Ministry of Health of Republic of Belarus

Education establishment «The Gomel State medical university»

Chair of Internal Disease №1 with Endocrinology Course

It is discussed at the meeting of chair 30.08.2016 Protocol № ______

METHODICAL REVIEW for practical training of foreign students of the 1st course

Subject: Sanitary care of patients. Patient’s hygiene. Patient’s transportation Theme 3 (Lesson 4; 5)

Time: 6 hours

Chief of chair______1. Training and educational goals, motivation for theme learning, requirements of initial level of knowledge

1.1 Aim of training: Get the concept of the receiving department of health institutions, patient admission rules and registration, to master the process of patient sanitary treatment, including treatment of the patient in identifying lice, as well as cutting hair and nails, preparations for holding hygienic baths, washing in the shower. To master the transportation of patients with self-limited skills, personal hygiene of the patient, methods of changing bed clothes, putting a rubber circle, skin care in the bedsore presence, patient’s transportation and moving.

1.2 Requirements to initial level of knowledge: during the training the student should

To know:

1) The structure of the receiving department

2) The process of patient sanitary treatment

3) The principles of hygiene procedures

4) Measures to prevent the bedsore formation

To be able:

1) To transport the patient with self-limited skills

2) To carry out hygienic procedures with the patient

3) To make a change of bed clothes and underwear patients.

2. Material equipment of training

1) Stretchers, wheel chairs, hand stretchers.

3. Questions on an occupation subject: Lesson 4:

1) Structure and equipment of the receiving hospital department

2) Patient’s sanitary treatment

3) Treatment of patients in identifying lice

4) Carrying out sanitary bath, holding a hygienic shower, wet wiping 5) Anthropometry

6) Patient’s hygiene. Moving regime. Taking care of oral cavity. Eyes Care. Nose care. Skin care

7) Change of bed clothes and underwear

Lesson 5:

8) Bedsore, bedsore prevention education

9) Types of patient transportation

10) Rules of patient transportation by stretchers

11) Rules of patient transportation by wheelchair

12) Rules of patient transportation by hand stretchers

4. Materials for self-preparation:

Lesson № 4

1. Structure and equipment of the receiving hospital department

Receiving department is the most important medical and diagnostic department, it is the "face" of the hospital. Here is the first meeting of the patient with hospital staff.

The receiving department consists of a waiting room, an office duty nurse, one or more examination rooms, treatment room, dressing room, and sometimes a small operating room, an insulator, sanitary room, diagnostic wards, x-ray rooms, laboratories, sanitary unit and ancillary facilities (wardrobe for employees and patients, staff rooms).

To the receiving hospital department patients admitted in emergency and planned (with direction document) method. All the patients requiring emergency medical care, come to the emergency department, by passing the receiving department. Receiving the patient and his registration

Depending on the severity of the patient's condition during filling all the information obtained from the medical history of the patient, and if he is unconscious - from his entourage or relatives. When a patient is without documents he must be reported to the police like an "unknown".

Equipping of treatment room of receiving department

Receiving department staff is obliged to inform the relatives of the patient, if he was delivered by "emergency" because of the out home disease.

The duty nurse records the incoming patient, prepares the necessary documentation and submit to the examination room to examination by a doctor and giving a diagnosis. In particular, nurse fills the cover page history of patient of each incoming patient, enters patient information into account patients receiving magazine and the magazine alphabet (for the help desk), which indicates the surname, first name, last name, date of birth, date of admission to the department. It also fills the left side of the "Statistical card of a hospital left patient." There is a single magazine form to register for detection of infectious diseases, hospital- acquired infections and lice being ("Registration of infectious diseases').

The doctor on duty decides to which department the patient should be sent. If the diagnosis remains unclear after sanitizing patient is placed to the diagnostic ward of receiving department, where he should be examined, observed, diagnosed, and then sent to the appropriate department. The patient who does not need a hospitalization is assisted and directed for treatment to the polyclinic.

Doctor writes to the patient's medical history The result of the inspection, examination, prescription, sanitary treatment and type of patient transportation. Nurse is a list adopted for the storage of clothes, money and valuables if patient should be hospitalized. Documents and values are stored in a safe.

After inspecting the patient's physician and the evaluation of his condition, he is transferred to another room where the patient is carried out sanitization: inspection of the scalp on the head lice, skin in the presence of pustular rash, upper and lower limbs for the presence of fungal diseases. Depending on the patient's condition, it is prescribed hygienic bath, shower or sponging the most polluted areas of the skin, as well as produce anthropometric measurements, body temperature measurement.

2. Patient’s sanitary treatment

Depending on the condition of the patient sanitization can be total or partial. Character of sanitization determined by the doctor. Bathtub and shower refer to complete sanitization. Partial washing, wiping parts of the patient's body refer to partial sanitization. Sanitization is carried at sanitary inspection of a reception. Sanitary inspection includes observation, locker rooms, bath and shower room and a room where patients change their clothes. Rooms can be combined. Before sanitization nurse receptionist is obliged to carefully examine the hairy part of the patient's body to detect pediculosis (head, pubic and body lice). Head and body lice are carriers of serious infectious diseases, so the detection of lice or nits nurse should carry out disinfectation immediately.

3. Treatment of patients in identifying lice

Indications: head and body lice.

The goal: the destruction of lice and nits in a particular patient, preventing their distribution in the environment, the prevention of disease typhus.

Financial support.

