore leads to the development of reparative (restorative) processes and its healing;
endogenous , the development of which is determined by a violation of the vital activity of the organism, accompanied by neurotrophic changes in tissues. The healing of such bedsores is possible with an improvement in the general condition of the body and tissue nutrition.
There are three main factors that lead to the formation of bedsores: pressure, "shear force" and friction.
Pressure - under the influence of the body's own weight, tissue is compressed relative to the surface on which the person rests. At the same time, the diameter of the vessels decreases, as a result, less blood enters the tissues, i.e. less nutrients and oxygen. With full overpressure fortwo hours formednecrosis. Squeezing of vulnerable tissues is further enhanced under the influence of heavy bed linen, tight bandages, and clothing.
"Shear" - destruction and mechanical damage to tissues occurs under the influence of indirect pressure. It occurs as a result of tissue displacement relative to the supporting surface. Microcirculation in the underlying tissues is disturbed, and the tissue dies from lack of oxygen. The displacement occurs when the patient "slides" down the bed or pulls up to her headboard.
Friction - is a component of the "shearing force", it causes detachment of the stratum corneum of the skin and leads to ulceration of its surface. Friction increases when the skin is hydrated. Patients with urinary incontinence are most susceptible to this effect, increased sweating, in damp, non-absorbent underwear.
Factors affecting the development of bedsores: violation of touch; injuries and diseases of the spinal cord and brain; fever and sweating; incontinence of urine and feces; dirty skin; crumbs and small objects in bed; folds, seams, buttons on linen; reduced nutrition and lack of drinking; dietary habits, overweight and malnutrition; cardiovascular diseases; diabetes; allergic reaction to skin care products; age.
Signs of bedsores are the appearance of a pale area of the skin, then a bluish-red color without clear boundaries, then the epidermis is exfoliated, blisters form. Next, tissue necrosis occurs, spreading deep into the tissues and to the sides. Treatment is carried out in accordance with the degree of tissue damage.
Risk factors
Internal factors risk
reversible
irreversible
exhaustion
Senile age
Limited mobility
Anemia
Insufficient intake of protein, ascorbic acid
Dehydration
hypotension
Urinary and/or fecal incontinence
Neurological disorders (sensory, motor)
Peripheral circulatory disorders
thin skin
Anxiety
Confused mind
Coma
External factors risk
reversible
irreversible
Poor hygiene care
Creases in bed and/or underwear
Extensive surgical intervention lasting more than 2 hours
Bed rails
Patient fixation devices
Injuries of the spine, pelvic bones, organs abdominal cavity
Damage spinal cord
The use of cytotoxic drugs
Incorrect technique for moving the patient in bed
Remember ! Bedsores are easier to prevent than to treat!
Degree 1 - limited to the epidermal and dermal layers. The skin is not broken. There is a steady hyperemia with bluish-red spots, which does not disappear after the cessation of pressure. Treatment is conservative:
1st degree bedsores
Treatment of 1st degree bedsores
Restore blood circulation to the damaged area of the skin.
To do this, you need to turn the patient, freeing the place of redness from pressure (if the patient is lying on his back, you need to turn him every 2 hours and fix the position of the body, first on the right side, then on the left, excluding the position of the patient on the back).
Apply to redness Menalind professional – tonic liquidmassaging movements until completely absorbed at least 3 times a day
Strengthen pressure sore prevention measures.
Degree 2 – shallow superficial violations of the integrity of the skin, extending to the subcutaneous fat layer. Persistent hyperemia with bluish-red spots persists. There is a detachment of the epidermis - the appearance of blisters filled with serous fluid. Treatment is conservative:
Attention! On the heels, the formation of bedsores can proceed imperceptibly due to the thick layer of soft tissues. The signal for the beginning of the formation of a bedsore is the presence of a white spot!
inform the doctor;
to strengthen measures for the prevention of bedsores;
don't pop the bubbles!
at the opening of the blisters, the imposition of bio-occlusive dressings;
as prescribed by the doctor - dressings with solcoseryl ointment
deodorizing the wound with activated charcoal wipes;
deodorizing the room with a deodorant containing chlorophyll
washing the bedsore with saline or sterile water;
application of a dry aseptic bandage.
2nd degree bedsores
Grade 3 - complete destruction of the skin in its entire thickness to the muscle layer with penetration into the muscle itself.
Degree 4 - damage to all soft tissues. The formation of cavities ("pockets") with damage to the underlying tissues (tendons, up to the bone).
Third and fourth degree bedsores are treated by a surgeon.
3rd degree bedsores 4th degree bedsores
Features of patient care
Placement of the patient on a functional bed (in a hospital setting). There should be handrails on both sides and a device to raise the head of the bed. The patient should not be placed on a bed with armored mesh or with old spring mattresses. The height of the bed should be at the mid-thigh level of the caregiver.
The patient being transferred or moved to a chair should be on a bed with a variable height, allowing him to independently, with the help of other improvised means, move out of bed.
The choice of anti-decubitus mattress depends on the degree of risk of developing pressure ulcers and the patient's body weight. For low risk situations, a 10 cm thick foam mattress may be sufficient. At a higher degree of risk, as well as with existing bedsores of different stages, other mattresses are needed. When placing the patient in a chair (wheelchair), foam rubber pillows, 10 cm thick, are placed under the buttocks and behind the back. Foam rubber pads, at least 3 cm thick, are placed under the feet (convincing evidence B).
Bed linen - cotton. The blanket is light.
Under vulnerable areas, it is necessary to place rollers and foam rubber pillows.
Change the position of the body to carry out every 2 hours, incl. at night, scheduled: low position
Fowler, position "on the side", position Sims, position "on the stomach" (as agreed with the doctor). Fowler's position should coincide with the meal time. At each movement - inspect areas of risk. The results of the examination - write down in the list of registration of anti-decubitus measures (convincing evidence B).
Move the patient carefully, excluding friction and tissue shift, lifting him above the bed, or using a bed sheet.
Do not allow the patient to lie directly on big skewer hips.
Do not expose risk areas to friction. Full body massage, incl. near risk areas (within a radius of at least 5 cm from the bony prominence) should be carried out after abundant application of a nourishing (moisturizing) cream to the skin (strong evidence B).
Wash the skin without friction and bar soap, use liquid soap. Dry skin thoroughly after
washing with soaking motions (strength of evidence C).
Use waterproof diapers and diapers that reduce excessive moisture.
Maximize the patient's activity: teach him self-help to reduce pressure on the fulcrum.
