1. The importance of patient personal hygiene.
2. Hospital linen regime.
3. Bedsores, places of formation, stages of development. Factors contributing to the development of pressure ulcers.
4. Change of underwear and bed linen. Placing the patient in bed in the following positions: lying on the back, Fowler, lying on the side, on the stomach, Sims.
5. Caring for the skin and mucous membranes of a seriously ill patient.
6. Supply of bedpan and urinal. Techniques for washing hands, feet, cutting, hair care.

1. The importance of patient personal hygiene.

Seriously ill patients cannot perform personal hygiene measures. The nurse should implement personal hygiene measures in bed for a seriously ill patient. When presenting a bedpan or urinal, while washing, patients feel embarrassed, because... these events are intimate. When performing them, the nurse should:

Convince the patient that there is no reason for embarrassment;

Protect the patient with a screen;

Ask patients to leave the room;

After the vessel is served, leave the patient alone.

1. Hospital linen regime

The bed should be metal for better disinfection, there should be at least 1.5 m of distance between the beds, and the bed legs should be on wheels. Functional beds are available. The patient’s bed: a sheet, the edges of which are tucked under the mattress; two pillows, the bottom pillow should protrude from under the top; a flannelette or wool blanket with a duvet cover; towel.

The nurse should continually ensure that the patient's position is functional and comfortable. For this purpose, they use a functional bed consisting of 3 movable sections. Using the handles located at the foot end of the bed or on the side, you can lift the head end, and you can bend the legs at the knees at the foot end. An elevated position of the head end can be created using a headrest or several pillows.

1. Bedsores, places of formation, stages of development. Factors contributing to the development of pressure ulcers.

Bedsore - these are dystrophic ulcerative-necrotic changes in the skin, subcutaneous tissue and other soft tissues that develop as a result of prolonged compression, shear or friction.

Predisposing factors include disorders of local blood circulation, innervation and tissue nutrition.

Places prone to the formation of bedsores: the area of ​​the back of the head, shoulder blades, sacrum, coccyx, hip joint, heels.

There are 3 main factors that lead to the formation of bedsores: pressure, shearing force and friction.

Pressure - under the influence of the body's own weight, tissue compression occurs relative to the surface on which the person rests. When compression occurs, the diameter of the vessels decreases, resulting in tissue starvation. When tissues are completely starved, necrosis occurs within a short period of time.

"Shearing" force - destruction and mechanical damage tissue occurs under the influence of indirect pressure. It is caused by tissue displacement relative to supporting surface. Displacement occurs when the patient “slides” down the bed or is pulled towards the head of the bed.

Friction - is a component of the “cutting” force, it causes detachment of the stratum corneum of the skin and leads to ulceration of its surface.

Principles of care Ø Ø Ø 1. Safety (prevention of injury) 2. Confidentiality (private details should not be known to others) 3. Respect for dignity (perform all procedures with the consent of the patient. Ensure privacy, if necessary) 4. Communication (location of the patient and his family members for a conversation, discussing the progress of the upcoming procedure and the care plan in general) 5. Independence (encouraging each patient to be independent) 6. Infection 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 maintain cleanliness of the body.

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 - with this regimen, 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 meeting physiological needs) is carried out only with the help of nursing staff.

2. Bed rest - the patient is prohibited from getting out of bed. It is allowed to turn on your side in bed, bend and straighten your limbs, raise your head, sit in bed, and partially perform self-care. Nursing staff provide feeding (supplying food and drink), personal hygiene (supplying a bowl of water, comb, toothbrush, etc.), assistance in meeting physiological needs (supplying a duck, a boat). When caring for surgical patients, this regimen is prescribed a few hours after surgery for 2-3 days.

3. Semi-bed rest - 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 spending time hygiene procedures. It is allowed to use a sanitary chair to perform physiological needs. The rest of the time the patient should remain in bed. When moving the patient, it is advisable to monitor his condition.

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

Rules for changing linen The first way to change bed linen is to roll up a clean sheet halfway in the transverse direction; -raise the upper half of the patient’s body, remove the pillow; -roll up the dirty sheet from the head of the bed to the lower back; -spread a clean sheet on the vacant part of the mattress; - place the pillow, change the pillowcase on it, and lower the patient onto it; - lifting the pelvis and then the patient’s legs, remove the dirty sheet and spread a clean one in its place; - tuck the edges of the sheet under the mattress; - remove dirty laundry; -Wash the hands.

The second way to change bed linen is to roll up a clean sheet halfway lengthwise; - 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 on his back, and then on the other side, on a clean sheet (those making the bed and holding the patient change roles); -remove the dirty sheet and place a clean one in its place; - tuck the edges of the sheet under the mattress; - place a pillow under your head, changing the pillowcase on it; - it is convenient to place the patient on the bed, cover with a blanket, having previously changed the duvet cover; - remove dirty laundry; -Wash the hands.

Changing underwear to raise the upper half of the patient’s torso; -carefully roll up the dirty shirt to the back of the head; -raise both the patient’s arms and move the shirt rolled up at the neck over the patient’s head; -remove the sleeves. If the patient’s arm is injured, first remove the shirt from the healthy arm and then from the sick arm. Dress the patient in the reverse order: first you need to 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. -

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

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Handing the vessel to the patient Equipment: vessel, oilcloth, screen, gloves. Algorithm of action: 1. Put on gloves. 2. Separate the patient with a screen. 3. Rinse the vessel warm water, leaving in a little water. 4. Place your left hand under the sacrum on the side, helping the patient 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 vessel under the patient’s buttocks so that the perineum is above the opening of the vessel. 7. Cover the patient with a blanket and leave him alone for a while. 8. After defecation is completed, remove the pan with your right hand, while helping the patient to lift the pelvis with your left hand.

9. After examining the contents of the vessel, pour it into the toilet and rinse the vessel with hot water. If there are pathological impurities (mucus, blood, etc.), leave the contents of the vessel until examined by a doctor. 10. Clean the patient by first changing gloves and using a clean vessel. 11. After completing the manipulation, remove the vessel and oilcloth. 12. Disinfect the vessel. 13. Cover the vessel with oilcloth and place it on a bench under the patient’s bed or place it in a specially retractable device of a functional bed. 14. Remove the screen. 15. Remove gloves, wash your hands. Sometimes the method described above for bed support cannot be used because some seriously ill patients cannot sit up. In this situation, you can do the following.

Algorithm of action: 1. Put on gloves. 2. Separate the patient with a screen. 3. Turn the patient slightly to one side, with the patient's legs bent at the knees. 4. Place the bedpan under the patient's buttocks. 5. Turn the patient onto his back so that his perineum is above the opening of the bedpan. 6. Cover the patient and leave him alone for a while. 7. Once the bowel movement is complete, turn the patient slightly to one side. 8. Remove the bedpan. 9. After inspecting the contents of the vessel, drink it into the toilet. Rinse the vessel with hot water. 10. After changing gloves and using a clean vessel, wash the patient. 11. After completing the manipulation, remove the vessel and oilcloth. 12. Disinfect the vessel.

13. Remove the screen. 14. Remove gloves, wash your hands. In addition to enameled vessels, rubber ones are also widely used. A rubber bed is used for weakened patients, those with bedsores, and urinary and fecal incontinence. Do not inflate the vessel too tightly, as it will put significant pressure on the sacrum. The inflatable cushion of the rubber bedpan (that is, the part of the bedpan that will come into contact with the patient) must be covered with a diaper. Men are given a urine bag at the same time as the bedpan.

