In the generally accepted interpretation, care is a set of activities that provide comprehensive care for a person, including the creation of optimal conditions and environment for him, the implementation of procedures prescribed by the doctor, which, in turn, contributes to a more comfortable state of health for the patient and a faster recovery.

Nursing and its basic principles

Care is divided into special and general - subtypes, which, in turn, have their own characteristics.

Let's look at each subtype separately:

• General care. This subtype includes responsibilities for maintaining the hygienic condition of the patient, as well as maintaining the ideal cleanliness of the room in which he is located, organizing meals for the patient and properly performing all procedures prescribed by the doctor. Also, general care involves assisting the patient with physical activities, eating, and toileting. In addition, this also includes monitoring the dynamics of the patient’s condition and his well-being.
• Special care is usually associated with the specifics of a particular diagnosis.

It is worth noting that care is not an alternative to treatment: it is part of a complex of therapeutic measures. One of the main purposes of caring for a sick person is to maintain a comfortable psychological and domestic environment at each stage of treatment.

How is proper care built?

The basis of proper care for patients can be called a protective regime, which is designed to protect and spare the patient’s psyche:
- elimination of excessive irritants,
- ensuring peace/quiet,
- creating comfort.
When all these components are completed, the patient feels comfortable, has an optimistic attitude and confidence in the successful outcome of the disease.
It is especially worth noting that the effectiveness of caring for a sick person requires not only certain skills, but also a compassionate attitude. After all, physical suffering and illness create feelings of anxiety in a person, often hopelessness, irritability towards medical staff and even relatives. Tact, the ability to support a person during this difficult period for him, a sensitive and attentive attitude towards him, will allow the patient to escape from his painful situation and tune in to an optimistic mood. That is why care is one of the mandatory sections of the activities of medical personnel. If the patient is treated at home, care is provided by his relatives or medical personnel, after consultation with the attending physician.

Basic principles of care

1. Room. It should be bright, spacious, and, if possible, insulated and protected from noise. For any disease, an abundance of light, fresh air and a comfortable temperature in the room where the patient is located will have a beneficial effect on the person. Separately, it is worth mentioning about the light: its strength should be reduced if there is a patient with an ophthalmological disease or a disease of the nervous system in the room. During the day, electric lamps should be covered with a frosted lampshade, and at night only nightlights or other low-heat devices can be turned on.

2. Temperature. The optimal microclimate in the patient's room should be as follows: temperature within 18-20°, air humidity no more than 30-60%. It is very important that the room does not cool down in the morning. If the air is too dry, you can put a moistened rag on the radiator to increase the humidity, or place a vessel with water next to it. To reduce the humidity in the room, it is necessary to ventilate it. In city conditions, it is better to ventilate at night, since during the day the city air is much more polluted with dust and gases. In other conditions, in the summer, you can ventilate the room around the clock, but in the winter, ventilation should be done no more than 3-5 times a day. To protect the patient from the cold air flow during ventilation, it is necessary to cover him with a blanket and his head with a towel or scarf (the face is open). Instead of ventilation, it is unacceptable to fumigate the room with aromatizing agents!

3. Purity. The room in which the patient is located must be kept clean. So, cleaning must be done at least twice a day. Furniture, window frames and doors should be wiped with damp cloths, the floor should be washed or wiped with a brush wrapped in a damp cloth. Items on which dust can accumulate (drapes, carpets) are best removed or frequently shaken out/vacuumed. The patient's room must be isolated from street, traffic and industrial noise. It is also recommended to reduce the volume on radios, televisions, etc. You should talk in a low voice.

4. Transportation. A very important point. If a person is seriously ill, he must be transported carefully, on a special chair, stretcher or gurney, while avoiding jolts. The patient is carried on a stretcher by two or four people. It is important that they walk out of step, in short steps. Shifting and carrying the patient by hand can be carried out by one, two or three people. If the carrying is carried out by one person, then it is necessary to act in the following order: one hand is placed under the patient’s shoulder blades, the other under the hips, while the patient must hold the carrier by the neck. In order to move a seriously ill patient from a stretcher to a bed, you must proceed as follows: place the stretcher at a right angle to the bed, so that its foot end is closer to the head of the bed. Before transferring a seriously ill patient to a bed, it is necessary to first check its readiness, as well as the availability of individual care items and bedside accessories.
A seriously ill person, among other things, will need:

Lining oilcloth,
- rubber circle,
- urinal,
- bedpan.

The patient's bed should be neat, comfortable, of sufficient length and width. For a patient's bed, it is best to use a multi-sectional mattress, over which a sheet is laid. If necessary, put oilcloth under the sheet. In special cases, for example, with lesions of the spine, a hard shield is placed under the mattress. It is worth remembering that the patient’s bed should not be located next to heating sources. The best location would be one in which the patient can be approached comfortably from both sides.

A seriously ill patient must be helped to undress, take off his shoes, and in special cases, the clothes are carefully cut.

5. Change of bed linen. During this procedure, the patient must not be subjected to uncomfortable postures, forced muscle tension, or pain. The patient should be moved to the edge of the bed, and the freed part of the sheet should be rolled up to the patient's body. Next, spread a clean sheet on this part of the bed and shift the patient. With strict bed rest, the sheet rolls down in the direction from the legs to the head - first to the lower back, then to the upper part of the body. The edges of the sheet are attached to the mattress with safety pins. Every time you change your linen, you should also shake out your blanket.

6. Change of underwear. When changing a shirt for a seriously ill person,
You should first place your hand under his back, then lift the shirt to the back of his head, remove one sleeve, then the other (in cases where one arm is injured, you should start with the healthy one). After this, the patient should put on a shirt (starting with the sore arm), then lower it over the head to the sacrum and straighten out all the folds. If a patient is prescribed strict bed rest by a doctor, he should wear a vest. If the patient's underwear has been contaminated with blood or secretions, it should first be soaked in a bleach solution, then dried, and only then sent to the laundry.

7. Mode. The doctor prescribes different regimens for the patient, depending
on the severity of the disease:
Strict bed rest, in which it is forbidden to even sit.
Bed rest, in which you can move in bed, but you are prohibited from leaving it.
Semi-bed, in which you can walk around the room.
A general regimen in which, as a rule, the patient’s motor activity is not significantly limited.

Features of caring for a patient with bed rest

1. The patient carries out physiological functions in bed. The person is given a disinfected, cleanly washed bedpan (a specialized device for defecation), into which a little water is poured to absorb odors. The vessel is placed under the buttocks so that the patient’s perineum is above the large hole, and the tube is between the thighs. In this case, you need to place your free hand under the sacrum and lift the patient. After freeing the vessel, it must be thoroughly washed with hot water and then disinfected with a 3% solution of chloramine or Lysol. The container for collecting urine - a urine bag - must also be served well washed and warm. After each patient urinates, the urinal is washed with solutions of sodium bicarbonate and potassium permanganate, or a weak solution of hydrochloric acid.

2. Tools and equipment necessary for maintenance must be stored in a strictly designated place. Everything necessary for the patient should be ready for use. Heating pads, bedpans, urine bags, rubber rings, ice packs must be washed with hot water, then rinsed with a 3% chloramine solution and stored in specialized cabinets. Probes, catheters, gas tubes, enema tips are washed in hot water and soap and then boiled for 15 minutes. Enema tips must be stored in designated, labeled containers. Beakers and sippy cups are ordered to be boiled. If possible, you should use care products designed for one-time use. Chairs, gurneys, cabinets, beds, stretchers and other medical equipment must be periodically disinfected with a 3% solution of chloramine or Lysol, and must be wiped daily with a wet cloth or washed with soap.

3. Personal hygiene of the patient is of great importance during the rehabilitation period. Primary patients (with the exception of patients in extremely serious condition) should be subjected to sanitary treatment, which includes a bath, shower or wet wiping, and, if necessary, a short haircut followed by disinsection treatment of the scalp. If the patient needs outside help during hygiene procedures, he should be lowered into the bath on a sheet, or placed on a special stool placed in the bath and washed with a hand shower. If a person is seriously ill, taking a bath is replaced by wiping the body with a swab dipped in warm water and soap. Upon completion of the procedure, it is necessary to wipe the patient’s body with a swab dipped in warm water without soap and wipe dry. Unless otherwise prescribed, the patient should take a shower or bath at least once a week. The patient's toenails and fingernails must be cut short.

