Home Stomatitis The importance of personal hygiene in patient care. Personal hygiene of patients and staff

Stomatitis

The importance of personal hygiene in patient care. Personal hygiene of patients and staff

Patient personal hygiene

The student must know:

Position of the patient in bed.

Modes motor activity patient.

Risk factors for the formation of bedsores.

Places of possible formation of bedsores, stages of their formation.

Rules for assembling and transporting used linen.

Possible patient problems: violation of the integrity of the skin: diaper rash, bedsores, risk of bedsores; infection; pain, etc.

Nursing interventions.

The student must be able to:

Determine the risk level of pressure ulcers for each patient.

Treat the skin if there are bedsores.

Teach relatives of a seriously ill patient the elements of preventing pressure ulcers at home.

Create the necessary position for the patient in bed depending on the disease using a functional bed and other devices.

Prepare the patient's bed.

Change underwear and bed linen.

Carry out measures to prevent bedsores.

Treat natural skin folds and prevent diaper rash.

Provide morning toilet care to the patient.

Clean the patient in bed.

Treat the patient's eyes.

Treat the patient's mouth and nose.

Clean the patient's external auditory canal.

Wash your feet in bed and trim your toenails and fingernails.

Wash your hair in bed.

Bring a bedpan and a urinal.

Care for the external genitalia of men and women.

Questions for self-study

Features of caring for seriously ill patients.

The position that the patient can occupy in bed.

The main purpose of a functional bed.

Positions that can be created for the patient in bed using a functional bed and other devices.

Requirements for bed linen.

Methods for changing underwear and bed linen for a seriously ill patient.

Basic rules for changing underwear and bed linen for a seriously ill patient.

Preparing the bed for a seriously ill patient.

Hair care.

Providing a bedpan and urine bag to patients (men and women).

Technique for washing patients (men and women).

Diaper rash, causes, localization, prevention of occurrence.

Washing and brushing the patient's teeth in bed.

Wiping the patient's skin in bed.

Washing the patient's feet in bed.

Trimming the patient's fingernails and toenails.

Shaving a patient's face.

Bedsores, risk factors, localization.

Determination of the risk of pressure ulcers using the Waterlow table.

Measures to prevent bedsores.

Tactics for the development of bedsores.

Removing mucus and crusts from the patient's nasal cavity.

Caring for the eyes of a seriously ill patient.

Cleansing the external auditory canal.

Oral care.

Ethical and deontological support

The nurse should, without additional reminders, carry out personal hygiene measures in bed for a seriously ill patient, since this is her direct responsibility. She must convince the patient to accept her help. After all, good care requires not only knowledge and skills, but also sensitivity, tact, the ability to exert psychological influence, and the ability to overcome increased irritability patient. A restrained, even and calm attitude towards the patient helps to gain his trust and obtain consent to perform certain personal hygiene measures. For this, it is equally important to inform the patient in advance of the goal and progress of their implementation.

Since patients are often embarrassed when performing intimate manipulations (washing, feeding a pan, etc.), the nurse should:

tactfully convince the patient that there is no reason for embarrassment;

protect the patient with a screen;

ask other patients to leave the room if their condition allows them - after providing a bedpan or urine bag, leave the patient alone for a while.

Glossary

term

Formulation

Apathy

Morbid indifference, indifference to everything

Hemiplegia

Unilateral limb muscle paralysis

Depression

Depressed mental state

Bedsore

Necrosis (necrosis) of soft tissues (skin, subcutaneous fat, muscles, tendons and other tissues).

Theoretical part

Safety regulations

The nurse needs to know and be able to apply the rules of biomechanics in their work in order to prevent injuries in patients and medical staff. (See “Safe hospital environment. Rational physical activity regime. Biomechanical rules for the patient and medical staff”).

Don't forget to wear protective clothing!

Attention! Remember the safety rules when contacting the mucous membranes of a patient in order to prevent AIDS and hepatitis (see the topic “Prevention of HIV infection”).

Purpose of hygiene care

Create maximum patient comfort and ensure cleanliness and safety.

Principles of hygienic care

1 . Safety (prevention of patient injury, both physical and psychological).

2. Compliance with the principle of infection safety.

3. Privacy (not disclosing patient secrets).

4. Communication There should be a patient-friendly approach; before each manipulation, inform the patient:

1) the purpose of the manipulation;

2) how to prepare for manipulation;

3) what sensations will occur during the manipulation and how to behave;

4) what to do after the manipulation;

5) what sensations will there be after the manipulation;

6) what unwanted sensations there may be and what to do if

will appear.

5. Respect for feelings self-esteem patient.

6. Encouraging patient independence and autonomy.

Job responsibilities guard (ward) nurse:

(depending on the branch profile)

apply knowledge of the health care system and policy, the basics of legislation and law in health care Russian Federation in the conditions of budgetary insurance medicine;

introduce the basics of management into nursing;

maintain medical records;

monitor compliance with the sanitary and epidemiological regime in the department;

supervise the work of junior medical staff;

organize nursing care for patients:

a) organize general care,

b) organize differentiated care,

c) organize intensive care for patients;

provide nursing care to patients based on the nursing process:

a) assess the condition using anamnesis data, objective data of the patient,

b) formulate nursing diagnosis,

c) identify the patient’s violated needs,

d) create a patient care plan,

e) implement the nursing care plan,

f) evaluate the effectiveness of nursing care, quality standards

care, criteria for the effectiveness of nursing care;

apply knowledge of nursing pedagogy and communication in the implementation of all stages of the nursing process;

provide palliative nursing care;

apply traditional and alternative medicine in the treatment, care and rehabilitation of patients in pharmacotherapy, nutritional therapy, herbal medicine, using different kinds massage, physical therapy, methods of psychotherapy.

Medical documentation of the medical department

Log of reception and delivery of duties.

Portion requirement.

Temperature sheet.

Pharmacy requirement.

Requirement for medicines of the head nurse.

Summary of patient movement.

Notebooks for medical prescriptions.

Logbook for narcotic and potent drugs.

Assignment sheets.

Appointment notebooks.

Patient's position in bed

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, for example, in the first hours after a heart attack).

Forced position – the patient takes it himself to reduce pain, cough and other pathological symptoms.

Functional position - a position prescribed by a doctor in order to speed up recovery or to avoid harm.

The patient's position in bed does not always coincide with the movement regimen prescribed by the doctor.Forced The patient’s position in bed also does not always coincide with the functional one, for example, with pustular diseases in the lungs (lung abscess), the patient needs to lie on the healthy side, since this position promotes the outflow of pus. But the outflow of pus causes a cough, and coughing causes pain, and it is easier for the patient to lie on the sore side, and this position is harmful for him.

Patient's physical activity mode

General (free) – the patient stays in the department without restriction of physical activity within the hospital and

hospital grounds. Free walking in the corridor is allowed,

climbing the stairs, walking around the hospital grounds.

Ward (semi-bed) – the patient spends a lot of time in bed, free walking around the ward is allowed, all personal hygiene measures are carried out within the ward.

Bed – the patient does not leave the bed, can turn around, sit, but cannot get up. All personal hygiene measures are carried out in bed by medical personnel.

Strict bed – the patient is strictly prohibited from active movements in bed; he cannot even turn from side to side.

Change of bed linen and underwear

There are two ways to change bed linen.

First way used if the patient compliesbed rest subject to permission to turn in bed (see algorithms).

Second way apply in case of compliancestrict bed rest provided that the patient is prohibited from performing active movements in bed (see algorithms).

Rules for changing and transporting linen.

The patient's head should not rest on the bare mattress.

Do not shake linens at the patient’s bedside, especially dirty ones.

Do not place dirty laundry on the floor, place it immediately in a waterproof bag.

Carefully roll up clean laundry so that it does not touch the floor.

Transport laundry around the department only in waterproof bags.

Sort dirty laundry only in special rooms.

When changing linen, the patient and nurse should wear protective clothing (apron, gloves).

Remember! Patients' linen is changed at least once every 7–10 days, in a seriously ill patient - as contamination occurs, but at least every 7 days 1 time. To change the linen of a seriously ill patient, it is necessary to invite 1 - 2 assistants.

Vessel delivery

When caring for a patient who is on strict bed rest, if it is necessary to empty the intestines and bladder, a bedpan or urinal is placed in bed; women often use a bedpan when urinating. Metal with enamel coating, plastic or rubber vessels are used. When feeding a vessel, infection safety rules are observed, confidentiality during urination and defecation is ensured, as well as patient independence and personal hygiene are maintained (see algorithms).

Remember! The ship always arrives disinfected and warm, and for taking feces or urine for analysis and for washing - dry, in other cases, a little water is poured into the vessel before serving.

Currently, for urinary incontinence, diapers are used for seriously ill patients. They need to be changed every4 hours and monitor the condition of the skin, lubricate the skin with protective creams (for example, “for children”).

Algorithm for changing a diaper for a seriously ill patient

Equipment: non-sterile gloves, protective sheet (diaper), clean napkins, container with warm water, bag for used laundry, clean diaper, skin antiseptic.

