Basic principles of patient care. Nursing

For the care of seriously ill patients, an individual post can be organized both in a hospital and at home. Having taken up duty, the nurse or paramedic is constantly at the bedside of the patient, caring for him.

While on duty, the nurse constantly keeps a detailed hourly record of all appointments made, and also records complaints, pulse, respiration, body temperature, blood pressure, sputum, urine, meal times, and the presence of stools. The nurse monitors the personal hygiene of the patient, if necessary, changes underwear and bedding, prevents bedsores, feeds and waters. If the patient did not have a chair for 2 days, she puts a cleansing enema; if he does not urinate on his own, he lets out urine with a catheter 1-2 times a day.

The bed of a geriatric patient should be at least 60 cm and have devices for transferring a person to a sitting position. For seriously ill patients who need to raise the upper body, a headrest is used, as well as a footrest, so that the patient maintains the position that was given to him. The blanket should be light but warm. For the prevention of bedsores in bedridden patients, the elasticity of the mattress is of great importance. It should be flexible enough to support the entire body and eliminate pressure on individual areas.

For the prevention of bedsores and diaper rash, especially in patients with urinary and fecal incontinence, be sure to wash the patients and treat the natural folds of the skin. This manipulation should also be correctly performed, since if the procedure is performed incorrectly, an infection can be introduced from the anus into the genitourinary system.

The hair is washed with warm water and soap and gently combed, the nails are systematically cut. In patients who are on bed rest for a long time, thick keratinized layers sometimes form on the plantar side of the feet. They are removed while washing the feet with a pumice stone, and sometimes with special exfoliating ointments as prescribed by a doctor.

Careful oral care is required. Brush your teeth and the back of your tongue with a toothbrush at least twice a day; after each meal, the patient should rinse his mouth. Seriously ill teeth are wiped with a cotton ball soaked in a 0.5% solution of baking soda or in a slightly pink solution of potassium permanganate. The oral cavity is washed with a rubber balloon or drinking bowl with weak solutions of baking soda, borax, potassium permanganate. To do this, the patient is given a position with his head slightly tilted forward so that the liquid drains more easily and does not enter the respiratory tract, while pulling the corner of the mouth for better outflow.

Ears are washed regularly with warm water and soap. Sulfur from the auditory canal is carefully removed with a cotton flagellum, after having dripped a few drops of a 3% hydrogen peroxide solution into the external auditory canal. In this case, the head is tilted in the opposite direction, and the auricle is slightly pulled back and up. Do not remove wax from the ears with a match, hairpin and the like, because. this can accidentally damage the eardrum, as well as the external auditory canal, which can cause otitis externa.

With discharge from the eyes that stick together eyelashes and eyelids (more common in children), during the morning toilet, the eyes are gently washed with warm water using a cotton swab. With discharge from the nose and the formation of crusts, they are removed, after softening, for which vaseline oil or glycerin is instilled into the nose; the nose is carefully cleaned with a cotton wick.

The bedpan is served to the patient clean, disinfected. Before use, pour a little water into it. The vessel is brought under the buttocks, placing the free hand under the sacrum and lifting the patient so that the perineum is above the opening of the vessel. The feces should be immediately drained, the vessel thoroughly washed with hot water and disinfected with a 3% solution of Lysol or chloramine. After defecation, a toilet is performed on the perineum and skin folds around the anus.

The urinal is served well washed, warm. After each urination, urine is poured out, the urinal is washed with a solution of potassium permanganate or soda. Women use a vessel to urinate.

The basic principles of nutrition are the correct ratio of proteins, carbohydrates, fats, mineral salts, vitamins, a rational regimen. Food is taken at 34-hour intervals at the same hours. Overnutrition should be avoided. It is irrational to feed seriously ill patients with delicacies and products containing fat. For many diseases, the doctor prescribes a special diet or recommends an individual diet, methods of culinary food processing.

A sparing diet (exclusion of irritants: chemical spices, mechanical plentiful and solid food, thermal very hot or cold food) is prescribed, first of all, for diseases of the digestive system, kidneys, heart and blood vessels, obesity, diabetes mellitus. For a number of diseases, fractional meals (frequent, in small portions) are recommended. However, for each disease, the attending physician establishes an individual diet, which caregivers should be familiar with.

Bedridden, debilitated and febrile patients should be fed only freshly prepared food. Seriously ill people are given food at the time when their condition improves. Pureed or chopped food from a spoon in small portions, drinking and liquid food (broth, jelly, pureed soup) from a drinking bowl. For food, the patient's daytime sleep should not be interrupted.

Proper general patient care is one of the most important factors influencing his speedy recovery. Carrying out a set of measures aimed at restoring and maintaining the patient's strength, it is possible to prevent possible complications, and quickly return him to a full life. General patient care in the therapeutic clinic is provided by nurses who provide both physical and psychosocial support. That is why the concept of “general care” is synonymous with the concept of “nursing”.

Fundamentals of General Nursing

The complexity of care lies in the fact that each patient is individual, he has his own habits and character. Sometimes the patient is not able to think clearly and give an account of his actions and deeds. This makes it necessary for the carer to have such skills as patience, vigilance, compassion, the ability to think clearly in an unusual situation.

