30.06.2019

Legal foundations of nursing. The discipline program “Fundamentals of Nursing. Main types of treatment and preventive institutions

Galina Ivanovna Uncle

Nursing Basics Cheat Sheet

Section 1. Introduction to the discipline “Fundamentals of Nursing”

1. State organizational structures dealing with nursing issues

Russia has a healthcare system with different forms of ownership: state, municipal And private. It resolves issues of social policy and has three levels of management organization.

1. Ministry of Health of the Russian Federation, in which there are departments:

1) organization of medical care;

2) protection of maternal and child health;

3) scientific and educational medical institutions;

4) personnel, etc.;

2. Ministry of Health of the region (territory);

3. health department under the city administration.

The task of social policy is to achieve a level of health that will allow a person to live productively with the longest possible life expectancy.

The main priority areas of social policy in the field of healthcare:

1) development of laws to implement reforms;

2) protection of motherhood and childhood;

3) financing reform (health insurance, the use of funds from various funds to support and treat relevant categories of the population - pensioners, the unemployed, etc.);

4) compulsory health insurance;

5) reorganization of primary health care;

6) drug provision;

7) personnel training;

8) healthcare informatization.

The basic basis of the healthcare system should be the adoption of the laws of the Russian Federation “On the State Healthcare System”, “On the Rights of the Patient”, etc.

Already today, markets for medical services are being formed, medical and preventive institutions are being created with various forms of ownership, day-care hospitals, hospices, palliative medicine institutions, i.e., institutions where care is provided to the hopelessly ill and dying. In 1995 there were already 26 hospices in Russia, in 2000 there were already more than 100.

2. Main types of treatment and preventive institutions

There are two main types of treatment and prevention institutions: outpatient And stationary.

Outpatient facilities include:

1) outpatient clinics;

2) clinics;

3) medical units;

4) dispensaries;

5) consultations;

6) ambulance stations.

Inpatient institutions include:

1) hospitals;

2) clinics;

3) hospitals;

4) maternity hospitals;

5) sanatoriums;

6) hospices.

In order to improve the quality of medical and preventive work, since 1947, Russia has been merging clinics with outpatient clinics and hospitals. This organization of work helps to improve the qualifications of doctors, and thereby improve the quality of service to the population.

3. Structure and main functions of hospitals

There are general, republican, regional, regional, city, district, rural hospitals, which are often located in the center of the service area. Specialized hospitals (oncology, tuberculosis, etc.) are located depending on their profile, often on the outskirts or outside the city, in a green area. There are three main types of hospital construction:

2) centralized; 1) pavilion;

3) mixed.

With the pavilion system, small separate buildings are located on the hospital premises. The centralized type of construction is characterized by the fact that buildings are connected by covered above-ground or underground corridors. Most often in Russia, mixed-type hospitals were built, where the main non-infectious departments are located in one large building, and infectious diseases departments, outbuildings, and the like are located in several small buildings. The hospital site is divided into three zones:

1) buildings;

2) utility yard area;

3) protective green zone.

The medical and economic zones must have separate entrances.

The hospital consists of the following facilities:

1) a hospital with specialized departments and wards;

2) auxiliary departments (X-ray room, pathology department) and laboratory;

3) pharmacies;

4) clinics;

5) catering unit;

6) laundry;

7) administrative and other premises.

Hospitals are designed for ongoing treatment and care of patients with certain diseases, such as surgical, medical, infectious, psychotherapeutic, etc.

The hospital inpatient unit is the most important structural unit, where patients requiring modern, complex diagnostic methods and treatment are received, and treatment, care and other cultural and everyday services are provided.

The structure of a hospital of any profile includes wards for accommodating patients, utility rooms and a sanitary unit, specialized rooms (procedural, treatment and diagnostic), as well as a resident’s room, a nursing room, and the office of the head of the department. The equipment and equipment of the wards corresponds to the profile of the department and sanitary standards. There are single and multi-bed wards. The ward has:

1) bed (regular and functional);

2) bedside tables;

3) tables or table;

4) chairs;

5) a wardrobe for the patient’s clothes;

6) refrigerator;

7) washbasin.

The beds are placed with the head end to the wall at a distance of 1 m between the beds for the convenience of transferring the patient from a gurney or stretcher to the bed and caring for him. Communication between the patient and the nurse's station is carried out using an intercom or light alarm. In specialized departments of the hospital, each bed is provided with a device for centralized oxygen supply and other medical equipment.

The lighting of the wards complies with sanitary standards (see SanPiN 5.). It is determined in the daytime by the light coefficient, which is equal to the ratio of the window area to the floor area, respectively 1: 5–1: 6. In the evening, the chambers are illuminated with fluorescent lamps or incandescent lamps. In addition to general lighting, there is also individual lighting. At night, the wards are illuminated by a night lamp installed in a niche near the door at a height of 0.3 m from the floor (except for children's hospitals, where lamps are installed above the doorways).

Ventilation of the rooms is carried out using a supply and exhaust system of ducts, as well as transoms and vents at the rate of 25 m3 of air per person per hour. The concentration of carbon dioxide in the air environment of the room should not exceed 0.1%, relative humidity 30–45%.

The air temperature in the rooms of adults does not exceed 20 °C, for children – 22 °C.

The department has a distribution room and a canteen, providing simultaneous food intake for 50% of patients.

The department corridor must ensure the free movement of gurneys and stretchers. It serves as an additional air reservoir in the hospital and has natural and artificial lighting.

The sanitary unit consists of several separate rooms, specially equipped and designed to carry out:

1) personal hygiene of the patient (bathroom, washroom);

2) sorting dirty laundry;

3) storage of clean linen;

4) disinfection and storage of vessels and urinals;

5) storage of cleaning equipment and overalls for service personnel.

Infectious diseases departments of hospitals have boxes, semi-boxes, regular wards and consist of several separate sections that ensure the functioning of the department when quarantine is established in one of them.

Each department has, in accordance with the established procedure, an internal departmental routine that is mandatory for staff and patients, which ensures that patients comply with the medical and protective regime: sleep and rest, dietary nutrition, systematic observation and care, implementation of medical procedures, etc.

The functional responsibilities of a hospital nurse include:

1) compliance with the medical and protective regime of the department;

2) timely implementation of medical prescriptions;

3) patient care;

4) assistance to the patient during examination by a doctor;

5) monitoring the general condition of patients;

6) provision of first aid;

7) compliance with the sanitary and anti-epidemic regime;

8) timely transmission of an emergency notification to the Center for State Sanitary and Epidemiological Surveillance (State Sanitary and Epidemiological Surveillance Center) about an infectious patient;

Transcript

1 basics of NURSING ALGORITHMS OF MANIPULATION TRAINING MANUAL FOR MEDICAL SCHOOLS AND COLLEGES Recommended by the State Educational Institution of Higher Professional Education “Moscow Medical Academy named after I.M. Sechenov" as a teaching aid for students of secondary vocational education institutions studying in the specialties "Nursing" and "General Medicine" in the discipline "Fundamentals of Nursing"

2 UDC (07) BBK 53.5 Registration 641 reviews from the Federal State Institution Federal Institute for Educational Development Team of authors: Shirokova N.V. teacher of nursing, Moscow Regional Medicine College 2. Ostrovskaya I.V. associate professor of the department of management of nursing activities MMA I.M. Sechenov. Klyukova I.N. teacher of the fundamentals of nursing at the Lyubertsy Medical College. Morozova N. teacher of the fundamentals of nursing at the Mytishchi School of Medicine. Morozova G.I. teacher of the fundamentals of nursing at the Moscow Regional Medical College. Guseva I.A. teacher of the basics of nursing at Noginsk Medical University taught? 0-75 Fundamentals of nursing: Algorithms of manipulation: textbook / N.V. Shirokova and others - M.: GEOTAR-Media, p. ISBN The training manual contains algorithms for performing the necessary procedures for patient care and is designed to improve the quality of medical care provided. The manual was developed in accordance with the Federal Law of the Russian Federation of December 18, 2002 “On Technical Regulation”; provisions of the state standardization system of the Russian Federation (GOST R GOST R); general requirements for specialists in the field of nursing. Recommended for students and teachers of medical schools and colleges, students of advanced training departments in the specialties “Nursing”, “General Medicine” and medical workers. UDC "BBK53.5* The rights to this publication belong to LLC Publishing Group "GEOTAR-Media". Reproduction and distribution in any form of part or the whole publication cannot be carried out without the written permission of LLC Publishing Group "GEOTAR-Media". ISBN Team of authors, 2009 LLC Publishing Group "GEOTAR-Media", 2010 LLC Publishing Group "GEOTAR-Media", design, 2010

3 CONTENTS From the authors... 6 Chapter 1. Nursing examination... 7 Examination of the pulse on the radial artery... 7 Measurement of body temperature in the axillary region (in a hospital setting)... 8 Measurement of blood pressure... 10 Measurement of height patient...12 Weighing and determining body weight Chapter 2. Infectious safety. Infection control Carrying out disinfection and pre-sterilization cleaning of medical devices in one step manually...14 Chapter 3. Reception of the patient Treatment of a patient with lice...16 Chapter 4. Safe hospital environment. Therapeutic-protective regime Rotating the patient and placing him in the position on the right side...18 Transferring the patient from the supine position to the Sims position...20 Moving the patient with hemiplegia to the prone position...21 Placing the patient with hemiplegia in the Fowler position ...23 Placing the patient in a supine position...25 Chapter 5. Personal hygiene of the patient Changing bed linen in a transverse way...27 Changing bed linen in a longitudinal way Changing a shirt for a seriously ill patient Helping the patient use a bedpan or urinal Care of the external genitalia men... ".... :...32 Care of the external genitalia and perineum of women...34 Morning toilet of a seriously ill patient: washing Morning toilet of a seriously ill patient: toilet of the oral cavity...36 Application of medicinal effects on the oral mucosa ...38 Morning toilet of a seriously ill patient: toilet of the eyes...39 Morning toilet of a seriously ill patient: toilet of the nose Morning toilet of a seriously ill patient: toilet of the ears Chapter 6. Feeding the patient Feeding the patient in bed using a sippy cup Feeding the patient in bed using a spoon Feeding the patient through a nasogastric tube Caring for a nasogastric tube Feeding a patient through a gastrostomy tube Chapter 7. Methods of simple physiotherapy. Hirudotherapy Using mustard plasters Using a heating pad Using an ice pack Applying a warm compress Applying a cold compress... 56

4 Placement of cups Placement of leeches (hirudotherapy) Supply of humidified oxygen through a nasal catheter Chapter 8. Use of medications Instillation of oil drops into the nose Instillation of vasoconstrictor drops into the nose Teaching the patient how to use a pocket inhaler Introducing a suppository with a laxative effect to the patient A set of medicines from an ampoule Diluting antibiotics Performing intradermal injections Performing a subcutaneous injection Performing an intramuscular injection Performing an intravenous injection Filling an infusion system Performing an infusion Chapter 9. Enemas. Gas outlet pipe. Colostomy bag Cleansing enema Siphon enema Oil laxative enema Hypertonic laxative enema Medicinal microenema Drip enema Placement of a gas outlet tube Algorithm of patient actions when replacing an adhesive (adhesive) colostomy bag Chapter 10. Catheterization of the bladder Catheterization of a woman's bladder with a rubber catheter Catheterization of a man's bladder with a rubber catheter Placement and fixation of a permanent catheter...: Washing the bladder Chapter 11. Punctures Participation of the nurse in performing pleural puncture Participation of the nurse in performing lumbar puncture Participation of the nurse in performing sternal puncture Participation of the nurse in performing abdominal puncture Chapter 12. Laboratory and instrumental studies Guidelines “Rules and techniques for obtaining samples of clinical material for research in a clinical microbiology laboratory" Throat swab Nasal swab Collection of blood from a peripheral vein Collection of blood from a vein into vacuum containers Collection of sputum for clinical analysis Collection of sputum for bacteriological examination Collection of sputum for Mycobacterium tuberculosis Collection of sputum for tumor cells (atypical ) Collection of stool for scatological examination Collection of stool for bacteriological examination Collection of stool for examination for occult blood Collection of stool for detection of protozoa

5 5 Collection of stool for analysis of helminth eggs Collection of urine for general clinical analysis Collection of urine for sugar in daily quantities Collection of urine for diastase Collection of urine according to Nechiporenko Collection of urine according to Zimnitsky Preparing the patient for fibroesophagogastroduodenoscopy Chapter 13. Probe manipulations Gastric lavage with a thick probe Gastric lavage with a thin one probe Taking gastric contents to study the secretory function of the stomach Duodenal intubation (fractional method) Chapter 14. Cardiopulmonary resuscitation outside a medical institution Cardiopulmonary resuscitation performed by one rescuer Cardiopulmonary resuscitation performed by two rescuers Chapter 15. Handling a tracheostomy tube Care plastic tracheostomy tube with non-deflating cuff Patient education on how to care for the tracheostomy tube

