Theoretical foundations of general nursing. Basic principles of nursing. Features of caring for a patient with bed rest

STRUCTURE AND MAIN TASKS OF PATIENT CARE IN THE GENERAL SYSTEM OF TREATMENT OF THERAPEUTIC PATIENTS

THE CONCEPT OF GENERAL AND SPECIAL CARE FOR THERAPEUTIC PATIENTS

Defining the role and location of nursing

in the diagnostic and treatment process

Nursing is a set of measures aimed at alleviating the patient’s condition and ensuring the success of treatment.

Patient care is an integral and important part in the system of providing medical care to patients. At least 50% of the success of treatment belongs to proper effective care, because the patient’s well-being and mental state are important for the successful implementation of therapeutic, diagnostic and preventive measures.

All medical workers take part in the organization of patient care, especially service personnel who have the necessary training, namely: relevant knowledge, skills, familiarity with the methods of care, and knowledge of the basic principles of medical deontology. Responsibility for carrying out patient care activities lies with the doctor and the head of the department.

Patient care is divided into general and special. General care includes measures that can be applied to any patient, regardless of the type and nature of his disease. Special care includes measures that apply only to patients with certain diseases (surgical, infectious, urological, gynecological, mental, etc.).

General nursing care includes the following activities :

1. Creation of optimal sanitary and hygienic conditions around the patient and his care

· compliance with sanitary-hygienic and medical-protective regime;

· maintaining personal hygiene for seriously ill patients;

· providing assistance during meals and various physiological functions;

· alleviating the patient’s suffering, calming, encouraging, instilling faith in recovery;

2. Monitoring patients and carrying out preventive measures:

· monitoring the functions of all organs and systems of the body;

· provision of first medical (pre-hospital) aid (help with vomiting, dizziness; artificial respiration, chest compressions);

· prevention of complications that may arise due to unsatisfactory care for seriously ill patients (bedsores, hypostatic pneumonia);

· carrying out various medical procedures and manipulations

· carrying out diagnostic procedures (collection of urine, feces, duodenal and gastric contents);

4. Maintaining medical records.

Thus, patient care and the treatment process complement each other and are aimed at a common goal - alleviating the patient’s condition and ensuring the success of his treatment.

Moral, ethical and deontological principles of formation of a medical specialist

Medicine, unlike other sciences, is closely related to the fate of a person, his health and life. They are most fully defined by the concept of “humanism”, without which medicine has no right to exist, because its main goal is to serve people. Humanism constitutes the ethical basis of medicine, its morality, and ethics is a theory of morality. Morality is one of the forms of social consciousness, by which we mean the relationship of one’s individual experience with the meaning of life, with the social purpose of a person.

What is physician ethics? ? Physician ethics - this is part of general ethics, the science of the morality and behavior of a doctor in the field of his activity, which includes a set of norms of behavior and morality, the definition of professional duty, honor, conscience and dignity of a doctor. Medical ethics, as one of the varieties of professional ethics, is “... a set of principles of regulation and norms of behavior of physicians, predetermined by the peculiarities of their practical activities, position and role in society.”

The ethics of a medical worker finds its practical expression in specific moral principles that determine his attitude towards a sick person in the process of communicating with him and his relatives. This entire moral complex is usually defined by the word “deontology” (from the Greek “deon” - duty and “logos” - teaching). Thus, deontology is the doctrine of the duties of a medical worker, a set of ethical standards necessary for him to fulfill his professional duties. In other words, deontology is the practical implementation of moral and ethical principles in the activities of doctors, nurses and junior medical personnel. It is aimed at creating the most favorable conditions for effective treatment of the patient, because the word and behavior of the doctor (any health worker), his manners, gestures, facial expressions, and mood play an important role (positive or negative) in the treatment of the patient and the course of his disease.

Basic professional responsibilities of medical personnel

care in hospital inpatient departments

A medical professional must KNOW:

1.Human anatomy and physiology.

2.Mechanisms of development of the pathological process in the body; its course, possible complications.

3.Effect of medical procedures (enemas, baths, leeches, etc.).

4.Features of personal hygiene of seriously ill patients.

A medical worker must BE ABLE TO:

1.Assess the simplest physiological indicators of the patient’s condition (pulse, blood pressure, respiratory rate).

2.Assess the pathological signs of a particular disease (shortness of breath, swelling, sudden pallor, impaired breathing, cardiac activity).

3.Perform various hygiene measures.

4.Provide emergency medical care to the patient quickly and competently.

5.Perform the simplest medical procedures (changing underwear and bed linen, feeding a bedpan, performing injections).

Responsibilities of a doctor in caring for patients:

1.Constant monitoring of the correct and timely implementation of medical and diagnostic procedures by nursing staff and maintaining medical records.

2.Determination of measures for patient care: a) type of sanitization; b) type of transportation; c) position of the patient in bed, use of a functional bed; d) diet.

3.Determining the therapeutic measures that the nurse performs.

4.Determining the scope of diagnostic procedures performed by the nurse (duodenal intubation, collection of tests, etc.).

5.Constantly conducting classes with nursing and junior medical staff in order to improve their skills, conduct sanitary educational work among patients and their relatives, and teach them the rules of caring for the sick.

Responsibilities of a nurse in caring for patients:

1.Conscientiously follow all doctor’s orders and note their completion on the prescription sheets.

2.Preparing patients to perform diagnostic studies.

3.Collecting material for laboratory research and sending it to laboratories.

4.Monitoring the transportation of patients to various diagnostic rooms:

5.Monitoring the implementation of sanitary and hygienic measures and maintaining personal hygiene for seriously ill patients:

a) monitoring the order in the department and wards, the cleanliness of linen and bedside tables:

b) control over compliance with internal regulations by service personnel and patients:

c) implementation of hygienic measures for the care of seriously ill patients:

6.Providing nutrition for patients:

a) drawing up portion requirements;

b) monitoring patients’ diet compliance;

c) feeding seriously ill patients;

d) checking products that relatives give to sick people.

