Caring for patients after abdominal surgery

The postoperative period can last seven days, possibly several months. For a speedy recovery, proper care for the patient is organized. There are certain rules in this situation. Attentive care for the patient is carried out by medical personnel, since it is the first days after the operation that influence the positive outcome of the patient’s recovery.

If the operation is performed under general anesthesia, the patient should be placed in bed with his back down, his head turned to the side. A pillow is not used to avoid tongue sinking. Ice is placed in the area of ​​the surgical suture to narrow the blood vessels. Thus, damaged tissues during surgery will not be at risk of any complications. After anesthesia, patients usually sleep; it is undesirable to wake them until they are fully awake. The nurse who is nearby monitors the patient’s condition: pulse, blood pressure, breathing, appearance.

Patients undergoing surgery under local anesthesia require different care. There is a possibility of increased sensitivity to novocaine. The patient may feel weakened, accompanied by vomiting, tachycardia, and low blood pressure. With such symptoms, the patient needs to be given water as often as possible; the nurse should inject one or two cubes of ten percent caffeine subcutaneously. Glucose with saline is administered intravenously. Intoxication will decrease in four hours, blood pressure will return to normal.

Much attention is paid to pain after surgery. The medical staff also closely monitors the patient's mental state. In the ward where the patient is located, silence is maintained, the nurses speak in a whisper, ventilation is performed before bedtime, thereby maintaining a therapeutic and protective regime.

The postoperative period may be prolonged, and the patient may be sent home. Then you will need a professional nurse at home who will provide proper care. The room where the patient will be brought is ventilated before arrival. The bed is made with clean linen, the sheet must be carefully straightened. A bedpan is being prepared. On the cabinet near the patient there should be napkins, syringes, painkillers, and a pillow with oxygen.

Since the patient lies for a long time, there is a possibility of bedsores. They can appear in the area of ​​the elbows, sacrum, greater trochanter and shoulder blades. To avoid this, the patient’s bed must be changed more often. Be sure to monitor the skin, in places where bedsores appear, redness, swelling, detachment of the epidermis appear, then blisters appear, necrosis of the skin occurs, and then for the periosteum. The patient must be turned over three times a day. Disinfect the skin daily with cologne and camphor alcohol. If redness appears, rub with a dry cloth to improve blood circulation, you can use quartz. If bedsores appear, lubricate the blisters with brilliant green and apply a bandage. Dead skin needs to be removed. Treat the wound with a solution of potassium permanganate (one percent). Change the bandage three times a day. Subsequently, when the wound begins to heal, lubricate it with Vishnevsky ointment, syntomycin.

All efforts of medical personnel are aimed at restoring function, normal wound healing, preventing complications and combating them.

Postoperative period begins immediately after the end of the operation and continues until the patient returns to work and a normal lifestyle. The immediate postoperative period is the first 5 days, the long-term period is from discharge from the hospital until return to work. After major operations, patients are admitted to the intensive care unit (resuscitation unit), or (in the absence of one) to the postoperative ward. If the postoperative period is smooth, the patient is transferred from the intensive care unit after 2-4 days.

At the end of the operation and the patient awakens from anesthesia, when spontaneous breathing is restored, the endotracheal tube is removed and the patient, accompanied by an anesthesiologist and nurse, is transferred to the ward. Before the patient returns from the operating room, a functional bed should be prepared, installed so that it can be approached from all sides, and the necessary equipment should be installed rationally. The bed linen must be straightened, warmed, the room ventilated, and the bright lights dimmed. Depending on the condition, the nature of the operation and anesthesia, a certain position in bed is provided.

After abdominal operations, under local anesthesia, it is advisable to position yourself with the head end elevated and the knees slightly bent, which helps to relax the abdominal muscles. If there are no contraindications, after 2-3 hours you can bend your legs and turn on your side. Most often, after anesthesia, the patient is placed horizontally on his back without a pillow, with his head turned to his side. This position prevents anemia of the brain, mucus and vomit from entering the respiratory tract. After operations on the spine, the patient is placed on his stomach, while a shield is placed on the bed. Those operated under anesthesia need constant monitoring until they fully awaken and restore spontaneous breathing and reflexes. Immediately after surgery, a sandbag or ice pack is placed on the wound area to prevent the formation of a hematoma. While observing the operated patient, they monitor the general condition, appearance (skin color), frequency, rhythm, pulse filling, frequency and depth of breathing, blood pressure, diuresis, discharge of gases and stool, body temperature.

To combat pain, morphine, omnopon (pantopon), promedol are prescribed subcutaneously, which are administered every 4-5 hours on the first day. To prevent thromboembolic complications, it is necessary to combat dehydration, activate the patient in bed (therapeutic exercises from the first day), get up early, if indicated (for varicose veins) - bandage the legs with an elastic bandage, administer anticoagulants. Changing positions in bed, cupping, mustard plasters, breathing exercises (inflating rubber bags, balloons), special manipulations when coughing (put your palm on the wound and lightly press it while coughing) improve blood circulation and ventilation of the lungs.

If the patient is prohibited from drinking and eating (interventions on the digestive tract), parenteral administration of solutions of proteins, electrolytes, and glucose is prescribed. To compensate for blood loss and for stimulating purposes, blood, plasma, and blood substitutes are transfused. Several times a day, you need to clean the oral cavity, wipe with a damp ball (moisten with hydrogen peroxide, a weak solution of sodium bicarbonate (soda), boric acid, potassium permanganate) the mucous membrane, gums, teeth, remove plaque from the tongue with a lemon peel, a damp swab ( a teaspoon of sodium bicarbonate and a tablespoon of glycerin per glass of water), lubricate your lips with Vaseline. If the patient's condition allows, he should be offered to rinse his mouth. During prolonged fasting to stimulate salivation (prevention of inflammation of the parotid salivary gland) It is recommended to chew (do not swallow!) black crackers, orange and lemon slices.

After transection (laparotomy), hiccups, regurgitation, vomiting, bloating, stool and gas retention may occur. Help consists of emptying the stomach with a tube (after gastric surgery, the tube is inserted by a doctor) inserted through the nose or mouth. To eliminate persistent hiccups, atropine (0.1% solution 1 ml), aminazine (2.5% solution 2 ml) is administered subcutaneously, and a cervical vagosympathetic blockade is performed. To remove gases, a gas tube is inserted and medication is prescribed. After operations on upper section gastrointestinal tract after 2 days a hypertensive enema is given.

After surgery, patients are often unable to urinate on their own due to an unusual position and sphincter spasm. If there are no contraindications, a warm heating pad is placed on the bladder area. Urination is encouraged by flowing water (open the tap), a warm bed, intravenous administration of a solution of hexamethylenetetramine (urotropine), magnesium sulfate, atropine, morphine. If all these measures have no effect, resort to catheterization (morning and evening), keeping a record of the amount of urine excreted. A decrease in diuresis may be a signal of a serious complication - postoperative renal failure. To avoid the formation of bedsores, careful skin care is necessary: ​​frequent changes of body position, treating the skin with camphor alcohol, washing, changing linen when soiled, carefully straightening the folds in the sheets, placing a rubber circle.

The postoperative regimen is determined individually. The first getting up, the first steps always take place with the help of the sister, under her control.

Observation of dressing and drainage. Monitoring the condition of the dressing is carried out several times a day, paying attention to the convenience, safety of the dressing, its cleanliness and getting wet. If the wound is sutured tightly, the bandage should be dry. If you get slightly wet with ichor or blood, you should replace the top layers (with sterile material) and bandage them, in no case exposing the wound. If the wound is not completely closed, drains, tampons, or drains are left in it, then discharge may appear and the bandage will get wet. It is necessary to explain to the patient that drainage was carried out for normal healing of the wound and to take measures not to contaminate the bed: put an oilcloth on the mattress, and a bedding on the sheet. A long drain is either connected to a suction system or immersed in a vessel. Through short drains and tampons, the outflow of discharge goes into a bandage, which quickly gets wet and must be changed regularly. To prevent the drainage from falling out, it is fixed to the skin with sutures and strips of adhesive tape. If drainage into the vessel is established, the amount of discharge (per day, per day) is calculated and recorded in the temperature sheet. Changing, tightening, shortening drains and tampons is exclusively a medical procedure. Under no circumstances should you attempt to reinsert drains and tampons that have fallen out - such a complication must be immediately reported to the attending physician or the doctor on duty. If the discharge through the drainage has stopped, this is caused either by its absence (exudate does not accumulate, the abscess has emptied well), or by blockage of the drainage by an accumulation of fibrin, mucus (plug), or by a bend in the tube. Under the guidance of a doctor, the clogged drainage is washed and the contents are sucked out. After clean operations, tampons and drains placed to remove accumulating blood are removed on the 2-3rd day (manipulation is carried out in the dressing room). Drains and tampons designed to drain exudate, pus, and bile are removed gradually, as the amount of discharge decreases. If the postoperative period is favorable, the bandage on the sutured wound is not changed until the sutures are removed. If a circular bandage causes pain or compresses tissue, you should loosen the bandage without removing the sterile material from the wound. If the bandage gets wet with blood, you should, without touching it, invite a doctor, prepare sterile material for dressing, or bring the patient on a gurney to the dressing room. At heavy bleeding sometimes you have to decide on your own emergency measures. If the bandage on the abdomen suddenly becomes wet with serous bloody fluid, and a bulge appears underneath it (not always visible), one should think about the wound diverging and the viscera falling into the resulting defect (eventration). Eventration occurs most often after coughing, sneezing, or a sharp turn. In such cases, without touching the bandage, apply a sterile towel and sheet, lay the patient down (if he was sitting or walking) and immediately call a doctor. To some extent, eventration can be prevented by tightening the abdomen with a towel in the form of a bandage after removing the sutures.

After intrathoracic surgery patients are placed in specially equipped rooms equipped with devices for artificial ventilation of the lungs, a central oxygen supply, a set for pleural puncture, venesection, systems for intravenous infusion and intra-arterial blood injection, sterile syringes, containers with sterile material, and a device for measuring blood pressure. The necessary medications should be on hand: strophanthin, hydrocortisone, norepinephrine, mesaton, atropine, calcium chloride, narcotic analgesics, camphor, cordiamine, caffeine, cititon, 5-40% glucose solutions, sodium chloride (0.9%), etc. After emerging from anesthesia, the patient is given a semi-sitting position, which is most beneficial for breathing, heart function, and expectoration. Usually, constant drip infusions into a vein are continued on the first day. Every 2 hours, indicators of pulse, blood pressure, and respiration are recorded on the card. To maintain sufficient ventilation of the lungs, oxygen inhalation and tracheobronchial toilet (suction of mucus and sputum) are prescribed. If a drainage is left in the pleural cavity (or pericardium) to remove air and effusion, it is necessary to monitor its patency, the amount and nature of the discharge. An alarming sign is copious leakage of intensely blood-stained fluid. If the tightness of the drainage is broken, air is sucked into the pleural cavity, pushing back and compressing the lungs and mediastinum, creating a threat to life. This condition, manifested by severe shortness of breath, anxiety, increased heart rate, and cyanosis, can also occur in cases where the chest cavity is sutured tightly, without drainage, and air and effusion accumulate in it. These patients urgently need to be pleural puncture. The change of regime is regulated by the doctor, only he decides when the patient can sit down, stand up, etc. After transthoracic resection and esophagoplasty Along with the measures usually taken during interventions on the organs of the thoracic cavity, attention should be paid to creating maximum rest for the anastomosis of the esophagus with the intestine. On the 1st day, the patient should refrain from even swallowing saliva, spitting all the time. This stage is very difficult for the patient and requires the tireless attention of the staff, because excruciating thirst and dry mouth sometimes push patients to actions that cause harm (they are ready to drink water from an ice pack, a heating pad). Much attention is paid to intensive parenteral nutrition. Only from the 4th day you can drink liquid in sips. Gradually, the diet expands and after a week the patient receives raw eggs, kefir, jelly, broth, sour cream, and liquid porridge. The volume of food for 5-6 meals should not exceed 400 ml. On the 11-12th day, pureed meat, a steamed cutlet, and crackers are allowed; from the 15th day, table No. 1 is prescribed. These patients, due to severe exhaustion, are very predisposed to the formation of bedsores, and therefore wash the skin, change linen, change Positions in bed acquire important preventive significance.

After mastectomy(breast removal) usually leaves a drain in the armpit to remove blood and lymph. The patient is placed on the bed with the head end raised, and an oilcloth is placed under the back (on the mattress), because the bandage usually gets very wet. Breast loss causes great emotional trauma to young women. During the first dressing, it is necessary to shield the surgical wound from the patient and apply a bandage that creates the configuration of the mammary gland. From the 2nd day you need to start exercising the joints of the corresponding arm, because prolonged sparing can lead to the formation of contractures, especially in the area of ​​the shoulder joint.

After gastrectomy or gastrojejunostomy you should remember about the possibility of bleeding both into the lumen of the stomach and into the abdominal cavity. If profuse bloody vomiting occurs, the nurse should call a doctor, who will first prescribe conservative therapy(ice on the stomach, blood transfusion, administration of Vikasol, calcium chloride). If these measures do not lead to hemostasis, the patient is taken for a second operation. Intra-abdominal bleeding manifests itself as collapse and requires urgent measures(primarily operations). On the 3rd day, complaints of pain and heaviness in the epigastrium, belching, regurgitation and vomiting may appear - phenomena associated with impaired evacuation from the stomach due to an obstruction (swelling of the anastomosis) or atony (paresis). At the first signs of stagnation in the stomach, the doctor pumps out the contents once or leaves a nasogastric tube for continuous suction. The nurse should monitor the position of the probe after it is fixed. At the same time, stomach tonics are used. Usually, paresis of the gastric stump goes away soon. The diet is expanding gradually. In the first 2 days, absolute hunger, prohibition of drinking. Electrolyte solutions and proteins are administered only parenterally. From the 3rd day, rare sips of water are allowed (2 glasses per day). Next: raw eggs, butter, broth, kefir, jelly. After 6-7 days, table No. 1a and then No. 1 are prescribed. A patient with a resected stomach should be fed every 2-3 hours with small portions of warmed food.

In patients with a resected stomach, the so-called dumping syndrome may often be observed in the long term, which manifests itself after eating with bouts of fever, weakness, profuse sweating, and dizziness. In these cases, the patient should be laid down.

After surgery on the bile ducts and liver Drains are often left for external bile drainage. The end of the drainage is immersed in a vessel placed below the bed. It is necessary to ensure that the drainage does not fall out or bend, so that the contents continuously pass through it. The quantity and nature of the discharge are recorded. As the inflammatory phenomena subside, the bile becomes transparent, and the admixture of flakes and pus disappears. From this time on, they begin to clamp the drainage for 2-3 hours. If the patient tolerates this manipulation well and the jaundice does not increase, they extend the period of blocking the drainage and remove it on the 10-12th day. With long-term external biliary fistulas, part of the bile does not enter the intestines and does not participate in digestion, which negatively affects the absorption of food. In such cases, it is recommended to collect bile in a clean container, filter it and wash it down with food. It is necessary to remember about increased bleeding in patients with jaundice and monitor the soaking of tampons, the appearance of blood in the discharge, etc.

After intestinal surgery Drinking is allowed on the day of surgery. Otherwise, after intervention on small intestine care is the same as after gastric surgery. If the intervention is carried out on colon, a gentle diet with a minimum of toxins is indicated to inhibit motor skills. Sometimes, for these reasons, opium tincture is prescribed for 5 days. In order to liquefy and soften stool, give Vaseline oil orally, a tablespoon 2-3 times a day. Enemas are given only as prescribed by a doctor at a later date, and small oil enemas are recommended. Operations on rectum and anus often end with the introduction of oil tampons and rubber drainage into the rectum. In anticipation of heavy wetting, the mattress is covered with oilcloth. The first dressing with changing tampons (on the 3rd day) is very painful. It is done after the administration of narcotic analgesics, sometimes pre-soaking the bandage with a weak solution of potassium permanganate. After stopping opium, Vaseline oil is given orally to facilitate bowel movements. After defecation, a sitz bath is performed followed by dressing. Due to the fact that the dressings in such patients often get wet heavily, there should be a bix at the post and a lot of cotton wool to change the dressing.

Caring for patients with digestive tract fistulas. Gastrostomy(gastric fistula) is applied when there is obstruction of the esophagus, food is introduced directly into the stomach. In the first days, when the fistula canal has not yet formed, it is very unpleasant for the tube to fall out, which in no case should you try to put it in place yourself. An unskilled attempt to “blindly” insert a tube into a fistula may end up in the free abdominal cavity and the development of peritonitis. To prevent the contents of the stomach from constantly leaking out, the tube is bent and tied or clamped with a clamp, opening it for the period of feeding. In case of a temporary fistula, a rubber tube is fixed to the anterior abdominal wall with sutures, tapes, and adhesive tape. In case of unremovable esophageal cancer, a permanent labiform fistula is formed, suturing the gastric mucosa to the skin. Further, when the fistula is formed, the nurse, and then the patient (independently) insert the tube only for feeding. Before feeding, place a funnel on the end of the tube. Food should be high-calorie, liquid or semi-liquid, warm. To obtain a homogeneous mixture, it can be mixed in a mixer. Raw eggs, meat and milk soups, pureed meat, fruits, vegetables, cream, sour cream, butter, juices are added to the mixture; gastric juice, pepsin, and hydrochloric acid are added for better absorption. It is highly advisable to give part of the food (a piece of bread, a cutlet, soft fruit) through the mouth: the patient will chew it thoroughly and then spit it out into a funnel, from where it enters the stomach. This technique helps satisfy hunger, stimulates the secretion of the digestive glands, and includes the processing of food with saliva. To prevent irritation, the skin is lubricated with indifferent ointments (zinc, Lassar paste, etc.). Dermatol paste protects the skin well.

Sometimes temporarily or permanently applied fistula to the small intestine (jejunostomy, ileostomy). Care is the same as for a gastric fistula.

In case of intestinal obstruction, a fistula is placed to drain feces and gases - fecal fistula. In this case, quite liquid contents flow out of the cecum (with a cecostoma), and formed feces are released from the lower parts of the large intestine (unnatural anus). Caring for patients with intestinal fistulas is a labor-intensive task that requires skill, dexterity and great patience. With good care, the bandage is always clean, dry, there is no unpleasant odor, and the skin surrounding the fistula is not irritated. It must be well strengthened (not slip and not interfere with movements). After each bowel movement, the skin is cleaned, a napkin soaked in Vaseline is placed on the protruding mucous membrane (“rose”), the fistula is covered with gauze, cotton wool is applied and the bandage is secured with bandages or a bandage. You should not use cleol or sticky patches - this will aggravate skin irritation and dermatitis. The skin around the fistula is covered with indifferent ointment. When a fecal fistula has formed, baths are useful, which contribute to the improvement of the skin and the elimination of dermatitis. From this time on, patients are taught to use a colostomy bag. If stool is retained, an enema is given. First, insert a finger into the fistula (lubricate the glove with Vaseline), determine the direction of the overlying intestine, and guide the tip. For a laxative effect, you need to introduce 500-600 ml of water, or even better, 200 ml of Vaseline oil.