6 CHAPTER 1 NURSING EXAMINATION STUDY OF PULSE ON THE RADIAL ARTERY Purpose: diagnostic. Indications: doctor's prescriptions, preventive examinations. Equipment: clock or stopwatch, temperature sheet, pen. I. Preparation for the procedure Establishing contact with the patient 1. Collect information about the patient. Introduce yourself kindly and respectfully to him. Clarify how to contact him if the nurse sees the patient for the first time 2. Explain to the patient the purpose and sequence of the procedure Psychological preparation of the patient 3. Obtain the patient's consent to the procedure Respect for the patient's rights 4. Prepare the necessary equipment Carrying out the procedure and documenting its results 5. Wash and dry hands P. Performing the procedure 1. Invite the patient to sit or lie down. In this case, the hands should be relaxed, the hand and forearm should not be suspended. 2. Press the radial arteries on both hands of the patient at the base of the thumb with the 2nd, 3rd, 4th fingers (the 1st finger should be on the back of the hand), feel the pulsation and lightly compress the arteries Ensuring the reliability of the result Determining the synchrony of the pulse. If the pulse is synchronous, then further research is carried out on one arm 3. Determine the pulse rhythm. If the pulse wave follows one after another at regular intervals, then the pulse is rhythmic, if not, it is arrhythmic. In case of severe arrhythmia, an additional study is carried out to identify a pulse deficiency. The rhythm of the peripheral pulse should coincide with the rhythm of heart contractions. The difference between the number of heart beats per minute and the peripheral pulse rate at the same minute is called the pulse deficit

7 4. Determine the pulse rate per minute: take a watch or stopwatch and count the number of pulse beats within 30 seconds. Multiply the result by two (if the pulse is rhythmic) and get the pulse frequency. If the pulse is arrhythmic, then the number of pulse beats should be counted within 60 s. Heart rate depends on age, gender, physical activity. Ensuring accuracy of heart rate determination. Normal heart rate: from 2 to 5 years about 100 beats/min; from 5 to 10 years about 90 beats/min; adult men bpm; adult women bpm; pulse more than 80 beats/min, tachycardia; pulse less than 60 beats/min bradycardia 5. Determine the filling of the pulse: if the pulse wave is clear, then the pulse is full, if weak it is empty, if the pulse wave is very weakly palpable, then the pulse is thread-like Pulse filling depends on the volume of circulating blood and the magnitude of cardiac output 6. Determine pulse tension. To do this, you need to press the artery harder than before against the radius. If the pulsation stops completely, the tension is weak, the pulse is soft; if the tension weakens moderately; if the pulsation does not weaken, the pulse is tense, hard. Ensuring the accuracy of determining the pulse voltage. It depends on the tone of the arterial vessels. The higher the blood pressure readings, the more intense the pulse 7. Inform the patient the result of the study The patient’s right to information III. End of procedure 1. Wash and dry hands 2. Make a note reflecting the results obtained and the patient's reaction Ensuring continuity of nursing care Note. To determine the pulse, you can use the temporal, carotid, subclavian, femoral arteries, and dorsal artery of the foot. MEASURING BODY TEMPERATURE IN THE AXILLAR REGION (IN A HOSPITAL CONDITION) Purpose: diagnostic. Indications: routine temperature measurement in the morning and evening, in patients with fever as prescribed by a doctor. Equipment: watch, medical maximum thermometer, pen, temperature sheet, towel or napkin, container with disinfectant solution. I. Preparation for the procedure 1. Collect information about the patient. Introduce yourself kindly and respectfully, clarify how to address him if the nurse sees the patient for the first time 2. If the patient does not know the purpose and sequence of the procedure, explain them to him Establishing contact with the patient Psychological preparation of the patient for the procedure 3. Obtain the patient’s consent to the procedure Respect for the patient’s rights

8 4. Wash and dry your hands Prevention of hospital-acquired infections 5. Prepare the necessary equipment. Make sure that the thermometer is intact and that the reading on the scale does not exceed 35 C. Otherwise, shake the thermometer so that the mercury drops below 35 C. Ensuring patient safety and the reliability of the temperature measurement result P. Performing the procedure 1. Examine the axillary area, if necessary, wipe it dry with a napkin or ask the patient to do this. Attention! In the presence of hyperemia, local inflammatory processes, temperature measurement cannot be carried out. Ensuring the reliability of the result 2. Place the thermometer reservoir in the axillary area so that it is in close contact with the patient’s body on all sides (press shoulder to chest) Ensuring conditions for obtaining a reliable result 3. Leave the thermometer for at least 10 minutes The patient must lie in bed or sit 4. Remove the thermometer Assess the indicators, holding the thermometer horizontally at eye level Ensuring the reliability of the results Evaluating the measurement results 5 Inform the patient of the results of thermometry Ensuring the patient's right to information III. End of the procedure 1. Shake the thermometer so that the mercury column drops into the reservoir. Preparing the thermometer for subsequent measurement of body temperature 2. Immerse the thermometer in a disinfectant solution 3. Wash and dry your hands 4. Make a note of the temperature readings on the temperature sheet. Report patients with fever to the doctor on duty Ensuring continuity of patient monitoring

9 MEASUREMENT OF BLOOD PRESSURE Purpose: diagnostic. Indications: doctor's prescription, preventive examinations. Equipment: tonometer, phonendoscope, alcohol, swab (napkin), pen, temperature sheet. I. Preparation for the procedure Establishing contact with the patient 1. Collect information about the patient. Introduce yourself kindly and respectfully to him. Clarify how to contact him if the nurse sees the patient for the first time 2. Explain to the patient the purpose and sequence of the procedure Psychological preparation for the manipulation 3. Obtain consent for the procedure Respect for the patient's rights 4. Warn the patient about the procedure 15 minutes before its start, if the study is being carried out in a planned manner Ensuring the reliability of the result 5. Prepare the necessary equipment Ensuring the effective implementation of the procedure 6. Wash and dry your hands 7. Connect the pressure gauge to the cuff and check the position of the pressure gauge needle relative to the zero mark of the scale Checking the serviceability and readiness of the device for work 8. Treat the phonendoscope membrane with alcohol P Performing the procedure 1. Sit or lay the patient down, ensuring the arm position in which the middle of the cuff is at the level of the heart. Place the cuff on the patient's bare shoulder 2-3 cm above the elbow (clothing should not compress the shoulder above the cuff); fasten the cuff so that 2 fingers are placed between it and the shoulder (or 1 finger in children and adults with small arms). Attention! You should not measure blood pressure on the arm on the side of the mastectomy, on the weak arm of a patient after a stroke, on a paralyzed arm. Elimination of possible unreliability of the results (every 5 cm of displacement of the middle of the cuff relative to the level of the heart leads to an overestimation or underestimation of blood pressure readings by 4 mm Hg) . Elimination of lymphostasis that occurs when air is pumped into the cuff and the vessels are compressed. Ensuring the reliability of the result 2. Invite the patient to place his hand correctly: in an extended position with the palm up (if the patient is sitting, ask to place a clenched fist of the free hand under the elbow) Ensuring maximum extension of the limb 3. Find the place of pulsation of the brachial artery in the area of the ulnar cavity and lightly press it to the skin in this place (without any effort) the phonendoscope membrane Ensuring the reliability of the result

10 4. Close the valve on the bulb, turning it to the right, and pump air into the cuff under the control of a phonendoscope until the pressure in the cuff (according to the pressure gauge) exceeds 30 mm Hg. the level at which the pulsation disappeared 5. Turn the valve to the left and begin to release air from the cuff at a speed of 2-3 mm Hg/s, maintaining the position of the phonendoscope. At the same time, listen to the sounds on the brachial artery and monitor the indicators on the manometer scale. Eliminate discomfort associated with excessive compression of the artery. Ensuring the reliability of the result Ensuring the reliability of the result 6. When the first sounds (Korotkoff sounds) appear, “mark” the numbers on the pressure gauge scale and remember them; they correspond to the systolic pressure indicators. Ensuring the reliability of the result. The systolic pressure values should coincide with the pressure gauge readings at which pulsation disappeared during the process of pumping air into cuff 7. Continuing to release air, note the diastolic pressure readings corresponding to the weakening or complete disappearance of loud Korotkoff sounds. Continue auscultation until the pressure in the cuff decreases by mmHg. relative to the last tone Ensuring the reliability of the result 8. Round the measurement data to 0 or 5, record the result as a fraction (systolic pressure in the numerator; diastolic pressure in the denominator), for example 120/75 mm Hg. Release the air from the cuff completely. Repeat the procedure for measuring blood pressure two to three times with an interval of 2-3 minutes. Record the average values 9. Inform the patient the measurement result. Attention! In the interests of the patient, reliable data obtained during the study is not always reported. Ensuring reliable blood pressure measurement results. Ensuring the patient’s right to information III. End of the procedure 1. Treat the phonendoscope membrane with alcohol 2. Wash and dry your hands 3. Make a note reflecting the results obtained and the patient’s reaction Ensuring continuity of observation Note. At the patient’s first visit, you should measure the pressure on both arms, then only on one, noting which one. If persistent significant asymmetry is detected, all subsequent measurements should be carried out on the hand with higher values. Otherwise, measurements are carried out, as a rule, on the “non-working hand”.

11 MEASUREMENT OF PATIENT GROWTH Purpose: assessment of physical development. Indications: admission to hospital, preventive examinations. Equipment: stadiometer, pen, medical history. Problem: The patient cannot stand. I. Preparation for the procedure 1. Collect information about the patient. Kindly introduce yourself to him. Clarify how to contact him if the nurse sees the patient for the first time. Explain the upcoming procedure to the patient and obtain consent. Assess the patient's ability to participate in the Establishing contact with the patient procedure. Ensuring the patient’s psychological preparation for the upcoming procedure. Respect for the patient's rights 2. Prepare a stadiometer: place an oilcloth or disposable napkin under your feet. Invite the patient to take off his shoes and relax; women need to let their hair down. Ensuring the prevention of nosocomial infections. Ensuring reliable indicators II. Performing the procedure 1. Invite the patient to stand on the stadiometer platform with his back to the stand with the scale so that he touches it with three points (heels, buttocks and interscapular space) Ensuring reliable readings 2. Stand to the right or left of the patient Ensuring a safe hospital environment 3. Slightly tilt the patient’s head so that the upper edge of the external auditory canal and the lower edge of the orbit are located on the same line, parallel to the floor. Ensuring reliable indicators” 4. Lower the tablet onto the patient’s head, fix it, ask the patient to lower his head, then help him get off the stadiometer. Determine the indicators corresponding to the numbers located at the level of the bottom edge of the tablet. Providing conditions for obtaining results. Ensuring a protective regime 5. Communicate the received data to the patient Ensuring the patient's rights III. End of the procedure 1. Record the received data in the medical history Ensuring continuity of nursing care Note. If the patient cannot stand, the measurement is taken in a sitting position. I should offer the patient a chair. The fixation points will be the sacrum and interscapular space. And measure your height while sitting. Record the results.

12 WEIGHING AND DETERMINATION OF BODY WEIGHT Purpose: assessment of physical development, effectiveness of treatment and care. Indications: preventive examinations, diseases of the cardiovascular, respiratory, digestive, urinary and endocrine systems. Equipment: medical scales, pen, medical history. Problems: patient's serious condition. I. Preparation for the procedure 1. Collect information about the patient. Politely introduce yourself to him. Ask how to address him if the nurse sees the patient for the first time. Explain the procedure and rules (on an empty stomach; in the same clothes, without shoes; after emptying the bladder and, if possible, bowel movements). Obtain patient consent for the procedure. Assess the possibility of his participation in it Establishing contact with the patient. Respect for the patient's rights 2. Prepare the scales: align, adjust, close the shutter. Place oilcloth or paper on the scale platform to ensure reliable results. P. Performing the procedure 1. Ask the patient to take off his outer clothing, take off his shoes and carefully stand on the center of the scale platform. Open the shutter. Move the weights on the scales to the left until the level of the rocker matches the control level Ensuring reliable indicators 2. Close the shutter Ensuring the safety of the scales 3. Help the patient get off the weight platform Ensuring a protective mode 4. View the data. Remember that a large weight fixes tens of kilograms, and a small gram within a kilogram. Using the Ketele index body mass index, you can determine the correspondence of height to body weight. To do this, the weight must be divided by the squared height and compared with the indices below: 18 19.9 less than normal; 20 24.9 ideal body weight; 25 29.9 pre-obesity; over 30 obesity 5. Communicate data to the patient Ensuring patient rights III. End of the procedure 1. Remove the napkin from the site and throw it into the trash container. Wash and dry your hands Prevention of nosocomial infections 2. Record the findings in the medical history Ensuring continuity of nursing care Note. If it is not possible to weigh the patient at the moment, the manipulation can be postponed, since it is not vital. In intensive care units and hemodialysis, patients are weighed in bed using special scales.

