(one junior nurse participates).
Turn the patient onto his back, check the correct body position.
Lower the head of the bed to a horizontal position.
Place a pillow at the head of the bed to prevent the patient from hitting his head on the headboard.
Stand facing the foot of the bed at a 45* angle and move the patient's legs diagonally towards the head of the bed.
The procedure begins with moving the legs, because... they are lighter than other parts of the body and easier to move.
Move along the patient's thighs.
Bend your legs at the hips and knees so that your arms are level with the patient's torso.
Move the patient's hips diagonally towards the head of the bed.
Move along the patient's torso parallel to his upper body.
Place the hand closest to the head of the patient under the patient’s shoulder, clasping his shoulder from below. The shoulder must be supported at the same time with the hand.
Place your other hand under top part backs. Head and neck support ensures proper alignment of the patient's body and prevents injury, while torso support reduces friction.
Move the patient's torso, shoulders, head and neck diagonally towards the head of the bed.
Raise the side rail of the bed to prevent the patient from falling out of bed and move to the other side of the bed.
Moving from one side of the bed to the other, repeat the procedure until the patient’s body reaches the desired height.
Move the patient to the middle of the bed, in the same way alternately manipulating three parts of his body, until the goal is achieved.
Raise side rails to ensure patient safety.
Remove gloves, wash hands.
Hospital linen.
Hospital linen includes sheets, pillowcases, duvet covers, diapers, shirts, scarves, gowns, pajamas, etc. Clean linen is stored in the linen room located in the department, on painted shelves oil paint and covered with medical oilcloth. Shelves for clean linen are regularly treated with a disinfectant solution. Dirty laundry is stored in a special room in marked oilcloth bags. All linens must have a department tag and stamp. Each department has a housewife who is responsible for regularly changing linen and timely sending dirty linen to the laundry. Once every 7-10 days there is a bath day with a change of linen, but if there are seriously ill patients in the department with involuntary urination or defecation, then the host sister is obliged to leave the junior nurse several additional sets of clean linen for a change. Due to the fact that the patient spends most of his time in bed, it is important that it is comfortable and neat, that the mesh is well stretched and has a smooth surface. A mattress without bumps or depressions is placed on top of the mesh. Depending on the season, flannelette or wool blankets are used. Bed linen must be clean. The sheets should not have scars or seams, and the pillowcases should not have knots or fasteners on the side facing the patient. At the same time with bed linen the patient receives 2 towels. Bed sick with involuntary urination and fecal secretions must have special devices. Most often, a rubber bed is used, and the mattress is covered with oilcloth. Bed linen for such patients is changed more often than usual - as it gets dirty. If a sick woman has copious discharge from the genitals, then to keep the bed clean, an oilcloth is placed under the patient and a small sheet on top, which is changed at least 2 times a day, and if necessary, more often, a pad is placed between the thighs, which is changed as it gets dirty. The patient's bed must be changed regularly - in the morning, before the day's rest and at night. The junior nurse shakes the crumbs off the sheet, straightens it, and fluffs the pillows. The patient can be seated on a chair during this time. If the patient cannot get up, then move him together to the edge of the bed, then, straightening the mattress and sheet on the vacant half, remove the crumbs from them and transfer the patient to the cleaned half of the bed. Do the same on the other side. Changing the sheets under seriously ill patients requires a certain skill from the staff. If the patient is allowed to turn on his side, first, carefully lift his head and remove the pillows from under it. Then they help him turn over on his side, facing the edge of the bed. On the vacant half of the bed, located behind the patient’s back, a dirty sheet is rolled up so that it lies in the form of a roll along his back. A clean, also half-rolled sheet is placed on the vacant space. Then the patient is helped to lie on his back and turn to the other side. After this, he will find himself lying on a clean sheet facing the opposite edge of the bed. Next, remove the dirty sheet and straighten the clean sheet. If the patient cannot make active movements, the sheet can be changed in another way. Starting from the head end of the bed, roll up the dirty sheet, lifting the patient's head and upper torso. In place of the dirty sheet, place a clean one rolled up in the transverse direction and straighten it in the vacant space. Then a pillow is placed on a clean sheet and the patient’s head is lowered onto it. Next, lifting the patient’s pelvis, the dirty sheet is moved to the foot end of the bed, and a clean sheet is straightened in its place. After this, all that remains is to remove the dirty sheet. Shirts for a seriously ill patient are changed as follows: slightly raising the upper part of the body, collect the shirt from the back to the neck. Raising the patient's arms, remove the shirt over the head, and then release the arms from the sleeves. If one of the patient’s arms is injured, the sleeve is removed first from the healthy arm, and then from the sick one. They put a clean one on reverse order: First, starting with the sore arm, put on the sleeves, and then put the shirt on over the head and straighten it along the back.