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

Not all patients can urinate or have bowel movements freely in bed. To help the patient, you must: Ask everyone who can to leave the room, leaving the patient alone for a while. Separate the patient with a screen. Give the patient only a warm bedpan 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). To facilitate urination, you can open the water tap. The sound of flowing water reflexively causes urination.

Care of the external genitalia and perineum Severely ill patients should be washed after each act of defecation and urination, as well as several times a day in case of urinary and fecal incontinence. Equipment: gloves, oilcloth, screen, vessel, forceps, cotton swabs, gauze napkins, Esmarch jug or mug, tray, water thermometer, antiseptic solutions (furatsilin solution 1: 5000, faint pink solution of potassium permanganate). Algorithm of action 1. Wash your hands, put on gloves, isolate the patient with a screen. 2. Lay the patient on his back, his legs should be bent at the knees and spread apart. 3. Place an oilcloth under the patient and place a bedpan. 4. Take in right hand forceps with a napkin or cotton swab, and in left hand a jug with a warm antiseptic solution (a weak pink solution of potassium permanganate or a solution of furatsilin 1: 5000) or water at t W 0 -35 ° C.

Instead of a jug, you can use an Esmarch mug with a rubber tube, clamp and tip. 6. Pour the solution onto the genitals, and use a napkin (or tampon) to move from top to bottom (from the genitals to 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 inguinal folds; - lastly, wash the area of ​​the perineum and anus. 7. Dry in the same sequence: with a dry swab or napkin. 8. Remove the vessel, oilcloth and screen. 9. Remove gloves, wash your hands.

If it is impossible to wash the patient in the manner described above due to the severity of his condition (you cannot turn him or lift him to position the bedpan), you can do the following. Using a mitten soaked in warm water or an antiseptic solution, wipe the patient’s genitals (labia, around the genital opening in women, penis and scrotum in men), inguinal folds and perineum. Then dry. In patients with urinary and fecal incontinence, after washing the skin in groin area grease (vaseline or sunflower oil, baby cream and so on). You can powder your skin with talcum powder. REMEMBER! When caring for the external genitalia and perineum, special attention should be paid to the natural folds. Women are washed away only from top to bottom!

Caring for the skin and natural folds The skin must be clean to function properly. Contamination of the skin with secretions of sebaceous and sweat glands, dust and microbes that settle on the skin can lead to the appearance of a pustular rash, peeling, diaper rash, ulcerations, and bedsores. Washing the patient For patients who are on bed rest, the nurse provides assistance with morning toileting. Equipment: oilcloth, basin, jug, soap, towel, warm water. Algorithm of action: Place the basin on a chair next to the bed. Turn the patient onto his side or sit him 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 lap (if he is sitting). Give the patient soap in his hands.

Pour warm water from a jug over a basin onto the patient's hands until he washes his face. Give the patient a towel. Remove the basin, oilcloth, and towel. Place the patient comfortably in bed. Some patients cannot wash themselves even with the help of others. In this case, the nurse washes 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 using a sponge or mitten). Dry your skin with a towel. Remove gloves, wash your hands.

CARRYING OUT A HYGIENIC SHOWER INDICATIONS: skin contamination, lice. CONTRAINDICATIONS: severe condition of the patient. EQUIPMENT: bath bench or seat, brush, soap, washcloth, gloves, bath treatment products. PERFORMANCE OF MANIPULATION: - wear gloves; - wash the bathtub with a brush and soap, rinse with a 0.5% solution of bleach or 2% chloramine solution, rinse the bathtub with hot water (you can use household cleaners and disinfectants); - place 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 dry himself with a towel and get dressed; -remove gloves; - escort the patient to the room.

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

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

Washing the feet The feet of a seriously ill patient are washed once a week. Equipment: gloves, oilcloth, basin, jug with warm water, towel. Algorithm of action: Wash your hands, put on gloves. Place oilcloth at the foot end of the bed. Place the basin on the oilcloth. Place the patient's legs in the pelvis (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. Remove gloves, wash your hands.

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

Using a nail file, give the free edge of your nails the desired shape (straight on the legs, rounded on the hands). You should not file your nails deeply from the sides, as you can injure the skin of the side 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 the face Equipment: shaving machine, soap foam or shaving cream, napkin, container (tray) with water, towel, gloves. Algorithm of action: Wash your hands, put on gloves. Wet the napkin in hot water and squeeze it out. Place the napkin on the patient's face for 5-7 minutes. Apply soap lather or shaving cream to your face. While pulling the skin in the opposite direction to the movement of the machine, gently shave the patient. Wipe the patient's face wet wipe. Dry your face with a towel. Remove gloves, wash your hands.

Removing mucus and crusts from the nasal cavity Most patients independently care for the nasal cavity during the morning toilet. Seriously ill patients who are unable to independently monitor nasal hygiene must daily clear the nasal passages of secretions and crusts that form that interfere with free breathing through the nose. Equipment: gloves, 2 trays, cotton pads, petroleum jelly (or vegetable oil, or glycerin). Algorithm of action: Wash your hands, put on gloves. While lying down or sitting (depending on the patient's condition), tilt the patient's head slightly. Moisten cotton pads with Vaseline or vegetable oil, or glycerin. Insert the turunda into the nasal passage with a rotational motion and leave it there for 2-3 minutes. Then remove the turunda and repeat the manipulation. Remove gloves and wash your hands. Note: you can first drip one of the listed oils into your nose, and then clean your nasal passages with cotton wool. Mucus from the nasal cavity can also be removed with dry cotton swabs.

Rubbing the eyes If discharge appears from the eyes, eyelashes and eyelids stick together during the morning toilet, it is necessary to wash the eyes. Equipment: sterile gloves, 2 trays (one sterile), sterile cotton balls, antiseptic solution (furatsilin solution 1: 5000, 2% soda solution, 0.5% potassium permanganate solution), tweezers. Algorithm of action: Wash your hands thoroughly, put on sterile gloves. Place 8-10 sterile balls in a sterile tray and moisten them with an antiseptic solution (furatsilin 1: 5000, 2% soda solution, 0.5% potassium permanganate solution) or boiled water. Lightly wring out the swab and wipe your eyelashes with it from the outer corner of the eye to the inner. Repeat wiping 4-5 times (with different tampons!). Blot the remaining solution with dry swabs. Remove gloves, wash your hands.

Cleansing the external auditory canal Equipment: gloves, 3% hydrogen peroxide solution, pipette, cotton pads, 2 trays. Algorithm of action: Wash your hands, put on gloves. Sit the patient down, if there are no contraindications, tilt your head to the opposite shoulder or turn your head to the side while lying down. By pulling the pinna back and up, drop a few drops of warm 3% hydrogen peroxide solution into the patient's ear. Using rotational movements, insert the cotton wool into the outer ear canal. The ear is also pulled back and upward. After changing the turunda, repeat the manipulation several times. Repeat the same steps with the other external ear canal. Remove gloves, wash your hands. REMEMBER! Do not use hard objects to remove wax from your ears to avoid damage. eardrum.

Care oral cavity Name Manipulation equipment Rinsing Towel, 1. mouth oilcloth, 2. cavity glass, 3. tray, solutions 4. antiseptics (furacilin 1: 5000, 2% 5. solution 6. soda, 0.5% solution 7. potassium permanganate) gloves. Algorithm of action Wash your hands, put on gloves. Make the patient sit down. Place a towel or oilcloth on the patient's chest and neck. Give the patient a glass of antiseptic solution or warm boiled water. Place your chin tray. Invite the patient to rinse the mouth. Remove gloves, wash your hands.