13 CHAPTER 2 INFECTION SAFETY. INFECTION CONTROL DISINFECTION AND PRE-STERILIZATION CLEANING OF MEDICAL DEVICES IN ONE STAGE MANUAL Purpose: effective disinfection and removal of protein, fat, mechanical contaminants) drug residues to ensure the effectiveness of subsequent sterilization. Indications: contact of instruments and medical devices with biological > bones, wound surfaces and medications. Equipment: containers with tight-fitting lids, measuring cups or dispenser. syringes and needles, thick or “chain mail” gloves, medical instruments, trays, chemical compounds approved for use as detergents and disinfectants, cotton-gauze swabs, brushes, brushes, napkins. Conditions: presence of a ventilated room, strict adherence to guidelines (instructions regarding the timing of use of drugs and rules for working with each of them I. Preparation for the procedure 1. Put on protective clothing Preserving the health of personnel 2. Prepare equipment Efficiency of the procedure 3. Prepare a detergent and disinfectant complex, for example, based on amixan: add amixan to a container with drinking water using a measuring container at the rate of 30 ml per 1 liter of water. Stir P. Performing the procedure 1. Immerse the used instruments in the resulting 3% working solution: complex in disassembled form; having a locking part with open locks. Fill the internal channels of needles, tubular products with the resulting solution using a syringe. Make sure that the liquid level border rises above the instrument by more than 1 cm. Close with a lid. Attention! Stitching and cutting instruments must be soaked in separate containers. disinfection cleaning regime Ensuring the effectiveness of disinfection and cleaning. Environmental protection. Ensuring personnel safety 2. Maintain exposure of products for 15 minutes. Ensuring a disinfecting effect.

14 3. Remove the lid from the container and rinse each product in the solution using a sponge, brushes, napkin or cotton-gauze swab, channels using a syringe Removing contaminants from joints on instruments, from gaps, cavities, gaps 4. Raise the perforated tray with instruments over the container, allow the solution to drain. Place the tray with tools in the sink under running water and rinse each product for 5 minutes 5. Rinse each product with distilled water (channels using a syringe or electric suction) for 0.5 minutes Removing detergent residues from treated products Desalting the surface of products and prevention pyrogenic reactions 6. Dry the instruments with hot air in an air sterilizer at a temperature of 85 C until the moisture completely disappears Reducing the risk of contamination of products III. End of procedure 1. Remove gloves, wash hands with soap and running water Note. To carry out disinfection and pre-sterilization cleaning in one stage, you can use: alaminol, lysetol AF, veltolen, disinfectant, deconex dental, dulbak, septabic, septodor, septodor forte, virkon, peroximed, blanisol, anolytes from an ECHO installation, Vex-side, nika -exta M, lysofin and other approved products.

15 CHAPTER 3 RECEPTION OF A PATIENT TREATMENT OF A PATIENT WITH PEDICULOSIS Purpose: therapeutic and preventive. Indications: presence of pediculosis. Equipment: additional robe, headscarf, 2 waterproof aprons, gloves, oilcloth tires with warm water, anti-pediculosis agent, shampoo, 2 towels, comb (comb basin, cellophane cape, shower cap. I. Preparation for the procedure 1. Collect information about the patient before meeting him. Introduce yourself to him kindly and respectfully. Clarify how to contact him if the nurse sees the patient for the first time. Find out whether he is familiar with this manipulation; when, for what reason, how he underwent it Establishing contact with the patient 2. If not familiar the patient's purpose and sequence of the upcoming procedure explain them to him Psychological preparation for the manipulation 3. Obtain his consent Respect for the patient's rights 4. Prepare the necessary equipment Ensuring the effective implementation of the procedure 5. Wash and dry your hands, put on an additional robe, apron, gloves Lay an oilcloth on the floor and put a chair on it 6. Help the patient put on an apron and sit (if condition allows) on a chair, cover the patient’s shoulders with a cellophane drape 7. Give the patient (if possible) a towel and ask him to close his eyes. If the patient is unable to hold a towel, an assistant will do this for him, who should also have an additional robe, scarf and gloves. Dilute the pediculocide in accordance with the instructions for use II. Performing the procedure 1. Wet the patient's hair with a small amount of water from a jug (water temperature C) Ensuring the safety of the infectious patient Preventing the fagot from getting into the patient's eyes. Ensuring the procedure and organizing the safety of the nurse and patient. Providing conditions for nag pediculocidal agent

16 2. Treat the patient’s hair evenly with the prepared anti-pediculocidal agent (t 27 C). Cover the patient's head with a cap for min (exposure depends on the product used) 3. Rinse the patient's hair with warm water, rinse it with a 6% solution of table vinegar (t 27 C). Divide hair into strands and comb each strand with a fine comb. Remove the towel covering your eyes. Dry and examine the patient's hair. Attention! If there are flat spots, the hair in the armpits and pubic area is shaved off or treated with the same pediculocidal agent. Ensuring the quality of anti-pediculosis treatment. Quality control of the treatment. Ensuring quality treatment 4. Ask the patient how he is feeling Determine the patient's response to the procedure III. End of the procedure 1. Place the patient’s linen and clothing in a bag and send it to the disinfection chamber. Remove apron, robe, gloves, place in a bag for disinfestation. Wash and dry your hands 2. Make a note about head lice: on the title page in the right Ensuring continuity of further control and monitoring of the patient in the upper corner of the “Inpatient Medical Record”, put the letter “P” in red pencil 3. Fill out an emergency notification about the detection of an infectious disease and report to the branch of the Federal State Health Institution “Center for Hygiene and Epidemiology” (F. 058/U), register the patient’s data in the “Infectious Diseases Register” (F. 060/U) Compliance with the requirements for nosocomial infection control Note. If the hair is treated not with organophosphorus preparations, but with a soap-powder emulsion, the nits remain unharmed, so additional treatment is required with a 30% solution of table vinegar heated to 27 C (20 min). If head lice is detected in men, the hair can be cut short (with the patient's consent). The cut hair is collected in a bag and burned. Used instruments and care items, the room where the patient was treated, are disinfected with the same means.

17 TRANSFERING THE PATIENT FROM THE SUPINAL POSITION TO THE SIMPLE POSITION Purpose: to place the patient in a physiological position (done by one or two nurses; the patient can only help partially or cannot help at all). Indications: forced or passive position, change of position if there is a risk of developing bedsores or bedsores. Equipment: extra pillow, footrest or sandbag, bolsters, half a rubber ball. Note: the procedure can be performed on either a functional or a regular bed. I. Preparation for the procedure 1. Collect information about the patient. Introduce yourself kindly and respectfully to him. Clarify how to contact him if the nurse sees the patient for the first time Establishing contact with the patient 2. Explain the purpose and sequence of the procedure Ensuring the patient’s psychological preparation for the procedure 3. Obtain the patient’s consent to perform the procedure Respecting the patient’s rights 4. Prepare equipment Ensuring the effectiveness of the procedure 5. Wash and dry your hands. If there is a risk of contact with biological fluid, wear gloves II. Performing Procedure 1. Apply the bed brakes. Raise the bed to the maximum comfortable height for working with the patient 2. Lower the side rails (if any) on the left side of the patient. Move the head of the bed to a horizontal position (or remove the pillows) 3. Ask the patient to cross his arms over his chest, move him closer to the left edge of the bed 4. Inform the patient that he can help the nurse in the following way: put his left leg under his right. If the patient himself is not capable of such actions, the nurse needs to clasp the back of the patient's foot with one hand and move it towards the pelvis, sliding it along the bed. At the same time, with the other hand, located in the popliteal cavity, the nurse lifts the patient’s leg up. Prevention of nosocomial infections. Ensuring the safety of the patient and the correct biomechanics of the nurse’s body. Ensuring access to the patient and his safety. Ensuring that the patient's body is properly aligned. Providing sufficient space for the patient to turn onto their side. Ensuring the patient's active participation. Reducing physical stress on the nurse 5. Raise the side rails. Stand to the right of the bed and lower the grab bars 6. Place the protector on the bed next to the patient. Stand as close to the bed as possible, bend one leg at the knee. Place your knee on the protector. The second leg is a support if the bed level is not adjustable Ensuring the safety of the patient Ensuring the correct biomechanics of the nurse's body. Ensuring nurse and patient safety

18 7. Place your left hand on the patient’s left shoulder and your right hand on his left thigh and move the patient to a side-lying position and partially on his stomach (only part of the patient’s abdomen is on the mattress) 8. Push the right “lower” shoulder back and release “ lower" arm from under the patient's body, placing it along the body. Place a pillow under the patient's head 9. Place a pillow under the bent “upper” arm at shoulder level. Place the relaxed hand on half of the ball 10. Place a pillow under the bent “upper” leg so that the leg is at hip level. Ensuring correct biomechanics of the nurse’s body. Reducing the risk of falls and skin friction when moving the patient towards the nurse Ensuring that the patient's body is straightened. Reduce lateral neck flexion Prevent shoulder internal rotation. Maintaining the necessary straightness of the body Preventing internal rotation of the hip and placing the “upper” leg on the “lower”. Prevention of hyperextension of the leg. Reducing the pressure of the mattress on the knee and ankle 11. Provide support for the lower foot at an angle of 90 Ensuring dorsiflexion of the foot. Preventing foot drop. Ensuring the prevention of bedsores 12. Make sure that the patient is lying comfortably, straighten the sheet. Raise the side rails. Lower the bed to its previous height III. End of the procedure 1. Disinfect and further dispose of gloves if they have been used. Wash and dry hands Ensuring patient safety 2. Record the procedure and the patient's response Ensuring continuity of nursing care MOVEMENT OF A PATIENT WITH HEMIPLEGIA INTO THE PRODUCT POSITION Purpose: to place the patient in a physiological position (performed by one or two nurses as directed by the doctor, the patient cannot help) . Indications: forced or passive position, change of position if there is a risk of developing bedsores or bedsores. Equipment: extra pillow, footrest or sandbag, bolsters, footrest, half a rubber ball, napkin. Note: the procedure can be performed on either a functional or a regular bed. I. Preparation for the procedure 1. Collect information about the patient. Introduce yourself kindly and respectfully to him. Clarify how to contact him if the nurse sees the patient for the first time Establishing contact with the patient 2. Explain the purpose and sequence of the procedure Ensuring the patient’s psychological preparation for the upcoming procedure

19 3. Obtain the patient’s consent for the procedure Respecting the patient’s rights 4. Prepare equipment Ensuring the effectiveness of the procedure 5. Wash and dry hands. If there is a risk of contact with biological fluid, wear gloves P. Performing the procedure 1. Secure the bed brakes. Raise the bed to the height that is most comfortable for working with the patient 2. Lower the side rails of the bed (if any) on the side facing the paralyzed part of the patient’s body. Move the head of the bed to a horizontal position (or remove the pillows) 3. Cross the patient's arms over his chest. Move the patient towards the paralyzed side of the body Ensuring the safety of the patient and proper body mechanics of the nurse Ensuring access to the patient and his safety. Ensuring that the patient's body is properly straightened. Providing sufficient space to turn the patient onto his stomach. Prevention of injury to the paralyzed side 4. Place the patient's paralyzed leg on the healthy leg. Reduce physical stress on the nurse 5. Raise the side rails. Move to the other side of the bed and lower the rails 6. Place a thin pillow over the area where the patient's abdomen will be located. Ensuring the safety of the patient Preventing sagging of the abdomen. Reducing hyperextension of the lumbar vertebrae and tension in the lower back muscles 7. Straighten the elbow of the paralyzed arm. Press it along its entire length to the body. Place your healthy hand in. Eliminate the danger of your hand being crushed when moving the patient! on the stomach 8. Place the protector on the bed next to the patient. Stand as close to the bed as possible, bend one leg at the knee and place your knee on the protector. The second leg is a support if the bed level is not adjustable. Ensuring correct biomechanics of the nurse's body. Ensuring Nurse and Patient Safety 9. Place your left hand on the patient's "far" shoulder and your right hand on the patient's "far" thigh. Turn the patient on his stomach towards the nurse 10. Turn the patient's head to the side (towards the paralyzed side of the body). Place a thin pillow under the patient's head and neck 11. Bend the arm towards which the patient's head is facing at the elbow joint by 90. Place the relaxed hand on half of the ball covered with a napkin. Extend the other arm along the body. Ensuring the correct biomechanics of the sister’s body. Reducing the risk of falls and skin friction when moving the patient towards the nurse Reducing flexion and hyperextension of the cervical vertebrae of the neck muscles Preventing the risk of limiting the ability of the arm to perform external rotation around the shoulder joint

20 12. Bend both knees of the patient and place a pillow under Preventing prolonged hyperextension of the knee joints. Prevention of the lower leg so that the fingers do not touch the bed for the development of bedsores on the toes 13. Provide support for the feet at an angle of 90. Ensure dorsiflexion of the foot 14. Make sure that the patient is lying comfortably, straighten the sheet. Raise the side rails. Lower the bed to its previous height III. End of the procedure 1. Disinfect and further dispose of gloves if they have been used. Wash and dry hands Ensuring patient safety 2. Record the procedure and the patient's response Ensuring continuity of nursing care POSITIONING A PATIENT WITH HEMIPLEGIA IN THE FOWLER POSITION Goal: Place the patient in a physiological position (performed by one nurse). Indications: feeding (eating independently), performing procedures requiring this provision; risk of developing bedsores and contractures. Equipment: set of pillows, bolsters, footrest, rubber ball halves (2 pieces), 2 napkins. Note: the procedure can be performed on either a functional or a regular bed. I. Preparation for the procedure 1. Collect information about the patient. Introduce yourself kindly and respectfully to him. Clarify how to contact him if the nurse sees the patient for the first time 2. Explain to the patient the purpose and sequence of the procedure Establishing contact with the patient Ensuring the patient’s psychological preparation for the upcoming procedure 3. Obtaining the patient’s consent to perform the procedure Respecting the patient’s rights 4. Prepare equipment Ensuring the effectiveness of the procedure 5. Wash and dry your hands. If there is a risk of contact with biological fluid, wear gloves P. Performing the procedure 1. Secure the bed brakes. Raise the bed to the height that is most comfortable for working with the patient. Prevention of nosocomial infections. Ensuring the safety of the patient and the correct biomechanics of the nurse’s body. 2. Lower the side rails (if any) on the side where the nurse is. Ensuring access to the patient and his safety.