I. Preparation for the procedure.
1. Explain the process and purpose of the procedure to the patient (if possible), obtain his consent.
2. Treat hands hygienically and dry.
3. Prepare a clean diaper and protective sheet, and make sure that there are no personal belongings of the patient in the bed.
4. Wear gloves.
II. Execution of the procedure.
5. Lower the handrails and assess the patient’s position and condition.
6. Turn the patient on his side with his knees slightly bent.

7. Roll the waterproof diaper into a tube halfway along the long side and slip it under the patient’s back in the same way as changing bed linen.

8.Unfasten the used diaper and remove it from under the patient. Place in a used laundry bag. Provide care for the patient's intimate area.

9. Take a clean diaper out of the package, shake it and pull the ends so that the absorbent layer fluffs up and the side protective frills take a vertical position.

10. Turn the patient on his side, slightly bending his knees, and place the diaper under his back so that the Velcro fasteners are on the side of the head, and the filling indicator (the inscription on the outside of the diaper in the central part, directed along the diaper) is along the line of the spine .

11. Turn the patient on his back, his legs should be slightly bent at the knees.

12. Gently straighten the diaper under the patient’s back.

13. Pull the front part of the diaper between the patient’s legs onto the stomach and straighten it.

14. Lower the patient's legs.

15. Fasten the Velcro: first, sequentially fasten the lower Velcro, first the right, then the left, or vice versa, tightly covering the legs, directing the Velcro across the patient’s body, slightly from bottom to top; then secure the upper Velcro strips across the patient's body.

III. End of the procedure.
16. Position the patient comfortably in bed.

17. Remove gloves and place them in a container for disinfection
18. Treat hands hygienically and dry.
19. Make an appropriate entry about the results of the implementation in the medical documentation.

Change diapers at least three times a day: in the morning, at lunch and before bed.
If the diaper is contaminated with feces, replace the diaper immediately and carry out hygiene and treatment of the patient's skin.If there is a risk of developing bedsores, change the diaper every 4 hours

Washing patient's feet in bed

Feet in bed are washed every 3 days with warm water (see algorithms).

Washing feet in bed

Bedsores

Bedsore ( decubitus ) – these are deep lesions of the skin and soft tissues up to their necrosis as a result of prolonged compression. Factors contributing to the formation of bedsores include disruption of local blood circulation, innervation and tissue nutrition. Bedsores can form anywhere there are bony protrusions. When the patient is positioned on his back, this is the sacrum, heels, shoulder blades, sometimes the back of the head and elbows, rarely along the spinous processes of the vertebrae. When sitting, these are the ischial tuberosities, feet, and shoulder blades. When lying on your stomach, these are the ribs, knees, toes with back side, ridges iliac bones. When lying on the side, these are the convex parts of the joints (knee, elbow, shoulder, ankle)

Most common places The most vulnerable places for occurrence

localization of bedsores bedsores (marked with dots)

The following types of bedsores are distinguished:

exogenous , i.e. caused by mechanical factors leading to ischemia and tissue necrosis. In these cases, eliminating the causes that caused the bedsore leads to the development of reparative (restorative) processes and its healing;

endogenous , the development of which is determined by disruption of the body’s vital functions, accompanied by neurotrophic changes in tissue. Healing of such bedsores is possible with improvement of the general condition of the body and tissue nutrition.

Three main factors leading to the formation of bedsores have been established: pressure, shear force and friction.

Pressure – under the influence of the body’s own weight, tissue compression occurs relative to the surface on which the person rests. At the same time, the diameter of the vessels decreases, as a result, less blood flows to the tissues, i.e., less nutrients and oxygen. When fully compressed fortwo hours is formednecrosis. Compression of vulnerable tissues is further enhanced by heavy bedding, tight bandages, and clothing.

"Shear" – destruction and mechanical damage to tissue occurs under the influence of indirect pressure. It occurs as a result of tissue displacement relative to the supporting surface. Microcirculation in the underlying tissues is disrupted, and the tissue dies from lack of oxygen. Displacement occurs when the patient “slides” down the bed or is pulled towards the head of the bed.

Friction - is a component of the “shearing force”, it causes detachment of the stratum corneum of the skin and leads to ulceration of its surface. Friction increases as the skin becomes hydrated. Patients most susceptible to this effect are those with urinary incontinence, increased sweating, and wearing damp, non-absorbent underwear.

Factors influencing the development of bedsores: disturbance of touch; injuries and diseases of the spinal cord and brain; increased temperature and sweating; urinary and fecal incontinence; dirty skin; crumbs and small objects in the bed; folds, seams, buttons on linen; reduced nutrition and lack of fluids; diet, excess weight and exhaustion; cardiovascular diseases; diabetes; allergic reaction for skin care products; age.

Signs of bedsores are the appearance of a pale area of skin, then a bluish-red color without clear boundaries, then the epidermis peels off and blisters form. Next, tissue necrosis occurs, spreading deep into the tissue and to the sides. Treatment is carried out in accordance with the degree of tissue damage.

Risk factors

Internal risk factors

Reversible

Irreversible

Exhaustion

Senile age

Limited mobility

Anemia

Insufficient intake of protein and ascorbic acid

Dehydration

Hypotension

Urinary and/or fecal incontinence

Neurological disorders (sensory, motor)

Peripheral circulation disorder

Thin skin

Anxiety

Confusion

Coma

External risk factors

Reversible

Irreversible

Poor hygiene care

Folds in bedding and/or underwear

Extensive surgical intervention lasting more than 2 hours

Bed rails

Patient restraints

Injuries of the spine, pelvic bones, organs abdominal cavity

Damage spinal cord

Application of cytostatic medicines

Incorrect technique for moving the patient in bed

Remember ! Bedsores are easier to prevent than to treat!

Degree 1 – limited to the epidermal and dermal layers. The skin is not damaged. There is persistent hyperemia with bluish-red spots that does not go away after the pressure stops. Conservative treatment:

1st degree bedsores

Treatment of 1st degree bedsores

Restore blood circulation to the damaged area of skin.

To do this, you need to turn the patient, releasing the place of redness from the pressure (if the patient is lying on his back, you need to turn him every 2 hours and fix the position of the body first on the right side, then on the left, excluding the patient’s position on his back).

Apply to the area of redness Menalind professional – tonic liquidmassaging movements until completely absorbed at least 3 times a day

Strengthen measures to prevent bedsores.

Degree 2 – shallow superficial violations of the integrity of the skin, spreading to the subcutaneous fat layer. Persistent hyperemia with bluish-red spots persists. Detachment of the epidermis occurs - the appearance of blisters filled with serous fluid. Conservative treatment:

Attention! On the heels, the formation of bedsores can occur unnoticed due to the thick layer of soft tissue. The signal for the beginning of the formation of a bedsore is the presence of a white spot!

inform your doctor;

strengthen measures to prevent bedsores;

Do not open the bubbles!

when opening blisters, apply bio-occlusive dressings;

as prescribed by a doctor - bandages with solcoseryl ointment

deodorizing the wound using activated carbon wipes;

deodorizing the room using a deodorant containing chlorophyll

washing the bedsore with saline solution or sterile water;

applying a dry aseptic dressing.

Stage 2 bedsores

Degree 3 – complete destruction of the skin in its entire thickness to the muscle layer with penetration into the muscle itself.

Degree 4 - damage to all soft tissues. Formation of cavities (“pockets”) with damage to underlying tissues (tendons, up to bone).

Third and fourth degree bedsores are treated by a surgeon.

Stage 3 bedsores Stage 4 bedsores

Features of patient care

Placing the patient on a functional bed (in a hospital setting). There should be handrails on both sides and a device for raising the head of the bed. The patient should not be placed on a bed with armored mesh or old spring mattresses. The height of the bed should be at the height of the caregiver's mid-thighs.

The patient being moved or moved into a chair must be on a bed with a variable height that allows him to move out of the bed independently, using other available means.

The choice of an anti-bedsore mattress depends on the degree of risk of developing bedsores and the patient’s body weight. For low risk situations, a 10cm thick foam mattress may be sufficient. With a higher degree of risk, as well as with existing bedsores different stages need other mattresses. When placing the patient in a chair (wheelchair), foam rubber pads with a thickness of 10 cm are placed under the buttocks and behind the back. Foam rubber pads with a thickness of at least 3 cm are placed under the feet (convincing evidence B).

Bed linen is cotton. The blanket is light.

It is necessary to place cushions and foam rubber cushions under vulnerable areas.

Change body position every 2 hours, incl. at night, according to schedule: low position
Fowler, side position, Sims position, prone position (in consultation with the doctor). Fowler's position should coincide with meal times. Every time you move, inspect risk areas. The results of the inspection should be recorded on the registration sheet for anti-decubitus measures (convincing evidence B).

Move the patient carefully, avoiding friction and tissue displacement, lifting him above the bed, or using a back sheet.

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

Do not expose areas at risk to friction. Full body massage, incl. near risk areas (within a radius of at least 5 cm from the bony protrusion) should be carried out after generous application of nourishing (moisturizing) cream to the skin (convincing evidence B).

Wash the skin without rubbing or bar soap, use liquid soap. Dry your skin thoroughly after
washing with blotting movements (strength of evidence C).

Use waterproof diapers and diapers that reduce excessive moisture.