Washing the sick.
sick, long time Those who are in bed and do not take a hygienic bath every week must be washed several times a day, because the accumulation of urine and feces in the area of the inguinal folds can lead to disruption of the integrity of the skin and the formation of diaper rash, cracks and bedsores. Washing is carried out with a weak solution of potassium permanganate or another disinfectant solution. The solution should be warm (30 - 32С). To wash, you need to have a bedpan, a jug, a forceps and sterile cotton balls. Patients need to be washed after each act of defecation; women are washed more often.
When washing, place a bedpan under the buttocks. The patient should lie on her back with her legs bent knee joints and spreading your hips as far apart as possible. Take a jug with a warm disinfectant solution in your left hand and pour it on the external genital organs to the anus (from top to bottom), 1 cotton-gauze ball washes the inner surface of the labia majora, and 2 balls wash the outer surface and area of the inguinal folds, 3 balls wash the anus area. After this, dry the skin with a dry cotton-gauze swab in the same direction or place a clean diaper as a pad. Washing can be done from an Esmarch mug equipped with a rubber tube and a clamp, directing a stream of a weak solution of potassium permanganate to the perineum. It is much easier to wash men. The patient is also positioned on his back, legs bent at the knees, a bedpan is placed under the buttocks and a stream of a weak solution of potassium permanganate is directed to the perineum and inguinal folds. Using a cotton-gauze swab on a forceps, lift the foreskin and wash the head of the penis, and then the anus. Men are dried only with a diaper. If there are diaper rashes in the groin folds, they are lubricated with baby cream, brilliant green or powdered with the appropriate powder. Never lubricate with greasy ointments!
Supply of bedpan and urinal.
A vessel is one of the most necessary items for caring for seriously ill patients. Patients on strict bed rest must be provided with a bedpan when defecating, and men must be provided with a urinal when urinating. Vessels are made of earthenware, enamel-coated metal, rubber, and various plastics. Vessels have different shape with a large round hole on top and a relatively small hole in the tube extending from one side of the vessel. The large hole at the top is equipped with a lid. A clean vessel is stored in the toilet room, in a specially designated closet or under the patient’s bed on a stand. If a patient has a need to empty the intestines, he should, first of all, be fenced off from other patients with a screen. Before use, rinse the vessel with warm water and leave a little water in it. An oilcloth with a diaper is laid under the patient at a corner, the blanket is thrown back, the patient is asked to bend his knees and help him by bringing him left hand under the sacrum, raise the pelvis. Holding the open vessel by the tube with your right hand, bring it under the buttocks so that the perineum is above the large hole, and the tube is between the thighs towards the knees. Covering the patient with a blanket, leave the patient alone for a while. Then the vessel is removed from under the patient, covered with a lid and taken to the restroom, where it is emptied of its contents, thoroughly washed with a brush, disinfected, rinsed and put back in place. The patient must be washed after defecation. A rubber bedspread is often given to weakened patients or patients with urinary or fecal incontinence to prevent the formation of bedsores. When the vessel is parked for a long time, it is necessary to wrap it in a diaper or put a cover on it (to avoid skin irritation from contact with the rubber). The rubber vessel is not tightly inflated using a foot pump. It is disinfected in the same way as an enamel vessel. To eliminate odor, the rubber vessel is rinsed with a weak solution of potassium permanganate. Patients on strict bed rest are forced to urinate in bed. For this purpose, there are special vessels - urinals. They are made of glass, plastic or metal and have an oval shape with a hole elongated into a short tube. The shape of the tube - the opening of the female and male urinals is somewhat different. Women more often use a bedpan rather than a urinal. Urinals, just like bedpans, must be individual. They should be served clean and heated, and immediately freed from urine. Disinfection of urinals is carried out in the same way as vessels. Since urine is often a sediment that adheres to the walls in the form of plaque and produces an unpleasant ammonia odor, urinals must be washed from time to time with a weak solution of hydrochloric acid followed by rinsing with running water.
Enemas.
