Algorithm of actions of the district therapeutic nurse, general practice nurse at the reception. Algorithm of a nurse's action in an attack of bronchial asthma 2 compose an algorithm for a nurse's actions

Measurement of body temperature in the armpit

1. Examine the armpit, wipe the skin with a napkin

axillary area dry.

2. Remove the thermometer from the beaker with the disinfectant solution. After

disinfection thermometer should be rinsed with running water and

wipe dry thoroughly.

3. Shake the thermometer so that the mercury column drops to below 35 ° C.

4. Place the thermometer in the armpit so that the mercury reservoir is in contact with the patient's body on all sides; offer the patient to firmly press the shoulder to the chest (if necessary, the health worker should help the patient to hold the arm).

5. Remove the thermometer after 10 minutes, memorize the readings.

6. Shake the thermometer so that the mercury column drops below 35 ° C.

7. Place the thermometer in a container with a disinfectant solution.

8. Record the thermometer readings in the temperature sheet.

Blood pressure measurement

Sequence of execution

2. Explain the essence, the course of the upcoming actions.

3. Obtain the patient's consent to the procedure.

4. Warn the patient about the upcoming procedure 15 minutes before it

5. Prepare the necessary equipment.

6. Wash and dry your hands.

7. Give the patient a comfortable sitting or lying position.

8. Place the patient's arm in an extended position, palm up, placing the roller under the elbow.

9. Place the tonometer cuff on the patient's bare shoulder 2-3 cm above the elbow bend so that 1 finger passes between them. The cuff tubes are facing downward.

10. Connect the pressure gauge to the cuff by attaching it to the cuff.

11. Check the position of the pressure gauge pointer relative to the "0" -th mark of the scale.

12. Determine the pulsation in the cubital fossa with your fingers, apply a stethoscope to this place.

13. Close the valve of the pear, inject air into the cuff until the pulsation in the ulnar artery disappears + 20-30 mm Hg. Art. (slightly higher than the estimated blood pressure).

14. Open the valve, slowly release the air, listening to tones, follow the readings of the pressure gauge.

15. Mark the number of the appearance of the first beat of the pulse wave corresponding to systolic blood pressure.

16. Let the air out of the cuff slowly.

17. "Mark" the disappearance of tones, which corresponds to diastolic blood pressure.

18. Release all air from the cuff.

19.Repeat the procedure after 5 minutes.

20.Remove the cuff.

21. Place the pressure gauge in the cover.

22. Disinfect the head of the phonendoscope by the method of double

rubbing with 70% ethyl alcohol.

23. Evaluate the result.

24.Inform the patient about the measurement result.

25. Carry out registration of the result in the form of a fraction (in the numerator - systolic pressure, in the denominator - diastolic) in the necessary documentation.

Measurement of arterial pulse

1. Establish a relationship of trust with the patient.

2. Explain the essence and course of the procedure.

3. Obtain the patient's consent to the procedure

4. Prepare the necessary equipment

5. Wash and dry your hands

6. Give the patient a comfortable sitting or lying position.

7. Grasp the patient's hands at the same time with the fingers of your hands above

the wrist joint so that the 2nd, 3rd and 4th fingers are above the radial artery (2nd finger at the base of the thumb). Compare the vibrations of the walls of the arteries in the right and left arms.

8. Conduct a count of pulse waves on the artery where they are best expressed within 60 seconds.

9. Estimate the intervals between the pulse waves.

10. Evaluate the filling of the pulse.

11. Compress the radial artery until the pulse disappears and assess the pulse tension.

12. To register the properties of the pulse on the temperature sheet graphically, and in the observation sheet - digitally.

13. Inform the patient about the results of the study.

14. Wash and dry hands.

Respiratory rate measurement.

Sequence of execution:

1. Create a trusting relationship with the patient.

2. Explain to the patient the need to count the pulse, obtain consent.

3. Take the patient's hand, as for a pulse study.

4. Place your and the patient's hands on the chest (for chest breathing) or the epigastric region (for abdominal breathing) of the patient, simulating a pulse study.

6. Assess the frequency, depth, rhythm and type of breathing movements.

7. Explain to the patient that he was counted the frequency of respiratory movements.

8. Wash and dry your hands.

9. Carry out data registration in the temperature sheet.

The calculation of the respiratory rate is carried out without informing the patient about the study of the respiratory rate.

Height measurement

Execution order:

1. Place a removable napkin on the stadiometer platform (under the patient's feet).

2. Raise the bar of the stadiometer and invite the patient to stand (without shoes!) On the platform of the stadiometer.

3.Place the patient on the stadiometer platform; the back of the head, the spine in the area of ​​the shoulder blades, the sacrum and the heel of the patient should fit snugly against the vertical bar of the stadiometer; the head should be in such a position that the ear tragus and the outer corner of the orbit are on the same horizontal line.

4. Lower the stadiometer bar on the patient's head and determine the height on the scale along the lower edge of the bar.

5.Help the patient to get off the stadiometer platform and remove the napkin.

Determination of body weight (weight) of the patient

Execution order:

1. Place a removable napkin on the weighing plate (under the patient's feet).

2. Open the balance shutter and adjust them: the level of the balance beam, on which all weights are in the "zero position", must coincide with the reference mark - the "nose" of the balance on the right side of them.

3. Close the balance shutter and invite the patient to stand (without shoes!) In the center of the weighing platform.

4. Open the shutter and determine the patient's weight by moving the weights on the two bars of the rocker arm until the rocker arm is level with the reference mark of the medical scale.

5. Close the shutter.

6.Help the patient off the scale and remove the napkin.

7.Record measurement data.

Gastric lavage

Indications: It is carried out with a therapeutic, diagnostic purpose, as well as to eliminate the remains of a poor-quality product and other substances from the stomach. Necessary equipment: gastric tube with two holes, funnel, pelvis.

To determine the length of the probe, use the following formula:

I= L - 100 (cm), where I is the length of the probe, L is the patient's height, see

The tube is inserted a predetermined length into the stomach. Confirmation that the probe is in the stomach is the cessation of the urge to vomit. After the introduction of the probe, a funnel is attached to the outer end, then the funnel is lifted up and filled with a 2% sodium bicarbonate solution, after which it is lowered below the level of the stomach to remove gastric contents and this is repeated until pure lavage water arrives from the stomach. The amount of rinsing water in the basin should approximately correspond to the volume of the liquid introduced through the funnel.

Duodenal intubation technique

1. Explain to the patient the procedure for the procedure.

2. Correctly seat the patient: leaning on the back of the chair, tilt your head forward.

3. Put a towel on the patient's neck and chest; if there are removable dentures, they must be removed.

5. Carefully place the blind end of the probe on the root of the patient's tongue and ask to swallow.

6. When the probe reaches the stomach (50 cm mark on the probe), put a clamp on its free end.

7. Lay the patient on a couch without a pillow on his right side, offering to bend his knees, put a warm heating pad under his right side on the liver area.

8. Ask the patient to continue swallowing the probe for 20-60 minutes to the 70 cm mark.

9. Immerse the end of the probe into the test tube, remove the clamp: if the olive of the probe is in the initial part of the duodenum, a golden yellow liquid begins to flow into the test tube.

10. Collect 2 - 3 tubes of the supplied fluid (portion A - duodenal bile), apply a clamp to the end of the probe.

11. Lay the patient on his back, remove the clamp and inject a heated stimulus (40 ml of 40% glucose, magnesium sulfate or sorbitol) through the probe with a syringe to open the sphincter of Oddi, apply a clamp.

12. After 10-15 minutes, ask the patient to lie down on his right side again, lower the probe into the next tube and remove the clamp: a thick liquid of dark olive color should flow (portion B - from the gallbladder), which is released within 20-30 minutes.

13. When a clear, golden-yellow liquid begins to stand out (portion C - hepatic bile), lower the probe into the next tube and collect it for 20 - 30 minutes.

14.After the end of the procedure, carefully remove the probe and immerse it in a container with a disinfectant solution.

15.All three portions of bile in a warm state, together with a referral, are sent to the laboratory for diagnosis.

Preparing a patient for a urine test

1. Explain to the patient the purpose and rules of the study.

2. On the eve of the study, the patient must limit the consumption of foods (carrots, beets), refrain from taking medications as prescribed by the doctor (diuretics, sulfonamides).

3. Do not change the drinking regimen the day before the study.

4. On the eve and on the day of urine collection, it is necessary to conduct a toilet of the patient's external genital organs.

Determination of daily urine output

Purpose: diagnostics of latent edema.

Indications:

Monitoring a patient with edema;

Revealing hidden edema, increasing edema;

Monitoring the effectiveness of the effects of diuretics.

Required equipment: medical scales, measuring glass

graduated container for collecting urine, water balance sheet.

Sequence of execution:

1. Establish a trusting relationship with the patient, evaluate him

the ability to independently carry out the procedure. Ensure that the patient is able to record fluid.

2. Explain the purpose and course of the study and obtain the patient's consent to the procedure.

3. Explain to the patient the need to comply with the usual water-food and motor regimen.

4. Make sure that the patient has not taken diuretics for 3 days before the study.

5. Give detailed information about the order of entries in the sheet of water balance, make sure that you can fill out the sheet.

6. Explain the approximate percentage of water in food to facilitate water balance accounting.

7. Prepare equipment.

8. Explain that it is necessary to drain the urine into the toilet at 06.00.

9. Collect urine after each urination in a graduated container, measure urine output.

10. Record the amount of fluid allocated in the accounting sheet.

11. Record the amount of liquid drunk in the record sheet.

12.Explain that it is necessary to indicate the time of admission or administration

liquids, as well as the time of fluid release in the water balance sheet during the day, until 06.00 the next day.

13. At 06.00 the next day, hand over the registration sheet to the nurse.

14. Determine to the nurse how much fluid should be excreted in the urine (normal).

15. Compare the amount of fluid released with the amount of calculated fluid (normal).

18. Make entries in the water balance sheet.

Distribution of medicines

Medicines are prescribed only by a doctor. Before dispensing medicines, the ward nurse must:

1. Wash hands thoroughly.

3. Check the expiration date of the medicinal substance.

4. Check the prescribed dose.

5. Monitor the patient's intake of the drug (he

must take the medicine in the presence of a nurse).

6. If a medicinal product is prescribed for administration several times a day, the correct time intervals must be observed.

7. Preparations taken on an empty stomach are given to the patient in the morning 20-60 minutes before breakfast, taken before meals - 15 minutes before meals, taken after meals - 15 minutes after meals. Medicines should be stored only in packaging dispensed from the pharmacy.

When taking tablets, dragees, capsules, pills, the patient places them on the root of the tongue and drinks them with water. If the patient cannot swallow the pill whole, you can grind it first (with the exception of pills containing iron, they must be taken whole). Dragee, capsules, pills are taken unchanged. The powder is poured onto the root of the tongue to the patient and washed down with water. Potions, decoctions are prescribed in a dining room (15 ml), a teaspoon (5 ml) or a dessert (10 ml) spoon. It is more convenient to use a graduated beaker.