4. Secondary or dispensary patients are recommended to wash their hair with warm water and soap (after the procedure, the hair is carefully combed). If a person is seriously ill, then it is recommended to wash your hair in bed. As for the frequency of these hygienic procedures, it is as follows: the patient’s hands should be washed before each meal, feet - every day before going to bed. The upper body, as well as the face and neck should be washed daily. The genitals and anus should also be washed daily. In cases where a person is seriously ill, washing the genitals should be carried out at least twice a day. The procedure is as follows: a bedpan is placed under the patient’s buttocks (at this time the patient lies on his back, legs bent at the knees). For the washing procedure, it is also convenient to use an Esmarch mug, which is equipped with a special rubber tube with a tip, which, in turn, has a clamp or tap. A stream of water or a weak solution of potassium permanganate is directed into the perineum. At the same time, a cotton swab is passed in the direction from the genitals to the anus. Then, using another cotton swab, the skin of the perineum is dried. This procedure can also be performed using a jug into which a warm disinfectant solution is poured. Inguinal folds, axillary areas, as well as folds of skin under the mammary glands, especially if the patient is obese or prone to excessive sweating,
It is necessary to wash frequently to avoid diaper rash.

5. Exhausted patients, as well as those patients for whom bed rest lasts a large amount of time, need especially careful care of the body and skin to avoid the development of bedsores. As a preventative measure, in addition to skin care, it is necessary to keep the bed in perfect order: regularly smooth out the folds of the sheets and eliminate unevenness. The skin of patients at risk of developing bedsores should be wiped once or twice a day with camphor alcohol, and also powdered with talcum powder. In addition, it is necessary to use rubber circles wrapped in a pillowcase, placing them under the places that are most subject to pressure (for example, the sacrum). A necessary preventive measure is also to frequently change the patient's position on the bed. Caring for the patient’s feet is no less important - with insufficient care, thick horny layers can form on the soles, which is a manifestation of epidermophytosis in a scaly form. In these cases, removal of keratinized skin followed by treatment of the skin of the legs with antifungal agents is indicated.

6. Feeding seriously ill patients is an extremely important point in care. It is necessary to strictly follow the diet and diet prescribed by the doctor. When eating, bedridden patients must be placed in a position that will avoid fatigue. As a rule, this is a slightly elevated or semi-sitting position. The patient's neck and chest must be covered with a napkin. Feverish and weakened patients should be fed while the temperature decreases/improves. Such patients are fed with a spoon; pureed or crushed food is given in small portions. For the purpose of feeding, you should not interrupt daytime sleep in cases where the patient suffers from insomnia. Seriously ill patients are given a drink from a sippy cup. If a person cannot swallow food, he is shown artificial nutrition: tube feeding.

7. Another necessary condition for successful treatment is monitoring the patient’s condition. Thus, caregivers must regularly inform the doctor about every change that occurs in the patient’s condition. It is necessary to take into account the patient’s mental state, changes in the position of his body, skin color, facial expression, the presence of a cough, breathing rate, changes in the nature and color of urine, feces, and sputum. In addition, on the instructions of the doctor, it is necessary to measure body temperature, weigh, measure the ratio of the fluid excreted and drunk by the patient, and make other prescribed observations. It is important to monitor the patient's intake of prescribed medications. For the medication administration procedure, clean beakers and a carafe of boiled water should be prepared.

Features of caring for senile and elderly patients

Care for such patients must be carried out taking into account the characteristics of the aging organism and, as a consequence, a decrease in adaptive capabilities. It is also necessary to take into account factors such as age-related changes in the psyche, as well as the unique course of diseases in older people. Among these features the following can be distinguished:

Atypical sluggish course of the disease in the absence of a pronounced temperature reaction.
- relatively rapid onset of severe complications.

Elderly people are susceptible to various kinds of infectious diseases and the appearance of inflammatory processes, and this feature requires increased care of hygienic care.

In addition, older people often exhibit increased sensitivity to changes in diet and routine, to changes in microclimate, and to the appearance of noise. Among the characteristics of the behavior and psyche of an elderly person, one can highlight slight vulnerability, emotional instability, and, in the case of vascular diseases, a sharp decrease in memory, criticism, intelligence, helplessness, and, often, untidiness. Features of this kind require increased attention from service personnel, as well as a patient and sympathetic attitude.

Strict bed rest for older people is recommended to be reduced as early as possible. And it is recommended to prescribe physical therapy and massage as early as possible for the fastest return to motor activity. This will avoid hypokinesia. Also, elderly patients are recommended to prescribe breathing exercises with
for the purpose of preventing congestive pneumonia.

Features of care for resuscitated patients

The peculiarity of care for resuscitated patients, as well as for patients who are in intensive care, is that here care includes both elements of general and special, in relation to traumatological, surgical, neurological, as well as patients in in an unconscious state.

Much attention must be paid to monitoring the patient’s condition, including monitoring, monitoring the patient’s physiological functions, including breathing, urination, and blood circulation. In addition, it is necessary to monitor the condition of perfusion tubes, catheters and conductors from systems and devices connected to a person.
Special care is required for patients who are on mechanical ventilation through a tracheostomy or through an endotracheal tube. In such cases, a thorough toilet of the tracheobronchial tree is required (in some cases, every 15-20 minutes).
Without this procedure, bronchial obstruction may be impaired and, as a result, asphyxia may develop. Removal of secretions from the bronchi and trachea must be carried out wearing sterile gloves, or after the hands have been treated with a disinfectant solution. To perform the procedure, a specialized angled catheter is used, which is connected to a vacuum pump through a tee. One elbow of the tee must be left open. The patient's head must be turned, then, while inhaling, in one movement, insert the catheter into the tracheostomy or endotracheal tube and push it through the bronchi and trachea into the lung until it stops. After this, the tee hole is closed with a finger to ensure the action of vacuum suction; the catheter must then be removed by gently rotating it with your fingers. After this, the catheter is washed with isotonic sodium chloride solution or replaced and the procedure is repeated the required number of times. The effectiveness of the procedure will be doubled if you simultaneously perform a vibration massage of the chest.
In order to prevent the development of congestion in the lungs and the appearance of bedsores, the patient’s position must be changed every 2 hours. In addition, it is necessary to place ring gauze pads under the bone protrusions and wipe the patient’s skin with antiseptic solutions.
It is better if the patient lies on an anti-decubitus mattress.
It is also necessary to pay great attention to feeding patients, since eating on their own is often impossible for them. The feeding process is carried out using a sippy cup, to the outlet of which a rubber tube 20 to 25 cm long is attached. The end of the tube is inserted into the posterior parts of the oral cavity. Food is introduced through a tube, portions are regulated by squeezing it. Solid food must be brought to a creamy consistency by first subjecting it to heat treatment, then grinding it and diluting it with liquid. Do not give the patient spicy or hot food. During feeding, the patient must be placed in a sitting position (in severe cases, the head should be raised), covered with an oilcloth apron so as not to stain the bed linen, clothes, and bandages. The feeding procedure should be repeated an average of 4 times. If it is impossible to feed the patient through a sippy cup, feeding is carried out using a nasogastric tube.

If the patient is unconscious, it is necessary to provide parenteral feeding, as well as parenteral fluid administration. Before introducing the solution into the oral cavity or vascular bed, it is necessary to warm it up to the patient’s body temperature. Upon completion
feeding, the patient’s oral cavity is washed with a solution of sodium bicarbonate, and after that with a solution of potassium permanganate in a ratio of 1: 5000, or another disinfectant solution.

CONCEPT OF CARE FOR SURGICAL PATIENTS

Surgery is a special medical specialty that uses mechanical effects on body tissue or surgery 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 with the subsequent 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 intestinal and stomach motility, impaired urination, etc. develop.

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

Natural deviations from normal physiological processes most often represent a natural response to surgical trauma and partially do not 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 sufficient for a complete and rapid recovery of the patient.

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

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

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

Nursing is helping a patient in his frail state and is the most important element of medical activity.

In severe postoperative patients, care includes assistance in meeting their basic life needs (food, drink, movement, bowel movements, bladder, etc.); carrying out personal hygiene measures (washing, preventing bedsores, changing linen, etc.); assistance during painful conditions (vomiting, coughing, bleeding, breathing problems, etc.).

In surgical practice, for patients suffering from pain and fearful before or after surgery, care requires an active position on the part of the staff. Surgical patients, especially severe postoperative patients, do not ask for help. Any care activities bring them additional painful and unpleasant sensations, so they have a negative attitude towards any attempts to activate the motor mode and perform the necessary hygienic procedures. In these situations, staff must exercise caring, patient persistence.

An important component of nursing is to create as much physical and mental peace as possible. Silence in the room where patients are, a calm, even, friendly attitude of medical personnel towards them, the elimination of all unfavorable factors that can traumatize the patient’s psyche - these are some of the basic principles of the so-called medical and protective regime of medical institutions, on which the effectiveness largely depends treating 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 the medical staff contributes to recovery.

SANITARY PREPARATION OF THE PATIENT FOR OPERATION

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

Preoperative preparation is carried out to reduce the risk of surgery and prevent possible complications. The preoperative period can be very short during emergency operations and relatively extended during planned 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 functioning of various systems in order to lead to a certain readiness of the patient’s body for surgical intervention. The outcome 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 mild cold, the appearance of pustules on the body, etc. Sanitation of the oral cavity is mandatory.