An enema is the administration of various liquids through the rectum for diagnostic and therapeutic purposes. For therapeutic purposes, cleansing, siphon, oil, hypertonic, medicinal and nutritional enemas are used. Cleansing enemas, designed to liquefy and remove the contents of the lower parts of the colon, are used for persistent constipation, to remove toxic substances in case of poisoning, before operations and childbirth, X-ray examinations of the digestive tract and endoscopic examinations of the colon, before the use of medicinal and nutritional enemas. Contraindications for performing cleansing enemas are acute inflammatory and erosive-ulcerative lesions of the colon mucosa, some acute surgical diseases of the abdominal organs (acute appendicitis, acute peritonitis), intestinal bleeding, the first days of the postoperative period, after operations on the abdominal organs, severe heart disease. -vascular insufficiency. A cleansing enema is given using a glass or rubber Esmarch mug (a special tank with a volume of 1-2 liters with a hole), to which a rubber tube about 1.5 m long with a rubber, plastic, ebonite or glass tip is attached. At the end of the tube there is a tap with which you can regulate the flow of water from the mug. (If there is no tap, use a c/o clamp).
For a cleansing enema, an adult usually needs 1-1.5 liters of warm water (25-35°C). If it is necessary to stimulate contraction of the colon (with atonic constipation), you can try water at a lower temperature (12-20°C). On the contrary, if it is necessary to relax the smooth muscles of the intestine (for spastic constipation), use water with a temperature of 37-40°C. To enhance the cleansing effect of the enema, sometimes add 2-3 tablespoons of glycerin or vegetable oil, or dissolve 1 tablespoon of baby soap shavings in water.
Water is poured into Esmarch's mug and, opening the tap, the rubber tube is filled, displacing the air. Then the tap is closed again and the mug is suspended above the level of the bed (couch). The patient lies down on left side with legs bent at the knees, pulling them towards the stomach (in this position of the patient, the anus is more superficial, which makes insertion of the tip easier). If the patient cannot be placed on his left side, the manipulation is performed lying on his back with his knees bent (frog pose). An oilcloth is placed under the patient, the edge of which is lowered into the basin.
The first and second fingers of the left hand spread the patient’s buttocks, and with the right hand, using translational and rotational movements, carefully insert the tip into the rectum to a depth of 10-12 cm, previously lubricated with sterile Vaseline. If the patient has not had a bowel movement for several days, before inserting the tip, a digital inspection of the rectal ampulla is performed in order to diagnose the presence or absence of a fecal blockage. Initially (the first 3-4 cm), the tip is inserted towards the patient’s navel, and then rotated according to the lumen of the rectum and the insertion continues parallel to the coccyx. After this, open the tap and introduce liquid, raising the mug to a height of 1 m. If water does not flow, you need to slightly extend the tip and increase the water pressure, raising the mug higher. On the contrary, if pain occurs along the colon, the water pressure is reduced. After the end of the fluid administration, the patient is asked to refrain from bowel movements for 5-10 minutes. Then, due to the stimulation of peristalsis of the colon, its lower sections are emptied of feces. Used tips and Esmarch mugs are disinfected, and then the tips are sterilized. For persistent constipation, especially of spastic origin, oil enemas are used. To do this, use 100-200 g of any food heated to a temperature of 37-38°C. vegetable oil, which is injected into the rectum using a rubber bulb-shaped balloon or a Janet syringe. Oil enemas, which help relax the intestinal wall and subsequently increase peristalsis, are usually given in the evening (after which the patient should lie quietly for half an hour), and the laxative effect occurs after 10-12 hours, usually in the morning. To stimulate bowel movement in atonic constipation, hypertonic enemas (salt enemas) are also used. 50-100 ml of a 10% sodium chloride solution or a 20-30% magnesium sulfate solution is injected into the rectum using a rubber balloon or a Janet syringe, after which the patient is asked to refrain from bowel movements for 20-30 minutes. Since hypertonic enemas, due to their osmotic effect, promote the release of water from tissues into the lumen of the rectum, they can be used in the fight against edema. Siphon enemas are used for therapeutic purposes for various poisonings, intoxication with metabolic products, for dynamic and mechanical intestinal obstruction (in the latter case as preoperative preparation), as well as for the ineffectiveness of cleansing