Hygienic care for bedridden patients. Personal hygiene of patients and staff

Principles of care Ø Ø Ø 1. Safety (injury prevention) 2. Confidentiality (personal details should not be known to outsiders) 3. Respect for dignity (performing all procedures with the patient's consent. Providing privacy, if necessary) 4. Communication (patient disposition and his family members for a conversation, discussion of the course of the upcoming procedure and the care plan in general) 5. Independence (encouraging each patient to be independent) 6. Infectious safety (implementation of appropriate measures)

Personal hygiene is a broad concept that includes the implementation of rules that contribute to the preservation and strengthening of human health. The first priority is to keep the body clean.

For each patient, an individual regimen is prescribed by the attending physician. The individual regimen depends on the disease, its severity, condition and well-being of the patient. There are 5 types of individual patient regimen: 1. Strict bed rest - in this mode, the patient is strictly forbidden to move in bed and get out of it. Self-care is prohibited. All patient care (feeding, changing clothes, hygiene procedures, assistance in sending physiological needs) is carried out only with the help of caring personnel.

2. Bed rest - the patient is forbidden to get out of bed. It is allowed to turn on its side in bed, bend and unbend limbs, raise your head, sit in bed, and partially self-care. The caring staff provides feeding (serving food and drink), personal hygiene (feeding a bowl of water, a comb, a toothbrush, etc.), assistance in the administration of physiological needs (feeding a duck, a boat). When caring for surgical patients, this regimen is prescribed a few hours after the operation for 2-3 days.

3. Half-bed mode - the patient is prohibited from moving outside the room or ward. It is allowed to sit in bed and on a chair at the table for eating and performing hygiene procedures. It is allowed to use a sanitary chair for the administration of physiological needs. The rest of the time the patient should be in bed. When moving the patient, it is desirable to control his condition.

4. Ward mode - the patient is allowed to spend half of the wakefulness in a sitting position in a room or a ward outside the bed. For eating, self-care and hygiene procedures, the patient can independently move around the room or ward. 5. General regimen - the patient is not limited in movement around the apartment and outside of it or the hospital department or hospital territory.

Rules for changing linen The first way to change bed linen is to roll a clean sheet up to half in the transverse direction; -lift the upper half of the patient's body, remove the pillow; -Roll the dirty sheet from the side of the head of the bed to the lower back; - spread a clean sheet on the vacant part of the mattress; -Put the pillow, changing the pillowcase on it, lower the patient on it; - lifting the pelvis, and then the patient's legs, remove the dirty sheet, spreading a clean sheet in its place; -fill the edges of the sheet under the mattress; -to remove dirty linen; -Wash the hands.

The second way to change bed linen is to roll a clean sheet up to half in the longitudinal direction; -to remove the pillow; -turn the patient on his side, moving him to the edge of the bed (the assistant holds the patient so that he does not fall); - roll the free edge of the dirty sheet towards the patient; - spread a clean sheet on the vacant part of the mattress; -turn the patient onto his back, and then on the other side, onto a clean sheet (covering the bed and holding the patient back change roles); - remove the dirty sheet and spread a clean sheet in its place; -fill the edges of the sheet under the mattress; - put a pillow under your head, changing the pillowcase on it; - it is convenient to put the patient on the bed, cover with a blanket, having previously changed the duvet cover; -to remove dirty linen; -Wash the hands.

Change of underwear to raise the upper half of the patient's body; - carefully roll up the dirty shirt to the back of the head; - raise both hands of the patient and transfer the shirt rolled up at the neck over the patient's head; - take off the sleeves. If the patient's arm is injured, then first remove the shirt from the healthy hand, and then from the patient. Dress the patient in reverse order: first, you need to put on the sleeves (first on the sore arm, then on the healthy one, if one arm is damaged), then throw the shirt over your head and straighten it under the patient's body. -

Hair Care Hair should be brushed daily, and once a week, check for head lice and wash your hair. Equipment: basin, oilcloth, gloves, roller, shampoo (or soap), towel, jug, comb. Procedure: 1. Wash your hands, put on gloves. 2. Place the basin at the head end of the bed. 3. Place a roller under the patient's shoulders and an oilcloth on top. 4. Lift the patient's head slightly and tilt it back slightly. 5. Pour warm water from a jug on top of your hair, lather your hair and wash gently. 6. Then rinse your hair, towel dry and comb through. 7. Remove gloves, wash your hands. Note: special headrests can be used to wash the head of a seriously ill patient in bed.

Delivery of the vessel to the patient Equipment: vessel, oilcloth, screen, gloves. Procedure: 1. Put on gloves. 2. Divide the patient with a screen. 3. Rinse the vessel with warm water, leaving some water in it. 4. Move your left hand under the sacrum from the side, helping the patient to raise the pelvis. In this case, the patient's legs should be bent at the knees. 5. Place an oilcloth under the patient's pelvis. 6. With your right hand, move the boat under the patient's buttocks so that the perineum is over the opening of the boat. 7. Cover the patient with a blanket and leave him alone for a while. 8. At the end of defecation with the right hand, remove the vessel, while helping the patient to raise the pelvis with the left hand.

9. After examining the contents of the vessel, pour it into the toilet, rinse the vessel hot water... In the presence of pathological impurities (mucus, blood, etc.), leave the contents of the vessel until examined by a doctor. 10. Wash the patient by changing gloves and substituting a clean vessel. 11. After completing the manipulation, remove the boat and oilcloth. 12. Disinfect the vessel. 13. Cover the boat with oilcloth and place it on a bench under the patient's bed, or place it in the retractable device of the functional bed. 14. Remove the screen. 15. Remove gloves, wash your hands. Sometimes the above method of transporting the boat cannot be used, as some seriously ill patients cannot be lifted. In this situation, you can proceed as follows.

Procedure: 1. Put on gloves. 2. Divide the patient with a screen. 3. Turn the patient slightly to one side with the patient's legs bent at the knees. 4. Move the boat under the patient's buttocks. 5. Rotate the patient onto their back so that their perineum is over the opening of the vessel. 6. Cover the patient and leave him alone for a while. 7. At the end of the bowel movement, turn the patient slightly to one side. 8. Remove the ship. 9. After examining the contents of the vessel, drink it down the toilet. Rinse the vessel with hot water. 10. After changing gloves and holding a clean vessel, wash the patient. 11. After completing the manipulation, remove the boat and oilcloth. 12. Disinfect the boat.

13. Remove the screen. 14. Remove gloves, wash your hands. In addition to the enameled vessel, rubber is also widely used. A rubber vessel is used for debilitated patients, in the presence of pressure sores, with urinary and fecal incontinence. Do not inflate the vessel tightly, as it will exert significant pressure on the sacrum. The inflatable cushion of the rubber vessel (that is, the part of the vessel that will come into contact with the patient) must be covered with a diaper. A urine collection bag is also given to men at the same time as the vessel.

Using the bag for emptying Bladder urine bags are given to patients. Urine bags for men and women differ in the design of the funnel. The male urinal has a tube directed upwards, the female at the end of the tube has a funnel with bent edges, located more horizontally. But women often use the vessel when urinating. Before giving the urine bag to the patient, rinse it with warm water. The contents of the bag are poured out and rinsed with warm water. To remove the pungent ammonia odor of urine, the urine bags are rinsed weak solution hydrochloric acid or potassium permanganate. For urinary incontinence, permanent rubber urine receptacles are used, which are attached with straps to the patient's body. After use, urine bags must be disinfected.

Not all patients are free to urinate or empty their bowels in bed. To help the patient, it is necessary to: Ask everyone who is able to leave the room, leaving the patient alone for a while. Separate the patient with a screen. Give the patient only a warm vessel and urine bag. Give the patient, if there are no contraindications, a more comfortable position for urination and defecation using a functional bed or other devices (sitting or semi-sitting). You can turn on the water tap to allow urination. The sound of pouring water reflexively triggers urination.

Care of the external genitals and perineum Severely ill patients should be washed after each act of defecation and urination, as well as several times a day for urinary and fecal incontinence. Equipment: gloves, oilcloth, screen, boat, forceps, cotton swabs, gauze napkins, Esmarch jug or mug, tray, water thermometer, antiseptic solutions (furacilin solution 1: 5000, slightly pink solution of potassium permanganate). Procedure 1. Wash your hands, put on gloves, and shield the patient with a screen. 2. Place the patient on his back with his legs bent at the knees and apart. 3. Place an oilcloth under the patient and place the boat. 4. Take the forceps with a napkin or cotton swab in your right hand, and in left hand a jug with a warm solution of an antiseptic (a slightly pink solution of potassium permanganate or a solution of furacilin 1: 5000) or water at t З 0 -35 ° С.

Instead of a jug, you can use an Esmarch mug with a rubber tube, clip and tip. 6. Water the solution onto the genitals, and with a napkin (or swab) move from top to bottom (from the genitals to anus), changing tampons as they become dirty. The sequence of washing the patient: - first wash the genitals (labia in women, penis and scrotum in men); -then the groin folds; - lastly, wash the perineum and anus area. 7. Dry in the same sequence: with a dry swab or tissue. 8. Remove the boat, oilcloth and screen. 9. Take off your gloves, wash your hands.

If it is impossible to wash the patient in the way described above due to the severity of his condition (it is impossible to turn, raise to substitute the vessel), you can proceed as follows. Using a mitten dipped in warm water or an antiseptic solution, wipe the patient's genitals (labia, around the genital slit - in women, the penis and scrotum - in men), groin folds and perineum. Then dry it. In patients with urinary and fecal incontinence, after washing, the skin in the groin area is lubricated with fat (petroleum jelly or sunflower oil, baby cream and so on). You can powder your skin with talcum powder. REMEMBER! When caring for the external genitals and perineum Special attention it is necessary to pay attention to natural folds. Women are only washed from top to bottom!

Caring for Skin and Natural Creases The skin needs to be clean to function properly. Contamination of the skin with the secretion of the sebaceous and sweat glands, dust and microbes that settle on the skin can lead to the appearance of a pustular rash, peeling, diaper rash, ulceration, bedsores. Washing the patient Patients who are on bed rest, the nurse assists with the morning toilet. Equipment: oilcloth, basin, jug, soap, towel, warm water. Algorithm of action: Place the basin on a chair next to the bed. Turn the patient on their side or sit on the edge of the bed if there are no contraindications. Place an oilcloth on the edge of the bed or on the patient's knees (if he is sitting) Give the patient soap in their hands.

Pour warm water over the basin from a jug onto the patient's hands until they are cleaned. Give the patient a towel. Remove the basin, oilcloth, towel. Place the patient comfortably in bed. Some patients cannot wash even with someone else's help. In this case, the nurse will wash the patient herself. Equipment: basin, mitten or sponge, towel, gloves, warm water. Algorithm of action: Wash your hands, put on gloves. Soak a mitten or sponge in warm water poured into a basin (you can use the end of a towel). Wash the patient (sequentially - face, neck, hands with a sponge or mitten). Dry your skin with a towel. Take off your gloves, wash your hands.

CONDUCTING A HYGIENIC SHOWER INDICATIONS: skin contamination, head lice. CONTRAINDICATIONS: serious condition of the patient. EQUIPMENT: bench or bath seat, brush, soap, washcloth, gloves, bath treatment products. PERFORMANCE OF MANIPULATION: - put on gloves; -wash the bath with a brush and soap, rinse with 0.5% bleach solution or 2% chloramine solution, rinse the bath with hot water (you can use cleaning and disinfecting household products); -Put a bench in the bath and seat the patient; - wash the patient with a washcloth: first the head, then the torso, upper and lower limbs, groin and perineum; -Help the patient to dry off with a towel and get dressed; - take off gloves; - escort the patient to the ward.

CONDUCTING A HYGIENE BATH. EQUIPMENT: brush, soap, washcloth, gloves, bath products, footrest. PERFORMANCE OF MANIPULATION: - put on gloves; - wash the bathtub with a brush and soap, rinse with 0.5% bleach solution or 2% chloramine solution, rinse the bathtub with hot water (you can use household cleaning and disinfecting products); -fill the bath warm water(water t 35 -37); -help the patient to take a comfortable position in the bathroom; - wash the patient with a washcloth: first the head, then the torso, upper and lower extremities, groin and perineum; -Help the patient to get out of the bath, dry off with a towel and get dressed; - take off gloves; - escort the patient to the ward. The duration of the bath is no more than 25 minutes.

