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Ministry of Health of Republic of Belarus
Education establishment
«The Gomel State medical university»
Chair of Internal Disease №1 with Endocrinology Course
It is discussed at the meeting of chair 30.08.2016
Protocol № ___________
METHODICAL REVIEW
for practical training of foreign students of the 1st course
Subject:
Sanitary care of patients. Patient’s hygiene. Patient’s transportation
Theme 3 (Lesson 4; 5)
Time: 6 hours
Chief of chair______________
1. Training and educational goals, motivation for theme learning,
requirements of initial level of knowledge
1.1 Aim of training: Get the concept of the receiving department of health
institutions, patient admission rules and registration, to master the process of
patient sanitary treatment, including treatment of the patient in identifying lice, as
well as cutting hair and nails, preparations for holding hygienic baths, washing in
the shower. To master the transportation of patients with self-limited skills,
personal hygiene of the patient, methods of changing bed clothes, putting a rubber
circle, skin care in the bedsore presence, patient’s transportation and moving.
1.2 Requirements to initial level of knowledge: during the training the student
should
To know:
1) The structure of the receiving department
2) The process of patient sanitary treatment
3) The principles of hygiene procedures
4) Measures to prevent the bedsore formation
To be able:
1) To transport the patient with self-limited skills
2) To carry out hygienic procedures with the patient
3) To make a change of bed clothes and underwear patients.
2. Material equipment of training
1) Stretchers, wheel chairs, hand stretchers.
3. Questions on an occupation subject:
Lesson 4:
1) Structure and equipment of the receiving hospital department
2) Patient’s sanitary treatment
3) Treatment of patients in identifying lice
4) Carrying out sanitary bath, holding a hygienic shower, wet wiping
5) Anthropometry
6) Patient’s hygiene. Moving regime. Taking care of oral cavity. Eyes Care. Nose
care. Skin care
7) Change of bed clothes and underwear
Lesson 5:
8) Bedsore, bedsore prevention education
9) Types of patient transportation
10) Rules of patient transportation by stretchers
11) Rules of patient transportation by wheelchair
12) Rules of patient transportation by hand stretchers
4. Materials for self-preparation:
Lesson № 4
1. Structure and equipment of the receiving hospital department
Receiving department is the most important medical and diagnostic
department, it is the "face" of the hospital. Here is the first meeting of the patient
with hospital staff.
The receiving department consists of a waiting room, an office duty nurse,
one or more examination rooms, treatment room, dressing room, and sometimes a
small operating room, an insulator, sanitary room, diagnostic wards, x-ray rooms,
laboratories, sanitary unit and ancillary facilities (wardrobe for employees and
patients, staff rooms).
To the receiving hospital department patients admitted in emergency and
planned (with direction document) method. All the patients requiring emergency
medical care, come to the emergency department, by passing the receiving
department.
Receiving the patient and his registration
Depending on the severity of the patient's condition during filling all the
information obtained from the medical history of the patient, and if he is
unconscious - from his entourage or relatives. When a patient is without documents
he must be reported to the police like an "unknown".
Equipping of treatment room of receiving department
Receiving department staff is obliged to inform the relatives of the patient,
if he was delivered by "emergency" because of the out home disease.
The duty nurse records the incoming patient, prepares the necessary
documentation and submit to the examination room to examination by a doctor and
giving a diagnosis. In particular, nurse fills the cover page history of patient of
each incoming patient, enters patient information into account patients receiving
magazine and the magazine alphabet (for the help desk), which indicates the
surname, first name, last name, date of birth, date of admission to the department.
It also fills the left side of the "Statistical card of a hospital left patient." There is a
single magazine form to register for detection of infectious diseases, hospitalacquired infections and lice being ("Registration of infectious diseases').
The doctor on duty decides to which department the patient should be sent.
If the diagnosis remains unclear after sanitizing patient is placed to the diagnostic
ward of receiving department, where he should be examined, observed, diagnosed,
and then sent to the appropriate department. The patient who does not need a
hospitalization is assisted and directed for treatment to the polyclinic.
Doctor writes to the patient's medical history The result of the inspection,
examination, prescription, sanitary treatment and type of patient transportation.
Nurse is a list adopted for the storage of clothes, money and valuables if patient
should be hospitalized. Documents and values are stored in a safe.
After inspecting the patient's physician and the evaluation of his condition,
he is transferred to another room where the patient is carried out sanitization:
inspection of the scalp on the head lice, skin in the presence of pustular rash, upper
and lower limbs for the presence of fungal diseases. Depending on the patient's
condition, it is prescribed hygienic bath, shower or sponging the most polluted
areas of the skin, as well as produce anthropometric measurements, body
temperature measurement.
2. Patient’s sanitary treatment
Depending on the condition of the patient sanitization can be total or
partial. Character of sanitization determined by the doctor. Bathtub and shower
refer to complete sanitization. Partial washing, wiping parts of the patient's body
refer to partial sanitization. Sanitization is carried at sanitary inspection of a
reception. Sanitary inspection includes observation, locker rooms, bath and shower
room and a room where patients change their clothes. Rooms can be combined.
Before sanitization nurse receptionist is obliged to carefully examine the hairy part
of the patient's body to detect pediculosis (head, pubic and body lice). Head and
body lice are carriers of serious infectious diseases, so the detection of lice or nits
nurse should carry out disinfectation immediately.
3. Treatment of patients in identifying lice
Indications: head and body lice.
The goal: the destruction of lice and nits in a particular patient, preventing
their distribution in the environment, the prevention of disease typhus.
Financial support.