enemas. The use of siphon enemas for intestinal obstruction is contraindicated if thrombosis or embolism of the mesenteric vessels is suspected. When performing a siphon enema, use a large funnel with a capacity of 0.5-2 liters, as well as a rubber tube 1-1.5 m long with a diameter of at least 1 cm, connected to a flexible rubber tip 20-30 cm long. The patient takes the same position, as when administering a cleansing enema (on the left side or on the back with the legs slightly bent at the knees). The flexible end of the rubber tip, lubricated with sterile petroleum jelly, is inserted through the rectum to a depth of 20-30 cm. The action of a siphon enema is based on the principle of communicating vessels. Having attached the funnel to the outer end of the tube, it is held in a slightly inclined position, at the level of the patient’s pelvis, and filled with rinsing liquid - clean boiled water, a weak solution of potassium permanganate, a 2% solution of sodium bicarbonate. The funnel is raised up, about 30 cm above body level, after which the liquid begins to flow into the intestines. As soon as the liquid in the funnel reaches its narrowing, the funnel is quickly lowered below the level of the patient’s body, and it begins to fill with fluid coming back from the intestines along with gas bubbles and feces. After turning the funnel over and pouring out the contents, fill it with water and repeat the washing procedure until clean wash water flows from the intestines into the funnel. Typically, one siphon enema requires 10-12 liters of liquid. Medicinal enemas include therapeutic enemas with the introduction of various medicinal substances. Medicinal enemas are most often microenemas, and their volume is usually 20-100 ml.
For medicinal enemas, a rubber pear-shaped balloon or Janet syringe with a long rubber tip (catheter) is used, which is inserted into the rectum to a depth of 10-12 cm. Before using them, as a rule, a cleansing enema is given. Nutrient enema. After a cleansing enema and bowel movement, release of gases, the intestines are allowed to calm down for 20-30 minutes, then a sterile tip is inserted with either an Esmarch mug with a dropper connected to it, or a special system for introducing nutrients; an adjustable clamp is placed on the system tube, which will provide 30 -40 drops per minute (rate of administration of substances for nutritional purposes). The patient is placed comfortably, carefully covered, and this procedure lasts 2-3 hours, depending on the amount of nutrient required for administration. The rate of administration is adjusted in accordance with the patient’s ability not to respond to the procedure (the solution should not flow from the rectum and should not cause the urge to defecate).
Staging technique vent pipe.
Gas removal is carried out with a thick-walled rubber tube 40 cm long and 8-10 mm in diameter. One end is rounded and has two side holes, the other is slightly widened. The indication for insertion of a gas outlet tube is the accumulation of gases in the intestines (flatulence) and the presence of spasms of the external or internal sphincter of the anus. The purpose and procedure for the manipulation are explained to the patient. An oilcloth is laid on the sheet, a diaper is covered on top, the patient is turned on his left side and asked to pull his knees to his stomach. If the patient cannot be placed on his left side, the manipulation is performed with the patient lying on his back with his knees bent and legs spread apart. The gas outlet tube is lubricated with sterile Vaseline. With your left hand, spread your buttocks and carefully insert it into anus to a depth of 20-30 cm. The outer end of the tube is lowered into a bedpan, into which a little water is poured (since a small amount of liquid feces can be released with gases). It is necessary to ensure that the tube is in the patient’s intestines for no more than 2 hours to avoid the formation of bedsores. After 2 hours, carefully remove the tube and wash the patient. The tube is placed in a marked container for disinfection, then processed according to OST 42-21-2-85 and sterilized. Sometimes insertion of a gas outlet tube can be difficult due to the accumulation of a large amount of feces, so before this manipulation it is necessary to do a cleansing enema with glycerin or chamomile.
Bedsores.
Bedsores are dystrophic ulcerative-necrotic processes that occur in weakened patients who remain in bed for a long time. Most often, bedsores form in the area of the shoulder blades, sacrum, greater trochanter, elbows, occipital region, and back of the heels.
The formation of bedsores is promoted by poor skin care, uncomfortable bed, and infrequent re-bedding. One of the first signs of bedsores is pale skin and wrinkles, followed by redness, swelling and peeling of the epidermis. Then blisters and skin necrosis appear. Infection can lead to sepsis and cause death.