Skin rubbing Patients who are on a general regimen, if there are no contraindications, take a bath or shower at least 1 time 7-10 days. The skin of a seriously ill patient must be wiped at least 2 times daily. Equipment: gloves, a basin of warm water, a mitt or cotton swab, a towel. Algorithm of action: Wash your hands, put on gloves. Soak a mitten or cotton ball (you can use the end of a towel) in warm water. Wipe the patient's chest and abdomen in sequence. Then pat dry with a towel. Especially carefully wipe and dry the folds of skin under the mammary glands in women (especially in obese women), armpits. Turn the patient onto their side and wipe their back while doing light massage... Then dry it. Lay the patient down comfortably, cover with a blanket. Take off your gloves, wash your hands.

Washing the feet Feet of a seriously ill patient is washed once a week. Equipment: gloves, oilcloth, basin, jug of warm water, towel. Algorithm of action: Wash your hands, put on gloves. Place an oilcloth on the foot end of the bed. Place a basin on the oilcloth. Place the patient's legs in the pelvis (with the legs slightly bent at the knees). Pour warm water from a jug onto your feet, wash them (you can first pour water into a basin). Remove the basin. Dry the patient's feet with a towel, especially between the toes. Remove the oilcloth. Cover the patient's legs with a blanket. Take off your gloves, wash your hands.

Nail trimming Seriously ill patients need to trim their fingernails and toenails regularly, but at least once a week. The nails should be trimmed so that the free edge is rounded (on the hands) or straight (on the legs). Do not cut your nails too short, as the fingertips will be overly sensitive to pressure. Equipment: scissors, nippers, nail file, towel, oilcloth, bowl with hot soapy water. Algorithm of action: Place the oilcloth under the patient's arm or leg (depending on where you will cut your nails). Place a bowl of hot soapy water on the oilcloth. Dip your fingers in hot soapy water for 10-15 minutes to soften the nails. Then wipe your fingers alternately with a towel and shorten the nails to the required length using scissors or nippers.

Using a file, give the free edge of the nails the desired shape (straight - on the legs, rounded - on the hands). You should not file the nails deeply from the sides, as you can injure the skin of the lateral ridges and thereby cause cracks and increased keratinization of the skin. Repeat the same steps with the other limb. ATTENTION! Places of accidental cuts must be treated with a 3% solution of hydrogen peroxide or iodine.

Shaving face Equipment: shaving machine, soap suds or shaving cream, napkin, container (tray) with water, towel, gloves. Algorithm of action: Wash your hands, put on gloves. Soak a tissue in hot water and wring it out. Place the tissue on the patient's face for 5-7 minutes. Apply lather or shaving cream to your face. Pulling the skin in the opposite direction to the movement of the machine, gently shave the patient. Wipe the patient's face with a damp cloth. Dry your face with a towel. Take off your gloves, wash your hands.

Removing mucus and crusts from the nasal cavity Most patients take care of the nasal cavity on their own during the morning toilet. Severely ill patients who are not able to independently monitor the hygiene of the nose, it is necessary to free the nasal passages daily from secretions and formed crusts that interfere with free breathing through the nose. Equipment: gloves, 2 trays, cotton turunds, Vaseline oil(or vegetable oil, or glycerin). Algorithm of action: Wash your hands, put on gloves. While lying or sitting (depending on the patient's condition), slightly tilt the patient's head. Dampen cotton swabs with Vaseline or vegetable oil, or glycerin. Insert the turunda into the nasal passage with a rotational movement and leave it there for 2-3 minutes. Then remove the turunda and repeat the manipulation. Take off your gloves and wash your hands. Note: you can first drip one of the listed oils into the nose, and then clean the nasal passages with cotton turunds. Mucus from the nasal cavity can also be removed with dry cotton swabs.

Rubbing the Eyes If you get eye discharge, eyelashes and eyelids sticking together, you should rinse your eyes during the morning toilet. Equipment: sterile gloves, 2 trays (one sterile), sterile cotton balls, antiseptic solution (furacilin solution 1: 5000, 2% soda solution, 0.5% potassium permanganate solution), tweezers. Algorithm of actions: Wash your hands thoroughly, put on sterile gloves. Put 8-10 sterile balls in a sterile tray and moisten them with an antiseptic solution (furacilin 1: 5000, 2% soda solution, 0.5% potassium permanganate solution) or boiled water. Squeeze the tampon lightly and rub the eyelashes with it from the outer corner of the eye to the inner corner. Repeat rubbing 4-5 times (with different tampons!). Blot the rest of the solution with dry swabs. Take off your gloves, wash your hands.

Cleansing the external auditory canal Equipment: gloves, 3% hydrogen peroxide solution, pipette, cotton swabs, 2 trays. Algorithm of action: Wash your hands, put on gloves. Sit down the patient, if there are no contraindications, tilt your head to the opposite shoulder or turn your head to one side in a prone position. Pulling back auricle back and up, put a few drops of warm 3% hydrogen peroxide solution into the patient's ear. Insert the cotton ball into the ear canal with rotational movements. The ear is also pulled back and up. After changing the turunda, repeat the manipulation several times. Repeat the same steps with the other external auditory canal. Take off your gloves, wash your hands. REMEMBER! Do not use hard objects to remove wax from the ears to avoid damage to the eardrum.

Oral cavity care Name Handling equipment Rinsing Towel, 1.Oral oilcloth, 2.cavity glass, 3.tray, solutions of 4. antiseptics (furacilin 1: 5000, 2% 5.solution 6.soda, 0.5% solution 7 potassium permanganate) gloves. Procedure Wash your hands, put on gloves. Sit down the patient. Place a towel or oilcloth on the patient's chest and neck. Give the patient a glass of antiseptic solution or warm boiled water in his hand. Substitute your chin tray. Ask the patient to rinse the mouth. Take off your gloves, wash your hands.

Processing 2 spatulas, 1. Wash your hands, put on gloves. mucous membrane sterile 2. On the patient's chest and neck, put a towel or oral cotton balls, oilcloth. cavity and clamp or 3. Ask the patient to open his mouth and lips wide with forceps, two stick out the tongue. tray, solutions 4. A sterile cotton ball on a sterile antiseptic clamp or in tweezers moistened with a solution (antiseptic solution, carefully remove the plaque from the tongue, while changing the furacilin balls. 1: 5000, 2% 5. Sterile cotton balls moistened with soda solution, antiseptic solution, thoroughly wipe the teeth with a 0.5% solution of the inner and outer sides, using a potassium spatula for exposing teeth to permanganate), 6. After the end of the procedure, offer the patient gloves, rinse the mouth. oilcloth, 7. Dry the skin around the mouth with a towel. towel, 8. Apply petroleum jelly on a sterile napkin with a spatula, sterile petroleum jelly (you can use baby cream). 9. Treat the patient's lips with petroleum jelly (or napkins. cream). 10. Remove gloves, wash your hands.

Teeth cleaning Tooth 1.brush, 2.toothpaste, 3. towel, oilcloth, 4. a glass of boiled 5. water, tray, gloves, 6. spatula 7. Wash your hands, put on gloves. Sit down the patient. Place a towel or oilcloth on the patient's chest and neck. Ask the patient to rinse the mouth once. Apply a small amount of toothpaste to your toothbrush. Ask the patient to open their mouth wide. Using a spatula to expose the teeth, brush the outer surface of the teeth in sequence, making sweeping movements (from top to bottom), then the chewing and inner surfaces of the teeth (also clean the inner surface with sweeping movements from top to bottom). 8. Ask the patient to rinse the mouth thoroughly with water. 9. Dry the skin around your mouth with a towel. 10. If necessary, apply petroleum jelly or cream to the patient's lips. 11. Remove gloves, wash your hands.

If a patient on bed rest can brush their teeth themselves, help him with this. Provide him with everything he needs and make him comfortable in bed. REMEMBER! Rinsing the mouth should be done after each meal, teeth should be brushed at least 2 times a day (morning and evening). Treatment of the oral mucosa and teeth for seriously ill patients is also carried out 2 times a day. If there is a lack of personal hygiene, the nurse needs to: Explain the need for personal hygiene measures in a hospital setting. Assess the ability to self-care. Help in carrying out the morning and evening toilet, shaving in the morning. Partial sanitization daily. Ensure that hands can be washed before eating and after using the toilet. Help with washing (at least once a day). Provide washing of hair and feet once a week. Provide oral care, mouthwash after each meal. Provide nail clipping once a week. Provide care for the natural folds of the skin daily. Provide a change of linen as it gets dirty.

ATTENTION! Teach the patient to take care of themselves as much as possible. Develop the patient's self-help skills, encourage independent action. Personal contact with the patient, careful observation and listening to the patient will help you the best way organize the care of each patient. Severely ill patients can also be at home. Therefore, it is necessary to teach relatives the elements of proper skin care and natural folds, mucous membranes, measures to prevent pressure ulcers.

LEARNING OBJECTIVES

Students should KNOW:

Pressure ulcer risk factors

Places of possible formation of pressure ulcers

Stages of bedsore formation

Rules for assembling and transporting dirty laundry

Give the patient the desired position in bed using a functional bed and other devices

Prepare a bed for the patient;

Change underwear and. linens

Determine the risk of pressure ulcers in each patient £

Take measures to prevent pressure ulcers

Treat skin if bedsores are present

Train the relatives of a seriously ill patient on the elements of prevention of pressure ulcers at home

Treat natural skin folds to prevent diaper rash

Assist the patient with the morning toilet

Wash the patient

Remove nasal secretions and crusts

Wipe your eyes

Treat the mucous membrane of the mouth and lips

Cleanse the ear canal

Brush the patient's teeth

Cut your fingernails and toenails

Shave the patient's face

Submit the vessel and urine bag (man and woman)

Wash the patient's head and legs

Wipe off the skin with a gentle back massage

Take care of the external genitals and perineum

Educate patient and family in home care for natural folds and mucous membranes.

QUESTIONS FOR SELF-TRAINING

1. Features of caring for a seriously ill patient.

2. Positions that the patient can take in bed.

3. The main purpose of a functional bed.

4. Positions in which the patient can be seated, put in bed using a functional bed and other devices.

5. Requirements for bed linen

6. Preparing the bed for a seriously ill patient.

7. Methods for changing underwear and bed linen for a seriously ill patient.

8. Basic rules for collecting and transporting dirty laundry.

9. Hair care.

10. Submission of the vessel and urine collection bag to the patient (man and woman).

11. Technique of washing the patient (men and women).

12. Diaper rash, causes of formation, localization, prevention of diaper rash. "

13. Morning toilet of a seriously ill patient in bed.

14. Rubbing the skin of a seriously ill patient.

15. Washing the patient's feet in bed.

16. Trimming nails on hands and feet.

17. Shaving the patient's face.

18. Bedsores. Risk factors for the development of pressure ulcers, localization.

19. Determination of the risk of bedsores.

20. Measures for the prevention of pressure ulcers.

21. Tactics of a nurse in the development of pressure sores.

22. Removal of mucus and crusts from the nasal cavity.

23. Rubbing the eyes of a seriously ill patient.

24. Cleansing the external auditory canal.

25. Care of the oral cavity.

ETHICAL AND DEONTOLOGICAL SUPPORT

Severely ill patients cannot carry out personal hygiene measures in full. They are embarrassed to ask the nurse for help, as they believe that it takes a lot of her time. And some patients think that the nurse does not have to do this.

A nurse should, without additional reminders, carry out personal hygiene measures for a seriously ill patient in bed, since this is her direct responsibility. She must

convince the patient to accept her help. After all, for good care, you need not only knowledge and skills, but also sensitivity, tact, ability psychological impact, the ability to overcome the patient's increased irritability. A restrained, even and calm attitude towards the patient helps to gain his trust and obtain consent to perform certain personal hygiene manipulations. For this, it is equally important to inform the patient in advance of the goal and the course of their implementation.

Since patients are often embarrassed when carrying out intimate manipulations (washing the patient, feeding the vessel, urine collection bag), the nurse should:

Tactfully convince the patient that there is no reason for embarrassment,

Shield the patient with a screen,

Ask other patients to leave the room if their condition allows them,

After the vessel and urine collection bag have been supplied, leave the patient alone for a while.

SAFETY RULES

ATTENTION!

Remember the safety rules for contact with the mucous membranes and secretions of the patient in order to prevent AIDS (see the topic "AIDS and how to prevent it").

THEORETICAL PART Patient position in bed

The main location of the patient in the hospital is the bed. Depending on the general condition, the patient takes one or another position in bed.