1. A bag for the collection of items of the patient (sufficient in volume).
2. Set (medical gown, cap, oilcloth apron) - 1 pc.
3. Rubber gloves - 2-3 pairs.
4. Mask - 1 pc.
5. Galvanised container for burning the hair (of not less than 5 liters) 1pc.
6. Oilskin cape - 1 pc.
7. Solitaire cloth - 1 piece.
8. Scissors - 1 pc.
9. Hair clipper - 1 pc.
10. Razor single application 1 unit.
11. Frequent comb - 1 pc.
12. Wadding.
13. Vinegar.
14. Insecticide, anti pediculosis solution (to kill head lice, disinfection of
premises and furniture, for example - Nittifor).
15. Capacity for delousing facilities, respectively labeled - 1 pc.
16. Spray irrigation anti pediculosis solution - 1 pc.
Mandatory requirement: procedure is carried out at sanitary inspection by the
nurse.
The sequence of execution:
1. Put on an extra set of overalls and personal protective equipment (gown,
oilcloth apron, cap, gloves, mask).
2. Seat the patient (if his condition allows) on the couch, covered with
oilcloth, put on his oilskin cape. Tie a towel, folded cushion on the top line of the
patient's eyebrows to prevent ingress of the drug in the eye.
3. Hair head profusely moisten 0.5% aqueous-alcoholic "Nittifor" solution
or other insecticide with a cotton, gauze pad or sponge (rubbing the hair roots).
4. Cover the head by scarf.
5. At the end of the exposure time rinse hair with warm running water and
soap or shampoo, rinse with warm water with the addition of 6% solution of
vinegar (at the rate of 50 ml of vinegar to 1 liter of water).
6. Comb patient's hair with fine-toothed comb to remove dead insects
(previously through the fine comb teeth skip thread, abundantly moistened
vinegar).
7. The patient underwear fold in the bag and send it together with the list
for delousing chamber, previously abundantly irrigating the bag with anti
pediculosis solution.
8. On the front page of medical records in the right corner make a mark on
the revealed lice «P» (pediculosis) and sanitation (with an indication of the
methods and means) and the re-processing in a week (if necessary).
9. Premises and objects with which the patient was contacted, treat with a
anti pediculosis solution.
10. Gown, cap, gloves, in which was processing, fold in the bag and send it
to the camera pest.
11. Arrange "Emergency notification of infectious disease," and send it to
the sanitary and epidemiological station in the community.
Note: The drug "Nittifor" flammable, use it near an open flame can not. Avoid
contact with the drug on the mucous membranes of the eyes, nose, mouth. In the
case of getting the drug to the mucous membranes, they should be rinsed with
water.
4. Carrying out sanitary bath, holding a hygienic shower, wet wiping
Carrying out sanitary bath
1. Ask the patient to undress, help him in this.
2. Fill in two copies of the "Admission ticket" patient things.
3. Inspect the skin in the abdomen, thighs, interdigital folds of brushes to
detect scabies.
4. Fill a clean bath water temperature + 35-37 ° C for half of its volume.
Note: in order to prevent accumulation of vapors initially pour the cold and
then hot water.
5. Put on gloves.
6. Seat the patient in the bath so that the foot end rested on the footrest
lock, and the water level reached the xiphoid process of the sternum of the patient.
7. Give the patient a clean sponge and a piece of a batch of soap or liquid
dose.
8. Help the patient to wash his head first, then the trunk, upper and lower
limbs, groin and perineum. Duration of the bath does not exceed 25 minutes.
9. Keep monitoring the condition of the patient (skin color, pulse, heart
rate, etc.).
10. Help the patient get out of the bath and wipe clean warmed towel or
sheet.
11. The used towels and sponge put in a container labeled "dirty laundry"
and "used washcloths."
12. Help the patient to wear clean underwear.
13. Wash the bath with a brush cleaner, disinfection solution adopted for
use, rinse the bath with hot water.
14. Remove gloves, wash and dry your hands.
Conduct a hygienic shower
1. Put on gloves.
2. Put a bench in bath and seat patient on her.
3. Help patient wash his body in the same sequence as during a sanitary
bath.
4. Help the patient get out from the bath.
5. Wipe the body in the same sequence.
6. Cut the patient’s nails on the hands and feet.
7. Remove gloves and put them in a disinfection solution.
8. Help the patient to wear clean underwear.
9. The used towels and washcloths pute in a container labeled "dirty
laundry" and "used washcloths."
10. Wash and disinfect the bath.
Wet wiping
Equipment: mat, diaper, reniform tray, warm water, an alcohol, a large
napkin or a towel, changeable underwear and bed linen, gloves.
1. Establish confidential friendly relationship with the patient.
2. Wash your hands, dry it, put on gloves.
3. Put under the patient the oilcloth diaper.
4. Pour into pan warm water (you can add 1 table spoon of alcohol per 1
liter of water).
5. Expose the upper portion of the patient's body.
6. Moisten the napkin, gently squeeze.
7. Wipe the patient in the following sequence: the face, neck, arms, back,
chest.
8. Dry the patient's body with a towel in the same sequence and cover with
sheets.
9. Wipe the same way the stomach, hips, legs.
10. Cut patient's nails (if necessary).
11. Change his underwear.
5. Anthropometry
Indications: conformity assessment of physical development to age, the
proportionality of the patient.
Equipment: medical scales, height meter, centimeter tape.
The sequence of execution:
Measurement of height standing
1. Place the patient back to the height meter rack.
2. The heels, buttocks and shoulder blades must touch the rack height
meter. The upper edge of the external auditory canal and the corners of the eyes
should be on one horizontal line.