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

Brushing teeth Tooth 1. brush, 2. toothpaste, 3. towel, oilcloth, 4. glass of boiled 5. water, tray, gloves, 6. spatula 7. Wash your hands, put on gloves. Make the patient sit down. Place a towel or oilcloth on the patient's chest and neck. Instruct the patient to rinse the mouth once. Apply no a large number of toothpaste on a toothbrush. Ask the patient to open his mouth wide. Using a spatula to expose teeth, brush sequentially outer surface teeth, making sweeping movements (from top to bottom), then chewing and inner surface teeth (also clean the inner surface with sweeping movements from top to bottom). 8. Instruct the patient to rinse their mouth thoroughly with water. 9. Dry the skin around your mouth with a towel. 10. If necessary, treat the patient's lips with Vaseline or cream. 11. Remove gloves, wash your hands.

If a patient on bed rest can brush his teeth himself, assist him in this. Provide him with everything he needs and give him a comfortable position in bed. REMEMBER! Rinsing the mouth should be done after each meal, brushing your teeth at least 2 times a day (morning and evening). Treatment of the oral mucosa and teeth of seriously ill patients is also carried out 2 times a day. If there is a lack of personal hygiene, the nurse must: Explain the need for personal hygiene measures in a hospital setting. Assess self-care ability. Help with morning and evening dressing, shaving in the morning. Carry out partial sanitization daily. Provide opportunities for hand washing before eating and after using the toilet. Help with washing (at least once a day). Ensure hair and feet are washed once a week. Provide oral care, rinsing your mouth after every meal. Provide nail trimming once a week. Provide care for natural skin folds daily. Ensure linen is changed when soiled.

ATTENTION! Teach the patient to take care of himself to the best of his ability. Develop the patient's self-help skills and encourage him to act independently. Personal contact with the patient, careful observation and listening to the patient will help you best manage the care of each patient. Seriously ill patients can also stay at home. Therefore, it is necessary to teach relatives the elements proper care for the skin and natural folds, for mucous membranes, measures to prevent bedsores.

Orenburg Institute of Railways –

branch of the State budgetary educational institution of higher professional education

« Samara State University means of communication"

Orenburg Medical College

PM.04, PM.07 Performing professional work

Junior nurse

MDK 04.03, MDK 07.03

Solving patient problems through nursing care.

Specialty 060501 Nursing

Specialty 060101 General Medicine

Topic 3.4. Personal hygiene of the patient Lecture

Prepared by teacher

Marycheva N.A.

Agreed

at a meeting of the Central Committee

protocol No.___

From "___"___________2014

Chairman of the Central Committee

Tupikova N.N.

Orenburg -2014

Lesson No. 4 Lecture

Topic 3.4. Patient personal hygiene

The student must have an idea:

about the types of patient care, about the methodology for determining the degree of development of bedsores, the prevention and treatment of bedsores and diaper rash.

The student must know:

Principles of hygienic care;

The importance of patient personal hygiene;

Hospital linen regime (bed linen requirements);

Rules for the collection and transportation of dirty laundry;

Disinfection mode for care items

Risk factors for the formation of bedsores;

Places of possible formation of bedsores;

Stages of bedsore formation.

Lecture outline

Introduction.

Types of patient care.

Principles of hygienic care.

The importance of patient personal hygiene.

Hospital linen regime (bed linen requirements).

Rules for collecting and transporting dirty laundry.

Disinfection regime for care items.

Places of possible formation of bedsores.

Risk factors for the formation of bedsores.

Methodology for determining the degree of development of bedsores.

Stages of bedsore formation.

Prevention and treatment of bedsores and diaper rash.

Introduction.

Nursing care is integral integral part treatment. IN Everyday life care is understood as providing assistance to a patient in meeting various needs. In medicine, the concept of “patient care” is interpreted more broadly. Care is understood as a whole range of therapeutic, preventive, hygienic and sanitary measures aimed at alleviating the suffering of the patient, speeding his recovery and preventing complications of the disease.

A sick person often needs help with personal hygiene: washing, shaving, caring for the oral cavity, hair, nails, washing, taking a bath, as well as carrying out waste products. In this part of care, the nurse's hands become the patient's hands. But when helping a patient, you need to strive as much as possible for his independence and encourage this desire.

Types of patient care.

Patient care is divided into general and special.

General care includes activities that any patient needs, regardless of the nature of the disease. All patients need medications, a change of linen, etc.

Special care includes measures that apply only to a certain category of patients (for example, washing the bladder for a patient with diseases genitourinary organs).

Care components:

Patient safety

Gymnastics

Infection control

Monitoring your medication intake

• Monitoring the patient

  Patient education

• Medical procedures

  General care procedures

  Rehabilitation

  Patient modes

  Own safety

Principles of care.

safety(preventing patient injury);

confidentiality(details of personal life should not be known to strangers);

respect feelings dignity(performing all procedures with the patient’s consent, ensuring privacy if necessary);

communication (the patient and his family members are willing to talk, discuss the progress of the upcoming procedure and the care plan in general);

independence(encouraging each patient to become independent);

infectious safety(implementation of relevant activities).

Target help to the patient- personal hygiene, ensuring comfort, cleanliness and safety.

The importance of patient personal hygiene.

Personal hygiene patient is of great importance in the process of its treatment. First of all, it is worth understanding that each patient’s concept of cleanliness is individual. That is why medical personnel need to ask him about his personal care habits, and also assess how much the patient is able to independently follow the rules of hygiene that will allow him to most effectively carry out his treatment.

One of the important parts patient personal hygiene is the care of his skin. In order to keep your skin clean, you need to wash your face every morning and evening and take a hygienic bath once a week. Of course, this applies to those patients who, for health reasons, can carry out hygiene procedures themselves. Don’t forget about oral care; you need to brush your teeth twice a day, paying attention to the cleanliness of your tongue and gums.

Personal hygiene of a seriously ill patient

Since with a number of diseases a person cannot take care of himself, personal hygiene of a seriously ill patient a nurse is in charge. It is worth noting that the reason for the inability to carry out personal hygiene procedures can be not only a severe physical, but also a mental condition, such as depression. Skin care for seriously ill patients with bed rest in hospital has a number of features. To avoid the risk of infection due to skin contamination, daily wiping with a soapy solution using a sponge or napkins should be carried out. Particular attention should be paid to places where sweat gland secretions accumulate. Such patients should brush their teeth twice a day. In addition, the oral cavity is treated with a cotton ball soaked in a solution of potassium permanganate or boric acid. Also, the duties of the medical staff include caring for the eyes, ears and nasal cavity of seriously ill patients.

Personal hygiene of the patient in the hospital

The place where the patient spends most of his time while being treated in medical institution, is his bed. That is why, in addition to the basic rules personal hygiene of a patient in a hospital It is necessary to take care of the cleanliness of bed linen. It needs to be changed as it gets dirty, and in bedridden patients, all folds must be carefully straightened, since even the smallest of them can cause skin damage. The sheets on the beds of such patients should be very soft, without scars or seams, since they often have increased sensitivity due to illness.

Hospital linen regime (bed linen requirements).

Medical organizations must be provided with sufficient linen.

