Hygiene of patients in a hospital. Lecture for students on the topic: "Personal hygiene of the patient"

Personal hygiene of the patient is maintaining the cleanliness of his body, underwear and bedding, shoes, clothes, and home.

Following the rules of personal hygiene contributes to the speedy recovery of a sick person, and in healthy people it helps to maintain and improve health.

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Principles and goals of hygienic patient care

A sick person often cannot cope with hygiene procedures on his own and needs outside help:

1. When taking a bath or shower.
2. Shaving.
3. Washing.
4. Nail and hair care.
5. When performing physiological functions.

The hands of the nurse become the hands of the patient himself. However, when providing assistance, one must strive for independence and encourage this desire on the part of the patient.

The basic principles of hygienic patient care are:

• safety – prevention of injuries to the patient;
• Confidentiality – keeping details of the patient’s personal life secret;
• respect for dignity - performing all manipulations strictly with the consent of the patient, ensuring privacy if necessary;
• communication - discussion of the plan for upcoming manipulations, the location of the patient and his relatives for the conversation;
• independence – encouraging the patient’s desire for independence;
• infection safety – carrying out appropriate measures.

Assistance with the patient's personal hygiene is provided to ensure cleanliness, comfort and safety. All hygiene procedures must be carried out under the supervision of hospital staff.

What happens if you do not provide the patient with the necessary care products?

What care products are provided free of charge to seriously ill, bedridden patients in hospitals? Does a medical organization have the right to demand that relatives purchase care products at their own expense?

Basic hygiene measures

Personal hygiene of the patient involves daily morning and evening toilet, brushing teeth 2 times a day and rinsing the mouth after each meal. If there are no contraindications, take a shower at least once a week.

Washing

Change of underwear

Patient card

The form of the document is contained in GOST R 56819-2015 “National Standard Russian Federation. Proper medical practice. Infological model. Prevention of bedsores."

Taking a bath

Personal hygiene of the patient is impossible without taking a bath (except when the patient is unconscious). Baths are divided into:

1. Hygienic.
2. Medicinal.
3. Are common.
4. Local.

A weakened patient should be immersed in the bath very slowly, on a sheet that must be held on both sides. While taking a bath, the patient should remain constantly near him.

Wet wraps are performed using two sheets soaked hot water. First, the patient is wrapped in them, and then in oilcloth and two woolen blankets.

Features of catering

Medical nutrition presupposes a certain qualitative composition of food, as well as the quantity, timing and frequency of intake. Best option for a sick person - four meals a day at the same time of day.

Poor nutrition in different time days with a significant simultaneous overload of the stomach negatively affects the process of food digestion, impairs digestibility and provokes disturbances in the gastrointestinal tract.

In a hospital setting, food is served in the dining room, where patients receiving the same diet sit at the same table.

Seriously ill patients are spoon-fed in the ward, in a semi-sitting or sitting position, with a napkin or towel placed under the chin. The patient should be given water from a special sippy cup or small teapot.

The dishes from which the patient ate must be immediately washed with hot water, soap and mustard, and then rinsed with boiling water.

Caring for the oral cavity and dentures in conscious patients

Personal hygiene of the patient involves caring for the teeth and oral cavity. Below is an algorithm for caring for the oral cavity and dentures in conscious patients.

Necessary equipment	Preparation for the procedure	Executing the procedure	Completing the procedure
towel	Explain to the patient the essence and course of the upcoming procedure, obtain his consent.	Ask the patient to rinse his mouth with water (hold the tray at the chin);	Rinse your dentures in cool running water and use your other hand to rinse the cup.
two pairs of gloves	Ask the patient to turn their head in your direction.	If necessary, dry the patient's chin with a towel.	Place dentures in a cup for overnight storage.
mitten	Cover the patient's chest to the chin with a towel.	Help the patient clean the mouth with a napkin (if he has his own teeth, help brush them with toothpaste and a brush);	Close the faucet valve using a paper towel.
gauze wipes	Wash your hands with hot water and soap, wear gloves; if the patient is coughing, wear glasses and a face shield.	Help clean the palate, gums, tongue, the area under it, the inner surfaces of the cheeks (the napkin should be changed every time it becomes covered with sticky saliva or mucus, throw used napkins into a garbage bag).	Help the patient put on dentures (if the patient does not want to put them on, leave the dentures in a cup, adding enough water to cover them completely).
glass with clean water	Place one tray on a towel under the patient's chin.	Ask the patient to rinse his mouth with water (hold the tray at the chin);	Remove gloves and place them in a trash bag.
two trays	If possible, ask the patient to hold the tray.	If necessary, wipe the patient's chin dry.	Wash your hands with hot water and soap.
toothpaste and brush	Ask the patient to draw water and rinse his mouth (to prevent water from spilling, you must hold the tray under the chin).	Bring a cup with dentures to the sink, toothpaste and a brush, mitten, towel.
lip cream or chapstick	Wipe the patient's chin dry if necessary.	Place a terry mitt on the bottom of the sink.
paper napkins	Ask the patient to remove dentures and place them in a cup (if he cannot do this on his own, then using a napkin, carefully large and index finger grab the prosthesis, carefully remove it with oscillatory movements and put down the cup).	Open the tap, adjust the water temperature (it should be cool).
denture cup		Moisten toothbrush water, apply toothpaste to it,

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Personal hygiene of a seriously ill patient

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

Personal hygiene, types of care, principles.

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

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

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

· degree of independence from others;

· level of culture;

· socio-economic status;

level general development;

· degree of individual need.

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

Nursing (or hypurgia) is the activities carried out to meet his basic life needs, alleviate the patient's condition and achieve favorable outcome diseases.

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

Scope of independent nursing interventions:

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

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

· satisfaction physiological needs(feeding, fluid intake);

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

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

Scope of dependent nursing interventions:

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

Special care - allows you to serve patients of a certain type of pathology (neurological, gynecological patients - profiles).

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

Basic principles of care:

1. Safety - infectious and physical.

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

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

4. Individuality - personal approach;

5. Tactfulness - the ability to control oneself;

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

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

· assess self-care ability;

· clarify the degree of professional participation and preferences;

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

Help with washing (at least once a day)

· carry out timely change of underwear and bed linen;

Encourage and encourage the patient to self-care;

· involve relatives, neighbors, social workers.

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

Linen regime in the hospital.

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

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

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

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

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

6. Linen and containers must be labeled by compartment.

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

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

Requirements for a patient's bed

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

Change of linen.

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

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

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

When changing linen, the patient must follow the principles:

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

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

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

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

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

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

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

Elements of caring for a seriously ill patient

Before starting any personal hygiene procedure:

1. Prepare the necessary equipment.

2. Communicate the goal and progress to the patient.

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

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

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

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

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

Skin care.

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

Skin functions:

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

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

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

Skin and mucous membrane care provides:

· its cleaning - removal of secretory and excretory secretions;

· stimulation of blood circulation;

· hygienic and emotional comfort;

· feeling of satisfaction.

The purpose of skin care: maintaining its cleanliness, normal functioning, prevention of diaper rash, bedsores.

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

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

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

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

Areas of diaper rash formation:

under the mammary glands

in the armpits

· in the intergluteal fold

in the groin folds

between the toes (for excessive sweating)

Degrees of development of diaper rash:

1 - skin irritation

2 - bright skin hyperemia, small erosions

3- weeping, erosion, ulceration of the skin.

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

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

Oral care

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

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

· brushing teeth (dentures) morning and evening;

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

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

Caring for removable dentures:

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

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

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

Eye care

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

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

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

Nose care

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

Purpose: prevention of nasal breathing disorders.

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

Mandatory condition: do not use sharp care items.

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

Ear care

The external auditory canal produces wax, accumulations of which can form cerumen plugs and cause hearing loss.

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

Indications: patient's serious condition.

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

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

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

Hair care for seriously ill patients

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

Use of modern care products.

Cosmetic skin care products provide:

· cleansing

nutrition and hydration

· skin protection

Cleansing products:

· Cleansing foam - cleanses skin without water or soap.

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

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

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

Moisturizing products:

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

· Skin care oil - intensive care for irritation.

· Bathing oil; body lotion.

· Hand cream.