3. Height meter board lower on the parietal region of the head.
4. Count the division on the scale on the bottom edge of the height meter,
and record the result.
Weighing
Weigh produce with empty stomach, in underwear, after urination and
defecation. When determining the weight of the dynamics weigh on the same
scale. Weighing made at admission, weekly and at discharge.
1. Install and adjust the balance.
2. Raise the shutter of the balance.
3. Put the patient in the middle of the platform scales,
covered with oilcloth.
4. When the equilibrium of the balance is reached,
push the latch weights.
5. Determine and record weighing results.
6. Disinfect the oilcloth.
Scales and stadiometer
Measurement of the circumference of the chest
1. Attach a measuring tape in front of the 4th rib, back - under the angles of
the blades. The patient should be calm breathing, arms down.
2. Write down the result.
3. Measure the circumference at a height of maximum inhalation, then exhale.
4. Record the result.
Measuring waist circumference, hip circumference
1. Attach the measuring tape on the point located at the mid-axillary lines in
the middle of the distance between the lower edge of the costal arch and the iliac
crest.
2. Write down the result.
3. Apply the measuring tape at the level of the greater trochanter.
4. Record the result.
The calculation of body mass index (BMI)
1. Calculate the BMI formula:
BMI = body weight in kg / (height in meters)².
2. Write down the result.
3. Calculate the ratio of waist circumference / hip circumference by the
formula: waist cm / hips cm.
4. Record the result.
6. Patient’s hygiene. Moving regime. Taking care of oral cavity. Eyes Care.
Nose care. Skin care
Personal hygiene of the patient includes the activities of the admission of
the patient to the hospital, as well as activities undertaken in the course of his stay
in the hospital.
Personal hygiene, maintenance of clean bed chamber and create conditions
for a speedy recovery of patients and prevent the development of many
complications. The heavier the patient, the more difficult to care for him, difficult
to carry out any manipulation of oral care products, ears, eyes, nose, etc.
Main propulsion modes
There are four types of individual patient modes: strict bed, bed, semi bed
and overall.
In strict bed rest patient is not allowed to actively move in bed, all the
physiological functions he performs in bed, and the nurse is caring, feeding the
patient and ensures that he did not get up.
While the patient bed rest is allowed to rotate freely in bed, but do not
leave it.
While semi bed mode the patient is allowed to go to the toilet.
While the common mode the patient is allowed to walk on the department
and the hospital.
Taking care of oral cavity
In the mouth (mucosal, teeth) in the absence of adequate care accumulated
plaque, which consists of desquamated epithelial cells, food debris, which leads to
an increase in the number of microorganisms and there is formation of
inflammation. The patient feels discomfort can be disrupted meal, leading to a
deterioration of health and general condition.
Patients on the common mode, independently monitor the oral cavity.
Nurse handles seriously ill patient’s mouth after every meal in the Intensive Care
Unit. If patients are on the probe or parenteral nutrition, the mouth handled at least
2 times per day.
If you have dentures need to follow the recommendations to care for them,
clean them thoroughly with special pastes decontaminate special solutions. At
night time they should be removed from the mouth, handle and put in a glass of
water.
The purpose of the oral care:
1) prevention of infections;
2) the preservation of the oral mucosa and lips clean and moisturized,
undamaged (intact);
3) prevention of halitosis (bad breath);
4) removal of food residues, to prevent the occurrence of discomfort in the
mouth, the preservation of appetite;
Indications: Seriously ill, debilitated, febrile patients, patients who are on
mechanical ventilation, tube feeding.
Facilities (sterile): Tray, two sterile forceps, packing with sterile material
(cotton balls, swabs, wipes), two sterile spatula, pear-shaped balloon, petrolatum
(cream, lip balm), beaker; towel, a glass of water, a container of disinfectant *,
container for waste materials, gloves, vacuum suction system fluid from the
patient's mouth (if necessary).
* Choose a doctor performs an antiseptic, it is necessary to clarify the
requirements for oral care in a sheet of medical appointments (care may be used
water, 0.05% solution of chlorhexidine bigluconate, sometimes 2% soda solution,
sodium chloride solution (1 teaspoon of salt in the 500 ml of water. professional
care products can be used (sterile cotton «Pagavit» sticks).
Prerequisite: rinse your mouth after each meal and regularly, at least 2
times a day, brush your teeth. Seriously ill patients should be wipe the mucous
membrane of the mouth and teeth with an antiseptic solution 2 times a day.
Antiseptic solutions with prolonged use (more than 7 days) recommended
alternate.
Before performing the procedure, you must wash your hands, perform their
hygienic antiseptic and wear gloves.
Stages of the procedure:
1. Explain to the patient the purpose and course of the procedure, to obtain
consent to use the screen when the manipulation *
2. Pour into a beaker antiseptic solution (if, for example, sodium
bicarbonate, prepare in advance a solution for the treatment of: 1/2 teaspoon to 1
cup water).
3. Help the patient to turn his head to the side, neck and chest covered with
oilcloth, chin substitute tray.
4. Inspect the mouth using a spatula (if the blood, ulcers, lesions of the
mucous - inform your doctor).
5. Ask the patient to close the teeth (if you have dentures - remove).
6. Push the patient's cheek with a spatula and forceps with gauze ball
soaked in antiseptic solution, treat each tooth from the gum to the crown of the
tooth from the molars to the incisors on the outside, on the left.
7. Reset the ball into the tray, to prepare and carry out a new treatment in
the same sequence on the right.
8. Ask the patient to open his mouth, changed the gauze ball, moisten in an
antiseptic solution. Process each tooth from the gingiva, from the root to the
cutting edges, on the inside.
