Therapeutic and protective mode

Therapeutic and protective mode

Therapeutic and protective mode - this is a set of preventive and curative measures to care, treatment and return patients to society as its full members, who have mastered more appropriate to maintain a healthy lifestyle.  

Wednesday the facility should provide the patient mental and physical peace, contributing to overcome the disadvantages of hospitalization: the fear and anxiety before the research, treatment, feelings of separation from familiar homely difficulties adjusting to the new environment surrounding the medical staff and ward mates. Wednesday the facility-sided effect on the patient. Therefore, the hospital environment should be responsible not only hygienic, but also the aesthetic requirements.  

The younger the nurse should be an example of purity and cleanliness, caring and sensitive to patients, maintaining and enhancing their morale.  

The success of therapeutic activity is largely provided by the rules of the Internal regulations set forth in this department. Their strict performance helps to create for the patients physical and mental comfort, establishes a rapport between patients and medical staff.  

Well-formed mode provides patients timely pi-nutrition, hygiene and implementation of therapeutic and diagnostic measures, proper rest, and also helps to maintain appropriate sanitary conditions in the wards (department).  

The junior nurse is obliged to monitor compliance in the department of silence, in a timely disconnection lighting, radio, TV during the daytime and nighttime rest. Comply with internal regulations necessary for all health care workers. Clear mode, along with other rules helps to maintain health protective regime in the medical-enforcement institution (department).  

Each patient depending on the severity of the condition is appointed determine lenny individual mode.  

Strict bed rest. Patient is not allowed to stand, sit, move actively in bed, turn around.

All hygiene measures, the physiological origin of the patient completes in bed. The younger the nurse caring for a patient, feeds him, makes sure he does not get up, make all arrangements necessary to perform personal hygiene seriously ill.  

Bed rest. The patient is allowed to turn around and sit in on the stele, but not to leave her. Feeding and activities of personal hygiene helps him to fulfill the younger nurse.  

Polupostelny mode. The patient is allowed to move within the chamber, sit in a chair near the bed. Feeding occurs in the chamber. Activities of personal hygiene patient can perform independently or with the help of younger nurses (depending on the device chamber).  

Common mode. Patient self-serving themselves, carries out activities of personal hygiene, walking freely in the ward, down the hall, the dining room. He may be permitted to walk the hospital grounds.  

Filing ship seriously ill, perestilanie bed, shifting the patient-cient on a stretcher, gurney, and other actions younger nurses associated with significant physical stress on the spine, musculoskeletal system, which can lead to spinal injuries, the knee joints. To prevent injury, remember the following:  

1) to show the gravity should bend your knees, keeping the body in the vertical position;  

2) feet apart, because broad support improves balance;  

3) one foot must be pushed forward (anteroposterior position of the feet). Such a stance can knead the center of gravity in the commission of physical activity, which reduces the force expended;  

4) when lifting a patient needs to be pressed to imagine;  

5) does not make any sudden movements, rotations;  

6) if you want to turn around while moving the patient, it is first necessary to raise the patient, and then slowly turn around.  
 

Moving patients in bed is carried out in stages.  
 

Stage 1. To assess a patient's ability to participate in the procedure, namely: its mobility, muscle strength, an adequate response to the words.  

Step 2. Raise the bed to the most convenient to work with patients of high-To.  

Stage 3. Remove from the bed pillows and other items that prevent movement of the patient.  

Stage 4. If necessary, enlist the help of a nurse, a doctor.  

Stage 5. Explain the meaning of the procedure the patient to reassure him and to call for cooperation.  

Stage 6. Give the bed a horizontal position, to fix the wheel.  

Step 7. To reduce the risk of infection carry out the procedure gloves.  

Round 8. After moving the patient's lower bed, raise the handrails to ensure patient safety.  

Round 9. Check the correct position of the patient's body. The back should be rectified to prevent any bending, tension. Find out whether it is convenient to the patient.

Moving a helpless patient in bed  

(There is only one practical nurse).  
 

I. Turn the patient on his back, to check the correct position of the body.  

II. Lower the head of the bed in a horizontal position.  

III. Put a pillow at the head of the patient did not hit his head on the headboard.  

IV. Stand facing the foot of the bed at an angle of 45 * and move the legs diagonally to the patient bedside.  
 

The procedure begins with the movement of the feet, as they are lighter than other parts of the body and easier to move.  
 