1. A bag for the collection of items of the patient (sufficient in volume).

2. Set (medical gown, cap, oilcloth apron) - 1 pc.

3. Rubber gloves - 2-3 pairs.

4. Mask - 1 pc. 5. Galvanised container for burning the hair (of not less than 5 liters) 1pc.

6. Oilskin cape - 1 pc.

7. Solitaire cloth - 1 piece.

8. Scissors - 1 pc.

9. Hair clipper - 1 pc.

10. Razor single application 1 unit.

11. Frequent comb - 1 pc.

12. Wadding.

13. Vinegar.

14. Insecticide, anti pediculosis solution (to kill head lice, disinfection of premises and furniture, for example - Nittifor).

15. Capacity for delousing facilities, respectively labeled - 1 pc.

16. Spray irrigation anti pediculosis solution - 1 pc.

Mandatory requirement: procedure is carried out at sanitary inspection by the nurse.

The sequence of execution:

1. Put on an extra set of overalls and personal protective equipment (gown, oilcloth apron, cap, gloves, mask).

2. Seat the patient (if his condition allows) on the couch, covered with oilcloth, put on his oilskin cape. Tie a towel, folded cushion on the top line of the patient's eyebrows to prevent ingress of the drug in the eye.

3. Hair head profusely moisten 0.5% aqueous-alcoholic "Nittifor" solution or other insecticide with a cotton, gauze pad or sponge (rubbing the hair roots).

4. Cover the head by scarf.

5. At the end of the exposure time rinse hair with warm running water and soap or shampoo, rinse with warm water with the addition of 6% solution of vinegar (at the rate of 50 ml of vinegar to 1 liter of water). 6. Comb patient's hair with fine-toothed comb to remove dead insects (previously through the fine comb teeth skip thread, abundantly moistened vinegar).

7. The patient underwear fold in the bag and send it together with the list for delousing chamber, previously abundantly irrigating the bag with anti pediculosis solution.

8. On the front page of medical records in the right corner make a mark on the revealed lice «P» (pediculosis) and sanitation (with an indication of the methods and means) and the re-processing in a week (if necessary).

9. Premises and objects with which the patient was contacted, treat with a anti pediculosis solution.

10. Gown, cap, gloves, in which was processing, fold in the bag and send it to the camera pest.

11. Arrange "Emergency notification of infectious disease," and send it to the sanitary and epidemiological station in the community.

Note: The drug "Nittifor" flammable, use it near an open flame can not. Avoid contact with the drug on the mucous membranes of the eyes, nose, mouth. In the case of getting the drug to the mucous membranes, they should be rinsed with water.

4. Carrying out sanitary bath, holding a hygienic shower, wet wiping

Carrying out sanitary bath

1. Ask the patient to undress, help him in this.

2. Fill in two copies of the "Admission ticket" patient things.

3. Inspect the skin in the abdomen, thighs, interdigital folds of brushes to detect scabies.

4. Fill a clean bath water temperature + 35-37 ° C for half of its volume.

Note: in order to prevent accumulation of vapors initially pour the cold and then hot water.

5. Put on gloves.

6. Seat the patient in the bath so that the foot end rested on the footrest lock, and the water level reached the xiphoid process of the sternum of the patient. 7. Give the patient a clean sponge and a piece of a batch of soap or liquid dose.

8. Help the patient to wash his head first, then the trunk, upper and lower limbs, groin and perineum. Duration of the bath does not exceed 25 minutes.

9. Keep monitoring the condition of the patient (skin color, pulse, heart rate, etc.).

10. Help the patient get out of the bath and wipe clean warmed towel or sheet.

11. The used towels and sponge put in a container labeled "dirty laundry" and "used washcloths."

12. Help the patient to wear clean underwear.

13. Wash the bath with a brush cleaner, disinfection solution adopted for use, rinse the bath with hot water.

14. Remove gloves, wash and dry your hands.

Conduct a hygienic shower

1. Put on gloves.

2. Put a bench in bath and seat patient on her.

3. Help patient wash his body in the same sequence as during a sanitary bath.

4. Help the patient get out from the bath.

5. Wipe the body in the same sequence.

6. Cut the patient’s nails on the hands and feet.

7. Remove gloves and put them in a disinfection solution.

8. Help the patient to wear clean underwear.

9. The used towels and washcloths pute in a container labeled "dirty laundry" and "used washcloths."

10. Wash and disinfect the bath. Wet wiping

Equipment: mat, diaper, reniform tray, warm water, an alcohol, a large napkin or a towel, changeable underwear and bed linen, gloves.

1. Establish confidential friendly relationship with the patient.

2. Wash your hands, dry it, put on gloves.

3. Put under the patient the oilcloth diaper.

4. Pour into pan warm water (you can add 1 table spoon of alcohol per 1 liter of water).

5. Expose the upper portion of the patient's body.

6. Moisten the napkin, gently squeeze.

7. Wipe the patient in the following sequence: the face, neck, arms, back, chest.

8. Dry the patient's body with a towel in the same sequence and cover with sheets.

9. Wipe the same way the stomach, hips, legs.

10. Cut patient's nails (if necessary).

11. Change his underwear.

5. Anthropometry

Indications: conformity assessment of physical development to age, the proportionality of the patient.

Equipment: medical scales, height meter, centimeter tape.

Measurement of height standing

1. Place the patient back to the height meter rack.

2. The heels, buttocks and shoulder blades must touch the rack height meter. The upper edge of the external auditory canal and the corners of the eyes should be on one horizontal line. 3. Height meter board lower on the parietal region of the head.