Encourage him to change position: turn around using the bed rails, pull himself up. Teach relatives and other caregivers how to reduce the risk of tissue damage from
pressure:
regularly change the position of the body;
use devices that reduce pressure (pillows, foam rubber, gaskets);
observe the rules of lifting and moving: exclude friction and shear of tissues;
inspect all skin at least 1 time per day, and risk areas - with each movement;
exercise proper nutrition and adequate fluid intake;
correctly carry out hygienic procedures: exclude friction.
Avoid excessive moisture or dryness of the skin: in case of excessive moisture, dry using
powders without talc, in case of dryness - moisten with cream (strength of evidence C).
Constantly maintain a comfortable state of the bed: shake off the crumbs, straighten the folds.
Teach the patient breathing exercises and encourage him to do them every 2 hours.
Recommended care plans for the risk of developing pressure ulcers in a recumbent patient and a patient who can sit are given in Appendix No. 2. Registration of anti-decubitus measures is carried out on special form(See Appendix N 2 to the order of the Ministry of Health of Russia of 17.04.02 N 123).
6.1.8 Dietary requirements and restrictions
The diet should contain at least 120 g of protein and 500 - 1000 mg of ascorbic acid per day (strength of evidence C). The daily diet should be sufficient in calories to maintain the ideal body weight of the patient.
The patient should be informed about:
risk factors for the development of bedsores;
the purpose of all preventive measures;
the need to implement the entire prevention program, incl. manipulations performed by the patient and / or his relatives;
the consequences of non-compliance with the entire prevention program, incl. a decrease in the quality of life.
The patient must be educated:
The technique of changing the position of the body on the plane with the help of auxiliary means (handrails of the bed, armrests of the chair, device for lifting the patient)
Breathing technique.
Additional information for relatives:
places of formation of bedsores;
movement technique;
features of placement in various positions;
dietary and drinking regimen;
technique of hygiene procedures;
monitoring and maintaining moderate skin moisture;
stimulating the patient to move independently every 2 hours;
stimulating the patient to perform breathing exercises.
Note: Education of the patient and/or his relatives must be accompanied by a demonstration and comments on the drawings from clause 10 of OST 91500.11.0001-2002.
Data on informing the patient's consent are recorded on a special form (see Appendix 2 to the order of the Ministry of Health of Russia dated April 17, 2002 N123).
6.1.10 Additional information for patients and family members
Reminder for the patient
Prevention - the best treatment. To help us prevent you from getting pressure sores, you should:
Eat a sufficient (at least 1.5 l.) amount of liquid (the amount of liquid should be checked with a doctor) and at least 120 g of protein; 120 g of protein you need to "dial" from different foods you love, like an animal,so plant origin. For example, 10 g of protein is found in:
72.5 g
fat cottage cheese
51.0 g
lean chicken
50.0 g
low-fat cottage cheese
51.0 g
turkeys
62.5 g
soft diet cottage cheese
57.5 g
beef liver
143 g
sweetened condensed milk, sterilized
64.0 g
flounders
42.5 g
Dutch cheese
62.5 g
carp
37.5 g
cheese from Kostroma, Poshekhonsky, Yaroslavl
54.0 g
river perch
47.5 g
Russian cheese
53.0 g
halibut
40.0 g
Swiss cheese
59.0 g
herring
68.5 g
cheese from sheep's milk
56.5 g
Atlantic oily herring
56.0 g
cheese from cow's milk
55.5 g
low fat Pacific herring
78.5 g
chicken egg
55.5 g
mackerel
48.0 g
lean lamb
54.0 g
horse mackerel
49.5 g
Lean beef
52.5 g
zander
48.5 g
rabbit meat
57.5 g
cod
68.5 g
pork meat
60.0 g
hake
51.0 g
veal
53.0 g
pike
55.0 g
Chur
Protein is also found in plant foods. So, 100 g of the product contains a different amount of protein:
wheat bread
6.9 g
semolina
8.0 g
pasta, noodles
9.3 g
Rice
6.5 g
buckwheat
8.0 g
green peas
5.0 g
Consume at least 500-1000 mg of ascorbic acid (vitamin C) per day;
move in bed, including from bed to chair, excluding friction;
use aids;
use an anti-decubitus mattress and/or chair cushion;
try to find a comfortable position in bed, but do not increase pressure on vulnerable areas (bones
protrusions);
change position in bed every 1 to 2 hours, or more often if you can sit;
walk if you can; do exercises by bending and unbending arms, legs;
do 10 breathing exercises every hour: deep, slow breath in through the mouth, exhale through the nose;
take an active part in your care;
ask the nurse questions if you have any problems.
General scheme for the treatment of bedsores
Initial assessment of the overall situation:
place of pressure sore formation, severity, general state wounds;
assessment of the patient's status.
Etiological therapy: complete
elimination of pressure on the bedsore
before healing.
Treatment
adequate treatment and treatment of the wound.
Yes: control and continuation of therapy
according to the treatment plan.
Has the bedsore healed?
No: rigorous quality control
activities carried out
especially stress relief.
Reminder for relatives
At each movement, any deterioration or change in condition, regularly examine the skin in the area of the sacrum, heels, ankles, shoulder blades, elbows, occiput, greater trochanter of the femur, the inner surface of the knee joints.
Do not expose vulnerable areas of the body to friction. Wash vulnerable areas at least once a day if you need to follow the usual rules of personal hygiene, as well as in case of urinary incontinence, heavy sweating. Use mild and liquid soap. Make sure the cleanser is rinsed off, dry the area of skin. If the skin is too dry, use a moisturizer. Wash your skin with warm water.
Use barrier creams if indicated.
Do not massage in the area of protruding bony protrusions.
Change the patient's position every 2 hours (even at night): Fowler's position; Sims position; "on the left side"; "on the right side"; "on the stomach" (with the permission of the doctor). The types of provisions depend on the disease and the condition of the particular patient. Discuss this with your doctor.
Change the position of the patient by lifting him off the bed.
Check the condition of the bed (folds, crumbs, etc.).
Avoid skin contact with the hard part of the bed.
Use foam rubber in a case (instead of cotton-gauze and rubber circles) to reduce pressure on the skin.
Release pressure on areas of broken skin. Use the appropriate tools.
Lower the head of the bed to the lowest level (angle no more than 30 degrees). Raise the headboard a short time to perform any manipulation.
Do not allow the patient to lie directly on the greater trochanter in the lateral position.
Avoid continuous sitting in a chair or wheelchair. Remind you to change position every hour, independently change the position of the body, pull yourself up, examine vulnerable areas of the skin. Advise him to relieve pressure on the buttocks every 15 minutes: lean forward, to the side, rise, leaning on the arms of the chair.
Reduce the risk of tissue damage from pressure:
regularly change the position of the body;
use devices that reduce body pressure;
observe the rules of lifting and moving;
inspect the skin at least 1 time per day;
Maintain proper nutrition and adequate fluid intake.