Maximize the patient’s activity: teach him self-help to reduce pressure on support points.

Encourage him to change position: turn around using the bed rails, pull himself up. Teach relatives and other caregivers how to reduce the risk of tissue damage from exposure.
pressure:

change body position regularly;

use devices that reduce pressure (pillows, foam rubber, pads);

follow the rules of lifting and moving: avoid friction and tissue shear;

inspect all skin at least once a day, and risk areas every time you move;

realize proper nutrition and adequate fluid intake;

carry out hygiene procedures correctly: avoid friction.

Do not allow the skin to become overly moisturized or dry: if it is overly moisturized, dry it using
powder without talc; if dry, moisturize with cream (convincing evidence C).

Constantly maintain a comfortable state of the bed: shake off crumbs, straighten folds.

Educate the patient breathing exercises and encourage him to do them every 2 hours.

Recommended care plans for the risk of developing bedsores in a bedridden patient and a patient who can sit are given in Appendix No. 2. Registration of anti-bedsore measures is carried out on a special form (see Appendix No. 2 to the order of the Ministry of Health of Russia dated April 17, 2002 N 123).

6.1.8 Dietary requirements and restrictions

The diet should contain at least 120 g of protein and 500 - 1000 mg of ascorbic acid per day (Strength of Evidence C). The daily diet should be high enough in calories to maintain the patient’s ideal body weight.

The patient must have information about:

risk factors for the development of bedsores;

for the purposes of all preventive measures;

the need to implement the entire prevention program, incl. manipulations performed by the patient and/or his relatives;

consequences of non-compliance with the entire prevention program, incl. decrease in quality of life.

The patient must be taught:

Technique for changing body position on a plane using auxiliary means (bed rails, chair armrests, devices for lifting the patient)

Breathing exercise technique.

Additional Information for relatives:

places of formation of bedsores;

moving technique;

features of accommodation in various positions;

dietary and drinking regime;

technique hygiene procedures;

monitoring and maintaining moderate skin moisture;

encouraging the patient to move independently every 2 hours;

encouraging the patient to perform breathing exercises.

Note: Education of the patient and/or his relatives must be accompanied by a demonstration and comments on the drawings from clause 10 of OST 91500.11.0001-2002.

Data on informing the patient’s consent are recorded on a special form (see Appendix 2 to the order of the Ministry of Health of Russia dated April 17, 2002 N123).

6.1.10 Additional information for patients and family members

Memo for the patient

Prevention - best treatment. To help us prevent you from developing bedsores, you should:

Drink a sufficient amount of liquid (at least 1.5 liters) (the volume of liquid should be checked with your doctor) and at least 120 g of protein; 120 g of protein needs to be “gained” from different foods you love, like animals,so and plant origin. For example, 10 g of protein is contained in:

72.5 g

fat cottage cheese

51.0 g

lean chicken

50.0 g

low-fat cottage cheese

51.0 g

turkeys

62.5 g

soft diet cottage cheese

57.5 g

beef liver

143 g

condensed milk, sugar-free, sterilized

64.0 g

flounder

42.5 g

Dutch cheese

62.5 g

carp

37.5 g

Kostroma, Poshekhonsky, Yaroslavl cheese

54.0 g

river perch

47.5 g

Russian cheese

53.0 g

halibut

40.0 g

Swiss cheese

59.0 g

herring

68.5 g

sheep's milk cheese

56.5 g

Atlantic fatty herring

56.0 g

cow's milk cheese

55.5 g

Pacific herring low-fat

78.5 g

chicken egg

55.5 g

mackerel

48.0 g

lean lamb

54.0 g

horse mackerel

49.5 g

Lean beef

52.5 g

zander

48.5 g

rabbit meat

57.5 g

cod

68.5 g

pork meat

60.0 g

hake

51.0 g

Veal

53.0 g

pike

55.0 g

Kur

Protein is also found in foods of plant origin. So, 100 g of product contains different amounts of protein:

wheat bread

6.9 g

semolina

8.0 g

pasta, noodles

9.3 g

Rice

6.5 g

buckwheat

8.0 g

green peas

5.0 g

Consume at least 500-1000 mg of ascorbic acid (vitamin C) per day;

move in bed, including from bed to chair, eliminating friction;

use aids;

use an anti-bedsore mattress and/or chair cushion;

try to find a comfortable position in bed, but do not increase pressure on vulnerable areas (bone
protrusions);

change your position in bed every 1 to 2 hours, or more often if you can sit up;

walk if you can; do exercises by bending and straightening your arms and legs;

do 10 breathing exercises every hour: deep, slow breath in through your mouth, exhale through your nose;

take an active part in your care;

Ask the nurse questions if you have any problems.

General treatment regimen for bedsores

Initial assessment of the general situation:

location of bedsore formation, severity, general state wounds;

assessment of the patient's status.

Etiological therapy: complete

relieving pressure on the bedsore

until healing.

Treatment

Local therapy:

adequate treatment and treatment of the wound.

Yes: control and continuation of therapy

according to the treatment plan.

Has the bedsore healed?

No: rigorous quality check

carried out activities,

especially stress relief.

Memo for relatives

With each movement, any deterioration or change in condition, regularly inspect the skin in the area of the sacrum, heels, ankles, shoulder blades, elbows, occiput, greater trochanter femur, the inner surface of the knee joints.

Do not expose vulnerable areas of the body to friction. Wash vulnerable areas at least once a day if you need to maintain normal personal hygiene rules, as well as if you have urinary incontinence, heavy sweating. Use mild and liquid soap. Make sure that detergent rinsed off, dry this area of skin. If your skin is too dry, use a moisturizer. Wash your skin with warm water.

Use barrier creams if indicated.

Avoid massaging the area of prominent bony protrusions.

Change the patient's position every 2 hours (even at night): Fowler's position; Sims position; "on the left side"; "on the right side"; "on the stomach" (with the doctor's permission). The types of positions depend on the disease and condition of the individual patient. Discuss this with your doctor.

Change the patient's position by lifting him off the bed.

Check the condition of the bed (folds, crumbs, etc.).

Avoid skin contact with the hard part of the bed.

Use foam rubber in the case (instead of cotton-gauze and rubber circles) to reduce pressure on the skin.

Relieve pressure on areas where skin integrity is compromised. Use appropriate equipment.

Lower the head of the bed to the most low level(angle no more than 30 degrees). Raise the head of the head a short time to perform any manipulations.

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

Avoid continuous sitting in a chair or wheelchair. Remind them to change position every hour, change their body position independently, pull themselves up, and examine vulnerable areas of the skin. Advise him to relieve pressure on the buttocks every 15 minutes: lean forward, to the side, or rise, leaning on the arms of the chair.

Reduce the risk of tissue damage due to pressure:

change your body position regularly;

use devices that reduce body pressure;

Observe lifting and moving rules;

examine your skin at least once a day;

Maintain proper nutrition and adequate fluid intake.

Monitor the quality and quantity of food and fluids, including urinary incontinence.

Expand the activity of your ward as much as possible. If he can walk, encourage him to take a walk every hour.

Use waterproof diapers, diapers (for men - external urinals) for incontinence.

6.1.11 Rules for changing requirements when implementing the protocol and termination of protocol requirements

The requirements of the protocol cease to apply if there is no risk of developing pressure ulcers due to Waterlow scale.

II . Sheet nursing assessment risk of development and stage of pressure ulcers

Name

N p/p

Body mass

Skin type

Floor

Age

Special risk factors

Incontinence

Mobility

Appetite

Neurological disorders

Extensive surgery below the belt/injury

More than 2 hours on table 5

Drug therapy

Instructions: Circle the number corresponding to the Waterlow scale.

Sum of points -

Risk: no, yes, high, very high (underline as appropriate) Bedsores: yes, no (underline as appropriate)

Stage 1,2,3,4.

Agreed with the doctor

(Doctor’s signature)_________________

Recommended care plan for those at risk of developing pressure ulcers (bedridden patient)

Nursing interventions

Multiplicity

1. Conducting a current assessment of the risk of developing bedsores at least once a day (in the morning) according to the Waterlow scale

1 time daily

2. Change the patient's position every 2 hours:

- 8 - 10 o'clock - Fowler's position;

- 10 - 12 o'clock - position "on the left side";

- 12 - 14 o'clock - position "on the right side";

- 14 - 16 o'clock - Fowler's position;

- 16 - 18 hours - Sims position;

- 18 - 20 hours - Fowler's position;

- 20 - 22 o'clock - position "on the right side";

- 22 - 24 hours - position “on the left side”;

- 0 - 2 hours - Sims position;

- 2 - 4 hours - position “on the right side”;

- 4 - 6 hours - position “on the left side”;

- 6 - 8 o'clock - Sims position

Daily 12 times

1 time daily

Daily 12 times

5. Teaching the patient’s relatives the technique of correct movement (lifting above the bed)

By individual program

6. Determination of the amount of food eaten (the amount of protein is at least 120 g, ascorbic acid 500 - 1000 mg per day)

Daily 4 times

7. Ensuring the consumption of at least 1.5 liters of fluid per day:

from 9.00 - 13.00 - 700 ml;

from 13.00 - 18.00 - 500 ml;

from 18.00 - 22.00 - 300 ml

During the day

3. Use of foam pads in risk areas, eliminating pressure on the skin

During the day

9. For incontinence:

During the day

- urine - changing diapers every 4 hours,

10. If pain intensifies, consult a doctor

During the day

11. Teach and encourage the patient to change position in bed (pressure points) using bars, grab bars, and other devices.