9. Change gauze ball, moisten in an antiseptic solution. Edit language
(remove plaque in the direction from the root of the tongue to the tip).
10. Help the patient to rinse the mouth or conduct irrigation using a pearshaped balloon. Pull the corner of his mouth with a spatula and rinse alternately
left and then right buccal space jet under moderate pressure solution.
11. Wipe the skin around the mouth, dry cloth, brush lips with Vaseline
(use chapstick), if infected with cracks in the corners of the mouth - "levomikol"
(ointment), lubricate 2 times a day;
In the presence of non-healing of cracks in the corners of the mouth dental consultation (ointments containing antibiotics, corticosteroids,
epithelialization promoting agents, moisturizers / emollients ( "Panthenol",
"Bepanten")).
12. Put beads tools and gauze after container for processing waste
materials.
13. Remove gloves and put them in a container for waste materials.
14. Wash and dry hands.
Make a record of the performance of the procedure in the medical record.
Note that if a patient terminal is not available, check the identification data
and destination.
Oral care in patients unconscious: the patient should be turned on its side
(head rolled to the side), you must use a suction, these activities prevent aspiration.
Recommends the use of water for the treatment of oral cavity, as there is the risk
that the disinfectant in the airways. The recommended frequency of oral treatment
is every 4 hours, which will reduce the risk of infection.
Eye Care
Production of tears and blinking leads to natural cleansing the eye. When
these functions are violated, an additional eye care.
Indications: a serious condition of the patient, lack of consciousness,
infections of the eye.
Objective: rehabilitation, prevention of infection, prevent dryness (the use
of "artificial tears"), the treatment of infection.
Facilities (sterile): tray, tweezers, package of sterile gauze balls, 0.02%
sterile furatsilin solution, 0.9% sodium chloride solution, pipettes, gloves (sterile /
non sterile).
Stages of the procedure:
1. Inspect the eyes, to assess the state.
2. If the patient is unable to sit, the assistant is necessary to fix the patient's
head.
2. Wash hands, put on gloves (if the eye is infected, then use sterile gloves,
otherwise - disposable).
3. Pour into a sterile tray antiseptic solution.
4. Moisten a sterile balls with tweezers in the solution.
5. Wipe one eyelid in the direction from the outer corner of the eye to the
inner, then blot dry eyelid ball. Repeat 4-5 times wiping different balls.
7. In the presence of purulent conjunctival cavity *: a) rinse the conjunctival
cavity with sterile saline, parting forever thumb and forefinger of his left hand and
right hand hold irrigation conjunctival sac with a pipette;
b) wipe dry with a sterile eyelid ball in the same direction;
c) treat other eye in the same manner.
8. Put the waste balls, tweezers, beakers, pipette into the container for waste
materials.
9. Remove gloves, place in a container for the waste material (subsequently
performed their disinfection and disposal). Wash your hands, dry.
10. Make a record in the documents on the implementation of the procedure
and the patient's response.
Patients in the intensive care unit, who for one reason or another are not
closed eyelids during sleep, it is necessary to impose gauze moistened with warm
saline eye (to avoid drying of the conjunctiva), is used as an ointment or gel to
prevent drying of the cornea (eg "Solcoseryl gel").
* Note: the presence of infection treatment starts with a healthy eye.
Consultation of an ophthalmologist with the determination of tactics of the patient.
For the purpose of mechanical removal of conjunctival discharge cavity is washed
with an antiseptic solution (furatsilin); antibiotic therapy is conducted in the
presence of purulent discharge, for example, eye drops 0.3% ofloxacin solution.
Instill drops in eyes
The sequence of execution:
1. Wash your hands.
2. Check the consistency of the drug to the appointment;
3. Seat or lay the patient.
4. Preheat the drug to a temperature of + 35-37 ° C.
5. Type medicament in a sterile pipette based on both eyes.
6. Instruct the patient to tilt the head back.
7. Pull the lower eyelid with a sterile cotton ball (ball) and ask the patient
to look up.
8. Drip drops at intervals of 1-2 seconds in the conjunctival cavity closer to
the inner corner of the eye without touching the eyelashes and eyelids (always keep
the pipette vertically only to medicine does not fall into its rubber part).
9. Push the inner corner of the eye for 1-2 minutes, so that the medicine is
not on the glass tear ducts in the nose.
10. Excess drug dab the swab.
11. Waste materials add a container to collect the waste materials.
12. Make a note in the medical record of the manipulations.
Note: the presence of purulent eye discharge furatsilin first rinse, then drip
drug.
Care for the nose
In critically ill patients in the nasal mucosa accumulates large amounts of
mucus, making it difficult to breath and aggravates his condition. Weakened
patients can not relieve nasal passages independently, a nurse must remove the
crust formed on a daily basis.
Purpose: prevention of disorders of nasal breathing.
Indications: a serious condition of the patient, presence of secretions from
the nose, dry nose, plenty of scabs.
Facilities (sterile): tray, beakers, tweezers, cotton turundy, gloves, sterile
vegetable oil (sea buckthorn olive, peach,).
Prerequisite: Do not use sharp objects.
Stages of the procedure:
1. Wash and follow hygienic hand antisepsis, wear gloves.
2. Pour into a sterile beaker vegetable oil *.
3. Take turunda tweezers, gently squeeze.
4. Transfer turunda in his right hand and enter the rotary movements in the
nasal passage for 1-3 minutes, lifting the tip of the patient's nose with his left hand.
5. Remove turunda rotational movements of the nasal passage.
6. Deal with the second nostril in the same way.
7. Place the processed turundy, tweezers, a beaker into a container for
waste materials.