Monitor the quality and quantity of food and fluids, including for urinary incontinence.
Maximize the activity of your ward. If he can walk, encourage him to take a walk every hour.
Use waterproof diapers, diapers (for men - external urinals) for incontinence.
6.1.11 Rules for changing requirements during protocol execution and termination of protocol requirements
The requirements of the protocol cease to apply in the absence of the risk of developing pressure ulcers on the Waterlow scale.
II . Sheet nursing assessment risk of development and stage of bedsores
Name
N p / p
1
2
3
4
5
6
7
Body mass
1
0
1
2
3
skin type
2
0
1
1
1
1
2
3
Floor
3
1
2
Age
4
1
2
3
4
5
Special Risk Factors
5
8
5
5
2
1
Incontinence
6
0
1
2
3
Mobility
7
0
1
2
3
4
5
Appetite
8
0
1
2
3
Neurological disorders
9
4
5
6
Major surgery below the belt/trauma
10
5
Over 2 hours on table 5
11
4
Instructions: circle the number corresponding to the points on the Waterlow scale
Sum of points -
Risk: no, yes, high, very high (underline as appropriate) Bedsores: yes, no (underline as appropriate)
Stage 1,2,3,4.
Agreed with the doctor
(Physician's signature)__________________
Recommended care plan for people at risk of pressure ulcers (in the supine patient)
Nursing Interventions
multiplicity
1. Carrying out a current assessment of the risk of developing pressure ulcers at least 1 time per day (in the morning) on the Waterlow scale
Daily 1 time
2. Changing the position of the patient every 2 hours:
- 8 - 10 hours - Fowler's position;
- 10 - 12 hours - position "on the left side";
- 12 - 14 hours - position "on the right side";
- 14 - 16 hours - Fowler's position;
- 4 - 6 pm - Sims position;
- 18 - 20 hours - Fowler's position;
- 20 - 22 hours - position "on the right side";
- 22 - 24 hours - position "on the left side";
- 0 - 2 hours - Sims position;
- 2 - 4 hours - position "on the right side";
- 4 - 6 hours - position "on the left side";
- 6 - 8 o'clock - Sims position
Daily 12 times
Daily 1 time
Daily 12 times
5. Teaching the patient's relatives the technique of correct movement (lifting above the bed)
According to an individual program
6. Determining the amount of food eaten (the amount of protein is not less than 120 g, ascorbic acid 500 - 1000 mg per day)
Daily 4 times
7. Ensuring the consumption of at least 1.5 liters of fluid per day:
from 9.00 - 13.00 - 700 ml;
from 13.00 - 18.00 - 500 ml;
from 18.00 - 22.00 - 300 ml
During the day
3. Use of foam pads in the area of risk areas that exclude pressure on the skin
During the day
9. Incontinence:
During the day
- urine - change diapers every 4 hours,
10. If pain increases - consult a doctor
During the day
11. Patient education and encouragement to change position in bed (pressure points) using bars, handrails and other devices
During the day
12. Massage the skin around risk areas
Daily 4 times
13. Teaching the patient breathing exercises and encouraging him to do them
During the day
14. Monitor skin moisture and maintain moderate moisture
During the day
The choice of position and their alternation may vary depending on the disease and the condition of the patient.
Recommended care plan for pressure ulcers (in a patient who can sit)
Nursing Interventions
multiplicity
Conduct a current pressure ulcer risk assessment at least once a day (morning) on the Waterloo scale
Daily 1 time
Change the position of the patient every 2 hours:
8 - 10 hours - the position of "sitting";
10 - 12 hours - position "on the left side";
12 - 14 hours - position "on the right side";
14 - 16 hours - the position of "sitting";
16 - 18 hours - the position of Sims;
18 - 20 hours - the position of "sitting";
20 - 22 hours - position "on the right side";
22 - 24 hours - position "on the left side";
0 - 2 hours - Sims position;
2 - 4 hours - position "on the right side";
4 - 6 h, - position "on the left side";
6 - 8 hours - the position of Sims;
If the patient can be moved (or moved independently with the help of assistive devices) and in a chair (wheelchair), he can be in a sitting position and in bed
Daily 12 times
3. Washing contaminated skin areas
Daily 1 time
4. Checking the condition of the bed when changing position (every 2 hours)
Daily 12 times
Teaching relatives of the patient the technique of correct movement (lifting above the bed)
According to an individual program
Teaching the patient to move independently in bed using a lifting device
According to an individual program
Teaching the patient how to move safely from bed to chair using other means
According to an individual program
. .
Determining the amount of food eaten (the amount of protein is not less than 120 g, ascorbic acid 500 - 1000 mg per day)
Daily 4 times
Ensure consumption of at least 1.5 liters. liquids
per day:
During the day
from 9.00 - 13.00 - 700 ml; from 13.00 - 18.00 - 500 ml; from 18.00 - 22.00 - 300 ml
Use foam pads that exclude pressure on the skin under risk areas, incl. in the position of the patient "sitting" (under the feet).
During the day
For incontinence: - urine - diaper change every 4 hours,
- feces - change of diapers immediately after defecation followed by gentle hygienic procedure
During the day
If the pain gets worse - consult a doctor
During the day
Teaching and encouraging the patient to change position in bed (pressure points) using bars, handrails, and other devices.
During the day
Skin massage around risk areas
Daily 4 times
Waterlow scale for assessing the risk of developing pressure ulcers
Build: body weight relative to height
score
skin type
score
Gender Age, years
score
Special Risk Factors
score
The average
0
Healthy
0
Male
1
skin malnutrition,
8
Above average
1
Cigarette paper
1
Female
2
e.g. terminal cachexia
Obesity
2
14 - 49
1
Below the average
3
Dry
1
50 - 64
2
edematous
1
65 - 74
3
sticky (increasedT°- bodies)
1
75 - 81 over 81
4 5
Heart failure
5
Color change
2
Diseases peripheral vessels
5
Cracks, spots
3
Anemia
2
Smoking
1
Incontinence
score
Mobility
score
Appetite
score
Neurological disorders
score
Full control
0
Complete
0
Average
0
e.g. diabetes
4
/
Restless
1
Bad
1
multiple
through a catheter
Fussy
Feeding
through a probe
2
sclerosis, stroke
-
periodic
Apathetic
2
Liquids only
motor/sensory, paraplegia
6
Through a catheter/
1
Limited mobility
3
Anorexia
3
fecal incontinence
2
Inert
4
Not by mouth (anorexia)
3
Feces and urine
3
Chained to a chair
5
Major surgery trauma
score
Orthopedic - below the belt, spine;
5
More than 2 hours on the table
5
Drug therapy
score
Cytostatic drugs
4
high doses of steroids
4
Anti-inflammatory
4
Waterlow scores are summed up and the degree of risk is determined by
the following totals:
– no risk
– there is a risk
– high degree risk
– very high risk
– 1 - 9 points,
– 10 points,
– 15 points
– 20 points.
diaper rash ( Intertrigo )
Inflammatory lesion of the skin fold, which develops under the influence of skin secretion products and friction of the contacting skin surfaces. Diaper rash is observed in the interdigital folds of the legs, less often in the hands, in the inguinal-femoral and intergluteal folds, in the folds of the abdomen and neck in obese patients, under the mammary glands in women with poor care. Causes of diaper rash: increased sweating and sebum secretion of skin folds, leucorrhoea, urinary incontinence, discharge from fistulas, hemorrhoids, insufficient drying of skin folds after bathing.