During the day

12. Massage the skin near risk areas

Daily 4 times

13. Teach the patient breathing exercises and encourage him to do them

During the day

14. Monitor skin moisture and maintain moderate humidity

During the day

The choice of position and their alternation may vary depending on the disease and condition of the patient.

Recommended care plan for patients at risk of developing pressure ulcers (in a patient who can sit)

Nursing interventions

Multiplicity

Conduct an ongoing assessment of the risk of developing pressure ulcers at least once a day (in the morning) using the Waterlow scale

1 time daily

Change the patient's position every 2 hours:

8 - 10 o'clock - sitting position;

10 - 12 o'clock - position "on the left side";

12 - 14 o'clock - position "on the right side";

14 - 16 o'clock - sitting position;

16 - 18 hours - Sims position;

18 - 20 o'clock - sitting position;

20 - 22 o'clock - position "on the right side";

22 - 24 hours - position “on the left side”;

0 - 2 hours - Sims position;

2 - 4 hours - position "on the right side";

4 - 6 hours, - position "on the left side";

6 - 8 o'clock - Sims position;

If the patient can be moved (or move independently with the help of assistive devices) and in a chair (wheelchair), he can be in a sitting position and in a bed

Daily 12 times

3. Washing contaminated skin areas

1 time daily

4. Checking the condition of the bed when changing position (every 2 hours)

Daily 12 times

Teaching the patient's relatives the technique of correct movement (lifting above the bed)

According to an individual program

Teaching the patient to move independently in bed using a lifting device

According to an individual program

Teaching the patient how to safely move independently from bed to chair using other means

According to an individual program

. .

Determination of the amount of food eaten (the amount of protein is at least 120 g, ascorbic acid 500 - 1000 mg per day)

Daily 4 times

Ensure consumption of at least 1.5 liters. liquids

per day:

During the day

from 9.00 - 13.00 - 700 ml; from 13.00 - 18.00 - 500 ml; from 18.00 - 22.00 - 300 ml

Use foam pads that eliminate pressure on the skin under risk areas, incl. with the patient in a “sitting” position (under the feet).

During the day

For incontinence: - urine - changing diapers every 4 hours,

- feces - changing diapers immediately after defecation, followed by careful hygiene procedures

During the day

If pain intensifies, consult a doctor

During the day

Teach and encourage the patient to change position in bed (pressure points) using bars, grab bars, and other devices.

During the day

Skin massage around risk areas

Daily 4 times

Waterlow scale for assessing the risk of developing pressure ulcers

Body build: body weight relative to height

Point

Skin type

Point

Gender Age, years

Point

Special risk factors

Point

Average

healthy

Male

Violation skin nutrition,

Above average

Cigarette paper

Female

for example, terminal cachexia

Obesity

14 - 49

Below the average

Dry

50 - 64

Edema

65 - 74

Sticky (increasedT° - body)

75 - 81 over 81

4 5

Heart failure

Color change

Diseases peripheral vessels

Cracks, stains

Anemia

Smoking

Incontinence

Point

Mobility

Point

Appetite

Point

Neurological disorders

Point

Full control

Full

Average

for example diabetes

Restless

Bad

multiple

through a catheter

Fussy

Feeding

through a probe

sclerosis, stroke

Periodic

Apathetic

Liquids only

motor/sensory, paraplegia

Through a catheter/

Limited mobility

Anorexia

fecal incontinence

Inert

Not by mouth (anorexia)

Stool and urine

Chained to a chair

Extensive surgical intervention trauma

Point

Orthopedic - below the belt, spine;

More than 2 hours on the table

Drug therapy

Point

Cytostatic drugs

High doses of steroids

Anti-inflammatory

The Waterlow scale scores are summed up and the degree of risk is determined by

the following total values:

– no risk

– there is a risk

– high risk

– very high risk

– 1 – 9 points,

– 10 points,

– 15 points

– 20 points.

Diaper rash ( Intertrigo )

An inflammatory lesion of a skin fold that develops under the influence of skin secretion products and friction of the contacting surfaces of the skin. Diaper rash is observed in the interdigital folds of the legs, less often in the arms, in the inguinal-femoral and intergluteal folds, in the folds of the abdomen and neck in obese patients, under the mammary glands in women with poor care. Causes of diaper rash: increased sweating and sebum secretion of skin folds, leucorrhoea, urinary incontinence, discharge from fistulas, hemorrhoids, insufficient drying of skin folds after bathing.

Diaper rash appears in the form of erythema, which without sharp boundaries turns into healthy skin. In the depths of the fold, superficial non-bleeding cracks form. In advanced cases, the stratum corneum macerates and is rejected - an abrasion with unclear outlines is revealed. Elimination of irritating factors and treatment with indifferent anti-inflammatory drugs quickly leads to cure.

However, diaper rash can be chronic, sometimes persistently dragging on for years, which is sometimes associated with the addition of an infection (infectious diaper rash); Streptococci (more often) cause intertriginous streptoderma, yeast-like fungi (less often) - intertriginous candidiasis (see), sometimes infectious agents are combined. Clinical picture infectious diaper rash is characterized by the formation of erythematous, sometimes infiltrated foci, surrounded by a narrow collar of exfoliating stratum corneum of the skin with clear, large scalloped contours. The lesions may increase in size along the periphery, their surface is weeping or covered with lamellar crusts and scales; in the depths of the folds there are superficial, non-bleeding cracks. Subjectively - itching, less often pain, burning.
Treatment of diaper rash: lotions and wet-dry dressings with a 0.1% solution of copper sulfate or zinc sulfate; lubrication with water and alcohol solutions, pastes and ointments containing 2% gentian violet, locacorten, oxycort, geocortone. Finish treatment with 2-5% tar pastes and ointments. In persistent cases - radiotherapy. After eliminating the lesions, it is necessary to wipe the skin folds with 2% salicylic alcohol and powder with talc containing 1% copper sulfate (copper sulfate).

Prevention: elimination of the causes of increased sweating - treatment of vegetative neurosis, obesity, recommend wearing rational (breathable) clothing and shoes, taking frequent hygienic baths. It is necessary to pay attention to proper feeding of infants and careful care of their skin: change diapers more often, take daily baths with a weak solution of potassium permanganate, after which lubricate skin folds and affected areas with boiled sunflower or almond oil, fish oil.

Homework:

Compose rough plan caring for bedridden patients at risk of developing bedsores (independent work).

Lectures.

S.A. Mukhina, I.I. Tarnovskaya. Practical guide to the subject "Fundamentals of Nursing", 154 - 224.

Educational and methodological manual on the basics of nursing, pp. 325 - 360.