8. Remove gloves and put them in a container for waste materials. Wash
your hands, dry it.
If the patient is in serious condition observed runny nose (rhinorrhoea;.
Rhino- + Greek rhoia for, expiration) - copious exudate mucosa of the nasal cavity,
it is recommended to drip into the nose sterile saline solution, followed by
aspiration of the contents by suction.
* Note: sterile vegetable oil can be used for nasal instillation patient with
severe mucosal dryness, such as uremia, diabetes. It is possible to perform nasal
irrigation with sterile 0.9% sodium chloride solution followed by instillation of 5
drops of vegetable oil. If you have dry crusts in the nasal vestibule via turundy can
be applied ointment "levomikol".
Instill drops in nose
Material Required: Sterile eye pipette tray drug nasal turundy for waste
materials tray gloves.
The sequence of execution:
1. Wash your hands, dry them, put on gloves.
2. The patient should lay or seat, ask him to throw back his head slightly
tilted back and to the side.
3. In the presence of secretions in the nose, or crusts nose clean cotton
turundas (see algorithm. Above).
4. Preheat the drug to a temperature of + 35-37 ° C.
5. Eye pipette type required amount of the drug based on the two halves of
the nose.
6. The left hand gently lift the tip of the nose.
7. Drip alternately assigned to the number of drops in the other half of the
nose, where rotated head, nose wing press, hold for 1-2 minutes, then do the
burying in the other half of the nose (always keep the pipette vertically only to cure
has not got it in the rubber part ). If the patient is lying, his head to one side and
expand somewhat posterior to the drops do not flow from the nasal cavity.
8. The waste material disinfect, disposable tools, gloves, fold into a
container for waste materials.
9. Follow the hygienic hand antisepsis, drain, put on protective hand cream.
Skin care
For patients moving by themselves at hospital hygiene bath or shower with
a change of bed clothes suit once in 7 days. Patients with bed rest, who are not able
to take a bath or shower, sanitization of the whole body skin is accomplished by
wiping with disposable wipes impregnated with an antiseptic.
Patients who are on a shared mode, a daily skin care is carried out
independently. Patients with bed rest, morning toilet helps to hold the medical
staff. This warm water and soap to wash their hands, face, neck, ears, wipe the skin
armpits, under the breasts and crotch.
The skin of genitals and anus in normal conditions require daily washing.
Walking patients for this purpose use a bidet, wash away bedridden for at least 2
times a day.
Hands should be washed in the morning, before eating and after any
contamination during the day, especially after using the toilet. Feet should be
washed daily at night with warm water and soap.
In the last decade there was a set of hygienic means to facilitate the care of
seriously ill patients, located in the long-term bed rest, patients. Modern hygiene
products used in the world . This, for example, products of the «Paul Hartmann»,
«Seni Care», etc. Frequent use of conventional hygiene products (soap) as well as
antiseptics in the hospital can lead to irritation, damage to the sensitive skin of the
patient, especially the elderly. Developed care products for daily hygiene, do not
require soap, especially such important tools for patients who used diapers (these
cosmetics can be used both in hospital and at home for preventing chafing and
pressure sores). Thus, for example, lotions, wipes, gels, cleansing foam, wet
gloves, foam sponges, used without soap and water, used to cleanse the patient's
intact skin and fecal incontinence. On clean skin applied balm, cream for the care
and protection of the skin, containing zinc. These funds are handled all folds that
prevents chafing. Products that contain in their composition of camphor and
menthol (such as liquid «Menalind professional»), is applied to at least 3 times a
day in the field of education possible bedsores.
Processing algorithm patient's skin
The purpose of skin care:
1) prevention of infections;
2) preservation of the skin clean, hydrated, uninjured.
Indications: seriously ill, weakened, feverish patients, patients who are on
mechanical ventilation, patients with disorders of the musculoskeletal system
functions.
Equipment: bowl, packaging, bottles with a material for skin care; towel
capacity for waste materials, gloves.
Before performing the procedure, you must wash your hands, perform their
hygienic antiseptic and put on gloves.
Stages of the procedure:
1. Explain to the patient the purpose and course of the procedure, obtain
consent, use the screen when performing manipulations in the chamber, put on
gloves.
2. Put on the bedclothes absorbent diaper.
3. Remove the patient's shirt (pajamas).
4. Moisten a disposable mitten (eg, «Vala Slean soft») warm water, wring it
out and wipe her face, pat face with a towel.
4. Pre-dissolve 10 ml detergent lotion (for example, «Menalind
professional») in 1.5 liters of warm water soak solution disposable mitten.
5. Wipe consistently ears, neck, chest (front), abdomen and extremities.
6. Blot dry with a towel.
7. Patients in the folds under the breasts, in obese patients - in the folds on
the anterior abdominal wall, apply a sunscreen with zinc oxide (the cream should
completely soak).
8. Turn the patient on his side, rub back and lumbar region, legs back, pat
dry with a towel.
9. Inspect the areas of potential chafing and pressure sores (on the limbs interdigital spaces).
10. On the heels and elbows, apply protective foam protector (for the
purpose of prevention of bedsores).
11. Before changing the diaper disinfect pelvis, change gloves, mix the
solution (look №4).
12. Undo the diaper fasteners velcro wrap inside to avoid damage to the
patient's skin.
13. Extend the patient's legs and fold the diaper inside.
14. Wet the mitten disposable, squeeze and rub the intimate area from front
to back. Each side of the gloves used once.
15. Soak cloth intimate area.
16. Turn the patient on his side.
17. Remove the used diaper in a waterproof bag for waste materials.
18. Take a disposable mitten, soak in the solution, wring out and wipe the
buttocks, dab a napkin.