Oxygen therapy

The indication for oxygen therapy is the elimination of hypoxia of various origins. Distinguish between inhalation, non-inhalation (extrapulmonary) and hyperbaric methods of oxygen supply. The most common methods of oxygen administration are inhalation. Inhalation of oxygen (oxygen mixtures) is carried out using oxygen masks, caps, tents and awnings, catheters, ventilator. Hyperbaric oxygenation is carried out using pressure chambers, it is a therapeutic application of oxygen under a pressure of more than 1 atm. The oxygen therapy regimen can be continuous or in sessions of 20-30-60 minutes.

Oxygen therapy rules:

1. Ensure airway patency before oxygen supply.

2. Strictly observe the oxygen concentration (the most effective and safe oxygen concentration is 30-40%).

3. Ensure oxygen humidification through the thickness of the sterile liquid using the Bobrov apparatus, where the height of the humidifying liquid should be 15 cm.

4. Provide oxygen warming.

5. Control the oxygen supply time.

6. Observe safety precautions when working with oxygen to monitor the patency of the respiratory tract.

7. Control the patient's condition or monitor the rate of respiration and heart rate, oxygen tension in the blood.

Performing bladder catheterization with a soft catheter

Indications:

Acute urinary retention for more than 6 - 12 hours;

Taking urine for research;

Bladder lavage;

Administration of medicines.

Contraindications:

Damage to the urethra;

Acute inflammation of the urethra and bladder;

Acute prostatitis.

Security:

Soft catheter;

Anatomical tweezers (2 pcs.);

Kornzang;

Latex gloves;

Furacilin solution 1: 5000;

Napkins;

Sterile vaseline oil;

Container for collecting urine;

Lining oilcloth;

Antiseptic solution for washing;

Disinfectant containers.

Male urinary bladder catheterization

Patient preparation:

2. Ensure the isolation of the patient (use of a screen).

3. Clarify the patient's understanding of the purpose and course of the upcoming procedure, obtain his consent, exclude contraindications.

4. Put on a mask, gloves.

5. Lay the patient on his back with knees slightly bent and legs apart.

6. Place an oilcloth with a diaper under the patient's buttocks. Place the boat on top of the protruding edge of the oilcloth.

7. Prepare equipment, stand to the right of the patient. In the left hand, take a sterile napkin, wrap it around the patient's penis below the head.

8. Stand to the right of the patient, take a sterile napkin in the left hand, wrap the penis below the head.

9.Take the penis between the 3 and 4 fingers of the left hand, slightly squeeze the head, 1 and 2 fingers move the foreskin.

10.Take a gauze swab with tweezers, clamped in the right hand, moisten it in a solution of furacilin and process the glans penis from top to bottom, twice, from the urinary drip to the periphery, changing the tampons.

11. Pour a few drops of sterile petroleum jelly into the open external opening of the urethra.

12. Change the tweezers.

Procedure execution:

1.Take the catheter with sterile forceps at a distance of 5 - 6 cm from the side opening, circle the end of the catheter over the hand and clamp between 4 and 5 fingers (the catheter is positioned over the hand in the form of an arc).

2. Pour sterile vaseline oil over the catheter 15-20 cm over the tray.

3. Insert the catheter with tweezers (right hand), the first 4-5 cm, holding the glans penis with 1 - 2 fingers of the left hand.

4.Take the catheter with tweezers another 3-5 cm from the head and slowly immerse it into the urethra to a length of 19-20 cm.

5. Lower the penis simultaneously with the left hand towards the scrotum, which facilitates the advancement of the catheter along the urethra, taking into account the anatomical features.

6. When urine appears, immerse the peripheral end of the catheter in a urine collection container.

End of procedure:

1.Carefully remove the catheter with tweezers in reverse order after the urinary flow has stopped.

2. Place the catheter (if reusable) in a container with disinfectant solution.

3. Press on the anterior abdominal wall above the pubis with your left hand.

4. Remove gloves, place them in a container with disinfectant solution.

5. Wash and dry your hands.

6. Provide physical and psychological rest to the patient.

Female bladder catheterization

Sequence of execution:

1. Establish a friendly relationship with the patient.

2. Ensure the isolation of the patient (use of a screen).

3. Check with the patient about the purpose and course of the upcoming procedure, get her consent, exclude contraindications.

4. Put on a mask, gloves.

5. Lay the patient on her back with knees slightly bent and legs apart.

6. Spread the labia with your left hand, take gauze napkins moistened with furacilin solution with your right hand using tweezers.

7.Treat the urethra from top to bottom, twice, between the labia minora, changing napkins.

8. Dispose of the napkins in the disinfectant solution, change the tweezers.

9.Take the catheter with tweezers (right hand) at a distance of 5 - 6 cm from the side opening, like a writing pen.

10. Circle the outer end of the catheter over the hand and clamp between the 4th and 5th fingers of the right hand.

11.Pour sterile petroleum jelly over the catheter.

12.Spread the labia with your left hand, carefully insert the catheter into the urethra by 4-6 cm with your right hand until urine appears.

13. Lower the free end of the catheter into a urine collection container.

End of procedure:

1. Press with your left hand on the anterior abdominal wall above the pubis when urine begins to flow drop by drop.

2. Carefully remove the catheter after stopping urine flow from it.

3. Dispose of the catheter into a disinfection container.

4. Place seven gloves in a container with disinfectant solution.

5. Wash and dry your hands.

6. Provide physical and psychological rest to the patient.

Cleansing enema

Indications: prescribed to free the intestines from feces and gases with constipation and to prepare the patient for endoscopic methods

examination, X-ray methods of examination of the abdominal organs.

Necessary equipment: for a cleansing enema use water with a temperature of 37-39 ° C (volume of liquid 1 - 1.5 l), Esmarch mug, rubber tube, 1.5 m long, plastic tip.

Sequence of execution:

1. Establish a friendly relationship with the patient.

2. Pour 1.0-1.5 liters of water at room temperature -20-22 ° C into Esmarch's mug; with atonic constipation - t water 12 ° C (to stimulate intestinal motor activity), with spastic constipation - t water 40 ° C (to relieve spasm of intestinal muscles).

3. Hang the Esmarch mug on the rack, lubricate the sterile tip with Vaseline.

4. Open the valve on the rubber tube and fill it with water (release air). Close the valve.

5. Place the patient on his left side with knees bent and slightly brought to the stomach on a couch covered with oilcloth hanging in the pelvis.

6. With the 1st and 2nd fingers of the left hand, push the patient's buttocks apart, and with the right hand carefully insert the tip into the anus 3-4 cm towards the navel, then to a depth of 8-10 cm parallel to the spine.

7. Open the valve - water will begin to flow into the intestines (in the presence of gases and the patient's feeling of fullness, it is necessary to lower the mug below the couch and after the gas has passed, raise it again). Introduce the required volume of fluid into the intestine.

8. Close the valve and carefully remove the tip.

9. Leave the patient in the position on the left side for 10-15 minutes.

10. The patient empties the intestines into a toilet bowl or vessel.

STATE BUDGET EDUCATIONAL INSTITUTION

SECONDARY PROFESSIONAL EDUCATION

"ULYANOVSK PHARMACEUTICAL COLLEGE"

MINISTRY OF HEALTH AND SOCIAL DEVELOPMENT OF THE RUSSIAN FEDERATION

ALGORITHMS

NURSE ACTIONS

WHEN PERFORMING PRACTICAL MANIPULATIONS

List of practical manipulations

	Scroll	Page
	Social level of hand processing.
	Hygienic level of hand treatment.
	Putting on sterile gloves.
	Removing sterile gloves.
	Preparation of 10% basic clarified bleach solution (10 l).
	Preparation of 1% working solution of bleach (10 l).
	Preparation of 1% chloramine solution (1 l).
	Preparation of 3% chloramine solution (1 l).
	Preparation of 5% chloramine solution (1 l).
	Disinfection of patient care items by wiping twice (ice bladder).
	Disinfection of patient care items by wiping twice (heating pad).
	Azopiram sample.
	Phenolphthalein test.
	Amidopyrine test.
	Placement of dressing material in a sterilization box.
	Putting on a sterile gown.
	Targeted stacking for sterile table setting.
	Patient placement in Fowler position (high, medium, low).
	Placing the patient in the Sims position.
	Placing the patient in the supine position (performed by one nurse).
	Preparation of dressing material for sterilization (cotton and gauze balls).
	Pre-sterilization cleaning of medical devices.
	Preparation of a washing complex for pre-sterilization cleaning.
	Preparing the sterilization box for sterilization.
	General cleaning of the procedural (dressing) room.
	Carrying out the current cleaning of the procedural (dressing) room.

Compiled by:

The algorithms of professional nurses are compiled in order to comply with the unified requirements for teaching students in the specialty 060501 Nursing. in accordance with the Federal State Educational Standard in the specialty SPO 060501 "Nursing" of basic training in terms of mastering the main type of professional activity (VPA): performing work in the profession of a junior nurse in caring for patients of the corresponding professional competencies (PC):

PC 4.1. Communicate effectively with the patient and his environment in the course of professional activities.

PC 4.2. Comply with the principles of professional ethics.

PC 4.3. Caring for patients of different age groups in a health care facility and at home.

PC 4.4. Advise the patient and those around him on nursing and self-care issues.

PC 4.5. Prepare medical documentation.

PC 4.6. Provide medical services within the limits of their authority.

PC 4.7. Provide infectious safety.

PC 4.8. Provide a safe hospital environment for patients and staff.

PC 4.9. Participate in sanitary and educational work among the population.

PC 4.10. Master the basics of hygienic nutrition.

PC 4.11. Provide industrial sanitation and personal hygiene in the workplace.

PC 4.12. Carry out the nursing process.

The implementation of the national project "Health" is impossible without the availability of highly qualified mid-level medical workers, whose training is carried out in medical colleges and schools.

This manual presents algorithms for nursing manipulations, which reflect modern requirements for patient preparation, technique for performing and completing the procedure, which allows future nursing specialists to form knowledge, skills and responsibility for the quality of work performed.

The safety precautions when working with the patient and his biological fluids are being updated, which is very important at the present time.

This manual is intended for students of medical colleges and schools.

Practical manipulation algorithms

1. The social level of hand processing.

Social level: washing not heavily contaminated hands with soap and water removes most of the transient microorganisms from the skin.

Social processing of hands is carried out:

• before eating;
• after using the toilet;
• before and after caring for the patient;
• with dirty hands.

Equipment: household soap (liquid) for single use, a watch with a second hand, warm running water, sterile napkins on a tray, an individual towel (electric dryer).