additional information

Daily patient care

Daily morning and evening patient care

They start with washing, which is done in several stages:
1. treatment of the patient's eyes
2. treatment of the patient’s nasal cavity
3. ear treatment
4. treatment of the patient's oral cavity
5. facial skin care
Hair care;
Dailyeye treatment- this is the removal of physiological secretions or purulent crusts from the eyes, the removal of impurities. Routine hygienic care should be carried out 1-2 times a day, more often if necessary. Lack of proper care can lead to inflammation of the mucous membrane of the eyes, conjunctivitis and inflammation of the skin around the eyes.
Prepare:
* container with liquid (boiled water, chamomile decoction, calendula decoction, old tea leaves, furacillin solution 1:500);
* cotton swabs (4 pieces or more);
* soft towel or gauze napkins;
* capacity or plastic bag for dirty tampons;
* diaper, protective bib or towel.
To treat your eyes you should:
1. wash your hands;
2. place or sit the patient comfortably and cover the patient’s pillow and/or chest with a diaper, protective bib or towel;
3. place several cotton balls in a container with liquid;
4. if there are dry crusts on the eyelashes, then place cotton swabs, generously moistened with liquid, on your closed eyes for a few minutes so that the crusts soak and their subsequent removal is painless;
5. start processing with a cleaner eye;
6. Use a dry swab to slightly pull down the lower eyelid, and with swabs moistened with liquid, rinse the eye with a single movement from the outer edge of the eye to the inner one;
7. dry with blotting movementsskin around the eye with gauze pads or a towel;
8. remove equipment, throw away used cotton swabs, wash hands;
Store the liquid container separately from other containers in a clean place and rinse with boiling water before use.
Dailytreatment of the nasal cavitynecessary, because on the nasal mucosaseriously ill A large amount of mucus and dust accumulates, which makes breathing difficult and aggravates the patient’s condition.
Prepare:
*narrow cotton swabs (at least four);
*vaseline heated to 38°C or any vegetable oil without strong odor;
*cotton balls or gauze napkins;
*container or plastic bag for used material;
*if there is liquid discharge from the nose - a small pear-shaped balloon with a soft tip, the so-called “syringe”.
To clean the nasal cavity:
1. place the patient comfortably;
2. moisten one cotton swab in warm oil, squeeze it slightly and insert it with a rotational movement with your right hand, holding the tip of the nose with your left hand in one nasal passage for 1 minute, then also remove with rotational movements. Repeat the steps with a dry swab to remove residual oil and softened crusts from the nasal passage. Repeat the manipulation with the other nasal passage;
3. if there is liquid discharge from the nose, it is necessary to suck out the mucus from the nasal passages with a pear-shaped balloon and remove the remaining mucus with dry swabs;
4. Use a cotton swab or gauze to clean the skin around the nasal passages from mucus and oil;
5. throw away the used material, close and remove the oil, wash your hands.
6. If the indoor air is dry, it is advisable to periodically irrigate the nasal cavity with water or Aquamaris-type drops.
Dailyear treatment(external auditory canals) is necessary because sulfur is constantly released in it - a yellowish-brown mass. The accumulation of such secretions can lead to the formation of sulfur plugs, which causes hearing loss.
You will need: 3% hydrogen peroxide solution, cotton pads.
First, treat the ears and around the ear space with a means for washing the patient, then pull left hand auricle To straighten the external auditory canal, with the right hand, carefully insert a turunda moistened with a 3% solution of hydrogen peroxide with a rotational movement. This allows sulfur formations to dissolve. The procedure is repeated with the other ear.
Carebehindoral cavity
Many microbes accumulate in the oral cavity, which, if the body weakens, can cause diseases and worsen the general condition of a person.
Useriously ill patients stomatitis often develops - inflammation of the oral mucosa. There is pain when eating, drooling, and the temperature rises. Sometimes patients experience dry lips and painful cracks in the corners of the mouth.Seriously ill The patient needs to treat the oral cavity after sleep, every meal and vomiting. Patients who have dentures need to take them off at night, rinse them thoroughly with a toothbrush and toothpaste and store them in a clean individual glass until the morning, rinse them with running water in the morning and put them on. Once a week, treat Corega or Protefix tablets in a special solution. Dissolve 1 tablet in half a glass of water. Place the dentures in the solution for 15 minutes, after the dentures are cleaned, all odors and germs will be destroyed. The dentures are then washed with running water and put on again.
Care behind the oral cavity can be divided into:
1. care for the mucous membranes of the oral cavity (mucous membranes of the lips, cheeks);
2. care for the surface of the tongue;
3. dental care.
To care for the oral cavity, you should use a very soft toothbrush, and for weak patients, gauze swabs. If the patient is able to rinse the mouth well, toothpaste can be used. After eating, it is useful to rinse your mouth with warm water or decoctions of chamomile, sage, and St. John's wort.
For those who are weak, it is better to use dental elixir or antiseptic solutions:
furacillin solution (2 tablets per 400 ml of water);
soda solution (1/2-1 teaspoon per glass of water);
boric acid solution (1-2% solution);
slightly pink solution of potassium permanganate (1:5000);
chamomile decoction;
decoction of oak bark (for bleeding gums).
You will need:
toothbrush and toothpaste
gauze swabs,
gauze napkins,
clamp
container with antiseptic solution;
pear-shaped balloon - for those who cannot hold water in their mouth, or a glass;
a container for spitting (a kidney-shaped tray, a regular bowl or a small basin);
a spatula (if you don’t have one, you can use the handle of a spoon) - to move the cheek away and press the tongue;
gloves, preferably latex;
Vaseline, cocoa butter or hygienic lipstick.
To treat the oral cavity you should:
1. give the patient a comfortable sitting or lying position
help a bedridden patient turn his head to one side, cover his neck and chest with a protective bib, place a tray under his chin;
2. wash your hands, dry them, put on gloves;
3. ask the patient to close his teeth or help him remove dentures
4. move away with a spatula left cheek patient
5. Using tweezers with a gauze swab moistened with an antiseptic solution or a toothbrush from the outside, treat each tooth from the gum, starting from the molars to the incisors;
6. Throw the used tampon into the tray, prepare a new one and process it in the same sequence on the right.
7. The movements of the toothbrush are carried out along the axis of the tooth (up and down), capturing part of the gum.
8. Ask the patient to open his mouth. Using tweezers with a new gauze swab moistened with an antiseptic solution or a toothbrush with inside treat each tooth from the gums, starting from the molars to the incisors.
It is not recommended to brush your teeth using movements across the axis of the teeth, as this can lead to abrasion of the enamel in the area of the tooth neck;
9. Clean your tongue last. If you don't hold your tongue, it will be difficult to clean, so wrap it in gauze and pull it towards you. When removing plaque, do not press on the root of the tongue so as not to accidentally induce vomiting;
10. ask the patient to rinse his mouth well or rinse with an antiseptic solution from a pear-shaped balloon, that is, pull back the corner of the mouth with a spatula and alternately rinse the left and then the right cheek space with a stream of solution or herbal decoction;
11. dry lips and skin around the mouth;
12. lubricate lips with Vaseline or hygienic lipstick; cocoa butter moisturizes, heals and protects lips very well;
13. remove equipment; remove gloves, wash hands.
Facial skin care:
When the patient was caring for himself, he could wash his face with soap and water and apply a nourishing cream to his face. Now the condition of his skin depends entirely on the treatment method. You can wash your face with Menalind Washing Lotion, a No-Rinse napkin or an Aqua mitten, but the best Bel Premium wet cosmetic discs are suitable; they thoroughly cleanse and moisturize the skin of the face. Take a wet disc and wipe your face: forehead from the center to the temples, nose from top to bottom, cheeks from the nose to the ears, chin.
Hair care:
Hygienic hair care is individual, washing oily hair is done once every 5 days, and dry hair - once every 10 days. For information about the hair washing procedure, please refer to the “patient hygiene instructions”.
Daily combing of hair is necessary. Short hair is combed from roots to ends, and long hair must be divided into small strands and carefully combed from ends to roots, being careful not to pull them out. You need to comb your hair with a comb with infrequent plastic teeth with blunt ends. To more effectively comb out dandruff and dirt, the comb can be moistened with a vinegar solution.
Those with long hair need a special hairstyle so that the hair does not get tangled and does not pull on the scalp: it is better to braid it into two weak braids starting from the parietal tubercles. It is better to secure braids with cotton tape or braid, rather than with an elastic band, which can get lost. You can also braid one braid; you need to start it at the top of your head so that it doesn’t get under your head while lying down and doesn’t put pressure on the skin on your head. For the same reason, it is better not to use hairpins, hairpins or other hard objects to hold your hair. Braided hair is easy to undo, comb and braid again, and takes little time compared to detangling hair.
Rules for combing long hair:
1. divide your hair into small strands;
2. start combing a strand of hair from the ends;
3. To comb the hair on the back of the head of a bedridden patient, simply turn your head to the side.

Compliance with the rules of personal hygiene of patients is great importance. A comfortable bed, a clean bed create conditions for Get well soon patients to prevent complications. And therefore proper care, personal hygiene, sanitary treatment of patients is of great importance. The more severe the patient’s disease, the more difficult it is to care for him. Therefore, the nurse must thoroughly understand the methodology for carrying out all manipulations and procedures for caring for patients and be able to accurately carry them out.

In the hospital, it is necessary to observe the sanitary-epidemiological regime and carry out sanitary treatment of patients admitted to the hospital. Upon admission to the hospital, patients, if necessary, undergo sanitary treatment in reception department, including: taking a shower or bath, cutting nails and other procedures, depending on the results of the examination. After sanitization, the patient is given a set of clean underwear, pajamas/robe, and slippers. Personal clothing and shoes are left in special packaging with hangers (plastic bags, thick fabric covers) in the storage room for the patient’s belongings or given to his relatives (acquaintances). Patients in hospitals are allowed to wear home clothes. Personal clothing of patients with infectious diseases must be subjected to chamber disinfection in cases provided for by sanitary rules.

In the department, the patient is given soap, a towel, a glass (cup, mug), and, if necessary, a sippy cup, a spittoon, and a bedpan with a stand. You are allowed to use your own personal hygiene items.

Hygienic treatment of patients (in the absence of medical contraindications) should be carried out at least once every 7 days with a note in the medical history. Hygienic care for seriously ill patients (washing, wiping the skin of the face, body parts, rinsing the mouth, etc.) is carried out in the morning, as well as after meals and when the body is dirty. Patient haircuts and shaving should be arranged periodically.

Patients' linen should be changed when soiled, regularly, but at least once every 7 days. Contaminated linen must be replaced immediately.

Keeping your skin clean is an important part of patient care. Human skin performs a protective function and is involved in heat production and metabolism. Therefore, clean skin and absence of damage are the main conditions for its normal functioning.

The function of the sebaceous and sweat glands contributes to maintaining the elasticity, softness and flexibility of the skin. However, the accumulation of fat and profuse sweating lead to skin contamination.

It is estimated that within a week, the sebaceous glands secrete from 100 to 300 g of sebum onto the surface of human skin, and sweat glands from 3.5 to 7 liters of sweat. Along with sebum and sweat, microorganisms accumulate on the skin, causing itchy skin. Itching leads to scratching and the appearance of abrasions, which are the entrance gates for the penetration of microorganisms into the thickness of the skin. If you do not take care of your skin, areas of diaper rash may form on it.