Collection, transportation and storage of linen

In hospitals and clinics, central storerooms for clean and dirty linen are equipped. In low-power medical organizations, clean and dirty linen can be stored in separate cabinets, including built-in ones. The pantry for clean linen is equipped with racks with a moisture-resistant surface for wet cleaning and disinfection.

In “dirty” rooms (rooms for dismantling and storing dirty linen), finishing involves ensuring moisture resistance to their entire height. Floors should be covered with waterproof materials. It is allowed to install suspended, suspended, suspended and other types of ceilings that ensure a smooth surface and the possibility of wet cleaning and disinfection.

Transportation of clean linen from the laundry and dirty linen to the laundry must be carried out in packaged form (in containers) by specially designated vehicles. You cannot transport dirty and clean laundry in the same container. Washing fabric containers (bags) is carried out simultaneously with laundry.

Dirty linen is collected in closed containers (oilcloth or plastic bags, specially equipped and labeled linen trolleys or other similar devices) and transferred to the central pantry for dirty linen. Temporary storage of dirty linen in compartments (no more than 12 hours) is allowed in rooms for dirty linen with waterproof surface finishes, equipped with a sink and an air disinfection device.

Pantries for storing linen should have shelves with hygienic coating, accessible for wet cleaning and disinfection.

Issuing and changing linen for patients

Upon admission to the hospital, the patient is given a set of clean underwear, pajamas/robe, and slippers. Patients leave personal clothing and shoes in special packaging with hangers (plastic bags, covers made of thick fabric) in the storage room for patients' belongings or give them to relatives (friends). Patients in hospitals are allowed to wear home clothes. Personal clothing of patients with infectious diseases, in cases provided for by sanitary rules, is subjected to chamber disinfection. Patients' linen is changed as it gets dirty, regularly, but at least once every 7 days. Before the patient is admitted, bedding is changed (mattress, pillow, blanket) and the bed is made with a clean set of bed linen (sheet, pillowcase, duvet cover). Contaminated linen must be replaced immediately. Postpartum women should change bed linen once every 3 days, change underwear and towels daily, and change diapers at least 4-5 times a day and as needed. The use of industrially produced gaskets is allowed.

Before the patient returns to the ward after surgery, a mandatory change of linen is carried out. In the postoperative period, patients should change linen systematically until discharge from the wounds stops.

In operating rooms and obstetric hospitals (maternity units, as well as wards for newborns), sterile linen is used. For newborns, the use of diapers is allowed.

When carrying out therapeutic and diagnostic manipulations, in particular in an outpatient setting, the patient is provided with an individual set of linen (sheet, diaper, napkin, shoe covers), including disposable ones.

Medical staff clothing

Medical personnel must be provided with sets of changeable clothing, gowns, caps and replacement shoes. Staff clothing in surgical and obstetric departments is changed daily and when soiled. In therapeutic institutions it is carried out 2 times a week and when soiled. Reusable napkins, if it is impossible to use disposable fabric ones, must be washed.

Staff clothes are washed centrally and separately from patients’ laundry. Laundry is washed in special laundries or a laundry as part of a medical organization. The laundry washing regime must comply with current hygienic standards. It is prohibited to wash workwear at home.

Disinfection of linen

Disinfection of textile products contaminated with secretions and biological fluids (underwear, bed linen, towels, medical clothing, etc.) is carried out in laundries, soaking in disinfectant solutions before washing, or during the washing process using disinfectants approved for these purposes. funds in washing machines pass-through type according to program No. 10 (90°C) according to the technology for processing linen in medical organizations. Newborn underwear is treated in the same way as infected linen.

After patients are discharged, as well as when they become contaminated, mattresses, pillows, and blankets must be subjected to chamber disinfection treatment. If covers made of material that allows wet disinfection are used to cover mattresses, chamber processing is not required. If mattresses and pillows have covers made of moisture-proof materials, they are disinfected with a disinfectant solution by wiping. A medical organization must have an exchange fund of bedding, for the storage of which a special room is provided.

The premises and equipment for cleaning laundries and storage rooms for temporary storage of linen are washed and disinfected daily. Cleaning equipment (carts, mops, containers, rags, mops) must be clearly marked or color-coded based on their functional purpose and stored in a room designated for this purpose. A color coding scheme is placed in the inventory storage area.

Washing machines for washing mops and other rags are installed in the areas where cleaning carts are assembled. Used cleaning equipment is disinfected in a disinfectant solution, then rinsed in water and dried.

Laundry in medical institutions is carried out in accordance with SanPiN 2.1.3.2630-10 “Sanitary and epidemiological requirements for organizations engaged in medical activities” and MU 3.5.736-99 “Technology for processing linen in medical institutions”.

Disinfection regime for care items.

Equipment: overalls, used care items; a disinfectant approved for use in the Russian Federation (the list of basic means of disinfection and their characteristics is given in the “Guidelines for disinfection, pre-sterilization cleaning and sterilization of medical supplies”, approved by the Ministry of Health of Russia on December 30, 1998, No. MU-287-113) ( the concentration of the solution, exposure and method of treatment are selected depending on the presence of blood and biological secretions of the patient on care items); rags - 2 pcs.; container for disinfection with a lid and markings. Required condition: care items are disinfected immediately after use.

Preparation for the procedure

Wear protective clothing and gloves.

Prepare equipment.

Pour the disinfectant solution of the required concentration into the container.

Perform the procedure using a care item.

Performing disinfection using the full immersion method:

Immerse the care item completely, filling its cavities with disinfectant solution).

Remove gloves.

Note the start time of disinfection.

Leave for 60 minutes (or the required time of the disinfection process with this product).

Wear gloves.

End of the procedure

Pour the disinfectant solution into the sink (sewer).

Store the care item in a specially designated place.

Double wipe method:

Wipe the care item with a disinfectant solution twice in succession, with an interval of 15 minutes (see “Guidelines for using a disinfectant”).

Make sure that there are no untreated gaps on the care item.

Let dry.

Wash the care item under running water using detergents, dry.

End of the procedure

Pour out disinfectant solution into the sink (sewer).

Store the care item in a specially designated place.

Remove protective clothing, wash and dry your hands.

Risk factors for the formation of bedsores.

The skin must be clean to function properly. Contamination of the skin with secretions 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, ulcerations, and bedsores.

Intertrigo - inflammation of the skin in folds that occurs when rubbing wet surfaces. Develop under the mammary glands, in the intergluteal fold, armpits, between the toes with excessive sweating, in inguinal folds. Their appearance is promoted by excessive sebum secretion, urinary incontinence, and genital discharge. They occur more often in the hot season in obese people and in infants with improper care. With diaper rash, the skin turns red, its stratum corneum seems to become wet and torn away, weeping areas with uneven contours appear, and cracks may form deep in the skin folds. Diaper rash is often complicated by a pustular infection or pustular diseases. To prevent the development of diaper rash, regular hygienic skin care and treatment for sweating are necessary.

If you are predisposed 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 them with talcum powder.

Bedsores- this is necrosis of soft tissues that develops as a result of their prolonged compression, shear or friction due to a violation local circulation and nervous trophism.

Long-term (more than 1 - 2 hours) pressure leads to vascular obstruction, compression of nerves and soft tissues. In the tissues above the bone protrusions, microcirculation and trophism are disrupted, hypoxia develops, followed by the development of bedsores.