7.Carrying out thermometry and recording temperatures on temperature sheets.

8.Mandatory attendance at the doctor’s rounds, informing him of all changes in the patients’ condition during the day, and receiving new appointments.

9.Hospitalization of patients, checking the correctness of sanitization, familiarizing the patient with the internal regulations.

10.Measuring blood pressure, pulse rate, respiratory rate, daily diuresis and reporting their results to the doctor.

11.Correct assessment of the patient’s condition and provision of emergency care, and, if necessary, calling a doctor.

12.Maintaining medical documentation (prescription sheets, temperature sheets, duty log, log of medication and portion requirements).

13.Supervising the work of junior medical staff.

Responsibilities of junior medical personnel for patient care:

1.Daily cleaning of wards, bathrooms, corridors and other areas of the department.

2.Changing underwear and bed linen for patients together with the nurse.

3.Insertion and removal of the vessel and urinal.

4.Washing, wiping, washing seriously ill patients, toileting nails and hair.

5.Bathing patients with a nurse.

6.Transportation of seriously ill patients.

7.Delivery of biological material to the laboratory.

Junior nurse has no right: distributing food, feeding seriously ill people, washing dishes!

Principles of professional subordination in the system of doctor-nurse-junior medical personnel

The relationship between medical personnel is based on the principle of professional subordination. The relationship between a doctor, a nurse and junior medical staff is built on a business basis and mutual respect. They must address each other by name and patronymic.

Relationship between doctor and nurse. The ward doctor works closely with the nurse, who is his assistant and carries out his assignments. Since a nurse spends much more time near the patient’s bed than a doctor, she can give the doctor complete information regarding changes in the patient’s condition (worsening of appetite, the appearance of allergic reactions, etc.). If a nurse has any doubts or questions while carrying out doctor’s orders, she should contact the doctor for clarification and clarification, but not in the presence of the patient. Having noticed an error in the doctor’s prescriptions, the nurse should not discuss it with the patients, but tactfully address this issue to the doctor.

The nurse must be honest not only with the patient, but also with the doctor. If she gave the patient the wrong medications or exceeded their dose, she must immediately report this to the doctor, because here we are talking not only about ethical standards, but also about the life and health of the patient.

Relationships between nurses and junior medical staff. Junior medical staff (nurse) reports to the ward nurse. The orders that the nurse gives to the nurse must be clear, consistent, consistent, and not abrupt, so that the nurse has the feeling that she is not being ordered, but that her actions are being directed and controlled.

The responsibilities of a nurse and a junior nurse are mostly different, but they also have common actions - changing bed and underwear, bathing, transporting the patient. If the nurse is busy, the nurse can provide a bedpan or urinal herself.

Relationships between medical staff and patients. A medical worker must not only conscientiously fulfill his duties regarding the patient, but also fight for the physical perfection and mental health of people, and maintain medical confidentiality. When communicating with a patient, address him by name and patronymic, talk tactfully, with sympathy, calmly, instill in the patient hope for a quick recovery and return to work, even if there is a cancer patient in front of him. In other words: “The patient should be treated the way you would like to be treated.”

Types of medical institutions

There are two types of treatment and prevention facilities: outpatient and inpatient.

In institutions outpatient type Medical care is provided to patients who are at home. These include outpatient clinics, clinics, medical units (MSU), ambulance stations, dispensaries, consultative and diagnostic centers; in rural areas, outpatient facilities include: paramedic-midwife stations (FAP), rural outpatient clinics, clinics of central district and regional hospitals. Outpatient clinic– a small medical and preventive institution at the enterprise, where only doctors of basic specialties receive treatment; There are treatment rooms and physiotherapy rooms, but there is no diagnostic department. Clinic – a large medical and preventive institution where qualified medical care is provided by various specialists; There is a diagnostic department. Medical and sanitary unit- a medical and preventive institution at a large industrial enterprise or military unit, where its workers and employees are provided with first aid, treatment of patients, and prevention of production-related diseases. Dispensary– a medical and preventive institution that carries out observation, treatment, prevention, patronage, active identification of patients with a certain pathology (anti-tuberculosis, dermatovenerological, oncological, endocrinological, etc.). Ambulance station" - a medical and preventive institution that provides care to patients at home, at the place of work or at the site of emergency conditions. Consultative and diagnostic center – a medical and preventive institution in large cities, equipped with the most modern diagnostic equipment.

In institutions stationary type Treatment is carried out for patients who are hospitalized in the department of one of the medical institutions: hospital, clinic, hospital, sanatorium. Hospital– a medical and preventive institution where various diagnostic and therapeutic assistance is provided to patients in need of inpatient treatment, long-term treatment and care, and the need to conduct complex examinations. Clinic– a medical and preventive institution in which, in addition to medical work, student training and research work are carried out; well equipped with modern diagnostic equipment, has a large staff of experienced specialists. Hospital– a medical and preventive institution intended for the treatment of military personnel and war veterans. Sanatorium– a medical and preventive institution designed for the rehabilitation of patients with the help of various natural factors (climate, mineral waters, mud) in combination with diet therapy, physical therapy and physiotherapy.

Structure and functions of a therapeutic hospital

Therapeutic hospital– a medical and preventive institution designed to provide medical care to patients with internal diseases who require long-term treatment, care, and complex diagnostic procedures.

In a therapeutic hospital there are: treatment and diagnostic departments (reception, general therapy, cardiology, gastroenterology, pulmonology, diagnostic, physiotherapy) and auxiliary departments (administrative department, catering department, etc.).

In order to successfully treat patients, care for them, prevent possible harmful effects on the patient, to prevent nosocomial infections in the hospital, it is necessary to strictly adhere to hospital regime , including the implementation of medical-protective and sanitary-anti-epidemic measures (medical-protective and sanitary-anti-epidemic regime).