The responsibilities of junior and middle staff include sanitary preparation of the patient. It usually starts the evening before surgery. The patient is explained that the operation must be performed on an empty stomach. In the evening, patients receive a light dinner, and in the morning they are not allowed to 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, his underwear and bed linen are changed. At night, as prescribed by the doctor, the patient is given sleeping pills or sedatives.

In the morning, immediately before the operation, hair is shaved widely from the future surgical field and its circumference, taking into account 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 measures cannot be carried out in advance, since abrasions and scratches received during shaving may become infected. A few hours are enough to turn them into a source of infection with subsequent development of postoperative complications.

In the morning the patient washes his face and 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. Women with long hair have their hair braided.

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 for emergency reasons, the amount of sanitary preparation depends on the urgency of the required operation and is determined by the doctor on duty. Mandatory measures are emptying the stomach using a gastric tube and shaving the hair of the surgical field.

HYGIENE OF THE BODY, LINEN, 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 damaged functions of life-supporting organs and systems.

In patients in the postoperative period, active, passive and forced positions are distinguished.

The active position is typical for patients with relatively mild diseases, or in the initial stages of severe diseases. The patient can independently change position in bed, sit down, stand up, and walk.

A passive position is observed when the patient is unconscious and, less commonly, in cases 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 towards the lower end of the bed. Such patients require special monitoring by medical staff. It is necessary to change the position of the body or its individual parts from time to time, which is important in the prevention of complications - bedsores, hypostatic pneumonia, etc.

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

Caring for patients with a general regime after surgery comes down mainly to organizing and monitoring their compliance with hygienic measures. Seriously ill patients with bed rest need active assistance in caring for the body, linen, and performing physiological functions.

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

To give the patient a functionally advantageous position, special headrests, bolsters, 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 using handles. The legs of the bed are equipped with wheels for moving it to another place.

An important element of caring for seriously 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 prolonged compression, disturbances of local blood circulation and nervous trophism. Bedsores usually form in severe, weakened patients who are forced to remain in a horizontal position for a long time: when lying on the back - in the area of ​​the sacrum, shoulder blades, elbows, heels, on the back of the head, when the patient is positioned on the side - in the area 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, food crumbs in the bed, long stay of the patient in one position.

When bedsores develop, the skin first appears as redness and pain, then the epidermis peels off, sometimes with the formation of blisters. Next, necrosis of the skin occurs, spreading inward and to the sides, exposing muscles, tendons, and periosteum.

To prevent bedsores, change the position every 2 hours, turning the patient, while the places where bedsores may appear are inspected, wiped with camphor alcohol or another disinfectant, and a light massage is performed - stroking, patting.

It is very important that the patient’s bed is neat, the mesh is well stretched, with a flat surface; a mattress without bumps or 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 or gather in folds.

For patients suffering from urinary and fecal incontinence, or with copious discharge from wounds, it is necessary to place an oilcloth over the entire width of the bed and bend its edges well to prevent soiling of the bed. A diaper is placed on top, which is changed as needed, but no less than every 1-2 days. Wet, soiled linen is changed immediately.

A rubber inflatable circle covered with a diaper is placed under the patient’s sacrum, 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 areas of the skin in waves, thereby producing a massage and improving blood circulation in the skin. 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 treating purulent wounds, as prescribed by a doctor.

Bed and underwear are changed regularly, at least once a week, after a hygienic bath. In some cases, linen is changed additionally as needed.

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

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 carefully lift his head and remove the pillow from under it, and then help the patient turn on his side. On the vacant 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 cushion along the patient’s back. In the vacated space 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 find himself lying on a clean sheet, turning his face to the opposite edge of the bed. After this, remove the dirty sheet and straighten the clean one.

If the patient cannot move at all, you can change the sheet in another way. Starting at the bottom end of the bed, roll the dirty sheet under the patient, lifting his legs, thighs and buttocks in turn. The roll of the dirty sheet will be placed 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 lifting the patient’s lower limbs and buttocks. The roll of the clean sheet will be next to the roll of the dirty one - under the lower back. Then one of the orderlies slightly raises the patient’s head and chest, while the other at this time removes the dirty sheet and straightens a clean one in its place.

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

If there is no gurney, the two of you need to move the patient to the edge of the bed, then straighten the mattress and sheet on the vacant half, then transfer the patient to the removed half of the bed and do the same on the other side.

When changing underwear in seriously ill patients, the nurse should place her hands under the patient’s sacrum, grab the edges of the shirt and carefully bring it to the head, then raise both of the patient’s arms and move the rolled up shirt at the neck over the patient’s head. After this, the patient's hands are freed. Dress the patient in the reverse order: first put on the sleeves of the shirt, then throw it over the head, and finally straighten it under the patient.

For very seriously ill patients, there are special shirts (vests) 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 sick one. First they dress the sore hand, and then the healthy one.

In severely ill patients who are on bed rest for a long time, various skin disorders 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, alcohol half and half with water, table vinegar (1 tablespoon per glass of water), etc. To do this, take the end of a towel, moisten it with a disinfectant solution, wring it out lightly and begin to wipe behind the ears, neck, back, front surface of the chest and in the armpits. You should pay attention to the folds under the mammary glands, where obese women can develop diaper rash. Then wipe the skin dry in the same order.

A patient on bed rest needs to 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 soaps his feet, washes, wipes, and then trims his nails.

Seriously ill patients cannot brush their teeth on their own, so after each meal the nurse must clean the patient’s mouth. To do this, she alternately removes the patient’s cheek from the inside with a spatula on each side 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 this, the patient thoroughly rinses his mouth with the same solution or just warm water.

If the patient is unable to rinse, then he should irrigate the oral cavity using an Esmarch mug, a rubber bulb or a Janet syringe. The patient is given a semi-sitting position, the chest is covered with oilcloth, and a kidney-shaped tray is brought to the chin to drain the washing liquid. The nurse alternately pulls back the right and then the left cheek with a spatula, inserts the tip and irrigates the oral cavity, while washing away food particles, plaque, etc. with a stream of liquid.

In severely ill patients, inflammation often occurs on the mucous membrane of the mouth - stomatitis, gums - gingivitis, tongue - glossitis, which is manifested by redness 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, weak potassium permanganate solution). Applications can be made by applying sterile gauze pads soaked in a disinfectant solution or analgesic for 3-5 minutes. The procedure is repeated several times a day.

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

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

If purulent discharge appears that sticks the eyelashes together, the eyes are washed with sterile gauze swabs soaked in a warm 3% boric acid solution. The tampon is moved in the direction from the outer edge to the nose.

To instill drops into the eye, use an eye pipette, and there should be different sterile pipettes for different drops. The patient throws back his head 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 applied with a special sterile glass rod. The patient's eyelid is pulled down, ointment is placed behind it and rubbed over the mucous membrane with gentle finger movements.

If there is nasal discharge, they are removed with cotton swabs, inserting them into the nasal passages with light rotational movements. When crusts form, you must first drop a few drops of glycerin, vaseline or vegetable oil into the nasal passages; after a few minutes, the crusts are removed with cotton wool.

Wax that accumulates in the external auditory canal should be carefully removed with a cotton swab, after dropping 2 drops of a 3% hydrogen peroxide solution. To put drops into the ear, the patient's head must be tilted in the opposite direction, and the auricle must be pulled back and up. After instilling the 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 your ears due to the risk of damaging 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, a patient who is on strict bed rest is given a bedpan, and when urinating, a urinal is provided.

The vessel can be metal with an enamel coating or rubber. A rubber bed is used for weakened patients, those with bedsores, and fecal and urinary incontinence. Do not inflate the vessel too tightly, otherwise it will put significant pressure on the sacrum. When placing the vessel into the bed, be sure to place an oilcloth under it. Before serving, the vessel is rinsed with hot water. The patient bends his knees, the nurse places his left hand on the side under the sacrum, helping the patient to raise the pelvis, and with his right hand he places the vessel under the patient’s buttocks so that the perineum is above the hole 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, since otherwise maceration and inflammation of the skin are possible in the area of ​​the inguinal folds and perineum.

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

When washing, a woman should lie on her back, bend her knees and slightly spread them at the hips, and place a bedpan under her buttocks.

The nurse takes a jug with a warm disinfectant solution in her left hand and pours water on the external genitalia, and uses a forceps with a cotton swab clamped in it to make movements from the genitals to the anus, i.e. top down. After this, wipe the skin in the same direction with a dry cotton swab so as not to spread the infection from the anus to 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.