4. Count the division on the scale on the bottom edge of the height meter, and record the result.

Weighing

Weigh produce with empty stomach, in underwear, after urination and defecation. When determining the weight of the dynamics weigh on the same scale. Weighing made at admission, weekly and at discharge.

1. Install and adjust the balance.

2. Raise the shutter of the balance.

3. Put the patient in the middle of the platform scales, covered with oilcloth.

4. When the equilibrium of the balance is reached, push the latch weights.

5. Determine and record weighing results.

6. Disinfect the oilcloth.

Scales and stadiometer

Measurement of the circumference of the chest

1. Attach a measuring tape in front of the 4th rib, back - under the angles of the blades. The patient should be calm breathing, arms down.

2. Write down the result.

3. Measure the circumference at a height of maximum inhalation, then exhale.

4. Record the result. Measuring waist circumference, hip circumference

1. Attach the measuring tape on the point located at the mid-axillary lines in the middle of the distance between the lower edge of the costal arch and the iliac crest.

3. Apply the measuring tape at the level of the greater trochanter.

4. Record the result.

The calculation of body mass index (BMI)

1. Calculate the BMI formula:

BMI = body weight in kg / (height in meters)².

3. Calculate the ratio of waist circumference / hip circumference by the formula: waist cm / hips cm.

4. Record the result.

6. Patient’s hygiene. Moving regime. Taking care of oral cavity. Eyes Care. Nose care. Skin care

Personal hygiene of the patient includes the activities of the admission of the patient to the hospital, as well as activities undertaken in the course of his stay in the hospital.

Personal hygiene, maintenance of clean bed chamber and create conditions for a speedy recovery of patients and prevent the development of many complications. The heavier the patient, the more difficult to care for him, difficult to carry out any manipulation of oral care products, ears, eyes, nose, etc.

Main propulsion modes

There are four types of individual patient modes: strict bed, bed, semi bed and overall. In strict bed rest patient is not allowed to actively move in bed, all the physiological functions he performs in bed, and the nurse is caring, feeding the patient and ensures that he did not get up.

While the patient bed rest is allowed to rotate freely in bed, but do not leave it.

While semi bed mode the patient is allowed to go to the toilet.

While the common mode the patient is allowed to walk on the department and the hospital.

Taking care of oral cavity

In the mouth (mucosal, teeth) in the absence of adequate care accumulated plaque, which consists of desquamated epithelial cells, food debris, which leads to an increase in the number of microorganisms and there is formation of inflammation. The patient feels discomfort can be disrupted meal, leading to a deterioration of health and general condition.

Patients on the common mode, independently monitor the oral cavity. Nurse handles seriously ill patient’s mouth after every meal in the Intensive Care Unit. If patients are on the probe or parenteral nutrition, the mouth handled at least 2 times per day.

If you have dentures need to follow the recommendations to care for them, clean them thoroughly with special pastes decontaminate special solutions. At night time they should be removed from the mouth, handle and put in a glass of water.

The purpose of the oral care:

1) prevention of infections;

2) the preservation of the oral mucosa and lips clean and moisturized, undamaged (intact);

3) prevention of halitosis (bad breath);

4) removal of food residues, to prevent the occurrence of discomfort in the mouth, the preservation of appetite; Indications: Seriously ill, debilitated, febrile patients, patients who are on mechanical ventilation, tube feeding.

Facilities (sterile): Tray, two sterile forceps, packing with sterile material (cotton balls, swabs, wipes), two sterile spatula, pear-shaped balloon, petrolatum (cream, lip balm), beaker; towel, a glass of water, a container of disinfectant *, container for waste materials, gloves, vacuum suction system fluid from the patient's mouth (if necessary).

* Choose a doctor performs an antiseptic, it is necessary to clarify the requirements for oral care in a sheet of medical appointments (care may be used water, 0.05% solution of chlorhexidine bigluconate, sometimes 2% soda solution, sodium chloride solution (1 teaspoon of salt in the 500 ml of water. professional care products can be used (sterile cotton «Pagavit» sticks).

Prerequisite: rinse your mouth after each meal and regularly, at least 2 times a day, brush your teeth. Seriously ill patients should be wipe the mucous membrane of the mouth and teeth with an antiseptic solution 2 times a day. Antiseptic solutions with prolonged use (more than 7 days) recommended alternate.

Before performing the procedure, you must wash your hands, perform their hygienic antiseptic and wear gloves.

Stages of the procedure:

1. Explain to the patient the purpose and course of the procedure, to obtain consent to use the screen when the manipulation *

2. Pour into a beaker antiseptic solution (if, for example, sodium bicarbonate, prepare in advance a solution for the treatment of: 1/2 teaspoon to 1 cup water).

3. Help the patient to turn his head to the side, neck and chest covered with oilcloth, chin substitute tray.

4. Inspect the mouth using a spatula (if the blood, ulcers, lesions of the mucous - inform your doctor).

5. Ask the patient to close the teeth (if you have dentures - remove).

6. Push the patient's cheek with a spatula and forceps with gauze ball soaked in antiseptic solution, treat each tooth from the gum to the crown of the tooth from the molars to the incisors on the outside, on the left. 7. Reset the ball into the tray, to prepare and carry out a new treatment in the same sequence on the right.

8. Ask the patient to open his mouth, changed the gauze ball, moisten in an antiseptic solution. Process each tooth from the gingiva, from the root to the cutting edges, on the inside.