Therapeutic and protective regime is a system of therapeutic and preventive measures that eliminate or limit the adverse effects of irritants that may occur in a hospital environment, protect the patient’s psyche, have a positive effect on the entire body and promote rapid recovery. The basis of the medical and protective regime is strict adherence to the daily routine, which ensures the physical and mental peace of the patient. The daily routine, regardless of the profile of the medical department, includes the following components: getting up, measuring body temperature, following doctor’s orders, medical rounds, diagnostic and treatment procedures, eating, resting, walking, cleaning and ventilating the premises, day and night sleep (Table 1.1).

Table 1.1.

Daily routine in the therapeutic department and responsibilities

nurse

Watch	Daily routine events	Responsibilities of a nurse
		Turns on the lights in the rooms
	Thermometry	Distributes thermometers and ensures that temperatures are measured correctly; The thermometry results are recorded on a temperature sheet.
	Morning toilet of patients	Helps seriously ill patients carry out hygienic procedures (skin care, treatment of the mouth, eyes, nose, washing, combing; making the bed), sends biological material (urine, feces, sputum) to the laboratory
	Taking medications
	Medical rounds	Takes part in rounds, writes down doctor's orders
	Fulfilling medical prescriptions	Performs medical appointments: makes injections, probing; prepares patients for examination, accompanies them to diagnostic rooms and to consulting doctors; looks after the seriously ill.
	Taking medications	Dispenses medications and monitors their intake
		Helps distribute food, feeds seriously ill people
	Daytime rest, sleep	Maintains order in the department and the condition of seriously ill patients
	Thermometry	Distributes thermometers and ensures that temperatures are measured correctly; The thermometry results are recorded in a temperature sheet

Continuation of Table 1.1

	Visiting sick relatives	Maintains order in the department, controls the contents of food parcels
	Taking medications	Dispenses medications and monitors their intake
		Helps distribute food, feeds seriously ill people
	Fulfilling medical prescriptions	Carry out medical appointments: give injections; puts enemas, mustard plasters, compresses; prepares patients for x-ray and endoscopic examination; looks after the seriously ill.
	Evening toilet	Washes the seriously ill, makes the bed, treats the oral cavity, toilets the nose and ears; ventilates the chambers
		Turns off the lights in the wards, covers the sick, keeps order in the wards. Makes rounds in the department every hour

In addition to observing the daily routine, the measures of the medical and protective regime include: proper sanitary condition in the department, a cozy atmosphere in the wards and corridors; medical personnel must be an example of cleanliness and neatness, always be smart, calm, restrained, patient and at the same time demanding in fulfilling all doctor’s orders; It is important to prevent negative emotions arising from the type of medical care items (dirty bandages, unwashed bedspread, etc.). You should not overdramatize the situation or show excessive concern for the patient. Often ineptly expressing their regrets or giving examples of severe consequences for such diseases instills anxiety and anxiety in patients. It is necessary to create peace of mind around the patient, a favorable emotional climate with an optimistic mood.

Sanitary and anti-epidemic regime – This is a complex of organizational, sanitary, hygienic and anti-epidemic measures that prevent the occurrence of nosocomial infections.

Sanitary and hygienic regime includes requirements for the sanitary condition of the territory on which the hospital is located, the internal equipment of the hospital, lighting, heating, ventilation and the sanitary condition of the hospital premises. The main elements of a set of measures that are aimed at ensuring a sanitary and hygienic regime in the hospital are disinfection, strict compliance with the requirements of asepsis, antiseptics and sterilization.

Ÿ regarding the source of infection (sick person or carrier);

Ÿ regarding persons who were in contact with the source of infection;

Ÿ relative to the external environment (disinfection).

Regarding the source of infection (sick person or carrier):

1.Early identification of the patient (active or when seeking medical help).

2.Early diagnosis (laboratory).

3.Reporting an infected patient to the sanitary-epidemiological station (emergency message F. 58, by phone).

4.Timely hospitalization (within 3 hours in the city and 6 hours in rural areas).

5.Sanitation upon admission to the hospital.

6.Making a final diagnosis and carrying out specific treatment.

7.Compliance with the sanitary and anti-epidemic regime in the hospital for infectious patients.

8.Compliance with the rules and deadlines for the discharge of convalescent drugs.

9.Dispensary observation.

10.Sanitary educational work among the population.

Regarding persons who have been in contact with the source of infection:

1.Early identification of contact persons (in the family, at work, in child care institutions).

2.Establishment of medical supervision (quarantine, observation).

3.Bacteriological, serological, biochemical research to identify the carrier or early diagnosis.

4.Sanitation for certain diseases.

5.Specific prevention (vaccination, seroprophylaxis, administration of γ-globulin, administration of bacteriophage).

6.Sanitary educational work.

Regarding the external environment - disinfection measures (see below).

In addition to the general treatment regimen, there are several types of individual regimens regulated by the general condition of the patient.

This includes stationary mode, having several varieties, namely :

strict bed rest prescribed to a patient with a serious illness (acute myocardial infarction, gastrointestinal bleeding, etc.), when even minor movements of the patient can lead to his death;

semi-bed rest is prescribed to a patient with a moderate disease (angina pectoris, heart failure), this patient can sit in bed and go to the bathroom.

Individual mode prescribed to debilitated patients who are slowly recovering from serious illnesses, they can be prescribed additional walks in the fresh air, additional nutrition, and physical therapy.

Some human diseases can greatly damage his physical condition and forever change the life of the patient and relatives. The most common disease after which a person becomes practically bedridden is. In second place in frequency are spinal injuries and oncology. At the same time, a person, due to his condition, cannot move independently, as well as provide independent support. Therefore, relatives or specially trained medical personnel become assistants who are ready to help a sick person at any moment.

Basic principles of caring for a bedridden patient

Aimed at timely assistance and providing all the necessary conditions for the life of a bedridden patient, no matter where the person is - in a hospital or at home. The person caring for the patient must understand what exactly needs to be done and how to correctly perform various manipulations for successful completion, as well as in order to prevent injury to himself or the bedridden patient.