It is much easier to wash men. The patient is positioned on his back, legs bent at the knees, and a bed is placed under the buttocks. Using cotton wool clamped in a forceps, wipe the perineum dry and lubricate it with petroleum jelly to prevent diaper rash.

POST-OPERATIVE WOUND CARE

The local result of any operation is a wound, which is characterized by three important signs: 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 of non-viable tissue, 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 a 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 of surgical pathology largely depends on proper observation and care of the postoperative wound.

The wound healing process is absolutely objective, occurs independently and is worked to perfection by nature itself. However, there are reasons that interfere with the wound process and inhibit normal wound healing.

The most common and dangerous reason 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. Fighting an infection requires a significant effort of the macroorganism, time, and is always risky with regard to the generalization of the infection and the development of other severe complications.

Infection of the wound is facilitated by its gaping, since the wound is open for microorganisms to enter 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, the gaping is eliminated during surgery by restoring the anatomical relationships by layer-by-layer suturing of the wound.

Caring for a clean wound in the postoperative period comes down primarily to measures to prevent its microbial contamination from secondary, hospital infections, which is achieved by strictly following well-developed asepsis rules.

The main measure aimed at preventing contact infection is sterilization of all objects that may come into contact with the surface of the wound. Instruments, dressings, gloves, linen, solutions, etc. must be sterilized.

Directly in the operating room, after suturing the wound, it is treated with an antiseptic solution (iodine, iodonate, iodopirone, brilliant green, alcohol) and covered with a sterile bandage, which is tightly and securely fixed by bandaging or using glue or adhesive tape. If during the postoperative period the bandage becomes loose or wet 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.

During any dressing (removal of a previously applied dressing, examination of the wound and therapeutic manipulations on it, application of a new dressing), the wound surface remains open and comes into contact with air for a more or less long time, as well as with instruments and other objects used in dressings. Meanwhile, the air in dressing rooms contains significantly more microbes than the air in operating rooms, and often in other hospital rooms. 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 when changing dressings is mandatory to avoid droplet infection from splashing saliva, coughing, or breathing onto the wound surface.

After the vast majority of clean operations, the wound is sutured tightly. Occasionally, between the edges of a 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, residual blood and accumulated lymph in order to prevent wound suppuration. Most often, drainage of clean wounds is performed after operations on the mammary gland, when a large number of lymphatic vessels are damaged, or after operations for extensive hernias, when after removal of large hernial sacs pockets remain in the subcutaneous tissue.

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

Postoperative care for patients with vacuum therapy, as a method of protecting uncomplicated wound processes, comes down to monitoring the presence of 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 joints between tubes and adapters. If the system depressurizes, it is necessary to create a vacuum in it again and eliminate the source of air leakage. Therefore, it is desirable that the vacuum therapy device have a device for monitoring the presence of vacuum in the system. When using a vacuum of less than 0.1 atm, the system stops functioning on the first day after surgery, since the tube becomes obstructed due to thickening of the wound exudate. When the degree of vacuum is more than 0.15 atm, clogging of the side holes of the drainage tube with soft tissues is observed, involving them in the drainage lumen. This has a damaging effect not only on the fiber, but also on young developing connective tissue, causing it to bleed and increase wound exudation. A vacuum of 0.15 atm allows you to effectively aspirate discharge from a wound and have a therapeutic effect on 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 subject to pre-sterilization cleaning and disinfection. They are first washed with running water so that no clots remain in their lumen, then 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 initially performed for a purulent disease, then the wound must be treated in an open manner, that is, the edges of the wound must be separated and the wound cavity drained in order to evacuate the pus and create conditions for cleansing the edges and bottom of the wound from necrotic tissue .

When working in 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 you need to 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 body, 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 dressing, which should remain dry and not contaminate the linen and furniture in the room. Bandages often have to be bandaged and changed.

The second important sign of a wound is pain, which occurs as a result of organic damage to nerve endings and 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 a trigger for collapse and the development of shock. Severe pain usually absorbs the patient's attention, interferes with sleep at night, limits the patient's mobility, and in some cases causes a feeling of fear of death.

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

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 promotes thrombus formation and prevents the development of hematoma in the wound.

To prepare “cold”, water is poured into a rubber bladder with a screw cap. Before screwing the cap on, the air must be forced out of the bubble. The bubble is then 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 after surgery to give the affected organ or part of the body the correct position, which achieves maximum relaxation of the surrounding muscles and functional comfort for the organs.

After operations on the abdominal organs, a position with a raised head and slightly bent knees is functionally advantageous, which helps relax the muscles of the abdominal wall and provides rest 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 shoulder abduction 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 carried out to an angle of 140°, and the foot should be at right angles to the lower leg. After surgery, the limb is immobilized in this position using splints, splints or a fixing bandage.

Immobilization of the affected organ in the postoperative period significantly facilitates the patient’s well-being by relieving pain, improving sleep, and expanding the general motor pattern.

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

Controlling bleeding, the third important sign of a wound, is a major challenge in any operation. However, if for some reason this principle was not implemented, then in the next few hours after the operation the bandage becomes wet with blood or blood leaks through the drains. These symptoms serve as a signal for immediate examination by a surgeon and active action in terms of revision of the wound in order to finally stop the bleeding.

The organization of care depends on where the patient is located (at home or in a hospital). All medical workers, as well as relatives and friends of the patient (especially if the patient is at home) should actively participate in the organization of patient care. The doctor organizes care for the patient, regardless of where the patient is located (in the hospital this is the attending physician, at home - the local doctor). It is the doctor who gives instructions regarding the patient’s physical activity regimen, nutrition, prescribes medications, etc. The doctor monitors the patient’s condition, the progress and results of treatment, constantly monitoring the correctness and timeliness of the necessary treatment and diagnostic procedures.

The decisive role in providing patient care belongs to nursing staff. The nurse carries out the doctor’s prescriptions (injections, dressings, mustard plasters, etc.) regardless of whether the patient is at home or in the hospital. Certain manipulations of general patient care in a hospital are performed by junior medical staff, i.e. nurses (cleaning premises, providing a patient with a bedpan or urine bag, etc.).

Features of general care for patients in a hospital. A feature of inpatient treatment is the constant presence of a large group of people in one room around the clock. This requires patients and their loved ones to comply with the internal regulations of the hospital, the sanitary and epidemiological regime, and the medical and protective regime.

Compliance with the rules of the regime begins with the hospital admissions department, where, if necessary, the patient is sanitized and changed into hospital clothes (pajamas, gown). In the admission department, the patient and his relatives can familiarize themselves with the internal rules of the hospital: hours for patients to sleep, get up, have breakfast, visit the doctor, visit relatives, etc. Relatives of the patient can familiarize themselves with the list of products allowed to be given to patients.

One of the most important tasks of general patient care is the creation and provision of a therapeutic and protective regime in the hospital.

Therapeutic and protective regime are measures that are aimed at ensuring maximum physical and mental peace for patients. The therapeutic and protective regime is ensured by the internal regulations of the hospital, compliance with the prescribed regime of physical activity, and careful attitude towards the patient’s personality.

Sanitary and hygienic regime- a set of measures aimed at preventing the occurrence and spread of infection within the hospital. These measures include sanitary treatment of patients upon admission to the hospital, regular change of underwear and bed linen, measurement of the patient’s body temperature upon admission and daily during the patient’s stay in the hospital, disinfection, and sterilization.

Features of general care for patients at home. Organizing care for a patient at home has its own characteristics, since most of the time during the day is spent not by medical workers, but by the patient’s relatives. It is especially important to properly organize care for a long-term ill person at home.

The care organization is usually led by a local therapist. Care manipulations are performed by the local nurse, relatives and friends of the patient under the guidance of the local doctor and local nurse. The doctor, just like in a hospital, prescribes a regimen, diet, and medications for the patient.

It is advisable that the patient be in a separate room. If this is not possible, then it is necessary to separate the part of the room where the patient is located with a screen. The patient's bed should be located near a window, but not in a draft, since the room must be ventilated several times a day. It is advisable for the patient to see the door. The room should not have unnecessary things, but it should be cozy. It is necessary to wet clean the room daily. At least twice a day it is necessary to ventilate the room where the patient is. If the patient cannot be taken out of the room during ventilation, then the patient must be covered.

An essential aspect of care is proper bed preparation. First, a mattress in an oilcloth mattress cover is laid on the bed, then a flannel bedding, and a sheet on top of it. An oilcloth is placed on the sheet, and changing diapers are laid on top of the oilcloth as needed. A pillow and blanket are placed on top.

It is advisable to place a small rug near the bed. Under the bed on a stand there should be (if the patient is assigned to bed rest) a bedpan and a urine bag.

Relatives and friends of the patient should learn how to care for the patient (or invite a trained nurse).