Prevention of bedsores:
turn the patient on his side several times a day, if his condition allows (change the patient’s position);
shake off the sheets several times a day so that there are no crumbs in the bed;
ensure that there are no folds or patches on bed linen and underwear;
for seriously ill patients who have been in bed for a long time, place an inflatable rubber circle with a pillowcase on it, so that the sacrum is above the hole in the circle;
wipe the skin daily with a disinfectant solution: camphor alcohol, vodka, cologne, and in their absence, wipe the skin with a towel moistened with warm and soapy water, and wipe dry, lightly rubbing the skin.
To wipe, moisten the end of a clean towel with a disinfectant solution, wring it lightly and wipe the neck, behind the ears, back, buttocks, front surface of the chest and armpits. Particular attention should be paid to the folds under the mammary glands, where obese women can develop diaper rash. Then the skin is wiped dry in the same order. These procedures are performed daily at night for patients who cannot take a weekly hygienic bath, as well as for unconscious patients. Thus, with proper care, the patient’s skin should always be dry and clean.
Sanitary and hygienic regime
In the premises of hospital departments, it is necessary to carry out wet cleaning daily using disinfectant solutions of the floor, wiping dust from furniture, doors, door handles, panels and window sills. At least once a week, general cleaning of the premises is carried out: washing floors, panels, etc. For cleaning, specially designated and marked equipment is used. One of the most important requirements for organizing a medical and protective regime is the creation of silence. Therefore, the noise level in hospital rooms should not exceed 30 dB. Wherein great importance have soundproofing properties of walls and interfloor ceilings, silence on the hospital premises, as well as staff behavior: quiet conversation, not knocking on doors, preventing the clinking of dishes, etc.
Medical personnel should be a model for patients and in observing the rules of personal hygiene: be neat, collected and cultured appearance, nails are cut short, clean, ironed overalls that match the size and shape of the medical worker’s figure. During sanitary inspection various hospital premises (wards, corridors, doctor’s offices, manipulation rooms, rooms day stay sick, rooms older sister), land plots and assessments of their sanitary and technical support constitute acts of sanitary inspection. It has 3 parts. In the first (passport) part they indicate the last name, first name and patronymic of the person carrying out the inspection and those present, the name and address of the object, and the date of the inspection. The second (stating) part provides data from the inspection of the territory, main, auxiliary and service premises and indicates the results of instrumental studies. The third part (conclusion) indicates the identified deficiencies and provides specific deadlines for their elimination, agreed upon with the administration of the institution. The act is signed by the person who checks and the administration representative.
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Pull the patient to the head of the bed.
If the ward can help the nurse, then she acts alone.
· Go to the patient's bed.
◦ stand to the right of the patient;
◦with one hand, take the person under your charge from behind under the right armpit;
◦place your other hand under the patient’s left armpit so that he axilla rested on the carpal crook of your hand from the side thumb;
◦ bend your knees slightly and place your knees firmly on the edge of the bed.
2. Pull back the blanket as far as necessary.
3. Ask the patient to bend their knees and place their feet on the mattress.
4. Lift the patient using a supportive grip:
5. Ask the patient to raise his head and tilt it forward.
6. Command “One, two - hold your breath”
7. Pull your ward up so that he simultaneously pushes off the bed with his feet and helps you move him.
8. Let the patient rest his head on the pillow.
9. Check whether the patient is positioned correctly, cover him with a blanket; find out how he feels.
Ticket number 27
When putting drops into the ear, the patient almost always feels dizzy. She stores the drops in a first aid kit, in a cool place.
In the department, when drops are instilled into the ear, nothing like this happens, the procedure is pleasant, the drops are warm and do not cause discomfort associated with dizziness.
1. Demonstrate putting drops into the eyes, ears, nose, providing medical service within the limits of their powers.
2. Prepare 10 liters of 5% chloramine solution, ensuring infection safety.
3. List adverse effects medicinal substances on the patient when safety precautions are not followed, ensuring a safe hospital environment.
Response standard
Demonstrate the placement of drops into the eyes, ears, and nose while providing medical services within the scope of your authority.
Putting drops into the eyes
Prepare sterile:
Pipettes,
Gauze balls.
1. Heat the drops to 36-37°C.
2. Sit the patient facing the light with the head slightly thrown back or lay on the back without a pillow.
3. Pipette the medicine with your right hand, and take a sterile gauze swab in your left hand.
4. Pull back the lower eyelid with your left hand using a gauze pad.
5. Invite the patient to look up (if possible).
6. Release 1-2 drops slowly medicine into the conjunctival sac, closer to the nose.
7. Ask the patient to close his eyes ( medicinal solution should not leak).
8. Place the pipette in the boiling container
Performed by two people; the patient can help (Fig. 2.23).