21 3. Make sure the patient is lying on his back in the middle of the bed. Remove pillows 4. Raise the head of the bed at an angle (or place three pillows) Position the patient in a position convenient for movement Ensuring the patient's comfort. Improving pulmonary ventilation Ensuring patient relaxation. 5. Sit the patient as high as possible. Place a small pillow under the head (if the headboard is raised) 6. Slightly lift the patient's chin up. Move the patient's upper limbs away from his body and place small pillows under the elbows and hands 7. Place the hands on halves of rubber balls covered with napkins. Place a thin pillow under the patient's lower back. Bend the patient’s legs at the knee and hip joints, placing a pillow or folded blanket under the lower third of the thigh 8. Place a bolster under the patient’s lower third of the lower leg so that the heels do not touch the mattress. Reducing the likelihood of the patient “falling over” to the paralyzed side of the body. Improving ventilation of the lungs, heart function, reducing intracranial pressure. Ensuring comfortable eating and liquids. Prevention of aspiration of food, liquids, and vomit. Prevention of neck muscle tension Reducing the load on the cervical spine. Prevention of flexion contracture of the muscles of the upper limb and overstretching of the capsules of the shoulder joint. Preservation of functional damage to the hands. Prevention of contracture of the joints of the hands. Reducing the load on the lumbar spine. Prevention of prolonged hyperextension of the knee joints and compression of the popliteal artery. Prevention of bedsores in the heel area. 9. Provide support for the feet at an angle of 90. Providing dorsal flexion of the foot. Prevention of foot drop. Maintaining muscle tone 10. Make sure that the patient is lying comfortably, straighten the sheet. Raise the side rails. Lower the bed to its previous height III. End of the procedure 1. Disinfect and further dispose of gloves if they have been used. Wash and dry hands Ensuring patient safety Preventing hospital-acquired infections 2. Record the procedure and the patient's response Ensuring continuity of nursing care.

22 PLACEMENT OF THE PATIENT IN A SUPRINE POSITION Purpose: to give the patient a physiological position (performed by one nurse). Indications: forced or passive position; risk of developing bedsores; hygiene procedures in bed. Equipment: extra pillow, bolsters, footrest, two rolled sheets, towel. Note: the procedure can be performed on either a functional or a regular bed. I. Preparation for the procedure 1. Collect information about the patient. Introduce yourself kindly and respectfully to him. Clarify how to contact him if the nurse sees the patient for the first time Establishing contact with the patient 2. Explain the purpose and sequence of the procedure Ensuring the patient’s psychological preparation for the upcoming procedure 3. Obtain the patient’s consent to perform the procedure Respecting the patient’s rights 4. Prepare equipment Ensuring the effectiveness of the procedure 5 Wash and dry your hands. If there is a risk of contact with biological fluid, wear gloves P. Performing the procedure 1. Secure the bed brakes. Raise the bed to the height that is most comfortable for working with the patient Ensuring the safety of the patient and the correct biomechanics of the nurse’s body 2. Lower the side rails (if any) on the side where the nurse is 3. Lower the head of the bed (remove excess pillows), giving the bed a horizontal position . Remove the blanket. Make sure that the patient is lying in the middle of the bed Ensuring access to the patient and his safety Ensuring the correct position of the patient 4. Give the patient the correct position: a) put a pillow under the head (or adjust the remaining one); b) place your arms along your body, palms down; c) position the lower limbs in line with the hip joints 5. Place a small pillow under the upper part of the shoulders and neck Ensuring a comfortable position for the patient Ensuring proper distribution of the load on the upper body. Preventing tension in the neck muscles 6. Place small pillows under the forearms to facilitate the outflow of blood. Preventing swelling of the hand 7. Place a small towel rolled up under the lower back, without folds. Preventing hyperextension of the lumbar spine.

23 8. Place rolls of rolled sheets along the outer surface of the thighs from the area of the greater trochanter of the femur and further 9. Place a small pillow or roll under the lower leg in the area of its lower third. Preventing the hip from rotating outward. Preventing prolonged pressure of the mattress on the heels and forming bedsores 10. Provide support to support the feet at an angle of 90 Ensuring dorsiflexion of the feet Preventing foot drop 11. Ensure that the patient is lying comfortably. Straighten the sheet and cover the patient with a blanket. Raise the side rails. Lower the bed to its previous height Ensuring patient safety III. End of procedure 1. Disinfect and dispose of gloves if they have been used. Wash and dry hands 2. Make a record of the procedure and the patient's response Ensuring continuity of nursing care

24 CHAPTER 5 PERSONAL HYGIENE OF THE PATIENT CHANGING BED LINEN BY THE CROSS-WAY METHOD Purpose: maintaining personal hygiene, preventing hospital-acquired infections (the procedure is performed by a nurse and an assistant, the patient is in bed). Indications: deficiency of self-care. Equipment: a set of clean linen, a bag for dirty linen, gloves, a container with a disinfectant solution. I. Preparation for the procedure 1. Collect information about the patient. Introduce yourself kindly and respectfully to him. Clarify how to contact him if the nurse sees the patient for the first time. Explain the sequence of the procedure to the patient and obtain his consent. Attention! If relatives or other members of the medical team are involved in the procedure, the extent of each intervention should be determined in advance 2. Prepare a set of clean linen. Roll up a clean sheet like a bandage (in the transverse direction) 3. Wash your hands, if possible contact with biological fluids, wear gloves II. Performing the procedure 1. Stand on both sides of the bed, lower the head of the bed. Establish contact with the patient. Ensuring the patient’s psychological preparation for the upcoming procedure. Respect for the patient's rights and hygienic comfort Ensuring the patient's safety and correct body biomechanics 2. The nurse place his hands under the patient's shoulders and head, slightly lift him up; Ensuring the effectiveness of the procedure; assistant remove the pillow from under the head 3. Lower the patient onto the bed. Change the pillowcase Ensuring a safe hospital environment 4. Remove the blanket from the patient, cover it with a small sheet Reducing discomfort in the patient without underwear 5. The nurse raises the patient's head and shoulders, the assistant rolls the dirty sheet from the side of the head to the middle of the bed. On the freed part, lay and spread a prepared and rolled up clean sheet for hygienic comfort.

25 6. Place a pillow at the head and lower the patient’s head and shoulders onto it 7. Raise the patient’s pelvis (ask the active patient to lean on his legs and rise above the bed), move the dirty sheet in the direction of the feet, then straighten the clean one, lower the patient onto it Ensuring physical comfort Ensuring the patient's comfort and infectious safety (the patient's active participation in care helps to increase self-esteem) 8. Place the dirty sheet in a laundry bag 9. Tuck the edges of a clean sheet under the mattress on all sides Ensuring comfort 10. Remove the duvet cover from the blanket, put on a clean one. Place the dirty duvet cover in the bag. Cover the patient. Tuck the blanket and hygienic comfort 11. Ensure that the patient feels comfortable Ensuring psychological comfort 12. Remove dirty linen from the room III. End of the procedure 1. Disinfect and further dispose of gloves if they have been used. Wash and dry your hands 2. Make a note about the change of linen in the documents Ensuring continuity of patient care CHANGING BED LINEN IN A LONGITUDINAL WAY Purpose: maintaining personal hygiene, preventing hospital-acquired infections (the procedure is performed by a nurse and an assistant, the patient is in bed). Indications: deficiency of self-care. Equipment: a set of clean linen, a bag for dirty linen, gloves, a container with a disinfectant solution. I. Preparation for the procedure 1. Introduce yourself kindly and respectfully to the patient. Clarify how to contact him if the nurse sees the patient for the first time. Explain to the patient the purpose and sequence of the upcoming procedure and obtain his consent. Assess the patient's ability to participate in the procedure. Attention! If relatives or other members of the medical team are involved in the procedure, the extent of each intervention should be determined in advance 2. Prepare a set of clean linen. Roll up half the sheet into a roll along its entire length Establishing contact with the patient. Psychological preparation of the patient for the upcoming procedure. Respect for patient rights. Ensuring careful procedure and hygienic comfort

26 3. Wash and dry your hands, if there is a risk of contact with biological fluid, wear gloves II. Performing the procedure 1. Stand on both sides of the bed, lower the head of the bed. Prevention of nosocomial infections. Ensuring the safety of the patient and correct body biomechanics 2. The nurse put his hands under the patient’s shoulders and head and slightly lift him, the assistant removes the pillow from under the head. Lower the patient onto the bed (without a pillow). Remove the pillowcase from the pillow and place it in the laundry bag. Put on a clean pillowcase Ensuring the procedure is effective 3. The nurse removes the blanket from the patient and covers him with a small sheet 4. The nurse turns the patient on his side, facing the edge of the bed, and holds him in this position. At the same time, monitor his condition. Reduce psychological discomfort. Provide the opportunity to change linen. Preventing the patient from falling 5. For the assistant to roll up the dirty sheet with the roller towards the back. Ensure the possibility of changing the patient’s linen and lay out a previously prepared and half-rolled clean sheet, covering the vacated part of the bed 6. For the assistant, turn the patient on his back, then carefully on the other side so that he is on the clean sheet. Keep the patient in a lateral position Ensure hygienic comfort. Preventing Patient Falls 7. The nurse rolls up the dirty sheet and places it in a laundry bag. Roll out a clean sheet and tuck its edges under the mattress 8. Turn the patient and lay him on his back. Place a pillow under your head and shoulders 9. Have your assistant remove the dirty duvet cover and put it in a dirty laundry bag. Wear a clean one. Cover the patient. Tuck the blanket and hygienic comfort Ensuring comfort in bed and hygienic comfort 10. Ensure that the patient feels comfortable Ensuring psychological comfort III. End of the procedure 1. Remove the bag with dirty linen from the room. Disinfect and further dispose of gloves if they have been used. Wash and dry your hands 2. Make a note about the change of linen Ensuring continuity of patient care

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Introduction.

I.Founder of modern nursing.

II. Our compatriots in the history of nursing.

III. The concept of the nursing process.

Conclusion.

Introduction

The modern concept of nursing, aimed at strengthening the status of the nurse, was adopted in Russia in 1993 at the international conference “New nurses for a new Russia. A notable recent event was the II All-Russian Congress of Medical Workers in October 2004, at which health care reform was discussed. More than 1,100 delegates and guests took part in its work.

Today, the topic “Modern ideas in the development of nursing” is very relevant, since we are faced with very serious tasks, the implementation of which will radically change the existing situation in nursing, as an integral part of organizational health care technology, aimed at solving the problems of individual and public health in today's complex and rapidly changing conditions.

Today, nursing is an art, a science, it requires understanding, application of special knowledge and skills.

Nursing is "the act of using the patient's environment to promote his recovery." Nursing is based on knowledge and technology created on the basis of the humanities and natural sciences: biology, medicine, psychology, sociology, and others.

The nurse accepts responsibility and acts with appropriate authority while directly performing professional duties. She is responsible for the medical services she provides. She has the right to independently evaluate and decide whether she needs further education in management, teaching, clinical work and research and to take steps to meet these needs.

Nursing involves the planning and delivery of care during illness and rehabilitation and considers the impact of various aspects of a person's life on health, illness, disability and death.

Founder of modern sisterhoodncivil affairs

Florence Nightingale, the first researcher and founder of modern nursing, revolutionized public consciousness and views on the role and place of the nurse in protecting public health. There are many definitions of nursing, each of which was influenced by the characteristics of the historical era and national culture, the level of socio-economic development of society, the demographic situation, the population's needs for medical care, the state of the health care system and the availability of its personnel, as well as the ideas and views of the person formulating this concept.

The first definition of nursing was given by Florence Nightingale in her famous “Notes on Nursing” (1859). Emphasizing cleanliness, fresh air, silence, and proper nutrition, she characterized nursing as “the action of using the patient’s environment to promote his recovery.” The most important task of the sister, according to Nightingale, was to create conditions for the patient under which nature itself would exert its healing effect. Nightingale called nursing an art, but she was convinced that this art required "organization, practical and scientific training."