V. Move along the patient's thighs.  

VI. Bend your hips and knees so that the hands were at the level of the patient's torso.  

VII. Move the patient's thigh diagonally to the head.  

VIII. Move along the patient's torso parallel to the upper part of his body.  

IX. Slip hand, are closer to the head, under the patient's shoulder, clasping below his shoulder. Shoulder must simultaneously maintain wrist.  

X. Other hand to slip under the upper back. Support for head and neck ensures proper rectified the patient's body and warn-confirms injuries, and support the body to reduce friction.  

XI. Move the torso, shoulders, head and neck patient bias toward the headboard.  

XII. Raise the side rail bed to prevent the patient from falling out of bed and go to the other side of the bed.  

XIII. Passing from one bed to the other side, repeat the procedure until the patient's body until it reaches the desired height.  

XIV. Move the patient to the middle of the bed, just as alternately manipulating the three divisions of his body, to achieve this goal.  

XV. Raise the side rails to ensure patient safety.  

XVI. Remove gloves, wash your hands.  
 

Hospital linen.  
 

To hospital linen are sheets, pillowcases, duvet covers, diapers, shirts, scarves, robes, pajamas, etc.  

Clean linen is stored in the linen in the nursery, on the shelves painted with oil paint and the laid Medical oilcloth. Shelves for clean linen regularly handled disinfecting solution.  

Dirty laundry is stored in a special place in oilskin promarki-doped bags.  

All clothes should have a label and stamp office.  

Each department is working housekeeper, which has a responsibility for the regular change of linen and timely dispatch of dirty laundry to the laundry.  

Once in 7-10 days held bath day with a change of linen, but if the department are seriously ill from involuntary urination or defecation, the housekeeper must keep the younger nurse a few extra sets of clean clothes to change.  

Because with the fact that the patient most of the time in bed, it is important that she was comfortable and neat, net - well-stretched, with a smooth surface. Surface mesh bag mattress without humps and hollows. Depending on the season using flannelette or wool blankets. Bed linen should be clean. Sheets should not have scars and stitches, and pillowcases - knots and buckles on the side facing the patient. Simultaneously with linen patient receives two towels.

Bed of patients with involuntary urination and fecal droppings must have special adaptations. Most often used by bed-rubber boat, and a mattress sheathe oilcloth. Bed linen is changed in such patients more often than usual - to the extent of contamination.  

If a sick woman has abundant selection of the genital organs, in order to preserve purity of the bed, under the ailing enclose a small oilcloth and top sheet, which I was at least 2 times a day, and if necessary, and often placed between the thighs, seal, they change as pollution.  

Bed patient should be regularly perestilat - in the morning, before daytime nym rest and at night. The younger nurse shakes crumbs from the sheets, fluff it and beat the pillow. Patient at this time you can sit on a chair. If the patient can not get up, then shift it together on the edge of the bed, then straightened in the vacated half of the mattress and the sheet, remove them with crumbs, and shift the patient to the cleaned half the bed. Do the same with the other side.  

Change of sheets half seriously ill requires staff certain skills. If the patient is allowed to rotate on its side, at first, gently raising his head, removed from under her pillow. Then help him to roll over on its side facing the edge of the bed. At the vacated half of the bed, located behind the patient rolled dirty sheets, so that she lay in a bead along its back. A seat lay a clean, well half-rolled sheet. Then help the patient to lie back and turn on the other side. After that he will be lying on a clean sheet face to the opposite side of the bed. Next, clean the dirty and straighten a clean sheet.

If the patient can not perform active movements, the sheet can be changed in another way. Starting from the head end of the bed, roll up the dirty towel, raising the patient's head and upper torso. In place of the dirty sheets, lay rolled up in a transverse direction of a clean and straighten it into the empty place. Then on a clean sheet and put a pillow on her head lowered patient. Further, raising the pelvis the patient, soiled sheet shift to the foot end of bed to straighten her place clean. Now it remains to remove the dirty sheet. 

Shirts seriously ill change as follows: slightly raising the upper body, collect his shirt from the back of the neck. Raising his hands the patient, remove the shirt over his head, then release him from the sleeves of his hands. If one arm in a patient is damaged, the hose is removed first with a healthy arm, and then with the patient. Net put in reverse order: first, beginning with patient hands, wear sleeves and then put a shirt over her head and straightened along the back. 
 

Cleaning the patients. 
 