Maceration of the skin around the fistula causes pain. To protect the skin, special ointments and pastes are used. To strengthen the skin and give it greater strength, use an aqueous solution of tannin (10%). This solution is used to lubricate areas of skin affected by dermatitis. Powders made from dry tannin, gypsum, talc, and kaolin are used. This creates a crust that protects the skin. Intestinal contents, falling on the crust, drain from it (with an open method of treatment) or are absorbed by a bandage covering the fistula.

Caring for patients with tracheostomy(tracheal fistula). Tracheostomy in surgical practice is used to long-term maintenance of free airway patency. The main task of care is to maintain the patency of the trachea and cannula. The inner tube is removed twice a day, cleaned of mucus, washed with boiling water and reinserted. It is better to use sterilized plastic tubes. To prevent the mucous membrane of the trachea from drying out, the tube is covered with a damp gauze curtain: the bandage is protected from contamination by a rubber gasket placed under the tube. Toilet of the trachea and bronchi involves suctioning the contents through a catheter (sterile) passed through a cannula. Before suctioning, oxygen is inhaled and 3-5 ml of warm sterile sodium bicarbonate solution is instilled into the trachea to thin the thick mucus. Enzyme solutions (chymotrypsin) dilute sputum even better. As prescribed, a solution of penicillin is injected into the tracheostomy. With a tracheostomy, unhumidified and unheated air enters the lungs, which leads to drying of the mucous membrane of the respiratory tree. Therefore, it is necessary to take measures to humidify the air in the room (a special humidifier, hanging wet sheets); periodic inhalation of aerosols is indicated. Prolonged stay of a tracheostomy tube can cause tracheobronchitis, which can only be prevented by good care of the suite. The skin around the fistula must be carefully treated: dried, lubricated with Lassara paste. It is necessary to warn the patient that with a tracheostomy he will not be able to talk. In order for speech to be sonorous, you need to cover the hole in the tube with your finger.

Care after thyroid surgery. Those operated on for thyrotoxic goiter should be protected from mental or physical stress. The most comfortable position after thyroid surgery is semi-sitting with the head slightly tilted forward to relax the neck. You need to prepare the bed first. The nurse observes the general condition of the patient, the color of the skin, the frequency, filling and rhythm of the pulse, blood pressure, and the condition of the bandage. Often, after removing a goiter, gauze or rubber strips are left in the wound - graduates. Excessive blood soaking of the bandage indicates bleeding, which may require emergency intervention. In the coming hours after surgery on the thyroid gland, anxiety, agitation (the patient is tossing about), redness of the face, increased trembling of the hands and body, increased heart rate, sometimes arrhythmia, and increased temperature may occur. The nurse immediately informs the doctor about this and is actively involved in providing urgent help. You must have boiled syringes and the necessary medications ready: cordiamine, strophanthin, glucose, hydrocortisone, inderal, a sterile system for intravenous and subcutaneous administration fluids, blood transfusions, oxygen cylinder.

Sometimes such patients after surgery experience painful cramps of the limbs or face as a result of injury or removal parathyroid glands, which regulate calcium metabolism. In this case, calcium chloride is prescribed intravenously and orally. In addition, the parathyroid hormone, parathyroidin, is indicated. The skin of patients with thyrotoxic goiter is delicate and thin; Often after surgery, irritation occurs from lubrication with iodine and cleol. In such cases, it is good to lubricate the skin with Vaseline and other indifferent ointments. It is important to pay attention to the sonority of the voice: hoarseness is a sign of surgical injury to the recurrent nerve. In the first 3 days after surgery, semi-liquid food is given, as swallowing is painful and difficult.

After care urological operations . Most urological operations involve leaving drains and catheters to drain urine. The bed (preferably a functional one) must be prepared in such a way as to protect the linen (oilcloth, bedding) from secretions and ensure the outflow of secretions into transparent urinals suspended from the bed - glass or plastic vessels (bottles), tightly closed with a stopper in which there is a hole corresponding to the caliber of the tube , connected to the drainage or catheter by transition tubes, preferably transparent (glass). The urine bag and tubes are pre-boiled (prevention of ascending infection). Before immersing the drainage, 50-100 ml of a slightly colored solution (furacilin, rivanol) is poured into the urinal, which, in addition to the antiseptic effect, eliminates the ammonia smell of decomposed urine. When laying down an operated patient, you need to take care of the drains; they must be firmly fixed with a bandage, correctly immersed in the urinal - without bending, to a certain depth (do not rest against the walls or bottom of the vessel, do not hang above the liquid).

A characteristic feature of urological interventions is leakage of urine around drains. This requires frequent changing of bandages (several times a day) as they get wet. Bandages are applied without cotton wool, because the latter, absorbing urine, becomes a source of unpleasant odor and maceration of the skin, which should be lubricated with Vaseline and Lassara paste in case of heavy discharge. A bandage consisting of several layers of gauze is cut at the edge according to the drainage and placed on top in the form of panties, the second layer of the bandage is also cut and laid from below so that the drains are in the center of the bandage, a sticker with holes for drainages is placed on top. Gauze tape is used to tie the drainage at the exit of the wound, and then the tape is tied around the abdomen; sometimes the drainage is fixed at the wound with strips of adhesive plaster.

A suspensor is put on the scrotum (after surgery on the testicle, spermatic cord), either purchased at a pharmacy (indicate the appropriate size) and sterilized, or made by a sister from gauze folded in several layers (20x25 cm). Ribbons are sewn to the ends of the sewn jockstrap (at the front closer to the edges, at the back next to it, narrowing the edge), which are tied to a belt (from a bandage); Closer to the front, a hole for the penis is made in the triangular area of ​​the suspensor.

Along with general postoperative care, special importance is attached to monitoring the functioning of drainages. The color of the discharge is of great importance for recognizing complications (admixture of blood, pus); it can be judged by monitoring through the connecting tubes. Accumulated discharge must be poured out more often in order to maintain cleanliness and be able to judge the nature of the discharge in a given period of time. In this case, it is imperative to keep track of the amount of fluid released through drainages, as well as naturally (diuresis). The appearance of fresh blood and clots in the discharge is an alarming signal. It is very important to notice in time the cessation of outflow of drainage, which may be caused by blockage, loss or kinking of the catheter (urinary leaks may form if urine is retained). As prescribed by the doctor, the bladder is washed through a catheter inserted into the fistula (epicystostomy) or urethra. To do this, use either a Janet syringe or an Esmarch mug. 10 ml of the prescribed solution (0.1% rivanol solution, 2% boric acid solution, etc.) is carefully introduced into the bladder, then released, repeating the procedure until the rinsing waters become clear. Strict asepsis is required: the mug, syringe, and solutions must be sterile, and sterile gloves must be worn on hands. If you have to rinse through drains inserted into the pelvis or pelvis, use a 20-gram syringe.

In urological practice, early activation and getting up are recommended. It is necessary to take measures to ensure that the drains do not fall out or become dislodged. In these cases, you need to clamp the lumen of the drains by bending and tying the tip of the tube; the same should be done when the patient is taking a bath. To prevent walking patients from getting their underwear wet, they are given a small bottle, which is hung by the neck. After removing the suprapubic drainage during prostatectomy, a capsule is put on, from which urine is drained through two tubes into urinals (but on both sides of the bed). The patient is placed on the fistula, the capsule is strengthened so that the fistula is in the center of it. As the discharge from the capsule decreases, urination through the urethra increases. The capsule is then replaced with a bandage and the patient is allowed to walk. This type of prostatectomy operation is usually performed on older people who need especially careful care. Sometimes such patients are discharged home after the first stage of the operation (application of a urinary suite) and until re-hospitalization they are treated on an outpatient basis: bandages and drainage are changed, the bladder is washed. In the urology department, good ventilation of the rooms and frequent airing are of great importance. These simple measures, combined with frequent changes of dressings and emptying urine bags, help to achieve good clean air and eliminate the specific odor.

Care for postoperative complications. Collapse- cm. " Urgent Care".

Bleeding may complicate any intervention. In addition to external bleeding, intracavitary hemorrhage should be taken into account. Jaundiced patients are particularly prone to bleeding. The reasons are insufficient hemostasis during surgery, slipping of the ligature from a ligated vessel, prolapse of a blood clot, and impaired blood clotting. Help is to eliminate the source of bleeding (often operationally, sometimes with conservative measures - cold, tamponade, pressure bandage), local use of biological hemostatic agents ( horse serum, hemostatic sponge, fibrin film, thrombin), replenishing blood loss, increasing blood coagulation properties (plasma, freshly citrated blood, calcium chloride, vikasol, aminocaproic acid, fibrinogen, gelatin).

Pulmonary complications caused by impaired circulation and ventilation of the lungs due to shallow breathing due to pain in the wound, accumulation of mucus in the bronchi (poor coughing and expectoration), blood stasis in the posterior parts of the lungs (long stay on the back), decreased lung excursions due to bloating and intestines, etc. When ventilation of the corresponding part of the lung ceases, atelectasis develops, which can be complicated by infection and develop into pneumonia. Prevention of pulmonary complications consists of preliminary training in breathing exercises and coughing, frequent changes of position in bed with the chest raised, pain control (strict frequency of administration of painkillers), administration of camphor (together with 1-2 ml of ether, which is secreted by the respiratory tract), circular cups, anti-flatulence, oxygen inhalation. Treatment of pneumonia is carried out according to general rules.

Laryngeal edema may result from trauma during intubation. In the initial period, it manifests itself as hoarseness or loss of voice; its further increase leads to respiratory distress (inhalation and exhalation are difficult, auxiliary muscles are tense). Treatment is with antihistamines (diphenhydramine, diprazine), decongestants (calcium chloride, hydrocortisone), inhalations of menthol, sodium bicarbonate solution, humidified oxygen, mustard plasters on the chest, heating pads on the legs (distraction therapy). If conservative treatment is ineffective, tracheostomy is performed.

Pulmonary edema- cm. "Urgent Care". Asthma cardiac.

Paresis of the stomach and intestines observed after abdominal surgery, caused by atony of the muscles of the digestive tract and accompanied by hiccups, belching, vomiting, stool and gas retention. In the absence of complications from the operated organs, paresis can be managed by nasogastric suction, hypertonic enemas and gas tubes, intravenous administration of hypertonic solutions, agents that enhance peristalsis (prozerin), relieve spasms (atropine), enhance tone (strychnine), and perinephric blockade. Persistent paresis, not amenable to the described measures, most often accompanies peritonitis.

Mumps- inflammation of the parotid gland. Occurs in weakened, elderly patients after extensive, often oncological, operations on the digestive tract. In patients who do not take food orally or who receive semi-liquid light food, the function of the masticatory muscles is turned off and secretion is impaired. salivary glands, conditions are created for the growth of microbes in the oral cavity and their penetration through the salivary ducts into the gland. In this case, inflammation of both or one gland occurs: accordingly, pain and swelling are determined, the patient has difficulty opening his mouth, chewing, talking, his general condition worsens, and his body temperature rises. Treatment consists of local warming compresses, physiotherapy (if there are no contraindications), and the prescription of antibacterial drugs. When suppuration occurs, it is necessary to resort to incisions. For prevention purposes, attention should be paid to stimulating the function of the salivary glands: wipe your mouth with a slice of lemon, chew black crackers (spit them into a tray), rinse your mouth with weak antiseptic solutions.

Peritonitis- inflammation of the peritoneum, a severe complication of intra-abdominal operations, most often caused by divergence (insufficiency) of sutures placed on the stomach or intestines. With an acute onset, pain suddenly occurs, the initial localization of which often corresponds to the affected organ. Then the pain becomes widespread. At the same time, intoxication quickly increases: the pulse quickens, the temperature rises, facial features become sharper, thirst occurs, dry mouth, nausea, vomiting, and tension in the abdominal wall appears. Against the background of massive antibiotic therapy, as well as in weakened elderly patients, the picture of peritonitis is not so bright. If peritoneal symptoms appear, the patient should be prohibited from eating by mouth, put ice on the stomach and, without giving any medications (especially drugs), invite a doctor.

Psychosis after surgery occur in weakened, easily excitable patients. They are manifested by motor agitation with disorientation, hallucinations, and delusions. In this state, the patient can jump out of bed, push the staff, rip off the bandage, and injure himself and others. Persuasion, attempts to put the patient to sleep are ineffective. All measures must be taken to forcibly (involve recovering patients) immobilize the patient, tie him to the bed with sheets, and place him under a net. At the first opportunity, it is necessary to administer chloral hydrate (50 ml of 4% solution) subcutaneously (1-2 ml of 2.5% solution) or chloral hydrate (50 ml of 4% solution), ensure constant monitoring and call a psychiatrist for consultation. If there is no confidence in the absence of surgical complications, it is better to refrain from transferring such patients to a psychiatric department, since sometimes psychosis is the first manifestation of intoxication, insufficient sutures, etc. There should be an individual post at the bedside of such a patient.

Sepsis- a severe complication caused by the spread of infection. Symptoms are not specific, but reflect intoxication: excitement, then lethargy, insomnia; the liver and spleen enlarge, sometimes jaundice and diarrhea occur. Anemia and a shift in the leukocyte formula progress, and protein appears in the urine. The appearance of a septic wound is characteristic: its tissues are pale, swollen, the granulations are sluggish, the discharge is scanty and cloudy. Exhaustion and depression are increasing. At the height of the process - high temperature, rapid pulse, hypotension, dry mucous membranes, thirst, pain in muscles and joints. Treatment consists of emptying, draining purulent foci, intensive local treatment (disinfection, antibiotics, immobilization, physiotherapeutic procedures), general antibacterial therapy. It is important to ensure rest, careful care of the skin and oral cavity, a high-calorie varied diet (if indicated - parenteral nutrition) with plenty of fluids and increased content proteins. Activation of the patient is of great importance: frequent changes of position, gymnastics.

Tetanus- cm. Caring for infectious patients.

Thromboembolic complications. Individuals with varicose veins, blood clotting disorders, slow blood flow, vascular injury during surgery, obese and weakened (especially cancer) patients, multiparous women.

When a blood clot forms and a vein becomes inflamed, thrombophlebitis occurs. Thrombophlebitis can occur in superficial (lower leg) and deep veins (lower leg, pelvis), where it is quite difficult to detect. Pain and increasing swelling of the limb, sometimes a rise in temperature suggest damage to the deep veins.

First aid consists of prescribing strict bed rest to avoid the detachment of a deep vein thrombus and its introduction (embolism) by the blood flow into the overlying parts of the circulatory system, even up to the pulmonary artery, with all the ensuing complications, up to lightning death from blockage of the main trunk of the pulmonary artery. If it is not the main vessel that is clogged, a pulmonary infarction occurs.

To prevent thrombosis, the patient’s activity in postoperative period(reducing congestion), combating dehydration (i.e. blood thickening), wearing elastic bandages (stockings) in the presence of varicose veins.

Local treatment of thrombophlebitis is reduced to the application of oil-balsamic dressings (heparin ointment is preferred), giving the limb an elevated position (Behler splint, roller). Drugs that reduce blood coagulation are widely used - anticoagulants, fibrinolysin (strictly under the control of indicators of the blood coagulation system, in particular prothrombin). For thrombophlebitis accompanied by infection, antibacterial drugs are prescribed.

In the absence of conditions for controlling prothrombin, it is advisable to use leeches for thrombophlebitis of superficial veins (see. General nursing). Once the acute effects have passed, the issue of further treatment is decided.

State Budgetary Educational Institution of Higher Professional Education Volga State Medical University of the Ministry of Health of Russia

Department of Surgical Diseases, Pediatric and Dental Faculty

Research work

on the topic: “Features of patient care in the postoperative period”

Completed by: 1st year student, 5th group

Faculty of Pediatrics

Semchenko Maria Sergeevna

Volgograd 2016

Introduction

1.1 Transporting the patient from the operating room to the ward

1.2 Arrangement of the ward

2. Complications associated with anesthesia

2.1 Tongue retraction

2.2 Vomiting in the post-anesthesia period

2.3 Impaired thermoregulation

4. Caring for a seriously ill postoperative patient

5. Prevention of postoperative complications

5.1 Control of hyperthermia

5.2 Combating gastrointestinal paresis

5.3 Combating urinary retention

5.4 Preventing bedsores

6. Nutrition of the patient

7. Recovery period

8. Role of medical personnel

Conclusion

Bibliography

Introduction

The postoperative period is the time between the end of the operation and the patient’s complete recovery. Its duration varies - from 7-8 days to several months. The course of this period is also different and depends on a number of conditions (surgery, anesthesia, state of health of the patient), especially on complications that sometimes occur after surgery. During this period, careful observation and care of the patient is necessary, since proper care, especially in the first postoperative days, often not only the result of the operation depends, but also the life of the patient. Symptoms not noticed in a timely manner and lack of attentive care often lead to severe complications leading to the death of a patient who underwent the operation well. Any changes in the patient's condition must be reported to the doctor.

Objectives: To study the features of care in the postoperative period. Know the possible complications of the postoperative period and methods of their prevention. Learn to recognize postoperative complications.

Objectives: To study the prevention of bedsores and urinary retention. Will study the peculiarities of nutrition in the postoperative period. To study the care of the oral and nasal cavity of a postoperative patient. Become familiar with the role of medical personnel.

Often after surgical treatment complications arise that complicate the healing process. Therefore, preparing a patient for surgery includes a number of preventive measures, both general and local, aimed at preventing complications, both during surgery and in the postoperative period. Surgery and anesthesia lead to certain changes in the human body, which are general in nature and are a response to surgical trauma. Proper management of the patient in the postoperative period, organizing his stay in the department to perform the necessary manipulations and procedures for the treatment and care of the patient are extremely important for prevention possible complications and favorable treatment results. The favorable outcome of treating a patient in the postoperative period largely depends not only on the adequacy of the operation performed, but also on the knowledge and professional skills of nursing staff. Therefore, mastering practical skills and professional skills in caring for patients who have undergone surgery is important for all employees of the surgical department.

1. Basic definitions and concepts

postoperative patient care

The postoperative period is the time from the moment the patient is removed from the operating table until the wound heals and the disappearance of disorders caused by surgical trauma.

Bedsore is necrosis (necrosis) of soft tissues as a result of constant pressure, accompanied by local circulatory and nervous trophism disorders.

Anesthesia is an artificially induced reversible state of inhibition of the central nervous system, which causes sleep, loss of consciousness and memory (amnesia), relaxation skeletal muscles, reduction or shutdown of some reflexes, and pain sensitivity disappears (general anesthesia occurs).

Regurgitation is the reverse of the normal direction of rapid movement of liquids or gases that occurs in the hollow muscular organs when they are reduced.

Aspiration is the entry of foreign substances into the airways during inhalation.

Asphyxia is an acutely or subacutely developing and life-threatening pathological condition caused by insufficient gas exchange in the lungs, a sharp decrease in oxygen content in the body and the accumulation of carbon dioxide.

The postoperative period is the period from the end of the operation until the patient’s recovery (or until the patient is discharged from the hospital).