1. Active position - patients can independently turn in bed, sit down, get up, move around, take care of themselves.

2. Passive position - patients are inactive, cannot turn around on their own, raise their head, arm, change body position.

Most often these are unconscious patients or neurological patients with motor paralysis.

3. The patient takes a forced position to alleviate his condition. For example, with an attack of suffocation, the patient takes the orthopnea position - sits with his legs lowered down, with a howling pleura (pleurisy) and the presence of pain - lies on the sore side, and so on.

The position of the patient in bed can, to a certain extent, characterize the condition of the patient.

Depending on the disease, the patient may need to be given a certain position in the bed (on the back, on the stomach, on the side), taking into account the biomechanics of the body, using a functional bed, pillows, bolsters, headrests or other special devices. This is especially necessary for patients who are in passive and forced positions for a long time.

For details on the positions that can be given to the patient in bed, see the module "Biomechanics of the body".

Bed linen requirements

Preparing the patient's bed

Due to the fact that the patient is in bed most of the time, it is important that she is comfortable and tidy. The bed net is well stretched, with a flat surface. A mattress without bumps and depressions is placed on top of the net.

For patients suffering from urinary and fecal incontinence, an oilcloth is placed on the mattress across the entire width (under the patient's pelvis) and its edges are well folded to prevent contamination of the bed.

For convenience, you can sheathe the mattress with oilcloth. Now the mattresses are produced, placed in an oilcloth cover. They are easy, disinfected and convenient to use for critically ill patients. A clean sheet is placed on top of the mattress. The edges of the sheet are tucked under the mattress so that it does not roll and fold.

A seriously ill patient can be put on a sheet of oilcloth (if it is not on the mattress), covering it with a diaper or another sheet folded in half. A pillow in a pillowcase (one or two) is placed at the head end. The patient is given a blanket with a duvet cover, preferably a flannel or wool (depending on the season).

Sheets and pillowcases on the beds of critically ill patients should not have seams, scars, fasteners on the side facing the patient.

Bed linen should always be dry and clean. This is one of the conditions for preventing pressure ulcers.

The device and the main purpose of a functional bed

The nurse must constantly monitor that the patient's position is functional (improves the function of an organ or system) and comfortable.

For this purpose, it is best to use a functional bed, consisting of three movable sections. With the help of the handles located at the foot end of the bed or on the side, you can raise the head end (up to a sitting position), raise the foot end, you can bend your knees. The elevated position of the head end can also be created with a headrest or multiple pillows. You can create an elevated position of the leg end using a pillow or roller placed under the lower leg.

There are now very modern beds that are easy to move around, with specially fitted bedside tables, drip stands, storage nests for bed vessels and urine bags.

REMEMBER!

The main purpose of a functional bed is the ability to give the patient the most comfortable and functional position, depending on his disease and condition.

REMEMBER!

Before proceeding with any personal hygiene manipulation:

1. Prepare the required equipment.

2. Communicate the goal and progress to the patient.

3. Obtain the patient's consent to perform the manipulation.

4. Ask if the patient wants to be fenced off with a screen.

5. In the course of performing the manipulation, monitor the patient's condition.

6. Ask the patient about his state of health at the end of the manipulation.

7. If the patient's condition worsens, stop performing the manipulation. Call a doctor urgently! Provide first aid to the patient prior to the arrival of the doctor.

Change of linen in a seriously ill patient

Equipment: clean linen, waterproof (preferably oilcloth) bag for dirty linen, gloves. 1

Change of underwear

Algorithm of action

2. Lift the patient's upper body.

Gently roll the dirty shirt up to the back of your head.

4. Raise both arms of the patient and slide the shirt rolled up at the neck over the patient's head.

5. Then remove the sleeves. If the patient's arm is injured, then first remove the shirt from the healthy arm, and then from the sick one.

6. Place the dirty shirt in an oilcloth bag.

7. Dress the patient in reverse order: first put on the sleeves (first on the sore arm, then on the healthy arm, if one arm is injured), then throw the shirt over your head and straighten it under the patient's body.

REMEMBER!

A patient's linen is changed at least once every 7-10 days, and for a seriously ill patient - as it gets dirty. To change the linen of a seriously ill patient, it is necessary to invite 1-2 assistants.

Change of bed linen

Bed linen for a seriously ill patient can be changed in two ways. Method I - used if the patient is allowed to turn in bed.

Algorithm of action:

1. Wash your hands and put on gloves.

2. Roll a clean sheet halfway down.

3. Unfold the patient, lift their head and remove the pillow.

4. Move the patient to the edge of the bed and gently turn him onto his side.

5. Roll the dirty sheet along its entire length towards the patient.

6. Spread a clean sheet on the vacant part of the bed.

7. Gently turn the patient onto their back and then onto the other side so that they are on a clean sheet.

8. From the loose part, remove the dirty sheet $ d and put it in an oilcloth bag. I

9. Spread a clean sheet on the vacant part, the edges of which are tucked under the mattress.

10. Place the patient on his back.

11. Place a pillow under your head, changing the pillowcase on it if necessary.

12. If dirty, change the duvet cover, cover the patient.

13. Remove gloves, wash your hands.

Method II - used in cases where the patient is prohibited from active movements in bed.

Algorithm of action:

1. Wash your hands and put on gloves.

2. Roll a clean sheet completely laterally.

3. Unfold the patient, gently lift the patient's upper body, remove the pillow.

4. Quickly roll the dirty sheet from the head of the bed to the lower back, and spread a clean sheet over the vacant part.

5. Place a pillow on a clean sheet and lower the patient onto it.

6. Lift the pelvis, and then the patient's legs, move the dirty sheet, continuing to straighten the clean sheet in the vacant place. Lower the patient's pelvis and legs, tuck the edges of the sheet under the mattress.

7. Place the dirty sheet in an oilcloth bag.

8. Cover the patient.

Rules for collecting and transporting dirty laundry

The department should have a supply of clean linen for a day. Under no circumstances should wet linen be dried on central heating radiators and given back to the patient, as well as soiled linen should not be thrown onto the floor when rewiring.

Dirty wet linen is collected in waterproof bags and immediately taken out of the ward to the sanitary room (or other separate room). As dirty linen accumulates, but at least once a day, it is sorted and delivered to the laundry. This is usually done by the hostess in the department. G-

G; " Hair care

Hair should be combed daily, and once a week it is imperative to check for head lice and wash your hair.

Equipment: basin, oilcloth, gloves, roller, shampoo (or soap), towel, jug, comb.

Algorithm of action:

1. Wash your hands and put on gloves.

2. Place the basin at the head end of the bed.

3. Place a roller under the patient's shoulders and an oilcloth on top.

4. Lift the patient's head slightly and tilt it back slightly.

5. Pour warm water from a jug on top of your hair, lather your hair and wash gently.

6. Then rinse your hair, towel dry and comb through.

Note: special headrests can be used to wash the head of a seriously ill patient in bed.

Delivery of the boat to the patient

Equipment: ship, oilcloth, screen, gloves.

Algorithm of action:

1. Put on gloves.

3. Rinse the boat with warm water, leaving some water in it.

4. Move your left hand under the sacrum from the side, helping the patient to raise the pelvis. In this case, the patient's legs should be bent at the knees.

5. Place an oilcloth under the patient's pelvis.

6. With your right hand, move the boat under the patient's buttocks so that the perineum is over the opening of the boat.

7. Cover the patient with a blanket and leave him alone for a while.

8. At the end of defecation with the right hand, remove the vessel, while helping the patient to raise the pelvis with the left hand.

9. After examining the contents of the vessel, pour it into the toilet, rinse the vessel with hot water. In the presence of pathological impurities (mucus, blood, etc.), leave the contents of the vessel until examined by a doctor.

10. Wash the patient by changing gloves and substituting a clean vessel.

11. After completing the manipulation, remove the boat and oilcloth.

12. Disinfect the vessel.

13. Cover the boat with oilcloth and place it on a bench under the patient's bed, or place it in the retractable device of the functional bed.

14. Remove the screen.

15. Remove gloves, wash your hands.

Sometimes the above method of transporting the boat cannot be used, as some seriously ill patients cannot be lifted. In this situation, you can proceed as follows.

Algorithm of action:

1. Put on gloves.

2. Divide the patient with a screen.

3. Turn the patient slightly to one side with the patient's legs bent at the knees.

4. Move the boat under the patient's buttocks.

5. Rotate the patient onto their back so that their perineum is over the opening of the vessel.

6. Cover the patient and leave him alone for a while.

At the end of the bowel movement, turn the patient slightly to one side.

8. Remove the ship. .,

9. After examining the contents of the vessel, pour it into the toilet. Rinse the vessel with hot water.

Y. After changing gloves and substituting a clean vessel, wash the patient.

11. After completing the manipulation, remove the boat and oilcloth. 12. Disinfect the boat. 13. Take the screen. 14. Take off your gloves, wash your hands.

In addition to the enameled vessel, rubber is also widely used. A rubber vessel is used for debilitated patients, in the presence of pressure sores, with urinary and fecal incontinence. Do not inflate the vessel tightly, as it will exert significant pressure on the sacrum.

The inflatable cushion of the rubber vessel (that is, the part of the vessel that will come into contact with the patient) must be covered with a diaper. Men are served with a urine bag at the same time as the vessel,

Using a urine bag

To empty the bladder, patients are given urine bags. Urine bags for men and women differ in the design of the funnel. The male urinal has a tube directed upwards, the female at the end of the tube has a funnel with bent edges, located more horizontally. But women often use the vessel when urinating.

Before giving the urine bag to the patient, rinse it with warm water. The contents of the bag are poured out and rinsed with warm water.

To remove the pungent ammonia odor of urine, urinals are rinsed with a weak solution of hydrochloric acid or potassium permanganate.

In case of urinary incontinence, permanent rubber urinals are used, which are attached with ribbons to the patient's body. After use, urine bags must be disinfected.

REMEMBER!

Patients who are on bed, strict bed and ward rest are allocated individual vessels and urinals.

Not all patients are free to urinate or empty their bowels in bed. To help the patient, you must:

1. Ask everyone who is able to leave the ward, leaving the patient alone for a while.

2. Separate the patient with a screen.

3. Give the patient only a warm vessel and urine bag.

4. Give the patient, if there are no contraindications, a more comfortable position for urination and defecation using a functional bed or other devices (sitting or semi-sitting).

5. To facilitate urination, you can open the tap with water. The sound of pouring water reflexively triggers urination.

External Genital Care

and crotch

Severely ill patients should be washed after each act of defecation and urination, as well as several times a day for urinary and fecal incontinence. 1

Equipment: gloves, oilcloth, screen, boat, forceps, cotton swabs, gauze napkins, Esmarch jug or mug, tray, water thermometer, antiseptic solutions (furacilin solution 1: 5000, low-borne potassium permanganate).

Algorithm of action

1. Wash your hands and put on gloves.

2. Divide the patient with a screen.

3. Place the patient on his back with his legs bent at the knees and apart.

4. Place an oilcloth under the patient and place the boat.

5. Take in your right hand a forceps with a napkin or cotton swab, and in your left hand a jug with a warm antiseptic solution (weakly borne potassium permanganate solution or furatsilin solution 1: 5000) or water at a temperature of 30-35 ° C. Instead of a jug, you can use an Esmarch mug with a rubber tube, clip and tip.

6. Water the solution on the genitals, and with a napkin (or tampon) move from top to bottom (from the genitals to the anus), changing tampons as they become dirty.

The sequence of washing the patient: - first, the genitals are washed (labia in women, penis and scrotum in men);

Then the groin folds;

Last but not least, the area of the perineum and anus is washed away.

7. Dry in the same sequence: with a dry swab or tissue.

8. Remove the boat, oilcloth and screen.

9. Take off your gloves, wash your hands.

In patients with urinary and fecal incontinence, after washing, the skin in the groin area is lubricated with fat (petroleum jelly or sunflower oil, baby cream, and so on). You can powder your skin with talcum powder.

REMEMBER!

When caring for the external genitals and perineum, special attention should be paid to natural folds. Women are only washed from top to bottom!

Skin care and natural folds

The skin must be clean to function properly. Contamination of the skin with the secretion of the sebaceous and sweat glands, dust and microbes that settle on the skin can lead to the appearance of a pustular rash, peeling, diaper rash, ulceration, bedsores.