General care for patients with a therapeutic profile is necessary for all patients, regardless of the type of their disease. This concerns, as a rule, the satisfaction of the natural needs of the body: the patient needs food, drink, personal hygiene. It is very important to help the patient to be active. A light stretch in bed or a short walk will have a positive impact on both physical and mental health. No less important are the conditions in which the patient lives: silence, clean linen, respect for oneself and one's needs.

Basic Rules

There are several general rules for patient care. More about them.

First of all, the care provided to the patient should depend on the prescriptions of the attending physician. The patient may not be able to get out of bed, or may not have significant restrictions in movement. This or that regimen prescribed by the doctor determines the amount of care needed. Nevertheless, it is necessary even for those who are able to serve themselves on their own.

Ideally, patients should be in a bright room, isolated from noise, and have fresh air. Even such basic amenities as comfortable temperature, silence, abundance of light and clean air have a beneficial effect on the body, regardless of the type of disease.

Cleanliness is the key to health. Cleaning of the room in which the patient is located should be carried out at least twice a day to avoid accumulation of dust. The patient's bedding and underwear should also be kept clean. It must be changed in such a way as not to create unnecessary pain and tension for the patient.

Washing is necessary every morning and evening. If there are no restrictions from the doctor, then the patient is allowed to wash in the shower or in the bath. Bedridden patients should be wiped daily with wet swabs, paying special attention to places where diaper rash often occurs: armpits, groin, skin folds.

The body, exhausted by the disease, needs a constant supply of nutrients. Proteins, fats, carbohydrates and vitamins must be supplied in a balanced amount at the same time, as it is necessary to follow the diet. Many diseases require a special diet or a special diet prescribed by a doctor.

Another important rule is monitoring the patient's condition. The doctor should be aware of the changes that occur with the patient: well-being, activity, psycho-emotional state, color of natural secretions. Timely detection of deviations will allow them to be eliminated faster, preventing the development of complications.

Psychological help

Another general principle of caring for a sick person requires knowledge not only in medicine, but also in psychology: illness is stress, and people tolerate it differently, sometimes becoming capricious and irritable or withdrawn and uncommunicative. The emotional state in the process of recovery plays a significant role, therefore, caregivers should observe medical ethics - a respectful attitude towards the patient, an interest in a speedy recovery. Properly built dialogue and a good attitude will set the patient in a positive way.

What is a hospital?

Patients are cared for in the hospital. A hospital is a medical institution where patients stay for a long time, there are all the necessary conditions for this.

Types of hospitals

Typically, the following types of hospitals are distinguished:

• daytime - allow you to carry out procedures that cannot be performed at home, but at the same time, long-term hospitalization is not required;
• round-the-clock - necessary for treatment under the constant supervision of doctors;
• surgical - designed to restore patients after surgery;
• at home - is created at stationary medical institutions, whose doctors provide all the necessary medical care to the patient at home.

Hospital profiles

Hospitals also differ in profile, depending on the treatment of which diseases they specialize in. This determines the level of qualification of doctors and medical personnel, the equipment of the medical institution with everything necessary to fulfill its task. According to the profile in a broad sense, there are two types of hospitals:

• multidisciplinary - work with various types of diseases;
• monoprofile or specialized - are engaged in the treatment and rehabilitation of patients with a certain pathology.

What medical departments are there?

Each medical institution is divided into departments according to its structure, among which the main one is medical. Medical departments also differ in profile: general and specialized. General departments usually provide therapeutic and surgical care, while specialized departments work with diseases of a specific body system. In addition, there is a reception and diagnostic department, a laboratory.

General and specialized care - application algorithms

By specialization, not only inpatient medical institutions differ, but also the types of care provided. In addition to general patient care, there is also specialized care for patients with a specific disease. If the first is designed to create comfortable conditions and ensure vital processes, then the second is aimed directly at treating the disease. Health professionals caring for the patient must have a wide range of skills and knowledge necessary for the rehabilitation of the ward.

Patient care is carried out according to a clear algorithm. First of all, a diagnosis of the state of health is carried out, and then the caregiver determines what needs the ward is unable to satisfy on his own, what is the degree of these difficulties. Based on this, the patient's response to his illness and condition is revealed, the so-called "nursing diagnosis" is made, which includes a list of existing and potential physiological, psychological problems of the patient associated with the disease.

The next step is planning - for each problem, a goal and a care plan are formed. Within the limits of their strength and competence, medical personnel set realistic and achievable goals for the short or long term. They should be accessible to the patient for understanding, set out in simple language without complex terms. Throughout the time spent in the hospital, care is provided, specialized procedures necessary for recovery are performed. Due to the fact that the state of the ward is changeable, it is important to track changes and make adjustments to the developed plan.

A correct diagnosis and prescribed treatment is only half of the recovery. Fulfillment of doctor's prescriptions, observance of hygiene and dietary standards, a favorable emotional background play an equally important role. The combination of general and specialized care will seriously speed up the recovery process of the ward, and prevent possible complications.

THE CONCEPT OF CARE OF SURGICAL PATIENTS

Surgery is a special medical specialty that uses methods of mechanical action on body tissues or a surgical operation for the purpose of treatment, which causes a number of serious differences in the organization and implementation of care for surgical patients.

Surgery- this is a complex targeted diagnostic or, most often, therapeutic action associated with the methodical separation of tissues, aimed at accessing the pathological focus and its elimination, followed by the restoration of the anatomical relationships of organs and tissues.