Required condition: healthy skin of hands, nails no more than 1 mm, without varnish. Before the procedure, clean under the nails, wash under running water.

Algorithm of actions.

1. Remove the rings from the fingers, check the integrity of the skin of the hands.

2. Wrap the sleeves of the robe up to the elbow, take off the watch.

3. Open the tap, adjust the water temperature (35 - 40 ° C).

4. Lather your hands and wash the faucet with soap (the elbow faucet is not washed, if a bar of soap is used, wash it, put it on a clean napkin or in a bar soap dish).

After superficial contact with the patient (for example, measuring blood pressure), hand washing is not required.

Fig 1. Preparation for hand washing.

5. Wash hands with soap and running water up to 2/3 of the forearm for 30 seconds. Paying attention to the phalanges and interdigital spaces of the hands, then wash the back and palm of each hand and rotate the base of the thumbs.

Note: This time is sufficient for decontamination of hands on a social level, if the surface of the skin of the hands is washed thoroughly and the dirty areas of the skin of the hands are not left.

6. Rinse hands under running water to remove soap suds.

Note: hold your hands with your fingers upward so that the water drains into the sink from your elbows (do not touch the sink). The phalanges of the fingers should remain the cleanest.

7. Repeat hand washing in the same sequence.

8. Close the tap using a napkin (close the elbow tap by moving the elbow).

9. Dry your hands with a dry clean individual towel or dryer.

2. Hygienic level of hand treatment

Hand washing is the most important procedure to prevent nosocomial infections.

It identifies three levels of hand decontamination: social, hygienic (disinfection), and surgical.

Target: ensuring hand decontamination at a hygienic level.

Indications:

Before putting on and after taking off gloves;

After contact with body fluids and after possible microbial contamination;

Before caring for an immunocompromised patient.

Equipment:

1. laundry soap,
2. watch with a second hand,
3. warm running water,
4. container for dumping with disinfectant solution.
5. sterile: tweezers, cotton balls, napkins.

Required condition: no skin damage on the hands.

Algorithm of actions.

1. Remove the rings from the fingers (preparation for processing the required surface of the hand).

2. Wrap the sleeves of the gown on 2/3 of the forearm, remove the watch to ensure the infectious safety of the nurse.

3. Open the tap (running water is used).

4. Wet your hands under running water.

5. Lather your hands with soap

6. Wash your hands using the technique shown in Figure 2.

A) energetic mechanical friction of the palms - 10 seconds, repeat 5 times;

B) the right palm, rubbing, washes (disinfects) the back of the left hand, then the left palm also washes the right, repeat 5 times;

B) the left palm is on the right hand; fingers intertwined, repeat 5 times;

D) the fingers of one hand are bent and are on the other palm (fingers are intertwined), repeat 5 times;

E) alternating rubbing of the thumbs of one hand with the palms of the other; palms clenched, repeat 5 times

8. Rinse your hands under running water, hold them so that the wrists and hands are below the level of the elbows.

9. Close the tap using a sterile tissue.

10. Dry hands with a napkin (ensuring infectious safety).

Rice. 2. Technique of hand washing

3. Putting on sterile gloves

Target: prevent the spread of microorganisms, ensure infectious safety.

Equipment:

Bix with sterile gloves;

Sterile tweezers;

Antiseptic;

Individual napkin (towel);

Sterile tray.

Procedure for putting on gloves:

The nurse washes her hands, dries them, and treats them with a skin aniseptic.

1) open the bix lid using the foot pedal;

2) check the type of the indicator;

3) unfold the package with gloves (you can put the package on the table, as shown in Fig. 3);

Take gloves in sterile packaging, unfold.

4) take the glove by the lapel with your left hand so that your fingers do not touch the inner surface of the glove;

5) close the fingers of your right hand and insert it into the glove (Fig. 3);

6) open the fingers of your right hand and pull the glove over your fingers (Fig. 3), without breaking its lapel;

7) put under the cuff of the left glove II, III and IV fingers of the right hand, already wearing a glove (see Fig. 3) so that the I finger of the right hand is directed towards the I finger on the left glove;

8) hold the left glove II, III, IV vertically with the fingers of the right hand (Fig. 3);

9) close the fingers of your left hand and insert it into the glove;

10) spread the lapel first on the left glove, pulling it over the sleeve, then on the right

(see Figure 3) with the help of II and III fingers, bringing them under the tucked edge of the glove.

Attention!

When a long-sleeved robe is not required, gloves cover the wrist and part of the forearm.

Rice. 3 Procedure for putting on gloves

4. Removing sterile gloves

Purpose: to ensure infectious safety.

Equipment:

Container with a disinfectant solution;

Individual towel (napkin);

Emollient cream.

Procedure for removing gloves:

1) grab the edge of the right glove II and III with the fingers of your left hand and pull it up slightly (Fig. 4), making a cuff on the glove;

2) free the hand and the lower third of the forearm from the gown (without touching the surface of the gown and the forearm with the left glove); take off your right glove and leave it in your left hand;

3) take the raised edge of the left glove with I finger (from the inside) and the rest from the outside (Fig. 4);

4) remove the glove, turning it inside out, from the left hand (fig. 4);

5) immerse used gloves in disinfectant solution.

6) Wash hands, dry.

7) Treat hands with an emollient cream to prevent cracks.

Note: Disposable gloves are disposed of after disinfection, and reusable gloves are treated as medical devices.

Rice. 4. The sequence of actions when removing gloves.

5. Preparation of 10% basic clarified bleach solution (10 l)

Equipment:

- overalls - long robe, hat, oilcloth apron, medical gloves, respirator, goggles, removable footwear.

Dry bleach in standard packaging with the name, date of preparation

shelf life, activity for Cl- (chlorine);

Containers for disinfectants (enameled, plastic, dark glass) with appropriate marking;

Documentation: log of preparation of 10% solution of bleach, log of control of the preparation for active chlorine;

Wooden spatula for stirring the solution;

Personal hygiene products: soap, towel.

Mandatory conditions:

Cooking should be carried out in a room with supply and exhaust ventilation, in the absence of strangers.

Shelf life 10 days.

Dark container so that bleach does not decompose in the light.

Algorithm of actions:

1. Put on overalls
2. Prepare equipment
3. Mark the start time of the procedure
4. Pour in 1kg of dry bleach, stirring with a wooden spatula and kneading the lumps
5. Top up with water to 10 liters, stirring until smooth
6. Close the container with a lid
7. Make a mark on the tag about the cooking time, put your signature
8. Take off your overalls
9. Wash your hands, face with soap, wipe dry
10. Lock the room
11. Stir the solution several times during the day
12. Drain the settled solution after 24 hours into another container with marking, put the date of preparation, mark it in the log book, put your signature

6. Preparation of 1% working solution of bleach (10 l)

Equipment:

- overalls

Containers for disinfectants

10% clarified bleach solution (mother liquor)

Volumetric dishes with a marking capacity of 1L and 10L (bucket)

Wooden spatula

Mandatory conditions:

Solution apply once

Algorithm of actions:

1. Put on overalls
2. Prepare equipment
3. Check the labeling of the mother solution, buckets for the working solution
4. Take a 1L measuring vessel, pour 10% stock solution into a 1L container
5. Pour into a container for 1% working solution (bucket)
6. Top up with water up to 10L
7. Stir solution with a wooden spatula
8. Close the lid, check the marking, put the date of preparation of the solution and the signature
9. Use for application immediately after preparation
10. Take off overalls, wash hands, wipe dry

The prepared disinfectant solution should be used during the working day. Health care facilities should have a constant supply of detergents and disinfectants (3 months, based on need). Chlorine content is monitored every 3 months in a chemical laboratory.

7. Preparation of 1% chloramine solution (1 l)

Equipment:

- overalls

Weigh of dry chloramine powder 10g

Container for disinfecting solution

Wooden spatula

Mandatory conditions:

Solution is applied once

Algorithm of actions:

1. Put on overalls

3.Pour a small amount of water into the container

4. Place a weighed portion of dry chloramine powder (10) into the container

5.Add water to the 1L mark

7.Close the lid

10.Take off overalls, wash your hands

8. Preparation of 3% chloramine solution (1 l)

Prepare 3% chloramine solution in the amount of 1 liter.

Equipment:

- overalls

Weigh of dry chloramine powder 30g

Water tank with markings up to 1L

Container for disinfecting solution

Wooden spatula

Mandatory conditions:

Solution is applied once

Algorithm of actions:

1. Put on overalls

2.Prepare equipment, check markings

3.Pour a small amount of water into the container

4. Place a weighed portion of dry chloramine powder (30 g.) Into the container.

5.Add water to the 1L mark

6.Stir the solution with a wooden spatula

7.Close the lid

8.Check container markings and tags

9.Put the date of preparation, list

10.Take off overalls, wash your hands

9. Preparation of 5% chloramine solution (1 l)

Equipment:

- overalls

Weigh of dry chloramine powder 50g

Water tank with markings up to 1L

Container for disinfecting solution

Wooden spatula

Mandatory conditions:

Solution is applied once

Algorithm of actions:

1. Put on overalls

2.Prepare equipment, check markings

3.Pour a small amount of water into the container

4. Place a weighed portion of dry chloramine powder (50 g.) Into the container.

5.Add water to the 1L mark

6.Stir the solution with a wooden spatula

7.Close the lid

8.Check container markings and tags

9.Put the date of preparation, list

10.Take off overalls, wash your hands

10. Disinfection of patient care items by wiping twice (ice bubble, heating pad)

Equipment: overalls, used care item; rags with markings - 2 pcs., disinfectant solution approved for use in the Russian Federation; tray, container for disinfection of rags with a lid and marking, soap and skin antiseptic for treating hands.

Required condition: care items are disinfected immediately after use.

Disinfection modes depend on the clinical situation.

Preparing for the procedure

1. Put on overalls, carry out hygienic treatment of hands, wear gloves.

2. Prepare a container with a disinfectant solution with a tight-fitting lid and markings, make sure it is correctly labeled: read the name, concentration of the solution, purpose of use.

3. Prepare rags - 2 pcs. on a labeled tray indicating the purpose of use.

4. Pour a disinfectant solution of the required concentration into the tray. Moisten a cloth, wring it out for a single wipe

Procedure execution

1. Wipe the object in sequence with a rag soaked in a disinfectant solution.

2. Place the used rag in the disinfection container.

3. Maintain the exposure time in accordance with the guidelines for the use of the appropriate disinfectant.

4. Take a second rag from the tray, moisten it with disinfectant solution, squeeze it out to wipe it again

5. Wipe the object in sequence with a second cloth soaked in a disinfectant solution. Withstand the exposure time, place the used rag in a container for disinfection

6. Maintain exposure time.

7. Rinse the item of care under running water using detergents.

8. Dry, store dry.

The ending

1. Remove the apron, gloves, throw into a container for disinfection, wash and dry your hands in a hygienic manner.

Quality control of pre-sterilization cleaning

1. The quality of pre-sterilization treatment is controlled by samples:

For the presence of blood - amidopyrine try;

Oily medicinal contamination - sample with Sudan III;

Alkaline components of detergents - phenolphthaleic breakdown.