Patients, a long time being in bed and do not take a bath every week, hygienic, it is necessary several times a day, wash away, because accumulation of urine and feces in the inguinal folds may violate the integrity of the skin and the formation of diaper rash, cracks, and bedsores. Cleaning the hold weak potassium permanganate solution or other disinfectant. The solution should be warm (30 - 32 C). For cleaning the need to have a bedpan, a pitcher, forceps and sterile cotton balls. Patients should wash away after every act of defecation, women often tempted. 

When cleaning the buttocks under enclose the vessel. The patient must lie on their backs, legs bent at the knee joints and the maximum spreading in the hips. In the left hand take a pitcher of warm water with a disinfectant solution and on the vulva to the anus (top down), 1 cotton-gauze ball when it is washed with the inner surface of the labia majora, and the 2 ball washed the outside of the area and inguinal folds, 3 ball washed with the anus. After that, dry cotton-gauze pad in the same direction as dried skin or enclose a clean diaper as a liner. Cleaning the mugs can be produced from Esmarha with a rubber tube and clip, directing the jet at the crotch of a weak solution of potassium permanganate.

Men wash away much easier. The patient's position is also on the back, legs bent at the knees, under your buttocks enclose the vessel and sent a stream of weak solution of potassium permanganate on the perineum and inguinal folds. Cotton-gauze forceps to pick up the foreskin and wash the glans penis, and then anus. Men are draining only a diaper. If you have diaper rash in the inguinal folds, and their cuticles baby cream, Zelenko or pripudrivayut corresponding powder. Never grease greasy ointments! 
 

Submission of the vessel and urinals. 
 

The vessel - one of the most necessary care for seriously ill subjects. Patients on strict bedrest, in the act of defecation is necessary to submit a vessel, and men urinating - urinal. 

Vessel made of earthenware, metal with enamel coating, rubber, as well as various plastics. Vessels have a different shape with a large round hole on top and a relatively small hole in the tube, departing from one side of the ship. A large hole in the lid has a lid. Net vessel stored in the toilet, in a dedicated closet or under the bed of the patient to stand. 

If the patient there is a need to free the intestine, it should be, above all, separated from other patients screen. Before use, the vessel is rinsed with warm water and leave it a little water. Angle trail under the patient with oilcloth diaper, throwing a blanket, a patient asked to bend your knees and help him, bringing his left hand under the sacrum to lift the pelvis. Keeping your right hand, an open boat for the receiver, lets him down under your buttocks so that the crotch was over a large hole, and the tube - between the hips toward the knees. Covering a patient with a blanket, leaving the patient at one time. Then the vessel is removed from the patient, cover with lid and carry to the bathroom, where the release of the contents, thoroughly wash brush, disinfect, rinse and put in place. Patient after the act of defecation is necessary substitution.

Dinghy is often served in debilitated patients or patients with Neder-zhaniem urine or feces to prevent formation of pressure sores. At long statement of the vessel it is necessary to wrap the nappy and put him cover (to avoid skin irritation from contact with the rubber). Rubber vessel tightly inflated using a foot pump. Disinfect it as well as glass-lined vessel. To eliminate the smell of rubber vessel is rinsed with a weak solution of potassium permanganate. 

Patients who are on strict bed rest, forced Sauveur-shat in the bed and urinate. For this purpose there are special vessels - the urinals. They are made of glass, plastic or metal and have an elongated oval shape with a short tube orifice. The form of tube - opening the male and female urinals are slightly different. Women are more likely to use no urinals, and the vessel. Urinals, as well as the ship should be private. Serve them to clean and heated, immediately dismiss the urine. Disinfecting urinals shall also, as a vessel. Since urine is often precipitate adhering to the walls in the form of plaque and gives off an unpleasant odor of ammonia, from time to time urinals should be cleaned with a weak solution of hydrochloric acid, followed by washing with running water. 
 

Enema. 
 

Enema called the introduction of through the rectum of different fluids for diagnostic and therapeutic purposes. 

With the purpose of treatment used cleaning, siphon, oil, hyper-tonic, medicinal and nutritional enemas. 

Cleansing enemas, designed to liquefy and remove the contents of the lower divisions of the colon, is used in refractory constipation, for the removal of toxic substances in poisoning of surgery and childbirth, radiological studies of digestive tract and endoscopic examinations of the colon, before use of medicinal and nutritional enemas.