Diaper rash appears in the form of erythema, which passes into healthy skin without sharp boundaries. In the depth of the fold, superficial non-bleeding cracks are formed. In advanced cases, the stratum corneum macerates and is rejected - an abrasion with fuzzy outlines is revealed. Elimination of irritating factors and treatment with indifferent anti-inflammatory drugs quickly leads to a cure.
However, diaper rash can be chronic, sometimes stubbornly dragging on for years, which is associated with the addition of an infection (infectious diaper rash); streptococci (more often) cause intertriginous streptoderma, yeast-like fungi (less often) - intertriginous candidiasis (see), sometimes infectious agents are combined. The clinical picture of infectious diaper rash is characterized by the formation of erythematous, sometimes infiltrated foci, surrounded by a narrow collar of the exfoliating stratum corneum with clear large-scalloped contours. Lesions may increase along the periphery, their surface is weeping or covered with lamellar crusts and scales; in the depth of the folds are superficial, non-bleeding cracks. Subjectively - itching, less often pain, burning.
Treatment of diaper rash: lotions and wet-drying dressings with a 0.1% solution of copper sulfate or zinc sulfate; lubrication with water and alcohol solutions, pastes and ointments containing 2% gentian violet, locacorten, oxycort, geocorton. Finish treatment with 2-5% tar pastes and ointments. In persistent cases - X-ray therapy. After the elimination of lesions, it is necessary to wipe the skin of the folds with 2% salicylic alcohol and powder with talc containing 1% copper sulfate (copper sulfate).
Prevention: elimination of the causes of increased sweating - treatment of vegetative neurosis, obesity, recommend wearing rational (breathable) clothes and shoes, taking frequent hygienic baths. It is necessary to pay attention to the correct feeding of infants and careful care of their skin: change diapers more often, take baths daily with a weak solution of potassium permanganate, after which the skin folds and affected areas should be lubricated with boiled sunflower or almond oil, fish oil.
Draw up a rough plan for the care of bedridden patients at risk of developing pressure ulcers (independent work).
Lectures.
S.A. Mukhina, I.I. Tarnovskaya. Practical guide to the subject "Fundamentals of Nursing", 154 - 224.
Educational and methodological guide on the basics of nursing, pp. 325 - 360.
additional information
Daily patient care
Daily morning and evening patient care
They start with washing, which is done in several stages:
1. treatment of the patient's eyes
2. treatment of the patient's nasal cavity
3. ear treatment
4. treatment of the patient's oral cavity
5. face care
Hair care;
Dailyeye treatment- this is the removal of physiological secretions or purulent crusts from the eyes, the removal of impurities. Normal hygienic care should be carried out 1-2 times a day, if necessary - more often. Lack of proper care can lead to inflammation of the mucous membrane of the eyes, conjunctivitis and inflammation of the skin around the eyes.
Prepare:
* container with liquid (boiled water, chamomile decoction, calendula decoction, old tea leaves, furacillin solution 1:500);
* cotton swabs (4 pieces or more);
* soft towel or gauze pads;
* container or plastic bag for dirty tampons;
* diaper, protective bib or towel.
For eye treatment:
1. wash your hands;
2. lay or seat the patient comfortably and cover the patient's pillow and/or chest with a diaper, bib or towel;
3. put a few cotton balls into a container with liquid;
4. if there are dry crusts on the eyelashes, then put on closed eyes for several minutes, cotton swabs, abundantly moistened with liquid, so that the crusts get wet, and their subsequent removal is painless;
5. start processing with a cleaner eye;
6. With a dry swab, slightly pull the lower eyelid, and with swabs moistened with liquid, rinse the eye with a single movement from the outer edge of the eye to the inner;
7. dry with blotting movementsskin
around the eye with gauze or a towel;
8. remove equipment, discard used cotton swabs, wash hands;
Store the liquid container separately from other dishes in a clean place, rinse with boiling water before use.
Dailynasal cavity treatmentnecessary, because on the nasal mucosaseriously ill
a large amount of mucus and dust accumulates, which makes breathing difficult and aggravates the patient's condition.
Prepare:
* narrow cotton swabs-turundas (at least four);
* vaseline or any vegetable oil heated to 38 ° C without a strong odor;
* cotton balls or gauze napkins;
* container or plastic bag for used material;
* in the presence of liquid discharge from the nose - a small pear-shaped balloon with a soft tip, the so-called "syringe".
To clean the nasal cavity, you should:
1. lay the patient comfortably;
2. moisten one cotton swab-turunda in warm oil, wring it out slightly and insert it with a rotational movement with your right hand, holding the tip of the nose with your left hand in one nasal passage for 1 minute, then also remove it with rotational movements. Repeat the steps with a dry swab to remove oil residues and softened crusts from the nasal passage. Repeat the manipulation with the other nasal passage;
3. in the presence of liquid compartments from the nose, it is necessary to suck out the mucus from the nasal passages with a pear-shaped balloon and remove the remaining mucus with dry swabs;
4. clean the skin around the nasal passages from mucus and oil with a cotton swab or gauze;
5. Discard the used material, close and remove the oil, wash your hands.
6. When the air in the room is dry, it is advisable to periodically irrigate the nasal cavity with water or drops like "Aquamaris".
Dailyear treatment(external auditory canals) is necessary because sulfur is constantly released in it - a yellowish-brown mass. The accumulation of such secretions can lead to the formation of sulfur plugs, which causes hearing loss.
You will need:
3% hydrogen peroxide solution, cotton turundas.
First, the auricles and near the ear space are treated with a means for washing the patient, then pulling the auricle with the left hand to straighten the external auditory canal, with the right hand, gently insert the turunda moistened with a 3% hydrogen peroxide solution with rotational movements. This allows the sulfur formations to dissolve. The procedure is repeated with the other ear.
Careperoral cavity
A lot of microbes accumulate in the oral cavity, which, when the body is weakened, can cause diseases and worsen the general condition of a person.