Features of caring for elderly and senile patients. With age, changes gradually develop in all organs and systems of a living organism: visual acuity, hearing decreases, skin elasticity decreases, etc. The course of diseases in older people also has its own characteristics. Most often, elderly and senile people develop diseases such as atherosclerosis, diabetes mellitus, hypertension, diseases of the musculoskeletal system, etc. Very often, such patients have a combination of several diseases. Many diseases occur in elderly and elderly patients latently, without clear symptoms, with a tendency to complications. For example, in these patients, infectious diseases occur without a pronounced temperature reaction, which is due to a decrease in the body’s reactivity. “Erased” symptoms are also observed in acute surgical diseases (for example, appendicitis), which require immediate surgical intervention.

Medicines act more slowly on older people. their effectiveness is lower. Drug therapy requires great caution. Older people should not be given medicines for the whole day at once. It should not be difficult to explain the effect of medications, as the patient may forget it. The caregiver himself must give the patient medicine at a certain time. Elderly and elderly patients can often be disoriented in space and time (for example, the patient thinks that he is not at home, but on the street and he needs to go to the store). At such moments, you should not oppose him, but, on the contrary, try to “play along” with him, go with him to the “store” and after a while he will forget about his idea.

For elderly and geriatric patients, a therapeutic and protective regime is of great importance. Therefore, for such patients it is very important to maintain a sleep-wake schedule, not to disturb their peace with loud sounds, etc. Very often, the cause of disturbances in night sleep is not only insomnia, but frequent urination at night due to age-related characteristics of the functioning of the kidneys. Therefore, it is necessary that the patient has the bedpan at hand at night.

Skin care is of great importance for elderly and geriatric patients. Dry areas of the skin should be lubricated with special creams, calluses should be removed in a timely manner, etc.

Skin care for diabetes mellitus is of particular importance, since one of its complications is the so-called diabetic foot, when disruption of blood microcirculation processes due to changes in blood vessels in diabetes mellitus can lead to gangrene of the lower extremities. It is necessary to examine the skin of the feet of such patients daily (if it is difficult for the patient to do this himself due to impaired mobility of the limbs, then the patient can examine the feet using a mirror).

Patients with urinary incontinence require careful care. because they quickly develop bedsores and diaper rash. To prevent them, it is necessary to wash the patient more often, wipe the skin of the perineum dry and lubricate the skin with cream (preferably children's).

Often in elderly and geriatric patients, intestinal function is impaired (due to weakened motor activity of the gastrointestinal tract, patients experience constipation). In such cases, it is better to avoid enemas, since they irritate the intestinal mucosa. It is more advisable to regulate stool with the help of diet: you need to eat more fruits (apples, prunes, etc.), vegetables (beets), infusions of medicines such as buckthorn or senna bark, i.e. laxatives (infusions of these herbs are drunk 1/4 cup per day 30 minutes before meals). You can drink a glass of cold water daily on an empty stomach for laxative purposes.

Sometimes hemorrhoids make defecation painful. To prevent this, it is necessary to insert suppositories with glycerin or belladonna into the anus before defecation, and after defecation, wash the anus with soap.

Older people often experience age-related changes in the oral cavity: various diseases of the oral mucosa, dental caries, etc. develop. Therefore, when caring for the elderly, special attention should be paid to oral care. They should use salt toothpastes, alternating them with toothpastes containing fluoride. It is good to use decoctions of medicinal herbs when rinsing the mouth: sage, chamomile, Kalanchoe, etc. To remove food debris from the teeth, you can use floss or disposable wooden toothpicks. You should especially carefully care for your oral cavity when using dentures. For the purpose of prevention and timely treatment, the patient needs to consult a dentist at least 2...3 times a year.

Physical inactivity has a negative impact on well-being and health. Therefore, care for elderly and elderly people must necessarily include a set of physical exercises, if possible, staying in the fresh air for 1.5...2 hours (or at least frequent ventilation of the room where the patient is).

Features of the nutrition of the elderly and the elderly is to reduce the energy value of the daily diet to 70...80% of the daily diet of people in the age group of 20...30 years by reducing the amount of carbohydrates (bread, sugar, confectionery, potatoes). The elderly should limit the consumption of animal fats and salt (liquid is limited only in case of edema).

Personal hygiene of the patient

The patient's personal hygiene measures largely depend on the patient's position - active, passive, forced. In an active position, the patient can voluntarily and independently change the position of the body; in a passive position, the patient cannot change the position of the body without assistance. The patient accepts a forced position to improve his well-being and alleviate his suffering. The passive position of the patient greatly complicates patient care.

Change of underwear and bed linen. Linen change is necessary at least once a week, and also when soiled. Changing bed linen depends on the physical activity regimen prescribed to the patient by the doctor. This regime can be general (the patient is allowed to walk and climb stairs), semi-bed (the patient is allowed to go to the toilet located in the ward, accompanied by him), bed (when the patient is allowed to sit in bed and turn around in bed) and strict bed (when the patient is not allowed to even turn over in bed). The method of changing linen (sheets) consists of rolling a dirty sheet into a roll and then spreading a clean sheet, also previously rolled into a roll. For patients with strict bed rest, linen is changed in a transverse direction, from the head, carefully lifting the upper body. If bed rest, then the sheet is changed in the longitudinal direction, sequentially rolling up the dirty one, while simultaneously straightening the clean sheet along the patient’s body, turning him on his side (Fig. 9.1).

Remove underwear (shirt) after rolling it up to the back of the head, first freeing the head, then the hands. Put on a clean shirt in the opposite direction (Fig. 9.2).

Skin, hair, nail care. For the skin to function properly, it must be clean. To do this, it is necessary to perform her morning and evening toilet. The skin becomes contaminated with secretions of the sebaceous and sweat glands, keratinization of the skin epithelium, etc. The skin also becomes contaminated with secretions from the genitourinary organs and intestines.

Rice. 9.1. Changing bed linen for a seriously ill patient: a - rolling up the sheet lengthwise; b - rolling the sheet wide

Rice. 9.2. Sequentially removing the shirt from a seriously ill patient

The patient should be washed in a bath or shower at least once a week. Every day the patient must wash his face, wash his hands, and wash his face. If a bath and shower are contraindicated, then in addition to daily washing, rinsing, washing hands before each meal and after using the toilet, it is necessary to wipe the patient daily with a cotton swab moistened with water, warm camphor alcohol or a vinegar solution (1 - 2 tablespoons per 0.5 liters of water ). After wiping, wipe the skin dry.

The perineal skin must be washed daily. Seriously ill patients should be washed after each urination (Fig. 9.3). To wash, you should prepare a warm (30...35°C) weak solution of potassium permanganate or water, an oilcloth, a vessel, a napkin, tweezers or a clamp.

The sequence of actions is as follows:

Place the patient on his back, legs should be bent at the knees and apart;

lay down an oilcloth and place the vessel on it;

stand to the right of the patient and, holding a jug of water in your left hand, and a clamp with a napkin in your right, pour water onto the genitals, and with the napkin make movements from the genitals to the anus, i.e. from top to bottom;

dry the skin of the perineum with a dry cloth in the same direction;

remove the vessel and oilcloth.

Rice. 9.3. Devices and methods

perineal care: a - bidet; b - method of washing the patient

Rice. 9.4. Method of washing the hair of a seriously ill patient

The patient's hair must be combed daily and his hair must be washed once a week. If necessary, you can wash the patient's hair in bed (Fig. 9.4).

Fingernails and toenails must be trimmed regularly; it is better to do this after a hygienic bath or shower, or after washing your feet. If necessary, feet can be washed in bed (Fig. 9.5). After washing your feet, you need to dry them, especially the skin between the toes. Nails, especially on the toes (they are often thickened), should be trimmed especially carefully, not rounding the corners, but cutting the nail in a straight line (to avoid ingrown nails).

Care for the oral cavity, teeth, ears, nose, eyes. Oral care means that the patient needs to rinse the mouth after each meal and brush his teeth at least twice a day. Seriously ill patients need to wipe the mouth and teeth with an antiseptic solution 2 times a day (Fig. 9.6). To do this, you need to prepare: cotton balls, tweezers, a 2% soda solution or a weak solution of potassium permanganate, or warm boiled water.

Rice. 9.5. Method of washing the feet of a seriously ill patient

The sequence of actions is as follows:

wrap your tongue with a napkin and carefully pull it out of your mouth with your left hand;

moisten a cotton ball with a solution of soda and, removing plaque, wipe your tongue;

If the patient can, then let him rinse his mouth with warm water. If the patient cannot rinse his mouth on his own, then it is necessary to

Rice. 9.6. Toilet of teeth and tongue

Irrigation (rinsing) of the oral cavity, for which fill a rubber balloon with a solution of soda or other antiseptic; turn the patient's head to one side, cover the neck and chest with oilcloth, place a tray under the chin; pull back the corner of your mouth with a spatula (instead of a spatula, you can use the handle of a cleanly washed tablespoon), insert the tip of the balloon into the corner of your mouth and rinse your mouth with a stream of liquid; rinse the left and right cheek space alternately;

Before treating the oral cavity, removable dentures should be removed. At night, dentures should be removed and thoroughly washed under running water and soap. Store the dentures in a dry glass and rinse them again in the morning before putting them on.