Damage to soft tissue from friction occurs when the patient moves, when the skin is in close contact with a rough surface. Friction leads to injury to both the skin and deeper soft tissues.

Shear damage occurs when the skin is immobile and deeper tissues are displaced. This leads to impaired microcirculation, ischemia and skin damage, most often against the background of additional risk factors for the development of bedsores.

Places possible appearance bedsores.

Depending on the patient's position (on his back, on his side, sitting in a chair), the pressure points change. The pictures show the most and least vulnerable areas of the patient's skin. (6)

In the supine position - in the area of ​​the tuberosities calcaneus, sacrum and coccyx, shoulder blades, on the back surface of the elbow joints, less often over the spinous processes of the thoracic vertebrae and in the area of ​​the external occipital protrusion.

In the “stomach” position - on the front surface of the legs, especially above the anterior edges of the tibia, in the area of ​​the patellas, the upper anterior iliac spines, at the edge of the costal arches.

When positioned on the side - in the area lateral malleolus, condyle and greater trochanter of the femur, on the inner surface of the lower extremities in places where they are closely adjacent to each other.

In a forced sitting position - in the area of ​​the ischial tuberosities. In order to determine whether a patient is at risk of developing pressure ulcers, it is necessary to identify all risk factors.

Risk factors for the formation of bedsores.

Risk factors for the development of pressure ulcers may be reversible (eg, dehydration, hypotension) or irreversible (eg, age), intrinsic or extrinsic.

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Personal hygiene of a seriously ill patient

The concept of personal hygiene, types of care and its principles. Linen regime in the hospital. Making bed, changing bed and underwear. The main elements of care for a seriously ill patient: skin, mucous membranes, hair. Usage modern means personal hygiene for patient care.

Personal hygiene, types of care, principles.

Personal hygiene is a branch of hygiene that studies the issues of preserving and strengthening human health by observing the hygienic regime of his life and activities. Currently, personal hygiene has become a powerful factor in promoting health and preventing infectious diseases, allows you to effectively combat physical inactivity and mental stress.

Personal hygiene is measures aimed at keeping one’s own body clean and carefully caring for it.

The level of satisfaction of this need will depend on the characteristics of the individual, including:

· degree of independence from others;

· level of culture;

· socio-economic status;

level general development;

· degree of individual need.

The nurse assists the patient in care if it is impossible to provide it independently.

Nursing care (or hypurgia) is activities carried out to satisfy the basic needs of life, alleviate the patient's condition and achieve a favorable outcome of the disease.

General care allows you to serve patients regardless of the type and nature of the disease. General care includes nursing interventions. hygiene seriously ill patient hospital

Scope of independent nursing interventions:

· personal hygiene procedures (change of linen, skin hygiene, morning toilet);

· general hygiene premises (cleaning, ventilation, quartz treatment);

· satisfaction of physiological needs (feeding, fluid intake);

· satisfaction of physiological functions (feed, vessel, urinal);

· communication with the patient (relatives) on issues of 30G, leisure, personal hygiene.

Scope of dependent nursing interventions:

· Carrying out medical prescriptions (injections, physiotherapy, enemas)

Special care - allows you to serve patients certain type pathologies (patients with neurological, gynecological --- profiles).

Adequate care means the success of treatment and adaptation to a new quality of life.

Basic principles of care:

1. Safety - infectious and physical.

2. Respect for dignity - informed consent to perform the procedure; ensuring privacy:

3. Confidentiality - information about the patient is not subject to public disclosure;

4. Individuality - personal approach;

5. Tactfulness - the ability to control oneself;

6. Independence - encouraging the patient to self-care.

If the patient's personal hygiene is deficient, the nurse must:

· assess self-care ability;

· clarify the degree of professional participation and preferences;

· provide assistance in morning and evening toilet routine; washing head

Help with washing (at least once a day)

· conduct timely change underwear and bed linen;

Encourage and encourage the patient to self-care;

· involve relatives, neighbors, social workers.

The purpose of helping the patient is to provide personal hygiene, ensure comfort, cleanliness and safety.

Linen regime in the hospital.

1. Bed and underwear are changed at least once every 7 days.

2. Linen is changed for postoperative and seriously ill patients as needed.

3. Contaminated laundry must be collected in special containers (bags or laundry carts) and transferred to the laundry.

4. Disassembling dirty linen in the department is prohibited. It is acceptable to temporarily store dirty linen in closed containers in sanitary rooms.

5. Clean linen is stored in special rooms (linen rooms). The department must have a daily supply of clean linen.

6. Linen and containers must be labeled by compartment.

7. Linen of infectious patients, purulent-surgical departments, must be disinfected before washing.

8. Mattresses, pillows, blankets must be processed in a disinfection chamber after each patient is discharged.

Requirements for a patient's bed

The bed mesh is well stretched, with flat surface. The mattress on the bed should be of sufficient thickness, not lumpy, with an elastic surface. The pillows are soft, feather, and the blanket, depending on the time of year, is flannelette or wool. Sheets and pillowcases on the beds of seriously ill patients should not have seams, scars, or fasteners on the side facing the patient. A seriously ill patient should put a disposable diaper on the sheet.

Change of linen.

Bed linen and underwear are changed after taking a hygienic bath (or wiping off in a seriously ill patient). Changing bed linen for a seriously ill patient can be done in 2 ways. The first method is used if the patient is allowed to turn on his side (in bed rest).

When changing linen, the clean sheet rolls down lengthwise. The second method is used if the patient is prohibited from active movements (under strict bed rest). In this case, the clean sheet is folded in the transverse direction. In this case, it is better to change clothes together.

NB! Regularly, in the morning and before bedtime, it is necessary to remake the bed for a seriously ill patient (shake off crumbs, straighten folds in the sheet)

When changing linen, the patient must follow the principles:

· do not expose the patient when changing his underwear (respecting his sense of dignity and excluding hypothermia);

· when taking off and putting on clothes, you need to be sure that the seated patient will not fall (ensure his safety)

· make sure that the patient’s shoes do not have slippery soles and fit tightly around the foot (safety measures)

· talk with the patient, changing his clothes (necessary communication is ensured)

Encourage the patient to participate as much as possible in changing clothes (this helps him feel independent)

· wash your hands before and after taking off (putting on) clothes (infection safety is ensured).

NB! When changing the shirt of a seriously ill patient with injured hand, first it is removed from the healthy arm, and then from the sick one. Put it on in the reverse order: first on the sore arm, then on the healthy arm.

Elements of caring for a seriously ill patient

Before starting any personal hygiene procedure:

1. Prepare the necessary equipment.

2. Communicate the goal and progress to the patient.

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

4. Ask if it needs to be fenced off with a screen.

5. Monitor the patient’s condition as the procedure progresses.

6. Ask the patient how he feels after the procedure is completed.

7. If the condition worsens, stop performing the procedure. Call a doctor immediately! Before the doctor arrives, provide first aid.

Skin care.

The painful condition requires special attention to skin care. The skin is contaminated by sweat and sebaceous glands, desquamated epidermis, transient microflora. The surface of the armpits is covered with the secretion of the apocrine glands, the skin of the perineum is covered with the secretion of the genitourinary organs and intestines.

Skin functions:

1. Protective (from mechanical damage, harmful effects UV rays, toxins and microorganisms.

2. Exchange (participation in gas exchange - respiration, excretion)

3. Analyzer (ability skin receptors perceive external stimuli: pain, heat, cold, touch).

Skin and mucous membrane care provides:

· its cleaning - removal of secretory and excretory secretions;

· stimulation of blood circulation;

· hygienic and emotional comfort;

· feeling of satisfaction.