For blood residues, disinfectants, residual amounts of alkaline components of the detergent - azopyram- universal test.

In modern healthcare, the phenolphthalein test has lost its relevance, therefore, a universal azapiram test is carried out.

Self-control in the healthcare facility is carried out by:

At the CSO - every day;

In departments - at least once a week (senior m / s)

2. Subject to control: In the CSO - 1% of each product name, but not less than 3-5 units.

3. In the case of a positive sample, the entire batch of products is re-cleaned. The control results are recorded in the journal.

11. Azopiram sample

Target:

Conduct comprehensive quality control of pre-sterilization cleaning of medical instruments from hemoglobin, detergents, chlorine-containing, rust, medicines;

Evaluate the efficiency of the washing machines in the central office.

Equipment:

Azopyram reagent:

1. 100 ml of amidopyrine, 1 ml of aniline hydrochloric acid, mix in a dry bowl and pour 96% alcohol up to 1 liter, mix until all ingredients are completely dissolved.

2. Pipettes for 1% alcohol solution of azopyram and 3% hydrogen peroxide solution.

3. Tray with cotton swabs, instruments under control.

Mandatory conditions:

Use of a freshly prepared 1% solution of azopyram for 2 hours;

Compliance with the shelf life of azopyram: store in a tightly closed container at 4 ° C for 2 months. At room temperature - up to 1 month. Moderate yellowing of azopyram without precipitation does not impair its working properties. The temperature of the investigated product is +18, +25 degrees C.

Stages	Justification
Preparation
1. Put on a mask, wash your hands, dry, wear gloves.	Ensuring the safety of a nurse in the workplace.
2. Prepare equipment.	A condition for maintaining clarity in work.
3. Prepare 1% working solution of azopyram: a) open the vial with azopyram, take a pipette labeled "azopyram reagent", draw a certain amount of reagent into the pipette, release the solution from the pipette into a container labeled "1% working solution of azopyram". Place the pipette in a special container for storing pipettes. Close the vial with azopyram reagent; b) open a bottle with a 3% peroxide solution hydrogen, take a pipette marked "3% hydrogen peroxide solution", draw up the solution in the same amount as the azopyram reagent, release the solution into a container marked "1% azopyram working solution"; c) mix the ingredients of the prepared 1% azopyram solution, close the solution; d) prepare the necessary disassembled instruments for setting the sample.	Compliance with the rules for preparing a solution of percentage concentration. Compliance with storage rules. For quality control of pre-sterilization cleaning of instruments.
Performance
1. Take a small amount of the solution with a pipette marked "1% working solution of azopyram".	Quality assurance control.
2. Apply it on the object, in the cavity of the instrument, the thread of the clamp, in the places of contact with biological fluids.
3. Hold an object or equipment over the cotton wool, observing the color of the flowing reagent. Note: a sample is considered positive if the color of the reagent changes within the first minute.
Completion
1. Assess the result. Note: a sample is considered negative if the color of the reagent has not changed.	Quality control of pre-sterilization cleaning.

A test is considered positive if the color of the reagent changes to blue-violet, which indicates the presence of blood on the items. Brown staining indicates the presence of chlorine-containing oxidants, rust. A pink color indicates the presence of an alkaline detergent.

12. Phenolphthalein test

Equipment: reagent: 1% alcoholic solution of phenolphthalein, a pipette for a reagent, a tray with cotton swabs, a tray with dry instruments for a sample that has been pre-sterilized.

Performance:

1. Apply a 1% alcohol solution of phenolphthalein to the body of the instrument, into the lumen of the needle, etc.

2. Hold the needle over the cotton wool, observing the color of the flowing reagent.

3. Evaluate the result within two minutes. If the sample is negative, the color of the reagent will not change.

4. Carry out rinsing and pre-sterilization processing of the instrument used for the sample (if the sample is negative).

This test determines the quality of cleaning tools from the detergent solution.

If the test is positive, the color of the reagent changes from pink to crimson.

13. Amidopyrine test

Equipment: solutions for the reagent: 3% hydrogen peroxide solution, 30% acetic acid solution, 5% alcohol solution of amidopyrine, check their expiration dates. Individual pipettes with markings, a beaker marked "Reagent", a tray with cotton swabs, a tray with dry instruments for a sample that has been pre-sterilized.

Performance:

1. Prepare a reagent by mixing equal amounts of 3% hydrogen peroxide solution, 30% acetic acid solution, 5% alcohol solution of amidopyrine with different marked pipettes.

2. Apply a colorless reagent with a reagent pipette on dry items that have undergone pre-sterilization cleaning: the body and into the cavity of the instrument, into the lumen of the needle, etc.

3. Hold the object over a cotton wool or napkin, observing the color of the flowing reagent.

4. Assess the result. If the sample is negative, the color of the reagent will not change.

5. Carry out rinsing and pre-sterilization processing of the instrument used for the sample (with a negative sample).

If the sample is positive, the color of the reagent changes to blue-violet.

14. Putting the dressing in the sterilization box

Equipment: bix, dressing, sterility indicators, tag, soap, napkins.

Sequencing:

1. Handle your hands, put on gloves
2. Prepare the bix: wipe the inner surface of the bix and the lid with a cloth moistened with disinfectant solution twice, with an interval of 15 minutes.
3. Remove gloves.
4. Line the bottom and edges of the sterile box (KS or KF) with a napkin so that it hangs down 2/3 of the container height. Place the sterility indicator.
5. Lay the dressing loosely in layers:

Sectorally;

Vertically.

1. Place the sterility indicator.
2. Cover with a napkin hanging from the bix.
3. Place a tissue for the treatment of hands, place a sterility indicator.
4. Close the lid of the bix.
5. Attach a tag to the handle and indicate:

Installation date;

Branch;

Put a signature.

1. Place in a bag and send to the CSO.

15. Putting on a sterile gown

When handling hands at the hygienic level, the nurse uses a sterile forceps or tweezers, while at the surgical level, she works with her hands.

Target: performing manipulations with sterile medical items in areas of special sterility.

Equipment: sterile bix with linen, dressing material;

sterile bix with gloves

Indications: preparation for work in the operating room, dressing room.

Sequencing:

1. The nurse treats the hands in a hygienic manner.
2. Open the bix using a foot pedal or an assistant.
3. Assess the sterility indicators from three points, the condition of the laundry.
4. Take out the mask, put it on.
5. Remove the robe by the edge of the collar, without touching its outer surface.
6. Turn the inner side towards you and keep at face level.
7. Slip into the sleeves of the robe by throwing on the right and then the left hand (or at the same time raising your hands up and spreading them to the sides).
8. Tie ribbons at sleeves.
9. Take the belt of the robe so that the loose ends hang down.
10. Ask the nurse to tie them at the back without touching the gown and the nurse's hands.
11. Wear sterile gloves.

Rice. Putting on a sterile gown.

16. Target stacking for sterile table setting

Target: packaging for sterilization in an autoclave, maintaining sterility during storage for a specified time.

Equipment:

Disinfectant solution for treating bix (1% chloramine solution or other regulated solution);

Rags for disinfecting the bix - 2 pcs.;

Containers with a disinfectant solution for rags and gloves;

Gloves, mask;

Large napkin for lining the bix;

Sterility indicator - 3 pcs.,

Target styling:

Coarse sheet -2 pcs.;

Surgical gown - 2 pcs.;

Mask, kerchief (or hat);

Large styling wipes;

Personal towel for drying hands.

A label indicating the department (office), the contents of the bix, the date of laying, the signature of the nurse who performed the procedure, and the time.

The necessary conditions:

Sterilization boxes of sufficient capacity and different shapes;

Laundry in a quantity corresponding to the norms for loading bix.

Sequencing:

1. Check the serviceability of the bix.

2. Put on gloves and a mask.

3. Treat the bix from the inside and outside with a disinfectant solution sequentially, twice, with different rags.

4. Dispose of the disinfection rag into a container with a disinfectant solution.

Note. The rags are used once and disinfected.

5. Remove gloves, immerse in disinfectant solution.

6. Line the bottom and edges of the bix with a napkin so that it hangs down 2/3 of the container height.

7. Place the sterility indicator on the bottom of the bix.

8. Fold the 1st sheet in four layers, then bend the ends, wrap it loosely in a roll so that it can be easily unwound.

9. Fold the 2nd sheet in four layers, then bend the ends, wrap it loosely in a roll so that it can be easily unwound.

10. Fold the surgical gown for m / s with ribbons inward, inside out, roll up longitudinally several times to the height of the bix, wrap it in a roll so that it can be easily unwound.

11.Fold the surgical gown, right side out, roll it up longitudinally several times to the height of the bix, wrap it in a roll for easy unwinding.

12. Place the sterility indicator in the central part of the bix.

13. Place the mask superficially between the gown and the sheet.

14.Cover with a napkin hanging from the bix

15. Place a napkin and tweezers. Place indicator.

16. Cover with a napkin hanging from the bix.

17. Close the lid of the bix with the lock.

18. Tie a tag to the bix handle.

19. Put the date of installation and the signature of the person responsible for the installation.

20. Deliver the bix to the CSO in a tight moisture-resistant bag.

Note. The bag is subject to sterilization in the CCO and is used for efficient transportation of bix from the CCO.

17. Patient placement in Fowler position (high, medium, low)

Indications: the risk of developing pressure ulcers, the need for physiological administration in bed, the forced position of the patient.

Preparing for the procedure

1. Explain the purpose and the course of placement, obtain consent.

2. Prepare the necessary equipment: pillows, blanket bolsters, footrest.

3. Assess the patient's condition and environment. Apply the bed brakes (if applicable).

Procedure execution

2. Make sure the patient is supine in the middle of the bed and remove the pillows.

3. Raise the head of the bed at an angle of 45 - 60 ° (90 ° - high Fowler position, 30 ° - low Fowler position) or put three pillows: the person sitting upright on the bed is in the Fowler position.

4. Place a pillow or folded blanket under the patient's shins.

5. Place a pillow under the forearm and hand (if the patient cannot move his arms on his own).

Note: Forearms and wrists should be raised and palms down.

6. Place a pillow under the patient's lower back.

7. Place a small pillow or roller under the patient's knees.

8. Place a small patient pillow under the heels.

9. Provide a support to support the feet at a 90 ° angle (if necessary).

End of procedure

1. Make sure the patient is comfortable. Raise the side rails.

2. Wash and dry your hands.

Rice. Fowler Positioning of the Patient

18. Placing the patient in the Sims position

It can be performed both on a functional bed and on a regular bed.