Ears should be washed regularly with warm water and soap. Wax that accumulates in the external auditory canal should be carefully removed with a cotton swab, after dropping 2...3 drops of a 3% hydrogen peroxide solution into the external auditory canal. To put drops into the ear, the patient's head must be tilted in the opposite direction, and the auricle must be pulled back and up. After instilling the drops, the patient should remain in this position for 1...2 minutes.

Discharge from the nose should be removed with cotton wool, inserting it into the nose with light rotational movements. The resulting crusts in the nose can be removed with cotton wool moistened with vegetable or petroleum jelly.

To instill drops into the nose, tilt the patient's head in the opposite direction and tilt it back slightly. Having dropped drops into the right nasal passage, after 1 ... 2 minutes you can drop them into the left nasal passage.

Discharge from the eyes must be wiped or washed with a solution of furatsilin or a 1...2% soda solution. The sequence of actions when wiping the eyes is as follows:

wash your hands thoroughly;

moisten a sterile cotton swab in an antiseptic solution and, squeezing it slightly, wipe the eyelashes and eyelids with it in the direction from the outer corner of the eye to the inner one in one movement, after which the swab should be thrown away;

take another swab and repeat wiping 1...2 times;

blot the remaining solution with a dry swab.

The sequence of actions when washing the eyes is as follows:

pour the solution prescribed by the doctor into a special glass (for washing the eyes) and place it on the table in front of the patient;

ask the patient to take the glass by the stem with his right hand and tilt his face so that the eyelids are in the glass, press it to the skin and raise his head, while the liquid should not flow out;

the patient should blink frequently for 1 minute; the patient must place the glass on the table without removing it from his face;

pour a fresh solution into the glass and ask the patient to repeat the procedure.

The eye ointment is applied using a glass rod with the patient in a sitting position. The sequence of actions when putting ointment from a tube into the eye is as follows:

pull the patient's lower eyelid down;

hold the tube at the inner corner of the eye and move it so that the ointment, when squeezed out, is located along the entire eyelid on its inner side (Fig. 9.7, a);

release the lower eyelid so that the ointment presses against the eyeball.

When putting ointment into the eye from a bottle using a glass rod (see Fig. 9.7,-a), you must: take the ointment from the bottle onto a sterile glass rod, pull back the patient’s lower eyelid, place the stick with ointment behind the pulled lower eyelid, release the lower eyelid, after which the patient must close his eyelids.

When instilling drops into the eye, you should check that the drops comply with the doctor’s prescription; take the required number of drops into the pipette (2...3 drops

Rice. 9.7. Applying eye ointment (a) and instilling eye drops (b)

for each eye); the patient should throw back his head and look up; pull back the lower eyelid and, without touching the eyelashes, drip drops behind the lower eyelid (remember that you cannot bring the pipette closer to the eye than 1.5 cm) (Fig. 9.7, b).

Prevention of bedsores. Bedsores are the death of skin and soft tissues as a result of prolonged compression between the patient’s bones and the surface on which he lies. Bedsores occur in patients who remain in one position for a long time. When the patient is positioned on his back, bedsores most often form in the area of ​​the shoulder blades, sacrum, elbows, heels, and back of the head. With the patient lying on his side, bedsores can form in the hip joint. Bedsores pose a serious problem for the patient, his relatives and medical staff. The presence of bedsores causes the patient not only physical suffering, but also has a psychologically adverse effect on the patient, since most often patients perceive the presence of bedsores as evidence of the severity and hopelessness of their condition.

Treatment of deep and infected bedsores is a process that drags on for several months. Therefore, it is easier to prevent the occurrence of bedsores. A number of other reasons also contribute to the occurrence of bedsores: trauma to the skin, even the most minor (crumbs on the bed, scars and folds on linen, adhesive plaster); wet laundry; poor nutrition (leading to impaired trophism of the skin); diabetes; obesity; thyroid diseases, etc. Bad habits (smoking and alcohol) increase the likelihood of developing bedsores. Bedsores are quickly accompanied by infection. Bedsores develop in several stages: white spot, red spot, blister, necrosis (necrosis).

Prevention of bedsores involves: changing the patient’s position every 2 hours; careful preparation of the bed without folds, scars and crumbs; checking the condition of the skin every time the patient changes position; Immediate change of wet or soiled linen; maintaining the patient’s personal hygiene (daily washing the skin in places where bedsores are most likely to appear with warm water, followed by massaging movements, treating the skin with antiseptic solutions - 10% solution of camphor alcohol or 0.5% solution of ammonia, or 1% - m solution of salicylic alcohol diluted with vinegar; washing after each urination and defecation); use of special anti-decubitus mattresses; balanced nutrition of the patient with a high content of carbohydrates and fats to ensure maximum mobilization of proteins.

Use of a bedpan and urine bag. Patients who are on strict bed rest are given a bedpan to empty their bowels, and a urinal to empty the bladder (women are also given a bedpan when urinating). The vessel can be enameled or rubber. In seriously ill patients, the vessel is usually permanently under the bed.

When putting the vessel into bed you should:

place an oilcloth under the patient’s pelvis;

rinse the vessel with warm water, leaving a little water in it;

place your left hand under the patient’s sacrum, helping him raise the pelvis (the patient’s legs should be bent at the knees);

With your right hand, bring the vessel under the patient’s buttocks so that the perineum is above the opening of the vessel;

cover the patient with a blanket and leave him alone;

pour the contents into the toilet, rinse the vessel with hot water (you can add Pemoxol-type powder to the vessel);

wash the patient, thoroughly dry the perineum, remove the oilcloth;

disinfect the vessel with a disinfectant solution (for example, chloramine).

When using a rubber bedpan, do not overinflate it, as it may place significant pressure on the sacrum.

Before applying the urine bag, it should be rinsed with warm water. To remove the smell of urea, the urinal can be rinsed with the Sanitary-2 cleaning agent.

The basis of general care is the creation of a hygienic environment and an appropriate regime in a medical institution, direct individual patient care, proper nutrition and strict implementation of treatment prescriptions, and constant monitoring of the condition of patients. Patient care begins with the correct and quick organization of the necessary assistance in the emergency department of a medical institution.

The nurse helps seriously ill patients undress and, if necessary, very carefully cuts clothes and shoes. Clothes are placed in a special bag. Afterwards, the patient is put on hospital clothes and transferred to a ward, accompanied by a nurse. Seriously ill patients are transported on gurneys or chairs, accompanied by a nurse. In the emergency department, he often assists in providing emergency care. Seriously ill patients are transported within a medical institution, observing general rules, as quickly and carefully as possible, avoiding shocks. Stretchers with patients are carried by 2 or 4 people, walking out of step, in short steps. When going up the stairs, the patient is carried head first, when going down the stairs - feet first, in both cases the foot end of the stretcher is raised. Carrying and shifting the patient in their arms can be done by 1, 2 or 3 people. If 1 person is carrying the patient, then he places one hand under the shoulder blades, the other under the patient’s hips; at the same time, the patient holds the carrier’s neck with his hands. A nurse must be involved in carrying and repositioning severely weakened and seriously ill patients. When transferring seriously ill patients from a stretcher to a bed, the stretcher is placed at right angles to the bed so that the foot end of the stretcher is closer to the head end of the bed (or vice versa). Nurses must thoroughly understand the rules of carrying patients in order to be able to instruct junior nursing staff if necessary.

In the room, the nurse checks the readiness of the bed, bedside accessories, personal care items and alarms. For a seriously ill patient, an oilcloth lining, a urine bag, a rubber ring, and bedside accessories are necessary. The patient should be familiarized with the daily routine and hospital regime immediately upon admission. The regimen of the department and the individual regimen of the patient requires strict adherence to the daily routine and correct behavior of patients and medical staff.

Depending on the nature and severity of the disease, patients may be prescribed strict bed rest (not allowed to sit), bed rest (you can move in bed without leaving it), semi-bed rest (you can walk around the ward and to the toilet) and the so-called general regime, which does not significantly limit the patient’s motor activity. The nurse, ward or guard, ensures that patients carefully follow the internal rules and the prescribed regimen. Performing manipulations and dispensing medications should not coincide with the hours of eating, sleeping and resting of patients, with the exception of providing emergency care or hourly fulfillment of medical prescriptions. It is necessary to ensure that there is no noise in the department: you should talk in a low voice, move furniture quietly, the operation of medical equipment, the movement of gurneys should be silent, etc.