Intertrigo- inflammation of the skin in the folds, which occurs when rubbing wet surfaces. They develop under the mammary glands, in the intergluteal fold, armpits, between the toes at excessive sweating, in the groin folds. Their appearance is facilitated by excess sebum secretion, urinary incontinence, discharge from the genitals. More often occur in the hot season in obese people, in infants with improper care. With diaper rash, the skin turns red, its stratum corneum, as it were, is soaked and torn away, weeping areas with uneven contours appear, deep in the skin fold may form tre-

shins. Often, diaper rash is complicated by a pustular infection. To prevent the development of diaper rash, you need regular hygienic skin care, sweating treatment.

If you have a predisposition to diaper rash, after washing and thoroughly drying, it is recommended to wipe the skin folds with boiled vegetable oil (or baby cream) and dust with talcum powder.

Bedsores

Pressure ulcers are dystrophic, ulcerative-necrotic changes in the skin, subcutaneous tissue and other soft tissues that develop as a result of their prolonged compression, shear or friction due to local circulatory disorders and nervous trophism.

Pressure ulcers are formed most often in weakened and emaciated critically ill patients who are forced to stay in one position for a long time, with improper care after them. The skin suffers greatly from the patient's long stay in bed, especially when he has a large body weight. Additional problems arise in older people, as their skin is thinner and more vulnerable.

All of the above factors increase the risk of pressure ulcers. The risk of pressure ulcers is high in some diseases, in which tissue trophism is disturbed, sensitivity decreases, there are no movements in the paralyzed part of the body, metabolism is disturbed (diseases of the cardiovascular system, nervous system, disturbances in the activity of the endocrine glands).

Risk factors for the development of pressure ulcers can be:

1. Compression of soft tissues during a long stay of the patient in one position, if he is not turned over in a timely manner. When compressed, the diameter of the vessels decreases, resulting in tissue starvation. With complete starvation of tissues, necrosis occurs for a short time.

2. Contaminated patient's skin when inadequate hygiene... Patients may scratch their skin as they experience itching, thereby traumatizing it.

Damaged skin and soft tissues are much more at risk of pressure ulcers than healthy ones. If the patient has dry skin, it can flake and crack, which can lead to infection. Too moist skin has less resistance to damage. It loosens, becomes soft and easily injured when scratched. Its from-

worn to patients with urinary and fecal incontinence, to patients with excessive sweating.

3. Untidy maintenance of the patient's bed and underwear, for example, the use of an uneven shield when treating a patient with a spinal injury, an uneven mattress with folded sheets, underwear with coarse seams and a fold

Mi, leftover food in bed (crumbs). Wet and soiled underwear and bedding (especially soiled with feces and urine).

4. Displacement and rupture of soft tissues, which interferes with blood circulation. Shearing and friction of tissues can occur when pulling wet linen from under the patient, when dragging the patient while changing the bed, when pushing the boat when trying to pull up the patient alone, when slowly crawling out of bed, when the patient is seated for a long time. The shift of tissues is always harmful, especially if this is preceded by compression.

5. For some patients, even a patch can be dangerous, as it can stretch and compress the skin. When it is removed, the skin becomes thinner and easier to injure. Damaged skin and soft tissues are much more at risk of pressure ulcers than healthy ones. G

Inadequate patient nutrition.

REMEMBER!

Pressure ulcers are caused by poor patient care.

Places of possible formation of pressure ulcers

Pressure ulcers can form wherever there are bony protrusions. The place of formation depends on the position of the patient. In the supine position, these are the sacrum, heels, shoulder blades, nape, elbows. In the sitting position, these are the ischial tubercles, feet, shoulder blades. In the prone position, these are ribs, knees, toes with back side, iliac crests. In the lateral position - the area of the hip joint (the area of the greater trochanter).

Determining the risk of pressure ulcers

It is always necessary to assess the risk of pressure ulcers in each patient, especially in critically ill patients who are inactive or immobile.

The most common scoring system can be used to objectively assess the risk of pressure ulcers, depending on some overall indicators the patient's condition - D. Norton scale.

REMEMBER!

The risk of developing pressure ulcers is real with a score of 14 and

below. The smaller the amount, the greater the risk.

Pressure ulcer prevention measures

Prevention is always better than cure. If it is started on time, then in 95% of cases, the occurrence of bedsores can be avoided. Patients who are at risk of developing pressure ulcers ^ lro-

lead a number of measures to prevent them. G

\,- Nursing interventions at risk of pressure ulcers:

1. Avoid prolonged circulatory problems in areas where pressure ulcers may develop. For this:

Change the position of the patient in bed every 2 hours, if there are no contraindications;

Keep a comfortable position of the patient in bed, in accordance with the rules of biomechanics;

For the most comfortable position of the patient, in which the body weight is evenly distributed, use special devices and beds with anti-decubitus mattresses of various designs, cushions for arms and legs (instead of cushions, you can use ordinary pillows), foot stands;

Encourage the patient to change position in bed using special devices, handrails.

2. Check the condition of your skin by examining it daily. If your skin is dry, use moisturizing nourishing creams, especially in areas of possible future pressure sores. Where the skin sweats especially, it is possible to use a drying powder.

3. Keep your skin clean. Wash or wipe your skin at least twice a day (more often if necessary)

warm water, especially carefully - places of possible formation of pressure sores. In case of urinary incontinence, diapers for adult patients can be used, changing them in time (at least after 4 hours). For men, external urine bags can be used. If you have fecal incontinence, wash your patients while changing clothes.

4. Monitor the condition of the patient's bedding and underwear (this can be done when changing the patient's position):

Change wet soiled laundry in time;

Do not use underwear with rough seams, fasteners, buttons on the side facing the patient;

Do not use uneven mattresses and shields;

Straighten the wrinkles on the linen regularly;

Shake crumbs out of bed after every meal.

5. Move the patient correctly in bed to avoid tissue shearing. Teach the patient's relatives the technique of proper movement in bed.

6. Monitor the patient's food intake (quality and quantity of food consumed). The diet should have a sufficient amount of protein foods. Provide a sufficient amount of fluid consumed per day (at least 1.5 liters) if there is no indication to limit it.

7. Protect the patient's skin from the possibility of abrasions, scratching, irritating patches.

A bedsore is always a serious problem for the patient himself, his relatives and medical personnel.

The presence of pressure ulcers has a psychologically negative effect on the patient. Patients with a clear consciousness experience the presence of bedsores as an additional ailment, which may not have been. For some, it is very painful to understand that only because of bedsores, recovery is delayed.

For others, the fact that they have pressure ulcers is indisputable proof that they are doing very badly, and it can be difficult to convince them to change their minds. Many of them cannot tolerate discomfort or pain from pressure sores. They independently remove bandages, comb wounds, which delays the healing process.

Try to convince the patient that a lot depends on him in the treatment process. Explain what it is.

Interviewing the patient with the nursing staff reduces the patient's feelings of anxiety.

Treatment of pressure sores

The nurse treats pressure ulcers as prescribed by the doctor.

Washing the patient

For patients who are on bed rest, the nurse assists with the morning toilet.

Equipment: oilcloth, basin, jug, soap, towel, warm water.

Algorithm of action:

1. Place the basin on a chair next to the bed.

2. Turn the patient on one side or sit on the edge of the bed, if there are no contraindications.

3. Place an oilcloth on the edge of the bed or on the patient's knees (if he is sitting).

4. Give the patient a hand of soap.

5. Pour warm water over the basin from a jug onto the patient's hands until he is cleaned. (Instead of a jug, you can use a teapot specially designated for this purpose and marked "For washing patients").

6. Give the patient a towel.

7. Remove the basin, oilcloth, towel.

8. Tuck the patient into bed comfortably.

REMEMBER!

It is necessary to provide the patient with the opportunity to independently perform actions that are feasible for him. The nurse must create conditions for this, provide the patient with the necessary assistance.

Some patients cannot wash even with someone else's help. In this case, the nurse will wash the patient herself.

Equipment: basin, mitten or sponge, towel, gloves, warm water.

Algorithm of action:

1. Wash your hands and put on gloves.

2. Soak a mitten or sponge in warm water poured into a basin (you can use the end of a towel).

3. Wash the patient (sequentially - face, neck, hands with a sponge or mitten).

4. Dry your skin with a towel.

5. Remove gloves, wash your hands.

Rubbing the skin

Patients on a general regimen, if there are no contraindications, take a bath or shower at least 1 time 7-10 days.

The skin of a seriously ill patient must be wiped at least 2 times daily.

Equipment: gloves, a basin of warm water, a mitt or cotton swab, a towel.

Algorithm of action:

1. Wash your hands and put on gloves.

2. Soak a mitten or cotton swab (you can use the end of a towel) in warm water.

3. Wipe consistently the patient's chest and abdomen.

4. Then pat dry the skin with a towel. Especially carefully wipe and dry the folds of skin under the mammary glands in women (especially in obese women), armpits.

5. Turn the patient on their side and wipe the back while doing a gentle massage. Then dry it.

6. Lay the patient down comfortably, cover with a blanket.

7. Remove gloves, wash your hands.

REMEMBER!

Natural folds of the skin and places of possible formation of pressure sores require especially careful care.

Washing feet

The legs of a seriously ill patient are washed once a week. Equipment: gloves, oilcloth, basin, jug of warm water, towel.

Algorithm of action:

1. Wash your hands and put on gloves.

2. Place an oilcloth on the foot end of the bed.

3. Place the basin on the oilcloth.

4. Place the patient's legs in the pelvis (with the legs slightly bent at the knees).

5. Pour warm water from a jug onto your feet, wash them (you can first pour water into a basin).

6. Remove the basin.

7. Dry the patient's feet with a towel, especially carefully between the toes.

8. Remove the oilcloth.

9. Cover the patient's legs with a blanket.

10. Remove gloves, wash your hands.

Nail clipping

Severely ill patients need to regularly, but at least 1 time, a week to trim their fingernails and toenails. The nails should be trimmed so that the free edge is rounded (on the hands) or straight (on the legs).

Do not cut your nails too short, as the fingertips will be overly sensitive to pressure.

Equipment: scissors, nippers, nail file, towel, oilcloth, bowl with hot soapy water.

Algorithm of action:

1. Place an oilcloth under the patient's arm or leg (depending on where you will cut your nails).

2. Place a bowl of hot soapy water on the oilcloth.

3. Dip your fingers in hot soapy water for 10-15 minutes to soften the nails.

4. Then dry the fingers one by one with a towel and shorten the nails to the required length using scissors or nippers.

5. Using a file, give the free edge of the nails the required shape (straight - on the legs, round - on the hands). You should not file the nails deeply from the sides, as you can injure the skin of the lateral ridges and thereby cause cracks and increased keratinization of the skin.

6. Repeat the same steps with the other limb.

ATTENTION!

Places of accidental cuts must be treated with a 3% solution of hydrogen peroxide or iodine.

Shaving face

Equipment: shaving machine, soap suds or shaving cream, napkin, container (tray) with water, towel, gloves.

Algorithm of action:

1. Wash your hands and put on gloves.

2. Soak a tissue in hot water and wring it out.

3. Place the tissue on the patient's face for 5-7 minutes.

4. Apply lather or shaving cream to your face.

5. Pulling the skin in the opposite direction to the movement of the machine, gently shave the patient.

6. Wipe the patient's face with a damp cloth.

7. Dry your face with a towel.

8. Remove gloves, wash your hands.

Removal of mucus and crusts from the nasal cavity

Most patients take care of the nasal cavity on their own during the morning toilet. Severely ill patients who are not able to independently monitor the hygiene of the nose, it is necessary to free the nasal passages daily from secretions and formed crusts that interfere with free breathing through the nose.

Equipment: gloves, 2 trays, cotton balls, petroleum jelly (or vegetable oil, or glycerin).

Algorithm of action:

1. Wash your hands and put on gloves.

2. While lying or sitting (depending on the patient's condition), slightly tilt the patient's head.

3. Soak cotton balls with vaseline or vegetable oil, or glycerin.

4. Insert the turunda into the nasal passage with a rotating movement and leave there for 2-3 minutes.

5. Then remove the turunda and repeat the manipulation.

6. Remove gloves and wash your hands.

Note: you can first drip one of the listed oils into the nose, and then unclog the nasal passages with cotton wool. Mucus from the nasal cavity can also be removed with dry cotton swabs.

Rubbing eyes

If you have discharge from the eyes, sticking of eyelashes and eyelids during the morning toilet, you should rinse your eyes.

Equipment: sterile gloves, 2 trays (one sterile), sterile cotton balls, antiseptic solution (furacilin solution 1: 5000, 2% soda solution, 0.5% potassium permanganate solution), tweezers.