Compliance with the rules of personal hygiene is of considerable importance for the patient’s recovery, as well as for the prevention of various complications.

In order for the skin to be clean and function normally, it is necessary to carry out daily toilet.

If the patient’s condition allows, then he performs hygienic measures himself, sitting in bed; it is only necessary to organize this procedure for him.

Since the patient spends more time in bed, it is very important that the bed is comfortable and that the bed is clean, dry, and level. Proper preparation bed and monitoring its condition is creating a comfortable position for the patient and preventing the development of diaper rash, bedsores and other complications.

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Personal hygiene of the patient. Care for the seriously ill

Introduction

2. General patient care

3. Personal hygiene of the sick and seriously ill

Bibliography

Introduction

In the treatment of any disease, patient care plays an important role. Care should be understood as a set of measures aimed at alleviating the patient’s condition and ensuring the success of treatment. These measures can be of a general nature, that is, applied to any patient, regardless of the type and nature of the disease - general care, and special, applied only to patients of a certain type (gynecological, urological, dental, etc.) - special care.

General patient care is performed mainly nurse, which, when performing some activities, uses the experience of junior medical personnel - nurses.

Personal hygiene of patients includes a set of measures carried out either by the patient himself or with the help of medical staff in order to maintain a satisfactory hygienic condition of the patient.

1. General patient care

The scope of general care depends on the patient’s health condition and includes the following activities:

1. Creation and maintenance of a sanitary and hygienic environment

2. Making a comfortable bed and keeping it clean

3. Hygienic care of the patient

4. Monitoring the patient’s condition

5. Fulfilling medical prescriptions

6. Organization of leisure time for the patient

7. Maintaining the patient’s cheerful mood with the sensitive attitude of the staff

Nursing is often both preventive measure, preventing the development of serious complications in an organism weakened by the disease.

Personal hygiene of the sick and seriously ill

1. Body position

The patient’s body position can be normal or active, “painful” or passive and forced.

Active position - the patient easily changes the position of his body depending on his needs. Changing body position and staying in different positions does not cause him any inconvenience or suffering.

Passive position is the position that the patient assumes while in a state of extreme weakness or in unconscious. In this position, the patient is motionless, the head, arms and legs, if they do not have support, hang from the bed, the body slides from the pillows to the foot end of the bed.

Forced position - a position that the patient takes in order to avoid or weaken his existing painful sensations(pain, cough, shortness of breath). Having taken a forced position, the patient stubbornly adheres to it and reacts extremely negatively to attempts to change this position.

The patient's position is also determined by the treatment regimen:

* Strict bed rest - the patient is forbidden to get up and move in bed, or turn around.

* Bed - the patient is allowed to turn in bed * Ward - the patient is allowed to get up and move around within the ward

* General - the patient’s mobility is not limited

2. Making bed and changing linen

* Make sure that the patient agrees to change the bed linen;

* If you need help when changing linen, then plan to do it when there is someone helping nearby;

* Think over a plan of action together with the patient, taking into account his capabilities;

* Prepare the bed linen: fold it in the order in which you will take it and place it on a horizontal surface, for example, a table or chair;

* Prepare a container for collecting dirty laundry: for example, a plastic bin or a regular bucket. If you don’t have anything at hand, you can spread several newspapers on the floor.

Infection safety:

* Wash your hands before and after changing the bed;

* The biological secretions of the patient should be treated as if they were infected with the hepatitis virus or HIV infection;

* If the underwear is stained with blood or feces, wear gloves;

* During the rearranging process, do not lean either clean or dirty linen against you;

* Do not shake linens and bedding, do not fluff up pillows and blankets in the patient’s room!

* Do not place dirty laundry anywhere: on the floor, chairs or other places.

Changing the duvet cover and pillowcase

* Performed in the usual manner, as with any other bed making.

Changing the sheets

* The sheet can be changed longitudinally (from the head to the patient’s feet) or transversely (from one edge of the bed to the other);

Longitudinal sheet change

* Roll up the sheet with a longitudinal roller;

* If the patient uses oilcloth and a diaper, also roll up the oilcloth and separately the diaper using longitudinal rollers;

* Change the pillowcase on the pillow and place the pillow under the patient's head;

* Change the duvet cover, put the blanket in a clean duvet cover aside;

* Turn the patient on his side, roll up the dirty sheet under him along the entire length of the bed and at the same time roll out a roll of a clean sheet to half the bed;

* Turn the patient onto the other side, collect the dirty sheet and throw it into the laundry bin;

* Roll out the second part of the clean sheet;

* If you need oilcloth and a diaper, then cover them after the sheet in the same order.

Cross sheet change

* Roll up a clean sheet with a cross roller;

* Roll up a dirty sheet under the pillow;

* Place a roll of clean sheet under the patient's pillow and secure it;

* Consistently lifting first the upper body, then the buttocks and legs, roll up the dirty sheet and roll out the clean sheet;

* If you need to change the oilcloth and diaper, then place them when you lift the patient’s buttocks.

Further actions

* Cover the patient with a blanket;

* Finally tuck the sheet under the mattress and straighten out the folds;

* Position the patient comfortably;

* Remove dirty laundry;

* Wipe down the bedside table and floors around the patient's bed.

In order to change the patient's clothes, it is necessary:

* obtain patient consent;

* prepare clean linen and a container for dirty linen;

* Wash the hands;

* clearly understand the sequence of actions.

Sequence of actions when changing underwear:

* save the patient from prying eyes;

* do not allow jokes or even smiles during the procedure;

* take off your underwear, starting with the healthy part of the body, and ending with the sick one; when putting it on, vice versa - first put it on the sick part of the body, then on the healthy one;

* linen should be soft, comfortable, absorb moisture well, and not torn; for severe patients, in order to prevent bedsores, the linen should not have rough seams, buttons, or patches.

T-shirts are suitable for this purpose: they stretch well, have minimal seams, are soft, cover the shoulders and chest, which helps retain heat;

* if the patient can sit or at least sit down for a few minutes with your help, this will make changing clothes much easier;

* it is better to change clothes for patients in serious condition together;

* for patients with urinary incontinence, short shirts (men's or T-shirts) are used;

* the patient should be changed daily, and if necessary, several times a day;

3. Supply of bedpan and urine bag

Urination and defecation require intimate conditions and gentle handling of the patient. It must be remembered that a bedridden patient depends on a stranger.

If the desire to urinate or defecate arises, seriously ill people cannot go to the toilet on their own, but are forced to resort to our help. Moreover, they often cannot long time to retain the urge that has arisen, and therefore it is very important to quickly respond to the patient’s request and provide him with assistance in a timely manner. Unretained urine and feces that get on the patient’s underwear or bed linen not only contribute to the formation of bedsores, but also cause a sharp deterioration mental state patient, leading to depression.

In the room where the patient is forced to perform physiological functions, it is necessary to create following conditions:

* ask everyone to leave the room;

* close the door to the room;

* curtains if the room is located on the ground floor;

* prepare toilet paper in sufficient quantity;

* prepare a towel, soap, and a bowl of water so that the patient can wash his hands after the procedure.

During the procedure, jokes, smiles, grimaces, and remarks are unacceptable. As you feed the bedpan, lower the head and foot ends of the bed until the bed is as flat as possible. Ask the patient to bend their knees and lift their pelvis, moving their legs along the mattress. If necessary, the patient can use a bed support or other support devices.

If the patient does not have enough strength, you can put your hands under bottom part his back and lift her up. If the patient is not able to help you, first turn him on his side, place the bedpan in the place where the patient’s buttocks rest, then turn the patient back so that the buttocks rest on the bedpan.

The vessel or urine bag (“duck”) must be served warm. To do this, you need to rinse them before serving. hot water. If circumstances permit, leave the patient alone in the room and ask him to let you know when you are needed. If possible, after the patient lies down on the bedpan, raise the head end of the bed so that the patient's position is as close as possible to the natural position when performing a bowel movement. After defecation or urination, help the patient move from the bedpan, lower the head of the bed and ask the patient to lift the pelvis in order to remove the bedpan from under the patient. Take out the vessel or “duck” tightly closed with a lid or diaper.)

After serving, the vessel is thoroughly washed and disinfected with a 1-2% solution of bleach or a 3% solution of chloramine or Lysol. After washing, do not cover the vessel with a waterproof cloth so that it can dry. At the end of the procedure, do not forget to ventilate the room. The procedure must be carried out using disposable gloves. After removing the gloves, wash your hands thoroughly again.

It should be remembered that many men find it difficult to use urine bags in a supine position. Therefore, if possible, it is necessary to sit the patient in bed or on a bed with his legs dangling when urinating. If the patient can stand, urination can be done while standing.

4. Skin care therapeutic hygienic care for seriously ill patients

The skin performs very important functions: it breathes, removes metabolic products, protects against external influences, participates in thermoregulation. Only dry, clean and uninjured skin can cope with such tasks.

Hygienic skin care (washing) should be carried out depending on the patient’s needs, but at least 1-2 times a day. Lack of care can lead to a deterioration in overall health, the development of diaper rash, and bedsores.