Means providing protection:

· Protective creams - protect the skin from the irritating effects of urine

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

Hygienic care products:

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

· Absorbent diapers (hypoallergenic; do not wrinkle)

· Diapers (breathable; odor neutralization, antibacterial effect.

· Disposable gloves.

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

· Incontinence pads for men and women.

· Elastic pants for fixing pads.

Literature

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

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

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

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

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

8. Basikina G.S., Konopleva E.L. Educational and methodological manual on the basics of nursing for students. - M.: VUNMTs, 2000.

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B larger The environment in which the patient is located plays a role in the course and outcome of diseases. First of all, this is compliance with the rules of personal hygiene and hygiene in the ward, ensuring timely and proper nutrition of the patient. In creating favorable conditions in the ward, the main role is assigned to middle and junior medical personnel. Compliance with the rules of personal hygiene, keeping the bed and room clean are necessary for effective treatment. F. Nightingale wrote: “...What, exactly, is meant by hygienic conditions? In essence, there are very few of them: light, warmth, clean air, healthy food, harmless drinking water, cleanliness..." That is why observing the rules of personal hygiene, keeping the bed and room clean are necessary for effective treatment.

The patient's position in bed should be comfortable, the bed linen should be clean, the mattress should be flat; If the bed has a net, it should be taut. For seriously ill patients and patients with urinary and fecal incontinence, an oilcloth is placed on the mattress pad under the sheet. Women with heavy discharge A diaper is placed on the oilcloth, which is changed as it gets dirty, but at least 2 times a week. Seriously ill patients are placed on functional beds and headrests are used. The patient is given two pillows and a blanket with a duvet cover. The bed is made regularly before bed and after sleep. Underwear and bed linen are changed at least once a week after taking a bath, as well as in case of accidental contamination.

Rules for changing clothes

The first way to change bed linen(Figure 6-1)

1. Roll the dirty sheet into a roll in the direction from the head and foot ends
bed to the lumbar region of the patient.

2. Carefully lift the patient and remove the dirty sheet.

3. Place a clean sheet rolled up in the same way under the patient’s lower back and straighten it.

Rice. 6-2. Change of bed linen at heavy ballroom (second method).

The second way to change bed linen(Fig. 6-2)

1. Move the patient to the edge of the bed.

2. Roll up the free part of the dirty sheet with a roller from the edge of the bed towards the patient.

3. Spread a clean sheet over the vacant space, half of which remains rolled up.

4. Move the patient onto the spread half of a clean sheet, remove the dirty sheet and straighten the clean one.

Change of underwear

1. Place your hand under the patient’s back, lift the edge of his shirt to the armpit area and the back of the head.

2. Remove the shirt over the patient’s head (Fig. 6-3, A), and then from his hands (Fig. 6-3, b).

3. Put on the shirt in the reverse order: first put on the sleeves, then throw the shirt over the patient’s head and straighten it under his back.

4. Put a shirt on a patient who is on strict bed rest.
vest

Skin careand prevention of bedsores

The skin performs several functions: protective, analytical (skin sensitivity), regulatory (regulation of body temperature: heat loss through sweating healthy person accounts for 20% of the total heat loss per day, and in febrile patients - much more), excretory. Through the skin sweat glands water, urea, uric acid, sodium, potassium and other substances are released. At rest at normal temperature The body secretes about 1 liter of sweat per day, and in febrile patients - up to 10 liters or more.

When sweat evaporates, metabolic products remain on the skin, destroying the skin. Therefore, the skin must be clean, for which you should change your underwear more often, wipe the skin with cologne, water with 96% alcohol (1:1 ratio), disinfectant wipes or solutions (for example, 1 glass of water + 1 tbsp. vinegar + 1 tbsp camphor), wipe the skin with a dry, clean towel.

Particular attention should be paid to the condition of the skin groin area, armpits, in women - the area under the mammary glands. The skin of the perineum requires daily washing. Seriously ill patients should be washed after each act of defecation, and in case of urinary and fecal incontinence - several times a day to avoid maceration and inflammation of the skin in the area of ​​the inguinal and perineal folds. Women are washed more often.

Seriously ill patients may develop bedsores. Bedsore (lat. decubitus; syn. - decubital gangrene) - necrosis (necrosis) of soft tissues (skin involving subcutaneous tissue, the wall of a hollow organ or blood vessel, etc.), resulting from ischemia caused by prolonged continuous mechanical pressure on them. Bedsores appear most often on the sacrum, shoulder blades, heels, elbows from prolonged compression of the skin area and impaired blood circulation in it (Fig. 6-4). First, redness and soreness appear, then the epidermis (surface layer of skin) peels off and blisters form. With deep bedsores, muscles, tendons, and periosteum are exposed. Necrosis and ulcers develop, sometimes penetrating to the bone. Infection penetrates through damaged skin, which leads to suppuration and blood poisoning (sepsis).

The appearance of bedsores is evidence of insufficient care for the patient!

If a localized area of ​​skin redness appears, you should wipe it with a 10% camphor solution, a damp towel, and irradiate it with a quartz lamp 2 times a day. If bedsores have formed, it is necessary to lubricate them with a 5% solution of potassium permanganate, apply a bandage with Vishnevsky ointment, synthomycin liniment, etc.

Measures to prevent bedsores

The patient's position should be changed every 1.5-2 hours.

It is necessary to straighten the folds on the bed and linen.

You should wipe your skin with a disinfectant solution.

Wet or soiled linen should be changed immediately.

You should use backing rubber circles placed in a cover or covered with a diaper. The circle is placed in such a way that the place of the bedsore is located above the hole in the circle and does not touch the bed; They also use special air mattresses with a corrugated surface.

It is necessary to wash and wash patients in a timely manner.

Currently, to prevent bedsores, a so-called anti-bedsore system has been developed, which is a specially designed mattress. Thanks to the automatic compressor, the mattress cells are filled with air every 5-10 minutes, as a result of which the degree of compression of the patient’s tissues changes. Massage of tissues by changing the pressure on the surface of the patient’s body maintains normal microcirculation of blood in them, ensuring the supply of skin and subcutaneous tissue nutrients and oxygen.

Use of vessels and urinals

For patients on strict bed rest, if it is necessary to have a bowel movement, they are given a bedpan, and if they need to urinate, they are given a urinal (women usually use a bedpan when urinating, and men - a so-called duck). Vessels are made of metal with enamel coating, plastic and rubber. A rubber bed is used in weakened patients, as well as in the presence of bedsores, fecal and urinary incontinence.

Before giving a urine bag to the patient, the latter must be rinsed with warm water. After urination, having poured out its contents, the urinal is rinsed again with warm water.

Washing the sick (women)

Necessary equipment: a jug with a warm (30-35 °C) weak solution of potassium permanganate (antiseptic) or water, a forceps, a napkin, an oilcloth, a vessel, gloves (Fig. 6-5). Procedure:

1. Help the patient lie on her back; your legs should be slightly bent at the knees and spread apart.

2. Lay down an oilcloth and place a bedpan on it, placing it under the patient’s buttocks.

3. Stand to the right of the patient and, holding a jug in your left hand, and a forceps with a napkin in your right, pour an antiseptic solution onto the genitals, and wipe them with a napkin, making movements in the direction from the genitals to the anus, i.e. top down.

4. Dry the skin of the perineum with a dry cloth in the same direction.

5. Remove the vessel and oilcloth.

Vessel delivery

Necessary equipment: vessel, oilcloth, screen, disinfectant solution. If a seriously ill patient has an urge to defecate or urinate, the following is necessary (Fig. 6-6):

1. Separate him with a screen from those around him, place him under the patient’s pelvis next to the leonka.

2. Rinse the vessel with warm water, leaving a little water in it.

3. Place your left hand under the patient’s sacrum from the side, helping him raise the pelvic area (while his legs should be bent at the knees).

4. With your right hand, move the vessel under the patient’s buttocks so that the perineum is above the opening of the vessel.

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

6. Pour the contents of the vessel into the toilet, rinsing the vessel with hot water.

7. Wash the patient, dry the perineum, remove the oilcloth.

8. Disinfect the vessel with a disinfectant solution.

Oral care

Every person needs to follow basic rules of oral care:

Rinse your mouth with water after every meal;

Brush your teeth at night and in the morning, since during the night the surface of the mucous membrane of the mouth and teeth is covered with a soft coating consisting of epithelial cells, mucus and microorganisms. In patients, plaque formation accelerates, as metabolic products begin to be released through the oral mucosa: nitrogenous substances in renal failure, glucose in diabetes mellitus, mercury in mercury poisoning, etc. These substances contaminate the mucous membrane and often lead to intensive proliferation of microorganisms. Oral care for seriously ill patients should be more thorough; he is carried out by a nurse.