9. Change gauze ball, moisten in an antiseptic solution. Edit language (remove plaque in the direction from the root of the tongue to the tip).

10. Help the patient to rinse the mouth or conduct irrigation using a pear- shaped balloon. Pull the corner of his mouth with a spatula and rinse alternately left and then right buccal space jet under moderate pressure solution.

11. Wipe the skin around the mouth, dry cloth, brush lips with Vaseline (use chapstick), if infected with cracks in the corners of the mouth - "levomikol" (ointment), lubricate 2 times a day;

In the presence of non-healing of cracks in the corners of the mouth - dental consultation (ointments containing antibiotics, corticosteroids, epithelialization promoting agents, moisturizers / emollients ( "Panthenol", "Bepanten")).

12. Put beads tools and gauze after container for processing waste materials.

13. Remove gloves and put them in a container for waste materials.

14. Wash and dry hands.

Make a record of the performance of the procedure in the medical record.

Note that if a patient terminal is not available, check the identification data and destination.

Oral care in patients unconscious: the patient should be turned on its side (head rolled to the side), you must use a suction, these activities prevent aspiration. Recommends the use of water for the treatment of oral cavity, as there is the risk that the disinfectant in the airways. The recommended frequency of oral treatment is every 4 hours, which will reduce the risk of infection. Eye Care

Production of tears and blinking leads to natural cleansing the eye. When these functions are violated, an additional eye care.

Indications: a serious condition of the patient, lack of consciousness, infections of the eye.

Objective: rehabilitation, prevention of infection, prevent dryness (the use of "artificial tears"), the treatment of infection.

Facilities (sterile): tray, tweezers, package of sterile gauze balls, 0.02% sterile furatsilin solution, 0.9% sodium chloride solution, pipettes, gloves (sterile / non sterile).

1. Inspect the eyes, to assess the state.

2. If the patient is unable to sit, the assistant is necessary to fix the patient's head.

2. Wash hands, put on gloves (if the eye is infected, then use sterile gloves, otherwise - disposable).

3. Pour into a sterile tray antiseptic solution.

4. Moisten a sterile balls with tweezers in the solution.

5. Wipe one eyelid in the direction from the outer corner of the eye to the inner, then blot dry eyelid ball. Repeat 4-5 times wiping different balls.

7. In the presence of purulent conjunctival cavity *: a) rinse the conjunctival cavity with sterile saline, parting forever thumb and forefinger of his left hand and right hand hold irrigation conjunctival sac with a pipette;

b) wipe dry with a sterile eyelid ball in the same direction;

c) treat other eye in the same manner.

8. Put the waste balls, tweezers, beakers, pipette into the container for waste materials.

9. Remove gloves, place in a container for the waste material (subsequently performed their disinfection and disposal). Wash your hands, dry. 10. Make a record in the documents on the implementation of the procedure and the patient's response.

Patients in the intensive care unit, who for one reason or another are not closed eyelids during sleep, it is necessary to impose gauze moistened with warm saline eye (to avoid drying of the conjunctiva), is used as an ointment or gel to prevent drying of the cornea (eg "Solcoseryl gel").

* Note: the presence of infection treatment starts with a healthy eye. Consultation of an ophthalmologist with the determination of tactics of the patient. For the purpose of mechanical removal of conjunctival discharge cavity is washed with an antiseptic solution (furatsilin); antibiotic therapy is conducted in the presence of purulent discharge, for example, eye drops 0.3% ofloxacin solution.

Instill drops in eyes

1. Wash your hands.

2. Check the consistency of the drug to the appointment;

3. Seat or lay the patient.

4. Preheat the drug to a temperature of + 35-37 ° C.

5. Type medicament in a sterile pipette based on both eyes.

6. Instruct the patient to tilt the head back.

7. Pull the lower eyelid with a sterile cotton ball (ball) and ask the patient to look up.

8. Drip drops at intervals of 1-2 seconds in the conjunctival cavity closer to the inner corner of the eye without touching the eyelashes and eyelids (always keep the pipette vertically only to medicine does not fall into its rubber part).

9. Push the inner corner of the eye for 1-2 minutes, so that the medicine is not on the glass tear ducts in the nose.

10. Excess drug dab the swab.

11. Waste materials add a container to collect the waste materials.

12. Make a note in the medical record of the manipulations. Note: the presence of purulent eye discharge furatsilin first rinse, then drip drug.

Care for the nose

In critically ill patients in the nasal mucosa accumulates large amounts of mucus, making it difficult to breath and aggravates his condition. Weakened patients can not relieve nasal passages independently, a nurse must remove the crust formed on a daily basis.

Purpose: prevention of disorders of nasal breathing.

Indications: a serious condition of the patient, presence of secretions from the nose, dry nose, plenty of scabs.

Facilities (sterile): tray, beakers, tweezers, cotton turundy, gloves, sterile vegetable oil (sea buckthorn olive, peach,).

Prerequisite: Do not use sharp objects.

1. Wash and follow hygienic hand antisepsis, wear gloves.

2. Pour into a sterile beaker vegetable oil *.

3. Take turunda tweezers, gently squeeze.

4. Transfer turunda in his right hand and enter the rotary movements in the nasal passage for 1-3 minutes, lifting the tip of the patient's nose with his left hand.