A hygienic environment is achieved by carefully maintaining the cleanliness of the premises. Rooms are cleaned using a wet method 2 times a day: in the morning after patients get up and in the evening before bed. Walls, window frames, doors, furniture are wiped with a damp cloth; the floor is washed or wiped with a brush wrapped in a damp cloth. The contents of bedside tables are checked daily to prevent accumulation of food and unnecessary items. should be stored in the refrigerator in cellophane; bags, to which a note with the patient's name is attached. The contents of the refrigerator are monitored at least once a week by the head nurse. The air in the rooms should always be fresh, which is ensured by supply and exhaust ventilation and ventilation (in winter, transoms are opened 3-4 times a day for 10-15 minutes, in summer windows can be open around the clock). In winter, when ventilating, you need to cover the patient warmly with a blanket, cover your head with a towel, and leave your face open, except in cases where the influx of cold air causes irritation of the upper respiratory tract. The room temperature should be constant, within 18-20°, air humidity - 30-60%. To increase humidity in the wards, open vessels with water are placed, and ventilation is increased to reduce it. Electric lamps should be covered with frosted lampshades; at night, low-intensity light bulbs (night lights) are lit.

42. General principles of patient care (basic activities for general patient care). Administration of drugs. Complications.

The organization of care depends on where the patient is located (at home or in a hospital). All medical workers, as well as relatives and friends of the patient (especially if the patient is at home) should actively participate in the organization of patient care. The doctor organizes care for the patient, regardless of where the patient is located (in the hospital this is the attending physician, at home - the local doctor). It is the doctor who gives instructions regarding the patient’s physical activity regimen, nutrition, prescribes medications, etc. The doctor monitors the patient’s condition, the progress and results of treatment, constantly monitoring the correctness and timeliness of the necessary treatment and diagnostic procedures.

The decisive role in providing patient care belongs to nursing staff. The nurse carries out the doctor’s prescriptions (injections, dressings, mustard plasters, etc.) regardless of whether the patient is at home or in the hospital. Certain manipulations of general patient care in a hospital are performed by junior medical staff, i.e. nurses (cleaning premises, providing a patient with a bedpan or urine bag, etc.).

Features of general care for patients in a hospital. A feature of inpatient treatment is the constant presence of a large group of people in one room around the clock. This requires patients and their loved ones to comply with the internal regulations of the hospital, the sanitary and epidemiological regime, and the medical and protective regime.

Compliance with the rules of the regime begins with the hospital admissions department, where, if necessary, the patient is sanitized and changed into hospital clothes (pajamas, gown). In the admission department, the patient and his relatives can familiarize themselves with the internal rules of the hospital: hours for patients to sleep, get up, have breakfast, visit the doctor, visit relatives, etc. Relatives of the patient can familiarize themselves with the list of products allowed to be given to patients.

One of the most important tasks of general patient care is the creation and provision of a therapeutic and protective regime in the hospital.

The therapeutic and protective regime refers to measures that are aimed at ensuring maximum physical and mental rest for patients. The therapeutic and protective regime is ensured by the internal regulations of the hospital, compliance with the prescribed regime of physical activity, and careful attitude towards the patient’s personality.

The sanitary and hygienic regime is a set of measures aimed at preventing the occurrence and spread of infection within the hospital. These measures include sanitary treatment of patients upon admission to the hospital, regular change of underwear and bed linen, measurement of the patient’s body temperature upon admission and daily during the patient’s stay in the hospital, disinfection, and sterilization.

Features of general care for patients at home. Organizing care for a patient at home has its own characteristics, since most of the time during the day is spent not by medical workers, but by the patient’s relatives. It is especially important to properly organize care for a long-term ill person at home.

The care organization is usually led by a local therapist. Care manipulations are performed by the local nurse, relatives and friends of the patient under the guidance of the local doctor and local nurse. The doctor, just like in a hospital, prescribes a regimen, diet, and medications for the patient.

It is advisable that the patient be in a separate room. If this is not possible, then it is necessary to separate the part of the room where the patient is located with a screen. The patient's bed should be located near a window, but not in a draft, since the room must be ventilated several times a day. It is advisable for the patient to see the door. The room should not have unnecessary things, but it should be cozy. It is necessary to wet clean the room daily. At least twice a day it is necessary to ventilate the room where the patient is. If the patient cannot be taken out of the room during ventilation, then the patient must be covered.

An essential aspect of care is proper bed preparation. First, a mattress in an oilcloth mattress cover is laid on the bed, then a flannel bedding, and a sheet on top of it. An oilcloth is placed on the sheet, and changing diapers are laid on top of the oilcloth as needed. A pillow and blanket are placed on top.

It is advisable to place a small rug near the bed. Under the bed on a stand there should be (if the patient is assigned to bed rest) a bedpan and a urine bag.

Relatives and friends of the patient should learn how to care for the patient (or invite a trained nurse).

Depending on the mechanism of action of drugs, the route of administration of drugs can be different: through the digestive tract, injections, topically, etc.

When a patient uses medications, a number of rules should be remembered. Medicines are taken only as prescribed by a doctor.

To take a tablet, the patient must place it on the root of the tongue and wash it down with water (sometimes it is recommended to chew the tablet before use). Powders before taking should be poured onto the root of the tongue and washed down with water or dilute the powder before taking in water. Dragees, capsules and pills are taken unchanged. Alcohol tinctures are prescribed in drops, and the drops are counted either using a special dropper in the lid of the bottle, or using a regular pipette.

Ointments are used in various ways, but the skin must always be washed before rubbing the ointment.

Medicines prescribed before meals should be taken by the patient 15 minutes before meals. Medicines prescribed after meals should be taken 15 minutes after eating. Medicines prescribed to the patient on an empty stomach should be taken in the morning 20...60 minutes before breakfast.

Sleeping pills should be taken by the patient 30 minutes before bedtime.

You cannot cancel or replace some medications with others without a doctor’s prescription.

Medicines should be stored out of the reach of children. Do not store medicines without labels or with expired expiration dates (such medicines must be thrown away). You cannot change the packaging of medicines, replace or correct labels on medicines.

Medicines should be stored in such a way that you can quickly find the drug you need. Perishable medicines should be stored in the refrigerator on a shelf separate from food. Powders and tablets that have changed their color are unsuitable for consumption.

In a hospital, the optimal way to distribute medicines is to distribute medicines directly at the patient's bedside according to the prescription sheet, and the patient must take the medicine in the presence of a nurse.

There are the following ways of introducing drugs into the body:

enteral (i.e. through the gastrointestinal tract) - through the mouth, under the tongue, through the rectum. To take the medicine, you need to place the tablet or powder on the root of the tongue and drink it with a small amount of water (you can chew the tablet first; dragees, capsules and pills are taken unchanged). Medicines are administered into the rectum in the form of enemas, suppositories, external use in the form of compresses, lotions, powders, ointments, emulsions, mash, etc. (all these products must be applied to the surface of the skin with clean hands);

parenteral (i.e. bypassing the digestive tract) various injections (subcutaneous, intramuscular, intravenous), as well as intravenous drip infusions.

It is also possible to administer medications in the form of inhalations (usually in the treatment of diseases of the upper respiratory tract).

It is important to know about the problems that arise in long-term patients in order, firstly, to prevent them in time and, secondly, to contribute to their speedy resolution. For some diseases and conditions, timely prevention of complications that arise from prolonged lying down means a return to normal life after illness.

Speaking about the problems of long-term patients, one should also remember about prevention, but taking into account the fact that all preventive measures must be agreed upon with a doctor. All problems can be considered through life support systems.

Respiratory system. A long stay in bed leads to the accumulation of sputum in the bronchi, which becomes very viscous and difficult to cough up. Pneumonia occurs very often. Such pneumonia can be called hyperstatic or hypodynamic, i.e. its cause is either a lot of rest or little movement. How to deal with it? The most important thing is chest massage, physical exercise and taking sputum thinners - these can be both medicines and homemade ones: milk with Borjomi, honey, milk with butter, etc.

It is especially important to solve this problem for older people, so the prevention of pneumonia should be very actively started from the first day after a person falls ill, practically from the first hours.