Oral examination

The patient opens his mouth. The nurse uses a spatula to pull back the patient’s lips and cheeks. When examining the palatine tonsils and back wall The throat is pressed with a spatula on the root of the tongue and the patient is asked to pronounce the sound “A-A-A”. When examining the oral cavity, tonsils and pharynx, enhanced lighting is necessary, for which you can use a reflector lamp.

Mouth rinse

After each meal, the patient is recommended to rinse his mouth with a 0.5% sodium bicarbonate solution (solution baking soda) or 0.9% sodium chloride solution (saline). After this, the tongue is wiped: a sterile gauze napkin is placed on the tip of the tongue, the tip of the tongue is pulled out of the mouth with the left hand, and with the right hand, using a damp cotton ball held in tweezers, the plaque is removed from the surface of the tongue and the tongue is lubricated with glycerin.

Oral rinsing

Rinsing the oral cavity is carried out using a syringe, a rubber balloon, an Esmarch mug with a rubber tube and a glass tip. Weak solutions are used: 0.5% sodium bicarbonate, 0.9% sodium chloride, 0.6% hydrogen peroxide, potassium permanganate (1:10,000), etc. The patient is seated or given a semi-sitting position with his head slightly tilted so that the liquid did not enter the respiratory tract. The neck and chest are covered with oilcloth, and a basin or tray is placed under the chin. The patient lying on his back should have his head turned; if possible, then the patient himself is turned on his side. The corner of the mouth is pulled back with a spatula and a stream of water under moderate pressure is used to wash first the vestibule of the oral cavity, and then the oral cavity itself. If a seriously ill patient has removable dentures, they should be removed (and washed) before the procedure.

Esmarch's mug is a special mug for enemas and douching. Proposed German doctor Friedrich von Esmarch (1823-1908).

Personal hygiene- a branch of hygiene that studies the issues of preserving and strengthening human health by observing the hygienic regime of his life and activities. A patient treated in a hospital spends most of the time in bed, so an important condition bed comfort is essential for his well-being and recovery. Compliance with the rules of personal hygiene, keeping the room and bed clean create conditions for a speedy recovery of patients and prevent the development of many complications. Adequate care is the key to success in treating seriously ill patients. The more severe the patient’s condition, the more difficult it is to care for him, and the more difficult it is to perform any manipulations. It is necessary to clearly know the methods of manipulation and be able to perform them. The nurse must perform all manipulations regarding the patient’s personal hygiene while wearing gloves. M/s helps the patient in meeting hygienic needs if it is impossible to fulfill them himself.

Independent nursing interventions:

personal hygiene procedures (change of bed and underwear, skin hygiene, morning toilet, etc.);

satisfaction of physiological needs (feeding the patient, taking an adequate amount of fluid, etc.);

satisfaction of physiological functions (feeding of a vessel, urinal);

Dependent Nursing Interventions:

carrying out any manipulations as prescribed by a doctor (injections, dressings, distributing medications, physiotherapeutic procedures, administering enemas, administering urinary catheter and etc.).

Principles of patient care:

safety(preventing patient injury);

confidentiality(details of personal life should not be known

to outsiders);

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

communication(disposition of the patient and his family members to talk, discussion

progress of the upcoming procedure and care plan in general);

independence(encouraging each patient to become independent);

infection safety(implementation of relevant activities).

The patient's personal hygiene includes daily morning and evening body care. It includes a set of measures to care for the face, perineum and entire body.

Caring for the eyes of seriously ill patients.

Target. Prevention purulent diseases eye.

Equipment. Sterile kidney-shaped tray with 8-10 sterile cotton balls; kidney-shaped tray for used balls; two sterile gauze pads; 0.02% solution of furatsilin (in the presence of purulent discharge from the eyes).

Ask the patient to close his eyes and rub one eye with a ball in the direction from the outer corner of the eye to the inner. The procedure is repeated with the other eye. To avoid transfer of infection from one eye to another, different balls and wipes are used for each eye.

Carebehindnoseseriously ill.

Target. Cleansing the nasal passages of mucus and crusts.

Equipment. Cotton wool, Vaseline or other liquid oil: sunflower, olive, or glycerin; two kidney-shaped trays: for clean and used turundas.

Turunda is inserted into the lower nasal passage with rotational movements and leave for 1-2 minutes, then remove with rotational movements, freeing the nasal passage from crusts. Repeat the procedure with the second nasal passage.

Caring for the ears of a seriously ill patient.

Target. Cleansing the auricle and ear canal.

Equipment. Two kidney-shaped trays - for clean and used material; sterile cotton wool (wicks); 3% hydrogen peroxide solution; a napkin moistened with warm water; towel.

Nurse bridges hands with soap. The cotton wool is moistened with a 3% solution of hydrogen peroxide, poured from a bottle above the tray for used material. The patient's head is turned to the side. With your left hand, pull the auricle up and back, and right hand With a rotational movement, the turunda is inserted into the external auditory canal and, continuing to rotate, it is cleaned of sulfur secretions. Repeat the procedure with the other ear.The algorithm will be studied in more detail during a practical lesson.

Instead of hydrogen peroxide, you can use petroleum jelly. It is strictly forbidden to use sharp objects (probes, matches) to clean the ear canal to avoid injury to the eardrum. When wax plugs form, they are removed by ENT specialists.

Care of the oral cavity, teeth, dentures.

In weakened and feverish patients, plaque appears on the oral mucosa and teeth, which consists of mucus, desquamated epithelial cells, decomposing and rotting food debris, and bacteria. This contributes to the occurrence of inflammatory and putrefactive processes in the oral cavity, accompanied by unpleasant smell. The discomfort associated with this leads to a decrease in appetite and a deterioration in general well-being. Bacteria that form in the mouth destroy teeth, contributing to the development of caries (translated as caries). In addition, the resulting plaque causes inflammation of the gums and periodontitis, which contributes to the destruction of the neck of the teeth, their loosening and loss.

If the patient is conscious, but helpless, oral care consists of:

Rinse your mouth after every meal or after every bout of vomiting;

Brushing your teeth (dentures) in the evening and in the morning;

Cleaning the spaces between the teeth once a day (preferably in the evening).

To brush your teeth, it is better to use toothpaste containing fluoride, which strengthens tooth enamel and prevents the development of caries. The toothbrush should be soft and not injure the gums. The brush should be changed as it wears out, once every 3 months. A worn-out brush does not thoroughly clean your teeth. A floss should be used to clean the spaces between teeth (floss) without applying any force. significant efforts as this may cause gum damage and bleeding. When finishing your oral care, be sure to brush your tongue, removing plaque containing bacteria from it. Before brushing the teeth, the patient’s oral cavity must be mentally divided into 4 parts (in half the upper and lower jaws) and begin brushing from the upper one.

If the patient is unconscious, he is not only unable to brush his teeth, but also to swallow saliva, open and close his mouth. In such patients, oral care should be performed every 2 hours, day and night.

Hand and foot care.

Nail care must be carried out very carefully, otherwise this procedure can lead to injury to the skin around the nail bed and subsequent infection (felon). There is no need to cut the patient's nails to the very base, otherwise the skin may be damaged. Particular care must be taken when cutting the nails of patients suffering from diabetes and other ailments accompanied by skin sensitivity.

Diaper rash is an inflammation of the skin in natural folds due to maceration and friction of the skin surfaces. Maceration is the softening and loosening of tissues in a humid, warm environment.

Areas of diaper rash formation: under the mammary glands, in the armpits, inguinal folds, between the toes.

Development of diaper rash: skin irritation - bright hyperemia of the skin - small erosions, weeping, ulceration of the skin (wetting - separation of serous exudate through defects in the epidermis during inflammatory processes in the skin). Prevention of diaper rash: timely hygienic skin care, treatment of sweating. After washing the skin with soap, it must be thoroughly dried and treated with a powder containing talc (only for dry skin).