Having first identified two areas in nursing - caring for the sick and caring for healthy people, she defined caring for the healthy as “maintaining a person’s condition in which illness does not occur,” and nursing as “helping a person suffering from an illness to live as fully as possible.” a life that brings satisfaction." Nightingale expressed the firm belief that “nursing as a profession is fundamentally different from medical practice and requires special, distinct knowledge.” For the first time in history, she applied scientific methods to solve nursing problems. The first schools created on its model in Europe, and then in America, were autonomous and secular. The nurses themselves taught there, paying special attention to the formation of special nursing knowledge, skills and values. Professional values were understood as respect for the patient’s personality, his honor, dignity and freedom, showing attention, love and care, maintaining confidentiality, as well as observing professional duty. It is no coincidence that the motto of the first honorary international sisterhood was the words: Love, Courage, Honor.

But after Nightingale’s death, forces began to develop in society that opposed her views and ideals. The rapid development of capitalist market relations in the first quarter of this century in a number of Western countries, including the United States, not least affected the healthcare system. The development of medicine, as a profitable medical business in the West, has provided conditions for rapid technological progress and the creation of a complex system for the provision of medical services. In the process of forming the health care system in scientific, organizational and political terms, doctors and hospital administrations began to consider nurses only as a source of cheap labor that contributed to the achievement of economic goals.

Most nursing schools in the USA and Europe came under the control of hospitals, and doctors and hospital administrators began to provide theoretical and practical training in them. The nurses were only required to unquestioningly follow the doctor’s orders; their role increasingly began to be perceived as auxiliary.

However, despite the prevailing social conditions, nursing leaders from among the first graduates of Florence Nightingale's schools steadfastly followed the ideals of their outstanding mentor, striving to develop a body of specialized knowledge that forms the basis of professional nursing practice. They were actively involved in the development of independent nursing practice in hospitals, homes, and institutions where there was a need for such care on the part of individuals, families and community groups.

Nursing practice began to gradually transform into an independent professional activity based on theoretical knowledge, practical experience, scientific judgment and critical thinking. Interest in the development of scientific research in the field of nursing was partly due to the wide possibilities of using their results in alternative supportive health care services created after the Second World War in a number of Western countries. These, first of all, included nursing homes, in which professional nurses monitored and provided comprehensive care to the elderly, chronically ill and disabled people who did not need intensive therapeutic measures, i.e. in medical interventions. Nurses have taken responsibility for providing these patients with the required level of care and maintaining their optimal quality of life and well-being. The organization of nursing homes and units, as well as home care and nursing services for mothers and children from low-income communities, ensured greater access to health care for the population in the face of rampant price increases in the hospital health care sector.

The vast majority (about eighty percent) of the nurses continued to work in hospitals. However, the use of modern medical equipment and advanced technologies required a new level of knowledge from nurses. There was no doubt that the quality of nursing care is entirely determined by the level of professional education.

Students and followers of Florence Nightingale advocated for nursing education to take its rightful place in colleges and universities. The first university nursing training programs appeared in the United States at the end of the last century, but their number increased significantly in higher education institutions in America and Europe after the Second World War. Soon new theories and models of nursing began to appear, and after them even scientific schools with their own authorities. Thus, the famous nursing theorist Virginia Hendensen, defining the relationship between the nurse and the patient, noted that “the unique task of the nurse in the process of caring for individuals, sick or healthy, is to assess the patient’s attitude towards his state of health and help him in carrying out those actions to strengthen and restore health that he could perform himself if he had enough strength, will and knowledge for this.” According to another researcher, Dorothea Orem, "the main purpose of the nurse's activity should be to support the patient's ability to take care of himself."

In professional nursing communication, new terms increasingly appeared, such as “nursing process”, “nursing diagnosis”, etc. They were given a place in new formulations of nursing. For example, in 1980, the American Nursing Association defined the task of nursing as “the ability to make a nursing diagnosis and adjust the patient's response to illness.” Let us clarify that a nursing diagnosis differs from a medical diagnosis in that it determines not the disease, but the patient’s response to the disease. Evolving nursing knowledge required further discussion, testing, application and dissemination.

In 1952, the first international scientific journal on nursing, Nursing Research, was published. Currently, about two hundred professional nursing magazines are published in America alone. By 1960, doctoral programs in nursing began to appear. By the end of the seventies, the number of nurses with a doctorate degree in the United States reached 2000. In 1973, the National Academy of Nursing Sciences was created in America, and in 1985, the US Congress passed legislation that created the National Center for Nursing Research within the National Institutes of Health.

However, such favorable conditions for the development of nursing were not everywhere. Neglect of the nursing profession and misuse of nursing personnel in many countries have hampered the development of not only nursing care, but also health care in general. In the words of the eminent researcher and promoter of nursing in Europe, Dorothy Hall, "Many of the problems facing national health services today could have been avoided if nursing had developed at the same rate as medical science over the past forty years." “The reluctance to recognize,” she writes, “that the nurse occupies an equal position in relation to the doctor, has led to the fact that nursing care has not received the same development as medical practice, which has deprived both sick and healthy people of the opportunity to benefit from a variety of accessible, cost-effective nursing services."

However, nurses in all countries of the world are increasingly expressing their desire to make a professional contribution to the creation of a qualitatively new level of medical care for the population. In the context of global and regional, social and economic, political and national transformations, they see their role in society differently, sometimes acting not only as a medical worker, but also as an educator, teacher, and patient advocate. At a meeting of national representatives of the International Council of Sisters, held in New Zealand in 1987, the following wording was unanimously adopted: “Nursing is an integral part of the health care system and includes activities to promote health, prevent disease, provide psychosocial assistance and care to people with physical and mental illnesses, as well as the disabled of all age groups. Such assistance is provided by nurses both in medical and any other institutions, as well as at home, wherever there is a need for it."

I would like to believe that our Russian sisters are awakening a sense of professional self-awareness, that we are becoming equal participants in the transformation of the national healthcare system and members of the international nursing community. The future of nursing in Russia is in our hands; it depends on each of us, on each nursing team. And let the new professional magazine “Nursing” become a kind and wise assistant and advisor in all our endeavors.

Our compatriots in the history of sistersncivil affairs.

There is probably no person who does not know who nurses are. Many will remember that until 1917, nurses were called sisters of mercy or merciful sisters. Someone, perhaps, will remember that the sisters of mercy first appeared in Russia during the Crimean War of 1854-1855 in besieged Sevastopol, and will even argue that their appearance is connected with the name of the great Russian surgeon Nikolai Ivanovich Pirogov. But this will not be an entirely correct statement, because the institute of sisters of mercy owes its appearance not so much to Pirogov as to one remarkable woman, once very famous, but now, unfortunately, very rarely remembered - Grand Duchess Elena Pavlovna. It would seem that God gave this woman everything she needed for happiness: beauty, intelligence, a home - a beautiful palace, delight and veneration of outstanding people of her time, and finally, a large family - a husband and five daughters. But this happiness did not last long: in 1832, one-year-old daughter Alexandra died, and in 1836, two-year-old Anna died; in 1845, nineteen-year-old Elizabeth died, and a year later, the eldest daughter Maria, who was only 21 years old. In 1849, Mikhail Pavlovich died, and the Grand Duchess became a widow at the age of 43. After this, Elena Pavlovna completely devoted herself to social and charitable activities.

Back in 1828, Empress Maria Feodorovna bequeathed to her the management of the Mariinsky and Midwifery Institutes, and since then, the problems of medicine have been constantly in her field of vision. She, however, was accused of patronage and patronage mainly of German doctors, but it is unlikely that such reproaches were fair if we remember her participation in the fate of the outstanding Russian doctor Nikolai Ivanovich Pirogov...

In 1856, at the request of the same Elena Pavlovna, a medal was minted to reward especially distinguished sisters of the Holy Cross community. At the same time, Empress Alexandra Feodorovna, the widow of Nicholas I, established a similar medal. Elena Pavlovna died on January 3 (15), 1873. In the same year, it was decided to implement one of her latest plans - to build an institute for advanced training of doctors in St. Petersburg.

Concept of nursingm process.

The nursing process is one of the basic concepts of modern nursing models. In accordance with the requirements of the State Educational Standard for Nursing, the nursing process is a method of organizing and performing nursing care for a patient, aimed at meeting the physical, psychological, social needs of an individual, family, and society.

The nursing process requires from the nurse not only good technical training, but also a creative attitude towards patient care, the ability to work with the patient as an individual, and not as an object of manipulation. The constant presence of the nurse and her contact with the patient make the nurse the main link between the patient and the outside world.

The nursing process consists of five oWithnew stages.

1. Nursing examination. Collection of information about the patient’s health status, which can be subjective and objective. The subjective method is physiological, psychological, social data about the patient; relevant environmental data. The source of information is a survey of the patient, his physical examination, study of medical documentation data, conversation with the doctor, and the patient’s relatives. The objective method is a physical examination of the patient, including assessment and description of various parameters (appearance, state of consciousness, position in bed, degree of dependence on external factors, color and moisture of the skin and mucous membranes, presence of edema). The examination also includes measuring the patient's height, determining his body weight, measuring temperature, counting and assessing the number of respiratory movements, pulse, measuring and assessing blood pressure.

The end result of this stage of the nursing process is the documentation of the information received and the creation of a nursing medical history, which is a legal protocol - a document of the independent professional activity of the nurse.

2. Identifying the patient's problems and formulating a nursing diagnosis. The patient's problems are divided into existing and potential. Existing problems are those problems that are currently bothering the patient. Potential - those that do not yet exist, but may arise over time. Having established both types of problems, the nurse determines the factors that contribute to or cause the development of these problems, and also identifies the patient’s strengths that he can counteract the problems.

Since a patient always has several problems, the nurse must establish a system of priorities. Priorities are classified as primary and secondary. Primary priority is given to problems that are likely to have a detrimental effect on the patient in the first place.

The second stage ends with the establishment of a nursing diagnosis. There is a difference between medical and nursing diagnosis. Medical diagnosis focuses on recognizing pathological conditions, while nursing diagnosis is based on describing patients' reactions to health problems. The American Nurses Association, for example, identifies the following as the main health-related problems: limited self-care, disruption of normal functioning of the body, psychological and communication disorders, problems associated with life cycles. As nursing diagnoses, they use, for example, phrases such as “deficiency of hygiene skills and sanitary conditions”, “decreased individual ability to overcome stressful situations”, “anxiety”, etc.

3. Determining the goals of nursing care and planning nursing activities. The nursing care plan must include operational and tactical goals aimed at achieving specific long-term or short-term results.

When forming goals, it is necessary to take into account the action (execution), criterion (date, time, distance, expected result) and conditions (with the help of what and by whom). For example, “the goal is that the patient, with the help of a nurse, should get out of bed by January 5.” Action - get out of bed, criterion January 5, condition - help from a nurse.

After determining nursing goals and objectives, the nurse develops a written nursing care manual that details the nurse's specific nursing actions to be recorded in the nursing record.

4. Implementation of planned actions. This stage includes the measures that the nurse takes to prevent diseases, examine, treat, and rehabilitate patients. There are three categories of nursing interventions. The choice of category is determined by the needs of the patients.

Dependent nursing intervention is carried out on the basis of physician orders and under his supervision. Independent nursing intervention involves actions carried out by the nurse on his own initiative, guided by his own considerations, without direct demands from the doctor. For example, teaching the patient hygiene skills, organizing the patient’s leisure time, etc.

Interdependent nursing intervention involves the joint activities of the nurse with the doctor, as well as with other specialists. In all types of interactions, the sister's responsibility is exceptionally great.

5. Assessing the effectiveness of nursing care. This stage is based on the study of the dynamic reactions of patients to the nurse's interventions. The sources and criteria for assessing nursing care are the following factors: assessing the patient's response to nursing interventions; the following factors serve to assess the degree to which the goals of nursing care have been achieved: assessment of the patient’s response to nursing interventions; assessing the degree to which nursing care goals have been achieved; assessing the effectiveness of nursing care on the patient’s condition; active search and assessment of new patient problems.

An important role in the reliability of assessing the results of nursing care is played by the comparison and analysis of the results obtained.

Conclusion.

The goal of the nursing process is to maintain and restore the patient's independence and meet the basic needs of the body.

In conclusion, the current vision for the development of nursing in society is to help individuals, families and groups develop their physical, mental and social potential and maintain it at an appropriate level, regardless of changing living and working conditions.

This requires the nurse to work to promote and maintain health, as well as to prevent diseases.

List of used literature

1. S. A. Mukhina, I. I. Tarkovskaya “Theoretical foundations of nursing” part I - II 1996, Moscow

2. V. M. Kuznetsov “Nursing in surgery”, Rostov-on-Don, Phoenix, 2000.

3. Standards of practical activity of nurses in Russia volume I - II

4. S. I. Dvoinikoova, L. A. Karaseva “Organization of the nursing process in patients with surgical diseases” Med. Help 1996 No. 3 P. 17-19.