To clean the patient:

* place an oilcloth with a diaper under the area of the body that needs to be washed;

* moisten the skin with a rag;

* soap a rag and wash your skin with it;

* wash off the soap using the same rag;

* dry the skin with blotting movements (do not rub!)

Further treatment depends on the condition of the skin. Wet skin needs drying. If these are small areas, for example, folds of skin, then you can use medical talc, the so-called powder, ointments containing zinc: salicylic, zinc ointment and homeopathic ointment "Linin".

Excessively dry skin needs hydration and nutrition, which is achieved by applying moisturizing and nourishing creams (do not use creams with a strong smell - the cream should not cause allergies). Calendula ointment (preferably homeopathic) is a universal remedy for both wet and dry skin. It can be used for diaper rash and skin cracks. You should avoid using lotions and sanitary napkins containing alcohol (alcohol can dry out your skin). The patient can be washed partially or completely. Usually, daily care includes partial washing, and complete washing is recommended once every 3-7 days depending on need, although there may be cases when complete washing is necessary every day. Air baths are very beneficial for the skin (frequency and duration are individual for each patient). The condition of the skin is affected by the cleanliness of the laundry. Change your underwear as often as necessary.

The skin of the genitals and perineum must be washed daily. In severely ill patients, for this purpose, the genital organs should be regularly toileted by washing, which is done using a jug, directing a stream of warm water or a weak solution of potassium permanganate to the perineum. At the same time, make several movements with a cotton swab in the direction from the genitals to anus. Use another cotton swab to dry the skin of the perineum.

When caring for exhausted or weakened patients who have been on bed rest for a long time, special attention should be paid to the prevention of bedsores. Bedsores are deep skin lesions resulting in its necrosis, occurring when prolonged compression soft tissue between bone formations and external objects. Bedsores especially often develop in those areas where there is no or very thin fat layer- in the area of the sacrum, coccyx, ankles, tubercle of the calcaneus, condyles and trochanter of the femur.

Internal bedsores are also possible, for example, necrosis of the vein wall as a result of a long-term presence of a catheter in it. In their development, bedsores go through several stages: blanching and then redness of the skin with the appearance of bluish spots, the formation of blisters, detachment of the epidermis with skin necrosis, subcutaneous tissue, fascia and tendons. Bedsores are often complicated by the addition of a secondary purulent or putrefactive infection with an extremely unfavorable prognosis. Prevention of bedsores comes down to constant monitoring of the condition of the bed and underwear of a seriously ill patient (elimination of irregularities, seams, folds, shaking off crumbs). For preventive purposes, special rubber pads are used, which are placed under those areas of the body that are subject to prolonged pressure. The circle had to be slightly inflated so that it changed shape as the patient moved. Instead of a circle, you can use fabric mattresses filled with flaxseed, as well as special mattresses consisting of many rubber chambers filled with air, the degree of filling of which changes every 3 minutes.

It is also necessary to strive for a systematic change in the patient’s position, turning him in bed at least 8-10 times a day. Since bedsores most often form on contaminated skin, the skin in appropriate places must be washed 2-3 times a day cold water with soap, then wiping with napkins moistened with camphor alcohol or cologne, and dusting with talcum powder. Treating existing bedsores is much more difficult than preventing their formation. In the initial stages, I recommend lubricating the affected areas with a 5-10% iodine solution, 1% brilliant green solution, and using physiotherapeutic methods. The surface of the bedsore is covered with an aseptic bandage. After rejection of necrotic masses, various ointment dressings, general stimulating therapy, and in some cases, skin grafts are used.

5. Hair and nail care

Long and untreated nails pose a danger to the skin, as they contribute to its injury, especially in bedridden patients suffering from itchy skin.

Hygienic care of nails is carried out as they grow. On average, cutting and treating nails on the fingers is carried out once every 3-5 days, and on the toes - once every 7-10 days. In addition, careful daily cleaning of nails while washing hands is necessary. Special attention should be given to patients with fecal incontinence.

When cutting fingernails, it is best to use scissors with one or two rounded ends - this allows you to safely remove dirt and dead skin from under the nails. Pedicure clippers are more suitable for cutting toenails, since thick and hard nails cannot be cut with scissors.

Before cutting your nails, it is best to take warm soapy baths for your hands and feet for 15-20 minutes. This makes cutting easier and allows you to remove overgrown edges of the nail plates without damaging the skin.

If you have an individual file, you can use it to treat your nails to make the cut smoother - this will be a good preventative against scratching the skin.

Uncombed, dirty hair creates unpleasant feeling and make it difficult to communicate and care for the patient. Tangled hair cannot always be combed and therefore has to be cut, and quite short.

Hygienic hair care is individual, washing is carried out, on average, once every 5-7 days, in addition, daily combing is necessary. Those with long hair need a special hairstyle so that the hair does not get tangled and does not pull on the scalp: it is better to braid it into two weak braids starting from the parietal tubercles. It is better to secure braids with cotton tape or braid, rather than with an elastic band, which can get lost. You can also braid one braid; you need to start it at the top of your head so that it doesn’t get under your head while lying down and doesn’t put pressure on the skin on your head. For the same reason, it is better not to use hairpins, hairpins or other hard objects to hold your hair. Braided hair is easy to undo, comb and braid again, and takes little time compared to detangling hair.

Rules for combing long hair:

* divide hair into small strands;

* start combing a strand of hair from the ends;

* to comb the hair on the back of the head of a bedridden patient, simply turn your head to the side.

If the patient can go to the bathroom, washing his hair becomes easier. If the patient is not transportable, the hair can be washed in bed.

To wash your hair in bed:

* lay the patient down, placing an oilcloth under the neck, and wrap a diaper around the neck;

* place cotton swabs lubricated with Vaseline in your ears to prevent water from getting in;

* wet your hair, apply shampoo and foam it;

* rinse hair before complete removal foam;

* remove tampons from ears;

* wrap your head in a terry towel and put the oilcloth and diaper into the basin;

* take out the basin and remove the plastic film;

* conveniently place the patient;

* dry and comb your hair;

* tie a scarf on your head.

6. Oral care

Oral health affects appetite and ability to eat. If the tongue is coated, then the taste of food is not felt, and therefore the patient will have little desire to eat. The inflamed mucous membrane of the mouth will hurt, which forces patients, as a rule, to completely refuse to eat. This condition of the oral cavity is caused by its infection due to contamination with food debris, exfoliating epithelium, and mucus. When breathing through the mouth, the plaque that forms turns into crusts, which further aggravates the severity of the condition.

Hygienic care should include toileting the oral cavity after complete sleep and after each meal, as well as after vomiting. If the patient does not eat, then mouth treatment must be carried out at least 4 times a day. If the patient breathes through his mouth, then more often.

To care for your mouth, you should use a very soft toothbrush, and for weak patients, gauze pads. If the patient is able to rinse the mouth well, toothpaste can be used.

For those who are weak, it is better to use dental elixir or antiseptic solutions:

* furatsilin solution (2 tablets per 400 ml of water);

* soda solution (1/2 teaspoon per 200 ml of water);

* light pink solution of potassium permanganate;

* chamomile decoction;

* decoction of oak bark (for bleeding gums).

To treat the oral cavity you should:

* give the patient a comfortable position sitting or lying down (lying down - turn your head to the side);

* clean with a gauze swab moistened with an antiseptic solution upper teeth;

* continue processing, moving from the molars to the incisors and changing tampons (on average, 10-15 tampons are needed to treat the mouth);

* Clean your tongue last.

If you don't hold your tongue, it will be difficult to clean, so wrap it in gauze and pull it towards you.

When removing plaque, do not press on the root of the tongue so as not to accidentally induce vomiting;

* ask the patient to rinse his mouth well or rinse with an antiseptic solution from a pear-shaped balloon;

* dry lips and skin around the mouth;

* lubricate lips with Vaseline or hygienic lipstick;

7. Eye care

Routine hygienic care should be carried out 1-2 times a day, more often if necessary. Lack of proper care can lead to inflammation of the mucous membrane of the eyes, conjunctivitis and inflammation of the skin around the eyes. Eyes are washed boiled water or saline solution, soak the crusts in 2% boric acid.

To treat your eyes you should:

* Wash the hands;

* comfortably lay or sit the patient and cover the patient’s pillow and/or chest with a diaper or towel;

* place all cotton balls, except two, into a container with liquid;

* if there are dry crusts on the eyelashes, then place cotton swabs, generously moistened with liquid, on your closed eyes for a few minutes so that the crusts soak and their subsequent removal is painless;

* start processing with a cleaner eye;

* use a dry swab to slightly pull down the lower eyelid, and with swabs moistened with liquid, rinse the eye with a single movement from the outer edge of the eye to the inner;

* dry the skin around the eye with gauze napkins or a towel using blotting movements;

* remove equipment, throw away used cotton swabs, wash hands;

* store the container for liquid separately from other dishes in a clean place, rinse with boiling water before use.

8. Ear and nose care

Hygienic care of the nasal cavity includes cleaning the nasal passages from secretions and should be carried out 1-2 times a day, more often if necessary.