Personal hygiene- this is keeping a person’s body (skin, hair, mouth, teeth), his bed and underwear, clothes, shoes, and home clean. Maintaining personal hygiene contributes to recovery, preservation and promotion of health.

Rules for preparing a patient's bed. To prepare the bed, you must have a set of linen and bedding, which includes a mattress, two feather or down pillows with pillowcases, a sheet, a blanket with a duvet cover and a towel. A hair or cotton mattress with a smooth and elastic surface is placed on the bed. Place clean and ironed pillowcases on the pillows. The sheets and pillowcases should be straightened so that there are no wrinkles.

Rules for changing bed and underwear. Linen is changed after the next sanitary treatment, usually once every 7-10 days. In seriously ill patients this is done with great caution. The patient is carefully moved to the edge of the bed. If his condition allows, then he is laid on his side, the free half of the dirty sheet is rolled across the width to the back, and a clean sheet is spread on the free space, half of which is rolled up accordingly. Rolls of clean and dirty sheets lie side by side. Then the patient is transferred to a clean half of the sheet, the dirty one is removed, the clean one is unrolled and the restoring is completed (Fig. 30, b).

If the patient is prohibited from moving in bed, then the sheets are changed in another way. First, the patient’s head is slightly raised, and the head end of the sheet is folded toward the lower back, then the legs are raised and the other end of the sheet is gathered toward the lower back in the same way, after which it is carefully removed from under the patient. At the same time, on the other side, a clean sheet, rolled along the length with two rollers, is brought under the lower back, and then carefully straightened on both sides - to the head and legs (Fig. 30, a).

When changing underwear, a certain sequence is important: the shirt is lifted up from the back, removed first from the head, and then from the arms; put it on in the reverse order - first put the arms through, then the head and straighten it out. In case of diseases or injuries of the limbs, the underwear is first removed from the healthy limb, and then from the sick one. Put the underwear on in the reverse order, that is, on the injured limb first.

Rules for caring for the patient's skin. When caring for a patient, it is important to ensure that their skin is clean. If the patient's condition is satisfactory, then he takes a shower or a general hygienic bath with the entire body immersed in water, with the exception of the upper chest, in a semi-sitting position. Bedridden patients are given local baths with immersion of only some part of the body, for example, arms or legs. The water temperature should be +37...38°C, the duration of the procedure should not be more than 15 minutes. Seriously ill patients wipe their face daily with cotton wool soaked in warm water (temperature +36...37°C). The body is wiped with a sponge or towel moistened with warm water and toilet soap, in parts, one by one, in a certain sequence: neck, chest, arms, stomach, thighs, legs, rubbing the wetted areas with a dry towel until you feel warm.

Patients with strict bed rest are given warm water and a basin in bed for morning toilet. With the help of a sanitary attendant, they wash their hands first, and then their face, neck and ears. Axillary areas, inguinal folds, folds under the mammary glands, especially in people with excessive sweating and in obese patients, wash especially thoroughly and wipe dry, otherwise diaper rash will develop in the folds of the skin.

The genital area and anus require careful care. For this purpose, walking patients use special toilets (bidets) with a vertical jet of warm water or are washed in another way, and bedridden patients are washed at least once a day. At the same time, an oilcloth is placed under the patient’s pelvis, a bedpan is placed and the patient is asked to bend his knees and spread his legs slightly. A stream of warm water or a weak solution of potassium permanganate is directed from a jug onto the perineum. Then, using a sterile cotton ball, clamped with a forceps, make several movements in the direction from the genitals to anus. Use another cotton ball to dry the perineum (the direction of these movements should be the same).

The appearance of bedsores in bedridden patients is evidence of poor care for them. A bedsore is a superficial or deep ulcer formed as a result of poor circulation and tissue necrosis. Their appearance is facilitated by an uncomfortable, uneven, rarely remade bed with folds and food crumbs; scars on a shirt and sheet, as well as maceration (wet softening) of the skin in seriously ill patients as a result of unsystematic washing and wiping of skin areas contaminated with feces and urine. Most often, bedsores are localized in the area of ​​the sacrum, shoulder blades, coccyx, heels, back of the head, ischial tuberosities and other places with bony protrusions, where soft fabrics squeezed by the bed.

Places that are most dangerous for bedsores are rubbed with a sterile gauze cloth moistened with camphor alcohol, cologne or a 0.25% solution of ammonia, at least 1 time per day, do light massage. Periodically change the patient's position in bed if there are no contraindications to this. Rubber circles, previously covered with fabric, are placed under the points of greatest pressure. Areas of redness (the first signs of the development of bedsores) of the skin are lubricated with a 5-10% solution of potassium permanganate or 1% alcohol solution brilliant green 1-2 times a day. The dense crust that forms prevents necrotic areas from moisture and infection. As prescribed by the doctor, bandages are made with Vishnevsky ointment, which helps speed up the healing process.

Rules for caring for a patient’s hair and nails. The head is washed with warm water and soap once every 7-10 days, after washing the hair is wiped dry and combed. You should not comb your hair with metal combs, as they irritate the scalp. Long hair is combed in separate strands, gradually moving closer to the skin. Combs and combs should be kept clean at all times: washed in a hot 2% solution of sodium bicarbonate and periodically wiped with ethyl alcohol and vinegar. Fingernails and toenails are trimmed (trimmed) regularly.

Rules for caring for the patient’s oral cavity. Removal of plaque that forms on the oral mucosa and on the teeth, as well as food debris, is carried out using mechanical cleaning with a toothbrush or sterile gauze in the evening and in the morning. The movement of the toothbrush is made along the axis of the teeth in order to free the interdental spaces from food debris and the teeth themselves from plaque: on upper jaw- from top to bottom, and on the bottom - from bottom to top. Then the toothbrush is washed with warm, clean water and soap, lathered and left until the next use.

While chewing solid food, the oral cavity self-cleanses. In seriously ill patients it is disrupted. Oral care consists of wiping, rinsing or irrigating to avoid damage to the gum mucosa when using a toothbrush.

Wiping the teeth and tongue is done using a cotton ball or gauze ball held with tweezers, moistened with a 2% solution of sodium bicarbonate, a 3% solution of hydrogen peroxide, a weak solution of potassium permanganate, and saline. Wipe each tooth separately, especially carefully near its neck. To wipe the upper molars, you need to use a spatula to pull the cheek well so as not to introduce infection into the teeth. excretory duct parotid gland, located on the mucous membrane of the cheeks at the level of the posterior molars.

Rinsing the mouth, which in seriously ill patients should be done after each meal, is done using a rubber balloon. For this purpose the same medicinal solutions, as when wiping. The patient is seated with his head slightly tilted so that the liquid does not enter the respiratory tract. The neck and chest are covered with an oilcloth apron, and a kidney-shaped tray is placed under the chin. The corner of the mouth is pulled back with a spatula and a stream of liquid under moderate pressure is used to wash first the labial folds and then the oral cavity itself.

Rules for caring for the nasal cavity, ears and eyes. Crusts form from the discharge of the nasal cavity; disrupting nasal breathing. To remove them, a gauze cloth soaked in Vaseline oil is inserted into the nasal passages, and after 2-3 minutes the crusts are removed with rotational movements. In children, the nasal passages are cleaned with a cotton wick.

Caring for your ears involves regularly washing them with warm water and soap and gently cleaning the outer ear canal of earwax using a cotton wick.

If discharge from the eyes sticks together the eyelashes and eyelids, then eye rinsing is required. For this purpose, use a 2% solution boric acid, saline solution, chilled boiled water. Washing is carried out using a glass undine vessel, a pipette, and a moistened sterile gauze ball. Before the procedure, the caregiver thoroughly washes his hands, and then, with a stream of liquid, first rinses the edges of the closed eyelids, then the eyeball, using the fingers of his left hand to spread the eyelids and direct the stream from the temple to the bridge of the nose along the lacrimal canal.

The concept of therapeutic nutrition for patients, feeding them and serving drinks to seriously ill patients. Therapeutic nutrition provides for a certain qualitative composition of food (proteins, fats, carbohydrates, vitamins, enzymes, microelements, mineral salts and water), quantity, timing and frequency of intake. For a sick person, the best thing is to eat four meals a day, every day at the same hours. Random eating at different times with significant simultaneous overload of the stomach reduces the digestibility of food and leads to diseases of the gastrointestinal tract.