The purpose of skin care is to keep it clean, normal functioning, prevention of diaper rash, bedsores.

Skin care for a seriously ill patient is carried out daily by wiping with a napkin moistened with warm 10% camphor alcohol or vinegar solution (1-2 tablespoons per 0.5 liters of water). Modern technologies offer body wash wipes. Wipes replace full-fledged treatment; they clean, moisturize, deodorize the skin, and do not require water. Napkins are soaked antibacterial agents, effective against coli, staphylococci, salmonella. The package contains 8 napkins: for the face and neck, chest, left arm, right arm, perineum, buttocks, right leg and left leg.

NB! When caring for your skin, it is necessary to inspect it (prevention of bedsores, diaper rash).

Diaper rash is inflammation of the skin in natural folds due to maceration and friction of moist skin surfaces.

Maceration is the softening and loosening of tissues due to prolonged exposure to liquid.

Areas of diaper rash formation:

under the mammary glands

in the armpits

· in the intergluteal fold

in the groin folds

between the toes (for excessive sweating)

Degrees of development of diaper rash:

1 - skin irritation

2 - bright skin hyperemia, small erosions

3- weeping, erosion, ulceration of the skin.

Prevention of diaper rash: timely hygienic care, treatment of sweating.

If you are prone to diaper rash, skin folds after washing should be wiped with baby cream (or sterile vegetable oil).

Oral care

Untimely oral hygiene can lead to bad breath, inflammatory processes: stomatitis - inflammation of the oral mucosa, caries. The oral mucosa may be irritated or coated in weakened and febrile patients. Sometimes patients experience dry lips and painful cracks in the corners of the mouth. If the patient is conscious but helpless, oral care includes:

· rinsing your mouth after every meal; after each attack of vomiting;

· brushing teeth (dentures) morning and evening;

The toothbrush should be soft and not injure the gums. When completing your oral care, be sure to clean your tongue with a brush, removing plaque containing bacteria from it. If the patient is unconscious, the oral cavity is treated by a nurse every 2 hours, while preventing aspiration of the contents during the procedure.

For treatment of the oral mucosa and irrigation, antiseptics are used: 0.02% furatsilin solution, 2% soda solution.

Caring for removable dentures:

Patients with dentures need to remove them at night, treat them with toothpaste and a brush, and then store them in an individual container (glass) until the morning. In the morning, rinse under running water and put on.

NB! When caring for the oral cavity of a patient with dentures, inspect the surface of the gums, because... improperly selected dentures cause irritation of the gums and ulcerations on the oral mucosa.

Remember! When caring for the oral cavity, brushing teeth, dentures, follow universal precautions: wear latex gloves, and if the patient coughs, wear glasses or a face shield.

Eye care

Purpose: - cleansing the eyelids - removing eye discharge, foreign particles, reducing the risk of infection and creating comfort for the patient.

Indications: patient's serious condition. Antiseptic solutions for eye treatment: 0.02% furacillin solution, 2% soda solution.

Remember! When treating the eyes, the tampon must be moved in the direction from the outer corner of the eye to the inner.

Nose care

In a seriously ill patient, a large amount of mucus and dust accumulates on the nasal mucosa, which makes breathing difficult and aggravates the patient’s condition. Weakened patients cannot care for the nose on their own; the nurse must remove crusts from the nose daily.

Purpose: prevention of nasal breathing disorders.

Indications: patient's serious condition, presence of discharge from the nasal cavity.

Mandatory condition: do not use sharp care items.

To remove crusts from the nose, use glycerin or petroleum jelly, leaving the turunda in the nasal passage for 1-3 minutes.

Ear care

The external auditory canal secretes wax, which can accumulate in the form of sulfur plugs and cause hearing loss.

Purpose: ensuring hygienic comfort, preventing the formation of sulfur discharge.

Indications: patient's serious condition.

Contraindications: inflammatory processes in the auricle, external auditory canal.

Remember! 1. Do not use sharp objects when treating the ear, in order to prevent injury to the eardrum or the wall of the ear canal.

2. Removal of the wax plug is carried out by a nurse under the supervision of a doctor, while a warm 3% solution of hydrogen peroxide (37 0 C) is instilled into the external auditory canal to soften the wax.

Hair care for seriously ill patients

When caring for your hair, you need to inspect it for cleanliness, oiliness or dryness, and the presence of lice. The patient's hair is combed daily. Short hair should be combed from roots to ends, and long hair should be divided into strands and combed from ends to roots. Wash your hair at least once a week. Modern technologies allow the patient to wash his hair without using water. With this method, treatment of the head of seriously ill patients is carried out using shampoo and conditioner for washing the hair without water, with or without a special cap. The shampoo is applied to the patient’s head and rubbed in: if there is a cap, rub through it. Then conditioner is applied. After this, the head is dried with a towel.

Use of modern care products.

Cosmetic skin care products provide:

· cleansing

nutrition and hydration

· skin protection

Cleansing products:

· Cleansing foam - cleanses skin without water or soap.

· Washing lotion - for complete washing of bedridden patients. Does not require additional draining.

· Wet sanitary napkins - cleanses the skin with light dirt.

· Bath foam, shampoo - suitable for dry and sensitive skin.

Moisturizing products:

Tonic liquid - improves blood flow and metabolic processes in the skin.

· Skin care oil - intensive care when irritated.

· Bathing oil; body lotion.

· Hand cream.

Means providing protection:

· Protective creams- protect the skin from irritating effect urine

· Oil - spray; skin protector, protective foam - form a film on the skin that remains on the skin for up to 6 hours.

Hygienic care products:

· Oral care sticks (contain antiseptic and moisturizing agents).

· Absorbent diapers (hypoallergenic; do not wrinkle)

· Diapers (breathable; odor neutralization, antibacterial effect.

· Disposable gloves.

· Briefs for men and women suffering from urinary incontinence (protect against leakage, block odor)

· Incontinence pads for men and women.

· Elastic pants for fixing pads.

Literature

1. L.I. Kuleshova, E.V. Pustovetova "Fundamentals of Nursing", Rostov-on-Don: Phoenix, 2011 2. T.P. Obukhovets, O.V. Chernova "Fundamentals of Nursing", Rostov-on-Don: Phoenix, 2011 3. S.A. Mukhina, I.I. Tarnovskaya " Theoretical basis nursing" part I, Moscow 1996

4. V.R. Weber, G.I. Chuvakov, V.A. Lapotnikov "Fundamentals of Nursing" "Medicine" Phoenix, 2007

5. I.V. chYaromich "Nursing", Moscow, ONICS, 2007

6. K.E. Davlitsarova, S.N.Mironova Manipulation technology, Moscow, Forum-INFRA, Moscow, 2005

7.Nikitin Yu.P., Mashkov B.P. Everything about caring for patients in the hospital and at home. M., Moscow, 1998

8. Basikina G.S., Konopleva E.L. Educational and methodological manual in Fundamentals of Nursing for Students. - M.: VUNMTs, 2000.

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The importance of proper care for a newborn to maintain his health. Bedding, clothing and baby care items. Compliance with the necessary hygiene standards and regime. Morning toilet, care for eyes, mouth, ears, nose. Bathing and swaddling the baby.

Indications: Bed rest, semi-bed rest.