Contraindications for setting cleansing enemas are acute inflammatory and erosive and ulcerative lesions of the mucous membrane of the colon, some acute surgical abdominal disease (acute appendicitis, acute peritonitis), intestinal bleeding, the first postoperative day, onnogo period after operations on abdominal organs, severe cardiovascular failure.  

Cleansing enema pose using a glass or rubber cups Esmarha (special tank capacity 1.2 liters with a hole), to which is attached a rubber tube length of about 1,5 m with rubber, plastic, hard rubber or glass tip. At the end of the tube located crane, with which you can regulate the flow of water from a mug. (If you do not use a crane to / o clip).  

For cleansing enema adult usually requires 1-1,5 liter of warm water (25-35 C). If you want to stimulate contractions of the colon (for atonic constipation) can try on the water of lower temperature (12-20 C). On the contrary, if you want to relax the smooth muscles of the intestine (in spastic constipation) use water with a temperature of 37-40 C. In order to enhance the cleansing action of an enema, sometimes add 2-3 tablespoons of glycerin or vegetable oil, or dissolved in water 1 tablespoon baby soap shavings .  

In a mug Esmarha water is poured, and opening the tap, fill the rubber tube, displacing the air. Then tap again closed and the mug is hung above the bed (couch). The patient lies on her left side with knees bent legs, pulling them to the stomach (in this situation the patient anus is located more superficially, facilitating the introduction of the tip). If the patient can not be put on the left side, manipulation performed lying on your back with knees bent legs (frog pose). Under the patient enclose oilcloth, whose edge is immersed in a basin.

First and second fingers of his left hand pushing the buttocks, the patient and his right hand - translational and rotational motions gently insert the tip into the rectum to a depth of 10-12 cm, pre-lubricated with sterile vaseline. If the patient did not have a chair for several days, before the introduction of the tip, produce an audit of finger rectal ampulla to diagnose the presence or absence of fecal obstruction. In the beginning (first 3-4 cm) tip is introduced toward the patient's navel, and then rotate the lumen of the rectum, respectively, and continue parallel to the introduction of the coccyx. After that, open the tap and the liquid is introduced, raising the cup to a height of 1 m. If the water does not come, you need some push the tip and increase the water pressure, raising the mug above. In contrast, when a pain in the course of the colon, water pressure is reduced. After graduating from the introduction of fluid the patient asked to refrain from defecating in 5-10 minutes. Then, by stimulating the motility of the colon is emptied of its lower portions of the stool. Used balls and clubs Esmarha disinfected, and then tips are subject to sterilization. 

With persistent constipation, especially spastic origin, use oily enema. To do this, use 100-200 grams of heated to a temperature of 37-38 with any vegetable oil which is introduced into the rectum with a rubber balloon or pear-shaped syringe Janet. Oil enemas, bowel wall promotes relaxation and a subsequent increase peristalsis, put usually in the evening (after the patient has to lie within half an hour), and the laxative effect occurs within 10-12 hours, usually in the morning.

To stimulate a bowel movement in atonic constipation are also used hypertonic enemas (saline) enema. 50-100 ml of 10% sodium chloride solution or 20-30% magnesium sulfate solution injected into the rectum with a rubber balloon or a syringe Janet, after which patients are asked to refrain from defecation in 20-30 minutes. Since hypertonic enemas because of its osmotic action contributes to the exit of water from the tissues into the lumen of the rectum, they can be used to combat swelling. 

Siphon enemas are used for therapeutic purposes at various poisoning, intoxication, metabolic products, in the dynamic and mechanical bowel obstruction (in the latter case, the preoperative preparation), and also with the ineffectiveness of cleansing enemas. Application of siphon enemas in bowel obstruction is contraindicated in cases of suspected thrombosis or embolism of the mesentery. 

In formulating the siphon enema use a large funnel capacity of 0,5-2 liters, as well as a rubber tube length 1-1,5 m with a diameter of not less than 1 cm, which is connected with a flexible rubber tip length of 20-30 cm 

The patient takes the same position as in the formulation of cleansing enema (on the left side or back with a slightly bent at the knees). Flexible end of the rubber tip, lubricated with sterile petroleum jelly, injected through the rectum to a depth of 20-30 cm siphon action of the enema is based on the principle of communicating vessels. Attaching the funnel to the outer end of the tube, it is kept in several inclined position, at the level of the patient's pelvis and fill the rinsing liquid - pure boiled water, weak solution of potassium permanganate, a 2% solution of sodium bicarbonate. Funnel lift up, approximately 30 cm above the level of the body, after which the liquid begins to flow into the intestine. Once the liquid in the funnel reaches its restrictions, the funnel quickly lowered below the level of the patient's body, and it starts coming back filled with fluid from the gut along with bubbles of gas and feces. Flipping the funnel and pouring the contents, fill with water and wash procedure was repeated again as long as the intestines into the funnel will not come clean rinse water. Typically, one siphon enema requires 10-12 liters of fluid.