Food is served in the dining room, where patients are seated at the same table, receiving the same diet.

Seriously ill patients are spoon-fed in a sitting or semi-sitting position, and a napkin or towel is placed under the chin. Drinking should be done from a special sippy cup or small teapot (Fig. 31). The dishes used by the patient must be washed immediately after eating with hot water with mustard and soap intended for washing tableware, and then doused with boiling water.

Questions. 1. How to prepare a patient’s bed, change bed linen and underwear? 2. How is a patient’s skin cared for in the presence of bedsores and what are the measures to prevent them? 3. How is the patient’s mouth, nose, ears, eyes, hair and nails cared for? 4. How to feed and water seriously ill patients?

The patient's personal hygiene is always under the supervision of medical staff. Patients should do a morning and evening toilet every day, brush their teeth 2 times a day, while cleaning the back of the tongue with a toothbrush, rinse after each meal; If there are no contraindications, take a bath at least once a week. Bedridden patients are washed daily with the help of a nurse; seriously ill patients wipe their face and hands daily with cotton wool moistened with boiled or toilet water; the eyelids are washed with a 2% warm solution of boric acid using a pipette and a cotton ball. Seriously ill patients should wipe their tongue, gums and teeth with cotton wool moistened with a 2% solution of boric acid, a weak solution, or then with a gauze pad moistened with a 1% solution of borax with the addition of a 10% solution of glycerin. Gauze and cotton wool are held with a forceps. Use a damp towel to wipe the neck, chest, and armpits, then wipe dry. Hair is combed daily, and for women it is braided. Seriously ill and infectious patients are recommended to have their hair cut. After urination and defecation, seriously ill patients should be washed.



A rubber circle is placed under the sacrum for patients on long-term bed rest.

The circle is placed under a sheet or wrapped in a towel to prevent skin irritation from contact with the rubber.

Baths can be hygienic and therapeutic, as well as general or local (see Baths). It is better to immerse weakened patients in the bath slowly on a sheet, holding it at both ends. While in the bath, the patient is under the supervision of a nurse. Wet wraps are made from two sheets moistened with hot (up to 50°) water, they wrap the patient with them, then with oilcloth and two woolen blankets.

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

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

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

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

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

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

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

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

The sequence of actions is as follows:

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

lay down an oilcloth and place the vessel on it;

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

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

remove the vessel and oilcloth.

Rice. 9.3. Devices and methods

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

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

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

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

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

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

The sequence of actions is as follows:

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

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

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

Rice. 9.6. Toilet of teeth and tongue

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

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

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

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

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

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

wash your hands thoroughly;

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

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

blot the remaining solution with a dry swab.

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

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

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

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

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

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

pull the patient's lower eyelid down;

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

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

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

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

Rice. 9.7. Laying eye ointment(s) and instillation eye drops(b)

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

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

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

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

Use of a bedpan and urine bag. For patients who are on strict bed rest, a vessel is served in bed for bowel movements, and for bowel movements Bladder- urinal (women are given a pan when urinating). The vessel can be enameled or rubber. In seriously ill patients, the vessel is usually permanently under the bed.

When putting the vessel into bed you should:

place an oilcloth under the patient’s pelvis;

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

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

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

cover the patient with a blanket and leave him alone;

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

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

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

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

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

This educational and methodological manual is recommended for self-preparation of students for practical classes. The topic “Personal hygiene of a seriously ill patient” was prepared taking into account the requirements of the Federal State educational standard(hereinafter referred to as the Federal State Educational Standard) for secondary professions vocational education patient care nurse.

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St. Petersburg State Budgetary Professional educational institution"Paramedic College"

"APPROVED"

Deputy Director for SD

Kotova I.A.________

"___"_________2017

ALLOWANCE FOR SELF-TRAINING STUDENTS

TO THE PRACTICAL LESSON

TOPIC: “Personal hygiene of a seriously ill patient”

PM.07, PM.04 “PERFORMANCE OF PROFESSIONAL WORK

JUNIOR NURSE FOR PATIENT CARE"

for specialties

31.02.01 "Medicine"

34.02.01 "Nursing"

Developed by teacher PM 04.

Lobacheva G.R.

Considered at the meeting of the Central Committee

"Fundamentals of Nursing"

Protocol No. ________________

"___"________________2017

Saint Petersburg ,

2017

This educational and methodological manual is recommended for self-preparation of students for practical classes. The topic “Personal hygiene of a seriously ill patient” was prepared taking into account the requirements of the Federal State Educational Standard (hereinafter referred to as the Federal State Educational Standard) for the professions of secondary vocational education: nursing nurse.

The educational and methodological manual includes an information block, recommendations are given for self-training of students with an indication of the source, and a list of control material is proposed in the form of problem questions, situational tasks, and “silent” columns.

The manual is intended for the student to master the main type professional activity(VPD) – solving the patient’s problems through nursing care and relevant professional competencies.

Professional competencies (PC):

• Communicate effectively with the patient and his environment in the process of professional activities.
• Comply with the principles of professional ethics.
• Provide care to patients of various types age groups in healthcare settings and at home.
• Consult the patient and his environment on issues of care and self-care.
• Render medical services within the limits of their powers.
• Ensure infection safety.
• Provide a safe hospital environment for patients and staff.
• Participate in health education work among the population.
• Ensure industrial sanitation and personal hygiene in the workplace.
• Realize nursing process.

General competencies (GC):

• Understand the essence and social significance of your future profession, show sustained interest in it.
• Organize your own activities based on the goal and methods of achieving it, determined by the manager
• Analyze the work situation, carry out current and final monitoring, evaluation and correction of one’s own activities, and be responsible for the results of one’s work.
• Search for information necessary to effectively perform professional tasks.
• Work in a team, communicate effectively with colleagues, management, and consumers.
• Treat historical heritage and cultural traditions with care, respect social, cultural and religious differences.
• Comply with labor protection, fire and safety regulations.

Developer organization: GOBU SPO " St. PetersburgMedical College"

Prepared by the teacher Lobacheva G.R.

Topic: “Personal hygiene of a seriously ill patient”

Target:

• Develop your own topic
• To develop knowledge about the principles of hygienic care, the rules for collecting and transporting dirty linen
• To study the features of caring for the skin, hair, nails, and perineum of a seriously ill patient
• Learn to carry out the nursing process in case of violation of the patient’s needs for personal hygiene and changing linen
• Cultivate a sense of tact and courtesy when working with people

Personal hygiene refers to a set of activities that create a comfortable existence for a seriously ill patient, and is the most important aspect in the work of a nurse. Bed comfort and personal hygiene create conditions for the patient’s rapid recovery, because are preventive measures, preventing the emergence and spread of nosocomial infections, as well as the formation of bedsores. This concept includes: caring for the mucous membranes of the mouth, eyes, nose, caring for the ears, hair, skin, perineum, as well as shaving, washing hair, cutting nails.

The heavier the patient, the more difficult it is to care for him, and the more difficult it is to perform various manipulations.Therefore, it is necessary to know exactly the method of implementation and to clearly master these techniques.

The nurse must perform all manipulations regarding the patient’s personal hygiene strictly wearing rubber gloves.

When performing “dirty” manipulations (the word “dirty” in this case is used in a figurative sense, i.e. these are manipulations that imply contact with a large number of microorganisms), the nurse must wear an additional gown, which she takes off upon completion . “Dirty” manipulations include changing bed and underwear, cleaning the premises.

Today you must learn how to properly change underwear and bed linen, properly care for patients with urinary and fecal incontinence, learn how to properly wash both men and women after physiological functions. And also how to practically care for the mucous membranes of the mouth, nose, and external ear canal, wash your hair and cut your nails.

INFORMATION BLOCK

Patient position

When sick, the patient takes different positions in bed.

There are:

• Active position- the patient easily and freely performs voluntary (active) movements.

• Passive position- the patient cannot perform voluntary movements, retains the position that was given to him (for example, in case of loss of consciousness, or the doctor forbade him to perform them).

• Forced position- the patient takes it himself in order to reduce (lower the level) of pain and other pathological symptoms.

The patient's position does not always coincide with the movement regimen prescribed by the doctor.