5. Remove turunda rotational movements of the nasal passage. 6. Deal with the second nostril in the same way.

7. Place the processed turundy, tweezers, a beaker into a container for waste materials.

8. Remove gloves and put them in a container for waste materials. Wash your hands, dry it.

If the patient is in serious condition observed runny nose (rhinorrhoea;. Rhino- + Greek rhoia for, expiration) - copious exudate mucosa of the nasal cavity, it is recommended to drip into the nose sterile saline solution, followed by aspiration of the contents by suction.

* Note: sterile vegetable oil can be used for nasal instillation patient with severe mucosal dryness, such as uremia, diabetes. It is possible to perform nasal irrigation with sterile 0.9% sodium chloride solution followed by instillation of 5 drops of vegetable oil. If you have dry crusts in the nasal vestibule via turundy can be applied ointment "levomikol".

Instill drops in nose

Material Required: Sterile eye pipette tray drug nasal turundy for waste materials tray gloves.

1. Wash your hands, dry them, put on gloves.

2. The patient should lay or seat, ask him to throw back his head slightly tilted back and to the side.

3. In the presence of secretions in the nose, or crusts nose clean cotton turundas (see algorithm. Above).

4. Preheat the drug to a temperature of + 35-37 ° C.

5. Eye pipette type required amount of the drug based on the two halves of the nose.

6. The left hand gently lift the tip of the nose.

7. Drip alternately assigned to the number of drops in the other half of the nose, where rotated head, nose wing press, hold for 1-2 minutes, then do the burying in the other half of the nose (always keep the pipette vertically only to cure has not got it in the rubber part ). If the patient is lying, his head to one side and expand somewhat posterior to the drops do not flow from the nasal cavity.

8. The waste material disinfect, disposable tools, gloves, fold into a container for waste materials.

9. Follow the hygienic hand antisepsis, drain, put on protective hand cream.

Skin care

For patients moving by themselves at hospital hygiene bath or shower with a change of bed clothes suit once in 7 days. Patients with bed rest, who are not able to take a bath or shower, sanitization of the whole body skin is accomplished by wiping with disposable wipes impregnated with an antiseptic.

Patients who are on a shared mode, a daily skin care is carried out independently. Patients with bed rest, morning toilet helps to hold the medical staff. This warm water and soap to wash their hands, face, neck, ears, wipe the skin armpits, under the breasts and crotch.

The skin of genitals and anus in normal conditions require daily washing. Walking patients for this purpose use a bidet, wash away bedridden for at least 2 times a day.

Hands should be washed in the morning, before eating and after any contamination during the day, especially after using the toilet. Feet should be washed daily at night with warm water and soap.

In the last decade there was a set of hygienic means to facilitate the care of seriously ill patients, located in the long-term bed rest, patients. Modern hygiene products used in the world . This, for example, products of the «Paul Hartmann», «Seni Care», etc. Frequent use of conventional hygiene products (soap) as well as antiseptics in the hospital can lead to irritation, damage to the sensitive skin of the patient, especially the elderly. Developed care products for daily hygiene, do not require soap, especially such important tools for patients who used diapers (these cosmetics can be used both in hospital and at home for preventing chafing and pressure sores). Thus, for example, lotions, wipes, gels, cleansing foam, wet gloves, foam sponges, used without soap and water, used to cleanse the patient's intact skin and fecal incontinence. On clean skin applied balm, cream for the care and protection of the skin, containing zinc. These funds are handled all folds that prevents chafing. Products that contain in their composition of camphor and menthol (such as liquid «Menalind professional»), is applied to at least 3 times a day in the field of education possible bedsores.

Processing algorithm patient's skin

The purpose of skin care:

1) prevention of infections;

2) preservation of the skin clean, hydrated, uninjured.

Indications: seriously ill, weakened, feverish patients, patients who are on mechanical ventilation, patients with disorders of the musculoskeletal system functions.

Equipment: bowl, packaging, bottles with a material for skin care; towel capacity for waste materials, gloves.

Before performing the procedure, you must wash your hands, perform their hygienic antiseptic and put on gloves.

1. Explain to the patient the purpose and course of the procedure, obtain consent, use the screen when performing manipulations in the chamber, put on gloves.

2. Put on the bedclothes absorbent diaper.

3. Remove the patient's shirt (pajamas).

4. Moisten a disposable mitten (eg, «Vala Slean soft») warm water, wring it out and wipe her face, pat face with a towel.

4. Pre-dissolve 10 ml detergent lotion (for example, «Menalind professional») in 1.5 liters of warm water soak solution disposable mitten.

5. Wipe consistently ears, neck, chest (front), abdomen and extremities.

6. Blot dry with a towel.

7. Patients in the folds under the breasts, in obese patients - in the folds on the anterior abdominal wall, apply a sunscreen with zinc oxide (the cream should completely soak).

8. Turn the patient on his side, rub back and lumbar region, legs back, pat dry with a towel. 9. Inspect the areas of potential chafing and pressure sores (on the limbs - interdigital spaces).

10. On the heels and elbows, apply protective foam protector (for the purpose of prevention of bedsores).

11. Before changing the diaper disinfect pelvis, change gloves, mix the solution (look №4).

12. Undo the diaper fasteners velcro wrap inside to avoid damage to the patient's skin.

13. Extend the patient's legs and fold the diaper inside.

14. Wet the mitten disposable, squeeze and rub the intimate area from front to back. Each side of the gloves used once.

15. Soak cloth intimate area.

16. Turn the patient on his side.

17. Remove the used diaper in a waterproof bag for waste materials.

18. Take a disposable mitten, soak in the solution, wring out and wipe the buttocks, dab a napkin.

19. On the skin folds of the groin, buttocks and sacrum after drying, apply a protective foam protector.

20. Expand the clean diaper, fold it in half lengthwise and flatten the protective sleeve.

21. Spend the back of the diaper, which are fastening - velcro between the patient's legs from front to back.

22. Put on the front part of the diaper and fasten the buckle.

23. Place the patient.

24. Remove the used equipment (bowl should be cleaned and disinfected using a disinfectant disinfection according to plan in the hospital).