The changes that occur in the body of patients after surgery are extremely diverse and include functional, biochemical and morphological disorders. They are caused by a number of reasons: fasting before and after surgery, nervous tension, surgical trauma, blood loss, cooling, especially during abdominal operations, a change in the ratio of organs due to the removal of one of them.

Specifically, this is expressed by the loss of water and mineral salts, the breakdown of protein. Thirst, insomnia, pain in the wound area, impaired motility of the intestines and stomach, impaired urination, etc. develop.

The degree of these changes depends on the complexity and volume of the surgical operation, on the patient's initial state of health, on age, etc. Some of them are easily expressed, while in other cases they seem significant.

Regular deviations from normal physiological processes are most often a natural response to surgical trauma and do not partially require elimination, since the homeostasis system independently normalizes them.

Properly organized patient care sometimes remains the only important element in postoperative surgery, which may be quite enough for a complete and quick cure of the patient.

Professional care of patients after operations involves knowledge of both the regular changes in their general condition, local processes, and the possible development of complications.

CARE is one of the important elements in the treatment of the patient, organized on the basis of professional knowledge of possible changes or complications in patients after surgery and is aimed at timely prevention and elimination of them.

The amount of care depends on the condition of the patient, his age, the nature of the disease, the volume of surgery, the prescribed regimen, and the complications that arise.

Nursing is a help to the sick in his infirm state and the most important element of medical activity.

In severe postoperative patients, care includes assistance in meeting the basic needs of life (food, drink, movement, emptying the intestines, bladder, etc.); carrying out personal hygiene measures (washing, prevention of bedsores, change of linen, etc.); help during painful conditions (vomiting, coughing, bleeding, respiratory failure, etc.).

In surgical practice, in patients suffering from pain, who are in fear before or after surgery, care involves an active position on the part of the staff. Surgical patients, especially severe postoperative patients, do not ask for help. Any care measures bring them additional painful discomfort, so they have a negative attitude to any attempts to activate the motor mode, to perform the necessary hygiene procedures. In these situations, personnel must exercise caring, patient perseverance.

An important component of patient care is to create maximum physical and mental rest. Silence in the room where the patients are, a calm, even, benevolent attitude of the medical staff towards them, the elimination of all adverse factors that can injure the patient's psyche - these are some of the basic principles of the so-called medical-protective regime of medical institutions, on which the effectiveness largely depends treatment of patients. For a good outcome of the disease, it is very important that the patient is in a calm, physiologically comfortable position, in good hygienic conditions, and receives a balanced diet.

The caring, warm, attentive attitude of medical personnel contributes to recovery.

SANITARY PREPARATION OF THE PATIENT FOR OPERATION

The preoperative period occupies an important place in the system of treatment and its organization. This is a certain period of time necessary to establish a diagnosis and bring the vital functions of organs and systems to vital levels.

Preoperative preparation is carried out in order to reduce the risk of surgery, to prevent possible complications. The preoperative period can be very short during emergency operations and relatively extended during elective operations.

General preparation for planned operations includes all studies related to establishing a diagnosis, identifying complications of the underlying disease and concomitant diseases, and determining the functional state of vital organs. When indicated, drug treatment is prescribed, aimed at improving the activity of various systems, in order to lead to a certain readiness of the patient's body for surgical intervention. The result of the upcoming treatment largely depends on the nature and conduct, and ultimately on the organization of the preoperative period.

It is advisable to postpone planned operations during menstruation, even with a slight rise in temperature, a slight cold, the appearance of pustules on the body, etc. Mandatory sanitation of the oral cavity.

The duties of junior and middle staff include sanitary preparation of the patient. It usually starts the evening before the operation. The patient is explained that the operation must be performed on an empty stomach. In the evening, patients receive a light supper, and in the morning they cannot eat or drink.

In the evening, in the absence of contraindications, all patients are given a cleansing enema. Then the patient takes a hygienic bath or shower, he is changed underwear and bed linen. At night, according to the doctor's prescription, the patient is given sleeping pills or sedatives.

In the morning immediately before the operation, the hair from the future surgical field and its circumference is widely shaved, taking into account the possible expansion of access. Before shaving, the skin is wiped with a disinfectant solution and allowed to dry, and after shaving, it is wiped with alcohol. These activities can not be done in advance, as it is possible to infect abrasions and scratches obtained during shaving. A few hours are enough to turn them into a focus of infection with the subsequent development of postoperative complications.

In the morning the patient washes, brushes his teeth. The dentures are taken out, wrapped in gauze and placed in the nightstand. A cap or scarf is put on the scalp. Braids are braided for women with long hair.

After premedication, the patient is taken to the operating room on a gurney, accompanied by a nurse dressed in a clean gown, cap and mask.

For patients admitted on an emergency basis, the volume of sanitary preparation depends on the urgency of the necessary operation and is determined by the doctor on duty. Mandatory activities are emptying the stomach with a gastric tube and shaving the scalp of the surgical field.

HYGIENE OF THE BODY, UNDERWEAR, DISCHARGE OF THE PATIENT

IN THE POSTOPERATIVE PERIOD

The postoperative period is a period of time after the operation, which is associated with the completion of the wound process - wound healing, and stabilization of the reduced and affected functions of life-supporting organs and systems.