Atseriously ill
often develops stomatitis - inflammation of the oral mucosa. There is pain in eating, salivation, the temperature rises. Sometimes patients develop dry lips, painful cracks in the corners of the mouth.seriously ill
the patient needs to treat the oral cavity after sleep, every meal and vomiting. Patients with dentures should take them off at night, rinse thoroughly with a toothbrush and toothpaste and store in a clean individual glass until morning, rinse with running water in the morning and put on. Once a week, process Corega or Protefix tablets in a special solution. Dissolve 1 tablet in half a glass of water. Put the dentures in the solution for 15 minutes, after the dentures are cleaned, all odors and microbes will be destroyed. Then the prostheses are washed with running water and put on again.
Care
behind the oral cavity can be divided into:
1. care for the mucous membranes of the oral cavity (mucous membranes of the lips, cheeks);
2. care for the surface of the tongue;
3. dental care.
For oral care, a very soft toothbrush should be used, and for weak patients, gauze swabs should be used. If the patient is able to rinse their mouth well, toothpaste can be used. After eating, it is useful to rinse your mouth with warm water or decoctions of chamomile, sage, St. John's wort.
For those who are weak, it is better to use a dental elixir or antiseptic solutions:
furacillin solution (2 tablets per 400 ml of water);
soda solution (1/2-1 teaspoon per glass of water);
boric acid solution (1-2% solution);
weak pink solution of potassium permanganate (1:5000);
chamomile decoction;
decoction of oak bark (with bleeding gums).
You will need:
toothbrush and paste
gauze swabs,
gauze wipes,
clamp
a container with an antiseptic solution;
pear-shaped balloon - for those who cannot hold water in their mouth, or a glass;
spitting container (kidney-shaped tray, regular bowl or small basin);
spatula (in its absence, you can use the handle of a spoon) - to move the cheek and press the tongue;
gloves, preferably latex;
petroleum jelly, cocoa butter or hygienic lipstick.
To treat the oral cavity, you should:
1. Give the patient a comfortable sitting or lying position
help a bedridden patient turn his head to one side, cover his neck and chest with a protective bib, put a tray under his chin;
2. wash your hands, dry them, put on gloves;
3. Ask the patient to close their teeth or help remove dentures
4. move the patient's left cheek with a spatula
5. With tweezers with a gauze swab moistened with an antiseptic solution or a toothbrush on the outside, treat each tooth from the gums, starting from the molars to the incisors;
6. Throw the used tampon into the tray, prepare a new one and process in the same sequence on the right.
7. movements of the toothbrush are carried out along the axis of the tooth (up and down), capturing part of the gum.
8. Ask the patient to open their mouth. With tweezers with a new gauze swab moistened with an antiseptic solution or a toothbrush on the inside, treat each tooth from the gums, starting from the molars to the incisors.
It is not recommended to brush your teeth with movements across the axis of the teeth, as this can lead to abrasion of the enamel in the neck of the tooth;
9. clean the tongue last. If the tongue is not held, then cleaning it will be difficult, so wrap it with a gauze cloth and pull it towards you. During the removal of plaque, do not press on the root of the tongue, so as not to accidentally induce vomiting;
10. ask the patient to rinse the mouth well or rinse from a pear-shaped balloon with an antiseptic solution, that is, pull the corner of the mouth with a spatula and alternately rinse the left and then the right buccal space with a stream of a solution or decoction of herbs;
11. dry lips and skin around the mouth;
12. lubricate lips with petroleum jelly or hygienic lipstick, cocoa butter moisturizes, heals and protects lips very well;
13. remove equipment; remove gloves, wash hands.
Facial care:
When the patient took care of himself on his own, he could wash himself with soap and water and apply a nourishing cream to his face. Now the condition of his skin is completely dependent on the method of processing. You can wash your face with Menalind Washing Lotion, a No-Rinse napkin or an Aqua glove, but Bel Premium Wet Cosmetic Discs are best suited, they clean and moisturize the skin of the face with high quality. Take a wet disk and wipe the face: forehead from the center to the temples, nose from top to bottom, cheeks from the nose to the ears, chin.
Hair care:
Hygienic hair care is individual, washing oily hair carry out once every 5 days, and dry - once every 10 days. For the procedure of washing hair, read the "instructions for hygiene of the patient."
Hair needs to be combed daily. Short hair is combed from roots to ends, and long hair must be divided into small strands and carefully combed from ends to roots, trying not to pull out. You need to comb your hair with a comb with infrequent plastic teeth with blunt ends. For more effective combing of dandruff and dirt, the comb can be moistened with a solution of vinegar.
Owners of long hair need a special hairstyle so that the hair does not get tangled and does not tighten the scalp: it is better to braid them into two weak braids starting from the parietal tubercles. It is better to fasten the braids with cotton tape or braid, and not with an elastic band, which can be lost. You can also braid one braid; it should be started at the top of the head so that it does not fall under the head while lying down and does not squeeze the skin on the head. For the same reason, it is better not to use hairpins, hairpins and other hard objects to hold hair. Braided hair is easy to untangle, comb and re-braid, it takes a little time compared to untangling the hair.
Rules for combing long hair:
1. divide the hair into small strands;
2. start combing a strand of hair from the ends;
3. to comb the hair at the back of the head bedridden patient just turn your head to the side.
The environment in which the patient is located plays an important role in the course and outcome of diseases. First of all, it is the observance of the rules of personal hygiene and hygiene in the ward, ensuring timely and proper nutrition of the patient. In creating favorable conditions in the ward, the main role is assigned to the middle and junior medical personnel. Compliance with the rules of personal hygiene, keeping the bed and ward clean is necessary for effective treatment. F. Nightingale wrote: “... What, in fact, is meant by hygienic conditions? In fact, there are very few of them: light, warmth, clean air, healthy food, harmless drinking water, cleanliness ... ". That is why compliance with the rules of personal hygiene, keeping the bed and ward clean is necessary for effective treatment.
The position of the patient in bed should be comfortable, the bed linen should be clean, the mattress should be even; if the bed has a net, it should be stretched. For seriously ill patients and patients with urinary and fecal incontinence, an oilcloth is laid on the mattress pad under the sheet. For women with abundant discharge, a diaper is placed on the oilcloth, which is changed as it gets dirty, but at least 2 times a week. Seriously ill patients are placed on functional beds, head restraints are used. The patient is given two pillows and a blanket with a duvet cover. The bed is changed regularly before and after sleep. Underwear and bed linen are changed at least once a week after taking a bath, as well as in case of accidental contamination.
Rules for changing linen
The first way to change bed linen(Figure 6-1)
1. Roll up a dirty sheet into a roller in the direction from the head and foot ends of the bed to the lumbar region of the patient.