It is customary to divide the postoperative period into three phases:

Early phase (early postoperative period) - up to 3-5 days after surgery.

Late phase (late postoperative period) - 2 - 3 weeks after surgery.

Long-term phase - 3 weeks - 3 months after surgery.

1 Transporting the patient from the operating room to the ward

The patient is transported from the operating room on a gurney to the recovery room, or to the intensive care unit. In this case, the patient can be taken out of the operating room only with restored spontaneous breathing. The anesthesiologist must accompany the patient to the intensive care unit or post-anesthesia ward along with at least two nurses.

During transportation of the patient, it is necessary to monitor the position of catheters, drainages, and dressings. Careless handling of the patient can lead to loss of drains, removal of the postoperative dressing, and accidental removal of the endotracheal tube. The anesthesiologist must be prepared for respiratory distress during transport. For this purpose, the team transporting the patient must have a manual breathing apparatus (or an Ambu bag) with them.

During transportation, intravenous infusion therapy may be carried out (continued), but in most cases, during transportation, the system for intravenous drip administration of solutions is closed

2 Arrangement of the ward

By the time the operation is completed, everything should be ready to receive the patient. The room is ventilated in advance, beds are prepared with clean linen and the sheets are carefully straightened. After surgery, the patient feels best if no one bothers or irritates him. Therefore, in the room where he is located there should be no noise, conversations, or visitors.

The patient in the post-anesthesia period, until complete awakening, should be under constant supervision of medical staff, since in the first hours after surgery, complications associated with anesthesia are most likely:

2. Complications associated with anesthesia

Tongue retraction

Violation of thermoregulation.

Heart rhythm disturbance.

1 Tongue retraction

In a patient still in a narcotic sleep, the muscles of the face, tongue and body are relaxed. A relaxed tongue can move down and close the airway. Timely restoration of airway patency is necessary by introducing an airway tube, or by tilting the head back and moving the lower jaw.

It should be remembered that after anesthesia the patient must be constantly under the supervision of the medical staff on duty until complete awakening.

2 Vomiting in the post-anesthesia period

The danger of vomiting in the postoperative period is due to the possibility of vomit flowing into the oral cavity and then into the respiratory tract (regurgitation and aspiration of vomit). If the patient is in a narcotic sleep, this can lead to his death from asphyxia. If an unconscious patient is vomiting, it is necessary to turn his head to the side and clear the oral cavity of vomit.

In the recovery room there should be an electric aspirator ready for use, which is used to remove vomit from the oral cavity or from the respiratory tract during laryngoscopy. Vomit can also be removed from the mouth using a gauze pad on a forceps. If vomiting develops in a conscious patient, it is necessary to help him by giving him a basin and supporting his head above the basin. In case of repeated vomiting, it is recommended to administer Cerucal (metoclopramide) to the patient. Disturbances in the rhythm of cardiac activity and breathing until they stop occur more often in older people and infants. Respiratory cessation is also possible due to recurarization - repeated late relaxation of the respiratory muscles after muscle relaxation during endotracheal anesthesia. In such cases, it is necessary to be prepared to carry out resuscitation measures and have breathing equipment at the ready.

3 Violation of thermoregulation

Violation of thermoregulation after anesthesia can be expressed in a sharp increase or decrease in body temperature, severe chills. If necessary, it is necessary to cover the patient, or, conversely, to create conditions for improved cooling of his body.

For high hyperthermia, intramuscular injection of analgin with papaverine and diphenhydramine is used. If even after the administration of the lytic mixture the body temperature does not decrease, use physical cooling of the body by rubbing with alcohol. As hyperthermia progresses, ganglion blockers (pentamine or benzohexonium) are administered intramuscularly.

If there is a significant decrease in body temperature (below 36.0 - 35.5 degrees), warming the patient’s body and limbs with warm heating pads can be used.

3. Fighting pain in the postoperative period

Modern methods of anesthesia make it possible to prevent dangerous consequences pain due to injuries, surgical diseases and during surgical operations.

4. Caring for a seriously ill postoperative patient

The operated patient cannot take care of himself on the first day; in addition, for fear of complications, he tries to move as little as possible in bed and stops performing personal hygiene. The task of the medical worker is to surround the patient with attention and care, provide him with careful care and at the same time force the patient, in cases where necessary, to actively participate in the prevention of complications and the fight against them. The most severe complications, depending on poor care, are inflammation in the oral cavity (stomatitis), mumps, bedsores, inflammation and diaper rash in the perineum and natural folds of the body.

Oral care. After most operations, the patient suffers from dry mouth and thirst. It is not recommended to give the patient anything to drink immediately after surgery due to possible vomiting Therefore, to relieve the severe feeling of dryness, patients are allowed to rinse their mouths with water; more severe patients wipe their teeth, gums, and tongue with a cotton swab moistened with water. In case of severe dryness, reaching the point of cracking of the lips, tongue, or oral mucosa, they are re-lubricated with petroleum jelly. During some operations, eating by mouth is not allowed for several days; in these cases, it is necessary to sanitize the oral cavity with weak antiseptic solutions (solution of soda, rivanol, potassium permanganate, etc.). In addition, the patient must brush his teeth daily with a brush tooth powder or paste. An important prevention of purulent mumps (inflammation of the parotid gland) is to stimulate the secretion of the gland, achieved by wiping and rinsing the mouth with water with the addition of lemon juice or intensively chewing pieces of rubber or the crust of black bread.

Skin care. The patient's skin should be kept clean; accidentally contaminated areas of the skin should be washed and wiped. Be sure to wash your face and wash your hands repeatedly. Particular care must be taken to monitor the condition of the skin of those surfaces of the body on which the patient lies, in order to prevent bedsores. For the same purpose, all patients with strict bed rest and who are unable to turn independently in bed at least 2 times a day need to wipe their back (massage) with camphor alcohol. Places highest pressure need to be inspected and cleaned even more often. Of great importance in the prevention of bedsores is placing the patient on inflatable rubber rings, changing the patient’s position in the bed: turning on one side or the other (with the doctor’s permission). At the first sign of bedsores, suspicious areas should be tamed concentrated solution potassium permanganate. Tanning with a manganese solution is repeated several times a day. Usually, a combination of all these measures allows you to eliminate incipient bedsores. Developed bedsores are treated by smearing with tincture of iodine, applying an adhesive bandage, bandages with sulfidine and other emulsions. Ultraviolet irradiation has a good effect. In obese patients, diaper rash often occurs in places of natural folds (navel, inguinal and axillary areas, in women - under the mammary glands). Prevention of this complication is achieved by wiping the affected areas with petroleum jelly or dusting with talcum powder.

Caring for the perineal area. Constant contamination of the skin of the perineum can cause the development of a number of complications (pustular skin diseases, inflammation of the urinary tract, external genitalia). Therefore, after defecation, hygienic treatment of the perineum should be carried out. Place a vessel under the patient and, pouring boiled water or a weak solution of manganese over the perineum, treat the perineum using a cotton swab and then wipe it dry. In women, hygienic washing of the perineum should also be carried out daily at night. If redness appears, the perineum is powdered with talcum powder or lubricated with petroleum jelly.

5. Prevention of postoperative complications

Prevention of pulmonary complications. In many ways, the prevention of these complications depends on the ability to give the patient a semi-sitting position, when ventilation and blood circulation in the lungs improve. In a sitting position, it is easier for the patient to cough and remove secretions and phlegm accumulated in the bronchi. Relieving pain with drugs, giving cardiac medications and drugs that facilitate sputum production are an important point in the prevention of pneumonia (1 ml of a 10% caffeine solution, 3 ml of a 20% camphor solution 3 times a day, 2 ml of cordiamine 3 times a day). Much depends on the patient’s activity. The nurse’s task is to teach the patient breathing exercises - to periodically (hourly) take 10-15 maximum possible breaths, cough regularly, sometimes overcoming the pain. From the next day after surgery, circular cups or mustard plasters are of great importance in the prevention of pneumonia. The cups are placed on both the front and back surfaces of the chest, sequentially, sometimes in three steps, turning the patient on one side or the other. According to indications from for preventive purposes Penicillin therapy is also carried out.

1 Fighting hyperthermia

After some surgical interventions, on the first day there is sharp increase body temperature (surgeries on the nervous system, under conditions of hypothermia, etc.). An increase in temperature sharply worsens the patient's condition. Reducing the temperature and reducing the discomfort that arises in this case is achieved by applying ice packs to the head or area of ​​​​the operation, or applying cold compresses to the forehead. For persistent increases in temperature, it is possible to use antipyretics: aspirin, pyramidon, antipyrine, etc. The most effective is intramuscular injection of 5-10 ml of a 4% solution of pyramidon.

2 Combating gastrointestinal paresis

Intestinal bloating (flatulence) sometimes worsens the condition so much that the most drastic measures are required to eliminate it. It is very common to insert a gas outlet tube, which temporarily eliminates spasm of the rectal sphincter and facilitates the passage of gases. The intestines are better relieved of gases after a hypertensive enema: 100 ml of 5% solution table salt inserted into the rectum using a rubber bulb. Usually, after a few minutes, the enema causes stool and profuse passing of gas. Sometimes a hypertensive enema is combined with the administration of drugs that stimulate peristalsis (1-2 ml of a 0.05% solution of proserin under the skin, up to 50 ml of a 10% solution of table salt intravenously). For severe paresis, a perinephric blockade and a siphon enema are performed (see above). Intestinal paresis is accompanied by atony of the stomach and a sharp expansion of its gases. In these cases, relief of the patient's condition can be achieved by inserting a thin probe into the stomach (through the nose) and pumping out gases and stomach contents with a Janet syringe. Sometimes this is supplemented by gastric lavage with warm water through the same tube. In case of uncontrollable vomiting, the probe is left for a long time for constant suction.

3 Fighting urinary retention

If 10-12 hours after the operation the patient cannot urinate on his own, then it is necessary to carry out a number of measures aimed at achieving independent urination. After simple operations, a patient can be allowed to get up, since some patients cannot urinate while lying down, or taken on a gurney to the restroom. Patients who cannot stand should be allowed to turn on their side or be given a semi-sitting position. Sometimes applying a heating pad to the perineum, cleansing enema eliminate urinary retention.

4 Prevention of bedsores

Use a functional bed.

Use an anti-decubitus mattress or a Clinitron bed.

Inspect the skin daily in areas possible education bedsores: sacrum, heels, back of the head, shoulder blades, inner surface of the knee joints, areas of the greater trochanter of the femur, ankles, etc.

Place rollers or foam pads in cotton (cotton) covers under areas of prolonged pressure.

Use only cotton underwear and bed linen. Straighten wrinkles in laundry, shake off crumbs.

Change the patient's position in bed every two hours.

Move the patient carefully, avoiding friction and tissue movement, by lifting the patient off the bed or using a padded sheet.

Do not allow the patient to lie directly on the greater trochanter in the lateral decubitus position.

Wash your skin daily with water and liquid soap, thoroughly rinse off the soap and dry your skin with a soft towel using blotting movements.

When performing a general massage, lubricate the skin generously with moisturizer.

Carry out a light skin massage with Solcoseryl ointment in places where it turns pale.

Use waterproof diapers and nappies that reduce excessive skin moisture.

Maximize patient activity.

Teach the patient and relatives how to care for their skin.

Monitor the patient’s adequate nutrition: the diet should contain at least 120 g of protein and 500-1000 mg of ascorbic acid per day. 10g of protein is contained in 40g of cheese, in one chicken egg, 55g of chicken meat, 50g of low-fat cottage cheese, 60g of raba.

6. Nutrition of the patient

The patient's body loses a significant amount of fluid both during the operation (blood loss) and shortly after it (sweating, vomiting after ether anesthesia). As a result of this, the patient's body becomes dehydrated, and in the postoperative period the missing amount of fluid must first be replenished. Dehydration of the patient's body often results in painful thirst. After operations under local anesthesia, thirst can be satisfied by giving the patient water, warm or cold tea, mineral water, tea with lemon, cranberry juice. But this can only be done if the operation was not on the stomach. In the latter case, the patient is usually not allowed to drink on the first day. If it is impossible to administer fluid through the mouth, the missing amount (1-2 liters per day) should be administered in another way. It is possible, if the operation was not on the lower segment of the intestine, to introduce liquid in the form of a saline solution through the intestines (saline enemas of 100 ml of solution every 2-3 hours or drip enema of 500 ml 1-2 times a day). Often, in the first days after surgery, saline solution is injected under the skin or into a vein, 500-600 ml 2 times a day. When administering saline and glucose intravenously, large amounts of liquid are used, sometimes up to 2-3 liters or more.

7. Recovery period

The postoperative period is followed by a period of recovery, when the patient leaves the hospital, but cannot yet be considered fully recovered. During this period, the patient, weakened by surgery and prolonged lying down, must beware of all those harmful influences which can easily cause any disease. More than usual, he must beware of cold, overwork, must be careful in food and avoid lifting heavy objects, especially after abdominal operations, since the scar may stretch and a postoperative hernia may form. It is advisable that in the immediate postoperative period (3-4 weeks) the patient remains under medical supervision.

8. Role of medical personnel

The main tasks of medical staff in the postoperative period are:

Preventing the occurrence of postoperative complications is the main task, for which you should:

recognize a postoperative complication in time;

provide patient care by a doctor, nurses, orderlies (pain relief, provision of vital functions, dressings, strict implementation of medical prescriptions);

provide adequate first aid in a timely manner in case of complications.

An experienced, observant nurse is the doctor’s closest assistant; the success of treatment often depends on her.

Depending on the general condition of the person being operated on, the type of anesthesia, and the characteristics of the operation, the ward nurse ensures the desired position of the patient in bed (raises the foot or head end of a functional bed; if the bed is an ordinary one, then takes care of the headrest, bolster under the legs, etc.)

The room where the patient is admitted from the operating room must be ventilated and clean. Bright light not allowed in the ward. The bed must be placed in such a way that it is possible to approach the patient from all sides. These requirements are fulfilled by junior medical personnel.

Conclusion

Thus, the postoperative period is very important for the patient’s recovery. During this period, the patient is at risk of complications. There are many measures to create maximum peace for the patient. Of great importance are measures to eliminate pain both during operations and in the postoperative period, and during other manipulations, as well as attention to the mental state of the patient, his well-being, and experiences (mental prevention). All this creates a protective treatment regimen for patients.

Bibliography

1.Kolb L.I., Leonovich S.I., Yaromich I.V. General surgery. - Minsk: Higher school, 2008.

2.Evseev M. A. “Patient care in a surgical clinic” Publisher: GEOTAR-Media, 2010

.Gritsuk I.R. Surgery. - Minsk: New Knowledge LLC, 2004.

.Dmitrieva Z.V., Koshelev A.A., Teplova A.I. Surgery with the basics of resuscitation. - St. Petersburg: Parity, 2002.

.Dvoinikov S.I. Fundamentals of Nursing. M.: Medicine, 2005

FEATURES OF POSTOPERATIVE CARE

Care for surgical dental patients in the postoperative period is distinguished by a number of features due to the nature of pathological process, the complexity of the topographic-anatomical and functional relationships of the organs of the oral cavity and the tissues of the maxillofacial region.

To restore functional balance in the body, disturbed by the operation, bed rest is prescribed, the duration of which depends on the patient’s condition. Sometimes, in the first hours after surgery, vomiting occurs due to ingestion into the stomach during surgery. significant amount blood or using general anesthesia (endotracheal anesthesia). To prevent aspiration of vomit in the ward, the patient should lie in bed without a pillow with his head turned to one side. To protect the wound from contamination during vomiting, the bandage is covered with oilcloth. After vomiting, the contents of the oral cavity should be removed. In the coming days after surgery, bronchopulmonary complications may occur in the form of aspiration and hypostatic pneumonia. To prevent such complications, it is recommended to give patients a semi-sitting position, perform breathing exercises several times a day (5-10 deep inhalations and exhalations every hour), and turn them from side to side.

Special care involves keeping the mouth clean. After operations on the oral cavity and jaws, the self-cleaning ability of the oral cavity is significantly reduced. Food debris and blood clots are retained in the vestibule of the mouth, in the interdental spaces, etc. The basis of special care in the first days after surgery is thorough cleaning of the oral cavity from blood clots, mucus, food debris, which are a favorable environment for the proliferation and development of putrefactive microbes - one of the causes of inflammatory complications. This is achieved by rinsing the mouth with a stream of warm (37-38°C) 0.01-0.1% solution of potassium permanganate, which has a deodorizing effect and eliminates the unpleasant putrid odor from the mouth for some time. For these purposes, you can use a solution of furatsilin 1: 5000, 1-2% sodium bicarbonate solution. For moderately ill and seriously ill patients, the oral cavity is washed 3-4 times a day. The patient sits with his head tilted over the basin or lies with his head turned to the side, with a tray placed under the corner of his mouth (Fig. 3).

Usually they use an Esmarch mug filled with disinfectant solution and raised to a height of 1 m above the patient’s head. A sterile glass tip, placed on the end of a rubber tube, is inserted into the mouth and a stream of liquid thoroughly rinses the vestibule of the mouth and through the defect in the dentition - its cavity. During rinsing, the patient is asked to exhale, and during a break, inhale. Walking patients wash the oral cavity themselves in irrigation rooms (Fig. 4).

Glass tips are usually kept in a jar of disinfectant solution at the patient's bedside.

After operations in the oral cavity, there is an increased secretion of saliva, which fills the oral cavity. If swallowing movements are disturbed, then saliva flows out of the mouth in large quantities and gets onto clothes, moisturizes and contaminates the chest, macerates the skin, and contributes to the development of bronchopulmonary complications. To avoid this, patients are given a semi-sitting position and special saliva collectors made of polyethylene or other material are suspended under the chin. To prevent maceration, the skin of the cheeks is lubricated with Vaseline or zinc ointment.

Postoperative period- time from the end of the operation until the patient recovers or is transferred to disability. During this period of time, the patient needs maximum attention from the staff and good care.
The postoperative period is divided into three phases:
- early - ranges from 3 to 5 days;
- late - up to 2-3 weeks:
- remote - continues until the restoration of working capacity or the occurrence of permanent disability.
It is in the early postoperative period that all the effects of surgery and disease on the patient’s body become apparent. This is, first of all:
- psychological stress:
- impact of surgical trauma:
- consequences of anesthesia:
- pain in the area of ​​the postoperative wound;
- forced position of the patient;
- change in the nature of nutrition.
When examining the issues of pathophysiology of the postoperative period, it should be emphasized that the disease and surgery in their entirety are a serious test for the patient’s body, changing the functioning of its organs and systems, causing changes in blood circulation and metabolism. For example, impaired water metabolism in the postoperative period is in some cases aggravated by irrational preoperative preparation. Increased loss of water by the body leads to dehydration, blood thickening, and dystrophic disorders.
Surgical trauma leads to depletion of the body’s protein resources, which is observed primarily due to an increase in its energy consumption during the operation and during preoperative period, as well as due to blood loss during the intervention. In operated patients, as a rule, a combination of disorders of several types of metabolism is observed, and vitamin metabolism and hematopoiesis always suffer (a sharp increase in the number of leukocytes, a decrease in the number of erythrocytes, a decrease in the number of platelets, a decrease in blood clotting).
Compensation for dysfunction of various organs and systems in the postoperative period is achieved by the following measures:
- intravenous administration of glucose to combat acidosis in combination with insulin, sodium bicarbonate solution;
- after restoration of gastrointestinal motility - prescribing a sufficient amount of liquid for oral administration (boiled and/or mineral water, sweet tea, 5% glucose, Ringer's solution, saline solution);
- during protein starvation - administration of increased amounts of proteins with food, repeated transfusions of plasma, blood, protein, protein hydrolysates;
- sufficient introduction of vitamins into the body.
The main goal of the early postoperative period is the need to promote the processes of regeneration and adaptation of the body in connection with the newly emerged conditions of existence of the body as a whole. It is necessary to take care of maintaining (restoring) impaired body functions, to prevent and treat complications.