Thus, caring for bedridden patients is built on two basic principles, without which it is simply impossible to achieve complete and comprehensive care.

It is important to understand that patient care is an addition to primary treatment and cannot in any way serve as a substitute. Only a complex of various manipulations and care, together with the main treatment, can alleviate the patient’s condition and improve his well-being.

Aids for complete care

It doesn’t matter where the person is – in a hospital or at home. You should always remember that he must have personal hygiene products (towels, cutlery and dishes, etc.). In addition, full care for bedridden patients at home is possible with the help of special tools and devices that are designed specifically for the care of such patients. You can purchase them in specialized medical equipment stores, and also receive complete instructions for proper use.

• Multifunctional bed. It often has a control panel, with which you can easily change the tilt of the bed, raise the backrest at the head and at the feet. This greatly facilitates heavy physical labor when changing the position of the patient’s body. Using such a bed, you can bring the patient into a semi-sitting position for eating. There are also beds with a compartment for when there is no need to lift a person and put him on (if he cannot do it himself). You just need to remove a few spare parts and you have access to the container in which the feces are collected.

• Rollers . They are necessary to give a physiological position to the body if the patient cannot move independently. When lying on the side, there must be a cushion behind the patient’s back that will allow the person to relax and not fall back onto his back. Also, rollers are used to reduce the pressure on the heels - when placed under the shin, and when a special round roller is placed under the head - the likelihood of development on the back of the head is reduced. Thus, the likelihood of developing bedsores and the number of complications when caring for bedridden patients is reduced.

• Inflatable rubber ring . Used when lying on your back to reduce the pressure of your own weight in the area. This allows you to avoid the formation of bedsores, since this area is most often subject to complications such as bedsores and. it should be wrapped in a cloth or placed under a sheet, while inflating it halfway, otherwise the pelvic area will be much higher than the level of the body and the patient will be uncomfortable.

• Disposable wipes . These are special for caring for bedridden patients. They are impregnated with a variety of substances that disinfect, moisturize, and cleanse the skin. Since a common occurrence in such patients is decreased immunity, wipes can reduce the amount of pathogenic microflora on human skin. It promotes infection of the slightest skin lesions and causes complications that greatly worsen the patient’s condition.

• Mattress . Complete care for bedridden patients is achieved with the help of a special one. It performs a function. At the same time, it increases blood circulation and reduces pressure on vulnerable areas of the body, since with the help of special cells it inflates and deflates in a certain order. It has been established that these reduce the risk of bedsores by 45% in patients who are forced to lie down for a long time.

Contacting a medical facility

If a person is outside a medical facility and caring for a bedridden patient is carried out at home, it is important to monitor his condition and know when to seek help in order to prevent more serious violations of the patient’s condition. Usually, after discharge from the hospital, doctors give recommendations on caring for bedridden patients and inform them about which symptoms or health conditions require contact with doctors, and which can be treated independently.

When bedsores or bedsores appear, you should first call a therapist to your home so that he can examine the patient and explain which medications should be used for treatment. If the wound enlarges, deepens, or others appear, you should definitely seek help, since in stages 3 and 4 the patient must be hospitalized in order to excise dead tissue. , wheezing in the lungs, changes in the patient’s consciousness - all these conditions require immediate attention to a medical facility.

In any case, periodic scheduled examinations are necessary and should not be done by the patient on their own, as this can lead to a deterioration in well-being.

Rules for caring for a bedridden patient

To ensure proper and complete care for the patient, it is necessary to take into account that there are various rules that make it possible to provide the patient with maximum physiological and psychological comfort, and also, thanks to these rules, to reduce the number of complications and make patient care easier for medical personnel or relatives.

1. Room. It should be cozy, spacious and well lit. It is necessary to ensure that the patient is as comfortable as possible. Avoid loud noise in or around the room. If the patient likes, for example, watching TV or listening to the radio, provide the bedridden patient with his favorite activities. The room should be well ventilated, since the influx of fresh air will replace a short walk and ventilate the room, which is also important - air circulation is necessary in a confined space.

1. Warm. The room should not be hot so that the patient does not sweat and also do not allow the temperature to drop significantly. Hang a thermometer in the room. The most optimal room temperature should be no more than 18-22 degrees. In winter, when ventilating the room, you need to cover the patient with a blanket and prevent the patient from freezing. If the air is too dry, humidify it by placing a vessel with clean water near the radiator or heater, and if it is too humid, ventilate it.
2. Change of bed linen. When feeding the patient, you should be careful to prevent crumbs from getting on the bed linen and change it in time if, for example, the patient has an uncontrolled act. According to the rules of epidemiology, care for bedridden patients involves changing bed linen as it gets dirty, but not less than once every 48 hours. If the patient has bedsores, repositioning must be done every day, as pathological microorganisms accumulate in the linen.

1. Transportation . If the patient needs to be transported to any other room or institution, it is important to take into account that all movements must be smooth and careful, since a strong bump or jolt can cause the patient to become very frightened, which will lead to a disturbance in the psycho-emotional state. For transportation, both individual and specialized means of transportation are used - chairs - gurneys and ordinary recumbent gurneys specially designed for bedridden patients.
2. Furniture arrangement. If the patient can move independently and is able to serve himself with any needs, it is very important to arrange the furniture in such a way that the patient can take the items he needs without effort. In addition, caring for bedridden patients at home will be much easier and more productive if the bed can be approached from all sides.