25. Wash and dry hands.

26. Make a note on the implementation of procedures in the medical records. 7. Change of bed clothes and underwear

Matron works at each department, which is responsible for the regular change of linen and timely shipment of dirty laundry to the laundry. Linen is made regularly to the extent of its pollution, but at least once every 7 days. If there are seriously ill with involuntary urination or defecation at the department, the matron is obliged to leave the younger nurse a few extra sets of clean clothes to change.

Bed patients with involuntary urination and defecation release should have special mattresses, which consist of three parts: the middle part of a device for the vessel. Linens such patients change more often than usual - to the extent of contamination.

Patient's bed must be regularly relay: in the morning, at night and before day rest. The nurse shakes off the crumbs with sheets, spreads her fluffs pillows. The patient can sit on a chair at this time. If the patient can not move, then you need to shift it together on the edge of the bed, then spreading to the vacant half of the mattress and the sheets, remove them with crumbs and shift the patient to the cleaned half the bed. The same is done on the other side.

Change of bed clothes

Changing the sheets under the seriously ill requires a certain skill personnel. If the patient is allowed to turn on his side, first cautiously raising the patient's head, removed the pillow. Then help him to turn on his side, facing the edge of the bed. On the vacant half of the bed, located behind the patient, rolled dirty sheet so that it is in the form of a roll lay along its back. On the vacated seat put the net, and half rolled-up sheet. Then, help the patient to lie on his back and turn on the other side. After that, he will be lying on a clean sheet to face the opposite side of the bed. Next, take out dirty sheet and straighten clean sheet.

If the patient can not perform active movements, the sheet can be changed in the following manner. Starting with the head end of the bed, dirty rolled sheet, together with the lifting nurse the patient's head and upper torso. In place of dirt lay rolled up in the transverse direction of the clean sheet and straighten it to make space. Then, put a clean sheet and pillow lowered her patient's head. Furthermore, raising the patient's pelvis, dirty sheet slid to the foot end of the bed.

In its place straighten clean sheet. It then remains to delete the dirty sheet. Squaring a clean sheet until the end of the mattress, run by its edges under the mattress.

Change of linen undergarments patient in the hospital is done after hygienic bath at least once every 7 days. Untidy, sweating and very debilitated patients as needed linen changed often. Seriously ill shirts changed as follows: slightly lifting the upper torso, collect it from the back to the neck. Raising the hands of the patient, remove the shirt over his head and then released from the hands of the sleeves.

If one arm of the patient is damaged, the sleeve is removed first with healthy hands, and then - with damaged. Clean clothes patient dressed in reverse order: first - the sleeves, then - shirt over his head and straightened it along the back.

Basic skin care method - a washing disposer dust, microbes, sebum, sweat, and various contaminants skin.

Lesson 5:

8. Bedsore, bedsore prevention education

Bedsores (Latin decumbere (lie), dekubitalnaya gangrene.) is a deep lesion of the skin and soft tissue down to the immobilization due to prolonged compression of (ischemic necrosis of the skin and soft tissues). It should be noted that this term is today considered not quite correct, because the sores occur in patients with impaired nutrition of tissues, not only under the influence of external compression of, but also as a result of various diseases (eg, spinal cord). Pressure sores are formed in places where there is no muscle where soft tissues are tightly pressed against the bearing surface.

Predisposing factors include violations of local circulation, innervation and nutrition of tissues. Bedsores can be formed wherever there is bony prominences.

When the position of the patient on the back - it is the sacrum, heels, shoulder blades, elbows and sometimes the back of the head. When sitting it - point of the buttock, legs, feet, shoulder blades. In the prone position - a ribs, knees, toes on the back side, the iliac crest. Bedsores quickly become infected, leading to serious complications.

Places Education bedsores

Three main factors are established, leading to the formation of pressure ulcers: pressure, "shear" strength and friction.

Pressure is under the action of its own weight of body tissue compression takes place relative to the surface upon which the person. At full compression of 2 hours during formed necrosis.

"Shear" force is destruction and mechanical tissue damage occurs under the influence of indirect pressure. It is caused by displacement of the supporting surface tissues. Microcirculation in the underlying tissue is disturbed, and the tissue dies from lack of oxygen. Displacement occurs when the patient is "moving out" on the bed down or pulled up to her bedside.

Friction is a component of "shearing" forces, it causes detachment of the stratum corneum and leads to ulceration of the surface. Friction increases in skin moisture. The sign of bedsores is the appearance of the skin area bluish-red color without clear boundaries. Then exfoliate the epidermis, formed bubbles. Further, tissue necrosis occurs spreads in depth and laterally. On the heels of the formation of pressure sores goes unnoticed because of the presence there of a thick layer of skin, a sign of stage 1 can be the presence of white spots.

Diagnosis of infection is performed bedsores doctor. Diagnosis is based on survey data. It uses the following criteria: 1) purulent discharge; 2) pain, swelling of the wound edges.