24.1. Classification of postoperative complications

The early postoperative period can proceed either without complications (uncomplicated course) or with complications (complicated course):
- early complications, as a rule, develop in the first 7 days after surgery;
- late complications - develop later than 7 days and even after different periods after the patient is discharged from the hospital.
In the uncomplicated course of the early postoperative period, the resulting reactive changes are moderately expressed and last 2-3 days. The patient's body temperature remains within 37.0-37.5 °C. The patient may have some inhibition on the part of the central nervous system, and blood viscosity increases. When providing care during this period, it is necessary to monitor the functional state of the main body systems and take measures aimed at preventing possible complications.
The following complications occur on the part of the postoperative wound.
- bleeding from the wound;
- suppuration of the wound;
- eventration;
- postoperative hernias;
- ligature fistulas.
From the side of the operated organ (anatomical area):
- failure of anastomotic sutures (stomach, intestines, bronchus, etc.);
- bleeding:
- formation of strictures, cysts, fistulas (internal or external);
- paresis and paralysis;
- purulent complications (abscesses, phlegmon, peritonitis, pleural empyema, etc.).
From the cardiovascular system:
- acute coronary insufficiency;
- acute myocardial infarction;
- thrombosis and thrombophlebtitis;
- TELA.
From the central nervous system:
- acute disorder cerebrovascular accident (stroke);
- paresis and paralysis caused by injury to the central nervous system;
It also happens quite often:
- acute renal, liver failure;
- pneumonia.
Postoperative complications can be presented in the following diagram (Fig. 194).
Patient care must begin immediately after the end of the operation, i.e. on the operating table. If the operation was performed under anesthesia, then it is necessary to make sure that the patient is breathing well and his airways are clear. Permission for transportation is given by the anesthesiologist. With local anesthesia, the patient is moved onto a gurney after the operation independently or with the help of staff, after which he is transported to the postoperative ward or to a ward in the surgical department (depending on the volume of the operation and the patient’s condition; the anesthesiologist decides).
The patient's bed should be prepared upon his arrival from the operating room:
- laid with fresh linen;
- heated by heating pads;
- there should be no folds on the sheets.
The nurse must know what position the patient should be in after surgery. Patients usually lie on their back. Sometimes after surgery on the abdominal and thoracic cavities, patients lie in the Fowler's position (a semi-sitting position on the back with the limbs bent at the knee joints).

Patients operated on under anesthesia are transported to the intensive care unit on a bed in the same department. Transfer from the operating table to a functional bed is carried out under the supervision of an anesthesiologist. The unconscious patient is carefully lifted from the operating table and placed on the bed, while sharp flexion of the spine (possible dislocation of the vertebrae) and hanging limbs (possible dislocation) should be avoided. It is also necessary to ensure that the bandage from the postoperative wound is not torn off and that the drainage tubes are not removed. At the time of transferring the patient to the bed and during transportation, signs of respiratory and cardiac dysfunction may occur, so the accompaniment of an anesthesiologist and nurse anesthetist is mandatory. Until the patient regains consciousness, he is laid horizontally, with his head turned to the side (prevention of aspiration of gastric contents into the bronchi is necessary - the nurse must be able to use an electric suction to help the patient with vomiting). The patient is covered with a warm blanket.
To better supply the body with oxygen through special device humidified oxygen is supplied. To reduce bleeding of the operated tissue, an ice pack or a load (usually a sealed oilcloth bag with sand) is placed on the wound area for two hours. Drainage tubes are attached to the system to collect the contents of a wound or cavity.
In the first two hours, the patient is in a horizontal position on his back or with the head end down, since in this position the blood supply to the brain is better ensured. During operations under spinal anesthesia horizontal position is maintained for 4-6 hours due to the risk of development orthostatic hypotension. After the patient regains consciousness, a pillow is placed under his head, and his hips and knees are raised to reduce blood stagnation in the calf muscles (prevention of thrombosis).
The optimal position in bed after surgery may vary, depending on the nature and area of ​​surgery. For example, patients who have undergone surgery on the abdominal organs, after they regain consciousness, are placed in bed with their heads slightly raised and legs slightly bent at the knees and hip joints.
A long stay of the patient in bed is undesirable due to the high risk of complications caused by physical inactivity. Therefore, all factors that deprive him of mobility (drains, long-term intravenous infusions) must be taken into account in time. This is especially true for elderly and senile patients.
There are no clear criteria determining the timing of a patient getting out of bed. Most are allowed to get up 2-3 days after surgery, but implementation modern technologies changes a lot in medical practice. After laparoscopic cholecystectomy, you are allowed to get up within a few hours, and many patients are discharged for outpatient treatment the very next day. Getting up early increases confidence in a favorable outcome of the operation, reduces the frequency and severity of postoperative complications, especially respiratory and deep vein thrombosis.
Even before surgery, it is necessary to teach the patient the rules of getting out of bed. In the evening or the next morning, the patient should sit on the edge of the bed, clear his throat, move his legs, and in bed he should change his body position as often as possible and make active movements with his legs. First, the patient is turned on his side, on the side of the surgical wound, with his hips and knees bent, with his knees on the edge of the bed; the doctor or nurse helps the patient sit down. Then, after taking several deep breaths and exhalations, the patient clears his throat, stands on the floor, taking 10-12 steps around the bed, and goes back to bed. If the patient’s condition does not worsen, then he should become more active in accordance with his own feelings and the doctor’s instructions.
Sitting in bed or a chair is not recommended due to the risk of slowing venous blood flow and the occurrence of thrombosis in the deep veins of the lower extremities, which in turn can cause sudden death due to blood clot rupture and thromboembolism pulmonary artery. To timely identify this complication, it is necessary to measure the circumference of the limb daily and palpate the calf muscles in the projection of the neurovascular bundle. The appearance of signs of deep vein thrombosis (swelling, bluishness of the skin, increased volume of the limb) is an indication for special diagnostic methods (ultrasound Dopplerography, venography). Deep vein thrombosis occurs especially often after traumatological and orthopedic operations, as well as in patients with obesity, cancer, and diabetes. Reducing the risk of thrombosis in the postoperative period is facilitated by the restoration of impaired water and electrolyte metabolism, prophylactic use anticoagulants direct action(heparin and its derivatives), early activation of the patient, bandaging of the lower extremities elastic bandages before surgery and in the first 10-12 days after it.

24.2. Care and monitoring of postoperative wounds

Care of surgical wounds is an important part of overall care. With a favorable course of the postoperative period, patients complain of pain in the wound immediately after surgery, then their intensity gradually decreases, and by 3-5 days the pain, as a rule, ceases to bother the patient. To reduce pain and prevent bleeding from small vessels, an ice pack is applied to the wound in the first two hours after surgery.
Bleeding is one of the leading signs of any wound. If the wound is sutured tightly and there is no bleeding, the bandage remains dry. If the dressing is slightly wetted by sanguineous discharge, it is necessary to change only its upper layers. In the first 24 hours, external bleeding from the wound is possible (the bandage becomes very wet with blood, and it must be changed not only from a hygienic, but also from a diagnostic point of view).

Attention! If the bandage quickly gets wet with blood, it is necessary to call a doctor and take the patient to the dressing room.

For timely detection of bleeding, it is necessary to constantly monitor hemodynamic parameters:
- pulse;
- blood pressure;
- red blood indicators.
Bleeding after surgery is often of three types:
- externally, when blood enters the surgical wound, the bandage gets wet,
- internal bleeding when blood enters the internal cavities body;
- bleeding through the drainage if it is left in the wound.
In cases where drains and tampons are left in the wound, the bandage, as a rule, becomes saturated with bloody contents (the patient should be aware of this). For patients with drainages (Fig. 195), the nurse should prepare and bring containers to the bed to collect the discharge. In order not to contaminate the linen and bed, an oilcloth is placed on the mattress, and a diaper is placed on the bandage. The drainage tube is either lowered into a vessel containing a small amount of antiseptic solution (passive drainage) or connected to a suction system (active drainage), which creates negative pressure. To prevent the drain from falling out, it is fixed to the skin with sutures or strips of adhesive tape.

When the discharge enters a container (graduated glass container) through the drains, the quantity and nature of the discharge are measured, recording the results in the medical history. If the discharge of exudate ceases, it is necessary to inform the attending surgeon, who identifies the cause (kinked tube, blockage with mucus, pus, fibrin, lack of exudate) and eliminates it (straightening, washing the tube. Fig. 195. Drainage, suction of contents).

Attention! Under no circumstances should you attempt to blindly insert dropped drains, as this may create a false passage and cause damage. internal organs with internal bleeding.

In the dressing room (medical staff must wear rubber gloves), the patient carefully removes the contaminated bandage. Gauze pads stuck to the wound should be carefully removed, after moistening them with an antiseptic solution (3% hydrogen peroxide solution, 0.5% chlorhexidine solution). The used material is dumped into a plastic bag. After examining the wound, the skin is treated with an antiseptic solution (iodonate, chlorhexidine, etc.), the wound is covered with sterile napkins and secured with cleol or a circular bandage.
Before removing the tampons, the patient is given an anesthetic (analgin, promedol) 30-40 minutes before the procedure. Tampons, as a rule, are removed in several stages: first they are tightened, and after 1-2 days they are removed.
In the first 3-5 days after surgery, purulent complications from the surgical wound may develop. Suppuration of the wound is promoted by:
- failure to comply with aseptic rules during surgery;
- rough handling of tissues during surgery;
- accumulation of serous fluid or blood in the subcutaneous fatty tissue;
- decreased immunity.
Inflammatory complications are manifested by increased body temperature, signs of intoxication, and local signs of inflammation from the wound (redness, swelling, pain). It is necessary to perform an inspection of the wound. To do this, the surgeon in the dressing room removes the bandage, removes one or two sutures from the skin, separates the edges of the wound, and removes the purulent contents. The cavity is treated with a 3% solution of hydrogen peroxide, after which a bandage is applied with a hypertonic solution of table salt or an antiseptic solution (3% boric acid solution, 1% dioxidine solution, chlorhexidine digluconate solution, etc.). The pus is sent to a bacteriological laboratory to determine the growth of microorganisms and their sensitivity to antibiotics. The wound then heals by secondary intention.

In the first 7 days after surgery on the abdominal organs, divergence of the edges of the abdominal wall wound (eventration) is possible. The bandage suddenly becomes wet and a large amount of fluid is released orange color, sometimes intestinal loops fall out. Eventration is observed in patients who have undergone major surgery. The development of complications is promoted by:
- deficiency of vitamins C and group B;
- hypoproteinemia;
- bloating;
- tension in the abdominal wall with a strong cough;
- suppuration of a postoperative wound.
The main method of treatment is surgical. The prolapsed intestinal loops are repositioned and the wound is sutured. After surgery, patients observe strict bed rest for 5-7 days. To reduce tension in the abdominal wall, it is necessary to wear a bandage (Fig. 196) or tight bandaging.
When removing (removing) sutures from the surgical wound (Fig. 197), sterile gloves are put on, and the patient is placed on the table in a horizontal position. The wound is treated with an antiseptic solution. Using sterile tweezers, grab the ends of the threads and move them until an uncolored (white) area appears. At this level, the thread is cut with sterile scissors and removed. In some cases, one stitch is removed first, and the rest the next day. The wound is treated with an antiseptic solution and covered with a sterile napkin for 24 hours (Fig. 198).
From the second day, sutured wounds on the face and head are treated using the bandage-free method.

Bandaging algorithm

Target:
- stopping bleeding;
- preventing infection:
- wound healing.
Desired results:
- wound healing by primary intention;
- wound healing within 7-10 days;
- absence of neurovascular disorders;
- patient comfort.
Preparation for the procedure:
- introduce yourself to the patient, tell him about the purpose and progress of the procedure;


- help the patient undress and ask him to take a comfortable position on the dressing table or chair;
- wear gloves.
Performing the manipulation:

- remove all 3 layers of the bandage one by one in the direction from one edge of the wound to the other (pulling across the wound increases its gaping and causes pain); when removing the bandage, the skin should be held with a gauze ball or tweezers, not allowing it to reach for the bandage. The dried bandage should be peeled off with a ball soaked in a 3% solution of hydrogen peroxide (sometimes it is better to remove the dried bandage after soaking, if the condition of the wound allows the use of a bath of a warm solution of potassium permanganate 1: 3000);

- remove gloves, treat hands with antiseptic;


- treat the skin surrounding the wound with sterile gauze balls, changing them after each movement and moving the swab from the least contaminated area to the most contaminated and from the center to the outer part, first dry, then moistened with disinfectant solutions (ethyl alcohol 70%), the edges of the wound are lubricated with 5% iodine solution or 1% brilliant green solution;




Ending the procedure:


- wash and dry your hands (using soap or antiseptic);



- dressing in case of violation of the integrity of the skin is carried out at least every two days;
- dressing can be carried out not in the dressing room, but directly at the patient’s bedside in the ward, for medical reasons, subject to the rules of asepsis and antiseptics (the use of a mobile manipulation table is mandatory). Within 15-30 minutes after dressing, inspect the applied bandage to avoid bleeding and keep it dry, and also make sure that the fixation is secure.

Bandaging algorithm for purulent diseases skin and subcutaneous tissue

Preparation for the procedure:
- obtain informed consent from the patient, tell him about the purpose and course of the procedure;
- wash and dry your hands (using soap or antiseptic);
- put on signets;
- prepare everything necessary for dressing;
- help the patient undress and ask him to take a comfortable position on the dressing table or chair;
- place oilcloth under the dressing area;
- wear glasses, protective clothing (apron, mask).
Performing the manipulation:
- remove the fixing bandage (plaster or cleol napkin, bandage) using Richter scissors;
- remove all 3 layers of the bandage one by one in the direction from one edge of the wound to the other (traction across the wound increases its gaping and causes pain); when removing the bandage, the skin should be held with a gauze ball or tweezers, not allowing it to reach for the bandage. A dried bandage should be peeled off with a ball soaked in a 3% solution of hydrogen peroxide (sometimes it is better to remove dried bandages after soaking, if the condition of the wound allows the use of a bath of a warm solution of potassium permanganate 1: 3000);
- place the used material in a container for disinfection;


- wear sterile gloves;
- examine the wound and the surrounding area (smell, discharge, approaching wound edges, swelling, pain);
- treat the skin surrounding the wound with sterile gauze balls, changing them after each movement and moving the swab from the least contaminated area to the most contaminated and from the center outwards, first with dry, then moistened antiseptic solutions (ethyl alcohol 70%), the edges of the wound are lubricated with 5% iodine solution or 1% brilliant green solution;
- remove accumulated exudate (if any) by blotting with sterile balls or rinsing with a 3% solution of hydrogen peroxide, then dry the wound with dry swabs;
- as prescribed by the doctor, apply ointment or other medicine to the wound with a sterile spatula;
- use tweezers to apply a new sterile bandage in three layers;
- place a napkin cut to the middle under the drainage;
- secure the bandage with a plaster, adhesive bandage or bandage, depending on the location of the wound.
Ending the procedure:
- place used instruments in a container for disinfection;

- take off your glasses, protective clothing (apron or robe, mask) and throw them into a container or bag for collecting laundry;
- wash and dry your hands (using soap or antiseptic);
- inform the patient about the condition of the wound, instruct him on further actions;
- make an appropriate entry about the results of implementation in the medical documentation.
Additional information about the features of the technique:
Dressing for purulent diseases of the skin and subcutaneous tissue is carried out daily. It can be carried out not in a dressing room, but directly at the patient’s bedside in the ward, for medical reasons, subject to the rules of asepsis and antiseptics.

- cleansing the wound from microbial flora;
- stopping the development of the purulent process;
- wound healing by secondary intention, without the formation of keloid scars, skin necrosis, or cosmetic defects.

24.3. Drainage care

Drains after surgery are installed for:
- evacuation of pathological contents (liquid or air);
- control (hemostasis, consistency of anastomotic sutures, aerostasis, etc.);
- introduction of a medicinal solution or aerosol into the cavity.
There are two types of drainage: passive and active.
With passive drainage (Fig. 199), the liquid flows out without suction; with active drainage (Fig. 200), the contents of the wound or cavity are aspirated using devices that create a constant (0.4 atm.) discharge.

life The doctor will change the dressing around the drainage. The guard nurse monitors the drainage and changes the container as it is filled (containers for collecting discharge are fixed to the bed). If there is no discharge through the drainage, it is necessary to check its patency (the drainage may bend, become clogged with a clot, or be crushed by the patient’s body). The medical history records the amount of discharge and its nature (pus, blood, etc.). Once a day, replace the connecting tubes with new ones or wash and disinfect the old ones.

24.3.1. Drainage and wound care

Algorithm of actions

Preparing for the procedure.

- wash and dry your hands (using soap or antiseptic);

- wear gloves.
Performing the manipulation:
- remove the bandage. If its bottom layer has dried to the wound, moisten it with a small amount of sterile solution;
- use sterile tweezers to remove the bottom layer of the dressing, while trying not to disturb the position of the drains;
- assess the amount, nature and smell of discharge from the wound; determine how healing is progressing (bringing the edges of the wound closer together; is there any swelling, severe pain, divergence of the edges of the wound);
- remove gloves and place them and used dressings in a container for disinfection when performing the procedure in the office or in a plastic bag when performing the procedure in the ward;
- treat hands with antiseptic;
- prepare packaging with new dressings (wipes);
- pour a sterile solution for washing the wound into a container for solutions;
- wear sterile gloves;
- clean the wound with a tampon soaked in hydrogen peroxide, changing them after each movement and moving the tampons from the least contaminated area to the most contaminated one, moving from the center outwards. Wash the area around the drainage also from the center to the outer part, and then in a circular motion when the wound is clean. To support the drainage in a vertical position, you need to use a clamp. Remove the sutures if the drainage is in the wound underneath them;
- grab the drainage with a clamp along its entire width at the skin level and pull it out to the required length (if it is necessary to remove all the drainage, carefully pull it until it completely comes out of the wound, place it in a container for used material);
- dry the wound with sterile wipes;
- as prescribed by the doctor, apply ointment or other medicine to the wound with a sterile spatula;
- apply a sterile bandage in layers under the drainage or around it;
- secure the sterile bandage on top with a plaster or bandage. Ending the procedure:
- remove gloves and place them in a container for disinfection;
- wash and dry your hands (using soap or antiseptic);


Achieved results and their evaluation:
- the patient is able to breathe independently, which is expressed in smooth, undifficult breathing and respiratory rate indicators that are within the normal range for the patient;
- the patient has a restoration of lung volume - breathing sounds are heard in all lobes:

The patient does not feel pain, is able to perform hygienic procedures, and is active;
- healing of the surgical wound and restoration of functions are noted.