Algorithm of actions:

1. Wash your hands thoroughly, put on sterile gloves.

2. Put 8-10 sterile balls in a sterile tray and moisten them with an antiseptic solution (furacilin 1: 5000, 2%

soda solution, 0.5% potassium permanganate solution) or boiled water.

3. Slightly squeeze the tampon and rub the eyelashes with it from the outer corner of the eye to the inner corner.

4. Repeat rubbing 4-5 times (with different tampons!).

5. Blot the rest of the solution with dry swabs.

6. Remove gloves, wash your hands.

Cleansing the external auditory canal

Patients on a general regimen wash their ears on their own during the daily morning toilet.

Patients on bed rest should periodically toilet the external auditory canals.

Equipment: gloves, 3% hydrogen peroxide solution, pipette, cotton balls, 2 trays.

Algorithm of action:

1. Wash your hands and put on gloves.

2. Sit down the patient, if there are no contraindications, tilt your head to the opposite shoulder or turn your head to one side in a prone position.

3. Pulling the auricle back and up, drop a few drops of warm 3% hydrogen peroxide solution into the patient's ear.

4. Rotating the cotton swab into the ear canal. The ear is also pulled back and up.

5. Having changed the turunda, repeat the manipulation several times.

6. Repeat the same steps with the other external auditory canal.

7. Remove gloves, wash your hands.

REMEMBER!

Do not use hard objects to remove wax from the ears to avoid damage to the eardrum.

Oral cavity care

Note:

If a patient on bed rest can brush their teeth cap, help him with this. Provide him with everything he needs and make him comfortable in bed.

REMEMBER!

Rinsing the mouth must be done after

every meal, brush your teeth at least 2 times a day

(in the morning and in the evening). Treatment of the oral mucosa and

teeth for seriously ill patients are also carried out 2 times in

If there is a lack of personal hygiene, the nurse needs:

1. Explain the need for personal hygiene measures in a hospital setting.

2. Assess the ability to self-care.

3. Assist in carrying out morning and evening dressing, shaving in the morning.

4. Partially sanitize daily.

5. Provide the opportunity to wash hands before eating and after using the toilet.

6. Help with washing (at least once a day).

7. Provide washing of hair and feet once a week.

8. Provide oral care, mouthwash after each meal.

9. Provide nail clipping once a week.

10. Provide care for the natural folds of the skin daily.

11. Provide a change of linen as it gets dirty.

ATTENTION!

Teach the patient to take care of themselves as much as possible.

Develop the patient's self-help skills, encourage independent action.

Personal contact with the patient, careful observation and listening to the patient will help you organize the best possible care for each patient.

Severely ill patients can also be at home. Therefore, it is necessary to teach relatives the elements of proper skin care and natural folds, mucous membranes, measures to prevent pressure ulcers. -f

EXAMPLE OF NURSING PROCESS USE

Situation.

The nurse must treat the pressure sore Stage III v. area of the sacrum in a patient who is on strict bed rest for cardiac pathology.

Stage I - collection of information.

The patient's position is passive. In the region of the sacrum there is a bladder, around which there is an intense reddening of the skin. There are many folds on the sheet under the patient.

Violated the satisfaction of the need: TO BE CLEAN.

Stage II - staging nursing diagnoses:

Self-care deficits associated with strict bed rest and general weakness;

The risk of pressure ulcers of other localization. Priority nursing problem:

Violation of the integrity of the skin: pressure sore II stage in the sacrum;

Stage III - planning.

Short term goal: Patient will be free of sacral pressure ulcers by the end of the week.

Long-term goal: The patient will not have a decubitus sore from another location at the time of discharge.

Plan: - 1. The nurse will treat the pressure sore as directed by the doctor.

2. The nurse will apply activated charcoal wipes to the wound to deodorize the wound.

3. The nurse will wash the bedsore with nat. solution.

4. The nurse will place the patient on an anti-decubitus mattress.

5. The nurse will change the patient's underwear and bedding as it gets dirty, carefully straightening the folds on the underwear.

6. The nurse will pay close attention to the prevention of pressure ulcers.

Stage IV - implementation.

The nurse will carry out the treatment of the patient's bedsore according to the drawn up plan, the prevention of bedsores of other localizations.

Stage V - assessment.

~ - After a week, the bubbles and hyperemia in the sacrum area disappeared. Pressure ulcers of other localization are not observed. The goal has been achieved.

MANIPULATION

Giving the patient the necessary position in bed, depending on the disease, using a functional bed and other various devices;

Preparing the bed for the patient;

Change of underwear and bed linen;

Submission of the vessel and urine bag (man and woman);

Care of the external genitals and perineum (for men and women);

Washing and combing the head;

Organization and assistance to the patient in the morning toilet;

Washing the patient;

Shaving the patient's face;

Washing the patient's feet;

Trimming the nails on the hands and feet of the patient;

Rubbing the skin with a light back massage;

Treatment of natural skin folds to prevent diaper rash;

Determination of the patient's risk of pressure ulcers;

Carrying out measures for the prevention of pressure ulcers;

Treating the skin in the presence of pressure ulcers;

Teaching relatives on the elements of prevention of pressure ulcers at home;

WORKSPACE EQUIPMENT

Functional bed with bedding]

Bed and underwear;

Oilcloth;

Towel;

Mittens;

Gloves;

Diaper; G

Oilcloth bag; roller; pelvis;

A jug or teapot; oilcloth;

Esmarch's irrigator;

Vessel (enameled and rubber);

Urine collection bag (male and female);

Rubber circle;

Water thermometer;

Kornzang; tweezers;

Putty knife; scissors;

Pipettes;

Nippers;

Nail file;

Machine for shaving;

Comb; Cup; Toothbrush;

Toothpaste; shampoo;

Lather; shaving cream;

Baby cream; powder;

Vaseline oil;

Glycerol; petrolatum;

Cotton swabs;

Gauze napkins;

Cotton turundas;

Sterile cotton balls and wipes;

Antiseptic solutions:

Furacilin 1: 5000;

0.5%, 3% hydrogen peroxide;

3% chloramine;

0.5% and 10% bleach;

0.5% potassium permanganate.

GLOSSARY

BIOOCCLUSION BANDING ..........

INTERTRIGO..................

BED ..................

Bandage that provides isolation of the affected area of the body, impregnated medicinal substance

Inflammation of the skin in folds that occurs when rubbing wet surfaces

Dystrophic, ulcerative-necrotic changes in soft tissues, as a result of their prolonged squeezing, shift relative to each other and friction

The need to care for a sick person who cannot get out of bed and needs the care and attention of family and friends, always makes us think about the need to acquire some skills to help cope with this difficult problem. How to organize proper care using only your strength? How to ease the suffering and worries of a loved one or loved one? How to take care of the patient so that they do not form on the skin? What care products should you choose so as not to harm?

gentle cleansing of the skin;
effective and inflammatory reactions in the genital area, anus and in the natural folds of the skin;
therapeutic measures that contribute to the restoration of the skin.

In this article, we will introduce you to these important aspects of caring for bedridden patients, and this information can help you avoid mistakes in this difficult and important matter.

Hygiene procedures

Hygiene measures for patients who are forced to long time carried out in bed must be carried out in the morning and in the evening. Doctors recommend to carry them out before breakfast and before bedtime, since it is these time intervals that are most favorable for performing such procedures.

To perform hygiene procedures, it is necessary to prepare the following hygiene products:

two basins for water;
inflatable bath for shampooing;
support for the pelvis;
a jug for heated water;
special cosmetical tools and devices for the care of bedridden patients: gels, foams, lotions, creams, foaming mittens and sponges (for example, Tena Wash, Seni Care, Menalind, etc.);
gloves for medical and cleaning;
tissue and paper towels and napkins;
rubberized diapers and disposable oilcloths;
absorbent diapers;
cotton wool;
gauze napkins;
cotton buds;
special toothbrushes (if the patient himself cannot brush his teeth);
items for haircuts, manicure, pedicure and shaving;
male or female urine bags;
colostomy bags;
circles, rollers or mattresses to prevent pressure sores.

If necessary, other hygiene products can be added to this list:

bibs for neat feeding;
diapers;
urological and gynecological pads;
dry closets;
shower chairs or bath seats and handrails;
toilet chairs;
devices for the care of stomas;
disposable underwear and bedding, etc.

The doctor can help determine the need for certain means for caring for a bedridden patient, since their range largely depends on the patient's diagnosis.

Before starting skin cleansing procedures, it is necessary to eliminate all possible sources of drafts and make sure that the air temperature in the room is at least 20 degrees. Such precaution when caring for bedridden patients is never superfluous, since due to illness, their immunity becomes weakened, and sharp fluctuations in temperature can lead to an exacerbation of chronic diseases.

In what sequence should the procedures be carried out?

Before carrying out hygiene procedures, it is recommended to put on the first pair of medical gloves and protect the bedding with an absorbent or waterproof sheet and oilcloth. After that, a nightgown is removed from the patient and stage-by-stage hygiene procedures begin.

Stage 1 - caring for the patient's oral cavity

If the patient's condition allows, then he can be seated on a chair or give his body a semi-sitting position. If the patient cannot change the horizontal position of the body, then his head must be turned to one side and, using cotton swabs (pagavit), clean the cheek space from accumulated saliva and plaque. To facilitate the performance of hygienic procedures for the oral cavity, you can use special disposable plastic spatulas, with which you can alternately and gently move the left and right cheeks.

To clean the teeth of a sick person, you can follow the same rules as for cleaning teeth at healthy person, but the movement of the toothbrush in such situations should be more gentle and performed with the utmost care.

After completing the procedure, it is necessary to rinse the patient's mouth with water or a hygienic solution (special solutions for rinsing the mouth, solutions of soda, hydrogen peroxide, borax, etc.). To do this, you can use a rubber syringe and a soft tip or special rubber balloons to rinse the patient's mouth. When performing this procedure, the head must be slightly raised above the surface of the bed so that liquid does not enter the esophagus and respiratory tract.

A special approach is also recommended when choosing a toothbrush and toothpaste for the care of a bed patient. In most cases, in such patients, the oral mucosa becomes vulnerable and sensitive to the effects of stiff bristles, and the toothpaste should be selected in accordance with the age-related needs and characteristics of the patient's diagnosis.

Anti-bleeding gums

LACALUT aktiv;
LACALUT fitoformula;
Parodontax;
Parodontax F, etc.

For patients with increased sensitivity tooth enamel, the following toothpastes are recommended:

SPLAT;
LACALUT Extra Sensitive;
PRESIDENT Sensitive;
SILCA Complete Sensitive;
Oral-B Sensitiv.

a series of DIADENT toothpastes: DiaDent Regular, DiaDent Active;
PerioTherapy Healthy Gums Toothpaste.

For seriously ill children who are forced to lie down for a long time, it is recommended to choose toothpastes that are able to match their age and have the necessary properties that are determined by the diagnosis.

The duration of the use of medicinal toothpastes for seriously ill patients is determined individually, since some of them active ingredients with prolonged use can have Negative influence on the health of the oral cavity. After using them, it is recommended to use hygienic toothpastes.

After completing this procedure, it is necessary to blot the patient's lips with an absorbent napkin and apply hygienic lipstick or moisturizing balm to them, which prevents drying out and chapping of the lips. For this, the following means can be used:

balm EOS;
lip balm BABE Laboratorios SPF 20;
fatty oils: shea butter (shea butter), jojoba, cocoa, soy;
hygienic lipstick "Morozko".

When choosing such balms and hygienic balms, be sure to make sure that they are hypoallergenic.

Stage 2 - washing

The following solutions can be used to wash the patient's face:

Seni Care washing cream;
washing cream TENA Wash Cream;
EHAdez;
washing lotion Menalind professional;
ElekSi and others.

One of the above solutions is diluted in water and moistened with a sponge or hygroscopic glove. After that, they wipe the patient's face, and then proceed to the hygienic treatment of the eyes. It is recommended to use two wet cellulose discs for this procedure (use a separate disc for each eye). In this case, movements should be directed from the outer corner of the eye to the inner one.

You can use cotton swabs to clean the inner surface of the ears and ear canal. After that, using a damp sponge, it is necessary to cleanse the skin behind the ears, the region of the neck, chest (including the folds under the breast), the surfaces of the sides and the abdomen of the patient. In parallel with these actions, the cleaned areas of the skin are blotted with a well-absorbing cloth and covered with a towel (blanket) or put on clothes on the treated areas of the body.