The diagnosis is confirmed with bacteriological microorganism isolation in crops fluid samples obtained by puncture or smear of the wound edges. Infections bedsores that developed in the hospital, recorded as nosocomial.

Treatment is carried out in accordance with the degree of destruction.

Degree I - limited to the epidermal and dermal layers. Skin is not broken. The main objective of treatment at this stage is the prevention of infection and the impact of damaging factors.

If you have a first degree of damage should be intensified prevention activities: turning the patient every 2 hours, use of funds aimed at reducing the pressure force - plastic tire, special beds and mattresses, pillows, pads, filled with foam, water, gel, air systems controlled pressure and vibration, which reduce the local pressure on the skin. Local treatment of the emerging pressure ulcers involves a careful toilet area of modified skin. However, it should be remembered that currently do not recommend the use of hexachlorophene, chlorhexidine, and povidone-iodine, as they violate the permeability of cell membranes and inhibit the ability of cells to resist the invasion of bacteria. Not recommended for use and aniline dyes ("brilliant green"), which have no significant effect on the skin, however, difficult to assess the course of the process.

Treatment: Skin treatment is advantageously carried out with sterile physiological sodium chloride solution or inert drugs, not having ion-exchange properties, may be used bandage with ointment "Solkoseril" or ointment "Betadine". After careful drying of the skin is possible to use 10% alcohol, camphor or 2-fold diluted in 70% alcohol. Assign physiotherapy - UV irradiation.

Degree II - shallow surface compromising the integrity of the skin, apply to the subcutaneous fat layer.

Treatment: The treated skin around the bladder with sterile saline solution of sodium chloride, after opening the bladder, cut the shell of the latter, and the wound was washed with sterile physiological sodium chloride solution, closed with sterile dry cloth, which is replaced at least getting wet.

To protect the skin from infection recently used Adhesive transparent film dressings, hydrocolloid and hydrogel dressings ( "Kosmopor", "Gidrofilm», «Algoplaque»), foam semipermeable dressing. For wounds with exudation use superabsorbents ("TenderVet"), which facilitates the rapid purification of wound, stimulate the processes of proliferation.

Semipermeable hydrocolloid dressing («Algoplaque») has two layers: an inner layer which comprises particles of hydrocolloids CMC and grid on a flexible outer layer, which is a polyurethane substrate. Upon contact with the wound dressing slowly absorbs fluid, contributing to the healing process. It has great flexibility, conformability and adhesion, making it ideal for covering wounds in hard to reach areas (ulcers in the trochanter or the heel), does not flake when moving or when wet. Due to transparency it allows you to constantly monitor the wound. It is important to note that it is air permeable but waterproof and impermeable to bacteria. These properties allow you to take a bath or shower, to protect the wound from external contaminants and provide a gas exchange that promotes drainage of fluid.

Mode of application:

- Clean the wound with saline or antiseptic.

- Dry the skin around carefully with a sterile material.

- Select the appropriate size of the bandage so as to leave 3 cm bandage covering healthy skin around the wound.

- Remove the protective film and attach the dressing to the wound without tension, making sure not to touch the sticky part of the fingers.

- Smooth soft bandage over the wound and more firmly on healthy skin.

Change the bandage is held not earlier than 48 hours. It is best to wait to patch itself was partially undocked before the upcoming replacement. It is important to remember that change is too early can damage healthy skin! Contraindications: Do not use «Algoplaque» for infected wounds and wounds with a very pronounced exudation.

In the event of any signs of inflammation in the wound, the patient should be assigned to antibiotic therapy in combination with a more frequent change of dressings. Degree III - the complete destruction of the skin in its entire thickness to the muscle layer with the penetration into the muscle itself.

Degree IV - the defeat of all soft tissue. Education cavity with damage to her underlying tissues (tendons, down to the bone).

The third and fourth degrees are treated by using surgical dissection and removal of necrotic tissue. Use topical microbicides, necrolytic, dehydrating drugs, stimulators of reparative processes. The use of ready-to-use, sterile, hermetically packaged wound dressings facilitates wound care.

To stimulate healing processes using ultrasonic treatment of ulcers, phonophoresis (ultrasound) with preservatives, the impact on the fabric low- intensity laser radiation.

At all stages of the treatment of complicated bedsores conduct discharge crops to study the nature and sensitivity of microflora selected, and then apply antibiotics.

The criterion of effectiveness of conservative treatment of pressure ulcers is to reduce its size by 30% or more within two weeks. If it does not need to reconsider the tactics of treatment and consult a surgeon. It should be noted in patients with pressure ulcers must be balanced diet high in protein and vitamins. To this end use may further special nutrient mixture (Nutrizon et al.).

Preventing pressure ulcers

Indications: prolonged bed rest, damage to the central or peripheral nervous system, metabolic disorders in the body, dysfunction of the excretory system.

Facilities (sterile): tray, wipes, tweezers; 10% solution of camphor alcohol or 40% ethanol solution; underwear and bed linen, pillow, foam circles, foam cotton-gauze rings. The volume of necessary measures:

1. To assess the risk of bedsores at first contact (or use the Norton scale of Waterloo).

2. Inspect the skin daily in areas of potential pressure sores: sacrum, heels, ankles, shoulder blades, elbows, neck, trochanter, femur, the inner surfaces of the knee to assess the condition of the skin each time you move, change of state.

Note: The detection of pale and reddened skin areas need to call a doctor and immediately start preventive and therapeutic measures.