This position is intermediate between the prone position and the lateral position: the patient can only partially help. The placement is carried out by two nurses.

Indications: forced, passive position, the risk of bedsores.

Preparing for the procedure

1. Explain the purpose and course of placement, obtain consent.

2. Prepare the necessary equipment: 2 pillows, roller, footrest (sandbag).

3. Assess the patient's condition and environment. Apply the bed brakes.

Procedure execution

1. Lower the side rails (if equipped) on the nurse's side.

2. Make sure the patient is supine in the middle of the bed and remove the pillows.

3. Move the head of the bed to a horizontal position.

4. Move the patient to the edge of the bed.

5. Move the patient to a position lying on his side and partially on his stomach.

6. Place a pillow under the patient's head.

7. Place a pillow at shoulder level under the bent upper arm. Place the patient's other hand on the sheet.

8. Place a pillow under the bent, "upper" leg so that the leg is at the level of the thigh.

9. Place a sandbag at the sole of the foot.

End of procedure

1. Make sure the patient is comfortable. Unfold the sheet and diaper.

2. Raise the handrails.

3. Wash and dry your hands.

Fig. 13. Placing the patient in the Sims position

19. Placing the patient in the supine position (performed by one nurse)

It is performed both on a functional and on a regular bed in a forced or passive position; the risk of bedsores, hygiene procedures in bed; change of bed linen.

I... Preparing for the procedure

1. Explain to the patient the course of the upcoming procedure, make sure he understands, and get his consent for placement.

2. Assess the patient's condition and environment. Apply the bed brakes.

3. Prepare pillows, blanket bolsters, footrests.

II... Procedure execution

4. Lower the side rails (if equipped) on the nurse's side.

5. Lower the head of the bed (remove extra pillows), giving the bed a horizontal position. Make sure the patient lies in the middle of the bed.

6. Put the patient in the correct position:

• put a pillow under your head (or fix the rest);
• place your hands along the body, palms down;
• place the lower limbs in line with the hip joints.

7. Place a small pillow under your upper shoulders and neck.

8. Place a small, rolled up towel under the lower back.

9. Place the rolls of the rolled sheet along the thighs, from the outside, from the area of ​​the greater trochanter of the femur.

10. Place a small pillow or roller under the lower leg.

11. Provide a support to support the feet at a 90 ° angle.

12. Place small pillows under the forearms.

III... Completion of the procedure

13. Make sure the patient is comfortable. Raise the side rails.

14. Wash your hands.

20. Preparation of dressing material for sterilization

(cotton and gauze balls)

Dressing material is prepared on a special table with clean hands. For work in the treatment room, small napkins are prepared, as well as gauze tampons and cotton balls. Tampons, balls and wipes are used to remove blood, pressurize a bleeding vessel, and the like.

Making gauze balls: small balls are prepared from gauze 6x8 cm, medium - 8x10 cm. Pieces of gauze taken to prepare the balls are rolled up so that a gauze lump is formed in the form of a triangular envelope. In this case, no threads should stick out of the ball.

The most common method of rolling balls is the following, which consists of 3 points: the opposite sides of the gauze napkin are folded 2 cm, getting a gauze strip; a gauze strip is placed on the nail phalanges of the 2nd and 3rd fingers of the right hand; the free ends are put into one another, and a gauze ball is obtained.

21. Pre-sterilization cleaning of medical devices

Appendix 3 to the order of the USSR Ministry of Health dated July 12, 1989 No. 408 Methodical instructions "Means and methods of disinfection and sterilization" Disinfection measures for viral hepatitis.

Used and new medical devices are subjected to pre-sterilization cleaning in order to remove protein, fat, mechanical contaminants, as well as drugs. Detachable products must be pre-sterilized when disassembled.

Cleaning ways:

1. Mechanical - in special washing machines using ultrasound.

2. Manual - provides the following steps:

Stage I - Disinfection of medical supplies. To be carried out in the treatment room by the nurse in the treatment room.

Immediately after injection, rinse the syringe and needle with water in a separate container for a minute. After the injection of oil solutions, the syringe is washed with a brush and soap. Then, closing the hole on the under-needle cone with your finger, collect water into the cylinder, insert the piston into the cylinder, put on the needle and rinse it under the pressure of the piston (Fig. 5).

This water is disinfected with a 10% solution of clarified bleach in a 1: 1 ratio, exposure for 1 hour (or another regulated disinfectant solution).

Rice. Rinsing with running water in a separate container.

IIstage

Soaking in a 3% solution of chloramine (for tuberculosis - 5% solution) at a temperature of 22 0 for 60 minutes.

IIIstage

Rinsing with running water, water temperature 22 0, exposure 0.5 minutes

Pre-sterilization cleaning with 4 stages held in the CSO

IVstage.

Preparation of a cleaning solution in a container marked "detergent
solution".

The composition of the cleaning solution:

Soaking in a detergent solution in a container marked "detergent
solution "for 15 minutes.

Vstage.

Washing each product in a detergent solution using a brush or cotton-gauze swab for 0.5-1 minutes. on the product, needles with a syringe by pumping the solution, if necessary, first clean it with a mandrel.

VIstage.

Rinsing products under running water:

When using the Biolot detergent - 3 minutes,

When using detergents "Progress", "Marichka" - 5 minutes,

When using detergents "Astra", "Aina", "Lotos", "Lotos-machine" - 10 minutes.

Viistage.

Rinse each item in distilled water for 0.5 minutes.

VIIIstage.

Drying with hot air in an air oven until moisture completely disappears at a temperature of 85 0 С.

22. Preparation of a washing complex for pre-sterilization cleaning

Rules for the preparation of cleaning solutions

1 way.

5 grams of Biolot powder is dissolved in 995 ml of water, heated to a temperature of 40-45 degrees.

Method 2.

20 ml of 33% hydrogen peroxide solution (perhydrol) + 5 g of any detergent ("Progress", "Aina", "Astra", "Lotos") + 975 ml of water.

Method 3.

170 ml of 3% hydrogen peroxide solution + 5 g of detergent ("Progress", "Aina", "Astra", "Lotos") + 825 ml of water.

Warm up to a temperature of 50-55 gr.

Note: the washing solution is prepared for a day, it is allowed to heat it up 6 times. If a pink color appears, change it. Hydrogen peroxide causes corrosion of instruments, made of non-corrosive metals. Therefore, it is advisable to add a corrosion inhibitor - 0.14% sodium oleate solution to the washing solution containing hydrogen peroxide and SMS "Lotos", "Lotos-automat".

23. Preparing the sterilization box for sterilization

The dressing material and surgical linen prepared for sterilization are placed in sterilization boxes (bixes), which have different devices and sizes. In some buckets on the body there are side holes through which steam freely passes into the bucket when sterilized in an autoclave. These holes are opened and closed by moving a special metal belt on the bix body.

Bixes with holes located on the lid are more convenient. From the inside of the cover, these holes are covered with a filter.

Bix preparation for sterilization is as follows:

1) check the parts for leaks, determining:

a) the tightness of the closure of the lid;

b) ease of movement of the belt and the accuracy of matching the holes in the body with the holes in the belt;

c) the strength of fixing the metal belt to the body with a clamping device;

2) fixing the belt in a position in which the openings of the body are open;

3) wipe the bix from the inside and outside with a regulated disinfectant

4) cover the bottom and walls of the bix with a napkin or sheet;

5) dressing material and surgical linen are placed in the bix;

6) place indicators of material sterility in the bix - 3 pieces;

7) mark the bix.

24. Sterilization

The following methods are used sterilization:

Thermal: steam, air (temperature above 100 ° C);

Chemical (solution sterilization);

Radiation;

Gas (chemicals).

Thermal method:

Steam method(in an autoclave) - the sterilizing agent for this method is saturated water vapor under excess pressure.

Modes:

1. Sterilization at a pressure of 2.0 atm. and a temperature of 132 ° C with an exposure of 20 minutes. Sterilized products made of: corrosion-resistant metal, glass, fabrics (basic mode);
2. Sterilization at a pressure of 1.1 atm. and a temperature of 120 ° C with an exposure of 45 min. Sterilizable products made of: rubber, latex, polymeric materials (gentle mode).

Air method(in a dry oven) - dry hot air is a sterilizing agent.

Modes:

1. Temperature 180 ° С for 60 min. Sterilize metal and glass products.
2. Temperature 160 ° С for 150 min. Sterilize silicone rubber products.

Terms of sterility of packages:

Sterilization box without filter - 3 days,

Sterilization box with filter - 20 days,

Double packing of coarse calico, bags of various paper - 3 days.

Chemical method:

1 . 6% hydrogen peroxide solution at a temperature of 18-20 ° C - 6 hours.

2. 6% hydrogen peroxide solution at a temperature of 45-50 ° C - 3 hours. Products sterilized with solutions are freely laid out in containers. With a large length, the product is laid in a spiral, the channels and cavities are filled with a solution.

After the end of sterilization, the products are immersed three times for 5 minutes in sterile water, each time changing it, then they are transferred with a sterile forceps into a sterile container lined with a sterile sheet. Since products are sterilized with solutions without packaging, this method can only be used in a decentralized system.

Radiation method:

The sterilizing agent is ionizing γ (gamma) - and β (beta) radiation.

Polyethylene bags are used for packaging. Sterility remains in such packaging for years. The expiration date is indicated on the packaging. Radiation is the main method of industrial sterilization. It is used by enterprises producing sterile disposable products.

Gas method:

Carried out at 18-80 ° C. Products are sterilized in packages. In gas sterilization, ethylene oxide and its mixtures, formaldehyde are used. The sterilization process has a long cycle and is rarely used in a healthcare facility.

25. Quality control of sterilization

Types of control:

Chemical;

Technical;

Bacteriological.

Monitoring by indicators of integrated (thermal) action

Indicators of sterility of the company "Vinar" presented above change color to the standard only when exposed to the sterilization temperature during the entire sterilization exposure.

At each cycle, indicator strips are placed in the test points of the sterilizer. If the color of the indicator at any point is lighter than the standard, all products are considered non-sterile.

Series "STERIKONT" - self-adhesive indicators of class 4 for monitoring all critical parameters of steam (120 ° / 45 ", 132 ° / 20") and air, (160 ° / 150 ", 180/60") sterilization in the sterilizer chamber (outside the sterilized packages)

STERITEST series - self-adhesive indicators for monitoring all critical parameters of steam, 4 classes (120 ° / 45 ", 132 ° / 20") and air 5 classes (160 ° / 150 ", 180 ° / 60", 200 ° / 30 ") sterilization inside sterilized packages.

INTEST series - self-adhesive indicators of class 4 for monitoring all critical parameters of steam sterilization, both in the sterilizer chamber and inside sterilized packages in forevacuum sterilizers at modes: 121 ° / 20 ", 126 ° / 10", 134 ° / 5 " ...