Activity mode (motor mode)

• General (free)-the patient stays in the department without restrictions motor activity within the hospital and hospital grounds.
• Ward - the patient spends a lot of time in bed, free walking around the ward is allowed. All personal hygiene activities are carried out within the ward
• Semi-bed - the patient spends all the time in bed, can sit on the edge of the bed or a chair to eat, perform morning toilet, accompanied by nurse.
• Bed- the patient does not leave the bed, can sit and turn around. All personal hygiene measures are carried out in bed by medical personnel.
• Strict bed- The patient is strictly prohibited from active movements in bed, even from turning from side to side.

Concept of a functional bed

The nurse must constantly ensure that the patient's position is functional, i.e. improved the function of one or another affected organ. The easiest way to achieve this is by placing the patient on a functional bed. A functional bed is a special device consisting of several sections, the position of which can be changed by turning the corresponding control knob. The head and foot ends of the bed are quickly moved to the desired position. These beds may have special built-in accessories: bedside tables, IV stands, storage sockets for an individual bedpan and urine bag. The use of a functional bed is carried out by a nurse in order to provide a seriously ill patient with a comfortable position and motor mode. A semi-sitting position in a regular bed can be created using a headrest or several pillows. To prevent the patient from “slipping” down, a foot rest should be placed in the bed. You can create an elevated position for your legs using a pillow placed under your shins. The patient should not be left in one position for a long time.

REMEMBER! In any case, the patient should be given a comfortable position in bed. Bed comfort is important element therapeutic and protective regime.

Principles of care

Personal hygiene is understood as a very extensive and everyday process.

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

Purpose of patient care- personal hygiene, ensuring comfort, cleanliness and safety.

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

• assess self-care ability;
• clarify the degree of professional participation and preferences;
• assist the patient in performing morning and evening toilet procedures;
• help with washing, washing hair;
• carry out timely change of underwear and bed linen;
• encourage and encourage the patient to act independently;
• involve relatives, neighbors, social workers.

CHANGE OF BED AND UNDERLINEN

Target: Change the patient's bed linen and underwear.

Indications: After sanitary treatment of the patient and in seriously ill patients as contamination occurs.

Contraindications: No

Equipment:

1. Pillowcases (2 pieces).
2. Bed sheet.
3. Duvet cover.
4. Oilcloth.
5. Lining (diaper).
6. Towel.
7. Shirt.
8. Bag for dirty laundry.
9. Gloves.

Possible patient problems:Individually identified during the intervention process.

1. Wear gloves.
2. Lower the handrail on the side from which you will begin to rearrange the bed.
3. Roll up a clean sheet halfway and set aside.
4. Raise the patient's head and remove the pillow from under it, change the pillowcase
5. Move the patient to the edge of the bed, turning him to his side.
6. Roll the dirty sheet lengthwise towards the patient, along with the oilcloth and backing.
7. Spread a clean sheet on the vacant part of the bed, along with oilcloth and lining. Raise the handrail.
8. Go to the opposite side of the bed and lower the rail.
9. Turn the patient onto their back and then onto their other side so that they are on a clean sheet.
10. Place the dirty sheet in a bag and lay out a clean sheet and a disposable diaper pad.
11. Tuck the edges of the sheet under the mattress.
12. Place pillows under the patient's head. Cover the patient with a blanket.

The sequence of actions of the nurse to ensure the safety of the environment:

1. Inform the patient about the upcoming procedure and its progress.
2. Roll up a clean sheet crosswise.
3. Change the duvet cover and set it aside.
4. Wear gloves and prepare a waterproof bag for dirty laundry.
5. Raise the patient's head and change pillowcases.
6. Roll up the dirty sheet from the head of the bed to the lower back, placing a clean sheet on the vacated part of the bed.
7. Place a pillow on a clean sheet and rest the patient's head on it.
8. Raise the pelvis and then the patient’s legs, remove the dirty sheet, continuing to straighten the clean one, as well as the oilcloth with the backing. Lower the patient's pelvis and legs and tuck the edges of the sheet and mattress pad under the mattress.
9. Place the dirty sheet in a bag.
10. Remove gloves, wash your hands.

Sequence of actions when changing a patient's shirt while ensuring environmental safety:

1. Inform the patient about the upcoming procedure and its progress.
2. Elevate the patient's upper body.
3. Roll the dirty shirt up to the back of your head and remove it over your head.
4. Free the patient's hands.
5. Place the dirty shirt in the bag.
6. Put on the sleeves of a clean shirt.
7. Throw it over your head
8. Spread it on the patient.
9. Help the patient find a comfortable position. Cover the patient. Make sure he feels comfortable.
10. Remove the bag of dirty linen from the room.

The patient's bed linen and underwear were changed.

Note: When changing a shirt for a patient with an arm injury:

1. Place the shirt sleeve over the injured arm.
2. Place the other sleeve of your shirt over your unaffected arm.
3. Help the patient fasten the buttons.
4. For a patient who has difficulty sitting, shifts must be carried out with an assistant who holds the patient by the shoulders;
5. For a bedridden patient, perform the procedure in the same sequence, only in a lying position.
6. Disinfect and further dispose of gloves. Wash and dry your hands.
7. Make a note about the change of linen in the documentation.

CARE OF ORAL, NOSE, EYES, EARS.

1.Oral care.

Target: Treat the patient's oral cavity.

Indications:

1. The patient's serious condition.
2. Inability to self-care.

Contraindications: No.

Equipment:

1. Antiseptic solution of furatsilin 1:5000.
2. Spatulas.
3. Glycerol.
4. Sterile gauze wipes.
5. Boiled warm water.
6. Capacity 100-200 ml.
7. Two kidney-shaped trays.
8. Rubber balloon.
9. Towel.
10. Sterile swabs with cotton swabs.

Possible patient problems:Negative attitude towards intervention.

The sequence of actions of the nurse to ensure the safety of the environment:

1. Inform the patient about the upcoming procedure and its progress.
2. Elevate the patient's head or, if possible, place the patient in the Fowler's position.
3. Cover the patient's chest with a towel.
4. Place a kidney-shaped tray.
5. Pour an antiseptic solution into the container.
6. Use a spatula to move the patient's cheek away.
7. Moisten a sterile swab with a cotton swab with an antiseptic solution and treatvestibule of the mouth in a circular motion, moving the patient’s cheek away with a spatula.
8. Treat the inside of your cheeks, first on the left with a sterile stick moistened with an antiseptic solution and the other on the right in a circular motion.
9. Process solid sky with a sterile stick moistened with an antiseptic solution.
10. Treat the teeth from the root with sweeping movements, changing sterile sticks moistened with an antiseptic solution, changing as they become dirty. (at least 8 sticks).
11. Wrap the spatula in a sterile gauze cloth and moisten it with an antiseptic solution of furatsilin.
12. With your left hand, take the tip of the patient’s tongue with a sterile gauze pad and remove it from the mouth, fix it with a spatula.
13. Remove plaque from the tongue with a spatula in the direction from root to tip (scraping movements).
14. Release your tongue.
15. Fill a rubber balloon with warm boiled water.
16. Turn the patient's head to the side.
17. Remove the corner of your mouth with a spatula.
18. Irrigate the patient's mouth from a balloon with warm water on the left, right, and in the middle and ask him to spit.
19. Wipe your lips with a dry cloth.
20. Lubricate the cracks on your tongue and lips with glycerin.
21. Treat the container, rubber bladder and waste material in accordance with applicable regulations. regulatory documents according to the sanitary and epidemiological regime.

The oral cavity is clean. The cracks are smeared.

Education of the patient or his relatives.Advisory type of intervention in accordance with the sequence of actions of the nurse described above.

2. Nose care.

Target: Toilet the nasal cavity in the presence of crusts and mucus.

Indications:

1. The patient's serious condition.
2. Inability to self-care.

Contraindications: No.

Equipment.

1. Gauze turundas.
2. Beaker.
3. Sterile petroleum jelly.

The sequence of actions of the nurse to ensure the safety of the environment:

If crusts are present:

1. Inform the patient about the upcoming procedure and its progress.
2. Wash your hands, put on gloves.
3. Pour oil into a beaker.
4. Moisten the gauze turunda and squeeze it on the edge of the beaker.
5. Tilt the patient's head back slightly.
6. Lift the tip of the patient's nose with your left hand.
7. Insert the moistened oil solution turunda into the nasal passage.
8. Leave it for 2-3 minutes to soften the crusts.
9. Remove the cotton wool using rotating movements.
10. Repeat the procedure with the other nasal passage.
11. Process the beaker and waste material in accordance with current regulatory documents on the sanitary and epidemiological regime.