1. Compliance with the regime. There are 4 bed rests, which are prescribed for various diseases: from strict bed rest to minor motor restrictions. In addition, it is important to maintain a daily routine in which you need to be awake during the day and sleep at night. this allows family members to relax, while the patient does not feel lonely or abandoned.
   Types of bed rest and the amount of allowed physical activity of the patient:

Strict bed rest	Bed rest	Semi-bed rest (ward)	General bed rest
Complete restriction of mobility, which implies that the patient is strictly forbidden to leave the bed, sit or stand up. It is allowed to turn on one side and raise the head end of the bed so that the patient can assume a semi-sitting position.	The patient is allowed to sit up on the bed independently and use the bedside toilet. Walking and standing are not allowed. It is possible to perform light exercises within the bed (lying down).	Motor activity is limited in quantity, that is, standing and walking are possible, but not for a long time. It is prohibited to go outside, as well as to perform intense physical activity, but you can do light exercises, both within the bed and near it.	A person’s physical activity is practically not limited; it is allowed to walk in the fresh air, walk and do physical exercises.

1. Leisure organization . Here, depending on the motor activity of the bedridden patient and his interests, you can come up with a large number of different activities in which the patient will find it interesting and fun.

Nutrition

If the patient cannot feed himself, he should be helped. To do this, you need to raise the head end of the bed or place it under the back of the bedridden patient so that he is in a semi-sitting position. Feeding the patient when he is in a supine position is strictly prohibited! You should measure the temperature of the food first to ensure it is warm enough.

In case of swallowing disorders, when there is a high risk of choking, food should be given in small portions, carefully and slowly. Do not rush the patient, otherwise there may be unpleasant consequences. Also, do not overfeed the patient, clarify and ask. Otherwise, a full stomach may lead to vomiting.

For some diseases, a special diet is prescribed, in which the patient needs to be fed small portions throughout the day. Often patients do not feel hungry and refuse to eat. You should not indulge them - it is important to follow the doctor’s orders.

Hygienic care

Maintaining hygiene is important for all people, and especially for bedridden patients, since with a decrease in immunity, various diseases associated with insufficient hygiene quite often occur. For example, patients need to brush their teeth every day and rinse their mouths with special disinfectant solutions after any meal.

After each act of defecation, care should be taken to avoid the accumulation of microflora, which has a positive effect on the formation of bedsores. The best thing is to lay the person down and wash him away. This is the most effective way to keep your intimate area clean. Every day you need to wipe the body with damp rags or disposable ones, while using additional products for hygienic care for bedridden patients (foams, lotions, creams). If a person has, the frequency of rubbing should be increased, since sweat is a breeding ground for microorganisms living on the skin.

Washing your hair in bed should be done at least once every 4 days or whenever it gets dirty. It is enough to pull the person to the very top so that his head is outside the bed. For this manipulation, two people will be needed - one will hold the head, and the other. In this case, you need to place an empty basin under the patient’s head, and prepare soap supplies and a second basin with warm water in advance.

Maintaining hygiene for a bedridden patient will allow him to feel comfortable and reduce the number of complications in the future.

Turns and position of the patient in bed

If the patient is completely or partially immobilized and cannot independently change the position of the body, then this should be done for him. Turning is one of the mandatory conditions for caring for bedridden patients. Changing body position allows you to improve blood circulation and provide tissue nutrition with useful substances, and will also reduce the likelihood of formation, bedsores and contractures. Turns should be carried out daily, every 2-2.5 hours - no less. If the patient has serious tissue nutritional disorders due to the disease, the frequency of turns should be increased.

The patient must be turned carefully to prevent injury. If the bed has restrictive sides, they should be raised to prevent the patient from falling out of the bed. When turning, you do not need to take a person by the arm and leg - the correct position of the hands will be on the patient’s shoulder and thigh. Thus, the person who turns the patient will reduce the load on his back and will prevent the patient from dislocating the limb.

To fix a person in one position, they are used. In the lateral position, the bolsters should be behind the patient's back, between the knees and under the upper arm. Thus, those places that are most susceptible will be ventilated, and the flow of fresh air will prevent the formation of complications. Every time a person is turned on his side, the patient's back should be treated with camphor alcohol or any other substance with a similar irritant effect. Rubbing and patting will increase blood flow to these places and improve blood circulation.

Complications when caring for a bedridden patient

Caring for a patient at home does not exclude the formation of complications that can worsen the patient’s condition and even threaten his life. The most common complication in people who are forced to stay in bed for a long time is bedsores. They arise due to insufficient hygiene and a person staying in one body position for a long time. This can be avoided if you follow all the care conditions that are designed specifically for bedridden patients at home.

The second most likely complication is falling out of bed or injuring patients. Compliance with safety measures, such as handrails near the bed and performing similar manipulations together will prevent this from happening. At night, the patient should not be left alone, as he can try to sit down and even stand up on his own. Due to lack of strength and lying in bed for a long time, patients fall to the floor, receiving various injuries. To avoid this, it is enough to observe a sleep-wake schedule in which the patient, if he has not slept all day, will not make any movements alone at night.

The formation of contractures is inevitable if care for sick people is not fully carried out. When the body position changes, the joints begin to move, and if the patient is positioned correctly (with the help of pillows and bolsters), then the joints are in a physiological position and cannot lose mobility. For example, when lying on your back, a person’s feet should be at an angle of 90 degrees, and their arms should be placed on pillows so that they are slightly higher than body level. Kneading the limbs (passive flexion and extension of all joints) can completely eliminate the formation of contractures.

It is also a fairly common complication when caring for bedridden people. With the formation of drafts, hypothermia, and rare changes in body position, congestion in the pulmonary circulation inevitably leads to this disease. This can be avoided if you follow all the rules for caring for the patient and use additional measures to prevent education. Such measures include breathing exercises (inflating balloons), the use of camphor alcohol after each turn of the patient.

Psychological comfort of the patient and relatives

The very condition when a person becomes recumbent and practically bedridden has a negative effect not only on the patient himself, but also on his relatives. In such a situation, the main thing is to understand that recovery is possible and to let the patient understand that he is not alone. Support and care, communication and contact with a person are certainly important and play a major role. Caring for bedridden patients is not only physical work; creating a comfortable psychological atmosphere between the patient and family is also important.