Technical control method

Recording of temperature, pressure, start and end times of sterilization in a special journal.

Bacteriological control method

Carried out using a biotest - an object made of a certain material, seeded with test microorganisms. A small vial containing B. lichemiformis spores is used as carriers. Control is carried out in accordance with the approved method. There are also ready-made certified tests with B. Lichemiformis spores with colored culture media, which make it possible to carry out bacteriological control directly in the central heating center if there is a thermostat in it.

Control crops from various sterilized products are taken by SES workers.

26. Laying the sterile table for a medical nurse

Purpose: compliance with the sterility of medical instruments, syringes, needles, which ensures the prevention of nosocomial infections.

Equipment:

Manipulation table;

Work table: sterile bix (instruments, cotton balls, gauze napkins, sterile gloves); ethyl alcohol 70%; dry sterile container for tweezers or a sterile container with one of the disinfectant solutions; container for used material;

Sterile bix on the pedal set: robe, mask, gloves, cap, 2 large sheets, towel, tweezers, clip, diaper, tweezers container.

Sequence of execution:

1. Before covering the sterile table, the nurse: washes her hands, puts on a mask, gloves, treats the table twice with a disinfectant solution at intervals of 15 minutes, then rinses off the rest of the disinfectant solution with a clean cloth.

2. Takes off gloves, washes hands.

3. Checks bix with clothes (tightness, date of sterilization), puts the date of opening and time on the tag.

4. Carries out hygienic treatment of hands.

5. Opens the bix on the pedal set, checks the color change of the indicator according to the standard.

6. He takes out sterile tweezers from the bix and takes them out in turn: a container for tweezers, a sterile gown, a mask, a glove (puts them on according to the algorithm).

7. With sterile tweezers, he takes out the sheet and puts it in his left hand, the tweezers puts it in a dry sterile container (bix).

8. With outstretched arms, unfolds the sheet folded in 4 layers and covers the treatment table with a movement "away from you" so that the lower edges hang down by 20-30 cm.

9. He takes out the second sheet, folded into 4 layers, unfolds it and places it on top of the first one.

1. From the back it captures all 8 layers of sheets with her claws, in front she captures only 4 upper layers along the edges with 2 claws. The table is set.
2. Opens the sterile table by the front pins "away", folding the layers like an accordion, not reaching the edge of 10-15 cm, the pins hang over the table.
3. He puts the necessary sterile instrument on the table with tweezers in a convenient order (or according to the accepted scheme).
4. Grasping the front pins, lifts them up, spreads the "accordion" and the movement "towards itself" closes the table without touching the sterile part of the table.
5. Attaches a tag to the upper left corner of the sheet (date of sterilization of the sterile table, time of covering and signature of the nurse).

Attention!

1. The sterile table is set until 6 o'clock.
2. After taking the toolbox from the table, it immediately closes.
3. From the sterile table, the nurse takes the instruments with sterile dry tweezers.
4. An unused instrument taken from a sterile table is not returned back.

27. Contact of the patient's blood or other biological fluids on the nurse's clothes and skin

If the patient's blood or other biological fluids get on the clothes and skin of a nurse, it is necessary to:

1. Remove the soiled overalls with the right side inward.

2. Immerse in a 3% solution of chloramine for 1 hour (or other solution, see above).

3. Cover the stained place of personal clothing with a napkin soaked in a 3% solution of chloramine for 60 minutes, followed by washing in hot water.

4. Take a tampon in your hand, abundantly moistened with a 70-degree solution of ethyl alcohol.

5. Remove residues of biological fluid from the skin at the site of wetting of personal clothing by pinching with fingers using this tampon.

6. Dispose of the swab into a waste container.

7. Wash your skin with soap and water.

8. Repeat the removal of residues of biological fluid from the skin with a generously moistened swab in an antiseptic solution.

9. Dispose of the swab in the waste tray.

Note: Put the used swabs into a container and fill with a 3% solution of bleach for 60 minutes. (or use another regulated disinfectant solution); place the tray in a disinfectant solution, the exposure depending on the selected disinfectant solution. After disinfection, place the overalls in an oilcloth bag for dirty linen and send them to the laundry for further machine washing in hot water.

28. Contact of the patient's biological substrates on the mucous membrane of the eye

If the patient's biological substrates come into contact with the mucous membrane of the eye, the medical professional must take the following measures.

Prepare first aid kit in case of accidents, sterile: 2 trays, forceps.

1. Take a kraft bag with pipettes and a kraft bag with a dressing, undinki for washing the eyes and place in the tray.

2. Take from the first aid kit a 0.05% solution of potassium permanganate.

3. Pour a 0.05% potassium permanganate solution into the undinki and rinse the eyes.

4. Rinse the eye, tilting the head forward, firmly pressing the undinka with the solution to the face and making blinking movements for the eyelids.

5. Remove the undinka.

6. Wipe the eye with sterile napkins from a kraft bag moving from the outer corner of the eye to the nose.

Note: After use, boil eye droppers in 2% soda solution for 15 minutes. or in distilled water (30 min.). Disinfect used gauze swabs in 3% chloramine solution or 3% bleach solution for 60 minutes (or other regulated disinfectant solution).

29. Contact of the patient's biological substrates on the skin of the face and lips

If the patient's biological substrates get on the skin of the face and lips, the nurse needs to prepare 2 sterile trays, a sterile forceps, and a first aid kit in case of accidents.

1. Take a kraft bag with bandaging material from the first aid kit and put it in the tray.

2. Take from the first aid kit 70-degree alcohol or 0.05% solution of potassium permanganate.

3. Moisten a sterile gauze ball with 70-degree alcohol or 0.05% potassium permanganate solution and remove the patient's biological substrate from the skin of the face and lips by pinching the fingers, discard the used dressing material into the tray (for waste material).

4. Re-treat the face and lips with a sterile gauze ball moistened with 70 ° alcohol or 0.05% potassium permanganate solution.

5. Rinse the mouth with 70-degree alcohol or 0.05% potassium permanganate solution.

Note: Disinfect the used dressing in a container with a 3% solution of bleach for 60 minutes (or in another regulated disinfectant solution).

30. Contact of biological substrates on the nasal mucosa

If biological substrates get on the nasal mucosa of a medical worker, it is necessary to prepare 2 sterile trays, a sterile forceps, and a first aid kit in case of accidents.

1. Take a kraft bag with pipettes and a kraft bag with a dressing and place them on the tray.

2. Get a 1% solution of protargol from the first aid kit.

3. Put a pipette from a craft bag into a bottle with a 1% solution of Protargol.

4. Put the tray in hand.

5. Drip the nose with a 1% solution of protargol and lower the head down (the contents drain into the tray).

6. Re-instill the nose with a 1% solution of protargol and lower the head down (the contents flow into the tray).

7. Blot the nose with a sterile gauze ball.

Note: After use, disinfect the tray in a 3% solution of chloramine for 60 minutes. Pour the used dressing material into a container with a 3% solution of bleach for 60 minutes. (or other regulated disinfectant solution).

31. Injury to fingers of a hand by a potentially infectious instrument

If the fingers of the hand are injured by a potentially infectious instrument, it is necessary to:

Prepare a first aid kit in case of accidents, sterile bix, 2 trays, sterile forceps.

1. Without removing the gloves, squeeze out the blood from the wound, then remove the rubber gloves, throw them into a container with a 3% chloramine solution.

2. Take a kraft bag with bandaging material from the first aid kit and place it on the tray.

3. Get 70-degree ethyl alcohol, 5% iodine solution from the first aid kit.

4. Treat the wound surface with a sterile ball abundantly moistened with 70-degree ethyl alcohol and discard into a waste material tray.

5. Wash with soap and water without stopping the bleeding.

6. Dry the wound surface with a sterile ball and discard into a waste tray.

7. Treat the wound surface with 70-degree alcohol again, then treat with 5% iodine solution and discard the used dressing material into the tray.

8. Apply a bactericidal plaster to the wound surface.

9. Put on a rubber fingertip after applying a bandage from a bactericidal plaster, put on gloves.

10. Disinfect used items and dressings according to the current instructions (see above).

11. Put on sterile gloves.

12. Fill used rubber gloves with disinfectant solution (3% chloramine solution) and leave in the container for 60 minutes.

Note: Pour the used dressing material into a container with a 3% solution of bleach for 1 hour. Fill the container with washing water with dry bleach for 1 hour (at the rate of 200 g per 1 liter). Place the trays in a container with a disinfectant solution. Exposure depending on the selected disinfectant solution (or other regulated disinfectant solution).

32. First aid for contact with chlorine-containing solutions on the skin and mucous membranes.

Place of hit		First aid
	Hyperemia, dermatitis, eczema	Rinse with running water, consult a dermatologist.
Mucous membranes	Hyperemia of the mucous membranes of the eyes, lacrimation, pain	Rinse with a stream of water or 2% baking soda solution, drip 1% novocaine solution
	upset stool, in severe cases there may be cramps, fever	call a doctor, rinse the stomach with water or baking soda solution, give milk to drink.
Respiratory system	redness of the mucous eyes, runny nose, cough, there may be nosebleeds	remove the victim to fresh air, call a doctor, rinse the mouth and nasopharynx with water, give milk with the addition of baking soda (at least 2 glasses) to drink, inhalation with oxygen, antitussives.

There is no antidote for poisoning with chlorine-containing substances!

In severe cases, injected into a vein: 40% glucose solution 20 ml., 5% ascorbic acid solution 10-20 ml.

33. Routine cleaning of procedural (dressing) rooms.

Equipment:

1. special bathrobe,
2. hat,
3. mask,
4. rubber gloves,
5. mops for walls and floors,
6. rags.

It is carried out at least 2 times a day using detergents (hot 0.5% soap-soda solution) and, if necessary, disinfectants (1% solution of chloramine B or bleach, 6% hydrogen peroxide solution with 0.5% detergent) Cleaning consists in the treatment of floors, working surfaces of inventory and equipment, plumbing. Routine cleaning is carried out throughout the day to maintain cleanliness and order in the office (without stopping work).

Ultraviolet irradiation and airing of the office are carried out 4 times a day for 30 minutes.

34. General cleaning of procedural (dressing) rooms.

Equipment:

1. Sterile spec. clothes: robe, hat, mask;
2. rubber gloves,
3. marked inventory for furniture and equipment, walls, floors,
4. mops for walls and floors,
5. rags.
6. hydro-remote control or auto-max,
7. Solutions:

6% hydrogen peroxide solution with 0.5% detergent.

5% solution of chloramine B

1% deoxone solution

2% soap and soda solution

1. germicidal lamp

1. General cleaning of treatment rooms shall be carried out by a m / s and a nurse at least 1 time a week, while a corresponding entry is made in the general cleaning notebook.

2. The room is preliminarily freed from tools, medicines and other items that interfere with cleaning, equipment and inventory are moved away from the walls. Cleaning is carried out in stages: disinfection - washing - irradiation with bactericidal lamps.