Drug-related therapeutic enemas enema with the introduction of various drugs. Medicinal enemas are the most likely micro enemas and their volume is usually 20-100ml.  

For medicinal use of enemas rubber balloon or pear-shaped syringe Janet Long rubber tip (catheter), which is injected into the rectum to a depth of 10-12 cm before applying them, as a rule, pose a cleansing enema.  

Nutritive enema. After a cleansing enema and intestinal emptying-ka, flatus, bowel give 20-30 minutes to calm down, then enter the sterile tip connected thereto, or a mug Esmarha with a dropper or a special system for the introduction of nutrients to the tube system imposes adjustable clamp that provide 30-40 drops per minute (the rate of administration of substances with a nutritional purpose). The patient is conveniently placed, carefully harbor, and the procedure lasts 2-3 hours, depending on the amount of nutrients needed for administration. Introduction rate is regulated in accordance with the possibility of the patient does not respond to the procedure (the solution should not bleed from the rectum, and should not cause the urge to act of defecation).  
 

Appliances setting the vapor tube.  
 

Gazootvedenie carry a thick-walled rubber tube 40 cm long and 8-10 mm in diameter. One end is rounded and it has two side openings, the other slightly enlarged. The indications for the introduction of the vapor tube is the accumulation of gases in the intestines (flatulence) and the presence of spasms indoor or outdoor zhomov anus.  

Patient explain the purpose and procedure of manipulation. On the sheet trail oilcloth, top to cover her diaper, turn the patient on her left side and asked to pull his knees to his stomach. If the patient can not be put on the left side and manipulation is carried to the patient lying on your back with knees bent and legs apart. The vapor tube lubricated with sterile vaseline. Left hand pushing the buttocks and gently introduce it into the anus to a depth of 20-30 cm outer end of the tube is immersed in a bedpan, which poured in some water (because the gases can be allocated a small amount of liquid stool).

Care should be taken that the tube was in the patient's intestines are not more than 2 hours to avoid the formation of bedsores. After 2 hours, gently remove the pipe and tempted patient. The tube was placed in a marked capacity for disinfection, then treated according to the Ost 42-21-2-85 and sterilized.  

Sometimes the introduction of the vapor tube can be difficult because of the accumulations of the large amount of feces, so before this manipulation to make the cleansing enema with glycerine and chamomile.  
 

Bedsores.  
 

Decubitus - a dystrophic ulcer-necrotic processes arising-repentant debilitated patients, a long time being in bed. Most often, pressure ulcers are formed in the shoulder blades, sacrum, greater trochanter, on the elbows, the occipital region, back of the heel.  

Promotes the formation of bedsores bad skin care, uncomfortable bed, a rare perestilanie. One of the earliest signs of bedsores - pale skin and smyatost, followed by redness, swelling and peeling of the epidermis. Then there are blisters and skin necrosis. Accession infection can lead to sepsis and cause of death.

Preventing pressure ulcers: 

1) turning the patient on his side several times a day, if his condition allows (to change the pose of the patient); 

2) every day several times a day to shake the sheet to avoid crumbs in the bed; 

3) ensure that on bed and underwear had no wrinkles and patches; 

4) Seriously ill, long-term are in bed by placing an inflatable rubber circle wearing a pillowcase, so that we find the rump-dilsya over the hole of the circle; 

5) daily wipe the skin with a disinfectant solution: camphor spirit, vodka, cologne, and in their absence, wipe the skin half of competence dipped in warm, soapy water and wipe it dry, lightly rubbed with the skin. 

To wipe the end clean towel moistened with disinfectant and wipe gently squeeze the neck, behind the ears, back, buttocks, the front surface of the chest and armpits. Particular attention should be paid to the crease under the breasts, where obese women may be formed diaper rash. Then wipe dry skin in the same manner. 

These procedures are performed daily at night patients who can not take weekly hygiene bath, as well as patients being in a coma. Thus, if properly cared for leather patient should always be clean and dry.