2. Gently lift the patient up and remove the dirty sheet.
3. Place a clean sheet rolled up in the same way under the lower back of the patient and straighten it.
The second way to change bed linen(Figure 6-2) 1. Move the patient to the edge of the bed.
Rice. 6-1. Change of bed linen in a seriously ill patient (first method)
2. Roll up the free part of the dirty sheet with a roller from the edge of the bed towards the patient.
3. Spread a clean sheet on the vacated place, half of which remains rolled up with a roller.
4. Move the patient to the spread half of the clean sheet, remove the dirty sheet and straighten the clean one.
Change of underwear
1. Bring your hand under the back of the patient, raise the edge of his shirt to armpit and the back of the head.
2. Remove the shirt over the patient's head (Fig. 6-3, a), and then from his hands (Fig. 6-3, b).
Rice. 6-2. Change of bed linen in a seriously ill patient (second method)
Rice. 6-3. Changing underwear in a seriously ill patient: a - removing the shirt over the patient's head; b - removing the sleeves of the shirt from the hands of the patient
3. Put on the shirt in reverse order: first put on the sleeves, then throw the shirt over the patient's head and straighten it under his back.
4. On a patient who is on strict bed rest, put on an undershirt.
SKIN CARE AND PREVENTION OF PREVENTION
The skin performs several functions: protective, analytical (skin sensitivity), regulatory (regulation of body temperature: heat transfer through sweating in a healthy person is 20% of the total heat transfer per day, and in febrile patients - much more), excretory. Through the skin, its sweat glands excrete water, urea, uric acid, sodium, potassium and other substances. At rest, at normal body temperature, about 1 liter of sweat per day is released, and in febrile patients - up to 10 liters or more.
When sweat evaporates, metabolic products remain on the skin that destroy the skin. Therefore, the skin should be clean, for which you should change clothes more often, wipe the skin with cologne, water with 96% alcohol (1: 1 ratio), disinfectant wipes or solutions (for example, 1 glass of water + 1 tbsp vinegar + 1 tbsp .l camphor), wipe the skin with a dry, clean towel.
Particular attention should be paid to the condition of the skin of the inguinal region, armpits, in women - the area under the mammary glands. The skin of the perineum requires daily washing. Seriously ill patients should be washed after each act of defecation, and with incontinence of urine and feces - several times a day to avoid maceration * and inflammation of the skin in the inguinal and perineal folds. Women are washed more often.
In seriously ill patients, bed sores may form. Decubitus (lat. decubitus; syn. - decubital gangrene) - necrosis (necrosis) of soft tissues (skin involving subcutaneous tissue, walls of a hollow organ or blood vessel, etc.), resulting from ischemia caused by prolonged continuous mechanical pressure on them. Bed sores appear most often on the sacrum, shoulder blades, heels, elbows from prolonged compression of a skin area and impaired blood circulation in it (Fig. 6-4). First, redness and soreness appear, then the epidermis (surface layer of the skin) sloughs off, and blisters form. With deep bedsores, muscles, tendons, periosteum are exposed
Rice. 6-4. Places of the most frequent formation of bedsores
* Maceration (lat. maceratio- soaking, softening) - softening and loosening of tissues due to prolonged exposure to liquid.
ca. Develop necrosis and ulcers, sometimes penetrating to the bone. An infection penetrates through the damaged skin, which leads to suppuration and blood poisoning (sepsis).
If a localized area of skin redness appears, it should be wiped 2 times a day with a 10% camphor solution, a damp towel, and irradiated with a quartz lamp. If bedsores have formed, it is necessary to lubricate them with a 5% solution of potassium permanganate, apply a bandage with Vishnevsky ointment, synthomycin liniment, etc.
Pressure ulcer prevention measures
Every 1.5-2 hours should change the position of the patient.
It is necessary to straighten the folds on the bed and linen.
Wipe the skin with a disinfectant solution.
Wet or soiled linen should be changed immediately.
Rubber pads placed in a case or covered with a diaper should be used. The circle is placed in such a way that the place of the bedsore is above the hole of the circle and does not touch the bed; also use special air mattresses with a corrugated surface.
It is necessary to wash and wash the sick in a timely manner.
At present, for the prevention of bedsores, the so-called anti-decubitus system has been developed, which is a specially designed mattress. Thanks to the automatic compressor, the mattress cells are filled with air every 5-10 minutes, as a result of which the degree of compression of the patient's tissues changes. Massage of tissues by changing the pressure on the surface of the patient's body maintains normal blood microcirculation in them, providing the skin and subcutaneous tissue with nutrients and oxygen.
USE OF VESSELS AND URINES
Patients who are on strict bed rest, if it is necessary to empty the intestines, a ship is served in bed, and when
the need to urinate - a urinal (women usually use a vessel when urinating, and men use the so-called duck). Vessels are metal with enamel coating, plastic and rubber. A rubber vessel is used in debilitated patients, as well as in the presence of bedsores, incontinence of feces and urine.
Before giving the patient a urinal, the latter must be rinsed with warm water. After urination, having poured out its contents, the urinal is again rinsed with warm water.
Washing away the sick (women)
Necessary equipment: a jug with a warm (30-35 ° C) weak solution of potassium permanganate (antiseptic) or water, forceps, napkin, oilcloth, vessel, gloves (Fig. 6-5).
The order of the procedure:
1. Help the patient lie on his back; legs should be slightly bent at the knees and spread apart.
2. Lay an oilcloth and put a vessel on it, placing it under the buttocks of the patient.
3. Stand to the right of the patient and, holding a jug in your left hand, and a forceps with a napkin in your right, pour an antiseptic solution on the genitals, and wipe them with a napkin, making movements along
Rice. 6-5. Washing away the sick
Rice. 6-6. Vessel supply
direction from the genitals to the anus, i.e. top down.
4. Dry the skin of the perineum with a dry cloth in the same direction.
5. Remove the vessel and oilcloth. Vessel supply
Necessary equipment: vessel, oilcloth, screen, disinfectant solution.
If a seriously ill person has an urge to defecate or urinate, the following is necessary (Fig. 6-6):
1. Separate him with a screen from others, put an oilcloth under the patient's pelvis.
2. Rinse the vessel with warm water, leaving some water in it.
3. Move the left hand from the side under the sacrum of the patient, helping him to raise the pelvic area (while his legs should be bent at the knees).
4. With your right hand, bring the vessel under the buttocks of the patient so that the perineum is above the opening of the vessel.
5. Cover the patient with a blanket and leave him alone for a while.
6. Pour the contents of the vessel into the toilet by rinsing the vessel with hot water.
7. Wash the patient, dry the perineum, remove the oilcloth.
8. Disinfect the vessel with a disinfectant solution.
ORAL CARE
Every person needs to follow the basic rules of oral care:
Rinse your mouth with water after every meal.