3. Eliminate irregularities, wrinkles on the underwear and bed linen (optimal use of the tensioned sheets with elastic bands, blankets should be easy).

4. Shakes off the crumbs from the sheets after feeding.

5. To change the position of the patient's body in bed every 2 hours during the day, raising it above the bed, laying alternately on the side, abdomen (position Fowler Simpsa, on the left, the right side, abdomen, permitting the disease and the condition of the patient).

6. To wash 2 times a day (morning and evening) places the possible formation of bedsores with warm water and mild soap (it is better to use the funds for specialized care), then wipe dry with a towel (do blotting motion), to process a cloth soaked in warm camphor alcohol or ethyl alcohol.

7. Apply a protective cream.

8. Rub the soft tissue in areas of potential bedsores techniques of massage (massage is done very carefully). Do not do massage in the area of bone protruding portions.

9. Use the waterproof pad, diapers (incontinence of urine, feces).

10. Lay foam circle in the pillow under the patient's sacrum and elbows, and the patient's heel. But much better to use anti-bedsore pneumatic system. It is a polymer of a soft mattress, which consists of individual small sections alternately filled with air from a compressor of a special (picture compressor left on the table).

11. Educate family and all those involved in the care, prevention of bedsores measures. 12. Opportunity to influence the rating of risk factors of pressure sores (ie the introduction of nutritional support in the form of special nutritional formulas, increased fluid intake, etc.).

9) Types of patient transportation

Mode of transport determined by the physician. Patients in satisfactory condition after medical documentation and sanitizing is directed into the chamber, accompanied by a health professional. It is important to note that some of the patients in need of emergency care directly to the emergency room and they are non-transportable. After first aid they are transferred to the intensive care unit. In some cases, patients in serious condition, such as shock events, direct without first sanitizing, bypassing the emergency department directly to intensive care unit.

Patients in serious condition, as well as violations of the musculoskeletal system are transported on a gurney, stretcher or wheelchair. In the event that you need for admission office is located in another building, well away from the front desk, use a special ambulance transport.

10) Rules of patient transportation by stretchers

Each wheelchair must be filled with clean sheets and blankets depending on the season. The linen is changed after each patient. Blankets after infectious patients sent for disinfection. In the absence of seriously ill elevator lift on a stretcher 2 or 4 people, coming up; the patient's head is carried forward and lift the lower end of the foot stretcher. During the descent of the patient are kicking forward, also raising the lower end of the foot stretcher. Seriously ill patients who can not move, shift from the stretcher to the bed with great caution, observing certain rules: put the stretcher foot end to the head end of the bed. If the area does not allow the House, put in parallel stretcher beds and medical personnel becomes between the stretcher and the bed face of the patient. It is necessary to think in advance how to put the stretcher with respect to the bed, to avoid inconvenient and unnecessary movements.

It should be noted that at present for shifting patients are increasingly using special lifting devices, especially when they are needed shifting obese patients with a large weight.

In the absence of patient gurneys can transport: 1) one person - the patient clings to his neck paramedic; 2) two people - one holding the legs and buttocks of the patient, the other supporting the back and head; 3) The three men - one holding the legs, the other - the lower back and back, the third - the back and head. 11. Rules of patient transportation by wheelchair

1) Tilt the wheelchair forward, stepping on a footrest;

2) ask the patient to stand on the footrest, then, keeping him seated in a chair;

3) Lower the wheelchair to its original position;

4) using the frame located behind the wheelchair, give the patient to the desired position: sitting, reclining or lying down;

5) transporting the patient to the office, make sure that his hands did not extend beyond the wheelchair armrests;

6) in the House of help the patient to transfer to the prepared bed, place, cover it;

7) wheelchair disinfect.

12. Rules of patient transportation by hand stretchers

When transporting patients on stretchers bearers must follow certain rules: 1) to raise and lower the stretcher to be careful at the same time, holding them in a horizontal position;

2) should not be allowed rocking stretcher, shocks, sharp turns, for that porters should not go up;

3) on level ground and climbing stairs stretcher to wear head end forward, lifting the foot end, and when descending the stairs - feet first, lifting the foot end;

4) coming from behind must observe the condition of the patient;

5) If any of the porters when carrying felt tired, you should immediately report it as tired fingers may involuntarily relax.

5. LITERATURE Main literature 1. Zalikina, LS Nursing: the textbook / LS Zalikina. - M .: OOO "Medical News Agency", 2008. - 201 p.

2. Fundamentals of nursing: Ouch. Benefit / LV Roman'kov [et al.]. - Minsk: Elaida, 2012. - 200 p.

3. Basics of therapeutic care patients: Ouch. Benefit / KN Sokolov [et al.]. - Grodno, 2016. - 252 p.

Additional literature

4. Pocket Guide nurse. "Medicine for you" series. / OV Chernoff [et al.] - Rostov n / D .: Phoenix, 2010. - 672 p.

5. Mendzheritsky, IM Directory nurse / IM Mendzheritsky. - Rostov n / D .: Phoenix, 1997. - 640 p.

6. Obukhovets, ETC. Fundamentals of Nursing: a tutorial. / TP Obukhovets, TA Sklyarov, OV Chernoff. - 6th ed., Ext. and rev. - Rostov n / D .: Phoenix, 2005. - 505 p.

7. Annex 2 MZRB order from 28.08.2005, №477. Head of the department of Internal Diseases No.1 with Endocrinology Course,

PhD, assist. of Professor E.G. Malaeva