3. Disinfection treatment during general cleaning consists in irrigation with a hydro-control unit or an automatic machine, or rubbing with a cloth soaked in a working solution of a disinfectant from the ceiling, walls, windows, partitions, doors, plumbing and other equipment. For disinfection of honey. equipment, inventory, furniture, a separately prepared solution is used, which, after processing, is used for cleaning floors. The consumption rate of the disinfectant is 110-200 ml. for 1 sq. square meter.

4. The following preparations with an exposure of 1 hour are used as disinfectants for general cleaning:

6% hydrogen peroxide solution with 0.5% detergent.

5% solution of chloramine B

1% deoxone solution

In a room with a high demand for asepsis, according to epidemic indications, treatment is carried out with a 6% solution of hydrogen peroxide with 0.5 detergent or 5% chloramine solution (exposure 1 hour).

5. After disinfection of the office, they put on sterile special clothing used only for general cleaning and wash the premises, inventory, equipment with a 2% soap-soda solution (100g. Soda + 100g soap and up to 10 liters of water), and then warm running water.

6. After washing, with the windows closed, turn on germicidal lamps for 2 hours at the rate of 1 W of lamp power per 1 m 3 of the room area.

7. Air for at least 30 minutes.

Updated 27 Apr 2015... Created by 12 Dec 2014

The collection of sputum should be carried out in the presence and with the direct participation of medical personnel.

1. The nurse should explain to the patient the reasons for the study and the need to cough up not saliva or nasopharyngeal mucus, but the contents of the deep airways, which is achieved as a result of a productive cough that occurs after several deep breaths.

2. It is necessary to warn the patient that he must first brush his teeth and rinse the oral cavity with boiled water, which allows to mechanically remove the bulk of the microflora growing in the oral cavity and food debris that contaminate sputum and make it difficult to process.

3. A nurse wearing a mask, rubber gloves and a rubber apron should be behind the patient's back, choosing her position so that the direction of air movement is from her to the patient. She must open a sterile sputum collection bottle, remove the cap and give it to the patient.

several deep breaths.

5. Upon completion of the collection of sputum, the nurse must close the bottle with a lid, assess the quantity and quality of the collected material, enter these data in the referral. The bottle with the collected portion of sputum is carefully closed with a screw cap, marked and placed in a special container or box for transportation to the laboratory.

Logistics support.

Material for research on acid-fast mycobacteria is collected in sterile vials with tight screw caps. When using sealed vials, MBT is prevented from entering the external environment, the test material is protected from contamination with acid-resistant mycobacteria widespread in the environment.

Hemoptysis - practically never occurs in children with tuberculosis, in adolescents it is very rare.

Shortness of breath - does not occur in early forms of tuberculosis. It can be observed with a pronounced increase in the intrathoracic lymph nodes, damage to a large bronchus with a violation of its patency. Dyspnea is noted with miliary, disseminated tuberculosis, exudative pleurisy, widespread fibro-cavernous tuberculosis.

Chest pain - none in most children; they can be a manifestation of the involvement of the parietal pleura in the process, displacement of the mediastinum in case of complications. The pain is usually small, intermittent, associated with breathing.

In the history of the disease, it is necessary to find out the onset and course of the present disease and the possible connection with any provoking moments. Postponed acute respiratory viral infections, chronic bronchitis, repeated or prolonged pneumonia, sometimes bronchial asthma, exudative pleurisy can be masks of tuberculosis.

The first clinical manifestations of the disease often increase gradually, less often they develop sharply. The disease in children is often asymptomatic and is detected during preventive examinations. Acute course is more common in early childhood, asymptomatic - in school, especially from 7 to 11 years old. We find out if the child (teenager) received aminoglycosides, rifampicin, fluoroquinolones for this disease. These drugs have an anti-tuberculosis effect and improve the condition, lubricate the clinic.

In the history of life, we draw attention to information about anti-tuberculosis vaccinations - their timing, timeliness of setting tuberculin tests and their results in dynamics throughout the child's life. The presence of contact with people and animals with tuberculosis, the types of contact is determined.

At the same time, we find out the health status of family members - father, mother, relatives, as well as neighbors, with an emphasis on diseases suspicious of tuberculosis (pleurisy, bronchitis, repeated pneumonia, etc.). It is important to find out the timing and results of the last fluorographic examination of parents and other close relatives. The living conditions of the family, material security, social adaptation of parents, and the composition of the family matter. The nature of tuberculin sensitivity in other children in the family is important. We take into account the child's presence of diseases predisposing to tuberculosis, the methods of treatment.

BCG (Bacillus Calmette-Guérin or Bacillus Calmette-Guérin, BCG) is a tuberculosis vaccine prepared from a strain of a weakened live bovine tuberculosis bacillus (lat.Mycobacterium bovis BCG), which has practically lost its virulence for humans, being specially grown in an artificial environment.

The activity and duration of immunity to the causative agent of human tuberculosis, Mycobacterium tuberculosis, produced under the action of a vaccine in a child's body, has not been sufficiently studied

The vaccine components remain antigenic enough to make the vaccine effective against the development of bovine tuberculosis ("Pearl disease")

For atypical forms of the MAC group (eg Mycobacterium avium), it is known that the incidence rate in Sweden between 1975 and 1985 among unvaccinated children was 6 times higher than among vaccinated children, and amounted to 26.8 cases per 100,000.

At the moment, the effectiveness of vaccine prophylaxis against the causative agents of mycobacteriosis (eg Mycobacterium kansasii) has not been sufficiently studied.

Cases of post-vaccination complications are noted annually. The disease caused by the BCG strain is called BCGit and has its own characteristics of the development of the tuberculous process.

Contraindications:

Prematurity (birth weight less than 2500 g);

· Acute diseases (vaccination is postponed until the end of the exacerbation);

Intrauterine infection;

· Purulent-septic diseases;

· Hemolytic disease of newborns of moderate and severe form;

· Severe lesions of the nervous system with severe neurological symptoms;

· Generalized skin lesions;

· Primary immunodeficiency;

· Malignant neoplasms;

· Simultaneous administration of immunosuppressants;

· Radiation therapy (vaccination is carried out 6 months after the end of treatment);

· Generalized tuberculosis in other children in the family;

· HIV infection in the mother.

Tuberculin tests.

An important role in the prevention of tuberculosis is played by its timely detection. Fluorographic studies, diaskintest, Mantoux reaction, bacteriological studies of diagnostic material, preventive examinations are of great importance in this.

The main method for early detection of tuberculosis infection in children is systematic tuberculin diagnostics. Its main purpose is to study the infection of the population with microbacteria tuberculosis, based on the use of tuberculin tests.

Since 1974, a single tuberculin test has been used - the Mantoux reaction with 2TE. Since 2009, a new type of tuberculin test has been introduced - diaskintest.

Mass systematic planned tuberculin diagnostics

Goals of mass tuberculin diagnostics:

· Identification of persons newly infected with MBT;

· With giperrergicheskie and intensifying reactions to tuberculin;

· Selection for BCG-M vaccination of children aged 2 months and older who have not been vaccinated at the hospital;

· Selection for BCG revaccination;

· Early diagnosis of tuberculosis in children and adolescents.

According to the Order of the Ministry of Health of the Russian Federation No. 109 of March 21, 2003 "On improving anti-tuberculosis measures in the Russian Federation", tuberculin diagnostics is carried out for all vaccinated children from 12 months of age (except for children with medical and social risk factors) annually, regardless of the previous result.

The fight against tuberculosis is a state priority for Russia, which is reflected in legislative acts, the main of which are:

· Federal Law No. 77 FZ of 18.06.2001 “On the Prevention of the Spread of Tuberculosis in the Russian Federation;

· Decree of the Government of the Russian Federation of 25.12.2001 No. 892 "On the implementation of the Federal Law" On the prevention of the spread of tuberculosis in the Russian Federation ";

· Order of the Ministry of Health of Russia dated March 21, 2003 No. 109 "On improving anti-tuberculosis measures in the Russian Federation";

Mantoux test

A tuberculin skin test, better known as the Mantoux test or the Mantoux test, is used to determine whether the body has been in contact with a tubercle bacillus. For this, a small amount of the pathogen protein is injected intradermally on the inner side of the forearm, and after 72 hours, the result is interpreted according to the immune response, which is manifested by redness and the formation of a tubercle.

The Mantoux test can only answer the question of contact with the causative agent of tuberculosis or not. She is unable to determine whether this infection is active or inactive, and whether you are capable of infecting others. To confirm the diagnosis and determine the form of tuberculosis (open, closed, pulmonary, extrapulmonary), additional studies are carried out.

After the reaction, it is important not to wet or scratch the injection site, to exclude allergens, as this can lead to a false positive result.

Diaskintest

DIASKINTEST is an innovative intradermal diagnostic test, which is a recombinant protein containing two linked antigens - ESAT6 and CFP10, characteristic of virulent strains of Mycobacterium tuberculosis (Micobacterium tuberculosis and Micobacterium bovis).

These antigens are absent in the vaccine strain Micobacterium bovis BCG and in most non-tuberculosis mycobacteria, therefore Diaskintest induces an immune response only against Mycobacterium tuberculosis and does not give a reaction associated with BCG vaccination. Due to these qualities, Diaskintest has almost 100% sensitivity and specificity, minimizing the likelihood of developing false positive reactions, which are observed in 40-60% of cases when using the traditional intradermal tuberculin test (Mantoux test). The technique of setting Diaskintest is identical to the Mantoux test with tuberculin PPD-L, which makes its use available to the medical staff of medical institutions.

Diaskintest is intended for setting an intradermal test in all age groups in order to:

· Diagnostics of tuberculosis, assessment of the process activity and identification of persons with a high risk of developing active tuberculosis;

· Differential diagnosis of tuberculosis;

· Differential diagnosis of post-vaccination and infectious allergies (delayed-type hypersensitivity);

· Evaluation of the effectiveness of anti-tuberculosis treatment in combination with other methods.

At the moment, this method of diagnosing tuberculosis has been suspended indefinitely, in connection with the incident in Smolensk.

Chemoprophylaxis

Chemoprophylaxis is understood as the use of specific anti-tuberculosis (tuberculostatic) drugs by healthy people who are at particular risk of contracting tuberculosis in order to prevent their disease.

In what cases is chemoprophylaxis prescribed:

· Persons from contact with bacilli-releasing agents, including employees of tuberculosis institutions;

· Persons who have a tuberculin bend, samples;

· Persons with high sensitivity to tuberculin, with the so-called "hyperergic" reactions to tuberculin;

· Persons with inactive tuberculous changes, in whom, due to unfavorable conditions, an exacerbation of the process may occur (deterioration of working conditions, everyday life; nonspecific diseases that weaken the body; pregnancy, the postpartum period, etc.).