24.3.2. Chest drainage care

Algorithm of actions:

Preparation for the procedure:
- Explain to the patient the purpose and course of the procedure. Obtain informed consent;
- wash and dry your hands (using soap or antiseptic);
- prepare the necessary equipment and equipment;
- wear gloves.
Performing the procedure:
- remove the bandage around the drainage, place it in a container for waste material;
- treat the skin with an antiseptic around the drainage;
- apply a sterile bandage around the drainage, secure with a plaster or adhesive bandage;
- observe the hydraulic tank for the appearance of bubbles. If bubbles are observed and the patient does not have a pneumothorax, an air leak may be suspected. It is also likely if the presence of bubbles is noted and the chest tube is compressed, or if there are an excessive number of bubbles. Check pipe connections;
- every 1-2 hours (depending on the volume of drained fluid or on doctor’s prescriptions) it is necessary:
- note the volume of drained liquid in the container,
- check the drainage system for bubbles in the suction control compartment,
-check for vibrations in the hydraulic tank when breathing;
- when slowing down or stopping drainage, find out the rules adopted in the institution and, if permitted, carefully perform the “squeezing” procedure (or, as a last resort, squeeze the tube and forcefully move it along it, if this is not prohibited).
Milking;
- take the tube next to the chest and squeeze it between your fingers and the palm of your hand;
- take the tube a little lower with your other hand and squeeze it;
- release the first hand and move it to the next section of the tube;
- continue in this manner until the container for the drained liquid.
Sliding collapsing:
- apply lubricant to the fingers of one hand and squeeze the tube with the fingers of the other hand;
- squeeze the tube below the clamped part with lubricated fingers and slide them down the tube towards the drainage system.
- slowly release the tube with unlubricated fingers, then with lubricated ones;
- repeat once or twice. Tell your doctor if you are unable to remove clots from the tube. Emphasize on possible development pneumothorax, hemothorax;
- monitor every 2 hours (or more often if changes are observed);
- bandage, for the integrity of the bandage, the volume and type of contamination;
- sounds of breathing.
- measure the main indicators of the body’s condition and temperature every 2-4 hours.
Ending the procedure:
- remove gloves and place them in a container for disinfection;
- wash and dry your hands (using soap or antiseptic);
- give the patient a comfortable position; the call button must be within reach;
- make an appropriate entry about the results of implementation in the medical documentation.

24.3.3. Caring for drains in the urology department

When preparing the bed, attention should be paid to ensuring protection from secretions and ensuring the outflow of secretions from drains and catheters into drainage receivers suspended from the bed - plastic vessels tightly closed with a stopper in which there is a hole corresponding to the caliber of the tube connected to the drainage or catheter by adapter tubes (Fig. 201-203).

Before immersing the drainage, 50-100 ml of a slightly colored solution of furatsilin is poured into the urinal bag, which has an antiseptic effect and also helps eliminate the smell of urine.
When laying down the operated patient, it is necessary to take care of the drains: they must be firmly fixed with a bandage, correctly immersed in the urinal (without bending to a certain depth, without resting on the walls or bottom of the vessel) (Fig. 204).
A characteristic phenomenon for urological interventions is leakage of urine around drains. Therefore, frequent changes of dressings are required as they get wet. Bandages are applied without cotton wool, since the latter, absorbing urine, becomes a source of unpleasant odor and maceration of the skin.
In case of heavy discharge, the skin should be lubricated with Vaseline and Lassara paste (Fig. 205). The bandage, which consists of several layers of gauze, is cut at the edge according to the drainage and placed on top in the form of panties.
The second layer of the bandage is also cut and placed from below so that the drains are in the center of the bandage. A sticker with holes for drainage is placed on top. The drains are tied with a gauze band at the exit of the wound, then the band is tied around the abdomen, the drainage is sometimes fixed with an adhesive plaster.
After surgery on the testicle and spermatic cord, a suspensor is put on the scrotum, which is either purchased at a pharmacy or made by a sister from gauze folded in several layers. Ribbons are sewn to the ends of the sewn jockstrap and tied to a bandage belt. A hole for the penis is made in the triangular platform of the suspensor.
Monitoring the functioning of drains is of great importance in caring for urological patients. It is important to notice in time the cessation of outflow through the drainage - it may be caused by the catheter falling out or kinking. An alarming signal is the appearance of fresh blood and clots in the discharge.
As prescribed by the doctor, the bladder is washed through a catheter inserted into the fistula or urethra. To do this, use a Zhanne syringe. 10 ml of the solution prescribed by the doctor is carefully injected into the bladder, then released. The procedure is repeated until the wash water becomes clear. Strict adherence to aseptic rules is necessary; mug, syringe, solutions - everything must be sterile, sterile gloves should be worn on your hands. If washing is done through drains inserted into the kidney or pelvis, a 20-gram syringe is used for this purpose.
In urological practice, early activation of patients is recommended. In this case, measures should be taken to ensure that the drains do not fall out or become dislodged: the lumen of the drains should be clamped by bending and tying the tip of the tube. The same is done when the patient takes a bath.
Good ventilation of the rooms and regular airing are of great importance in urology departments. This, combined with frequent changes of dressings and emptying of urine bags, can achieve good clean air and eliminate specific odors.
To ensure good urine flow, the receiver must be located below the level of the bladder. This is important at night: the tube through which the outflow is carried out must not be twisted, as this can lead to disruption of the outflow of urine. When draining urine, you should wear gloves and wash your hands. It is necessary to place a measuring container under the outlet tube of the drainage bag. Then release the outlet tube from the holder: open the tube clamp: drain the urine into a measuring container. The outlet tube must not touch the walls of the measuring container or the floor.
You should squat down and not lean forward. Then close the clamp, wipe the end of the outlet tube with an alcohol swab, and secure the outlet tube in the holder. Make sure that the tubes connecting the catheter and the drainage bag are not kinked.
To prevent complications you should:
- change the catheter at least every 3-4 weeks;
- monitor the patency of the catheter (50% of patients have catheter blockage urinary stones);
- if the outflow of urine through the catheter is disrupted, rinse the bladder and replace the catheter.
The patient should drink more often so that the urine is less concentrated, and regularly care for the perineum, washing from front to back, with thorough drying. Observe the condition of the skin of the perineum.
Special attention should be paid to the issue of drainage of the kidney cavities. Most often, these are patients with severe bilateral kidney damage or with disease of a single kidney, when nephrostomy is the only possible way to prolong the patient’s life. Lifelong nephrostomy is also performed in patients whose ureters are compressed by an inoperable tumor in the pelvis. These patients are observed in the outpatient clinic and at home, and the drains in the kidney are changed.
For drainage, a rubber tube (Fig. 206) or Pezzer capitate catheters (Fig. 207) or Maleko (Fig. 208) are usually used.
With this method of drainage, rubber tubes often fall out due to unreliable fixation, so it is better to use capitate catheters. However, they are not applicable for ring drainage of the kidney; in these cases, drainage from a conventional rubber or polyvinyl tube is used. In the kidney, as in the bladder, the drainage should be changed after 3-4 weeks. A new sterile catheter is inserted into the renal fistula in the same way as into the bladder. The drainage tube located in the renal pelvis must be securely fixed to the skin. The tube should be additionally fixed to the patient’s body with a gauze band that encircles the patient’s body and is attached to the tube or by double tying around it, or by means of a thick silk ligature, which is tied to the tube and a gauze belt. Polyvinyl chloride drains must be wrapped with a strip of adhesive tape close to the skin and a gauze ribbon or silk ligature attached over it to prevent them from slipping off the smooth surface of the tube.
With ureterocutaneostomy, the ureters can be exposed to the skin in the suprapubic, iliac, or lumbar regions. They are usually intubated with thin tubes that drain urine into a urine bag. By eliminating stasis and reflux, ureterocutaneostomy helps preserve kidney function for a long time and differs favorably from nephrostomy in that it does not injure the renal parenchyma.
Flushing of intubating tubes should be carried out in strict compliance with the rules of asepsis and antisepsis, and if they are clogged (salts, mucus and

Urine continuously released from the ureters irritates the skin, leading to maceration and dermatitis. To combat these complications, it is advisable to lubricate the skin around the ureteral fistulas with indifferent ointments (see Appendix 1).
Intubating tubes, which are constantly located in the ureters, contribute to the development of a chronic inflammatory process. A gradually developing decrease in the tone of the upper urinary tract leads to stagnation of urine, precipitation of urinary salts and further intensifies the inflammatory process, the fight against which occupies an important place in the care of this category of patients.

24.4. Care for patients with fistulas of various organs

Stoma means an opening (gastrostomy is an opening in the stomach, choledocho-duodenostomy is an opening between the common bile duct and the duodenum). The stoma can communicate with the external environment (gastrostomy, colostomy, etc.) or not communicate (choledochoduodenostomy, gastrojejunostomy, etc.). The operation, as a result of which this hole is superimposed, is called stomia(for example, gastrostomy, choledochoduodenostomy, etc.).

24.4.1. Cervical esophagostomy

Cervical esophagostomy protects against the entry of oral contents (saliva, food) into the thoracic esophagus. It may be needed in a patient with an esophagotracheal fistula when mediastinitis occurs due to perforation of the esophagus. The need for such an operation may also arise in case of complete blockage of the underlying part of the esophagus, a disintegrating inoperable malignant tumor, etc. Simultaneously with the application of an esophagostomy, it is necessary to take care of the patient’s artificial nutrition (intravenous or through a gastrostomy tube).
The upper segment of the cervical part of the esophagus is brought out through the surgical incision from the wound.
The muscular layer of the esophagus is sutured to the platysma, the mucous membrane to the edge of the skin. The esophagostomy is closed with a loose bandage so that saliva can flow freely.

Cervical esophagostomy (Fig. 209) causes significant trouble, since swallowed saliva constantly flows out of the esophageal outlet. 209. The stage of applying the hole to the surrounding skin, moistens the maceric cervical esophagostomy.
ruins it. Therefore, when caring for an esophagostomy, emphasis must be placed on preserving the surrounding skin. The skin must be lubricated with Lassara paste (it is possible to use analogues), and it must be thoroughly cleaned when changing dressings.

24.4.2. Gastrostomy

A gastrostomy forms an artificial communication path between the stomach and the external environment. Gastrostomy- this is an operation to create an opening in the stomach (gastrostomy), through which a rubber tube is inserted to drain the contents or to provide the patient with nutrition.
The idea of ​​such an operation belonged to the Norwegian surgeon Egeberg, who in 1837 expressed the opinion that if foreign bodies can be removed from it by dissecting the stomach, then why not use the hole in the stomach to introduce food and medicine into it.
Priority in the theoretical justification and technical development of gastrostomy belongs to Moscow University professor V.A. Basov. In 1842, at the Moscow Society of Natural Scientists, he presented the results of eight experiments carried out on dogs, “Notes on the artificial route into the stomach,” and in the same year the experiments were published in the journal “Notes on Medical Sciences.” The first gastrostomy on a human was performed by the French surgeon Sedillo in 1849, the patient died of shock. A repeated attempt, made in 1853, ended in death on the tenth day from the progression of peritonitis. The first successful gastrostomy was performed by Verney in 1876 on a 17-year-old patient who died 15 months later from consumption.
Indications:
- if food cannot be introduced into the stomach through the cardia, for example, in case of significant burns of the esophagus as a result of ingestion of corrosive liquids;
- if it is impossible to introduce food into the stomach through the cardia, for example, with burn stenosis or with stenosing non-operable carcinoma of the cardia, when there is no possibility of palliative intervention;
- in case of failure of the sutures in the area of ​​esophagogastrostomy after resection of the cardia and the occurrence of an esophageal fistula, which must be unloaded for several weeks until its spontaneous healing;
- after surgery on the stomach or extensive intervention on other abdominal organs to relieve the stomach.
The patient is fed through a tube connected to a funnel. Food should be liquid. For example, meat is passed through a mixer and diluted with broth. You can use baby food.
The skin around the stoma must be treated with neutral pastes or ointments to prevent the effect of gastric juice on the skin, because the development of deep skin damage is possible.

Feeding algorithm for gastrostomy

Preparation for the procedure:
- introduce yourself to the patient, explain the purpose and course of the procedure;
- prepare the necessary equipment and equipment, nutritional mixture;
- wear non-sterile rubber gloves;
- help the patient take a high position.
Performing the manipulation (Fig. 210).
- remove the bandage and place it in a bag or bag for used material;
- place a towel on the epigastric area of ​​the abdomen under the tube;
- conduct a visual inspection of the tube and the skin surrounding the gastrostomy tube;
- remove the clamp from the gastrostomy tube, attach the syringe to Zhanna;
- check whether the tube is positioned correctly in the gastrostomy tube, check the residual contents in the stomach by suctioning it from the stomach: if the volume exceeds 100 ml, insert it again and draw the doctor’s attention to this; if the volume of the residual contents is less than 100 ml, insert it back and rinse a tube of 30 ml of warm boiled water;
- make an infusion nutritional mixture in slow mode. After introducing the nutrient mixture, rinse the tube with 30-50 ml of boiled water;
- disconnect the syringe to Zhanna and close the tube with a clamp;
- wash the patient’s skin around the gastrostomy with soap and pat it dry with a napkin.
- check the condition of the skin, focusing on its color in the stoma area and the presence or absence of edema and the gastrostomy itself (swelling of the gastric mucosa around the tube);

Apply a layer of ointment, paste or protective gel to the skin around the gastrostomy tube;
- apply a sterile napkin or a disposable bandage-sticker around the gastrostomy tube;
- secure a sticker bandage around the gastrostomy tube, preventing the formation of folds through which discharge (gastric contents) from the gastrostomy tube can leak out;
- carefully secure the end of the tube on top of the bandage to the skin with a bandage. Ending the procedure:
- place the used dressing material in a container or bag for used material;
- remove the towel and put it in a bag for used linen;
- after removing gloves, put them in a container for disinfection or a bag;
- wash your hands and dry them (using soap or antiseptic);
- make an appropriate entry about the results of the procedure in the appropriate medical documentation.

24.4.3. Enterostomy

Enterostomy- opening the lumen of the small intestine, keeping it open and connecting through this opening to the drainage brought out (Fig. 211).
The highest possible level of enterostomy is duodenostomy. Duodenostomy is performed very rarely, and mainly only in the following cases: with transpapillary and transduodenal drainage of the common bile duct, but also in some cases of diverticulum perforation duodenum.

24.4.3.1. Intestinal food intake fistula (jejunostomia)

Jejunostomy- this is the imposition of a food intake fistula below the stomach in cases where the imposition of a fistula on the stomach is impossible. Jejunostomy is performed in the proximal part, on the first loop of the jejunum. This intervention may have a dual purpose. By inserting the catheter upward and connecting it to a suction device, a jejunostomy can be used to unload an anastomosis located more orally, for example, an esophago-jejunostomy or a gastrojejunostomy. In addition, with the help of a probe and a dropper, a jejunal examination can be performed through the inserted catheter. Often alone
and the same jejunostomy tube is used first to unload the anastomosis, and after a few days to feed the patient.
And here, as with gastric fistulas, it is important that food is introduced easily and reliably and that nothing flows back.
The principle of caring for a jejunostomy is the same as for gastrostomies.
An ileostomy is placed at the distal portion of the intestinal tube near the cecum. Nowadays, much more often than before, they began to resort to the imposition of a permanent ileostomy during total proctocolectomy.

24.4.4. Cholecystostomy

An intervention that can be carried out quickly and easily, even seriously ill patients can easily tolerate it. In most cases, this is only a symptomatic measure, in acute stage serious illness this intervention provides temporary assistance, since final healing of the patient is possible only as a result of a new operation - cholecystectomy. Cholecystostomy (Fig. 212) is performed in all cases where cholecystectomy is indicated, but the patient's condition is so poor that removal of the gallbladder would be associated with too great a danger to his life. The bottom of the gallbladder is circularly attached to the parietal peritoneum, and a rubber tube is inserted into the cavity of the gallbladder. Here we encounter two situations.
1. If, in addition, during the operation all stones from the gallbladder were removed, and the common bile duct, hepatic ducts, Vater's nipple are free, then after 2-3 days pure yellow bile begins to be released from the cholecystostomy, the amount of which does not exceed 300 per day. 400 ml. The stool becomes normal in color. If the outflow is not obstructed, the cholecystostomy closes on its own under a regular protective bandage within a few days.

2. If during the operation all the stones were removed from the gallbladder, but the nipple of Vater is closed by the stone, then through the cholecystostomy after 2-3 days pure bile is separated, the amount of which per day is 800-1500 ml, and the feces become acholic. A lack of bile produced by the liver leads to severe and rapid disorders of water-salt balance, and a lack of bile in the intestine leads to severe digestive disorders and a lack of vitamin K. In this case, it is necessary to ensure that the patient drinks bile that does not enter the duodenum naturally . But the bile is very bitter. Some patients easily drink bile, having first mixed it with beer (usually men), and some patients mix bile with jelly (usually women).
The algorithm for other manipulations with cholecystostomy is similar to those listed above.

24.4.5. Colostomies

In everyday surgical practice, there are discrepancies regarding the names of the various colostomy or unnatural anus (anus praeternaturalis). Both concepts involve opening the colon and creating a connection with the outside world. By its etymology, the word “colostomy” means an opening in the colon through which only part of the feces comes out, while the rest still passes into the underlying parts of the colon. In contrast, the anus praeternaturalis is an opening in the large intestine through which the entire contents of the intestine are discharged.

A colostomy can be performed on any mobile portion of the colon. The most common places for stomas (Fig. 213):
- cecostoma;
- transversostomy;
stoma, 5 - sigmostoma. . sigmoidostomy.

24.4.6. Artificial anus

Artificial anus they call such an opening in the large intestine through which all intestinal contents are emptied out, but nothing enters the underlying parts of the intestine, since there is no communication. An artificial anus can only be created on a mobile segment of the colon (on the transverse colon, sigmoid colon).
In the following text, we will use the term “colostomy”, since in all cases the stoma is placed on the large intestine and feces are released to varying degrees, which allows the use of an almost uniform algorithm of actions.