Rice. 2.23.
- Imagine a person helping you move.
- Make sure the patient is lying horizontally. Ask him to raise his head and shoulders; if he cannot, gently lift his head and remove the pillow; lean it against the head of the bed.
- Stand on different sides facing the head of the bed.
- Both nurses place one hand under the patient's shoulders, the other under the hips (unsafe method);
or
one nurse stands at the patient's upper torso. The hand is placed under the patient's neck and shoulder. With her other hand she clasps the patient's arm and shoulder lying nearby. The second nurse stands near the patient's lower torso and places her hands under his lower back and hips. - Spread your legs 30 cm wide, placing one leg slightly back.
- Ask the patient to bend his knees without lifting his feet off the bed.
- Ask the patient to press their chin to their chest.
- Ensure that the patient can assist in ambulation by pushing off the bed with their feet.
- Bend your knees so that your forearms are level with the bed.
- Ask the patient to push off from the bed on the count of “three” and, exhaling, raise his torso and move towards the head of the bed.
- On the count of “three”, swing and transfer your body weight to the leg placed back. At this time, the patient pushes off with his heels and lifts his torso.
- Elevate the patient's head and shoulders and provide a pillow. Make sure it lies comfortably in the desired position.
Moving the patient to the head of the bed
Performed by one nurse, the patient can help (Fig. 2.24).
- Explain to the patient the process of the upcoming procedure, make sure he understands it and obtain his consent.
- Assess your surroundings. Lower the side rails, if equipped. Set the bed brakes.
Rice. 2.24.
- Make sure the patient is lying horizontally. Ask him to raise his head and if he cannot, gently lift his head and remove the pillow; lean it against the head of the bed.
- Spread your legs 30 cm wide. Turn the toe of the leg closest to the headboard towards the headboard.
- Ask the patient to bend their knees and press their feet firmly to the mattress and their hands to the bed, palms down.
- Place one hand under the patient's shoulders, the other under his buttocks. Don't lean forward. Keep your back straight. Bend your knees.
- Ask the patient to push off the bed with his feet and palms on the count of “three”, after exhaling, or ask him to grab the head of the bed with his hands; on the count of three, exhaling, help your sister by pulling yourself up.
- While rocking, count to “three” and transfer your body weight to the leg close to the head of the bed, moving the patient there too.
- Repeat these steps until the patient takes the appropriate position. Move it gradually, over a short distance, so as not to hurt your back.
- Elevate the patient's head and shoulders and provide a pillow. Make sure it lies comfortably.
Moving the patient to the head of a drop-down bed using a sheet
Performed by one sister (Fig. 2.25).
Indications: patient helplessness; lack of assistant.
- Explain to the patient the process of the upcoming procedure, make sure he understands it and obtain his consent.
- Assess your surroundings. The bed should not have a hard headboard and should be set back from the wall. Secure the bed brakes (if equipped).
Rice. 2.25.
- Ask the patient (if possible) how he can help.
- Pull the edges of the sheet out from under the mattress.
- Remove the pillow and place it next to you. Lower (remove) the head of the bed.
- Make sure the patient is lying horizontally.
- Stand at the head of the bed, spread your legs 30 cm wide and place one foot slightly in front. Do not lean over the headboard.
- Roll the sheet over the patient's head and shoulders. Ask him to bend his knees (if possible) and press his feet into the mattress.
- Take with both hands, palms up, the rolled edges of the sheet on both sides of the headboard.
- Bend your knees and keep your back straight!
- Ask the patient to help with the movement, after exhaling. On the count of three, tilt the body back and pull the patient to the head of the bed.
- Place a pillow under your head and straighten the sheet. Make sure it lies comfortably.
Performed by one sister (Fig. 2.26). Contraindications: spinal injury; spine surgery; epidural anesthesia.
- Explain the procedure to the patient (if possible), make sure he understands it, and obtain his consent.
- Assess your surroundings. Lower the side rails, if equipped. Set the bed brakes.
- Make sure the patient is lying horizontally. Ask him to raise his head; if he cannot, gently lift his head and remove the pillow; lean it against the head of the bed.
Rice. 2.26.