Brush your teeth at night and in the morning, as during the night the surface of the mucous membrane of the mouth and teeth is covered with soft plaque, consisting of epithelial cells, mucus and microorganisms.
In patients, the formation of plaque is accelerated, since metabolic products begin to be released through the mucous membrane of the oral cavity: nitrogenous substances during kidney failure, glucose in diabetes mellitus, mercury in mercury poisoning, etc. These substances contaminate the mucous membrane and often lead to intensive reproduction of microorganisms. Care of the oral cavity of seriously ill patients should be more thorough; carried out by a nurse.
Oral examination
The patient opens his mouth. The nurse pulls the lips and cheeks of the patient with a spatula. When examining the palatine tonsils and rear wall the pharynx is pressed with a spatula on the root of the tongue and the patient is invited to pronounce the sound "A-A-A". When examining the oral cavity, tonsils and pharynx, enhanced lighting is necessary, for which a reflector lamp can be used.
mouth rinse
After each meal, the patient is recommended to rinse the mouth with 0.5% sodium bicarbonate solution (baking soda solution) or 0.9% sodium chloride solution (physiological saline). After that, the tongue is wiped: a sterile gauze napkin is applied to the tip of the tongue, the tip of the tongue is pulled out of the oral cavity with the left hand, and with the right hand, with a wet cotton ball clamped in tweezers, the plaque is removed from the surface of the tongue and the tongue is lubricated with glycerin.
Washing the mouth
Washing of the oral cavity is carried out using a syringe, a rubber balloon, an Esmarch mug * with a rubber tube and a glass tip. Weak solutions are used: 0.5% sodium bicarbonate, 0.9% sodium chloride, 0.6% hydrogen peroxide, potassium permanganate (1:10,000), etc. The patient is seated or given a half-sitting position with his head slightly tilted so that the liquid did not enter the respiratory tract. The neck and chest are covered with oilcloth, and a basin or tray is placed under the chin. In a patient lying on his back, his head should be turned; if possible, the patient himself is turned to one side. The corner of the mouth is pulled with a spatula and a stream of water under moderate pressure is washed first with the vestibule of the oral cavity, and then with the oral cavity itself. If a seriously ill patient has removable dentures, they should be removed (and washed) before the procedure.
Cleaning the mouth and teeth
Necessary equipment: spatula, cotton balls, tweezers, antiseptic solution (2% sodium bicarbonate solution, weak potassium permanganate solution) or warm boiled water.
* Mug Esmarch - a special mug for enemas and douching. Suggested German doctor Friedrich von Esmarch (1823-1908).
The order of the procedure:
2. Wrap the tongue with a sterile gauze pad and gently pull it out of the mouth with your left hand.
3. Take a cotton ball with tweezers in your right hand, moisten it with an antiseptic solution and, removing plaque, wipe your tongue.
4. Release the tongue, change the swab and wipe the teeth from the inside and outside.
5. Ask the patient to rinse his mouth (if he is able).
Washing (irrigation) of the oral cavity
Necessary equipment: Esmarch's mug with a glass tip and a rubber tube (either a pear-shaped balloon or a Janet syringe *), oilcloth, kidney-shaped tray, spatula, antiseptic solution.
The order of the procedure:
1. Prepare for the procedure: lay out the necessary equipment, put on gloves.
2. Draw a warm antiseptic solution into Esmarch's mug and hang it 1 m above the patient's head.
3. Turn the patient's head to one side (otherwise he may choke!), cover his neck and chest with oilcloth, bring a tray to his chin.
4. Pull the corner of the mouth with a spatula, insert the tip into the vestibule of the mouth and rinse it with a jet of liquid under moderate pressure.
5. Rinse alternately the left, then the right buccal space (pull the cheek with a spatula).
6. Remove gloves, wash hands.
Lubrication of the oral cavity
Lubrication of the oral cavity is prescribed for diseases of the oral mucosa.
* Syringe Janet - a syringe for washing, characterized by a significant capacity (100-200 ml); for the convenience of work, there are soldered rings on the end of the rod and on the ring covering the glass cylinder of the syringe. Proposed by the French urologist J. Janet (1861-1940).
Necessary equipment: boiled spatula and tweezers, a few sterile cotton balls, a sterile tray, medicine, a flat glass vessel.
The order of the procedure:
1. Prepare for the procedure: lay out the necessary equipment, put on gloves.
2. Pour a small amount of medicine from the vial into a flat glass vessel.
3. Ask the patient to open his mouth.
4. Take a cotton ball with tweezers, moisten it with medicine.
5. Helping with a spatula, press a cotton ball to the affected area of the mucous membrane.
6. Then take a fresh ball of medicine and apply it to another lesion.
7. Remove gloves, wash hands.
Taking a smear from the mucous membrane of the mouth, nose and throat
A sterile metal brush is used (a cotton swab attached to a wire and passed through a stopper into a sterile test tube). For sowing, ulcer discharge or plaque is usually taken from the tonsils, palatine arches and oral mucosa. The patient is seated in front of a light source, asked to open his mouth wide. With a spatula in the left hand, they press the root of the patient's tongue, with the right hand they remove the shaving brush from the test tube by the outer part of the cork and carefully, without touching anything, reach the plaque, remove the plaque or discharge with the brush. To take a swab from the nose, the swab is very carefully, without touching the outer surface of the nose, injected first into one and then into the other nasal passage and take the material for sowing. After taking smears, they should be immediately sent to the laboratory, indicating the patient's name, age, ward number, department name, date, name of the material and the purpose of the study.
Taking a throat swab
Necessary equipment: a sterile metal shaving brush in a glass vial with a stopper, a spatula. The order of the procedure:
1. Prepare for the procedure: lay out the necessary equipment, put on gloves.
2. Seat the patient in front of a light source, ask him to open his mouth wide.
3. With a spatula in the left hand, press the root of the patient's tongue.
4. With your right hand, remove the shaving brush from the test tube by the outer part of the cork and, without touching the oral mucosa, run the brush over the arches and palatine tonsils.
5. Carefully, without touching the outer surface of the test tube, insert the swab with the material for inoculation into the test tube.
6. Remove gloves, wash hands.
7. Fill in the direction (last name, first name, patronymic of the patient, “Smear from the pharynx”, date and purpose of the study, name of the medical institution).
8. Send the tube to the laboratory (with a referral).
EYE CARE
To remove a purulent discharge, the eyes are washed with a 3% solution of boric acid, a solution of rivanol, or a weak solution of potassium permanganate (which has a pink color) from a rubber can or a gauze swab. To collect the flowing fluid, a tray is used, which the patient himself holds under his chin. In inflammatory diseases of the eyes, drugs are instilled or eye ointments are rubbed in.