Patients in the postoperative period distinguish between active, passive and forced position.

An active position is characteristic of patients with relatively mild diseases, or in the initial stage of severe diseases. The patient can independently change position in bed, sit down, get up, walk.

The passive position is observed in the unconscious state of the patient and, less often, in case of extreme weakness. The patient is motionless, remains in the position that was given to him, the head and limbs hang down due to their gravity. The body slides off the pillows to the lower end of the bed. Such patients require special monitoring by the medical staff. It is necessary from time to time to change the position of the body or its individual parts, which is important in the prevention of complications - bedsores, hypostatic pneumonia, etc.

The patient takes a forced position to stop or weaken his painful sensations (pain, cough, shortness of breath, etc.).

Care of patients with a general regime after surgery is reduced mainly to the organization and control over their compliance with hygiene measures. Severely ill patients with bed rest need active assistance in caring for the body, linen and in the implementation of physiological functions.

The competence of medical personnel includes the creation of a functionally advantageous position for the patient, conducive to recovery and prevention of complications. For example, after surgery on the abdominal organs, it is advisable to position with a raised head end and slightly bent knees, which helps to relax the abdominal press and provides peace to the surgical wound, favorable conditions for breathing and blood circulation.

To give the patient a functionally advantageous position, special head restraints, rollers, etc. can be used. There are functional beds, consisting of three movable sections, which allow you to smoothly and silently give the patient a comfortable position in bed with the help of handles. The legs of the bed are equipped with wheels for moving it to another place.

An important element in the care of critically ill patients is the prevention of bedsores.

A bedsore is a necrosis of the skin with subcutaneous tissue and other soft tissues, which develops as a result of their prolonged compression, disorders of local blood circulation and nervous trophism. Bedsores usually form in severe, weakened patients who are forced to be in a horizontal position for a long time: when lying on the back - in the region of the sacrum, shoulder blades, elbows, heels, on the back of the head, when the patient is positioned on his side - in the region of the hip joint, in the projection of the greater trochanter femur.

The occurrence of bedsores is facilitated by poor patient care: untidy maintenance of the bed and underwear, uneven mattress, crumbs of food in the bed, prolonged stay of the patient in one position.

With the development of bedsores, reddening of the skin, soreness first appears on the skin, then the epidermis is exfoliated, sometimes with the formation of blisters. Next, necrosis of the skin occurs, spreading deep into and to the sides with the exposure of muscles, tendons, and periosteum.

To prevent bedsores, change the position every 2 hours, turning the patient, while examining the places of possible occurrence of pressure sores, wiping with camphor alcohol or another disinfectant, performing a light massage - stroking, patting.

It is very important that the bed of the patient is tidy, the mesh is well stretched, with a smooth surface, a mattress without bumps and depressions is placed on top of the mesh, and a clean sheet is placed on it, the edges of which are tucked under the mattress so that it does not roll down and does not gather into folds.

For patients suffering from urinary incontinence, feces, with abundant discharge from wounds, it is necessary to put an oilcloth across the entire width of the bed and bend its edges well to prevent contamination of the bed. A diaper is laid on top, which is changed as needed, but at least every 1-2 days. Wet, soiled linen is changed immediately.

A rubber inflatable circle covered with a diaper is placed under the sacrum of the patient, and cotton-gauze circles are placed under the elbows and heels. It is more effective to use an anti-decubitus mattress, which consists of many inflatable sections, the air pressure in which periodically changes in waves, which also periodically changes the pressure on different parts of the skin in waves, thereby producing a massage, improving skin blood circulation. When superficial skin lesions appear, they are treated with a 5% solution of potassium permanganate or an alcohol solution of brilliant green. Treatment of deep bedsores is carried out according to the principle of treatment of purulent wounds, as prescribed by a doctor.

Change of bed and underwear is carried out regularly, at least once a week, after a hygienic bath. In some cases, linen is changed additionally as needed.

Depending on the condition of the patient, there are several ways to change bed and underwear. When the patient is allowed to sit, he is transferred from bed to a chair, and the junior nurse makes the bed for him.

Changing a sheet under a seriously ill patient requires a certain skill from the staff. If the patient is allowed to turn on his side, you must first gently raise his head and remove the pillow from under it, and then help the patient turn on his side. On the vacated half of the bed, located on the side of the patient's back, you need to roll up a dirty sheet so that it lies in the form of a roller along the patient's back. On the vacated place you need to put a clean, also half-rolled sheet, which in the form of a roller will lie next to the roller of the dirty sheet. Then the patient is helped to lie on his back and turn on the other side, after which he will be lying on a clean sheet, turning to face the opposite edge of the bed. After that, the dirty sheet is removed and the clean one is straightened.

If the patient cannot move at all, you can change the sheet in another way. Starting from the lower end of the bed, roll the dirty sheet under the patient, lifting his shins, thighs and buttocks in turn. The roll of the dirty sheet will be under the patient's lower back. A clean sheet rolled up in the transverse direction is placed on the foot end of the bed and straightened towards the head end, also raising the lower limbs and buttocks of the patient. A roller of a clean sheet will be next to a roller of a dirty one - under the lower back. Then one of the orderlies slightly raises the head and chest of the patient, while the other at this time removes the dirty sheet, and straightens a clean one in its place.