19. On the skin folds of the groin, buttocks and sacrum after drying, apply a
protective foam protector.
20. Expand the clean diaper, fold it in half lengthwise and flatten the
protective sleeve.
21. Spend the back of the diaper, which are fastening - velcro between the
patient's legs from front to back.
22. Put on the front part of the diaper and fasten the buckle.
23. Place the patient.
24. Remove the used equipment (bowl should be cleaned and disinfected
using a disinfectant disinfection according to plan in the hospital).
25. Wash and dry hands.
26. Make a note on the implementation of procedures in the medical
records.
7. Change of bed clothes and underwear
Matron works at each department, which is responsible for the regular
change of linen and timely shipment of dirty laundry to the laundry. Linen is made
regularly to the extent of its pollution, but at least once every 7 days. If there are
seriously ill with involuntary urination or defecation at the department, the matron
is obliged to leave the younger nurse a few extra sets of clean clothes to change.
Bed patients with involuntary urination and defecation release should have
special mattresses, which consist of three parts: the middle part of a device for the
vessel. Linens such patients change more often than usual - to the extent of
contamination.
Patient's bed must be regularly relay: in the morning, at night and before
day rest. The nurse shakes off the crumbs with sheets, spreads her fluffs pillows.
The patient can sit on a chair at this time. If the patient can not move, then you
need to shift it together on the edge of the bed, then spreading to the vacant half of
the mattress and the sheets, remove them with crumbs and shift the patient to the
cleaned half the bed. The same is done on the other side.
Change of bed clothes
Changing the sheets under the seriously ill requires a certain skill
personnel. If the patient is allowed to turn on his side, first cautiously raising the
patient's head, removed the pillow. Then help him to turn on his side, facing the
edge of the bed. On the vacant half of the bed, located behind the patient, rolled
dirty sheet so that it is in the form of a roll lay along its back. On the vacated seat
put the net, and half rolled-up sheet. Then, help the patient to lie on his back and
turn on the other side. After that, he will be lying on a clean sheet to face the
opposite side of the bed. Next, take out dirty sheet and straighten clean sheet.
If the patient can not perform active movements, the sheet can be changed
in the following manner. Starting with the head end of the bed, dirty rolled sheet,
together with the lifting nurse the patient's head and upper torso. In place of dirt lay
rolled up in the transverse direction of the clean sheet and straighten it to make
space. Then, put a clean sheet and pillow lowered her patient's head. Furthermore,
raising the patient's pelvis, dirty sheet slid to the foot end of the bed.
In its place straighten clean sheet. It then remains to delete the dirty sheet.
Squaring a clean sheet until the end of the mattress, run by its edges under the
mattress.
Change of linen undergarments patient in the
hospital is done after hygienic bath at least once
every 7 days. Untidy, sweating and very debilitated
patients as needed linen changed often. Seriously ill
shirts changed as follows: slightly lifting the upper
torso, collect it from the back to the neck. Raising the
hands of the patient, remove the shirt over his head
and then released from the hands of the sleeves.
If one arm of the patient is damaged, the
sleeve is removed first with healthy hands, and then with damaged. Clean clothes patient dressed in
reverse order: first - the sleeves, then - shirt over his
head and straightened it along the back.
dust,
Basic skin care method - a washing disposer
microbes, sebum, sweat, and various
contaminants skin.
Lesson 5:
8. Bedsore, bedsore prevention education
Bedsores (Latin decumbere (lie), dekubitalnaya gangrene.) is a deep lesion
of the skin and soft tissue down to the immobilization due to prolonged
compression of (ischemic necrosis of the skin and soft tissues). It should be noted
that this term is today considered not quite correct, because the sores occur in
patients with impaired nutrition of tissues, not only under the influence of external
compression of, but also as a result of various diseases (eg, spinal cord). Pressure
sores are formed in places where there is no muscle where soft tissues are tightly
pressed against the bearing surface.
Predisposing factors include violations of local circulation, innervation and
nutrition of tissues. Bedsores can be formed wherever there is bony prominences.
When the position of the patient on the back - it is the sacrum, heels,
shoulder blades, elbows and sometimes the back of the head. When sitting it -
point of the buttock, legs, feet, shoulder blades. In the prone position - a ribs,
knees, toes on the back side, the iliac crest. Bedsores quickly become infected,
leading to serious complications.
Places Education bedsores
Three
main
factors
are
established, leading to the formation of
pressure ulcers: pressure, "shear"
strength and friction.
Pressure is under the action of
its own weight of body tissue
compression takes place relative to the
surface upon which the person. At full
compression of 2 hours during formed
necrosis.
"Shear" force is destruction and
mechanical tissue damage occurs under
the influence of indirect pressure. It is
caused by displacement of the
supporting surface tissues. Microcirculation in the underlying tissue is disturbed,
and the tissue dies from lack of oxygen. Displacement occurs when the patient is
"moving out" on the bed down or pulled up to her bedside.
Friction is a component of "shearing" forces, it causes detachment of the
stratum corneum and leads to ulceration of the surface. Friction increases in skin
moisture.
The sign of bedsores is the appearance of the skin area bluish-red color
without clear boundaries. Then exfoliate the epidermis, formed bubbles. Further,
tissue necrosis occurs spreads in depth and laterally. On the heels of the formation
of pressure sores goes unnoticed because of the presence there of a thick layer of
skin, a sign of stage 1 can be the presence of white spots.
Diagnosis of infection is performed bedsores doctor. Diagnosis is based on
survey data. It uses the following criteria: 1) purulent discharge; 2) pain, swelling
of the wound edges.