Daily schedule for a bedridden patient

Time	Action
9.00 – 10.00	Morning toilet, breakfast, room ventilation
10.00 – 11.00	Charger,
11.00 – 13.00	Leisure activities: watching TV, reading books, board games, etc.
13.00 – 15.00	Lunch, hygiene measures after eating
15.00 – 17.00	Rest, sleep
17.00 – 18.00	Afternoon snack, room ventilation
18.00 – 21.00	Leisure and communication with relatives, dinner
21.00 – 23.00	Hygiene procedures, change of bed linen, lights out

If the family decides not to use the services of nurses or medical personnel, it will be useful to rotate each other so that the person does not consider himself a burden. And it is important to remember that if a person can do at least something on his own, give it to him. Motivate for even bigger “small victories” and seemingly insignificant achievements. For a sick person, this is significant progress and a correct, positive reaction will only strengthen the will to recover and will have a positive effect on the psychological state of the patient.

The emergence of conflict situations between a sick person and relatives only aggravates psychological comfort. If you cannot solve the problem on your own, you should contact a psychologist who will help you cope with this and resolve the conflict. Caring for bedridden patients is a difficult task that will require support, communication and understanding from the family, which will help maintain strong family relationships.

Video

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To care for seriously ill patients, an individual post can be organized both in a hospital and at home. Once on duty, a nurse or paramedic is constantly at the patient’s bedside, caring for him.

While on duty, the nurse constantly keeps a detailed hourly record of all appointments completed, and also records complaints, pulse, respiration, body temperature, blood pressure, amount of sputum, urine, meal times, and the presence of stool. The nurse monitors the patient’s personal hygiene, changes underwear and bed linen if necessary, prevents bedsores, feeds and waters. If the patient has not had a bowel movement for 2 days, she gives a cleansing enema; If he does not urinate on his own, he releases urine with a catheter 1-2 times a day.

The bed of a geriatric patient should be at least 60 cm and have devices for transferring the person to a sitting position. For seriously ill patients who need to elevate the upper body, a headrest is used, as well as a leg rest so that the patient maintains the position that was given to him. The blanket should be light but warm. To prevent bedsores in bedridden patients, the elasticity of the mattress is of great importance. It should be flexible enough to support the entire body without putting pressure on specific areas.

To prevent bedsores and diaper rash, especially in patients with urinary and fecal incontinence, be sure to wash the patients and treat the natural folds of the skin. This manipulation should also be performed correctly, since if the procedure is performed incorrectly, an infection can be introduced from the anus to the genitourinary system.

Hair is washed with warm water and soap and carefully combed, nails are systematically trimmed. In patients who are on bed rest for a long time, thick keratinized layers sometimes form on the plantar side of the feet. They are removed while washing the feet using pumice, and sometimes special exfoliating ointments as prescribed by the doctor.

Careful oral care is necessary. Use a toothbrush to clean your teeth and the back of your tongue at least twice a day; After every meal, the patient should rinse his mouth. For seriously ill patients, their teeth are wiped with a cotton ball soaked in a 0.5% solution of baking soda or a slightly pink solution of potassium permanganate. The oral cavity is washed using a rubber balloon or sippy cup with weak solutions of baking soda, borax, and potassium permanganate. To do this, the patient is placed in a position with his head slightly tilted forward so that the liquid drains more easily and does not enter the respiratory tract, while the corner of the mouth is pulled back for better outflow.

Wash your ears regularly with warm water and soap. Earwax is carefully removed from the ear canal using a cotton swab, after dropping a few drops of a 3% hydrogen peroxide solution into the external ear canal. In this case, the head is tilted in the opposite direction, and the auricle is slightly pulled back and up. You should not remove wax from your ears with a match, hairpin, or similar objects, because... in this case, you can accidentally damage the eardrum, as well as the external auditory canal, which can cause external otitis.

In case of discharge from the eyes, sticking together the eyelashes and eyelids (more common in children), during the morning toilet, carefully rinse the eyes with warm water using a cotton swab. In case of nasal discharge and the formation of crusts, they are removed after softening them, for which Vaseline oil or glycerin is instilled into the nose; The nose is carefully cleaned with a cotton wick.

The bedpan is served to the patient clean and disinfected. Before use, pour a little water into it. The vessel is placed under the buttocks, placing the free hand under the sacrum and lifting the patient so that the perineum is above the opening of the vessel. The feces should be drained immediately, the vessel should be thoroughly washed with hot water and disinfected with a 3% solution of Lysol or chloramine. After defecation, the perineum and skin folds around the anus are toileted.

The urine bag is served well washed and warm. After each urination, the urine is poured out, the urinal is washed with a solution of potassium permanganate or soda. Women use a pan when urinating.

The basic principles of nutrition are the correct ratio of proteins, carbohydrates, fats, mineral salts, vitamins, a rational regimen. Food is taken at 34-hour intervals at the same hours. Excessive nutrition should be avoided. It is irrational to feed seriously ill patients with delicacies and foods containing fat. For many diseases, the doctor prescribes a special diet or recommends an individual diet, methods of cooking food.

A gentle diet (exclusion of irritants: chemical spices, mechanical rich and solid foods, thermal very hot or cold foods) is prescribed, first of all, for diseases of the digestive system, kidneys, heart and blood vessels, obesity, diabetes. For a number of diseases, fractional meals (frequent, small portions) are recommended. However, for each disease, the attending physician establishes an individual diet, which caregivers should know well.

Bedridden, weakened and feverish patients should be fed only freshly prepared food. Seriously ill patients are given food during hours when their condition improves. Mashed or crushed food from a spoon in small portions, and drinks and liquid food (broth, jelly, pureed soup) from a sippy cup. The patient's daytime sleep should not be interrupted for food.

Proper general care for a patient is one of the most important factors influencing his speedy recovery. By carrying out a set of measures aimed at restoring and maintaining the patient’s strength, it is possible to prevent possible complications and quickly return him to a full life. The general care of patients in the therapy clinic is carried out by nurses who provide both physical and psychosocial support. That is why the concept of “general care” is synonymous with the concept of “nursing”.