Both ways of changing the sheet, with all the dexterity of the caregivers, inevitably cause a lot of anxiety to the patient, and therefore it is sometimes more expedient to put the patient on a gurney and make the bed, especially since in both cases it is necessary to do this together.

In the absence of a wheelchair, you need to shift the patient together to the edge of the bed, then straighten the mattress and sheet on the freed half, then transfer the patient to the cleaned half of the bed and do the same on the other side.

When changing underwear in seriously ill patients, the nurse should bring her hands under the patient's sacrum, grab the edges of the shirt and carefully bring it to the head, then raise both hands of the patient and transfer the rolled shirt at the neck over the patient's head. After that, the hands of the patient are released. The patient is dressed in the reverse order: first they put on the sleeves of the shirt, then throw it over the head, and, finally, straighten it under the patient.

For very sick patients, there are special shirts (undershirts) that are easy to put on and take off. If the patient's arm is injured, first remove the shirt from the healthy arm, and only then from the patient. They put on the sick hand first, and then the healthy one.

In severe patients who are on bed rest for a long time, various disorders of the skin condition may occur: pustular rash, peeling, diaper rash, ulceration, bedsores, etc.

It is necessary to wipe the skin of patients daily with a disinfectant solution: camphor alcohol, cologne, vodka, half alcohol with water, table vinegar (1 tablespoon per glass of water), etc. To do this, take the end of the towel, moisten it with a disinfectant solution, wring it out slightly and begin to wipe it behind the ears, neck, back, front surface of the chest and in the armpits. Pay attention to the folds under the mammary glands, where diaper rash can form in obese women. Then dry the skin in the same order.

A patient who is on bed rest should wash his feet two or three times a week, placing a basin of warm water at the foot end of the bed. In this case, the patient lies on his back, the junior nurse lathers his feet, washes, wipes, and then cuts his nails.

Severely ill patients cannot brush their teeth on their own, therefore, after each meal, the nurse must treat the patient's mouth. To do this, she alternately takes the patient’s cheek from the inside with a spatula and wipes the teeth and tongue with tweezers with a gauze ball moistened with a 5% solution of boric acid, or a 2% solution of sodium bicarbonate, or a weak solution of potassium permanganate. After that, the patient rinses his mouth thoroughly with the same solution or just warm water.

If the patient is not able to rinse, then he should irrigate the oral cavity with Esmarch's mug, rubber pear or Janet's syringe. The patient is given a semi-sitting position, the chest is covered with an oilcloth, a kidney-shaped tray is brought to the chin to drain the washing liquid. The nurse alternately pulls the right and then the left cheek with a spatula, inserts the tip and irrigates the oral cavity, washing away food particles, plaque, etc. with a jet of liquid.

Severely ill patients often experience inflammation on the oral mucosa - stomatitis, gums - gingivitis, tongue - glossitis, which is manifested by reddening of the mucous membrane, salivation, burning, pain when eating, the appearance of ulcers and bad breath. In such patients, therapeutic irrigation is performed with disinfectants (2% chloramine solution, 0.1% furatsilin solution, 2% sodium bicarbonate solution, a weak solution of potassium permanganate). You can make applications by applying sterile gauze pads soaked in a disinfectant solution or painkiller for 3-5 minutes. The procedure is repeated several times a day.

If the lips are dry and cracks appear in the corners of the mouth, it is not recommended to open the mouth wide, touch the cracks and tear off the crusts that have formed. To alleviate the patient's condition, hygienic lipstick is used, lips are lubricated with any oil (vaseline, creamy, vegetable).

Dentures are removed at night, washed with soap, stored in a clean glass, washed again in the morning and put on.

When purulent secretions appear that stick together the eyelashes, the eyes are washed with sterile gauze swabs moistened with a warm 3% solution of boric acid. The movements of the tampon are made in the direction from the outer edge to the nose.

For instillation of drops into the eye, an eye dropper is used, and for different drops there must be different sterile pipettes. The patient throws his head back and looks up, the nurse pulls back the lower eyelid and, without touching the eyelashes, without bringing the pipette closer to the eye than 1.5 cm, instill 2-3 drops into the conjunctival fold of one and then the other eye.

Eye ointments are laid with a special sterile glass rod. The eyelid of the patient is pulled down, an ointment is laid behind it and rubbed over the mucous membrane with soft movements of the fingers.

In the presence of discharge from the nose, they are removed with cotton turundas, introducing them into the nasal passages with light rotational movements. When crusts form, it is necessary to first drip a few drops of glycerin, vaseline or vegetable oil into the nasal passages, after a few minutes the crusts are removed with cotton turundas.

Sulfur that accumulates in the external auditory canal should be carefully removed with a cotton swab, after having dripped 2 drops of a 3% hydrogen peroxide solution. To drip drops into the ear, the patient's head must be tilted in the opposite direction, and the auricle pulled back and up. After instillation of drops, the patient should remain in a position with his head tilted for 1-2 minutes. Do not use hard objects to remove wax from the ears because of the risk of damage to the eardrum, which can lead to hearing loss.

Due to their sedentary state, seriously ill patients require assistance in carrying out their physiological functions.

If it is necessary to empty the intestines, the patient, who is on strict bed rest, is given a vessel, and when urinating, a urinal.