After this, the patient is gently turned over on his side and the back area is wiped with the same washing solution. The treated skin areas are dried with a towel and one of the means to protect the skin from pressure sores is applied to them:

Seni Care body gel;
protective cream Menalind professional with zinc;
protective body cream Seni Care with arginine;
protective body cream Seni Care zinc, etc.

In the absence of contraindications, after cleansing the skin and applying the products caring for it, it is recommended to perform percussion massage.

Sometimes, to wash the irritated areas of the patient's skin, you have to use special products that provide gentle cleansing of the skin. These include:

TENA Wash Mousse foam;
Seni Care foam, etc.

Stage 3 - washing hands

Use the same detergent solution for hand washing as for body wash. Each hand of the patient is alternately immersed in a basin with a washing solution and washed with a sponge or gloves. Close attention is paid to the cleansing of the areas of the interdigital space, since it is in it that a large number of pathogenic microorganisms often accumulate.

After washing, hands are dried with a towel and a special care product is applied to the elbow area (as a rule, coarseness is often observed on them) - Seni Care cream for dry and rough skin. After that, the patient's nails are trimmed and filed with a special file. Further, nail care is carried out as they grow back.

Stage 4 - changing diapers and hygiene of intimate areas

Before you start cleansing this area of the body, you must change the gloves to new ones and prepare new solution for washing.

lay a waterproof diaper under the patient's pelvis (if the bed was not previously covered with a waterproof oilcloth with an absorbent sheet or an absorbent sheet);
remove the diaper and wrap it in a bag;
put on a washing mitten or take a special soft sponge for treating intimate areas;
moisten a mitten or sponge in a washing solution and wring it out;
spread the patient's legs and place them so that they bend at the knees, and the heels are as close to the pelvis as possible;
process the perineal area so that the movements of the sponge are directed from the pubis to the anus;
dry the crotch area with a soft towel (only a specially selected towel or disposable absorbent diaper can be used for this);
turn the patient on his side, wipe the body and dry the skin with a towel (special attention should be observed when drying natural folds);
apply a protector (protective foam or cream) to the skin;
take a clean diaper, unfold it, fold it along and gently unfold the protective cuffs and fasteners;
put a diaper on the patient.

To treat the crotch area, you can use wet wipes for intimate hygiene or cleansing foams. To do this, you can purchase the following tools:

wet wipes Seni Care or TENA Wet Wipe;
Seni Care foam or TENA Wash Mousse.

Step 5 - washing your feet

To wash your feet, prepare a new detergent solution and change the sponge or washing mittens. Further, the procedure is performed in the following sequence:

wipe your feet with a sponge or washing mitten up to the ankle;
dry your feet with a towel
the patient's feet should be lowered into the pelvis and washed, paying close attention to the areas between the toes;
dry your feet with a towel;
turn the patient on their side and apply anti-pressure sores on the back of the legs;
lay the patient on his back;
trim your toenails and process the edges with a pedicure file.

After completing all the stages of washing the patient on the rough skin areas (for example, on the elbows, heels or knees), you can apply special means to effectively soften them - Seni Care cream for dry and rough skin. The completion of hygiene procedures should end with putting on a shirt, giving the body a comfortable position in bed and, if necessary, placing rollers or special inflatable rings to prevent bedsores. After that, cover the patient with a blanket. In some cases, after the completion of hygiene procedures, it is recommended to carry out treatment measures(for example: treatment, prevention, etc.).

All the above stages of hygiene procedures for the care of a bedridden patient should be performed daily. Compliance with this rule always positively affects the patient's condition and has a positive effect on the condition of the skin, preventing the appearance of pressure ulcers and the development of infectious complications.

Washing head

Washing the patient's head should be carried out as the hair becomes dirty. To complete this procedure, you must prepare the following accessories:

a basin for washing (for this it is more convenient to use special inflatable baths for washing your hair);
support for the pelvis;
a jug of water at a comfortable temperature;
shampoo;
oilcloth;
towel;
comb;
kerchief or hat.

The patient is placed on his back and a pillow is placed under the shoulders so that its upper edge is at shoulder level, and the head is slightly thrown back. A roller is rolled out of a towel and placed under the neck. The head of the bed is covered with oilcloth, on which a basin of water is installed.

Topic 2: Helping a seriously ill patient in the implementation of personal hygiene.

2.1. Skin care.

Personal hygiene is a broad concept that includes the implementation of rules that contribute to the preservation and strengthening of human health. The first priority is to maintain cleanliness of the body.

The skin of the body performs a protective function (protects the body from mechanical damage, penetration of harmful and toxic substances, microorganisms from the external environment), participates in metabolism (respiratory, excretory functions), is a component of one of the sensory organs - a skin analyzer.

During physical activity, with an increase in body temperature, with diseases of the kidneys, liver, respiratory system, digestive tract and skin excretory function is in a state of tension. Gas exchange increases through the skin, and the amount of emitted substances increases many times. At the same time, products of impaired metabolism also begin to be released through the skin.

It is obvious that for normal functioning the skin must be kept clean and protected from damage.

Patients who are on a general regimen wash themselves in the bathroom or under the shower at least 1 time in 7 days.
2.1.1. Conducting a hygienic bath.

Indications: contamination of the skin.

Contraindications:serious condition sick.

Equipment: brush, soap, washcloth - mitt, gloves, footrest, bath treatment products.

Performing manipulation:

put on gloves;
fill the bathtub with warm water (water temperature 35-37ºС);
help the patient to take a comfortable position in the bathroom (the water level should reach the xiphoid process);
help the patient get out of the bath, dry off and get dressed;
take off gloves;
escort the patient to the ward.

The duration of the bath is no more than 25 minutes.

Possible complications: deterioration of health - pain in the heart, palpitations, dizziness, discoloration of the skin. If such signs appear, it is necessary to stop taking a bath, transport the patient on a gurney to the ward, and provide the necessary assistance.

To facilitate the work of caregivers, there are special devices that make it easy to place the patient in the bath.

2.1.2. Conducting a hygienic shower.

Indications: contamination of the skin.

Contraindications: serious condition of the patient.

Equipment: bench or bath seat, brush, soap, washcloth - mitten, gloves, gloves, bath treatment products.

Performing manipulation:

put on gloves;
wash the bathtub with a brush and soap, rinse with 0.5% bleach solution or 2% chloramine solution, rinse the bathtub with hot water (you can use household cleaning and disinfecting products);

Fig. 4 Taking a shower

put a bench in the bathtub and seat the patient (Fig. 4);
wash the patient with a washcloth: first the head, then the torso, upper and lower limbs, groin and perineum;
help the patient to dry off with a towel and get dressed;
take off gloves;
escort the patient to the room.

2.1.3. Washing feet in bed.

Equipment: rubber oilcloth, basin, warm water 34-37⁰С, washcloth, soap, towel, petroleum jelly or emollient cream.

Manipulation (fig. 5):

put on gloves;
put the oilcloth on the mattress;
put a basin on an oilcloth;
pour water to half of the basin;
lower the patient's legs into the pelvis with minimal physical exertion for the patient;
it is good to soap your feet, especially the interdigital spaces and nail beds;
rinse the patient's feet with clean water, lifting them above the pelvis;
wipe your feet dry with a towel;
lubricate the soles and heels with cream;
take out the oilcloth;
it is convenient to lay your feet on the bed and cover them with a blanket;
Wash the hands.

Rice. 5 Washing feet in bed
2.1.4. Washing the patient.

Patients, who can serve themselves, wash with boiled water and soap every day, preferably in the morning and evening.

Seriously ill, staying in bed for a long time and not being able to take regularly hygienic bath, should be washed off after each act of defecation or urination. Patients suffering from incontinence need to be washed several times a day, as the accumulation of urine and feces in the perineum and groin folds can cause diaper rash, pressure sores and infection.

Indications: hygiene of the perineum.

Equipment: 8-16 cotton swabs, oilcloth, boat, forceps, jug, Esmarch mug with rubber tube, clamp and tip, antiseptic solution (low-boros potassium permanganate solution or furatsilin solution 1: 5000).

Washing women. At the same time, several movements are made with a cotton swab in the direction from the genitals to the anus (the tampons change after each movement from top to bottom). With another cotton swab, dry the skin of the perineum in the same way. If women have vaginal discharge, douching is also used - irrigation of the vaginal walls with the help of Esmarch's mug and a special vaginal tip with boiled water, a weak solution of sodium bicarbonate, potassium permanganate or isotonic sodium chloride solution.

Washing men. The patient is turned on the side, holding him by the shoulders and pelvis. Then they put an oilcloth under the patient's buttocks, the vessel and help him to return to his back so that his crotch is on the vessel. Next - take the penis with one hand, gently pull foreskin exposing the head of the penis. The napkin is moistened in warm water, squeezed out and wiped on the glans penis. Then they rub the skin of the penis and scrotum and dry them thoroughly. Then the anal area is washed and dried.
2.2. Hair care.

Poor hair care with irregular washing can lead to increased fragility, hair loss, and the formation of oily or dry scaly scales (dandruff) on the scalp.

Washing the head of a seriously ill patient is carried out in bed (Fig. 6). In this case, the basin is placed at the head end of the bed, and the patient's head is slightly raised and thrown back.

After washing, gently dry the hair

with a towel, after which it is thoroughly and carefully combed, starting from the root, if the hair

short, or, conversely, from the ends with long hair (Fig. 7).

Rice. 6 Washing your hair in bed

Fig. 7 Brushing hair

2.3. Nail care.

Nail care should be done very carefully. Otherwise, this procedure can lead to trauma to the skin around the nail bed and subsequent infection. You don't need to cut your nails all the way to the root, or you could cut your skin. Before cutting nails, alternately lower the hands and feet in warm water... It is necessary to be especially careful when cutting the nails of patients suffering from diabetes mellitus, hemiplegia and other ailments, accompanied by a decrease in skin sensitivity.

2.4. Feeding the vessel and urine bag

Patients who are on bed rest are forced to perform physiological procedures lying down. In such cases, the patient is given a bedpan (a special device for collecting feces) and a urine bag (a vessel for collecting urine).

Cleanly washed and disinfected vessel with a little water added to eliminate bad smell, is brought under the patient's buttocks, having previously asked him to bend his knees and helping him to slightly raise the pelvis with his free hand. After the vessel is freed from its contents, it is thoroughly washed with hot water and disinfected with any disinfectant used in these cases.

For a bedridden patient it is better to use a ship in the form of a "scoop", which practically does not have one side; it can be used by patients on their own.

When submitting a urine bag, it should be borne in mind that not all patients can freely urinate while lying in bed. Therefore, the urine bag must be warm. After urination, the drainage bag is emptied and washed well.
2.5. Changing diapers

One of the new forms of care for the seriously ill and elderly is the use of diapers (pampers).

Unfold the diaper and find the glued belt

Peel off the glued belt from right to left

Peel off the second belt layer from left to right

Spread the released belt

Topic 3: Skin care for a seriously ill patient.
Skin is the outer cover of the human body that protects the body from a wide range of external influences participating in respiration, thermoregulation, metabolic and many other processes. In addition, the skin presents a massive receptor field different types superficial sensitivity (pain, pressure, temperature). If the patient is immobilized and cannot turn on his side and sit down on his own, the formation of bedsores in such cases is very likely. The absence of pressure ulcers in this type of patient is one of the main criteria for good care. In order to prevent (prevent) the appearance of bedsores and diaper rash, it is necessary to conduct a thorough examination of the skin daily (Scheme 1).
WITH
Cracks, stains

A crack is a violation of the integrity of the skin of a linear shape.
Hema 1. Inspection of the skin

Examination of the skin

Examine and feel the skin:

Color change

Cyanosis, redness, paleness.

Theoretical justification

Theoretical justification:

Aging of the skin affects the state of the protective barrier, reduces the perception of pain, properties immune system, slows down the wound healing process.
Dry skin is more prone to injury.
Cracks facilitate the penetration of microorganisms deep into the tissues.

Any seriously ill patient is affected by numerous risk factors for the development of pressure ulcers.

A bedsore (from Latin decubare - to lie down) is an ulcer from pressure that occurs on certain parts of the body and under certain conditions.

A bedsore occurs as a result of a local lack of blood supply (ischemia) and the resulting cell death (necrosis).