Equipment: basin, oilcloth, warm water, jug, soap, sponge, towel, scissors, clean linen.

Performing the procedure:

The procedure is carried out as planned once every 7-10 days and additionally if necessary.

1. At the head end of the bed, roll the mattress towards the patient’s scapular area.

2. Lay an oilcloth on the bed net and place a basin.

3. Tilt the patient's head slightly over the pelvis).

4. Wash the patient’s hair by pouring warm water from a jug using soap.

5. Rinse your hair clean water, wipe, cover your head with a scarf.

6. Remove everything top part return the body to its original position.

7. Pour into tray warm water, lay an oilcloth with a diaper under the patient.

8. Expose the upper part of the patient’s body, moisten one end of the towel, wring it slightly, wipe the patient in the following sequence: neck, arms, back, chest.

9. Use the dry end of the towel to wipe the patient’s body in the same sequence and cover with a sheet.

10. In the same way, wipe the stomach, thighs, legs and wipe dry.

11. Roll the mattress under the patient’s knees with a bolster.

12. Lay oilcloth on the mesh and place a basin with warm water.

13. Wash the patient’s legs in the basin using a sponge and soap.

14. Wipe your feet, trim your nails, put everything away.

15. Change underwear and bed linen.

Vessel delivery.

Equipment: vessel, 2 marked oilcloths - “for ships” and “backing oilcloth”, diaper, screen, toilet paper, 2 pairs of gloves, regulated disinfectant solution in containers, marked: “disinfection of gloves”, “disinfection of oilcloths”, “disinfection of vessels”.

Performing the procedure:

1. At the patient’s request, ensure a comfortable position in bed.

2. Place a cloth with a diaper under the patient’s pelvis.

3. Rinse the vessel with warm water and leave a small amount of water in it.

4. Separate the patient with a screen (if necessary).

5. Ask the patient to bend his knees or help him do so.

6. Place your left hand under the sacrum, helping the patient lift the pelvis. With your right hand, move the vessel under the patient’s pelvis so that the perineum is above the opening of the vessel.

7. Make sure that the surface of the vessel in contact with the skin is dry.

8. Cover the patient with a blanket or sheet and leave him alone.

9. Remove gloves, discard in disinfectant solution.

10. After the patient has emptied his bladder or bowels, put on gloves.

11. Remove the vessel, cover it with oilcloth, and place it in a specially designated place (or next to the bed).

12. Place the patient in a comfortable position and cover with a blanket.

13. Take out the oilcloths, the vessel, pour the contents of the vessel into the sewer, rinse, immerse in a disinfectant solution.

14. Wash the patient, dry the perineum.

15. Remove the diaper and diaper, straighten the bed linen.

16. Remove gloves and place them in a container for disinfection.

17. Wash and dry your hands.

Supply of urine bag.

Equipment: A clean, warm urinal, oilcloth, gauze, screen.

Performing the procedure:

1. Place a screen by the bed.

2. Throw back the blanket, ask the patient to bend his knees and spread his hips (if he is not able to do it himself, then help).

3. Take a gauze napkin in your left hand, wrap it around the patient’s penis, take the urinal bag in your right hand.

4. Insert the penis into the opening of the urinal, place it between the patient’s legs, and remove the gauze pad.

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

6. After emptying the bladder, remove the urinal, oilcloth, cover the patient, remove the screen.

7. Pour the contents of the urinal into the drain, rinse, and immerse in a disinfectant solution.

8. Wash and dry your hands.

Washing women.

Target. Maintain personal hygiene, prevent ascending infection.

Equipment. Sterile: tray, forceps, napkins, oilcloth, diaper, soap, vessel, Esmarch jug or mug with water (water temperature 35-38 o), gloves.

Preparation for the procedure:

1. Install friendly relations(if the patient can perform the procedure on her own, suggest that she do so).

2. Place an oilcloth and a diaper under the patient’s pelvis.

3. Ask the patient to bend his knees or help him do so.

4. Place your left hand under the sacrum, helping the patient raise the pelvis. With your right hand, move the vessel under the patient’s pelvis so that the perineum is above the opening of the vessel.

5. Make sure that the surface of the vessel in contact with the skin is dry.

6. Prepare a soap solution (make shavings from a piece of laundry soap, beat the foam in water).

7. Take the rubber tube from Esmarch’s mug or jug ​​in your left hand, and the forceps soaked in soapy solution gauze pad into your right hand.

Performing the procedure:

1. treat the external genitalia and perineum in the following sequence: pubic area, external genitalia, perineum, anal area. (It is necessary to change the wipes in the same sequence as the treatment. (Throw used wipes into the disinfection tray).

2. Spread the labia with one hand and wash one labia, change napkins.

3. Wash the perineum in the direction from the pubis to the anus.

4. Rinse the patient’s perineum in the same sequence as washing. (Wipe the skin dry in the same sequence and direction, changing napkins).

5. Wash, rinse and thoroughly dry the patient’s perineum and anal area.

End of the procedure.

1. Remove the vessel, oilcloth, and remove gloves.

2. Straighten the bed linen and cover the patient.

3. Wash and dry your hands.

Washing men.

Preparation for the procedure: the same as a woman's.

Execution of the procedure.

1. Take the penis with one hand and move it foreskin.

2. Wash the head of the penis in a circular motion in the direction from the urethra to the pubic area and dry. (It is necessary to change napkins as consistently as the treatment).

3. Return the foreskin to its natural position.

4. Carefully treat, rinse and dry the rest of the penis, the skin of the scrotum, and anus.

End of the procedure: the same as a woman's.

Nail cutting.

Target. Maintain personal hygiene.

Equipment. Gloves, water container, liquid soap, hand and foot cream, scissors, tweezers, nail file, nail brush, tray, towel.

Execution of the procedure.

1. Treat hands hygienically and dry. Wear gloves. Ask the patient to lower the hand for 2-3 minutes. In a tray with warm water, add a little liquid soap to the water.

2. Remove your little finger from the water, dry it and carefully trim the nail.

3. Remove your fingers from the water one at a time, wipe and carefully trim your nails. When there's only one left in the water thumb, place the patient’s second hand in the water. Repeat the procedure with the second brush.

4. Treat your nails with a nail file and a soft brush. Apply the cream to the patient's hands.

5. When completing the treatment of fingernails, place the patient’s foot in a basin with a warm soapy solution for 3-5 minutes.

6. Remove the patient's foot from the water and dry it and place it on a diaper or towel. Place the other foot in a bowl of water for this time.

7. Trim your nails with special tweezers, being especially careful in the corners of the nail.

8. Treat your nails with a nail file and brush. Apply the cream to the patient's feet.

9. Treat the patient’s nails on the second leg in the same way.

10. Remove the basin, pour the contents down the drain, put a towel in a bag for dirty laundry, remove gloves, disinfect the tools. Remove gloves, place them in a container for disinfection, and wash your hands.

Shaving.

The patient should be shaved as needed.

Equipment. Water container, compress cloth, towel, safety razor, shaving cream. All items must be for individual use by the patient.

Execution of the procedure.

1. Treat hands hygienically and dry. Wear gloves.

2. Help the patient take a “half-sitting” position.

3. Wet a large napkin with hot water (40-45 o), wring it out and place it on the patient’s face, leaving him the opportunity to breathe.

4. Apply shaving cream to the patient's skin. Using the fingers of one hand, stretch the skin of the face, and with the other, shave with straight movements from the chin to the cheeks.