The diagnosis is confirmed with bacteriological microorganism isolation in
crops fluid samples obtained by puncture or smear of the wound edges. Infections
bedsores that developed in the hospital, recorded as nosocomial.
Treatment is carried out in accordance with the degree of destruction.
Degree I - limited to the epidermal and dermal layers. Skin is not broken.
The main objective of treatment at this stage is the prevention of infection and the
impact of damaging factors.
If you have a first degree of damage should be intensified prevention
activities: turning the patient every 2 hours, use of funds aimed at reducing the
pressure force - plastic tire, special beds and mattresses, pillows, pads, filled with
foam, water, gel, air systems controlled pressure and vibration, which reduce the
local pressure on the skin. Local treatment of the emerging pressure ulcers involves
a careful toilet area of modified skin. However, it should be remembered that
currently do not recommend the use of hexachlorophene, chlorhexidine, and
povidone-iodine, as they violate the permeability of cell membranes and inhibit the
ability of cells to resist the invasion of bacteria. Not recommended for use and
aniline dyes ("brilliant green"), which have no significant effect on the skin,
however, difficult to assess the course of the process.
Treatment: Skin treatment is advantageously carried out with sterile
physiological sodium chloride solution or inert drugs, not having ion-exchange
properties, may be used bandage with ointment "Solkoseril" or ointment
"Betadine". After careful drying of the skin is possible to use 10% alcohol,
camphor or 2-fold diluted in 70% alcohol. Assign physiotherapy - UV irradiation.
Degree II - shallow surface compromising the integrity of the skin, apply to
the subcutaneous fat layer.
Treatment: The treated skin around the bladder with sterile saline solution
of sodium chloride, after opening the bladder, cut the shell of the latter, and the
wound was washed with sterile physiological sodium chloride solution, closed
with sterile dry cloth, which is replaced at least getting wet.
To protect the skin from infection recently used Adhesive transparent film
dressings, hydrocolloid and hydrogel dressings ( "Kosmopor", "Gidrofilm»,
«Algoplaque»), foam semipermeable dressing. For wounds with exudation use
superabsorbents ("TenderVet"), which facilitates the rapid purification of wound,
stimulate the processes of proliferation.
Semipermeable hydrocolloid dressing («Algoplaque») has two layers: an
inner layer which comprises particles of hydrocolloids CMC and grid on a flexible
outer layer, which is a polyurethane substrate. Upon contact with the wound
dressing slowly absorbs fluid, contributing to the healing process. It has great
flexibility, conformability and adhesion, making it ideal for covering wounds in
hard to reach areas (ulcers in the trochanter or the heel), does not flake when
moving or when wet. Due to transparency it allows you to constantly monitor the
wound. It is important to note that it is air permeable but waterproof and
impermeable to bacteria. These properties allow you to take a bath or shower, to
protect the wound from external contaminants and provide a gas exchange that
promotes drainage of fluid.
Mode of application:
- Clean the wound with saline or antiseptic.
- Dry the skin around carefully with a sterile material.
- Select the appropriate size of the bandage so as to leave 3 cm bandage
covering healthy skin around the wound.
- Remove the protective film and attach the dressing to the wound without
tension, making sure not to touch the sticky part of the fingers.
- Smooth soft bandage over the wound and more firmly on healthy skin.
Change the bandage is held not earlier than 48 hours. It is best to wait to
patch itself was partially undocked before the upcoming replacement. It is
important to remember that change is too early can damage healthy skin!
Contraindications: Do not use «Algoplaque» for infected wounds and wounds with
a very pronounced exudation.
In the event of any signs of inflammation in the wound, the patient should
be assigned to antibiotic therapy in combination with a more frequent change of
dressings.
Degree III - the complete destruction of the skin in its entire thickness to
the muscle layer with the penetration into the muscle itself.
Degree IV - the defeat of all soft tissue. Education cavity with damage to
her underlying tissues (tendons, down to the bone).
The third and fourth degrees are treated by using surgical dissection and
removal of necrotic tissue. Use topical microbicides, necrolytic, dehydrating drugs,
stimulators of reparative processes. The use of ready-to-use, sterile, hermetically
packaged wound dressings facilitates wound care.
To stimulate healing processes using ultrasonic treatment of ulcers,
phonophoresis (ultrasound) with preservatives, the impact on the fabric lowintensity laser radiation.
At all stages of the treatment of complicated bedsores conduct discharge
crops to study the nature and sensitivity of microflora selected, and then apply
antibiotics.
The criterion of effectiveness of conservative treatment of pressure ulcers
is to reduce its size by 30% or more within two weeks. If it does not need to
reconsider the tactics of treatment and consult a surgeon. It should be noted in
patients with pressure ulcers must be balanced diet high in protein and vitamins.
To this end use may further special nutrient mixture (Nutrizon et al.).
Preventing pressure ulcers
Indications: prolonged bed rest, damage to the central or peripheral nervous
system, metabolic disorders in the body, dysfunction of the excretory system.
Facilities (sterile): tray, wipes, tweezers; 10% solution of camphor alcohol
or 40% ethanol solution; underwear and bed linen, pillow, foam circles, foam
cotton-gauze rings.
The volume of necessary measures:
1. To assess the risk of bedsores at first contact (or use the Norton scale of
Waterloo).
2. Inspect the skin daily in areas of potential pressure sores: sacrum, heels,
ankles, shoulder blades, elbows, neck, trochanter, femur, the inner surfaces of the
knee to assess the condition of the skin each time you move, change of state.
Note: The detection of pale and reddened skin areas need to call a doctor
and immediately start preventive and therapeutic measures.