- Start the transfer procedure from the patient’s feet:
- stand at the patient’s feet at an angle of 45°;
- spread your legs 30 cm wide;
- leg towards the head, set back a little;
- bend your knees so that your hands are at the level of the patient’s legs;
- move the center of gravity to the leg set back;
- move the patient's legs diagonally towards the headboard.
- Move the patient's pelvis diagonally towards the head of the bed.
- Move with your knees bent so that your arms are at the level of the patient’s torso.
- Place one hand under the patient's neck, supporting his shoulder, and the other hand under his back.
- Move the patient's head and upper torso diagonally toward the head of the bed.
- Raise the side rail (if it exists). Move to the other side of the bed and lower the side rail.
- Move from one side of the bed to the other, repeating previous operations until the patient’s body reaches the desired height in bed.
- Move the patient to the middle of the bed, alternately moving the upper body, pelvis, and legs.
- Elevate the patient's head and shoulders and provide a pillow. Make sure it lies comfortably.
Moving the patient to the edge of the bed
Performed by one nurse, the patient can help.
Use: changing linen; as a preliminary stage for other movements.
Contraindications: spinal injury; spine surgery; epidural anesthesia
- Explain the procedure to the patient, make sure he understands it and obtain his consent to perform it.
- Make sure the patient is lying horizontally. Lower the side rails on the sister's side.
- Raise the patient's head and shoulders, remove the pillow and lean it against the headboard.
- Stand at the head of the bed. Spread your legs 30 cm wide, bend your knees without leaning forward.
- Ask the patient to grab his or her elbows.
- Place one hand under the patient's neck and shoulders, the other under his upper back.
- On the count of three, tilt your body and pull the patient’s upper back towards you.
- Change the position of your hands: place one hand under your waist, the other under your hips.
- On the count of three, tilt your body and pull it towards you. bottom part torso.
- Place your hands under the patient's shins and feet and, on the count of three, move them towards you.
- Help the patient raise his head and place a pillow. Raise the side rails (if equipped).
- Perform the procedure for which the patient was moved.
Moving the patient from the “side lying” position to the “sitting with legs down” position
Performed by one sister (Fig. 2.27). Can be performed on both a functional and a regular bed.
Used in forced and passive positions.
- Explain the procedure to the patient, make sure he understands it and obtain his consent to perform it.
- Assess the patient's condition and environment. Set the bed brakes.
- Lower the side rails (if equipped) on the nurse's side.
- Stand opposite the patient: place your left hand under your shoulders, your right hand under your knees, covering them from above. Bend your knees. Don't bend over!
- Raise the patient by lowering his legs down and at the same time turning him on the bed in a horizontal plane at an angle of 90°.
Rice. 2.27.
- Sit the patient down, holding the shoulder with one hand and the body with the other.
- Make sure the patient is sitting firmly and confidently. Place a back support.
- Put on slippers for the patient if his feet touch the floor, or place a bench under his feet if they do not touch the floor.
Moving the patient to the head of the bed using a sheet (performed with one nurse)
4.Pull the edges of the sheet out from under the mattress on all sides.
5.Remove the pillow from under the patient’s head and place it next to him. Lower the head of the bed. Make sure the patient lies horizontally.
6.Stand at the head of the bed with your feet 30 cm wide and place one foot slightly in front of the other.
7.Roll up the sheet around the patient’s head and shoulders. Ask the patient to bend his knees (if he can do this) and press his feet to the mattress so that he is able to help.
8.Grip the rolled edges of the sheet on both sides of the patient’s head with both hands, palms up.
9.Bend your knees to keep your back straight.
10.Warn the patient to be ready to move.
11. Having warned the patient, tilt the body back and pull the patient to the head of the bed.
12.Place a pillow under the patient’s head and straighten the sheet.
Moving the patient to the edge of the bed (performed by one nurse, the patient can help).
4.Remove the pillow from under the patient’s head and place it next to him. Lower the head of the bed.
5. Make sure that the patient lies strictly horizontally.
6.Stand at the head of the bed with your feet 30 cm wide and place one foot slightly in front of the other. Bend your knees.
7.Ask the patient to cross his arms over his chest, clasping his elbows.
8. Place one hand under the patient’s neck and shoulders, and the other under his upper back.
9. Tilt your body back and pull your upper back towards you.
10.Change the position of the hands: place one hand under the patient’s waist, the other under the patient’s hips.
11.Also tilt the body back and pull the patient’s lower torso towards you.