5. After shaving, pat your face with a damp cloth, then dry.

6. Wash and put away care items in the patient’s bedside table.

7. Remove gloves, place them in a container for disinfection, and wash your hands.

Oral care.

After each meal, rinse your mouth with salted water (¼ tsp salt per 1 glass of water).

Help a patient on bed rest brush his teeth 2 times a day (morning and evening).

Target. Prevention of the development of inflammatory and putrefactive processes in the oral cavity.

Equipment. Sterile: trays, 2 tweezers, napkins, 2 spatulas, pear-shaped can or Janet syringe, beaker. Vaseline, furacillin 0.1%, 1% solution of brilliant green. Towel, glass of water, tray for used material, container with disinfectant solution.

Preparing for the procedure.

1. Treat hands hygienically and dry.

2. Place the patient lying on his back, turning his head to the side. Cover the neck and chest with oilcloth, a towel, and place a tray under the chin.

3. Ask the patient to close his teeth (remove dentures, if any). Pour one of the prepared solutions into a beaker.

4. Use a spatula to move the patient’s cheek and tweezers with a gauze ball soaked in antiseptic solution Brush your teeth, starting with the back teeth, and sequentially brush the inner, upper and outer surfaces of the teeth, moving up and down (from the gums) in the direction from the back to the front teeth. Repeat the same steps on the other side of the mouth. The procedure is repeated at least two times. (Processing begins from the molars to the incisors, on the left, then on the right in the same sequence, changing the gauze balls).

5. Treat the tongue of a seriously ill patient: Ask the patient to stick out his tongue; if he cannot do this, then take the tip of the tongue with your left hand with a sterile gauze napkin and pull it out of the mouth.

6. Wrap a sterile spatula in a sterile napkin and moisten it in an antiseptic solution.

7. Use this spatula to remove plaque from the tongue in the direction from the root of the tongue to the tip.

8. Irrigate the patient's mouth or help rinse the patient's mouth.

9. Take sterile tweezers with a napkin and treat the palate, inner surfaces of the cheeks, gums, and the area under the tongue. (You need to change the napkin every time it becomes covered with mucus or sticky saliva).

10. Drop the tweezers into the tray.

11. Help the patient rinse his mouth or irrigate using a pear-shaped can: pull back the corner of the mouth with a spatula and alternately rinse the left and then the right cheek space with a stream of solution under moderate pressure.

End of the procedure.

1. Wipe the skin around the mouth with a dry cloth, lubricate your lips with Vaseline. (If there are cracks, treat with a 1% solution of brilliant green).

2. Clean dentures, if any, and help the patient put them on. (Clean with a toothbrush and toothpaste, holding it over the sink.

3. Disinfect instruments and gauze wipes.

4. Remove gloves, place them in a container for disinfection, and wash your hands.

Note: If the patient is unconscious, then wrap it around forefinger hold the napkin with your thumb, fix it securely and moisten it in an antiseptic solution. We place a spatula or mouth opener between the teeth. Treat the palate, the inner surface of the cheeks, teeth, gums, tongue and the space under the tongue, then lips. (Change napkins as they become contaminated with mucus, plaque, and sticky saliva).

Eye care.

Indications.Serious condition patient.

Equipment. Sterile: tray, tweezers, gauze balls, 0.02% furacillin solution, petroleum jelly, saline solution, pipettes, gloves, containers with disinfectant solutions.

Preparation for the procedure.

4. Pour Vaseline oil into one beaker and into another - furacillin solution.

5. Wet the ball using tweezers in Vaseline oil, slightly squeezing it against the walls of the beaker.

Executing the procedure.

1. Take the ball in your right hand and wipe one eyelid in the direction from the outer corner of the eye to the inner.

2. Rub the eyelid with a dry ball in the same direction.

3. Moisten the ball in the furacillin solution in the same way and repeat wiping in the same direction. Repeat rubbing 4-5 times with different balls.

4. if there is pus-like discharge in the corners of the eyes: rinse the conjunctival cavity saline solution, spreading the eyelids with the index and thumb left hand, and use your right hand to irrigate conjunctival sac using a pipette.

5. Rub the eyelid with a dry ball in the same direction.

6. Treat the second eye in the same way.

Completion of the procedure. Place the used balls, tweezers, beakers, pipettes in a container with a disinfectant solution. Remove gloves, place them in a container for disinfection, and wash your hands.

Nose care.

Target. Prevention of nasal breathing disorders.

Indications. The patient's condition is serious, there is discharge from the nasal cavity.

Equipment. Sterile: tray. Beaker, tweezers, Vaseline oil, cotton pads. Gloves. Tray, container with disinfectant solution.

Preparing for the procedure.

1. Establish a trusting relationship with the patient (or his relatives).

2. Explain to the patient the purpose of the procedure and obtain his consent.

3. Wash and dry your hands and put on gloves.

4. Pour sterile Vaseline oil into one beaker.

5. Take the turunda with tweezers, moisten it in Vaseline oil, and squeeze it lightly.

Execution of the procedure. 1. Transfer the turunda to your right hand and insert it into the nasal passage with rotational movements for 1-3 minutes, lifting the tip of the patient’s nose with your left hand.

2. Remove the turunda from the nasal passage with rotational movements. 3. treat the other nasal passage in the same way.

Completion of the procedure.

Note.

Ear care.

Target. Prevention of hearing loss due to wax accumulation.

Indications. The patient is in serious condition and is on bed rest.

Contraindications. Inflammatory processes in the auricle, external auditory canal.

Equipment. Sterile: tray, tweezers, beaker, cotton pads, gloves. 3% hydrogen peroxide solution, tray, container with disinfectant solutions.

Preparing for the procedure.

1. Establish a trusting relationship with the patient (or his relatives).

2. Explain to the patient the purpose of the procedure and obtain his consent.

3. Wash and dry your hands and put on gloves.

4. Pour a 3% hydrogen peroxide solution into a sterile beaker.

5. Prepare a container with soap solution.

Execution of the procedure.

1. Moisten a napkin in a soapy solution and wipe the auricle, dry with a dry napkin.

2. Take a cotton swab with tweezers and moisten it in a 3% hydrogen peroxide solution.

3. put the turunda in your right hand, pull back the auricle with your left hand, so as to align the ear canal.

4. Insert the turunda with rotational movements into the external auditory canal to a depth of no more than 1 cm for 2-3 minutes.

5. Remove the turunda using rotational movements from the external auditory canal.

6. Treat the other ear canal in the same way.

Completion of the procedure.

Place the used turundas, tweezers, and beaker in a container with a disinfectant solution. Remove gloves, place them in a container for disinfection, and wash your hands.

Note. Do not use sharp care items.

Prevention of bedsores.

Bedsore- These are deep lesions of the skin and soft tissues up to their necrosis as a result of prolonged compression. Predisposing factors include disorders of local blood circulation, innervation and tissue nutrition.

Three main factors leading to the formation of bedsores have been established:

• Pressure – tissue compression occurs under the influence of its own weight.
• "Shear"- destruction and mechanical damage to tissues is caused by tissue displacement relative to the supporting surface.
• Friction- is a component of the “cutting” force, it causes detachment of the stratum corneum of the skin and leads to ulceration of its surface.

Signs of bedsores: the appearance of pale areas of the skin, then a bluish-red color without clear boundaries, then the epidermis peels off, blisters form. Next, tissue necrosis occurs, spreading deep into the tissue and to the sides.