24.4.6.1. Colostomy care

The development of medicine increases the number of people undergoing surgical interventions, completed by the application of a colonic stoma (Fig. 214) on the anterior abdominal wall. Depending on which part of the intestine was removed, the stoma can be located on the right or left, and the discharge from it can be of a different nature - from semi-liquid (mushy) to fully formed.
After surgery, a patient with a colon stoma is deprived of the ability to control the activity of his own intestines and carry out the voluntary function of retaining feces and gases. But if you follow simple recommendations and use modern means of care for your intestinal stoma, you can not only maintain your usual lifestyle, but also return to work.
The intestinal mucosa (the tissue lining the inside of the intestine) is extremely delicate and vulnerable, so caring for an intestinal stoma primarily involves:
- protecting her from injury;
- hygienic care of the intestinal stoma itself.
However, even with the most careful care, the intestinal stoma may periodically release droplets of blood, which is acceptable and does not require intervention. As a rule, the intestinal stoma, being in a colostomy bag, is reliably protected from injury.
The intestinal stoma and the skin around it (and it also requires careful care) should be washed in circular spiral movements with warm water and soap (children's, laundry), not forgetting to rinse it off at the end of the procedure. You can use a soft cloth for this. Use a similar napkin to dry the skin and intestinal stoma using a blotting motion after washing. This is done before lubricating or gluing the colostomy receiver, which is glued only to a clean, dry and unlubricated surface. If there is hair in the area of ​​the intestinal stoma, which is not uncommon, it should be removed using a razor or special cream with utmost care. Usually, caring for an intestinal stoma does not cause difficulties, except in cases of various complications.

Typically, an intestinal stoma does not cause significant disturbances in bowel function. Because of this, there is no single nutritional plan for patients with intestinal stoma. However, given some of the difficulties after surgery, it is recommended to start eating, introducing no more than one “new” product per day and being especially careful with foods that are individually perceived by the body. In pursuit of the goal of accustoming your intestines to the rhythm of work, you need to eat regularly, without limiting yourself to the amount of food you eat or the volume of liquid you drink. Intestinal activity should be regulated through a certain diet, consuming foods that have a strengthening or laxative effect. It is desirable that the stool be daily, soft and pasty. It is necessary to add dietary fiber to the diet. If the patient does not suffer from diseases of the intestinal wall (colitis in the acute phase, duodenal ulcer), it is recommended to introduce wheat bran into the daily diet in a physiological dose, adding it without additional processing by a tablespoon to ready-made food.
A correctly selected diameter of the opening of the colostomy bag for the intestinal stoma and its adhesive plates are able to ensure its tightness throughout the entire period of use (from 3 to 7 days) of the colostomy bag. Naturally, when selecting a colostomy bag, you should take into account individual characteristics intestinal stoma, its location, its type, condition.

24.4.6.2. Colostomy bag

Regarding the selection of care products, it is not recommended to use domestic waist colostomy bags (Fig. 215), as well as imported ones. Compression of the abdomen brings nothing but harm to the intestinal stoma, which applies to all elastic bandages, especially narrow ones.
There are several various types colostomy bags (Fig. 216):
- one-component;

Two-component:
- transparent;
- matte;
- with and without filters.
The one-component colostomy bag has
faeces collection bag, seal and outer adhesive ring in a single, solid unit. A two-component colostomy bag consists of a bag that is attached to an adhesive plate that acts as a “second skin.”

Algorithm for using adhesive colostomy bags

Before the next use of a fresh colostomy bag, thoroughly wash the skin around the stoma with warm water and neutral soap, having previously cleaned it of hair and remnants of the adhesive layer;
- select the size of the hole in the colostomy bag that corresponds to the diameter of the existing stoma;
- if the stoma has an irregular shape, you can change the shape of the hole in the stencil using scissors;
- the size of the cut hole should be 3-4 mm larger than the size of the stoma. We must not forget that bedridden patients the lower end of the colostomy bag should be directed not towards the legs, but towards the back;
- place a template with a cut hole on the protective paper covering of the adhesive layer of the colostomy bag and, if it does not coincide with any of the drawn lines, trace the outline of the cut hole with a pencil or pen;
- cut a hole in the adhesive layer along the applied contour, being careful not to cut through the colostomy bag;
- remove the protective paper covering with the applied markings and, slowly, align the lower edge of the cut hole with lower limit stoma;
- starting from the bottom edge of the plate, glue the colostomy bag to the skin, making sure that no folds form on the adhesive plate, which can lead to leakage of the colostomy bag;
- glue the colostomy bag to the skin for a minute, pressing the edge of the hole adjacent to the stoma with your hand;
- removal of the colostomy bag occurs in the reverse order, starting from the upper edge of the latter.

When washing colostomy bags during the next discharge of the contents, you should not allow water to enter the top part bag to avoid getting it under the adhesive layer, which leads to premature peeling of the colostomy bag, and when using two-component colostomy bags (a plate plus a bag with a snap), you should remember that you should not wash the plate standing on the body. If you experience a burning sensation under the adhesive layer, immediately remove the colostomy bag and consult a specialist, as this may be evidence of an allergic reaction.

Attention! A disposable colostomy bag is glued to the skin only once, and its reuse is not allowed.

Frequent causes of colostomy bag leakage:
- Poor adhesion to the skin around the stoma. The skin around the stoma must be dry and clean. Pressing the stick-on colostomy bag to the skin with your hand, hold it there for 1-2 minutes to ensure good adhesion.
- Incorrectly selected size of the colostomy bag opening and stoma. If the size of the stoma and the size of the cut hole do not exactly match, this may cause the contents to leak under the adhesive plate, which leads to a violation of the tightness of the colostomy bag.
- Irregularities in the surface of the skin or folds at the site where the colostomy bag is glued to the stoma area. The presence of uneven skin or folds in the place where the colostomy bag is glued can contribute to the leakage of the contents of the bag. It is possible to use special means to prevent leakage.
- Skin changes near the colostomy. Skin irritation in the colostomy area may cause poor adhesion of the colostomy bag.
- Inappropriate angle for gluing the bag. Obviously, if the bag is oriented inappropriately, then the very weight of the contents of the colostomy bag will create a twisting force on the adhesive plate of the colostomy bag and contribute to its rapid peeling off. Sometimes this angle differs slightly from strictly vertical, and each patient must determine it for himself based on his individual body configuration.
- Irregular emptying of the colostomy bag. Typically, the colostomy bag is emptied when its contents occupy from 1/3 to 1/g of volume. Failure to comply with this rule may result in contents getting under the adhesive layer and the colostomy bag coming off.
Extremely high temperature. A significant increase in body temperature or ambient air can lead to a change in the structure of the adhesive layer - its “melting”. Similar situations may arise
as a result of being in a very hot place (for example, a sauna) or diseases accompanied by a significant increase in temperature. Taking into account this possibility, in such situations it is necessary to change the colostomy bag more frequently.
- Inappropriate storage conditions for colostomy bags. Failure to comply with the rules for storing colostomy bags (for example, in a warm or damp room) can lead to a change in their adhesive properties, which must be taken into account. It is generally recommended to store colostomy bags in a cool, dry place.
- Using old colostomy bags. The shelf life of colostomy bags is limited and is individual for each type of colostomy bag. It is natural for the patient to want to have a certain supply of colostomy bags with him, but you should not make it too large.

Algorithm for benefits for colon stomas

Preparation for the procedure:
- check with your doctor about the type of colostomy bag and the need to change the care plan for your intestinal stoma;
- Explain the upcoming procedure to the patient. Explain each step as it is performed, allowing the patient to ask questions or perform any step of the procedure independently;
- provide the patient with the opportunity to observe the individuality of the procedure - put up a screen, help the patient take a lying position;
- wash (using soap and antiseptic) and dry your hands;
- prepare all the necessary equipment;
- wrap the patient in a sheet or diaper below the intestinal stoma (limitation of the manipulation field);
- prepare a clean colostomy bag;
- on the top side of the paper that sticks to the skin, draw a circle with a diameter 3-4 mm larger than the existing intestinal stoma (the average size of an intestinal stoma is 2.5-3.5 cm);
- use a special template with standard holes to select the size of the intestinal stoma. Place the template with the cut-out hole on the protective paper covering of the adhesive layer of the colostomy bag and, if it does not coincide with any of the drawn lines, trace the outline of the cut-out hole with a pencil. Cut a hole in the adhesive layer along the applied contour, being careful not to cut through the colostomy bag. Performing the manipulation:
- wear rubber gloves.
- disconnect and carefully remove the old colostomy bag. Remove the colostomy bag starting from its upper edge. Place the disposable bag in a plastic trash bag and leave the closure device for reuse. When reusing a colostomy bag, empty the bag into the vessel, after squeezing the lower part of the bag with a clamp, and measure the volume of stool. Wash the clamp and wipe it with toilet paper. Apply deodorant to the bottom of the bag;
- change gloves, placing used ones in a container for disinfection;
- wash the skin around the intestinal stoma with warm water and soap, clearing it of any remaining glue from the previous colostomy bag;
- carefully clean the area of ​​the intestinal stoma and the skin around the patient’s intestinal stoma with soap and water, blot the skin dry with a napkin;
- check the condition of the skin in the area of ​​the intestinal stoma and the intestinal stoma itself to identify swelling of the intestinal mucosa;
- remove gloves and place them in a container for disinfection;
- treat your hands with antiseptic and put on new gloves.
- treat the skin (if its integrity is violated) around the intestinal stoma with a protective drug (zinc ointment, stomagesin, Lassar paste or other product used in the institution);
- remove the protective paper covering with the markings applied to it and align the lower edge of the cut hole with the lower border of the intestinal stoma;
- place a clean colostomy bag directly on the patient’s skin or on the colostomy bag ring;
- glue the colostomy bag (from the lower edge of the plate) to the skin, pressing it with your hand for 1-2 minutes and avoiding the formation of folds through which discharge from the intestinal stoma may leak;
- when using a reusable colostomy bag, attach its edges to the skin barrier device with a plaster. Attach the belt to the edge of the colostomy bag.
Ending the procedure:
- remove gloves and place them in a container for disinfection;
- wash and dry your hands (using soap or antiseptic);
- make an appropriate entry about the results of implementation in the medical documentation.

Algorithm for washing a colostomy

Preparation of the procedure:


- provide an opportunity to maintain privacy if the procedure is performed in a lying position;
- Wash the hands;
- wear gloves;
- pour 500-1000 ml of warm water into the irrigation container;
- hang this container on an intravenous stand and fill the system with water;
- help the patient sit on a chair (facing the toilet) or lie on his side on the bed and place a bedpan;
- disconnect and throw away the used colostomy bag in a bag or bucket;
- wash the skin in the colostomy area, as when replacing a colostomy bag;
- remove gloves and place in a container for disinfection or a plastic bag;
- treat your hands with antiseptic and wear sterile gloves. Performing the manipulation:
- place an irrigation “sleeve” over the stoma;
- lubricate the catheter with Vaseline oil;
- carefully insert the catheter into the stoma to a depth of 5-10 cm;
- place the lower edge of the sleeve in the toilet or bedpan;
- turn on the system and hold the irrigation end;
- carry out the infusion for 10-15 minutes;
- hold back the flow of water, if the patient feels cramping pain in the abdomen or a backflow of fluid occurs, close the system and give rest;
- wipe the lower edge of the sleeve with toilet paper and cover or bend its upper part while the patient is sitting;
- rinse the hose with water, dry its end and close it;
- ask the patient to walk for 35-40 minutes;
- remove the sleeve and catheter, throw them into a container for disinfection;
- wash the patient’s skin around the stoma;

Ending the procedure:
- remove gloves and place in a container for disinfection;
- wash and dry your hands (using soap or antiseptic);

Stoma dilation algorithm

Preparation of the procedure:
- check with the attending physician about the type of equipment and the need to change the stoma care plan;
- explain the procedure in general to the patient or his family. Explain each step as it is performed, allowing the patient to ask questions or follow any step of the procedure;
- provide the opportunity to follow the procedure in a lying position;
- wash and dry your hands (using soap or antiseptic);

Performing the manipulation:
- lubricate the index finger with sterile petroleum jelly;
- carefully insert your finger into the stoma, repeating the movements back and forth;
- treat the skin around the stoma;
- secure the new colostomy bag.
Ending the procedure:
- remove gloves and place them in a container for disinfection;
- wash and dry your hands (using soap or antiseptic);
- make a record of the results of the implementation in the medical documentation.
Additional information about the features of the technique
It is advisable to teach the patient and his relatives how to care for the stoma. The colostomy bag should be emptied when it is filled with stool and gases to V2 or '/3 volume, otherwise the tightness of the joint around the stoma may be compromised.
As a rule, an ostomy does not impose any strict restrictions on the patient’s life. However, as a rule, the patient will be advised to refrain from significant physical activity during the first months after surgery. For the same purpose, to prevent the occurrence of a paracolostomy hernia, wearing a bandage may be recommended.
No less problematic than a paracolostomy hernia can be caused by such a frequent complication as prolapse of the mucous membrane of the removed intestine. In this case, the stoma begins to look like a stocking turned outward. Naturally, the prolapsed part becomes injured, begins to bleed, ulcerate, etc. The only way to get rid of the complications described above is surgical intervention, which, as a rule, is not large-scale, but is necessary.
You can often hear naive objections, for example, that I don’t want to have surgery because when I lie down, the prolapse goes inside (or the hernia disappears).
This misconception should be immediately explained. With each subsequent time, the prolapse of the mucosa will become more and more, since the prolapsed part of the mucosa “pulls” the remaining part with it, and in addition, there is a real threat of strangulation when the blood supply to the prolapsed part of the intestine is disrupted and the situation becomes life-threatening.
Unfortunately, we have to admit that many patients, after being discharged from the hospital, forget to follow the recommendations for digital bougienage of the stoma. But this simple procedure is a reliable guarantee that the stoma will not begin to overgrow, since the body perceives it as “extra” and seeks to get rid of it. For some reason, this procedure sometimes causes unreasonable fear, although the principle of execution is no different from clearing the nose of small children. Unless your gloved finger needs to be lubricated with Vaseline. At the same time, serious narrowing of the stoma almost always leads to the operating table.
Finally, as for the lower (inactive) part of the intestine in those who have it left. Rinsing this area of ​​the intestine should be done approximately once every one to two weeks, using about a glass of chamomile or sage decoction. This may be the only way to prepare this section of the intestine for reconstructive surgery, which should be performed 6-8 months after the ostomy.
Achieved results and their evaluation
The patient is able and demonstrates independent performance of the manipulation with 100% accuracy. The patient is in a comfortable condition, the skin around the stoma is without visible changes. The patient feels comfortable.
The most frequently asked questions by patients:
- What type of colostomy bag should I use?
- Will others notice that I am wearing a colostomy bag?
- Do I need to wear a belt?
- How often will the colostomy bag need to be changed?
- Where is the best place to change the colostomy bag?
- What will I need?
- How to change a colostomy bag?
- Will I be able to return to my job?
- When will I be in good enough shape?
- What can you say about my social life?
- How are things going with sports and favorite activities?
- Will I still be able to travel?
- Will I be able to have a child after having a stoma?

24.4.7. Tracheostomy

To treat some diseases, it is necessary to perform an operation - a tracheotomy - to provide air access to a person’s lungs. For longer treatment it is necessary to apply tracheostomy(Fig. 217).
The word "tracheotomy" comes from the Greek words tracheia - windpipe, and tome - dissection; The word "tracheostomy" includes another Greek word - stoma - hole.
With that said, tracheostomy is called the operation of dissecting the trachea (throat section) with the subsequent introduction of a cannula into its lumen or the creation of a stoma by suturing the edges of the tracheal and skin wounds to ensure breathing or performing endolaryngeal, endotracheal and endobronchial diagnostic and therapeutic interventions.

The first tracheotomy was performed by physician Antonio Brasavola (Antonio Musa Brasavola, 1500-1555) on a patient who was suffocating from a laryngeal abscess, and he came to life before the eyes of those present.
To date, there are many patients whose lives have been saved by this operation. Many people have a permanent tracheostomy and thanks to this they live, breathe and work. There are about two thousand such patients in St. Petersburg alone.

Attention! Tracheostomy provides the possibility of life - breathing and gas exchange in the lungs!

Nose function is lost. The nose performs quite important functions:
- filters and disinfects the air;
- heats the air to 36° and humidifies it up to 98%;
- gives the sense of smell;
- participates in the formation of taste sensations.
Therefore, the tracheostomized patient must learn to compensate for these deficiencies.
Changing the act of breathing! Exclusion of the nose and oropharynx from the act of breathing sometimes leads to;
- insufficiently humidified and warmed air enters the lungs;
- easier infection of the respiratory tract during epidemics.

24.4.7.1. Choosing the right tracheotomy tube

After tracheotomy, it is necessary to select a tracheostomy cannula. The danger of undetected loss of the tracheostomy tube from the trachea into the peritracheal tissue is observed mainly in the early postoperative period, when the channel for the cannula has not yet formed. This complication is facilitated by: the patient’s short and thick neck, cough, active and excessive flexion and extension of the head, development of emphysema, hematoma, inflammation of the soft tissues of the neck. Displacement, and even more so, loss of the cannula from the trachea in the first days after tracheostomy can create obstacles to breathing. There is a danger of blocking one of the bronchi with a tracheostomy cannula that is too long (intubation of one of the bronchi leads to the development of atelectasis of the opposite lung).
There is a danger of irritation of the tracheal bifurcation by the end of the long cannula tube, causing persistent cough and adverse changes in the functioning of the cardiovascular system. In such cases, you should contact an otolaryngologist.

24.4.7.2. Patient care

A tracheostomy is an open wound that must be managed according to the rules of asepsis. Therefore, the dressings around the tracheostomy need to be changed 5-6 times a day in the first days.
It is necessary to protect the skin around the tracheostomy due to the possibility of the formation of a zone of maceration of the epidermis, for which they use lubricating the skin with ointments prescribed on the recommendation of the attending physician.
After a tracheostomy is performed, ongoing oral care should be performed. Compliance with asepsis and antisepsis when caring for a tracheostomy and during aspirations from the tracheobronchial tree is a rule that must be strictly observed. This is an effective prevention of infectious complications that are possible after a tracheostomy. It is important to constantly remove mucus from the tracheobronchial tree by active coughing or suction, since partial or complete blockage of the tracheostomy cannula by dried or thickened tracheobronchial mucus is possible.
Strict adherence to the mucus aspiration technique is necessary:
- the outer diameter of the suction catheter should be less than half the diameter of the tracheostomy tube;
- catheters must be semi-rigid, since a hard catheter injures the mucous membrane, and a soft one does not allow its introduction into the underlying parts of the trachea and bronchi; it easily sticks together during aspiration;
- the duration of a single suction should not exceed 5 seconds, the intervals between individual suctions should be at least 5 seconds;
- before and after suction, it is advisable to provide the patient with breathing air enriched with oxygen;
- the catheter should be inserted and removed from the trachea slowly and carefully (atraumatically);
- during aspiration, it is necessary to avoid suction of the catheter to the mucous membrane of the trachea and bronchi, as this damages the mucous membrane, which increases the risk of infectious complications and causes the development of scars; The least invasiveness is ensured by the use of catheters with a lateral opening and a blind, cone-shaped bent end.
Before each suction from the tracheostomy, percussion and vibration massage chest, which facilitates the removal of sputum. For the same purpose, 10-15 ml of isotonic sodium chloride solution can be injected into the tracheostomy before suction.