The vessel can be metal with an enamel coating or rubber. The rubber vessel is used for debilitated patients, in the presence of bedsores, with incontinence of feces and urine. The vessel should not be tightly inflated, otherwise it will exert significant pressure on the sacrum. When giving the ship to the bed, be sure to put an oilcloth under it. Before serving, the vessel is rinsed with hot water. The patient bends his knees, the nurse brings his left hand to the side under the sacrum, helping the patient raise the pelvis, and with her right hand places the vessel under the patient's buttocks so that the perineum is above the opening of the vessel, covers the patient with a blanket and leaves him alone. After defecation, the vessel is removed from under the patient, its contents are poured into the toilet. The vessel is thoroughly washed with hot water, and then disinfected with a 1% solution of chloramine or bleach for an hour.

After each act of defecation and urination, patients should be washed away, otherwise maceration and inflammation of the skin are possible in the area of ​​​​the inguinal folds and perineum.

Washing is carried out with a weak solution of potassium permanganate or other disinfectant solution, the temperature of which should be 30-35 ° C. For washing, you need to have a jug, forceps and sterile cotton balls.

When washing away, a woman should lie on her back, bending her legs at the knees and slightly spreading them at the hips, a vessel is placed under the buttocks.

In the left hand, the nurse takes a jug with a warm disinfectant solution and pours water on the external genitalia, and with a forceps with a cotton swab clamped into it, movements are made from the genitals to the anus, i.e. top down. After that, wipe the skin with a dry cotton swab in the same direction, so as not to infect the anus into the bladder and external genitalia.

Washing can be done from an Esmarch mug equipped with a rubber tube, a clamp and a vaginal tip, directing a stream of water or a weak solution of potassium permanganate to the perineum.

Men are much easier to wash. The position of the patient on the back, legs bent at the knees, a vessel is placed under the buttocks. Cotton, clamped in a forceps, wipe the perineum dry, lubricate with vaseline oil to prevent diaper rash.

POSTOPERATIVE WOUND CARE

The local result of any operation is a wound, which is characterized by three major features: gaping, pain, bleeding.

The body has a perfect mechanism aimed at wound healing, which is called the wound process. Its purpose is to eliminate tissue defects and relieve the listed symptoms.

This process is an objective reality and occurs independently, passing through three phases in its development: inflammation, regeneration, reorganization of the scar.

The first phase of the wound process - inflammation - is aimed at cleansing the wound from non-viable tissues, foreign bodies, microorganisms, blood clots, etc. Clinically, this phase has symptoms characteristic of any inflammation: pain, hyperemia, swelling, dysfunction.

Gradually, these symptoms subside, and the first phase is replaced by the regeneration phase, the meaning of which is to fill the wound defect with young connective tissue. At the end of this phase, the processes of constriction (tightening of the edges) of the wound begin due to fibrous connective tissue elements and marginal epithelization. The third phase of the wound process, scar reorganization, is characterized by its strengthening.

The outcome in surgical pathology largely depends on the correct observation and care of the postoperative wound.

The process of wound healing is absolutely objective, takes place independently and is worked out to perfection by nature itself. However, there are reasons that impede the wound process, inhibit the normal healing of the wound.

The most common and dangerous cause that complicates and slows down the biology of the wound process is the development of infection in the wound. It is in the wound that microorganisms find the most favorable living conditions with the necessary humidity, comfortable temperature, and an abundance of nutritious foods. Clinically, the development of infection in the wound is manifested by its suppuration. The fight against infection requires a significant strain on the forces of the macroorganism, time, and is always risky in terms of generalization of the infection, the development of other serious complications.

Infection of the wound is facilitated by its gaping, since the wound is open to the ingress of microorganisms into it. On the other hand, significant tissue defects require more plastic materials and more time to eliminate them, which is also one of the reasons for the increase in wound healing time.

Thus, it is possible to promote the speedy healing of a wound by preventing its infection and by eliminating the gap.

In most patients, gaping is eliminated during the operation by restoring anatomical relationships by layer-by-layer suturing of the wound.

Care of a clean wound in the postoperative period comes down primarily to measures to prevent its microbial contamination by a secondary, nosocomial infection, which is achieved by strict adherence to well-developed asepsis rules.

The main measure aimed at preventing contact infection is the sterilization of all objects that may come into contact with the surface of the wound. Instruments, dressings, gloves, underwear, solutions, etc. are subject to sterilization.

Directly in the operating room after suturing the wound, it is treated with an antiseptic solution (iodine, iodonate, iodopyrone, brilliant green, alcohol) and closed with a sterile bandage, which is tightly and securely fixed by bandaging or with glue, adhesive plaster. If in the postoperative period the bandage is tangled or soaked with blood, lymph, etc., you must immediately notify the attending physician or the doctor on duty, who, after examination, instructs you to change the bandage.

With any dressing (removing the previously applied dressing, examining the wound and therapeutic manipulations on it, applying a new dressing), the wound surface remains open and, for a more or less long time, comes into contact with air, as well as with tools and other objects used in dressings. Meanwhile, the air of the dressing rooms contains significantly more microbes than the air of operating rooms, and often other rooms of the hospital. This is due to the fact that a large number of people are constantly circulating in the dressing rooms: medical staff, patients, students. Wearing a mask during dressings is mandatory in order to avoid droplet infection with saliva splashes, coughing, and breathing on the wound surface.