12. Place your hands under the patient’s shins and feet and move them towards you. Raise the patient’s head and place a pillow under it.
End of the procedure:
13. Make sure the patient is lying comfortably. Raise the side rails of the bed.
14.Move the bedside table next to the bed and place items frequently needed by the patient on the table.
15.Remove gloves.
16. Wash, dry and treat your hands with an antiseptic solution.
17.Make an appropriate entry about the procedure performed in the medical documentation.
Supporting the patient while walking
First, carefully assess what the patient can do independently or with the assistance of one or more persons, using assistive devices such as a cane, crutches, or when a support structure can be used. When you decide to help, stand close to the patient and apply a thumb grip: hold the patient's right hand in yours right hand and do the same with the left. The patient's hand should be straight, with the palm resting on your palm with the thumbs clasped together. You can use your other hand to avoid unnecessary stress on your back and also to support the patient. If he feels unsure, support him at the waist and support his knees with your dominant leg. In this position, you can keep the person from falling with minimal effort.
Learning to walk
When the doctor has allowed and strongly recommended that the patient begin to walk, a nurse assists him. The first step means a lot for the patient. First, help him get up. To facilitate walking and secure the patient, a belt can be worn. While the patient is moving, you should position yourself on the affected side, placing your non-working hand on your shoulder and holding the patient by the belt to increase his stability. If, however, the patient begins to fall, it is thanks to the belt that you can smoothly lower him to the floor.
Another option for learning to walk is to use a special device, a “walker.” Most modern models of “walkers” have variable height, which allows them to be used by both short and tall people. tall patients(according to standards, the “walker” should be up to the level hip joint patient).
There are several types of walkers:
Portable, consisting of a structure made of durable but lightweight metal on four legs with rubber tips (to reduce slipping when in contact with the floor) and two handles for gripping with a brush. This model is intended for people who are unstable but do not need to lean heavily on the walker.
Four-wheeled - a design similar to the first, in which wheels are attached instead of rubber tips. This model is designed for patients who need constant support while walking.
Two-wheeled - a kind of transitional option between the first and second models: two wheels in the front and two legs with rubber tips in the back. If the patient is tired, he can stop and lean on the walker. To resume movement, you just need to lift the back legs and roll the “walker” on the front wheels.
The next type of device that makes it easier for the patient to move is a stick with a rubber tip. The size of the stick is selected in this way: the upper end is located at the level of the hip joint, while the lower end should not reach the floor 20 cm.
There are several models of sticks. The most famous is with one rubber tip (necessary for those patients who have relatively good balance when walking). There are also sticks with three and four tips (for patients who are less stable when moving).
As a rule, the stick is used by the patient if he needs support on one side of the body, but only when he is able to move independently. And yet, in the first days of using the stick, the patient should be insured on the affected side.
Some patients prefer to use a crutch instead of a stick. When choosing the size of a crutch, use the rule - between it top edge and two fingers should fit under the armpit. In addition, the patient should be able to comfortably grasp the crossbar of the crutch and rest on his unbent arm.
Once the patient has started walking, it is very important to minimize the likelihood of him falling, each of which can result in injury. The injury will again bind the patient to bed, which will not only negatively affect his psychological state, but can also cause the development of potential problems and complications, including life-threatening ones.
What to do if the patient does fall?
Let it slide down along your body without straining yourself. This fall is controlled. You can then help the patient lie on their side or sit up with a pillow or blanket.
If there is no danger to the patient and he can assist you, then one of the nurses can lift the patient using an arm grab, while the other lifts the legs. You both bend your knees and carefully straighten up. Alternatively, you can use a modified shoulder lift technique. For the first stage of lifting - from the floor to a low chair - you may find it most comfortable to kneel, but at each stage of the lift you need to be sure that you have a firm support for your non-lifting arms.
Patients who are only partially ambulatory are sometimes able to cope with minimal assistance: they may first roll onto their side, then lean their shoulder on a low stool, chair, or bed to kneel; from this position they can sit or lie down.
Fallen patient
If the patient cannot or does not need to be seated using a lifting device, stretcher, or lifting aid, the patient must be lifted from the floor manually. In this case, the patient is lifted by three people. This requires great care. This technique involves bending in and lifting in front of the knees, so it is potentially dangerous. Put yourself physically strong man in the middle he would take on the heaviest part of the burden. Coherence of movements is important; If inexperienced persons assist in lifting, ensure that they are properly instructed.