3. Eliminate irregularities, wrinkles on the underwear and bed linen
(optimal use of the tensioned sheets with elastic bands, blankets should be easy).
4. Shakes off the crumbs from the sheets after feeding.
5. To change the position of the patient's body in bed every 2 hours during
the day, raising it above the bed, laying alternately on the side, abdomen (position
Fowler Simpsa, on the left, the right side, abdomen, permitting the disease and the
condition of the patient).
6. To wash 2 times a day (morning and evening) places the possible
formation of bedsores with warm water and mild soap (it is better to use the funds
for specialized care), then wipe dry with a towel (do blotting motion), to process a
cloth soaked in warm camphor alcohol or ethyl alcohol.
7. Apply a protective cream.
8. Rub the soft tissue in areas of potential bedsores techniques of massage
(massage is done very carefully). Do not do massage in the area of bone protruding
portions.
9. Use the waterproof pad, diapers (incontinence of urine, feces).
10. Lay foam circle in the pillow under the patient's sacrum and elbows,
and the patient's heel. But much better to use anti-bedsore pneumatic system. It is a
polymer of a soft mattress, which consists of individual small sections alternately
filled with air from a compressor of a special (picture compressor left on the table).
11. Educate family and all those involved in the care, prevention of
bedsores measures.
12. Opportunity to influence the rating of risk factors of pressure sores (ie
the introduction of nutritional support in the form of special nutritional formulas,
increased fluid intake, etc.).
9) Types of patient transportation
Mode of transport determined by the physician. Patients in satisfactory
condition after medical documentation and sanitizing is directed into the chamber,
accompanied by a health professional. It is important to note that some of the
patients in need of emergency care directly to the emergency room and they are
non-transportable. After first aid they are transferred to the intensive care unit. In
some cases, patients in serious condition, such as shock events, direct without first
sanitizing, bypassing the emergency department directly to intensive care unit.
Patients in serious condition, as well as violations of the musculoskeletal
system are transported on a gurney, stretcher or wheelchair. In the event that you
need for admission office is located in another building, well away from the front
desk, use a special ambulance transport.
10) Rules of patient transportation by stretchers
Each wheelchair must be filled with clean sheets and blankets depending
on the season. The linen is changed after each patient. Blankets after infectious
patients sent for disinfection. In the absence of seriously ill elevator lift on a
stretcher 2 or 4 people, coming up; the patient's head is carried forward and lift the
lower end of the foot stretcher. During the descent of the patient are kicking
forward, also raising the lower end of the foot stretcher.
Seriously ill patients who can not move, shift from the stretcher to the bed
with great caution, observing certain rules: put the stretcher foot end to the head
end of the bed. If the area does not allow the House, put in parallel stretcher beds
and medical personnel becomes between the stretcher and the bed face of the
patient. It is necessary to think in advance how to put the stretcher with respect to
the bed, to avoid inconvenient and unnecessary movements.
It should be noted that at present for shifting patients are increasingly using
special lifting devices, especially when they are needed shifting obese patients with
a large weight.
In the absence of patient gurneys can transport: 1) one person - the patient
clings to his neck paramedic; 2) two people - one holding the legs and buttocks of
the patient, the other supporting the back and head; 3) The three men - one holding
the legs, the other - the lower back and back, the third - the back and head.
11. Rules of patient transportation by wheelchair
1) Tilt the wheelchair forward, stepping on a footrest;
2) ask the patient to stand on the footrest, then, keeping him seated in a
chair;
3) Lower the wheelchair to its original position;
4) using the frame located behind the wheelchair, give the patient to the
desired position: sitting, reclining or lying down;
5) transporting the patient to the office, make sure that his hands did not
extend beyond the wheelchair armrests;
6) in the House of help the patient to transfer to the prepared bed, place,
cover it;
7) wheelchair disinfect.
12. Rules of patient transportation by hand stretchers
When transporting patients on stretchers bearers
must follow certain rules:
1) to raise and lower the stretcher to be careful at
the same time, holding them in a horizontal position;
2) should not be allowed rocking stretcher,
shocks, sharp turns, for that porters should not go up;
3) on level ground and climbing stairs stretcher
to wear head end forward, lifting the foot end, and when
descending the stairs - feet first, lifting the foot end;
4) coming from behind must observe the
condition of the patient;
5) If any of the porters when carrying felt tired,
you should immediately report it as tired fingers may
involuntarily relax.
5. LITERATURE
Main literature
1. Zalikina, LS Nursing: the textbook / LS Zalikina. - M .: OOO "Medical News
Agency", 2008. - 201 p.
2. Fundamentals of nursing: Ouch. Benefit / LV Roman'kov [et al.]. - Minsk:
Elaida, 2012. - 200 p.
3. Basics of therapeutic care patients: Ouch. Benefit / KN Sokolov [et al.]. Grodno, 2016. - 252 p.
Additional literature
4. Pocket Guide nurse. "Medicine for you" series. / OV Chernoff [et al.] - Rostov n
/ D .: Phoenix, 2010. - 672 p.
5. Mendzheritsky, IM Directory nurse / IM Mendzheritsky. - Rostov n / D .:
Phoenix, 1997. - 640 p.
6. Obukhovets, ETC. Fundamentals of Nursing: a tutorial. / TP Obukhovets, TA
Sklyarov, OV Chernoff. - 6th ed., Ext. and rev. - Rostov n / D .: Phoenix, 2005. 505 p.
7. Annex 2 MZRB order from 28.08.2005, №477.
Head of the department of Internal Diseases No.1
with Endocrinology Course,
PhD, assist. of Professor
E.G. Malaeva