24.4.7.3. Hydration

To prevent the inhaled air from irritating the mucous membrane, it is necessary to humidify the air inhaled through the tracheostomy and the tracheal mucosa. This is achieved:
- periodic use of inhalers;
- using an “artificial nose” of various designs and breathing through moistened gauze (all these methods increase breathing resistance, which reduces their value);
- periodic injection into the tracheostomy of 1-2 ml of 4% sodium bicarbonate solution or chymopsin solution, etc.;
- ensuring high hydration of the patient (sufficient water regime, required volume infusion therapy). High hydration during tracheostomy is an effective prevention and method of overcoming dryness of the trachea and bronchi, preventing the formation of thick and viscous secretions in them.

24.4.7.4. Tracheostomy tube care

Choosing the right quality tracheostomy tube and regular care is an important factor in reducing complications. When breathing through a tracheostomy tube, it often becomes clogged with thick mucus. When changing a tracheostomy tube, it must be taken into account that the tracheostomy tract is formed within 3-5 days. Changing the outer tube of a metal tracheostomy cannula or a plastic tracheostomy cannula before this time may be technically difficult.
If there is a need to perform this procedure in the first days after a tracheostomy, then it should be performed by a doctor, well
proficient in tracheal cannulation techniques. However, in the first days after tracheostomy there is usually no indication for replacing the outer tube with a metal cannula or a plastic thermoplastic cannula. In the first days after surgery, the inner tube of the metal cannula is removed 2-3 times a day, washed, cleaned with cotton wool wrapped on a flexible probe with threads, and boiled. After boiling, the tube is dried, lubricated with oil (vaseline, peach, etc.) and placed in the outer tube. The plastic cannula can be easily sanitized without removal from the tracheostomy. In the following days, the inner tubes of the metal cannulas are removed daily, as necessary, washed, cleaned, sterilized by boiling and reinserted.
The need to wash and sterilize a plastic cannula usually arises after 1-2 weeks. These tubes drain sputum well; they are much smaller than metal tubes and are susceptible to blockage by drying or thick mucus. But these tubes, if necessary, are removed from the tracheostomy opening, washed with plain and boiled water, treated with an antiseptic (furatsilin) ​​and inserted back into the trachea.
If there is excessive production of viscous sputum, tracheostomy tubes must be removed from the trachea and cleaned several times a day. The inner tube of the metal tracheostomy cannula is inserted along the channel of the outer tube. The introduction of a plastic tube is initially carried out with its shield in a sagittal position. Then the cannula is inserted into the trachea with a careful and confident movement, while at the same time its shield is moved to the frontal plane. Insertion of a plastic cannula into the trachea usually causes a cough reflex.
When changing plastic tubing or metal cannula outer tubing, use tubing of the same diameter. If, to facilitate insertion into the trachea, tubes of a smaller diameter are used, then a narrowing of the tracheostomy quickly occurs. Over time, this makes it impossible to insert a cannula of a size sufficient for free breathing into the trachea and may require surgical expansion of the tracheostomy tract.

24.4.8. Caring for patients with epicystostomy

For some diseases that interfere with the natural outflow of urine, for example, adenoma prostate gland, produce a high cross-section of the bladder. During this operation, it can be formed epicystostomy- suprapubic vesical fistula (hole in the bladder for drainage of urine).
If the epicystostomy is left for a long time or permanently, urine drainage is carried out through the capitate catheter of Pezzer, Maleko, which do not require fixation when the fistula is formed.
The catheter is changed at least once a month to avoid clogging it with urinary salts, damage and tearing off the head when replacing it. The patient needs to be shown how to install a catheter if it accidentally falls out. The distal end of the catheter is connected through a tube to a urinal. If the patient walks, the urinal bag is attached to his lower leg or thigh; if he is lying down, the urinal bag is suspended from the bed frame.
Urostomy is not a disease. This name is given to the hole surgically created through the wall of the abdominal cavity following the removal of all or part of the bladder. Removal of a urostomy is usually permanent. The stoma is located with right side abdominal cavity and protrudes outward by 2-3 cm. Urine continuously flows into a urine receiver equipped with an anti-reflux valve.
Main indications for urostomy:
- bladder cancer;
- wrinkled bladder;
- urinary incontinence;
- congenital anomalies;
- radiation therapy;
- injury.
When considering skin care, preventative measures are of great importance (Fig. 218). Urine leaks continuously from the stoma, so it is important to prevent it from coming into contact with the skin. This is often difficult to do in cases where the urostomy is below the level of the skin (retraction) or where there is scar tissue around the stoma. Alkali exposure to skin is a major cause of damage. It is advisable to use a cleansing lotion that has a bacteriostatic and fungistatic effect in order to reduce the risk of infection. Taking ascorbic acid (vitamin C) will reduce the risk of urinary tract and skin infections.

Another care product is boric acid paste. It provides a mild bacteriostatic and fungistatic effect, supports correct value Skin pH. If phosphate crystals form wok-Fig. 218. Rinsing the epicysto- stoma, it is necessary to use a stoma solution. table vinegar, diluted 5 times. Frequently washing the stoma and the skin around it will remove crystals, and the prophylactic use of vinegar will prevent further crystal formation.
When choosing a urine receiver, it is important to pay attention to the adhesive surface, which must be reliable and not susceptible to urine. In addition, the package must be drainable, equipped with a check valve and be able to connect to night storage systems. Such a system will ensure the prevention of reflux phenomena.
Often, patients with suprapubic bladder drainage experience false, painful, painful urges on urination, pain along the urethra and in the head of the penis. These sensations are observed in cases where the cystostomy opening is located very low, directly above the pubic bones. The head of the catheter rests against the neck of the bladder and causes severe irritation. Similar pain may bother the patient when urinary salts enter the neck of the bladder due to insufficient rinsing. Such patients are advised to thoroughly flush the bladder, prescribe analgesics, antispasmodics, including in the form of rectal suppositories, and intravesical administration of solutions of local anesthetics. With prolonged drainage of the bladder, easily bleeding granulations grow at the border of the skin and the fistula tract around the catheter. They should be subjected to electrocoagulation or cauterized with a 5% lapis solution.
In a small number of patients, unilateral or bilateral ureterocutaneostomy was performed for health reasons. In this case, the ureters can be exposed to the skin in the suprapubic, iliac or lumbar region. They are usually intubated with thin polyethylene tubes. Urine is collected in a urine bag. By eliminating stasis and reflux, ureterocutaneostomy helps preserve kidney function for a long time and differs favorably from nephrostomy in that it does not injure the renal parenchyma. The tubes should be washed with antiseptic solutions in small portions (5-6 ml) under low pressure. Flushing the tubes intubating the ureter with large portions of liquid and under pressure leads to reflux with all the undesirable consequences. Rinsing of intubating tubes should be carried out in strict compliance with the rules of asepsis and antisepsis, and if they are clogged (salts, mucus, etc.), replace them immediately.
Urine continuously released from the ureters irritates the skin, leading to maceration and dermatitis. To combat these complications, it is advisable to lubricate the skin around the ureteral fistulas with indifferent ointments or fat (rosehip oil, etc.)
Cicatricial narrowing of the ureterocutaneous anastomosis often occurs, which leads to impaired urine passage and the development of hydroureteronephrosis and pyelonephritis. To prevent the formation of strictures when changing intubators, very careful bougienage should be performed, avoiding injury to the ureters with large bougiens.
Rinsing the bladder through a drainage tube is carried out with disinfectant solutions (potassium permanganate 1: 5000, furatsilin 1: 5000; 2-3% boric acid solution, etc.). Solutions are ordered at the pharmacy. It is possible to prepare them at home. Furacilin dissolves in boiled water (2-3 tablets per 250 ml of water); boric acid(10 g per 500 ml of water), several crystals of potassium permanganate until a faint pink color appears. Before inserting into the bladder, the liquid must be cooled to body temperature.
The purpose of lavage is not only to maintain the patency of the drainage tube, but also to evacuate inflammatory products (pus, mucus, blood clots, urinary salts) from the bladder.
Equipment:
- solutions for washing the bladder (250-500 ml);
- disinfectant solutions for external use; iodine solution; brilliant green; 76% alcohol; betadine);
- plastic or glass syringe Zhanna (150 ml);
- a container for draining wash water (kidney-shaped basin, vessel);
- tweezers;
- scissors;
- gauze napkins and balls;
- adhesive plaster.
Execution algorithm:
The patient takes the supine position. A container is installed on the side of the patient to drain the rinsing water (kidney-shaped basin, vessel, etc.). Before washing, the outer end of the catheter is disconnected from the urinal and treated with an antiseptic solution (dioxidine, chlorhexidine bigluconate).
The aseptic sticker fixed around the catheter is removed. Zhanne's syringe is filled with a solution for rinsing the bladder and connected to the catheter. 40-50 ml of solution is slowly injected into the bladder, then the catheter is pinched with the fingers, the syringe is disconnected, the catheter is directed into the vessel, the fingers are unclenched, and the washing liquid flows out of the catheter in a stream. The procedure should be repeated 2-3 times until the washing liquid flowing from the tube becomes transparent. Typically, one wash takes about 250-300 ml of disinfectant solution. With a correctly installed catheter and a formed fistulous tract, the disinfectant solution easily passes into the bladder and is only released back through the catheter.
With insufficient rinsing, urinary salts may enter the neck of the bladder with further occurrence of pain. Such patients are advised to thoroughly flush the bladder, prescribe analgesics, antispasmodics, including in the form of rectal suppositories, and intravesical administration of solutions of local anesthetics.

24.4.9. Monitoring the functions of the respiratory system

In the postoperative period, the development of acute respiratory failure due to anesthesia is possible. You should also not forget about the prevention of postoperative pneumonia, which can cause the death of the patient.
Preventive measures in the postoperative period:
- early activation of patients:
- antibiotic prophylaxis;
- adequate position in bed, breathing exercises;
- dilution of sputum (use enzymatic preparations and expectorants);
- use of reflex therapy that stimulates breathing (mustard plasters, cupping);
- massage;
- various physiotherapeutic activities.
In the first hours after surgery, ventilation of the lungs is impaired (symptoms are pain in the wound, shallow breathing). Mucus can accumulate in the lungs (Fig. 219), which leads to cessation of ventilation in the corresponding areas, atelectasis, and subsequently to pneumonia. A serious complication is asphyxia, which occurs when the tongue retracts and the airways are blocked by vomit. When the tongue retracts, bubbling breathing, snoring appears, and the patient turns blue. In such cases, you should quickly move the patient’s lower jaw forward and insert an air duct into the oral cavity.
To prevent asphyxia that occurs when vomit enters the airways, the head must be turned to the side in advance, and after vomiting, the patient should be asked to rinse his mouth with water. When vomit enters the respiratory tract, a severe cough, bluishness of the skin and mucous membranes, and bubbling breathing appear. During an urgently performed bronchoscopy, the trachea and bronchi are released by suctioning out vomit and mucus, the bronchi are washed with saline, and antibiotics are administered. In the following days, antibiotics are administered parenterally (to prevent pneumonia).

To thin sputum in patients (especially smokers, chronic diseases lungs and bronchi) expectorants, inhalations with soda and bronchial dilators (aminophylline, etc.) are prescribed. In the first 2-3 days after the operation, painkillers are used to reduce pain during expectoration; the effect is observed 20-30 minutes after the injection, while the patient, when coughing, holds it with his hands to reduce pain in the wound. Patients must be taught proper coughing and deep breathing (breathing exercises) in the preoperative period. It is necessary to take 20-25 deep breaths several times a day, inflate rubber balloons, bladders, etc. Therapeutic exercises, if the condition allows, should begin from the first day after surgery, especially for bronchopulmonary diseases. Improvement of pulmonary ventilation is facilitated by early activation of patients after surgery (early getting up, walking, therapeutic exercises). To prevent congestive pneumonia, the patient should be in bed in a semi-sitting position at an angle of 30-35°, often turn to the left and right side; Chest massage, mustard plasters, cupping are useful.
Once the patient is allowed to walk independently, there is no need to use medications and preventive measures; the patient, under the guidance of a physical therapy instructor, should do breathing exercises daily.

Respiratory tract care algorithm

Preparation for the procedure:
- assess the patient’s level of consciousness, the state of the respiratory system, basic vital signs;
- explain the purpose and course of the procedure to the patient (if he is conscious), obtain consent;
- wash and dry your hands (using soap or antiseptic);
- perform procedures that promote sputum separation (postural drainage, vibration chest massage);
- prepare the necessary equipment;
- turn off the emergency alarm of the ventilator;
- wear protective clothing (apron, mask, goggles);
- wear sterile gloves.
Performing the procedure:
- open the package with a sterile suction catheter. The size of the catheter should not exceed half the internal diameter of the endotracheal or tracheostomy tube;
- open the suction container, fill with sterile saline solution;
- attach a sterile suction catheter to the connecting tube of the electric suction;
- check the pressure level by applying thumb left hand to the sensor at the outlet of the catheter;
- carry out preoxygenation with 100% oxygen for 2-3 minutes;
- treat the junction of the endotracheal tube and catheter with a sterile gauze swab moistened with 70% alcohol;
- disconnect the ventilator from the patient. Sanitation of the trachea and bronchi:
- carefully insert a sterile catheter into the endotracheal or tracheostomy tube until it stops with the electric suction turned off. When sanitation of the right bronchus, turn the head to the left, when sanitation of the left bronchus - to the right. Turn on the electric suction and, using careful rotational movements, remove the catheter from the respiratory tract, performing suction;
- monitor vital functions. If oxygen saturation decreases below 94-90%, bradycardia, rhythm disturbances and other complications appear, immediately stop the procedure, perform ventilation with 100% oxygen, and inform the doctor;
- Immerse the catheter in a sterile saline solution and apply suction to remove clots and mucus from the catheter.
Repeat aspiration repeatedly until the airway is clear.

Attention! Do not suction for more than 10-15 seconds!

In the intervals between aspirations, perform artificial ventilation of the lungs with a device.
Cuff care:
- check the inflation of the tube cuff by squeezing between the thumb and forefinger;
- release the air from the cuff using a syringe;
- carry out aspiration from the trachea using the above method;
- inflate the cuff with air using a syringe until a tight seal is created.
Manipulation should be carried out every 2-4 hours.
Before deflating the cuff, ensure that there is no content in the nasopharynx or oropharynx.
If necessary, before aspiration, sanitize the upper respiratory tract:
- use sterile catheters to aspirate the contents of the nasal passages one by one.
Aspirate the contents of each nasal passage and oropharynx using different catheters.
To open the mouth, use a mouth opener, to retract the tongue - a tongue holder, to retract the cheeks - a spatula.
To treat the oral cavity with a sterile saline solution, use sterile gauze swabs, tweezers and a clamp.
- Treat the nasal passages with sterile saline;
- repeat aspiration of the contents of the oral cavity with a catheter until it is completely removed;
- place used instruments, medical products and consumable materials in a container with a disinfectant solution.
If the patient has a tracheostomy, bandage the tracheostomy wound (change the dressing every 8 hours).
Ending the procedure:
- set the oxygen supply rate to the level prescribed before suctioning;
- assess the state of the respiratory system and vital signs;
- turn off the suction device;
- wrap the suction catheter around your hand with a sterile glove;
- disconnect the suction catheter from the connecting tube;
- remove the glove and wrap it over the catheter;
- place the used materials in a container with a disinfectant solution;
- check the tightness of the breathing circuit, the correct location of the tube, the presence of liquid in the humidifier of the breathing apparatus;
- wash and dry your hands (using soap or antiseptic);
- turn on the emergency alarm of the ventilator;
- make an appropriate entry about the results of implementation in the medical documentation.

24.4.10. Monitoring the functions of the cardiovascular system

In the postoperative period, complications such as myocardial infarction, thrombosis and thromboembolism are most often observed in patients with hypertension, diabetes mellitus, who have previously had a myocardial infarction, obesity, and elderly and senile patients. To make a correct diagnosis, and therefore for proper treatment, a heart monitor is used.
In the early postoperative period, heart problems are most often observed the following complications:
- arrhythmias;
- acute myocardial infarction;
- acute cardiovascular failure;
- cardiac arrest.

State of the cardiovascular system p£ g20 Kanit
controlled during surgery, after transferring the patient from the operating table and
during transportation of the patient to surgery department or intensive care unit. After the operation, under general anesthesia, control is carried out by an anesthesiologist, focusing on external manifestations:
- color of skin and mucous membranes;
- arterial pressure;
- pulse;
and on hardware control of the vital functions of the body.
Myocardial infarction is characterized by pain in the heart or behind the sternum radiating to the left scapula. A heart attack may proceed atypically (pain is localized in epigastric region), with diabetes mellitus, a painless form of myocardial infarction occurs in 30-50% of cases. In all cases of the disease, symptoms of acute cardiovascular failure are observed, expressed to varying degrees. In such a situation, it is necessary to urgently call a doctor and strictly follow all his instructions.
If infusion of solutions continues during transportation, it is necessary to control the position of the needle or catheter in the vein, ensuring that air does not enter the vein from the infusion system. The most common complication during these minutes is acute cardiovascular failure, in which the following rapidly develops:
- pallor of the skin and mucous membranes;
- cyanosis of the lips;
- cold sweat;
- increased heart rate (weak filling and tension, sometimes thread-like);
- increased breathing;
- lowering blood pressure.
In such cases, it is necessary to establish the cause of cardiovascular failure and, first of all, to exclude bleeding from the surgical area (slipping of a ligature from a vessel, pushing out a blood clot).
Easy to diagnose external bleeding(bleeding occurs into the surgical wound). Drainage bleeding is possible (when blood begins to flow through a drainage left in a wound or in some cavity). Much more difficult to diagnose internal bleeding(in the abdominal, chest cavity, stomach, etc.), the threat is especially great in diseases caused by impaired hemocoagulation processes (obstructive jaundice, sepsis, thrombocytopenia, etc.).
Treatment depends on the source and intensity of the bleeding. For capillary bleeding, the following is used topically:
- cold on the wound area;
- wound tamponade;
- pressure bandage;
- drugs that promote thrombus formation (fibrinogen, thrombin, hemostatic sponge, etc.).
Drugs that increase blood clotting (Vica-sol, etamsylate-aminocaproic acid, etc.) are administered systemically. It is important to remember the need for prompt medical care, because continued bleeding is a threat to the patient's life. If this or any other complication is suspected, the nurse should immediately notify the doctor.
A frequent complication of the postoperative period is thrombosis and thromboembolism, which are caused by blood clots, most often formed in the deep veins of the lower extremities, as well as at the site of venipuncture or prolonged standing of venous catheters.
In the lower extremities, thrombus formation occurs in the venous sinuses of the calf muscles and in the deep veins of the legs during surgery or in the first days after it. Deep vein thrombosis is characterized by pain in the calf muscles, slight swelling of the foot, pain in the calf muscles on palpation and in the projection of the vascular bundle. The so-called floating (floating) blood clots are especially dangerous, as they can break off even with slight physical exertion or coughing.
When they break off, blood clots travel through the bloodstream into the pulmonary arteries, causing thromboembolism. With a large thrombus, the trunk of the pulmonary artery becomes blocked and instant death occurs. Blockage of its smaller branches is manifested by sharp chest pain, shortness of breath, bluishness of the skin of the face, neck and upper half of the chest.