The accumulation of mucus and crusts can lead to difficulty breathing through the nose, inflammation of the mucous membranes of the nose and sinuses, and the formation of ulcers.

To clean the nasal cavity:

* conveniently place the patient;

* moisten one cotton swab in warm oil and insert it into one nasal passage for 1 minute, then use a dry swab to remove remaining oil and softened crusts from the nasal passage.

Repeat the same with the other nasal passage;

* if there is liquid discharge from the nose, it is necessary to suck out the mucus from the nasal passages with a pear-shaped balloon and remove the remaining mucus with dry swabs;

* use a cotton swab or gauze to clean the skin around the nasal passages from mucus and oil;

* throw away the used material, close and remove the oil, wash your hands.

Caring for your ears involves washing them regularly with warm water and soap. In some cases, it becomes necessary to cleanse the external auditory canal from secretions accumulated in it. The external auditory canal is cleaned with cotton wool wrapped on a sanitary stick.

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Content

Factors that can directly or indirectly affect human health and life expectancy are determined by hygiene. By observing the rules of personal hygiene, a person protects himself from negative impact external stimuli. Among the reasons that shape health are: professional, hereditary, environmental, psycho-emotional, lifestyle, nutrition, level of medical care. Find out how to make your life better through proper organization.

The importance of human hygiene

The main task of this science is to study the impact of the environment on the vitality and working capacity of the population. The environment is usually understood as the full range of domestic, natural, industrial and social factors. The main tasks of hygiene are the development of requirements aimed at increasing the body’s resistance to negative external factors. This is facilitated by proper self-care, a balanced regime of rest, work, balanced nutrition, and sports.

Failure to comply with personal hygiene rules can cause both minor health problems and serious illnesses. Fulfilling personal care requirements and using tools, which are classified as personal hygiene items, will be the first step in maintaining your own health. When considering what hygiene is, take into account the division of the subject into several subcategories:

personal;
food hygiene;
labor;
cities, establishments, premises.

How to maintain hygiene

One of the most important principles of strengthening and maintaining cleanliness and health by observing basic cleanliness standards is observing the rules of personal hygiene. Some tips on personal hygiene will help you correctly understand their role in life and structure your personal schedule:

Daily and periodic body hygiene: proper hand washing after going outside, before eating; washing; brushing teeth 2 times a day; taking a general shower, washing the genitals; hardening. Periodic treatments include cutting hair ends (every 4-8 weeks), cutting nails, washing hair with shampoo, and preventive visits to the doctor.
Hygienic requirements for clothing and shoes require periodic washing of items, steam ironing, and daily change of underwear. High-quality shoe washing is necessary. Clothing must fully comply with physiological and hygienic standards (provide an optimal microclimate, have low weight, good strength and high-quality chemical composition of the fabric).

To a woman

Body care is usually considered in a more in-depth aspect, taking into account periods of life, cycles, and age. A girl, a teenage girl, a woman, a pregnant woman and a woman after childbirth must follow the rules. Women's rules of personal hygiene are united by one principle - proper hygiene of the genitals and mammary glands. Considering that the main role of a woman is the production of offspring, the following hygiene requirements in the pelvic area are important:

daily hygiene of the external genitalia;
proper prenatal, postpartum hygiene(hygienic women's underpants are often used);
use of personal hygiene products in the form of tampons, pads during the menstrual cycle;
proper care of the mammary glands (especially important for pregnant and nursing mothers);
understanding how to use a hygienic shower, applying knowledge in practice;
washing and cleaning clothes, daily laundry, changing underwear.

To a man

How to maintain genital hygiene for a man? Skin care in the form of a daily shower is the way to maintain health. Everyday hygiene for men involves caring for the armpits, genitals and perineum. Reproductive health men depends on the level of activity and hygienic status. Since the male genital organs are external and not hidden in the pelvic area, like a woman’s, a man’s personal procedures involve the following activities:

washing the penis and testicles;
using clean and comfortable underwear, in which the man’s organs will not be severely compressed or overheated;
perineal hygiene (washing with soap, correct use toilet paper).

Teenager

An important stage that a child goes through on the way to growing up is adolescence. Physical changes occur in a teenager's body. Basic rules of personal hygiene include strict adherence to hygienic principles, and any deviation can lead to improper development of the reproductive system.

The requirements for a teenage girl are to use individual hygiene products (separate soap, towel, washcloth), and a sleeping place separate from her parents. Daily shower with correct technique washing (from the pubis to the anus), supporting the growing mammary gland with a bra. For girls during menstruation, the requirement to use tampons, pads, and frequent washing is included.

To kid

Health is formed from early childhood. Proper hygiene child will ensure the development and growth of a healthy future generation. Children's hygiene tasks:

proper hygiene of children's activities and rest;
prevention, prevention of diseases in children's groups;
checking and protecting children's nutrition;
developing a child’s concept of a healthy lifestyle.

According to existing norms and rules, every child in school age should be able to:

carry out daily morning and evening procedures independently (wash your face, brush your teeth, wash your face, wash your hair);
carry out hygiene procedures in educational institution(wash your hands, use a change of clothes or shoes if necessary);
take precautions during a viral epidemic.

Personal hygiene

Individualized nursing practice involves maintaining personal hygiene Everyday life. Among the conditions that are fundamental, the most important is the personal attitude of a person (child, schoolchild, adult) towards himself and his health. This is a condition for the prevention, treatment of diseases, and increasing life expectancy. The deterioration of living conditions negatively affects health and the ability to exercise independent hygienic control.

Hygiene methods include a healthy lifestyle as one of the most effective health factors. Smoking cessation, a ban on the consumption of complex dietary fats and alcohol, weight control, and sports are recommended. The range of issues that personal hygiene covers includes the organization of rational nutrition, mental work, maintaining the microclimate in the home, hardening and physiotherapy.

sick

During the period of the disease, the patient can be dangerous to others or aggravate his own situation. Sanitary care for patients in a surgical hospital is performed in accordance with established standards:

provision of separate utensils for meals;
regular change of bed linen;
supply of a vessel and urinal;
antiseptic treatment of the ward and hospital;
implementation of daily hygiene procedures in the department;
organized feeding of the patient;
taking medications, performing health procedures in a clean manner.

Food service workers

Employees of public catering establishments have direct contact with ready-made meals, semi-finished products, frozen products, and desserts. Sanitary hygiene ensures the health of consumers, depending on the level of cleanliness of catering workers. Failure to comply with sanitary and hygiene standards at the enterprise can cause poisoning and sometimes death of the client.

Every food service employee is required to have a medical book. To prevent human sweat, hair, and dead skin from getting on food, workers (cooks, waiters) observe sanitation standards and wear uniforms. Before and after work, they must wash their hands thoroughly. Basic clothing should be clean, comfortable and neat. In restaurants and food outlets, waiters are required to serve food with gloves.

Medical personnel

Compliance with personal hygiene rules by employees medical institution will ensure the protection of staff and patients from nosocomial infections. An employee of any medical rank must follow the established rules. Conditions for the protection of medical personnel:

washing and disinfecting hands;
Availability medical uniform(suit, hat, set of slippers or shoe covers);
in case of close contact with drugs and patients, use gloves and bandages.

Household hygiene

To prevent the appearance of carriers of infections, small insects, and excessive harmful dust in everyday life, a number of preventive measures should be taken:

removing dust from furniture surfaces;
daily disinfection of the bathroom (toilet, sink, bathtub);
washing the clothes of all family members;
regular ventilation or air purification using climate systems;
deep cleaning of carpets (fleecy coverings collect a lot of dust and germs);
high-quality everyday cleaning of kitchen surfaces and utensils.

Prevention measures developed by the ancient science of cleanliness address healthy body, but the same is required for patients. Hygiene is closely related to sanitation, the purpose of which is to develop primary disease prevention measures for the population. Among general recommendations for each person the following are mentioned:

professional oral hygiene (visiting a hygienist);
body care;
sanitation of household and food products;
care of the premises, cleaning and ventilation (otherwise, contamination of the respiratory system and disruption of the stable state of the body are possible).

Power

Sanitation and processing of food before consumption is the main rule of healthy eating. Before reaching the counter, food undergoes a sanitary examination, but this does not relieve the consumer of the obligation to wash it before using it as food. Domestic water is tested to exclude possible availability harmful impurities. Basic sanitary requirements for food products:

benefits (reimbursement of energy costs and useful substances in organism);
presence of expiration date on the packaging;
minimal processing, cleaning from dirt before sale.

Sex

Practicing proper hygiene procedures before sex will help prevent infectious diseases. The environment of the genital organs is favorable for the proliferation of inflammatory, purulent infections. Before sexual intercourse, both partners should take a shower to cleanse their body and genitals. It is also worth giving up adrenaline during intercourse in public places, preferring a clean bed to the exotic.

Mental labor

An integral part of human life is mental work, which is defined as work related to receiving or processing information. The basics of mental health hygiene are to avoid fatigue or overwork. A number of preventive measures will get rid of them:

The whole truth about “unwashed” Rus'

Attention! The information presented in the article is for informational purposes only. The materials in the article do not encourage self-treatment. Only qualified doctor can make a diagnosis and give recommendations for treatment based on the individual characteristics of a particular patient.

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