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The role and importance of the nurse are increasing along with the general development and improvement of medical science. Currently, nursing staff must have increasingly complex medical, pedagogical, psychological, technical knowledge and skills. The training of nurses belongs to the applied section of general medicine.

The responsibilities of a nurse are full patient care, accurate implementation of medical prescriptions; it is necessary that her human qualities be combined with high professional skills. She must be humane, kind, distinguished by a sense of mercy and compassion, competence, and be constantly ready to help, relieve pain and suffering.

The basic principles of nursing practice have remained unchanged over the past decades. Only certain details of the nursing process change, which are constantly being improved. The statement “without good care there cannot be a high level of treatment process” remains the rule. But a nurse is not a version of a “simplified” doctor. The knowledge acquired during training is updated only at the stages of subsequent confirmation or advanced training, therefore, during training and improvement, nurses need to have at hand simple and accessible educational materials that can be useful practical guidance in their daily work. The main purpose of the reference book is to help them in this work.

The activities of a nurse are aimed at alleviating the patient’s condition and restoring his health. At the same time, each patient is considered not just as a certain variant of the manifestation of the disease, but also as an individual. In some cases, the outcome of the disease is determined by the stage of nursing the patient. Properly organized work of nurses contributes to a faster recovery without additional costs, and increases the social status of nursing staff in society. There are ethical and legal aspects of activity in the work of nursing staff. Ethical aspects are reflected in society through the ideals of goodness and are accepted at the level of approval or condemnation. Legal aspects are based on moral requirements, some of them have received the force of law and are approved by various legal acts. In the context of conducting medical activities, ethics can somewhat smooth out the callousness of existing laws, replace to some extent existing laws, and help resolve many problems.

Nursing staff bears moral, administrative, civil and criminal responsibility for their activities. Moral responsibility is considered by society itself. The moral concept is determined by the level of culture of each person and the ability for self-analysis. Condemnation from society can be more effective than material methods of punishment (imposition of fines, deprivation of certain rights, even freedom). Administrative responsibility provides for punishment for failure to fulfill or abuse of one’s duties, which can lead to adverse consequences for the patient’s health. Civil liability is one of the types of legal liability. Punishments are used in accordance with the Civil Code of the Russian Federation. Damage caused to the patient’s health can be compensated morally and financially. The main articles of the Civil Code related to the activities of paramedical workers provide for liability in the following cases:

1) causing harm to health;

2) causing harm to health as a result of extreme necessity;

3) causing harm to health, taking into account the guilt of the victim;

4) responsibility of a legal entity for the activities of its employee;

5) and also provides for compensation for damage caused and damage caused in the event of the loss of a breadwinner.

Criminal liability concerns crimes and is determined by the Criminal Code of the Russian Federation. Crimes in the field of medicine constitute certain actions or inaction during the treatment process. Deontological aspects of activity are associated with improving the quality of patient care. The term “deontology” (Greek deon - “due”; Greek logos - “teaching”) was introduced by the English priest Bentham in the 18th century. In a narrow sense, the concept of “deontology” is part of social psychology and combines moral, ethical and legal aspects of activity. Deontology includes issues of relationships with patients, medical ethics and aesthetics, medical duty, medical confidentiality, medical law, as well as pedagogical issues. The concepts of ethics and deontology are closely related. A deontological approach, based on knowledge of the characteristics of psychological reactions, provides a certain moral comfort to the patient and is the key to successful cooperation. The promising situation of communication consists in the direct perception of each other by both subjects. Depending on the chosen line of communication (pleasant or unpleasant, mutual understanding or lack thereof, etc.), the outcome of treatment may be different. Medical deontology contains the following areas: medical worker And patient; medical worker And society; relationships between medical employees; medical worker And relative patient; self-esteem medical employee.

Sick - ThisNotJustan objectcarrying outmedicalmanipulations,Butsubject,activelyinteractingWithmedicalstaff!

Communication can be communicative and interactive. Communicative communication consists of the exchange of information through receiving and transmitting information, various intonations, crying, laughter, facial expressions and gestures, since external attributes sometimes say more about the disease than the patient himself. Interactive contact is the interaction of two subjects. Here, special attention is paid to the problem of conflicts and finding ways out of such situations. Equally important is the treatment of patients themselves with nursing staff. Not all patients know how to be polite; sometimes they have to deal with manifestations of outright rudeness. The nurse must be able to remain calm and not transfer negative attitudes to all patients. Any healthcare professional should strive to combine the abilities of a high-quality craftsman, polymath and actor. He must be able to present information in the right light and convince of the need to perform certain medical procedures. An experienced nurse will never allow the possibility of an unfavorable course of the disease associated with negative influences on her part ( seirogeny). The help of a nurse is necessary not only for the patient, but also for his relatives. For example, in severe cases, when the life of patients “hangs by a thread,” it is necessary to have conversations with relatives and prepare for a possible unfavorable outcome. A nurse can give advice to both the patient himself and his loved ones. A number of diseases require a change in lifestyle and lifestyle. A nurse can help with her advice in adapting to changing living conditions.

In the nursing process there is such a concept as " sister diagnosis " . It is set only on the basis of the patient’s subjective data and the main complaints, since the disease is considered as an external manifestation of a pathological condition. The action of the nurse is aimed at adapting the patient to the conditions of the disease. Therefore, the nursing diagnosis may change many times during the course of the disease depending on changes in the patient's condition. In relation to medical instructions, the nurse’s manipulations can be dependent, independent and interdependent. Dependent activity involves the direct implementation of doctor’s orders, independent - independent participation of the nurse in the treatment process, interdependent - coordinated actions of the nurse and doctor.

Nurses must monitor the patient’s reaction to various medical procedures and know the patients’ opinions about the interventions performed. The patient's response is assessed by the nurse at each manipulation. The success of a nurse’s work is largely determined by the variety of techniques that she owns and the ability to select them for a specific patient. She needs to know the physiological value of the manipulations being performed and apply them differentially, in accordance with the nature and characteristics of the disease. The conduct of the nursing process should be controlled primarily by the nurse herself. It should determine the degree to which the goals are achieved. For example, if there is pain after using an anesthetic drug, she must monitor the patient’s condition and reduce the severity of the pain syndrome. A nurse must be able to take initiative in the fight for the lives of patients. Carelessness, negligence, and failure to follow procedures are unacceptable in her work. She must timely understand all the doctor’s prescriptions, strictly measure the doses of medications, and observe the time of their dispensing; in case of significant deterioration in the patient’s health, she must be able to reassure him, instill in him confidence in a favorable outcome, and take the necessary measures to stabilize the patient’s condition. The appearance of the medical staff is of considerable importance: a clean robe, hair tucked under a headdress, and neatness calm the patient.

MedicalsisterNotIt hasrightsonerror. The slightestnegligence,inaccuracy,carelessnesscanbringToirreparableconsequences!

Functional responsibilities of a nurse

Medical sister - This face, past preparation By program nursing training, having sufficient qualifications And right fulfill responsible work By service sick. Tasks, assigned on medical sister, extremely multilateral.

homemedicalsister

The chief nurse must have organizational skills and high professionalism. A person with a higher medical education in the specialty "Nursing" or with a secondary medical education in the specialty "General Medicine" and having a certificate of "Organization of Nursing", confirmed by the highest qualification category, is appointed to this position. The chief nurse is directly subordinate to the deputy chief physician for medical work and the chief physician. She must ensure the rational work of nursing staff, conduct regular rounds of departments, checking the quality of work of nurses. Walk-throughs can be carried out during the day and evening. In addition, the duties include organizing control over the advanced training of nurses, the consumption of medicines and dressings. Together with the epidemiologist, the chief nurse monitors compliance with the sanitary and epidemiological regime in the departments and the implementation of organizing orders.

Oldermedicalsister

A person with secondary medical education, a diploma in the specialty "Nursing" or "General Medicine" and a certificate in the specialty "Organization of Nursing", confirmed by the highest qualification category, is appointed to this position. The senior nurse is subordinate to the head of the department, deputy chief physician for medical work, and chief nurse. The orders of the senior nurse are mandatory for the middle and junior medical staff of the department. In the department she is the financially responsible person. The senior nurse should:

1) directly supervise the activities of the department’s middle and junior staff;

2) carry out the placement of personnel in the department from among middle and junior personnel;

nursing nurse

3) promptly replace nurses and aides who do not go to work;

4) keep records and ensure the safety of property and medical equipment of the department, timely repair of equipment;

5) monitor the timeliness and quality of implementation of doctor’s prescriptions by nurses;

6) control the quality of sanitary treatment of newly admitted patients;

7) compile information about the movement of patients, monitor the timeliness of submission of medical histories of discharged patients to the archive;

8) draw up a work schedule and keep a time sheet for department employees;

9) monitor the compliance of mid-level and junior medical personnel with internal labor regulations and compliance with anti-epidemic measures;

10) ensure and strictly monitor compliance with the rules of asepsis and antisepsis by department staff;

11) issue requests to the hospital pharmacy for necessary medications, materials, and instruments, and control their correct use;

12) ensure correct storage and accounting of potent, toxic and psychotropic substances;

13) monitor the implementation of the plan for advanced training by nursing staff of the department;

14) maintain the necessary accounting and reporting documentation;

15) participate in the work of the hospital nursing council, scientific and practical conferences for nurses;

16) draw up a vacation schedule for department employees for the year, draw up sick leave certificates for staff;

17) monitor compliance with the rules of ethics and deontology by nursing and junior medical personnel;

18) control the implementation of hygienic training and education of the population, promote a healthy lifestyle;

19) ensure proper organization of nutrition for patients, draw up portion lists for patients’ meals, control the receipt and quality of food;

20) ensure the organization and control of the timeliness of medical examinations by department employees.

Wardmedicalsister

A person with a secondary medical education in the specialty “Nursing” or “General Medicine” and having the appropriate certificate is appointed to this position. The responsibilities of a ward nurse include:

1) care and observation of patients in accordance with the principles of medical deontology;

2) timely and accurate implementation of the attending physician’s prescriptions;

3) participation in rounds of attending physicians;

4) sanitary and hygienic services for physically weakened and seriously ill persons;

5) reception and placement of newly arriving patients, checking the quality of sanitary treatment, familiarization with internal regulations;

6) checking packages for patients, preventing the intake of contraindicated products, monitoring the storage of products in refrigerators and cabinets;

7) duty in the wards at the patient’s bedside;

8) control over the receipt of food according to the number of the dietary table prescribed by the attending physician;

9) control over the timely administration of medications;

10) timely and accurate execution of medical documentation;

11) ensuring the safety, serviceability and readiness for use of medical instruments and protective clothing;

12) professional development, participation in scientific and practical conferences for nursing staff;

13) promotion of a healthy lifestyle among patients and their relatives.

Medicalsisterproceduraloffice

A person with a secondary medical education in the specialty “Nursing” or “General Medicine” and having the appropriate certificate is appointed to this position. The treatment nurse organizes the work of the office and carries out the assigned procedures. The duties of a procedural nurse include:

1) preparing the treatment room for work;

2) carrying out prescribed medical procedures authorized to be performed by nursing staff;

3) assistance in performing medical procedures;

4) taking blood from a vein for diagnostic studies;

5) strict accounting and storage of drugs of groups A and B, ensuring the availability of emergency medical care;

6) compliance with the rules of asepsis and antisepsis in treatment rooms;

7) preparation of medical products and linen for sterilization;

8) control of the sanitary and hygienic content of the treatment room;

9) maintaining the necessary accounting and reporting documentation;

10) professional development;

11) promoting a healthy lifestyle among patients and their relatives.

Medicalsisteroperationalblock

A person with a secondary medical education in the specialty “Nursing” or “General Medicine” and having the appropriate certificate is appointed to this position. The work of an operating nurse is complex and requires clarity and organization from her. Each operating nurse should:

1) follow the rules of asepsis and antisepsis in the operating room;

2) master the technique of preparing suture and dressing material, equipment and methods of blood transfusions;

3) assist in conducting endoscopic examinations;

4) know the progress of all typical operations;

5) be able to apply all typical bandages, transport splints and plaster splints;

6) monitor the safety and serviceability of equipment, carry out repairs of faulty equipment;

7) systematically replenish the operating room with the necessary medications, dressings, linen and equipment;

8) directly participate in the operation as an assistant to the surgeon, and, if necessary, perform the duties of an assistant.

Fundamentals of Nursing

Illness and physical suffering often give rise to increased irritability in the patient, a feeling of anxiety and dissatisfaction, sometimes even hopelessness, and dissatisfaction with people around him. Medical personnel must be able to protect the patient from the influence of negative factors and distract him from excessive concentration on his painful condition.

During hospitalization in a hospital, it is necessary to decide on the methods of transporting the patient. If you can move independently, there is no need to use a stretcher or gurney. Upon admission to the emergency department, sanitary treatment is carried out. Subsequently, it is repeated every 7 days with a change of linen. Depending on the condition, the patient is prescribed a specific mode - strict bed, in which one is not even allowed to sit; bed, when you can move in bed without leaving it; semi-bed, allowing movement around the premises; general, not significantly limiting the patient’s motor activity. The less motor activity is limited, the more the patient’s ability to self-care is preserved. However, this does not relieve nursing staff from the need for appropriate care, providing the diet and diet recommended by the doctor, monitoring the condition and fulfilling medical prescriptions.