After the vast majority of clean operations, the wound is sutured tightly. Occasionally, between the edges of the sutured wound or through a separate puncture, the cavity of the hermetically sutured wound is drained with a silicone tube. Drainage is performed to remove wound secretions, remnants of blood and accumulating lymph in order to prevent wound suppuration. Most often, drainage of clean wounds is performed after breast surgery, when a large number of lymphatic vessels are damaged, or after operations for extensive hernias, when pockets in the subcutaneous tissue remain after the removal of large hernial sacs.

Distinguish passive drainage, when the wound exudate flows by gravity. With active drainage or active aspiration, the contents are removed from the wound cavity using various devices that create a constant vacuum in the range of 0.1-0.15 atm. Rubber cylinders with a sphere diameter of at least 8-10 cm, industrially manufactured corrugations, as well as modified aquarium microcompressors of the MK brand are used as a vacuum source with the same efficiency.

Postoperative care for patients with vacuum therapy, as a method of protecting an uncomplicated wound process, is reduced to monitoring the presence of a working vacuum in the system, as well as monitoring the nature and amount of wound discharge.

In the immediate postoperative period, air may be sucked in through skin sutures or leaky junctions of tubes with adapters. When the system is depressurized, it is necessary to create a vacuum in it again and eliminate the source of air leakage. Therefore, it is desirable that the device for vacuum therapy had a device for monitoring the presence of vacuum in the system. When using a vacuum of less than 0.1 atm, the system ceases to function on the very first day after the operation, since the tube is obturated due to thickening of the wound exudate. With a degree of rarefaction of more than 0.15 atm, clogging of the side holes of the drainage tube with soft tissues is observed with their involvement in the drainage lumen. This has a damaging effect not only on the fiber, but also on the young developing connective tissue, causing it to bleed and increase wound exudation. A vacuum of 0.15 atm allows you to effectively aspirate the discharge from the wound and have a therapeutic effect on the surrounding tissues.

The contents of the collections are evacuated once a day, sometimes more often - as they are filled, the amount of liquid is measured and recorded.

Collection jars and all connecting tubes are subjected to pre-sterilization cleaning and disinfection. They are first washed with running water so that no clots remain in their lumen, then they are placed in a 0.5% solution of synthetic detergent and 1% hydrogen peroxide for 2-3 hours, after which they are washed again with running water and boiled for 30 minutes.

If suppuration of the surgical wound has occurred or the operation was originally performed for a purulent disease, then the wound must be carried out in an open way, that is, the edges of the wound must be parted, and the wound cavity drained in order to evacuate pus, and create conditions for cleaning the edges and bottom of the wound from necrotic tissues .

Working in the wards for patients with purulent wounds, it is necessary to adhere to the rules of asepsis no less scrupulously than in any other department. Moreover, it is even more difficult to ensure the asepsis of all manipulations in the purulent department, since one must think not only about not contaminating the wound of a given patient, but also about how not to transfer the microbial flora from one patient to another. “Superinfection”, that is, the introduction of new microbes into a weakened organism, is especially dangerous.

Unfortunately, not all patients understand this and often, especially patients with chronic suppurative processes, are untidy, touch the pus with their hands, and then wash them poorly or not at all.

It is necessary to carefully monitor the condition of the bandage, which should remain dry and not contaminate the linen and furniture in the ward. Bandages often have to be bandaged and changed.

The second important sign of a wound is pain, which occurs as a result of an organic lesion of nerve endings and in itself causes functional disorders in the body.

The intensity of pain depends on the nature of the wound, its size and location. Patients perceive pain differently and react to it individually.

Intense pain can be the starting point of collapse and development of shock. Severe pains usually absorb the patient's attention, interfere with sleep at night, limit the patient's mobility, and in some cases cause a feeling of fear of death.

The fight against pain is one of the necessary tasks of the postoperative period. In addition to the appointment of medications for the same purpose, elements of a direct impact on the lesion are used.

During the first 12 hours after surgery, an ice pack is placed on the wound area. Local exposure to cold has an analgesic effect. In addition, cold causes contraction of blood vessels in the skin and underlying tissues, which contributes to thrombosis and prevents the development of hematoma in the wound.

To prepare the “cold”, water is poured into a rubber bladder with a screw cap. Before screwing the lid on, the air must be expelled from the bubble. Then the bubble is placed in the freezer until completely frozen. The ice pack should not be placed directly on the bandage; a towel or napkin should be placed under it.

To reduce pain, it is very important to give the affected organ or part of the body the correct position after the operation, in which maximum relaxation of the surrounding muscles and functional comfort for the organs are achieved.

After operations on the abdominal organs, a position with a raised head end and slightly bent knees is functionally beneficial, which helps to relax the muscles of the abdominal wall and provides peace to the surgical wound, favorable conditions for breathing and blood circulation.

The operated limbs should be in an average physiological position, which is characterized by balancing the action of antagonist muscles. For the upper limb, this position is the abduction of the shoulder to an angle of 60 ° and flexion to 30-35 °; the angle between the forearm and shoulder should be 110°. For the lower limb, flexion at the knee and hip joints is made up to an angle of 140 °, and the foot should be at a right angle to the lower leg. After the operation, the limb is immobilized in this position with splints, a splint, or a fixing bandage.