Reversible Irreversible

Wasting or overweight senile
Limited mobility age
Anemia
Insufficient intake of protein, vitamin C
Hypotension
Incontinence of urine and feces
Violation of peripheral circulation
Thinned skin
Anxiety
Confused mind
Coma

Reversible Irreversible

Poor hygiene care Extensive
Surgical folds on bed and underwear
Bed rails intervention
Patient fixation means for more than 2 hours
Injuries to the spine, pelvic bones, abdominal organs
The use of cytostatics
Incorrect patient movement technique

Places of localization of pressure ulcers
In the supine position, bedsores develop in the occiput, shoulder blades, elbows, sacrum, ischial tubercles, and heels. In the position "on the side" - in the area of the auricle, shoulder, elbow joints, femur, knee joints, on the ankle. In the "sitting" position - in the area of the shoulder blades, sacrum, heels, toes (see Fig. 9). The presence or absence of pressure ulcers can be used to judge the quality of patient care.

The main activities aimed at the prevention of pressure ulcers:

Decrease in pressure when the patient is sitting or lying down. To do this, it is necessary to change the position of the patient's body every 2 hours, turning it 30 degrees.
The use of special mattresses, bedding.
Activation of blood circulation:

daily skin massage using special products (skin oil, toning liquid, body lotion);
stabilization of blood circulation due to a change in active and passive movements;
clothes should be loose.

Skin protection:

daily washing or wiping of the skin using pH - neutral skin washes;
using clean, wrinkle-free laundry:
use of diapers, pads with a gelling agent for incontinence;
the amount of liquid consumed should be at least 1.5 - 2 liters (if there are no contraindications). Restricting fluid intake can irritate the bladder. The concentration of urine increases and can worsen urinary incontinence.

With age, the skin becomes thinner, the activity of sweat decreases and sebaceous glands are decreasing protective functions skin. Conventional detergents for skin care are alkaline, destroy

Rice. 9 Locations of pressure ulcers

the hydrolipid layer and shift the acid balance pH 9.0 - 14.0, which significantly worsens the skin condition. Bed rest, urinary and fecal incontinence negatively affect the skin and weaken its ability to regenerate.

Professional skin care, application disposable products hygiene, correct position patient in bed contribute to the prevention of pressure ulcers (Fig. 10).

Rice. 10 Determining the size of the bedsore.

To determine the likelihood of pressure ulcers formation, and therefore for the purpose of their prevention, it is necessary to use the Waterlow scale (Table 1).

Table 1. Waterlow scale for assessing the risk of developing pressure ulcers

Body type: body weight relative to height	Score	Skin type	Score	Gender, age (years)	Score	Special risk factors	Score
The average	0	Healthy	0	Male	1	Disruption of skin nutrition,	8
Above the average	1	Cigarette paper	1	Female	2	For example, terminal cachexia
Obesity	2			14-49	1
Below the average	3	Dry	1	50-64	2
		Edematous	1	65-74	3
		Sticky (fever)	1	75-81, more than 81	4,5	Heart failure	5
		Color change	2			Peripheral vascular disease	5
		Cracks, stains	3			Anemia	2
						Smoking	1

Incontinence	Score	Mobility	Score	Appetite	Score	Neurological disorders	Score
Full control	0	Full	0	Average	0	For example diabetes	4
		Restless	1	Bad	1	Multiple
Through a catheter		Fussy		Feeding probe	2	Sclerosis, stroke	-
Periodic		Apathetic	2	Liquids only		Motor / sensory, paraplegia	6
Through a catheter	1	Limited mobility	3
Fecal incontinence	2	Inert	4	Not through the mouth (anorexia)	3
Feces and urine	3	Chained to a chair	5

Waterlow scores are summed up and the degree of risk is determined by the following totals:

No risk 1-9 points,

There is a risk of 10 points,

High degree of risk 15 points,

Very high degree of risk 20 points.

In immobile patients, an assessment of the degree of risk of developing pressure ulcers should be carried out daily, even if the degree of risk was estimated at 1-9 points during the initial examination.

The results of the assessment are recorded in the nursing record of the patient. Anti-bedsore measures are started immediately according to the recommended plan.

The environment in which the patient is located plays an important role in the course and outcome of diseases. First of all, this is compliance with the rules of personal hygiene and hygiene in the ward, ensuring timely and proper nutrition sick. In creating favorable conditions in the ward, the main role is assigned to the middle and junior medical personnel. Compliance with the rules of personal hygiene, keeping the bed and ward clean are essential for effective treatment. F. Nightingale wrote: “... What, in fact, is understood by hygienic conditions? In fact, there are very few of them: light, warmth, clean air, healthy food, harmless drinking water, cleanliness ... ". That is why adherence to the rules of personal hygiene, keeping the bed and ward clean are necessary for effective treatment.

The position of the patient in bed should be comfortable, bed linen - clean, mattress - even; if the bed has a mesh, it should be stretched. For seriously ill patients and patients with urinary and fecal incontinence, an oilcloth is placed on the mattress topper under the sheet. For women with profuse discharge, a diaper is placed on the oilcloth, which is changed as it gets dirty, but at least 2 times a week. Severely ill patients are placed on functional beds, head restraints are used. The patient is given two pillows and a blanket with a duvet cover. The bed is made regularly before and after sleep. Underwear and bed linen are changed at least once a week after taking a bath, as well as in case of accidental contamination.

Linen change rules

The first way to change bed linen(fig. 6-1)

1. Roll the dirty sheet into a roller in the direction from the head and foot ends of the bed to the patient's lumbar region.

2. Carefully lift the patient up and remove the dirty sheet.

3. Place a clean sheet rolled in the same way under the patient's lower back and straighten it.

The second way to change bed linen(Fig. 6-2) 1. Move the patient to the edge of the bed.

Rice. 6-1. Change of bed linen in a seriously ill patient (first method)

2. Roll the free part of the dirty sheet with a roller from the edge of the bed towards the patient.

3. Spread a clean sheet on the vacant place, half of which remains rolled up with a roller.

4. Move the patient to the spread half of the clean sheet, remove the dirty sheet and straighten the clean one.

Change of underwear

1. Bring your hand under the patient's back, raise the hem of his shirt to axillary area and the back of the head.

2. Remove the shirt over the patient's head (Fig. 6-3, a), and then from his hands (Fig. 6-3, b).

Rice. 6-2. Change of bed linen in a seriously ill patient (second method)

Rice. 6-3. Change of underwear for a seriously ill patient: a - taking off the shirt over the patient's head; b - removing the shirt sleeves from the patient's hands

3. Put on the shirt in reverse order: first put on the sleeves, then throw the shirt over the patient's head and straighten it under his back.

4. On a patient who is on strict bed rest, put on a shirt-vest.

SKIN CARE AND PREVENTION OF BEDSUTS

The skin performs several functions: protective, analytical (skin sensitivity), regulatory (regulation of body temperature: heat transfer through perspiration in a healthy person is 20% of all heat transfer per day, and in febrile patients - much more), excretory. Water, urea, uric acid, sodium, potassium and other substances are secreted through the skin and its sweat glands. At rest, at normal body temperature, about 1 liter of sweat per day is secreted, and in febrile patients - up to 10 liters or more.

The evaporation of sweat leaves on the skin metabolic products that destroy the skin. Therefore, the skin must be clean, for which it is necessary to change linen more often, wipe the skin with cologne, water with 96% alcohol (in a 1: 1 ratio), disinfecting wipes or solutions (for example, 1 glass of water + 1 tablespoon vinegar + 1 tbsp l. camphor), wipe the skin with a dry clean towel.

Particular attention should be paid to the condition of the skin of the groin area, armpits, in women - the area under the mammary glands. The skin of the perineum requires daily washing. Severely ill patients should be washed after each act of defecation, and in case of urinary and fecal incontinence, several times a day to avoid maceration * and skin inflammation in the groin and perineal folds. Women are washed more often.

In critically ill patients, bedsores can form. Bedsore (lat. decubitus; syn. - decubital gangrene) - necrosis (necrosis) of soft tissues (skin with the involvement of subcutaneous tissue, walls of a hollow organ or blood vessel, etc.), resulting from ischemia caused by prolonged continuous mechanical pressure on them. Bedsores appear most often on the sacrum, shoulder blades, heels, elbows from prolonged compression of the skin area and disturbance of blood circulation in it (Fig. 6-4). First, redness and soreness appear, then the epidermis (the surface layer of the skin) sloughs off, and bubbles form. With deep bedsores, muscles, tendons, periosteum are exposed

Rice. 6-4. Places of the most frequent formation of pressure ulcers

* Maceration (lat. maceratio- soaking, softening) - softening and loosening of tissues due to prolonged exposure to liquid.

tsa. Necrosis and ulcers develop, sometimes penetrating to the bone. An infection penetrates the damaged skin, which leads to suppuration and blood poisoning (sepsis).

When a localized area of redness of the skin appears, wipe it with a 10% camphor solution, a damp towel, and irradiate it with a quartz lamp 2 times a day. If bedsores have formed, it is necessary to lubricate them with a 5% solution of potassium permanganate, apply a bandage with Vishnevsky ointment, synthomycin liniment, etc.

Pressure ulcer prevention measures

Every 1.5-2 hours, the patient's position should be changed.

It is necessary to straighten the folds on the bed and linen.

Wipe the skin with a disinfectant solution.

Change wet or soiled laundry immediately.

Backing rubber discs placed in a cover or covered with a diaper should be used. The circle is placed in such a way that the place of the bedsore is above the hole of the circle and does not touch the bed; also use special inflatable mattresses with a corrugated surface.

It is necessary to wash and wash patients in a timely manner.

Currently, the so-called anti-decubitus system has been developed for the prevention of pressure ulcers, which is a specially designed mattress. Thanks to the automatic compressor, the cells of the mattress are filled with air every 5-10 minutes, as a result of which the degree of compression of the patient's tissues changes. Tissue massage by changing the pressure on the patient's body surface maintains normal blood microcirculation in them, providing the skin and subcutaneous tissue with nutrients and oxygen.

APPLICATION OF VESSELS AND URINE RECEIVERS

Patients who are on strict bed rest, if necessary

the need to urinate - a urine bag (women usually use the vessel when urinating, and men use the so-called duck). The ships are metal with an enamel coating, plastic and rubber. The rubber vessel is used in debilitated patients, as well as in the presence of bedsores, fecal and urinary incontinence.

Before giving the patient a urine bag, the latter must be rinsed with warm water. After urination, pouring out its contents, rinse the urine bag again with warm water.

Washing the sick (women)

Required equipment: jug with warm (30-35 ° C) weak solution of potassium permanganate (antiseptic) or water, forceps, napkin, oilcloth, boat, gloves (Fig. 6-5).

Procedure for the procedure:

1. Help the patient to lie on his back; the legs should be slightly bent at the knees and apart.

2. Lay an oilcloth and put the ship on it, placing it under the patient's buttocks.

3. Stand to the right of the patient and, holding the jug in the left hand, and the forceps with a napkin in the right, pour antiseptic solution on the genitals, and wipe them with a napkin, making movements along

Rice. 6-5. Washing the sick

Rice. 6-6. Submitting the vessel

direction from the genitals to the anus, i.e. top down.

4. Dry the skin of the perineum with a dry cloth in the same direction.

5. Remove the ship and oilcloth. Submitting the vessel

Necessary equipment: ship, oilcloth, screen, disinfectant solution.

If a seriously ill person has an urge to defecate or urinate, the following is necessary (Fig. 6-6):

1. Separate him with a screen from those around him, put an oilcloth under the patient's basin.

2. Rinse the boat with warm water, leaving some water in it.

3. Bring the left hand to the side under the sacrum of the patient, helping him to raise the pelvic area (while his legs should be bent at the knees).

4. With your right hand, bring the vessel under the patient's buttocks so that the perineum is above the opening of the vessel.

5. Cover the patient with a blanket and leave him alone for a while.

6. Empty the contents of the vessel into the toilet by rinsing the vessel with hot water.

7. Wash the patient, dry the perineum, remove the oilcloth.

8. Disinfect the vessel with a disinfectant solution.

Oral Cavity Care

Each person needs to follow the basic rules of oral care:

Rinse your mouth with water after each meal;

Brush your teeth at night and in the morning, as during the night the surface of the mucous membrane of the mouth and teeth is covered with a soft plaque consisting of epithelial cells, mucus and microorganisms.

In patients, the formation of plaque is accelerated, since metabolic products begin to be released through the mucous membrane of the oral cavity: nitrogenous substances with renal failure, glucose for diabetes mellitus, mercury for mercury poisoning, etc. These substances contaminate the mucous membrane and often lead to intensive reproduction of microorganisms. Care for the oral cavity of critically ill patients should be more careful; is being carried out by his nurse.