Chemoprophylaxis:

Chemoprophylaxis is carried out in foci with fresh non-massive bacillus excretion 2 times a year for 2-3 months for 1-2 years

In foci with unfavorable epidemiological conditions - 2 times a year for 2-3 months for 2-3 years. According to indications, chemoprophylaxis is carried out for children and adolescents from family contact with patients with active forms of tuberculosis (once a year for 2-3 months for 1-2 years).

After vaccination or revaccination, chemoprophylaxis is not immediately prescribed, since anti-tuberculosis drugs act on the BCG culture and can weaken the production of immunity. It should be carried out only after 2 months of isolation of the patient or vaccinated. In those cases where isolation is not possible, chemoprophylaxis is immediately prescribed instead of vaccination.

Drug for chemoprophylaxis:

The main drug for chemoprophylaxis is tubazide. Its dose for adults is 0.6 g, for children - 5-8 mg per kg of human weight. The entire daily dose is given at one time, in the absence or intolerance of tubazide, it is replaced with another drug.

When carrying out chemoprophylaxis, it is extremely important to take the drug regularly. The nurse makes sure that the patient takes tubazide in the presence of a healthcare professional or a specially trained sanitary activist. If the patient takes tubazid on his own, then the drug is given for a short period of time - 7-14 days. This will allow you to monitor the correctness of the course of treatment and timely detect side effects. In such cases, the doctor reduces the dosage or cancels the drug for a while.

Practical part

Stage I (preparation for transfusion).

• 1. Take blood from the patient's vein by gravity into a marked (name, blood group, Rh-factor, date), dry, clean test tube. Leave the test tube with blood for an hour at room temperature to settle the serum. If serum is urgently needed, the blood tube is centrifuged for 10 minutes. After settling, the tube must be carefully poured into another labeled, dry, clean tube. Tubes with erythrocytes and serum should be closed with a cotton-gauze stopper and stored in a refrigerator at a temperature of 4-6 degrees Celsius until transfusion, but no more than 48 hours.
• 2. Prepare the patient for transfusion: measure temperature, AD, pulse. Remind the patient to empty the bladder. If the transfusion is planned, warn the patient not to eat 2 hours before the transfusion.
• 3. The primary determination of the patient's blood group is carried out by the doctor in the treatment room. The nurse prepares everything needed and invites the patient. After determining the blood group, the nurse draws up the test tube and sends it to the Rh laboratory.
• 4. After receiving a response from the laboratory about the patient's blood group and Rh identity, the nurse hands it over to the doctor along with the medical history for transferring these data to the front of the medical history. The nurse glues the laboratory analysis form with the answer about the Rh-affiliation and the group into the medical history.
• 5. The nurse must personally make sure that the prescription for the transfusion is written in the doctor's prescription sheet, which medium is prescribed, in what dosage, and the method of administration. A nurse does not have the right to prescribe, receive and infuse drugs as prescribed by a doctor.
• 6. The nurse must ensure that the medical history contains blood and urine tests no more than three days old.
• 7. Correctly write out the requirement for the transfusion medium, indicating: the patient's full name, age, diagnosis, medical history number, drug name, quantity, blood group, Rh factor, checking these data again with the medical history. The request is signed by the attending physician, and during the duty hours - by the doctor who prescribed the transfusion.
• 8. Before going to the transfusion room for the transfusion medium, the nurse must:
• 1. Prepare a water bath;
• 2. Put the stand with standard sera and test tubes with patient's serum and erythrocytes out of the refrigerator;
• 3. Warn the attending physician or the doctor on duty that she went to receive the transfusion medium.
• 9. In the blood transfusion room, the nurse receives the required drug, writes down the passport data in the form No. 9 journal.
• 10. Upon receipt of the drug, the nurse is obliged to conduct its macroscopic assessment, make sure that the brand is correct, the package is intact, and the environment is sound.
• 11. Carefully, without shaking the medium, deliver it to the department and give it to the doctor performing the transfusion for secondary macroscopic assessment. On duty, the transfusion media in the transfusion department is received by the doctor who transfuses the transfusion medium!

• 1. Prepare everything you need to determine the blood group of the donor from the vial and the recipient, to carry out tests for compatibility by group and Rh factor (test tubes in a rack, dry, clean, marked, plates for determining blood groups marked 2 pcs., White porcelain plate with wetted surface, stand with standard sera, ampoule with liquefied gelatin, saline NaCl solution, glass rods, pipettes, hourglass for 5 and 10 minutes, microscope slides, microscope, kidney-shaped tray). Bring the recipient's medical history to the treatment room and invite a doctor, warn the patient.
• 2. While the doctor registers the passport data of the transfusion medium in the transfusion log and in the temperature log of the refrigerator, starts the transfusion card, and then determines the recipient's blood group, the nurse prepares a bag with the transfusion medium for transfusion. It processes the bag abduction with 70 degree alcohol twice, with different balls, opens the system for transfusing blood products, opens the bag abstraction, with careful screwing movements inserts the dropper needle into the bag abduction, without violating the integrity of the bag, refills the system with the obligatory thorough displacement of air bubbles from it (during transfusion of the drug from the "Gemakon" package, the air duct is not inserted into the package! The medium is transfused due to the compression of the package!
• 3. After priming the system, a drop of blood is dropped from the system onto the plate to determine the blood group of the donor and conduct tests for compatibility.
• 4. Measures AD and Ps of the patient.
• 5. Treats the patient's elbow with 70 degree alcohol and covers with a sterile napkin.
• 6. Inserts the intravenous needle for the forthcoming transfusion and carefully fixes it with adhesive tape. The doctor proceeds to conduct a biological test.

ІІІ Stage (actual transfusion).

• 1. The nurse is present near the patient when the doctor conducts 3 times the biological sample.
• 2. After the doctor has carried out a biological test, the rate of drug administration indicated by the doctor is established, and the nurse remains at the patient's bedside until the end of the transfusion, monitors the rate of administration and the patient's condition.
• 3. At the slightest change in the patient's condition, the nurse is obliged to invite the doctor performing the transfusion.
• 4. After the end of the transfusion (3-10 ml of the drug remains in the "Gemakon" for control), the nurse removes the needle from the vein, and a sterile bandage is placed over the vein puncture site.
• 5. The nurse measures AD in the patient, counts Ps, informs the doctor about the end of the transfusion and the measurement results. The patient is assigned to bed rest. He is warned not to eat for two hours after the end of the transfusion.
• 6. Mark the package with the control portion of the drug, indicating the name on the label. recipient, date and hour of the transfusion. The package is placed in a refrigerator at a temperature of 4-6 degrees Celsius for 48 hours.
• 7. If the transfusion was carried out in the operating room, all packages with control portions of the drug are labeled and transferred together with the remaining serum of the recipient to the department where the patient will stay after the operation. The package is placed in the refrigerator of the treatment room of this department for 48 hours.
• 8. After the end of the transfusion and the fulfillment of all the above duties, the nurse participating in the transfusion must put the workplace in order.

The patient is closely monitored, this is the responsibility of every ward nurse.

• 1. The nurse measures the temperature one hour within three hours after the transfusion and records this data in the transfusion protocol.
• 2. Monitors the patient's first urination after transfusion, makes a macroscopic assessment of urine and shows it to the doctor, after which it transfers it to the laboratory, making a note on the direction "after blood transfusion".
• 3. If the patient complains of headaches, back pain, changes in appearance, increased heart rate, fever, sweating, urticaria, the nurse should immediately inform the doctor, the head of the department or the doctor on duty and follow all the doctor's instructions after the examination the patient.
• 4. Monitors the patient's daily urine output, records the data on the drunk and discharged fluid in the transfusion protocol.
• 5. Writes blood and urine tests on the day after the transfusion in the application log.
• 6. Transfer the patient to the next nurse on duty. The ward and treatment nurses are required to report the transfusion and the patient's condition to the blood transfusion department.

Such constant observation: Ps, AD, temperature, general condition, diuresis, - is carried out during the day. All changes in the patient's condition during this time must be recorded by the doctor in the transfusion protocol.

Nurse manipulation after blood transfusion.

Finish the infusion, leaving 5-10 ml of blood in the vial, and store it in the refrigerator for 2 days in case of late complications and the need for blood tests. Then the label is soaked from the vial, dried and pasted into the medical history. At the end of blood transfusion, the patient remains in bed for 2 hours. The first portion of urine is shown to the doctor and sent for analysis. Diuresis and body temperature are measured.

Algorithm of actions of the district therapeutic nurse,
general practitioner at the reception

Target: performing nursing duties during the appointment of a general practitioner and general practitioner

Algorithm of actions:

1. Make an appointment 30 minutes before the appointment

2.Prepare the office before the doctor's appointment for work:

Quartz cabinet

Ventilate the room

Bring outpatient cards, analyzes

Bring disinfection solutions

Treat the work table, changing table, scales, height gauge with a disinfectant solution

Prepare spatulas, thermometers, tonometer

3.Prepare the office of the doctor of the general practitioner and the general practitioner

Treat the couch with a disinfectant solution

Prepare referral forms for diagnostic examinations

Prepare medical documentation for the appointment

4. Differentiate patients by health status: assess the condition of patients, refer to a doctor out of turn according to indications

5. Greet the patient, establish a relationship of trust

6. Register the patient in the outpatient register by order of the Ministry of Health of the Republic of Kazakhstan

7. Introduce and let the patient fill out a standard contract for the provision of medical services for adults and children in 2 copies, paste one copy into the patient's outpatient card, hand the second copy to the patient

8. Introduce and give the patient to fill out the informed voluntary consent of the patient to perform the medical service in 2 copies, paste one copy into the patient's outpatient card, hand the second copy to the patient

9. Verify the details of the patient's identity cards with the apartment card. If there is no registration at this address, explain the rules for attaching to the Polyclinic

10. Verify the identity card data with the apartment card

11. Verify the patient's data with the site passport. If there is no registration at this address, explain to the patient the rules for attaching to the Polyclinic

12. Immediately before examining the patient, wash your hands according to the hand washing technique, if necessary, put on a mask

13. Conduct an assessment of the general condition, determine the patient's well-being

Measure blood pressure, heart rate, respiratory rate

Conduct anthropometric research (height, weight)

14. Send the patient to the examination room, pre-doctor's office, for fluorographic examination

16. Set a date for re-examination

19. Issue referrals for diagnostic examinations and specialist consultations to the patient as prescribed by the doctor

20. Explain to the patient the rules of preparation for conducting diagnostic tests.

21. Fill in statistical coupons

22. Fill in the dispensary register when the patient is registered with the dispensary, the dispensary observation card form No. 030 / y

23. Explain to the patient how to properly follow the doctor's prescriptions

24. In a woman, examine the mammary glands, evaluate lactation

25. To acquaint the patient with the work schedule of the local therapist and general practitioner