Fundamentals of General Nursing

The difficulty of care is that each patient is individual, he has his own habits and character. Sometimes the patient is not able to think clearly and be aware of his actions and actions. This necessitates the need for the caregiver to have skills such as patience, vigilance, compassion, and the ability to think clearly in an unusual situation.

General therapeutic nursing is necessary for all patients, regardless of the type of their disease. As a rule, this concerns the satisfaction of the natural needs of the body: the patient needs food, drink, and personal hygiene. It is very important to help the patient become active. A light workout in bed or a short walk will have a positive effect on both a person’s physical and mental health. The conditions in which the patient stays are no less important: silence, clean linen, respect for oneself and one’s needs.

Basic Rules

There are several general rules for caring for patients. More on them later.

First of all, the care provided to the patient should depend on the instructions of the attending physician. The patient may be unable to get out of bed, or may not have significant limitations in movement. This or that regimen prescribed by the doctor determines the amount of care required. Nevertheless, it is necessary even for those who are able to take care of themselves.

Ideally, patients should be in a bright room, isolated from noise, with a flow of fresh air. Even such basic amenities as a comfortable temperature, silence, plenty of light and clean air have a beneficial effect on the body, regardless of the type of disease.

Cleanliness is the key to health. The room in which the patient is located should be cleaned at least twice a day to avoid dust accumulation. The patient's bed linen and underwear must also be kept clean. It must be changed so as not to create unnecessary pain and stress for the patient.

Washing is necessary every morning and evening. If there are no restrictions from the doctor, then the patient is allowed to wash in the shower or bath. Bedridden patients should be wiped daily with damp swabs, paying special attention to places where diaper rash often occurs: armpits, groin, skin folds.

An organism depleted by disease needs a constant supply of nutrients. Proteins, fats, carbohydrates and vitamins must be supplied in balanced quantities at the same time, since it is necessary to follow a diet. Many diseases require a special diet or special diet prescribed by a doctor.

Another important rule is monitoring the patient’s condition. The doctor must be aware of the changes occurring with the patient: well-being, activity, psycho-emotional state, color of natural discharge. Timely identification of deviations will allow them to be eliminated faster, preventing the development of complications.

Psychological help

Another general principle of caring for a sick person requires knowledge not only in medicine, but also in psychology: illness is stress, and people tolerate it differently, sometimes becoming capricious and irritable or withdrawn and unsociable. The emotional state plays a significant role in the recovery process, so caregivers must adhere to medical ethics - respect for the patient, interest in a speedy recovery. A properly structured dialogue and a good attitude will help set the patient in a positive mood.

What is a hospital?

Patient care is provided in a hospital setting. A hospital is a medical institution in which patients stay for a long time; it has all the necessary conditions for this.

Types of hospitals

Typically, the following types of hospitals are distinguished:

• daytime - allow you to perform procedures that cannot be performed at home, but at the same time do not require long-term hospitalization;
• round-the-clock - necessary for treatment under the constant supervision of doctors;
• surgical - intended for the recovery of patients after surgery;
• at home - created at inpatient medical institutions, whose doctors provide all necessary medical care to a patient at home.

Hospital profiles

Hospitals also differ in profile depending on what diseases they specialize in treating. This determines the level of qualifications of doctors and medical personnel, the equipment of the medical institution with everything necessary to perform its task. By profile, in a broad sense, hospitals are of two types:

• multidisciplinary - work with various types of diseases;
• single-profile or specialized - engaged in the treatment and rehabilitation of patients with a certain pathology.

What types of treatment departments are there?

Each medical institution according to its structure is divided into departments, among which the main one is medical. Medical departments also differ in profile: general and specialized. General departments usually provide therapeutic and surgical care, while specialized departments work with diseases of a specific body system. In addition, there are reception and diagnostic departments and a laboratory.

General and specialized care - application algorithms

Not only do inpatient medical institutions differ in their specialization, but also the types of care they provide. In addition to general patient care, there is also specialized care intended for patients with a specific disease. If the first is designed to create comfortable conditions and ensure vital processes, then the second is aimed directly at treating the disease. Health care workers caring for a patient must have a wide range of skills and knowledge necessary for the rehabilitation of the person in their care.

Patient care is carried out according to a clear algorithm. First of all, a health condition is diagnosed, and then the caregiver determines what needs the ward is unable to satisfy on his own, and what the degree of these difficulties is. Based on this, the patient’s response to his illness and condition is identified, and a so-called “nursing diagnosis” is made, which includes a list of the patient’s existing and potential physiological and psychological problems associated with the disease.

The next stage is planning - a goal and care plan are formed for each problem. Within the limits of their strength and competence, medical personnel set realistic and achievable goals for the short or long term. They must be accessible to the patient to understand, presented in simple language without complex terms. Throughout the entire time spent in the hospital, care is provided and specialized procedures necessary for recovery are performed. Due to the fact that the patient’s condition is changeable, it is important to monitor changes and make adjustments to the developed plan.

A correct diagnosis and prescribed treatment are only half the recovery. Compliance with doctor's orders, compliance with hygiene and nutrition standards, and a favorable emotional background play no less a role. The combination of general and specialized care will seriously speed up the process of recuperation of the patient’s strength and prevent possible complications.