Morning eye toilet
Necessary equipment: sterile swabs (8-10 pieces), antiseptic solution (0.02% nitrofural solution, 1-2% sodium bicarbonate solution), sterile tray.
The order of the procedure:
1. Wash your hands thoroughly.
2. Put swabs into the tray and pour antiseptic solution.
3. Slightly squeeze the swab and wipe the patient's eyelashes and eyelids with it in the direction from the outer corner of the eye to the inner; discard the swab.
4. Take another tampon and repeat wiping 4-5 times (with different tampons).
5. Blot the remaining solution in the corners of the patient's eyes with a dry swab.
Eye wash
Necessary equipment: a special glass cup with a leg, medicinal solution.
The order of the procedure:
1. Pour the medicinal solution into a glass and place it on the table in front of the patient.
2. Ask the patient to take the glass by the leg with his right hand, tilt his face so that the eyelids are in the glass, press the glass to the skin and raise his head (while the liquid should not flow out).
3. Ask the patient to blink frequently for 1 minute without taking the cup away from the face.
4. Ask the patient to put the cup on the table without taking the cup away from the face.
5. Pour a fresh solution and ask the patient to repeat the procedure (8-10 times).
Instillation of drops in the eyes
Necessary equipment: a sterile eye dropper, a bottle of eye drops.
The order of the procedure (Fig. 6-7):
1. Check that the name of the drops matches the doctor's prescription.
2. Take the required number of drops (2-3 drops for each eye).
3. In the position of the patient sitting or lying down, ask him to throw his head back and look up.
4. Pull the lower eyelid and, without touching the eyelashes (do not bring the pipette closer to the eye than 1.5 cm), drip drops into the conjunctival fold of one and then the other eye.
Necessary equipment: a tube of eye ointment. The order of the procedure (Fig. 6-8):
2. Pull the lower eyelid of the patient with your thumb.
3. Holding the tube at the inner corner of the eye and moving it so that the “cylinder” of ointment is located along the entire eyelid and goes beyond the outer commissure of the eyelids, squeeze the ointment from the tube onto the conjunctiva of the lower eyelid along its border with the eyeball.
Rice. 6-7. Instillation of eye drops
Rice. 6-8. Applying eye ointment from a tube
4. Release the lower eyelid: the ointment will press against the eyeball.
5. Remove the tube from the eyelids.
Applying eye ointment with a glass rod
Necessary equipment: a sterile glass rod, a bottle of eye ointment.
The order of the procedure:
1. Place the patient in front of you and ask him to tilt his head back slightly and look up.
2. Take the ointment from the bottle onto the stick so that it covers the entire spatula.
3. Place the stick near the eye horizontally so that the spatula with the ointment is directed towards the nose.
4. Pull the lower eyelid and put a spatula behind it with ointment to the eyeball, and with the free surface to the eyelid.
5. Release the lower eyelid and ask the patient to close the eyelids without effort.
6. Remove the spatula from under the closed eyelids towards the temple.
EAR CARE
The patient needs to clean his ears 2-3 times a week so that sulfur plugs do not form. Sulfur falls out of the ear in the form of lumps
Rice. 6-9. Syringe jane
Rice. 6-10. Washing the ear canal
kov or crumbs. They can accumulate in the ear canal and form sulfur plugs; at the same time hearing is sharply reduced. In such cases, the ear canal is washed.
Washing the ear canal
Necessary equipment: Janet syringe (Fig. 6-9) with a capacity of 100-200 ml, water (36-37 ° C), kidney-shaped tray, cotton wool, glycerin drops.
The order of the procedure (Fig. 6-10):
1. Draw water into Janet's syringe.
2. Seat the patient in front of him sideways so that the light falls on his ear.
3. Give the tray to the patient's hands, which the patient should press against the neck under the auricle.
4. With your left hand, pull the auricle up and back, and with your right hand, insert the tip of the syringe into the external auditory canal. To inject a jet of liquid with jerks along the upper-posterior wall of the auditory canal.
5. ear canal after washing, dry with cotton wool.
6. If the cork cannot be removed, it must be softened with soda-glycerin drops. Within 2-3 days, 2-3 times a day, 7-8 heated drops should be poured into the ear canal. It is necessary to warn the patient that after the infusion of drops, hearing may deteriorate somewhat for a while.
Rice. 6-11. Instillation of drops in the ear
Instillation of drops in the ear
Necessary equipment: pipette, bottle with ear drops, sterile cotton.
The order of the procedure (Fig. 6-11):
1. Tilt the patient's head to the side opposite to the ear into which the drops will be instilled.
2. Pull the patient's auricle back and up with the left hand, and drop drops into the ear canal with a pipette in the right hand.
3. Invite the patient to remain in a position with the head tilted for 15-20 minutes (so that the liquid does not flow out of the ear), then wipe the ear with sterile cotton wool.
NOSE CARE
Taking a swab from the nose
Necessary equipment: a sterile metal shaving brush in a glass tube, a spatula. The order of the procedure:
1. Seat the patient (the head should be slightly thrown back).
2. Take the test tube in your left hand, remove the shaving brush from the test tube with your right hand.
3. With the left hand, lift the tip of the patient's nose, with the right hand, insert the shaving brush with light rotational movements into the lower nasal passage on one side, then on the other side.
Rice. 6-12. Removal of crusts from the nose
4. Carefully, without touching the outer surface of the test tube, insert the swab with the material for inoculation into the test tube.
5. Fill in the direction (last name, first name, patronymic of the patient, “Smear from the nose”, date and purpose of the study, name of the medical institution).
6. Send a test tube with a referral to the laboratory.
Removal of crusts from the nose
Necessary equipment: nasal probe, cotton wool, Vaseline oil(or glycerin). The order of the procedure (Fig. 6-12):
1. Wrap cotton wool moistened with vaseline oil around the probe.
2. Insert the probe into the patient's nasal passage, and then remove the crusts with rotational movements.
Instillation of drops in the nose
Necessary equipment: pipette, bottle of nasal drops. The order of the procedure:
1. Tilt the patient's head to the side opposite to the nasal passage into which the drops will be instilled.
2. Drop drops into the nasal passage.
3. After 1-2 minutes, drip drops into the other nasal passage.
HAIR CARE
It is necessary to ensure that dandruff does not form in the hair of patients. To do this, wash your hair once a week using shampoo and toilet soap. Seriously ill people wash their heads in bed. For this, a basin is placed at the head end of the bed, and the patient throws his head back so that it is above the basin. You should lather the scalp well, then the hair, rinse them with warm water, wipe dry and comb. After washing, a towel or scarf is tied over the head.
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