If mucus is present:

1. Invite the patient to blow his nose, sequentially pinching the right and left nostril.

Assessment of achieved results:The nasal passages are clear of crusts and mucus.

Advisory type nursing care in accordance with the above sequence of actions of the nurse.

3.Eye care.

Target: Morning toilet of the eyes.

Indications:

1. The patient's serious condition.
2. Discharge from the eyes sticking together the eyelashes.
3. Inability to self-care.

Contraindications: No.

Equipment:

1. Six gauze swabs.
2. Beaker.
3. Tray, gloves.
4. Boiled water (furacillin solution 1:5000).

Possible patient problems:More negative attitude towards intervention, etc.

The sequence of actions of the nurse to ensure the safety of the environment:

1. Inform the patient about the upcoming procedure and its progress.
2. Wash your hands, put on gloves.
3. Pour boiled water into a beaker.
4. Wet the gauze pads and squeeze out the excess on the edge of the beaker.
5. Wipe your eyes once, in one direction from the outer edge to the inner (each eye with a separate swab).
6. Ditch those tampons.
7. Repeat steps as necessary.
8. Take a dry swab and wipe your eyes in the same sequence, changing the swab for each eye.
9. Rinse your eyes with an antiseptic solution if you have white discharge in the corners of your eyes.
10. Treat the beaker, pipette and waste material in accordance with the sanitary and epidemiological requirements.

Evaluation of achieved results.Morning eye toilet is done.

Education of the patient or his relatives.Advisory type of intervention in accordance with the sequence of actions of the nurse described above.

4.Cleaning the external auditory canal.

Target: Clean the patient's ears

Indications:

Contraindications: No.

Possible complications:When using hard objects, damage to the eardrum or external auditory canal.

Equipment:

1. Gauze turundas.
2. Pipette.
3. Beaker.
4. Boiled water.
5. 3% hydrogen peroxide solution (as prescribed by a doctor)
6. Containers for disinfection.
7. Towel.

Possible patient problems:Negative attitude towards intervention, etc.

The sequence of actions of the nurse to ensure the safety of the environment:

1. Inform the patient about the upcoming procedure and its progress.
2. Wash your hands.
3. Wear gloves.
4. Pour boiled water into a beaker,
5. Moisten the turundas.
6. Tilt the patient's head in the opposite direction.
7. Pull your ear up and back with your left hand.
8. Remove the sulfur with a turunda using rotational movements.
9. Wipe dry with a dry turunda.
10. Treat the beaker and waste material in accordance with the sanitary and epidemiological requirements.

Assessment of what has been achieved. Auricle clean, external auditory canal is free.

Education of the patient or relatives.Advisory type of intervention in accordance with the sequence of actions of the nurse described above.

Notes If you have a small wax plug, drop a few drops of a 3% hydrogen peroxide solution into your ear as prescribed by your doctor. After a few minutes, remove the plug with a dry turunda. Do not use hard objects to remove wax from your ears.

WASHING HEAD

Target: Wash the patient's hair.

Indications:

1. The patient's serious condition.
2. Inability to self-service.

Contraindications:They are identified during an examination by a doctor and a nurse.

Equipment:

1. Basin for water.
2. Special headrest.
3. A jug of warm water (37-38 degrees).
4. Water thermometer.
5. Toilet soap or shampoo.
6. Towel.
7. Oilcloth.
8. Wide-toothed comb.

Possible patient problems:

1. Negative attitude towards manipulation.

The sequence of actions of the nurse to ensure the safety of the environment:

1. Inform the patient about the upcoming procedure and its progress.
2. Elevate the patient's head and upper torso along with the mattress.
3. Position the headrest.
4. Place an oilcloth under the patient's neck.
5. Tilt the patient's head back.
6. Place the basin at the head end of the bed.
7. Wet your hair with warm water.
8. Lather your hair well with soap or shampoo.
9. Rinse your hair well with warm water and rinse, repeating the lather twice.
10. Dry the patient's head with a towel.
11. Comb your hair with a sparse comb.
12. Put a dry scarf on your head.
13. Remove the basin, stand and oilcloth.
14. Place the patient comfortably on a pillow.
15. Remove gloves and immerse in disinfectant solution. Wash your hands.
16. Make a record of the procedure in medical documents

Assessment of achieved results:The patient's head is washed:

Education of the patient or his relatives.Advisory type of intervention in accordance with the sequence of actions of the nurse described above.

Possible complications.

1. Head burn when using hot water.
2. Deterioration of the patient's general condition.

Note: Start combing long hair from the ends, and short hair from the root.

Hair should be combed daily, and once a week be sure to check for lice and wash your hair. After washing your hair, especially women with long hair, should put a towel or scarf on their head to avoid hypothermia.

CARE OF THE EXTERNAL GENITAL ORGANS AND PERINEUM.

Target: Clean the patient

Indications: Self-care deficit.

Contraindications: No

Equipment:

1. Oilcloths
2. Vessel.
3. Jug of water (temperature 35 - 38 degrees Celsius).
4. Potassium permanganate, soda, furatsilin (for diaper rash).
5. Cotton swabs or napkins.
6. Forceps or tweezers.
7. Gloves.
8. Screen

Possible patient problems:

1. Psycho-emotional.
2. Inability to self-care.

The sequence of actions of the nurse to ensure the safety of the environment:

When washing men:

1. Inform the patient about the upcoming procedure and its progress.
2. Protect the patient with a screen.
3. Wear gloves.
4. Pull back the patient's foreskin, exposing the glans penis.
5. Wipe the head of the penis with a cloth soaked in water.
6. Wipe the skin of the penis and scrotum, then dry it.
7. Remove gloves, wash your hands.
8. Remove the screen.

When washing women:

1. Inform the patient about the upcoming procedure and its progress.
2. Protect the patient with a screen.
3. Wear gloves.
4. Place an oilcloth under the patient's pelvis and place the bedpan on it.
5. Help the patient lie on the bedpan with her knees bent and slightly apart.
6. Stand on the side of the patient, holding a jug in your left hand, and a forceps with a napkin in your right, pour warm water (t 35-38°) on the genitals, and move the napkin from top to bottom from the pubis to the anus, change napkins after each movement from above down.
7. Dry the genitals and perineal skin with a dry cloth.
8. Remove the vessel and oilcloth.
9. Cover the patient.
10. Remove the screen.
11. Make a record of the procedure in medical documents

Assessment of achieved results:The patient has been cleaned.

Education of the patient or his relatives.Advisory type of intervention in accordance with the sequence of actions of the nurse described above.

SUPPLYING THE VESSEL AND URINARY PAINTER, USING THE BACKER

Target: Provide a bedpan, urinal, backing circle to the patient.

Indications:

1. Satisfying physiological needs.
2. Prevention of bedsores.

Contraindications: No.

Equipment:

1. Screen.
2. Vessel (rubber, enameled).
3. Urine bag (rubber, glass).
4. Backing circle.
5. Oilcloth.
6. Jug of water.
7. Kornzang.
8. Cotton swabs.
9. Napkins, paper.

Possible patient problems:

1. Patient shyness, etc.
2. Determining the degree of self-care deficiency.

The sequence of actions of the nurse to ensure the safety of the environment:

1. Inform the patient about the use of a bedpan and urine bag.
2. Separate him with a screen from others.
3. Wear gloves.
4. Rinse the vessel with warm water, leaving some water in it.
5. Place an oilcloth or diaper under the patient's pelvis.
6. Help the patient turn slightly to one side, with his legs slightly bent at the knees.
7. Place the vessel under the patient’s buttocks with your right hand and turn him on his back so that the perineum is above the opening of the vessel.
8. Give the man a urine bag.
9. Take off your gloves.
10. Agree with the patient when it is best for you to approach.
11. Cover the patient with a blanket and leave him alone.
12. Adjust the pillows so that the patient is in a semi-sitting position.
13. Wear gloves.
14. Remove the vessel with your right hand from under the patient, cover it with oilcloth or a lid.
15. Wipe the anal area with toilet paper.
16. Provide a clean bedpan to the patient.
17. Wash the patient, dry the perineum, remove the bedpan, oilcloth, help the patient lie down comfortably. Place a rubber circle inflated 2/3.
18. Remove the screen.
19. Pour the contents of the vessel into the toilet.
20. Treat the vessel in accordance with sanitary and epidemiological requirements.
21. Remove gloves, immerse in disinfectant solution, wash hands.
22. Make a record of the procedure in medical documents

Assessment of achieved results:

1. The bedpan and urinal are supplied.
2. A rubber circle is placed.

Education of the patient or his relatives.Advisory type of intervention in accordance with the sequence of actions of the nurse described above.