Oral examination

The patient opens his mouth. Nurse with a spatula pulls the patient's lips and cheeks. When examining the palatine tonsils and back wall the pharynx is pressed with a spatula on the root of the tongue and the patient is asked to pronounce the sound "A-A-A". When examining the oral cavity, tonsils and pharynx, enhanced lighting is needed, for which a reflector lamp can be used.

Mouthwash

After each meal, the patient is advised to rinse his mouth with 0.5% sodium bicarbonate solution (baking soda solution) or 0.9% sodium chloride solution ( saline). After that, they wipe the tongue: a sterile gauze napkin is applied to the tip of the tongue, the tip of the tongue is pulled out of the oral cavity with the left hand, and with the right hand, a wet cotton ball clamped in tweezers is removed from the surface of the tongue and the tongue is lubricated with glycerin.

Oral rinsing

Rinsing of the oral cavity is carried out using a syringe, a rubber balloon, Esmarch mug * with a rubber tube and a glass tip. Apply weak solutions: 0.5% sodium bicarbonate, 0.9% sodium chloride, 0.6% hydrogen peroxide, potassium permanganate (1:10 000), etc. The patient is seated or given a half-sitting position with a slightly tilted head so that liquid did not enter the respiratory tract. The neck and chest are covered with oilcloth, and a basin or tray is placed under the chin. In a patient lying on his back, the head should be turned; if possible, the patient himself is turned to one side. The corner of the mouth is pulled back with a spatula and a stream of water under moderate pressure is washed first at the vestibule of the oral cavity, and then the oral cavity itself. If a seriously ill patient has removable dentures, they should be removed (and washed) before the procedure.

Rubbing the mouth and teeth

Required equipment: spatula, cotton balls, tweezers, antiseptic solution (2% sodium bicarbonate solution, weak solution of potassium permanganate) or warm boiled water.

* Esmarch's mug is a special mug for enemas and douching. Proposed German doctor Friedrich von Esmarch (1823-1908).

The order of the procedure:

2. Wrap the tongue with a sterile gauze pad and gently pull it out of the mouth with your left hand.

3. Take a cotton ball in your right hand with tweezers, moisten it with an antiseptic solution and, removing plaque, wipe your tongue.

4. Let go of the tongue, change the tampon and wipe the teeth from the inside and outside.

5. Ask the patient to rinse his mouth (if he is able).

Rinsing (irrigation) of the oral cavity

Necessary equipment: Esmarch mug with a glass tip and a rubber tube (or a pear-shaped balloon or Janet's syringe *), oilcloth, kidney-shaped tray, spatula, antiseptic solution.

The order of the procedure:

1. Prepare for the procedure: lay out the necessary equipment, put on gloves.

2. Collect warm antiseptic solution in Esmarch's mug and hang it 1 m above the patient's head.

3. Turn the patient's head to one side (otherwise he may choke!), Cover the neck and chest with oilcloth, bring the tray to the chin.

4. Pull off the corner of the mouth with a spatula, insert the tip into the vestibule of the mouth and rinse it with a stream of liquid under moderate pressure.

5. Rinse one by one the left, then the right cheek space (pull the cheek with a spatula).

6. Take off gloves, wash your hands.

Oral cavity lubrication

Lubrication of the oral cavity is prescribed for diseases of the oral mucosa.

* Janet's syringe - a syringe for washing, characterized by a significant capacity (100-200 ml); For convenience, there are soldered rings at the end of the rod and on the ring that surrounds the glass barrel of the syringe. Proposed by the French urologist J. Janet (1861-1940).

Required equipment: boiled spatula and tweezers, several sterile cotton balls, sterile tray, medicine, flat glass vessel.

The order of the procedure:

1. Prepare for the procedure: lay out the necessary equipment, put on gloves.

2. Pour a small amount of the medicine from the bottle into a flat glass container.

3. Ask the patient to open his mouth.

4. Take a cotton ball with tweezers, moisten it with medicine.

5. Using a spatula, press a cotton ball to the affected area of the mucous membrane.

6. Then take a fresh ball of medicine and apply it to another site of the lesion.

7. Take off gloves, wash your hands.

Taking a swab from the mucous membrane of the mouth, nose and throat

A sterile metal shaving brush is used (a cotton swab fixed on a wire and passed through a stopper into a sterile test tube). For sowing, a discharge of ulcers or plaque is usually taken from the tonsils, palatine arches and the oral mucosa. The patient is seated in front of a light source, asked to open his mouth wide. With a spatula in the left hand, press the root of the patient's tongue, with the right hand, remove the shaving brush from the test tube by the outer part of the cork and carefully, without touching anything, reach the plaque, remove the plaque or discharge with the shaving brush. To take a swab from the nose, the shaving brush is very carefully, without touching the outer surface of the nose, injected first into one and then into the other nasal passage and the material for inoculation is taken. After taking smears, they should be immediately sent to the laboratory with the name of the patient, his age, room number, department name, date, name of the material and the purpose of the study.

Taking a throat swab

Required equipment: sterile metal shaving brush in a glass test tube with a stopper, spatula. The order of the procedure:

1. Prepare for the procedure: lay out the necessary equipment, put on gloves.

2. Sit down the patient in front of a light source, ask him to open his mouth wide.

3. With a spatula in the left hand, press the root of the patient's tongue.

4. With your right hand, remove the swab from the test tube by the outer part of the cork and, without touching the mucous membrane of the oral cavity, run the swab along the arches and palatine tonsils.

5. Carefully, without touching the outer surface of the tube, insert the inoculum swab into the tube.

6. Take off gloves, wash your hands.

7. Fill in the referral (last name, first name, patronymic of the patient, "Throat swab", date and purpose of the study, the name of the medical institution).

8. Send the test tube to the laboratory (with a referral).

EYE CARE

To remove purulent discharge, the eyes are washed with a 3% solution of boric acid, a solution of rivanol or a weak solution of potassium permanganate (having a pink color) from a rubber can or a gauze swab. To collect the flowing fluid, a tray is used, which the patient himself holds under the chin. At inflammatory diseases the eyes are instilled with drugs or rubbed in eye ointments.

Morning eye toilet

Necessary equipment: sterile tampons (8-10 pieces), antiseptic solution (0.02% nitrofural solution, 1-2% sodium bicarbonate solution), sterile tray.

The order of the procedure:

1. Wash hands thoroughly.

2. Put the tampons in the tray and pour the antiseptic solution.

3. Slightly squeeze the tampon and wipe the eyelashes and eyelids of the patient with it in the direction from the outer corner of the eye to the inner one; discard the tampon.

4. Take another swab and repeat the rubbing 4-5 times (with different swabs).

5. Blot the remaining solution in the corners of the patient's eyes with a dry swab.

Rinsing the eyes

Required equipment: special glass cup with stem, medicinal solution.

The order of the procedure:

1. Pour the medicinal solution into a glass and place it on the table in front of the patient.

2. Ask the patient to take the glass by the leg with his right hand, tilt his face so that the eyelids are in the glass, press the glass to the skin and raise his head (while the liquid should not flow out).

3. Ask the patient to blink frequently for 1 minute without taking the glass away from his face.

4. Ask the patient to put the glass on the table without taking the glass away from his face.

5. Pour fresh solution and ask the patient to repeat the procedure (8-10 times).

Instillation of drops in the eyes

Required equipment: sterile eyedropper, bottle with eye drops.

The order of the procedure (Fig. 6-7):

1. Check the consistency of the name of the drops as prescribed by the doctor.

2. Collect the required number of drops (2-3 drops for each eye).

3. In the sitting or lying position of the patient, ask him to throw his head back and look up.

4. Pull back the lower eyelid and, without touching the eyelashes (do not bring the pipette closer than 1.5 cm to the eye), drip drops into the conjunctival fold of one and then the other eye.

Required equipment: tube with eye ointment... The order of the procedure (Fig. 6-8):

2. Pull the patient's lower eyelid off with the thumb.

3. Holding the tube at the inner corner of the eye and advancing it so that the "cylinder" of the ointment is located along the entire eyelid and extends beyond the outer lid adhesion, squeeze the ointment from the tube onto the conjunctiva of the lower eyelid along the border with the eyeball.

Rice. 6-7. Instillation of eye drops

Rice. 6-8. Applying eye ointment from a tube

4. To release the lower eyelid: the ointment will press against the eyeball.

5. Remove the tube from the eyelids.

Applying eye ointment with a glass stick

Required equipment: sterile glass stick, bottle of eye ointment.

The order of the procedure:

1. Sit the patient in front of you and ask him to tilt his head back slightly and look up.

2. Pick up the ointment from the bottle on the stick so that it covers the entire spatula.

3. Place the stick horizontally near the eye so that the spatula with the ointment is directed towards the nose.

4. Pull the lower eyelid and lay a spatula behind it with ointment to the eyeball, and the free surface to the eyelid.

5. Let go of the lower eyelid and ask the patient to close the eyelids without effort.

6. Remove the spatula from under the closed eyelids towards the temple.

EAR CARE

The patient needs to clean his ears 2-3 times a week so that sulfur plugs do not form. Sulfur falls out of the ear in the form of a lump.

Rice. 6-9. Janet's syringe

Rice. 6-10. Washing the ear canal

covs or crumbs. They can accumulate in the ear canal and form sulfur plugs; at the same time, hearing is sharply reduced. In such cases, the ear canal is flushed.

Washing the ear canal

Required equipment: Janet syringe (Fig. 6-9) with a capacity of 100-200 ml, water (36-37 ° C), kidney-shaped tray, cotton wool, glycerin drops.

The order of the procedure (Fig. 6-10):

1. Draw water into Janet's syringe.

2. Sit the patient in front of you sideways so that the light falls on his ear.

3. In the hands of the patient give a tray, which the patient must press to the neck under the auricle.

4. With your left hand, pull the auricle up and back, and with your right hand, insert the tip of the syringe into the external auditory canal. To pump a stream of liquid in jerks along the upper-posterior wall of the ear canal.

5. Ear canal dry with cotton wool after rinsing.

6. If the cork cannot be removed, soften it with soda-glycerin drops. Within 2-3 days, 7-8 heated drops should be poured into the ear canal 2-3 times a day. It is necessary to warn the patient that after the infusion of drops, hearing may deteriorate somewhat for a while.

Rice. 6-11. Instilling drops in the ear

Instilling drops in the ear

Required equipment: pipette, bottle with ear drops, sterile cotton wool.

The order of the procedure (Fig. 6-11):

1. Tilt the patient's head to the side opposite to the ear into which the drops will be instilled.

2. Pull the patient's auricle back and up with the left hand, and use a pipette in the right hand to drip drops into the ear canal.

3. Suggest the patient to remain in the tilted head position for 15-20 minutes (so that the liquid does not flow out of the ear), then wipe the ear with sterile cotton wool.

NOSE CARE

Taking a swab from the nose

Required equipment: sterile metal swab in a glass test tube, spatula. The order of the procedure:

1. Sit down the patient (the head should be slightly thrown back).

2. Take the test tube in your left hand, remove the shaving brush from the test tube with your right hand.

3. With the left hand, lift the tip of the patient's nose, with the right hand - introduce the shaving brush with light rotational movements into the lower nasal passage on one side, then on the other side.

Rice. 6-12. Removal of nasal crusts

4. Carefully, without touching the outer surface of the tube, insert the inoculum swab into the tube.

5. Fill in the referral (last name, first name, patronymic of the patient, "Swab from the nose", date and purpose of the study, the name of the medical institution).

6. Send the test tube to the laboratory.

Removal of nasal crusts

Necessary equipment: nasal probe, cotton wool, liquid paraffin (or glycerin). The order of the procedure (Fig. 6-12):

1. Wrap cotton wool soaked in Vaseline oil around the probe.

2. Insert the probe into the patient's nasal passage, and then remove the crusts with rotary movements.

Instillation of drops in the nose

Equipment required: pipette, bottle with nasal drops. The order of the procedure:

1. Tilt the patient's head to the side opposite to the nasal passage into which drops will be instilled.

2. Instill drops into the nasal passage.

3. After 1-2 minutes, drip the drops into the other nasal passage.

HAIR CARE

It is necessary to ensure that dandruff does not form in the hair of patients. To do this, you need to wash your hair once a week using shampoo and toilet soap. Seriously ill people wash their heads in bed. For this, a basin is placed at the head end of the bed, and the patient throws his head back so that it is above the basin. You should lather the scalp well, then the hair, rinse it with warm water, wipe it dry and comb it. After washing, a towel or kerchief is tied over the head.