Preface........................................................ ............................... 8

2.1. Main types of treatment and preventive institutions and principles of their work..................................... 19

2.2. Organization of work in a hospital (hospital) 21

2.2.1. Organization of the work of the reception department 21

2.2.2. Sanitary treatment of patients ............... 23

2.2.3. Transportation of patients...................... 26

2.2.4. Organization of the work of the therapeutic department................................................... ......... 27

2.2.5. The sanitary regime of the hospital and its significance.................................................... ................ 31

Test tasks.............................................. ......... ................................................... 35

A. M. Khokhlov, S. M. Muravyov................................. 234

17.1. Definition of the concept of “acute abdomen”...... 234

17.2. Observation and care of patients with acute inflammatory diseases of the abdominal organs at the diagnostic stage 236

17.3. Observation and care of patients after surgical interventions on the abdominal organs.................................................... ........................ 238

Test tasks......................................................... 241

A.M. Khokhlov,A. S. Sukhoverov...................................................................................... 242

18.1. Caring for patients with bone fractures....... 243

18.2. Caring for patients with skull injuries 249

18.3. Care for patients with closed soft tissue injuries.................................................... 251

Test tasks........................................ ... ........................................................ .......... 252

Chapter 19. Caring for dying patients. Resuscitation measures and first aid for some emergency conditions........ 253

19.1. The process of dying, its periods................... 253

19.2. Intensive care units and principles of their work.................................................................... .................... 255

19.3. Artificial respiration and indirect cardiac massage.................................................. ........................... 258

19.4. Resuscitation measures and first aid for poisoning.................................................... 262

19.5. Resuscitation measures and first aid in case of drowning.................................................... 267

19.6. Resuscitation measures and first aid for heatstroke, sunstroke, electrical injury.................................................... ............ 268

19.7. First aid and patient care for radiation injury.................................................. 271

19.8. Ascertainment of death and rules for handling a corpse.................................................... ............... 272

Test tasks......................................................... 273

Answers to test problems.................................................................. .......... 277

Application................................................. ................................... 279

Subject index................................................ ................. 283

In loving memory

A. L. Grebeneva

dedicated to

PREFACE

After including the academic discipline “General Patient Care” in the training program for students of medical institutes, A.L. Grebenev and A.A. Sheptulin prepared a textbook “Fundamentals of General Patient Care,” which was published in 1990. The manual sold out very quickly and received positive feedback from teachers and students. However, the authors, being therapists, considered in this publication mainly general issues and various aspects of caring for patients with a therapeutic profile. There was no special teaching aid on caring for surgical patients for students of medical institutes, which could not but complicate the teaching of this subject.

In its present form, the manual “Basics of General Nursing” has been significantly expanded and revised compared to the previous edition. It covered such important issues as asepsis in the work of the surgical department, operating unit, manipulation room and dressing rooms, observation and care of patients in the preoperative and postoperative periods (postoperative wounds, condition of the respiratory, cardiovascular , digestive and urinary systems), observation and care of patients with acute surgical diseases of the abdominal organs at the diagnostic stage and after surgical interventions, care of patients with bone fractures, skull injuries, closed soft tissue injuries.

Other chapters of the manual have also undergone significant revision. They include information regarding modern methods of instrumental diagnostics (daily monitoring of blood pressure, intragastric pH, etc.), and the necessary clarifications and additions are made taking into account new medications and treatment methods that have appeared in the doctor’s arsenal.

The joint work of employees of the departments of propaedeutics of internal diseases and general surgery of the I.M. Sechenov Moscow Medical Academy on improving the manual and its addition, which began during the life of A.L. Grebenev, was completed after his untimely death. The new edition of the manual is a tribute to the blessed memory of this wonderful man.

Head of the Department of Propaedeutics of Internal Diseases MM A named after. I.M.Sechenova Academician of the Russian Academy of Medical Sciences V.T.IVASHKIN

Head of the departmentGeneral surgery MML them. I. M. Sechenova Academician of the Russian Academy of Medical Sciences V.K. GOSTISHCHEV

The authors hope that in the context of constant improvement of diagnostic and therapeutic methods, the expanded and updated edition of the manual will help students of medical universities better master the difficult skills of caring for patients of various profiles, and will gratefully accept all comments and suggestions aimed at improving it .

GENERAL NURSING ISSUES

Nursing and its importance

In everyday life, nursing (compare - to look after, take care) is usually understood as providing assistance to a patient in meeting his various needs. These include eating, drinking, washing, moving, and emptying the bowels and bladder. Care also implies creating optimal conditions for the patient to stay in a hospital or at home - peace and quiet, a comfortable and clean bed, fresh underwear and bed linen, etc. This level of care is usually provided by junior medical personnel, as well as the patient’s relatives.

In medicine, the concept of “patient care” is interpreted more broadly. Here it stands out as an independent discipline and represents a whole system of measures, including the correct and timely implementation of various medical prescriptions (for example, administering medications by injection, placing cups, mustard plasters, etc.), carrying out some diagnostic manipulations (collection of urine, feces, sputum for analysis, gastric and duodenal probing, etc.), preparation for certain studies (x-ray, endoscopic, etc.), monitoring the patient’s condition (including respiratory systems, blood - addresses), providing first aid to the patient (gastric lavage, assistance with fainting, vomiting, coughing, suffocation, gastrointestinal bleeding, artificial respiration and chest compressions, etc.), maintaining the necessary medical documentation. Many of these procedures are performed by nurses, and some (for example, intravenous injections, bladder catheterization) by doctors.

This chapter only addresses issues general patient care, carried out regardless of the nature of the disease. Peculiarities special care(for example, for newborn children, for surgical, dental patients, etc.) are studied in the appropriate courses.

Abroad, the concept of “patient care” corresponds to the term “nursing”, which is defined by the International Council of Sisters as a system of measures to assist the patient in performing all types of activities related to the restoration of health. In addition, the concept of “nursing process” is often used to characterize patient care activities abroad. According to the definition contained in the documents of the WHO Regional Office for Europe (1987), “the content of nursing consists of caring for people, and the way in which this care is carried out represents the essence of the nursing process.”

The importance of nursing cannot be overstated. Often, the success of treatment and the prognosis of the disease are entirely determined by the quality of care. Thus, it is possible to flawlessly perform a complex operation, achieve significant restoration of damaged motor functions of the limbs after suffering a cerebrovascular accident or complete fusion of bone fragments after a severe fracture, but then lose the patient due to the progression of congestive inflammatory phenomena in the lungs that have arisen as a result of his long-term forced immobility in bed, due to bedsores formed as a result of poor care.