Immobilization of the affected organ in the postoperative period greatly facilitates the patient's well-being by relieving pain, improves sleep, and expands the general motor regimen.

With purulent wounds in the 1st phase of the wound process, immobilization helps to delimit the infectious process. In the regeneration phase, when the inflammation subsides and the pain in the wound subsides, the motor mode is expanded, which improves the blood supply to the wound, promotes faster healing and restoration of function.

The fight against bleeding, the third important sign of a wound, is a serious task of any operation. However, if for some reason this principle turned out to be unrealized, then in the next few hours after the operation, the bandage gets wet with blood or blood flows through the drains. These symptoms serve as a signal for an immediate examination of the surgeon and active actions in terms of revision of the wound in order to finally stop the bleeding.

Patient care- sanitary gipurgia (gr. hypourgiai- help, provide a service) - medical activities for the implementation of clinical hygiene in a hospital, aimed at alleviating the patient's condition and contributing to his recovery. During patient care, the components of personal hygiene of the patient and his environment are implemented, which the patient is not able to provide himself due to illness. In this case, physical and chemical methods of exposure based on the manual labor of medical personnel are mainly used.

Patient care is of particular importance in surgery as an extremely important element in surgical aggression, which mitigates its adverse effects and to a large extent affects the outcome of treatment.

Concept definition« Patient care». Types of care.

Care of the sick is based on the principles of personal and general hygiene (Gr. hygieinos- bringing health, healing, healthy), which provide optimal conditions for life, work, recreation of a person aimed at preserving, strengthening the health of the population and preventing diseases.

The set of practical measures aimed at the implementation of hygiene standards and requirements is denoted by the term sanitation (lat. sanitas- health; sanitarius- conducive to health).

Currently, in a broader sense, Sanitary-hygienic and epidemiological activities in practical medicine are called clinical hygiene(in stationary conditions - hospital hygiene).

Patient care is divided into general and special.

General care includes activities that are necessary for the patient himself, regardless of the nature of the existing pathological process (nutrition of the patient, change of linen, personal hygiene, preparation for diagnostic and therapeutic measures).

Special care is a set of measures applied to a certain category of patients (surgical, cardiological, neurological, etc.).

Definition concepts« Surgery»

« Surgery» in literal translation means handiwork, skill (chier- hand; Ergon- action).

Today, surgery is understood as one of the main sections of clinical medicine that studies various diseases and injuries, for the treatment of which methods of influencing tissues are used, accompanied by a violation of the integrity of body tissues to detect and eliminate the pathological focus. Currently, surgery, based on the achievements of the basic sciences, has found application in the treatment of relevant diseases of all human organs and systems.

Surgery widely uses the achievements of various disciplines, such as normal and pathological anatomy, histology, normal and pathological physiology, pharmacology, microbiology, etc.

Anatomy allows you to study the variants of the structure of various organs and systems of the body, anatomical zones, shows possible options for the restoration of pathologically altered structures.

Knowledge of physiology is important in understanding the consequences of surgical interventions and correction of body functions in the postoperative period.

Timely and adequate use of pharmacological preparations optimizes the patient's preparation for surgery, and in some cases, even avoids surgery or performs it in a planned manner.

An important point is the knowledge of pathogens of infectious diseases and complications, measures to combat them and possible ways to prevent nosocomial (hospital) infections.

Currently, surgery is a direction that actively uses not only the knowledge gained in other areas of theoretical and practical medicine, but also the achievements of such fundamental sciences as physics, chemistry, etc. This applies, for example, to the use of ultraviolet, laser, plasma, ultrasound, radiation, radio- and cryo-influences, the introduction into clinical practice of synthesized antiseptics, new suture material, prostheses, etc.

In modern conditions, surgical intervention is a complex and multi-stage process, during which a complex correction of various body functions is carried out through the use of mechanical, physical, chemical and biological methods of influence.

The high aggressiveness of surgical methods of treatment implies careful preparation of the patient for surgery, intensive and competent care for him in the postoperative period. It is no coincidence that the most experienced specialists say that a successfully performed operation is only 50% of the success, the other half is the nursing of the patient.

. Surgical care

Surgical care is a medical activity for the implementation of personal and clinical hygiene in a hospital, aimed at helping the patient to meet his basic life needs (food, drink, movement, emptying the intestines, bladder, etc.) and during pathological conditions (vomiting, coughing, breathing problems, bleeding, etc.).

Thus, the main tasks of surgical care are: 1) providing optimal living conditions for the patient, contributing to the favorable course of the disease; 3) fulfillment of doctor's prescriptions; 2) accelerating the patient's recovery and reducing the number of complications.

Surgical care is divided into general and special.

General Surgical Care consists in the organization of the Sanitary-hygienic and Medical-protective regimes in the department.

Sanitary and hygienic regime includes:

organization of cleaning of premises;

ensuring the hygiene of the patient;

Prevention of nosocomial infection. Therapeutic and protective regime consists in:

Creating a favorable environment for the patient;

provision of medicines, their correct dosage and use as prescribed by a doctor;

organization of high-quality nutrition of the patient in accordance with the nature of the pathological process;

proper manipulation and preparation of the patient for examinations and surgical interventions.

Special care It is aimed at providing specific care for patients with a certain pathology.