The temperature in hospital premises should be constant (within 18-20°C), the relative humidity should be 30-60%. The premises must be well ventilated daily. There should be daylight in the room, which affects the mood and condition of the patient. Light intensity decreases only in certain diseases of the eyes and nervous system.

Care behind body : If the patient is on bed rest, he is wiped daily with a sponge or towel moistened with warm water or some kind of disinfectant solution (camphor alcohol, table vinegar, etc.). Before wiping, an oilcloth is placed. The skin is wiped sequentially, special attention is paid to the treatment of folds behind the ears, under the mammary glands in women, in the gluteal-femoral folds, armpits, interdigital spaces of the legs, and perineum. After wet wiping, the skin is wiped dry. If there are no contraindications, patients wash in the shower or take a hygienic bath. Hygienic baths are contraindicated when hemorrhagic syndromes, expressed in general exhaustion, heart attack myocardium, acute cardiovascular insufficiency, violation brain blood circulation. The bathtub must first be washed and treated with a disinfectant solution. After use, washcloths and brushes are dipped in a disinfectant solution, for example solutions of 0.5% clarified bleach or 2% chloramine, and then boiled. The temperature of the bath water should be warm (about 38°C). The patient is helped to carefully immerse himself in the water; leaving him alone in the bath is not recommended. If necessary, the patient is helped to wash. Washing in the shower is easier for patients. The temperature in the bathroom should be comfortable and drafts should be avoided. Patients with urinary and fecal incontinence, as well as those on bed rest, must be washed at least twice a day with warm water or a weak solution of potassium permanganate from an Esmarch mug with a rubber tube and a clamp or a jug. Additionally, you must have a vessel, oilcloth, forceps, and cotton swabs. For diaper rash in the groin areas, the skin is lubricated with sunflower oil, Vaseline, and baby cream. If there are wet surfaces, use talc or baby powder. Areas of skin redness, especially in bedridden patients, are wiped with camphor alcohol, lemon pulp, a solution of brilliant green, and irradiated with quartz. To prevent incipient bedsores, the patient is placed on a rubber circle covered with a cotton bedding. In this case, the sacrum should be above the center of the circle. For fecal and urinary incontinence, a rubber bed is used instead of a circle. It is very important to ensure that the patient does not remain in one position for a long time. It needs to be turned. Underwear in such patients should be changed at least once a week, and for urinary and fecal incontinence - several times a day after appropriate washing.

Needs attention care behind hair . It is advisable for men to have their hair cut short. Each patient should have an individual comb. Bedridden patients wash their hair in bed at least once a week. If hair lice are detected, appropriate sanitary treatment is carried out using insecticides. If your hair is short, it is better to cut it and burn it. If pubic lice are detected, the pubic hair is covered with a generous amount of soap suds and shaved off. The skin is washed with warm water and sublimate vinegar (1: 300) is rubbed in or treated with ointments: sulfur 33% or mercury sulfur 5-10%. After a few hours, the pubic area is washed with soap. Nails are trimmed with small scissors. After use, scissors are wiped with alcohol, a 3% carbolic acid solution or a 0.5% chloramine solution.

Care behind eyes It usually comes down to washing them when the secretions stick together the eyelashes and form crusts on the eyelids. Rinsing is carried out with sterile gauze swabs moistened with a warm solution of boric acid 3%, in the direction from the outer corner of the eye to the inner. Bedridden patients need to clean the nasal passages with a cotton swab moistened with petroleum jelly or glycerin.

Care behind cavity mouth : in severely ill patients, after each meal, the oral cavity is treated with a cotton ball moistened with a weak solution of potassium permanganate, boric acid, soda or boiled water, food debris is removed from the oral mucosa and teeth. After this, the patient rinses his mouth. It is better to treat the oral cavity in a sitting or semi-sitting position. The neck and chest are covered with oilcloth, and a tray or basin is placed under the chin. Bad breath is reduced by rinsing with a 2% soda solution. Removable dentures are removed at night and washed with soap.

Physiological departures : For bedridden patients, a bedpan and a urine bag are used. Before use, the vessel is rinsed with warm water and a small amount of water is left in it. After completing the physiological functions, the perineal area is cared for, the vessel is washed, disinfected, for example, with a 3% chloramine solution or bleach and rinsed. In men, a urinal is more often used, which is located between the slightly spread thighs with a pipe towards the penis. The urine is poured out, and the urine bag is washed and disinfected. To remove the ammonia odor, the urinal is periodically washed with a weak solution of hydrochloric acid.

Nutrition patients : it is necessary to follow a strict diet. In this case, attention should be paid to setting the table or bedside table. For certain diseases, a corresponding treatment table is prescribed:

Table zero - the first days of the postoperative period for interventions on the stomach and intestines, a semi-conscious state due to cerebrovascular accident, traumatic brain injury, and febrile conditions.

Table No. 1 - peptic ulcer of the stomach and duodenum in the stage of fading exacerbation and in remission; chronic gastritis with preserved and increased secretion in the stage of fading exacerbation; acute gastritis in the subsiding stage.

Table No. 1a - exacerbation of gastric and duodenal ulcers in the first 10-14 days, acute gastritis in the first days of the disease, exacerbation of chronic gastritis with preserved and increased secretion in the first days of the disease.

Table No. 1b - exacerbation of gastric and duodenal ulcers in the next 10-14 days, acute gastritis in the next days of the disease, exacerbation of chronic gastritis with preserved and increased secretion in the next 10-14 days of the disease.

Table No. 2 - acute gastritis, enteritis and colitis during the recovery period, chronic gastritis with secretory insufficiency, enteritis, colitis during remission without concomitant diseases of the liver, biliary tract, pancreas.

Table No. 2a - the diseases are the same as with table No. 2, characterized by limiting table salt to 8-10 g.

Table No. 3 - chronic intestinal diseases, accompanied by persistent constipation during periods of mild exacerbation and remission, as well as accompanied by damage to the stomach, liver, biliary tract, and pancreas.

Table No. 4 - acute and chronic intestinal diseases during the period of profuse diarrhea and severe dyspeptic disorders, condition after intestinal surgery.

Table No. 4a - chronic enterocolitis with a predominance of fermentation processes in the intestines. Compared to table No. 4, carbohydrates and protein foods are more limited.

Table No. 4b - acute and chronic intestinal diseases during exacerbation, as well as when they are combined with damage to the stomach, liver, biliary tract, pancreas.

Table No. 4c - acute intestinal diseases during the recovery period, transition to a general diet, chronic intestinal diseases during the period of remission.

Table No. 5 - chronic hepatitis of a progressive and benign course with signs of mild functional liver failure, chronic cholecystitis, cholelithiasis, acute hepatitis during the recovery period (when switching to a general diet).

Table No. 5a - the diseases are the same as with table No. 5, characterized by restriction of table salt and fat.

Table No. 5 (sparing) - postcholecystectomy syndrome with concomitant duodenitis, exacerbation of chronic gastritis, hepatitis.

Table No. 5g - condition after cholecystectomy with the presence of bile stagnation syndrome and hypomotor dyskinesia of the biliary tract.

Table No. 5p - acute pancreatitis in the stage of sharp exacerbation (energy value 1300-1800 kcal).

Table No. 5p - acute pancreatitis in the stage of subsiding of acute phenomena and reduction of pain (energy value 2300-2500 kcal).

Table No. 6 - gout, uric acid diathesis.

Table No. 7 (low protein) - acute nephritis (after sodium-free days), exacerbation of chronic nephritis with edematous syndrome.

Table No. 8 - varying degrees of obesity.

Table No. 9 - diabetes mellitus (as a trial diet, with the exception of pre- and post-comatose states).

Table No. 9a - diabetes mellitus (in overweight patients).

Table No. 9b - diabetes mellitus (in patients receiving insulin).

Table No. 10 - heart defects, cardiosclerosis, hypertension of I and II degrees with mild signs of circulatory failure.

Table No. 10a - diseases of the cardiovascular system, accompanied by circulatory failure of II and III degrees.

Table No. 10c (anti-atherosclerotic) - atherosclerosis of coronary, cerebral and peripheral vessels, atherosclerosis of the aorta, atherosclerotic cardiosclerosis.

Table No. 10i - myocardial infarction.

Table No. 11 - pulmonary tuberculosis, the period of recovery after a serious long-term illness (with exhaustion, anemia, etc.).

Table No. 12 - diseases of the nervous system.

Table No. 13 - acute infectious diseases, a condition after extensive illnesses (but not in the gastrointestinal tract).

Table No. 14 - phosphaturia.

Table No. 15 is a common table, prescribed for diseases that do not require dieting.

Technique for basic medical procedures

Autohemotherapy

Autohemotherapy - application own blood sick For therapeutic goals. Blood is taken with a syringe from the cubital vein and immediately injected intramuscularly (or subcutaneously), usually into the buttock. The initial dose of blood taken is 2 ml. Every 2-4 days (depending on the reaction), the injections are repeated, the dose of blood taken is increased at each subsequent session by 1-2 ml. The maximum dose of blood taken is 10 ml. After this, the amount of blood taken is gradually reduced, also by 1-2 ml every 2-4 days. At the administered dose of 2 ml, the autohemotherapy procedure ends. The general course of treatment ranges from 5 to 10 injections.

Banksdry

Banks dry apply usually on region backs, lateral departments chest cells, lower back. The skin is wiped with alcohol and lubricated with Vaseline. Negative pressure is created in the cup by inserting and withdrawing a lit cotton swab soaked in denatured alcohol, after which the cup is quickly pressed against the skin. The jars are left for 10-20 minutes. In order to remove the can, the skin is pulled back from one end, and the can is tilted in the other direction. After removing the cups, wipe the skin with a towel.

Bougienage

Bougienage - extension narrowed lumen tubular organs (esophagus, urethra) through metal or soft elastic bougie.

Bathswatersimple

Baths water simple - treatment water. Baths can be shared, local or half-bath.

At general In baths, the patient is immersed in water up to the level of the nipples. Depending on the water temperature, shared baths are cold ( 24-27°C), cool ( 28-32°C), lukewarm ( 33-35°C), warm ( 36-38°C) and hot ( 39-40°C). At half baths the patient is immersed in water up to the waist. Half-baths are often combined with dousing and rubbing. Local there are baths manual, foot, sedentary, according to form cold ( 10-15°C), hot ( 40-45°C), variables with alternating action of cold and hot water. The duration of water baths ranges from 5-10 to 45 minutes.

Bathsmedicinal

Baths medicinal V dependencies from added medicinal drugs share on salty, conifers And other kinds bath. For salt baths, 2-5 kg of table salt is added to 300 liters of water. For pine baths, pour 25-100 g of powder containing pine extract into warm fresh or salt water, or pour in 2 tablespoons of liquid extract.

Venipuncture

Venipuncture - puncture veins, held With diagnostic purpose (fence blood For research), For transfusion blood, introduction various medicinal substances. The puncture is most often performed in the elbow or the back of the hand and foot. Before the procedure, the skin is treated with alcohol. To better identify the vein, the limb above the puncture site is tied with a tourniquet. When taking blood, the tourniquet is left until the end of the procedure; when infusing, the tourniquet is removed after the needle enters the vein. It is better to use needles with a short bevel.

Intravenousinfusion

Intravenous infusion - introduction large quantities liquids or medicinal solutions intravenously.

Rubbing

Rubbing - way introduction medicinal substances through skin. A small amount of the medicinal substance is applied to the skin after first washing it with hot water and soap and the applied product is rubbed in the direction of the lymph flow. This procedure is carried out daily or every other day.

Gas removal

Gas removal - way removal gases from intestines. A thick rubber tube, lubricated with fat, is inserted into the anus to a depth of 25-30 cm, leaving 10-15 cm outside. The end of the tube is lowered into a bedpan. The patient lies on his back. The tube is left in the rectum for 1-2 hours, after which it is removed. Before inserting the gas tube, you should do a siphon enema.

Mustard plasters

Mustard plasters overlap usually on region chest cells, backs, neck. Dry mustard plaster is moistened with water and applied to the skin for 10-30 minutes. To prepare mustard plasters (fresh), dry mustard is mixed with a small amount of water. The resulting paste is spread on cloth or paper, applied to the corresponding area of the skin and a piece of compress paper is placed on top. The mustard plaster is left for 5-30 minutes depending on the sensitivity of the skin.

Mud therapy

Mud therapy - usage mud various origin With medicinal purpose. Silt, peat and volcanic mud are used. The mud is heated using the principle of a water bath, as well as using steam, electric current, and sunlight. For mud therapy, the application method is usually used at a mud temperature of 40-50°C. The duration of the procedure is 15-30 minutes. At the end of the procedure, a shower is taken and rest is prescribed. Mud baths (thin, medium, thick), mud medallions, rubbing the body with mud in combination with sunbathing are used.