Vessels. One of the complications resulting from a long stay in bed is thrombosis and thrombophlebitis, i.e. the formation of blood clots in the veins, often accompanied by inflammation of the walls of the veins, mainly in the lower extremities. This occurs because a person lies motionless for a very long time, the vessels are compressed, the blood stagnates, which leads to the formation of blood clots and inflammation of the vein walls. The cause may be not only immobility, but also the tense position of the limbs. If we place our legs awkwardly, they are in a tense state, not in a relaxed state. This causes the muscle to contract, keeps the blood vessels constricted and reduces blood flow. The next complication that may arise in connection with blood vessels is orthostatic collapse. When a person lies down for a long time and then is forced, by doctor’s orders or for health reasons, to stand up without preparation, he most often experiences orthostatic collapse, when blood pressure drops sharply when moving from a horizontal to a vertical position. The person becomes ill, he turns pale and, most importantly, he gets scared. If the next day or a week later you try to raise such a patient again, he will remember how bad he felt, and it is very difficult to convince him that everything will be okay. Therefore, before you lift a person, raise the head of the bed, or sit him down, you should find out how long he has been lying in bed, and whether it is worth doing this now, because you should definitely prepare for lifting with physical exercises. If the vessels are not ready, you will cause orthostatic collapse in the patient. And the third complication is, of course, fainting. Orthostatic collapse is sometimes accompanied by loss of consciousness; fainting is always a loss of consciousness. This makes an even stronger impression on the patient; his rehabilitation without eliminating such an unpleasant psychological impact will be very difficult.

Skin covering. The skin suffers greatly because a person lies for a long time and, first of all, we are talking about bedsores. The person’s skin is compressed under the weight of the patient, which is aggravated by his immobility. This problem can occur in severe illnesses after only 4 hours. Thus, just a few hours of sitting still is enough, and a person may develop bedsores. The skin may also suffer from friction from underwear. In addition, a person lying in bed is usually covered with a blanket - poor ventilation contributes to the occurrence of diaper rash. Due to the fact that under the blanket it is difficult to notice whether the patient has urinated or not, whether he is lying wet or dry, maceration may appear over time - irritation of the skin from moisture and solid particles contained in the urine. How to deal with this? Firstly, the most important thing is to change underwear and bed linen very often, turn the patient as often as possible, and the best thing is, if possible, to sit him down for at least a short time. Sitting gives a person greater freedom of movement, activity and promotes recovery. If you are caring for a patient individually at home, then this problem is not so insurmountable. The most difficult thing is to provide proper care for patients in a hospital. When choosing among patients those who are able to sit without your help, you should sit them down at least for a while, having then the opportunity to take care of other patients.

Musculoskeletal system. Joints and muscles also undergo some changes because a person lies down. From a stationary and tense position, the joints begin to “ossify.” The first stage is the formation of contractures, i.e., a decrease in the amplitude of movement, the second is ankylosis, when the joint is completely immobilized in the position in which it is accustomed to being, and it is almost impossible to change its amplitude and restore movement.

In addition, you should pay attention to the foot. In a supine position, the foot, as a rule, sag a little, is in a relaxed state, and if you do not worry about its physiological position, then even when a person can get up, a sagging and relaxed foot will interfere with walking. In female neurology, we had the following case: a young woman lay in bed for a long time after a right-sided stroke, we did not take care of her leg in time. And when she was finally able to walk almost independently, this drop foot bothered her extremely; she constantly clung to everything, dragged and did not allow her to walk normally. We were forced to bandage the foot with a bandage, but still it was already relaxed.

Bones. Over time, prolonged lying causes osteoporosis, i.e., thinning of bone tissue, and the formation of platelets, cells that actively participate in the immune and blood coagulation system, decreases. With little movement, no matter how much calcium a person consumes, it will not bring the desired result. Calcium is absorbed by bones only during active muscle work. It is very important to monitor the body weight of patients who are susceptible to osteoporosis. Therefore, the prevention of osteoporosis consists not only of proper nutrition, but also of mandatory physical activity.

Urinary system. Prolonged lying down leads to increased calcium release. If a person does not actively move, then calcium, both obtained from food and contained in the bones, begins to be excreted from the body. Calcium is released through the urine, i.e., by the kidneys. The physiological position (lying down) contributes to the fact that calcium is deposited in the bladder, first in the form of “sand”, and then in the form of stones, so long-term patients begin to suffer from urolithiasis over time.

There are factors that contribute to urinary problems. Sometimes urinary incontinence is preceded by frequent urination. Over time, people, especially older people, suddenly “out of the blue” develop urinary incontinence, which is not a functional disorder. This may be due to two reasons. Due to the patient's lying position, firstly, a large surface of the bladder is irritated and, secondly, fluid is redistributed, the load on the heart increases by 20%, as a result of which the body tries to throw out excess fluid through urination. When a person is actively working, some of his fluid comes out through sweating, breathing, etc., but in a bedridden patient, water is released mostly through the bladder. In a hospital, with an acute shortage of medical personnel, the most important thing is to give patients the opportunity to learn how to use various objects so that urination can take place not in the bed, but in some kind of container.

People who depend on others for care often experience discomfort, which can lead to another complication: urinary retention. A person often cannot urinate on his own, because both an uncomfortable position and inability to use a vessel or duck - all this causes acute urinary retention. However, all these problems can be dealt with, especially if you know about them in advance. It is believed that men suffer more from urinary disorders.

Urinary incontinence, in itself, can lead to the formation and increase of bedsores - this is one of the most powerful factors. Urinary incontinence does not cause the formation of bedsores, but it greatly contributes to it. We need to remember this. It happens that, having once urinated in bed, the patient begins to suffer from severe skin irritation in the area of ​​the buttocks, thighs, etc.

Urinary incontinence is a problem that is very often expected by healthcare workers themselves, especially nurses. It seems that if an elderly person is admitted to the ward with some impairment of consciousness, then expect problems with incontinence. This waiting psychology is very harmful and should be eliminated.

Gastrointestinal tract. After just a few days of staying in bed, minor digestive disturbances appear. Lost appetite. At first, the patient may experience constipation, and subsequently constipation, interspersed with diarrhea. At home, all foods served to the patient must be fresh. You should always try them yourself first. This rule is written down even in the manuals of the last century for nurses.

Factors that contribute to various disturbances in the activity of the gastrointestinal tract are, of course, a supine position, immobility, constant use of a bedpan, uncomfortable conditions, and the lack of active muscle load, which increases intestinal tone.

Nervous system. The first problem here is insomnia. Patients who have been in the ward for one or two days immediately have their sleep disturbed. They begin to ask for sedatives, sleeping pills, etc. To prevent insomnia, the most important thing is to involve the person as much as possible during the day, so that he is busy with various medical procedures, self-care, communication, i.e., to keep him awake. If it was not possible to cope with insomnia in this way, you can, with the permission of a doctor, resort to soothing decoctions, mixtures, etc., but not to strong pills, since sleeping pills have a very serious effect on the brain, which may result in older people disturbance of consciousness.

Separately, it should be said about patients who already have a disease of the central or peripheral nervous system, for example, multiple sclerosis or any damage to the spinal cord, etc. If a person for some reason is forced to lie in bed, then his ability to lead an active lifestyle decreases. Even a short-term illness affects the functioning of all body systems. And in people who have diseases of the nervous system, this period increases three to four times. For example, if a patient with multiple sclerosis is forced to lie down due to a broken leg, then his recovery period is very long. A whole month of various physiotherapeutic procedures is needed for a person to learn to walk again and return to the lifestyle that he led previously. Therefore, if patients with a disease of the nervous system are in a lying position for a long time, they need to be especially intensively engaged in gymnastics and massage so that they can then return to a normal lifestyle.

Hearing. When people are admitted to the hospital, they often experience various, often progressive hearing impairments, especially in the elderly. Our foreign colleagues note that this is due to the fact that the hospital has very large rooms, and where there are large rooms, there is an echo, and where there is an echo, the hearing is constantly strained and weakens over time.

Nurses often do not understand that a person requires such an expenditure of strength to overcome pain that in order to distinguish the words addressed to him by medical personnel or people around him, additional effort is required, beyond his capabilities. For these cases, simple recommendations can be given. You need to talk to a person on the same level. In hospitals, in particular, and maybe at home, nurses get used to “hovering” over the patient’s bed, and talking to the person above you is very difficult, psychological depression arises - the patient no longer understands what is being said to him. Therefore, when you communicate with a patient, it is better to sit on a chair or the edge of the bed, so that you are on the same level with him. It is imperative to see the patient’s eyes in order to determine whether he understands you or not. It is also important that the patient can see your lips, then it is easier for him to understand what you are saying. If you are communicating in a really large room, then there is another technique - talk not in the middle of this large hall or room, but somewhere in a corner, where there is less echo and the sound is clearer.

Another group of patients are those who have hearing aids. When a person gets sick, he may forget about his hearing aid and this, of course, will complicate his communication with other people. Also, keep in mind that hearing aids operate on batteries; the battery may run out and the hearing aid will not function. There is another problem related to hearing. When we communicate with a person, not knowing that he does not hear us, his behavior sometimes seems very strange to us. He smiles when he is asked about something serious, when there is no need to smile at all. And it seems to us that the person is a little “out of his mind.” So, first you need to check your hearing, vision and speech. And only if it turns out that hearing, vision and speech are normal, then we can talk about mental disorders.