24.4.11. Classification of pulmonary embolism

It varies by localization (A.V. Pokrovsky, 1979):
- thromboembolism of small branches of the pulmonary artery, most often on both sides or on the right and never leads to death;
- thromboembolism of the lobar and segmental branches of the pulmonary artery, which ends in death in 6% of cases;
- thromboembolism of the trunk and main branches of the pulmonary artery, ending in death in 60-75% of cases.
By clinical course diseases are distinguished (N.A. Rzaev, 1970, G.A. Ryabov, 1978) into four main clinical forms of the disease:
I form - lightning fast- corresponds to massive thromboembolism of the pulmonary artery trunk or its main branches, in which death occurs suddenly within the first 5-10 minutes from acute cardiac arrest or asphyxia;
II form - acute- corresponds to thromboembolism of one of the main branches of the pulmonary artery, occurs with a sudden onset in the form of acute chest pain, difficulty breathing and collapse. Patients die within the first 24 hours;
III form - subacute- corresponds to thromboembolism of the lobar and segmental arteries with ongoing thrombosis. Outcomes depend on the cause of thromboembolism and concomitant diseases, manifested in the form of pulmonary infarction;
IV form - chronic- corresponds to thromboembolism of small arteries of the lung in combination with thrombosis. Clinically manifested as pulmonary infarctions.
Thrombosis is most often observed with:
- varicose veins;
- thrombophlebitis of deep veins (postthrombophlebetic syndrome);
- after long-term traumatic operations;
- in cancer patients:
- in old age;
- for obesity;
- in dehydrated patients;
- with a long stay in bed.
Prevention of thrombosis consists of:
- bandaging the lower extremities with elastic bandages before, during and after surgery;
- early physical activity in bed and early getting up and walking;
- prescribing anticoagulants (anticoagulants) of direct (heparin, fraxiparin) and indirect (pelentan, neodicoumarin, warfarin, etc.) action;
- conducting systematic monitoring of blood coagulation and anticoagulation systems.

24.4.12. Monitoring the functions of the digestive system

In the first hours after surgery, due to the residual effect of narcotic substances and relaxation of the sphincters, passive flow of acidic gastric contents into the respiratory tract and vomiting may occur. Therefore, it is necessary to take appropriate preventive measures (horizontal position with head turned to the side).
After surgery on the abdominal organs, a decrease in salivation is observed, which may be due to the use of atropine, disturbances in water-electrolyte metabolism, intoxication, and the absence of a physiological stimulus (food). As a result, dry mouth develops and the processes of desquamation of the epithelium in the oral cavity are disrupted. Due to the absence (small amount) of saliva, which has bactericidal properties, favorable conditions for the development of microbes, which can lead to inflammation of the gums (gingivitis), tongue (glossitis), buccal mucosa and the formation of ulcers ( aphthous stomatitis). Particularly dangerous is the penetration of microbes into the ducts of the salivary glands with the subsequent development of the inflammatory process in the parotid glands (mumps). Therefore, before and after surgery, it is necessary to carefully monitor the condition of the oral cavity. First of all, before surgery, carious teeth must be sanitized.
After surgery, salivary irritants are prescribed to enhance salivation:
- lemon with peel;
- chewing gum;
- products that cause salivation (kefir, yogurt, juices);
- you need to brush your teeth with toothpaste every day;
- rinse your mouth with a 2% solution of soda, a decoction of chamomile, sage;
- ulcers (aphthae) are treated with a 1% solution of brilliant green.
In cases of mumps development, physiotherapeutic warming procedures are prescribed (semi-alcohol compresses, UHF therapy, electrophoresis with antibiotics, etc.), and in case of suppuration, the abscess is opened.
In the early postoperative period, nausea, hiccups, vomiting, and bloating may be a consequence of anesthesia. Some of them pass quickly, others are very persistent and are a manifestation of life-threatening complications (intestinal obstruction, peritonitis). After providing first aid, the nurse should immediately report this to the doctor.
Hiccups associated with convulsive contractions of the diaphragm, accompanied by a strong inhalation with a characteristic sound. Contraction of the diaphragm is a reflex to irritation emanating from the abdominal cavity (fullness of the stomach with gases and liquids that press on the diaphragm and irritate it, which leads to rhythmic contractions). Long-term hiccups are an extremely serious condition that requires emergency care. Brief hiccups more often occurs in response to rapid filling of the stomach, especially with dry food. Hiccups may last longer in cases of gallbladder disease, after surgery in the abdominal cavity, intestinal obstruction, neuroses, and cerebrovascular accidents. When providing assistance to the patient, it is necessary to calm him down, give him a comfortable position, unfasten clothing that is restricting breathing, and provide access fresh air, give the patient a few sips of water, advise him to hold his breath. Treatment of hiccups begins with exposure to the diaphragm and stomach. First, the nurse tries to change the patient's body position. In the position on the sore side during operations on the chest organs, the hiccups stop. Effective actions include swallowing pieces of ice, sucking pieces of lemon, sometimes sugar with 2-3 drops of validol. Holding your breath and taking deep breaths also help relieve hiccups. A good effect is obtained by draining the stomach with a probe, administering a 0.1% solution of atropine - 1 ml subcutaneously, cerucal - 2-6 ml intravenously or intramuscularly.
Belching- exit of gases from the stomach cavity through the esophagus. Belching can release gases and air that enters the stomach when swallowing. Belching is caused by relaxation of the stomach and peritoneum. U healthy person belching can occur when the stomach is full of food. With diseases of the stomach, belching can often be sour, with a disease of the gallbladder - rotten, with the accumulation of a large amount of air in the stomach - airy. Belching is not a disease, but a symptom, therefore, if frequent belching bothers the patient, the underlying disease should be treated. If belching is associated with overeating, limit the amount of food taken at a time. After eating, it is advised not to lie down, but to walk around. No need to eat before bed.
Nausea- an unpleasant sensation in the upper abdomen (in the epigastric region), a feeling of heaviness, sometimes accompanied by paleness of the face, increased sweating, palpitations, salivation and slower breathing movements. Nausea often precedes vomiting. For nausea, patients with low acidity of gastric juice are prescribed 1 tablespoon of natural gastric juice with meals or a cerucal tablet.
Vomit- this is the involuntary ejection of the contents of the stomach out through the mouth (sometimes through the nose) - a complex reflex act involving the muscles of the stomach, diaphragm, anterior abdominal wall, as well as the epiglottis and soft palate, which results in the eruption of vomit from the stomach out through the mouth. Vomiting can be a sign of a serious disease of the nervous system, arterial hypertension, poisoning, irritation of the mucous membrane of the tongue, pharynx, soft palate, and gastrointestinal tract.
Purpose: to provide emergency care to prevent aspiration of vomit.
Equipment: diaper, oilcloth or apron, basin (bucket), boiled water, kidney-shaped tray, gloves, 2% sodium bicarbonate solution, napkins, tripod.
Performing the manipulation (if the patient is conscious):
- call a doctor immediately;
- sit the patient down, if his condition allows, if not, then turn his head to the side, remove the pillow;
- put on the patient an oilcloth apron or diaper, or oilcloth;
- place a basin (bucket) at the patient’s feet;
- during vomiting, hold the patient’s head by placing your palm on his forehead;
- after vomiting, allow the patient to rinse his mouth with water or soda solution;
- leave the vomit in the basin until the doctor arrives;
- disinfect gloves, vomit, and oilcloth apron in accordance with orders No. 288 and No. 408.
Complications:
- aspiration - entry of vomit into the respiratory tract;
- transition from single vomiting to multiple vomiting;
- the appearance of blood in the vomit.
Providing assistance with the appearance of blood in the vomit
If blood appears in the vomit, you must:
- call a doctor immediately;
- lay the patient horizontally;
- raise the foot end of the bed;
- place an ice pack on the abdominal area;
- prepare necessary medications;
- reassure the patient and monitor his condition.
After operations on the abdominal organs, almost all patients have impaired intestinal motor activity (paresis), which makes it difficult for the contents to move through the gastrointestinal tract. As a result, the processes of fermentation and putrefaction intensify, signs of intoxication appear, gases stop passing, there is no stool, moderate bloating is observed - flatulence, peristaltic intestinal sounds are not heard, a sound with a tympanic tint is detected by percussion.
The fight against paresis of the gastrointestinal tract includes nonspecific and specific means and measures.
Nonspecific measures include early activation of patients in bed (turning on their side, early getting up and walking, therapeutic exercises), timely withdrawal of narcotic analgesics that inhibit intestinal motility, as well as enteral nutrition.
Specific means include: medications (cerucal, etc.), physiotherapeutic (electrical stimulation), mechanical cleansing of the colon using a gas tube and enemas.

Attention! After operations on the intestines, it is strictly forbidden to use laxatives, as this can lead to catastrophic consequences:

Leakage of anastomotic sutures;
- intussusception (invasion of the intestine into the intestine);
- development of intestinal obstruction and peritonitis.
If flatulence occurs, a gas outlet tube with a diameter of 1.5 cm is inserted into the colon to a depth of 30-40 cm for 1.5-2 hours; activated charcoal is prescribed to reduce the amount of gases in the intestine. In the absence of independent stool, the intestines are cleansed on days 4-6 (depending on the level of intestinal anastomosis) using a cleansing enema.
If the operation is performed on the left half of the colon, hypertonic enemas (100 ml of 10% sodium chloride solution) are used. If there is no effect, add 30 ml of a 3% solution of hydrogen peroxide or Vaseline oil, which is also used internally, 1 tablespoon 3-4 times a day.
The phenomena of intestinal paresis after operations that are not accompanied by opening the intestine, as a rule, disappear after 2-3 days (in the absence of complications).
If the intestinal motor activity is not restored, which is most often associated with the development of inflammatory complications, it gradually becomes overfilled with gases and stagnant contents, which antiperistaltically enter the stomach through gaping sphincters. The abdomen increases in volume even more, patients complain of a feeling of heaviness in the epigastrium, nausea and vomiting (green vomit, often with an unpleasant odor). Peristalsis is not detected, and when the abdomen shakes, a characteristic splashing sound appears in the intestines overflowing with fluid. There is pallor of the skin, a rapid pulse, and the temperature often rises. An increase in pressure in the abdominal cavity due to overfilling of the intestines and stomach with stagnant contents leads to pressure on the diaphragm, a decrease in its excursion and impaired ventilation of the lungs. Respiratory failure develops, shortness of breath and cyanosis of the mucous membranes appear. In such cases, the stomach should be emptied using a thin probe inserted into it through the nasal passage (nasogastric intubation). The contents of the stomach are evacuated using a Zhanne syringe, the stomach is washed with a 2% soda solution and cold water until clean wash water appears. If a small amount of fluid accumulates in the stomach, it is washed as the contents accumulate (usually in the morning and evening - fractional intubation). If stagnant fluid accumulates in the stomach in large quantities, then the probe is left in it for 5-7 days or more until the paresis is eliminated, fixing it to the nose with strips of adhesive tape. The medical history records the amount and nature of the contents evacuated from the stomach.
Nutrition is provided parenterally. After the elimination of intestinal paresis, they switch to enteral nutrition in accordance with the nature of the operation undergone. After operations not related to the abdominal organs (hernioplasty), 2-3 hours after the operation, you are allowed to drink sips of water every 20-30 minutes. In the first 1-2 days, limit the intake of food containing large amounts of sugar and fiber, due to the risk of developing flatulence. From day 2-3, dietary restrictions are lifted.
After surgery on the stomach and intestines, in the first two days the need for water and nutrients satisfied by parenteral administration of the amount of water, electrolytes, proteins, carbohydrates and fats necessary for the body. Enteral nutrition is also possible (through a tube inserted into the small intestine). From the third day, patients are allowed to drink sips of water, broth - diet 0, then switch to diet 1a and 1.
Patients who have undergone colon surgery are allowed to drink from the next day after surgery. From the second day, a slag-free diet is prescribed in liquid and semi-liquid form.
If the phenomena of paresis increase, then within 2-3 days of treatment the presence of postoperative peritonitis should be excluded. In such cases, with appropriate clinical picture A repeat operation is performed - relaparotomy.
Serious complication development may appear liver failure, at which it is observed:
- deterioration of general condition:
- nausea:
- headache;
- physical inactivity;
- possible jaundice.
You need to call a doctor.
If the operation was not performed on the abdominal organs, then disturbances in motor activity (peristalsis) of the gastrointestinal tract usually do not occur. Sometimes there is the development of reflex vomiting and stool retention. If there is no stool within 2-3 days after surgery, it is necessary to empty the intestines with a cleansing enema.

24.4.13. Monitoring the function of the urinary system

Even before surgery, it is necessary to teach the patient to urinate in a lying position, thereby preventing urinary retention. It is also necessary to ensure hygienic conditions for the act of urination, especially for women.
In the first 2-4 days and further after major operations, as well as in case of concomitant kidney diseases, it is necessary to measure the amount of daily urine. This is necessary to assess not only renal function, but also to assess the degree of hemodynamic recovery, replenishment of lost fluid, and the effectiveness of anti-shock and detoxification therapy. At the same time, we must not forget that fluid loss also occurs extrarenally (with vomit, through drains and bandages, through the lungs with shortness of breath, through the skin with increased sweating). These losses and the amount of urine excreted must be recorded in the medical history. Normally, the patient excretes 1.5-2 liters of urine per day; the excretion of a smaller amount of urine is called oliguria, its absence anuria.
Urination may be absent if the patency of the urethra is impaired (in men - with prostate adenoma); sometimes psychological factors are important, for example, the patient cannot urinate in the ward in the presence of strangers. In this case, you need to fence off the bed with a screen or, if possible, ask everyone to leave the room.
To relax the bladder sphincter, heat is used (a heating pad with warm water on the bladder area); to increase the urge to urinate, open a water tap and pour water into a basin. If there is no effect, catheterization of the bladder is performed.
A serious complication is the development of renal failure, which is characterized by:
- decreased diuresis:
- headaches;
- nausea, vomiting:
- decreased appetite:
- increase in body weight;
- swelling:
- insomnia;
- itchy skin:
- increasing azotemia.
In this case, you must call a doctor.
Care is carried out by caring for the skin, oral cavity, administering an enema with a 2% soda solution to wash out toxins from the intestinal mucosa, administering and monitoring the drip administration of liquid, including soda solution; It is important to follow a diet with limited protein, liquid, salt, and foods containing potassium.

24.4.14. Disorders of carbohydrate metabolism

May develop hypoglycemic coma, which is characterized by weakness, hunger, sweating (immediately give sweet tea, sugar, chocolate), agitation, trembling, a weak, rapid pulse (administration of 20-30 ml of glucose solution), convulsions, loss of consciousness (intensive care).
It is possible to develop and hyperglycemic coma, manifested by: weakness, headache, loss of appetite, nausea, smell of acetone from the mouth (urgently drawing blood and urine for sugar, administering insulin). There is facial hyperemia, loss of consciousness, drop in blood pressure, increased heart rate, noisy deep breathing (40-70 units of insulin are administered with cardiac medications).

Test tasks:

1. Planned operations canceled when:
a. Menses.
b. A slight rise in body temperature.
c. ARVI in a mild form.
d. The presence of furunculosis.
e. The presence of compensated diabetes mellitus.
2. Complications from the surgical wound include everything except:
a. Bleeding.
b. Hematomas.
c. Infiltrates.
d. Pain in the wound.
e. Eventrations.
3. Preoperative measures that reduce the risk of infection of surgical wounds are:
a. Hygienic bath.
b. Antibiotic therapy.
c. Shaving the skin.
d. Cleansing the gastrointestinal tract.
4. Postoperative complications can be caused by:
a. Inadequate preoperative preparation.
b. Features of surgical intervention.
c. Features of anesthesia.
d. Inadequate postoperative care.
5. Signs of infection of a postoperative wound:
a. Increased pain.


d. Infiltration of the edges of the wound.
e. Sudden soaking of the bandage;

6. Add:
Failure of the sutures of a postoperative wound, as a result of which migration of internal organs occurs outside the anatomical cavity, is called ____________________ (answer with a capital letter in the nominative case).
7. Signs of eventration:
a. Increased pain.
b. Persistent increase in body temperature.
c. The appearance of signs of intoxication.
d. Infiltration of the edges of the wound.
e. Sudden soaking of the bandage.
f. The appearance of signs of dysfunction of internal organs.
8. Eventration promotes:
a. Wound infection.
b. Inadequate physical activity.
c. Constipation.
d. Cough.
9. Add:
The cavity inside a wound that contains fluid (except blood) is called ____________________ (answer with a capital letter in the nominative case).
10. Empty seroma should be differentiated in the first class from:
a. Eventratsiei.
b. Hematoma.
c. Suppuration.
11. Drains are installed for:
a. Control of the functions of internal organs.
b. Ensuring the outflow of exudate.
c. Hemostasis control.
d. Administration of medications.
e. Non-operative rinsing of cavities.
12. Complications that may arise as a result of drainage installation:
a. Loss of drainage.
b. Migration of drainage into the cavity.
c. Spread of infection through drainage.
d. Formation of a pressure sore of a wound or organ.
13. Signs of ongoing intracavitary hemorrhage:
a. Discharge of liquid blood through drains.
b. Discharge of liquid blood with clots through the drains.
c. The drainage of blood that is in the process of coagulation.
14. Postoperative complications can manifest as dysfunction of any
Wrong.
15. The duration of the postoperative period depends on:
a. Nature of the disease.
b. The patient's condition.
c. Urgency of the operation.
d. Anesthesia method.
16. The main goals of the early postoperative period are:
a. Stop bleeding.
b. Maintenance and restoration of impaired body functions.
c. Prevention and treatment of complications.
d. Adequate pain relief.
17. Prevention of deep vein thrombosis is facilitated by:
a. Long stay of the patient in bed.
b. Getting up early and walking.
c. Elastic bandaging of the lower extremities.
d. Normalization of water-salt metabolism.
18. The duration of stay of the ice pack on the area of ​​the postoperative wound is:
A. 20 minutes.
c. 5-6 hours.
d. 24 hours.
19. What should be done first when the bandage quickly gets wet with blood?
a. Remove the top layers of the dressing and replace them with new ones.
b. Administer hemostatic agents.
c. Call a doctor.
20. The skin around the intestinal fistula is treated:
a. Tincture of iodine.
b. Lassara paste.
c. Alcohol.
d. Dry it.
21. Add:
The anastomosis of a hollow organ with another hollow organ or the environment that occurs as a result of a pathological process is called __________________________ (answer with a capital letter in the nominative case).
22. Add:
An artificially imposed anastomosis of a hollow organ with the environment is called ___________________ (answer with a capital letter in the nominative case).
23. In order to prevent inflammatory processes in the oral cavity in the postoperative period, the following is prescribed:
a. Products that cause salivation (lemon, juices).
b. Rinsing the mouth with a 2% soda solution.
c. Rinsing the mouth with a decoction of chamomile.
d. Drinking is prohibited.