Injections

Introduction of medicinal substances into the patient's body using syringes. Having assembled the syringe with the needle, draw up the solution for injection, having first made sure that it corresponds to the intended purpose of the administered drug. Each injection requires two needles: one with a wide bore for drawing the solution into the syringe, the other for direct injection. Changing needles ensures sterility. Before collecting the material, the neck of the ampoule or the rubber stopper of the bottle with the medicinal substance is pretreated with alcohol or iodine. The opened ampoule is taken in the left hand, and a needle placed on a syringe is inserted into it with the right hand. By pulling back the plunger, the required amount of medicinal content is gradually drawn into the syringe. Then, by pressing on the piston, air is gradually pushed out of the syringe until drops appear from the lumen of the needle. If an oily liquid is injected, the ampoule is preheated by immersing it in warm water. Before injection, the patient's skin is wiped with a sterile swab soaked in alcohol.

Depending on the method of injection and the substance injected, syringes of various volumes (from 0.1 to 20 ml and more) with a marked graduation scale and needles with a length from 3-4 to 8-10 cm and a lumen width from 0.3 to 1 are used, 5 mm. Currently, mainly disposable sterile syringes are used, which are assembled as follows: with tweezers in the right hand, take the needle by the coupling, place it on the nipple of the cylinder and rub it in well. After this, the patency of the needle is checked by passing air or a sterile solution through it, holding the sleeve with the index finger.

Intradermal injections

To carry out the injection, a short needle 2-3 cm long with a small lumen is required. The palmar surface of the forearm is mainly used, and with novocaine blockades, other areas of the body are also used. The intended injection site is wiped with alcohol. The needle is inserted into the skin with the cut side up, then advanced 3-4 mm, releasing a small amount of the drug. Lumps appear on the skin, which, with further administration of the medicine, turn into a “lemon peel”.

Subcutaneous injections

The injection sites are the outer surface of the shoulder, the subscapular region, the lateral surface of the abdominal wall, and the anterior outer surface of the thigh. The skin at the injection site is wiped with alcohol, grasped in the fold with the fingers of the left hand, and the needle is inserted at an angle of 45°. After the needle passes through the skin, hold the syringe with your left hand and slowly press the plunger with the thumb of your right hand. Once the solution has been administered, the needle is quickly removed. The puncture site is treated with a new swab moistened with alcohol.

Intramuscular injections

The injection sites are the gluteus maximus, abdominal and thigh muscles. A needle 7–10 cm long is used. Visually, the buttock is divided into four squares by two perpendicular lines. The intended injection site is wiped with alcohol. The syringe is held perpendicular, then with a quick, clear movement, the needle is inserted into the muscle in the upper outer square to a depth of 7-8 cm. You should make sure that the needle does not fall into a blood vessel, for which you pull the piston towards yourself and look at the color of the medicinal solution. If the characteristic color of blood appears, the needle should be quickly removed and tried again. After a successful puncture, the medicine is slowly injected. When introducing oil solutions, they are preheated. The injection site is lubricated again with alcohol.

Intravenous injections

The injection site is most often the veins of the cubital fossa. Medicines are injected directly into a vein. The patient's arm is placed on a special rubber pad and extended as much as possible, then pulled with a tourniquet above the injection site. To better fill the vein with blood, the patient is asked to vigorously clench and unclench his fist. The injection site is treated with alcohol. The needle is inserted into the skin with the cut upward at an angle of 30-45°. After the puncture, the angle is reduced to 5-10°. When some resistance is felt, the wall of the vein is pierced and the needle is advanced a little more along the vein. Then pull the syringe plunger towards you. The flow of blood into the syringe indicates that it has entered a vein. The tourniquet is removed and the medicinal solution is slowly injected. After administering the medicine, the needle is slowly removed, a cotton swab moistened with alcohol is placed at the puncture site, and the patient’s arm is bent at the elbow.

Catheterization

Catheterization - introduction catheter V uric bubble With purpose receiving urine For research, excretion urine at her delay And With medicinal purpose. Soft rubber, semi-solid (made from silk fabric impregnated with a special mastic) and hard metal catheters are used.

Insertion of a soft catheter

The catheter is sterilized by boiling. After preliminary washing of the external opening of the urethra, a catheter, lubricated with vaseline or sterile vegetable oil, glycerin, and anatomical tweezers, is inserted into the urethra. Grasping it with tweezers, it is inserted up to the bladder.

Semi-solid catheters

They are usually sterilized with formaldehyde in special vessels. The catheters are inserted in such a way that their bend is directed towards the symphysis pubis, pulling the penis with the left hand onto the catheter. The catheter is brought to the symphysis pubis, then lowered down, after which it passes into the bladder.

Metal catheters

Sterilization of metal catheters is carried out by boiling. Inserted in the same way as semi-solid catheters.

Catheterization in women is carried out in compliance with all rules of asepsis. The patient lies on a gynecological chair or on a bed with her legs slightly bent at the knee joints, which are brought to the stomach and spread apart. With the left hand, the nurse spreads the labia, and with the right hand, from top to bottom (towards the anus), carefully wipes the vulva with a swab soaked in a solution of sublimate 1: 1000. Then with the same hand, with tweezers, takes a soft catheter or a female metal catheter, doused with Vaseline or sterile vegetable oil. Finds the external opening of the urethra and carefully inserts the catheter. The catheter is inserted only with the right hand, gradually moving deeper with tweezers; in this case, the tweezers must be held with the thumb and forefinger. The outer end of the catheter is clamped between the IV and V fingers. When urine stops coming out on its own, you can lightly press through the abdominal wall on the lower abdomen in the projection of the bladder to remove residual urine, and then the catheter is slowly withdrawn.

Catheterization in men is carried out subject to all rules of asepsis. The nurse takes the penis in her left hand, opens its head and thoroughly wipes it with a swab moistened with a solution of sublimate or boric acid. The catheter should be coated with sterile vegetable oil or petroleum jelly.

Enemas

Enemas are used for introduction V intestines through direct gut liquid substances.

Cleansing enema

Boiled water in the amount of 500-1500 ml is introduced into the large intestine through the rectum, the water temperature is 20-35°C. An Esmarch mug with a rubber tube ending in a tip is used, which is lubricated with fat before insertion. The patient lies on his right side with his legs pulled up to his stomach.

Siphon enema

This is done using a rubber probe connected to a funnel. The patient lies on his back, legs bent at the knees. The probe is inserted into the rectum, and liquid is poured into the funnel. When the funnel is lifted up, the liquid enters the intestines. When the funnel is subsequently lowered, the liquid, along with gases and pieces of feces, is released out. By performing such manipulations alternately for 10-20 minutes, it is possible to cleanse the intestines of feces.

Medicinal enemas

Introduction of small amounts of medicinal substances into the intestinal cavity. Before performing a medicinal enema, a cleansing enema is performed. It is used to reduce inflammation and irritation in the large intestine.

Suction enemas

The patient is given a cleansing enema, and after 30 minutes, 200-250 ml of the medicinal solution is administered in a heated form.

Drip enemas

Administration of large quantities of medicinal solutions (up to 6 liters) using an Esmarch mug with a rubber tube and a catheter, which is inserted into the rectum. A dropper is installed along the tube, the flow of liquid drop by drop is regulated by a Mohr clamp. A cleansing enema is performed first.

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1) causing harm to health;

2) causing harm to health as a result of extreme necessity;

3) causing harm to health, taking into account the guilt of the victim;

4) responsibility of a legal entity for the activities of its employee;

5) and also provides for compensation for damage caused and damage caused in the event of the loss of a breadwinner.

Sick - ThisNotJustan objectcarrying outmedicalmanipulations,Butsubject,activelyinteractingWithmedicalstaff!

MedicalsisterNotIt hasrightsonerror. The slightestnegligence,inaccuracy,carelessnesscanbringToirreparableconsequences!

Functional responsibilities of a nurse

Medical sister - This face, past preparation By program nursing training, having sufficient qualifications And right fulfill responsible work By service sick. Tasks, assigned on medical sister, extremely multilateral.

homemedicalsister

Oldermedicalsister

1) directly supervise the activities of the department’s middle and junior staff;

2) carry out the placement of personnel in the department from among middle and junior personnel;

Fundamentals of Nursing

Nutrition patients : it is necessary to follow a strict diet. In this case, attention should be paid to setting the table or bedside table. For certain diseases, a corresponding treatment table is prescribed:

Table zero - the first days of the postoperative period for interventions on the stomach and intestines, a semi-conscious state due to cerebrovascular accident, traumatic brain injury, and febrile conditions.

Table No. 1 - peptic ulcer of the stomach and duodenum in the stage of fading exacerbation and in remission; chronic gastritis with preserved and increased secretion in the stage of fading exacerbation; acute gastritis in the subsiding stage.

Table No. 1a - exacerbation of gastric and duodenal ulcers in the first 10-14 days, acute gastritis in the first days of the disease, exacerbation of chronic gastritis with preserved and increased secretion in the first days of the disease.

Table No. 1b - exacerbation of gastric and duodenal ulcers in the next 10-14 days, acute gastritis in the next days of the disease, exacerbation of chronic gastritis with preserved and increased secretion in the next 10-14 days of the disease.

Table No. 2 - acute gastritis, enteritis and colitis during the recovery period, chronic gastritis with secretory insufficiency, enteritis, colitis during remission without concomitant diseases of the liver, biliary tract, pancreas.

Table No. 2a - the diseases are the same as with table No. 2, characterized by limiting table salt to 8-10 g.

Table No. 3 - chronic intestinal diseases, accompanied by persistent constipation during periods of mild exacerbation and remission, as well as accompanied by damage to the stomach, liver, biliary tract, and pancreas.

Table No. 4 - acute and chronic intestinal diseases during the period of profuse diarrhea and severe dyspeptic disorders, condition after intestinal surgery.

Table No. 4a - chronic enterocolitis with a predominance of fermentation processes in the intestines. Compared to table No. 4, carbohydrates and protein foods are more limited.

Table No. 4b - acute and chronic intestinal diseases during exacerbation, as well as when they are combined with damage to the stomach, liver, biliary tract, pancreas.

Table No. 4c - acute intestinal diseases during the recovery period, transition to a general diet, chronic intestinal diseases during the period of remission.

Table No. 5 - chronic hepatitis of a progressive and benign course with signs of mild functional liver failure, chronic cholecystitis, cholelithiasis, acute hepatitis during the recovery period (when switching to a general diet).

Table No. 5a - the diseases are the same as with table No. 5, characterized by restriction of table salt and fat.

Table No. 5 (sparing) - postcholecystectomy syndrome with concomitant duodenitis, exacerbation of chronic gastritis, hepatitis.

Table No. 5g - condition after cholecystectomy with the presence of bile stagnation syndrome and hypomotor dyskinesia of the biliary tract.

Table No. 5p - acute pancreatitis in the stage of sharp exacerbation (energy value 1300-1800 kcal).

Table No. 5p - acute pancreatitis in the stage of subsiding of acute phenomena and reduction of pain (energy value 2300-2500 kcal).

Table No. 6 - gout, uric acid diathesis.

Table No. 7 (low protein) - acute nephritis (after sodium-free days), exacerbation of chronic nephritis with edematous syndrome.

Table No. 8 - varying degrees of obesity.

Table No. 9 - diabetes mellitus (as a trial diet, with the exception of pre- and post-comatose states).

Table No. 9a - diabetes mellitus (in overweight patients).

Table No. 9b - diabetes mellitus (in patients receiving insulin).

Table No. 10 - heart defects, cardiosclerosis, hypertension of I and II degrees with mild signs of circulatory failure.

Table No. 10a - diseases of the cardiovascular system, accompanied by circulatory failure of II and III degrees.

Table No. 10c (anti-atherosclerotic) - atherosclerosis of coronary, cerebral and peripheral vessels, atherosclerosis of the aorta, atherosclerotic cardiosclerosis.

Table No. 10i - myocardial infarction.

Table No. 11 - pulmonary tuberculosis, the period of recovery after a serious long-term illness (with exhaustion, anemia, etc.).

Table No. 12 - diseases of the nervous system.

Table No. 13 - acute infectious diseases, a condition after extensive illnesses (but not in the gastrointestinal tract).

Table No. 14 - phosphaturia.

Table No. 15 is a common table, prescribed for diseases that do not require dieting.

Technique for basic medical procedures

Autohemotherapy

Banksdry

Bougienage

Bougienage - extension narrowed lumen tubular organs (esophagus, urethra) through metal or soft elastic bougie.

Bathswatersimple

Baths water simple - treatment water. Baths can be shared, local or half-bath.

Bathsmedicinal

Venipuncture

Intravenousinfusion

Intravenous infusion - introduction large quantities liquids or medicinal solutions intravenously.

Rubbing

Rubbing - way introduction medicinal substances through skin. A small amount of the medicinal substance is applied to the skin after first washing it with hot water and soap and the applied product is rubbed in the direction of the lymph flow. This procedure is carried out daily or every other day.

Gas removal

Mustard plasters

Mud therapy

Injections

Intradermal injections

Subcutaneous injections

Intramuscular injections

Intravenous injections