CONDUCTING EVENTS TO PREVENT BEDSORES.

Target: Preventing the formation of bedsores.

Indications: Risk of bedsores.

Contraindications: No.

Equipment:

1. Gloves.
2. Apron.
3. Soap.
4. Bed sheets.
5. Cotton gauze circles - 5 pcs.
6. Camphor alcohol solution 10%
7. Pillows filled with foam rubber or sponge.
8. Towel.

Possible patient problems:Inability to self-care.

The sequence of actions of the nurse to ensure the safety of the environment:

1. Inform the patient about the upcoming procedure and its progress.
2. Wash your hands.
3. Wear gloves and an apron.
4. Examine the patient's skin in areas where bedsores may form.
5. Wash these areas of skin with warm water morning and evening and as needed.
6. Wipe them with a cotton swab moistened with a 10% solution of camphor alcohol or a 0.5% solution of ammonia or a 1% - 2% alcohol solution of tannin. When rubbing the skin, do a light massage.
7. Change the patient's position in bed every 2 hours.
8. Make sure there are no crumbs or folds on the sheet.
9. Change wet or soiled laundry immediately.
10. Inspect areas at risk of bedsores, perform a light massage 2 times a day.
11. Use pillows filled with foam rubber or sponge to reduce pressure on the skin where the patient comes into contact with the bed (or place a cotton-gauze circle placed in a cover under the sacrum and coccyx, and cotton-gauze circles under the heels, elbows, and back of the head) or use an anti-bedsore mattress .
12. Remove gloves and apron and treat them in accordance with sanitary and epidemiological requirements.
13. Wash your hands.

Assessment of achieved results:The patient does not have bedsores.

Teaching the patient or his relatives:Advisory type of intervention in accordance with the sequence of actions of the nurse described above.

Algorithm for caring for the nails of a seriously ill patient

I. Preparation for the procedure:

3. Lay an oilcloth with a diaper and a towel on the bed.

4. Wear gloves.

II. Performing the procedure:

5. Fill the container with warm water, place it on an oilcloth with a diaper, lower the patient’s hands/feet into the container for 5-10 minutes, wash them with soap.

6. Place the patient's hands/feet on a towel and wipe them dry.

7. Place a napkin, trim your nails with scissors, and apply a nail file.

8. Wrap the cut nails in a napkin and throw them into a garbage bag.

9. Apply nourishing cream to the skin of the patient’s hands/feet.

III.Complete procedure:

10. Place the towel in the laundry bag.

11. Position the patient comfortably in bed.

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

14. Carry out dez. Events.

When treating toenails, you should cut them straight, without rounding the corners, to prevent ingrown nails. You should not file your nails deeply from the sides, as you can injure the skin of the side ridges and thereby cause cracks and increased keratinization of the skin.

Algorithm for shaving a seriously ill patient

I. Preparation for the procedure:

1. Explain to the patient the purpose and course of the upcoming procedure and obtain his consent.

2. Wash (using soap or antiseptic) and dry your hands.

II. Performing the procedure:

3. When using an electric razor, use the fingers of one hand to stretch the skin of the face, and with the other hand, shave in a circular motion along the cheeks to the chin and neck.

4. When using a razor, place a towel under the patient’s chin, apply shaving cream to the skin of the patient’s cheeks and chin, and then begin shaving with successive movements.

5. Offer the patient to use aftershave lotion.

6. Offer the patient a mirror after the procedure.

III.Complete procedure:

7. Clean and put away the electric razor (immerse the razor in a disinfectant solution).

8. Position the patient comfortably in bed.

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

10. Wash (using soap or antiseptic) and dry your hands.

11. Make an appropriate entry about the performed manipulation in the medical documentation.

Shaving a critically ill patient should be done with an electric razor to reduce irritation and the risk of skin infection.

If the patient's skin is damaged, it should be treated with 70% alcohol.

Algorithm for foot care.

Legs seriously ill patient wash once a week.

I. Preparation for the procedure:

1. Explain the procedure and obtain informed consent.

2. Wash (using soap or antiseptic) and dry your hands.

3. Lay an oilcloth or diaper at the foot end of the bed.

4. Place a basin (container) on the oilcloth.

5. Wear gloves

II. Performing the procedure:

6. Measure the temperature of the water and pour it into the basin, add liquid soap

7. Place your foot in the water (with your legs slightly bent at the knees)..

8. Wash and rinse the leg, help the patient remove it from the water and place it on a diaper.

9. Dry your foot, making sure the skin between your toes is dry.

10. Repeat steps 7-9 with the other foot.

III.Complete procedure:

11. Remove the towel, oilcloth, diaper, basin.

12. Cover your feet with a sheet/blanket.

13. Wash (using soap or antiseptic) and dry your hands.

14. Make a record of the procedure performed and the patient’s reaction in the medical record.

15. Carry out dez. Events.

CONTROL UNIT

• Answer the questions:

1. List the principles of care.

S.A. Mukhina, I.I. Tarnovskaya “Practical guide to the subject “Fundamentals of Nursing””, 2012, p. 155-156

1. What is the purpose of a functional bed?

S.A. Mukhina, I.I. Tarnovskaya “Practical guide to the subject “Fundamentals of Nursing””, 2012

1. What position in bed can the patient take in bed.

T.P. Obukhovets “Fundamentals of Nursing”, 2013, p. 153

1. What goals does he set for himself? medical staff when preparing to change bed linen for a seriously ill patient?

T.P. Obukhovets “Fundamentals of Nursing”, 2013, p. 409

1. What needs to be prepared and how to treat the oral cavity of an unconscious patient?

T.P. Obukhovets “Fundamentals of Nursing”, 2013, p. 428-430

1. What needs to be prepared and how to treat the nasal cavity?

T.P. Obukhovets “Fundamentals of Nursing”, 2013, p. 432-433

1. How to treat a patient's eyes?

T.P. Obukhovets “Fundamentals of Nursing”, 2013, p. 430-432

1. How to treat the external auditory canal?

T.P. Obukhovets “Fundamentals of Nursing”, 2013, p. 433-435

1. How should the patient be positioned to wash his feet and head?

T.P. Obukhovets “Fundamentals of Nursing”, 2013, p. 435, 442

1. How to shave a patient's face?

S.A. Mukhina, I.I. Tarnovskaya “Practical guide to the subject “Fundamentals of Nursing””, 2012, p. 210-212

1. Rules for caring for the external genitalia.

T.P.Obukhovets “Fundamentals of Nursing”, 2013, pp.439-441

1. Changing underwear for a seriously ill patient.

T.P. Obukhovets “Fundamentals of Nursing”, 2013, p. 414-415

1. List modern means care that a nurse can use.

T.P. Obukhovets “Fundamentals of Nursing”, 2013, p. 417, 437, 441

• Describe the patient's position in bed:

1. Active position _________________________________________________
2. Passive position ________________________________________________
3. Forced position ________________________________________________

• Solve situational problems:

1. The patient complains of dry nose and the formation of crusts in the nasal cavity.
   Patient problems? How to help the patient?

2. The patient developed bad breath.

What needs to be done? Patient problems?

3. The patient cannot open his eyes; the eyelids and eyelashes are stuck together.
   What is the assistance to the patient? Patient problems?

4. While performing a morning toilet routine on a patient, the nurse noticed accumulated wax in the external auditory canal.

What are your actions to help? Patient problems?

5. The patient complains of itchy scalp and greasy hair.
   What to do? Patient problems?

1. S.A. Mukhina, I.I. Tarnovskaya “Practical guide to the subject “Fundamentals of Nursing””, 2012.
2. T.P. Obukhovets “Fundamentals of Nursing”, 2013.