Personal hygiene of a seriously ill patient. Personal hygiene of seriously ill patients
B larger The environment in which the patient is located plays a role in the course and outcome of diseases. First of all, this is compliance with the rules of personal hygiene and hygiene in the ward, ensuring timely and proper nutrition of the patient. In creating favorable conditions in the ward, the main role is given to middle and junior medical personnel. Compliance with the rules of personal hygiene, keeping the bed and room clean are necessary for effective treatment. F. Nightingale wrote: “...What, exactly, is meant by hygienic conditions? In essence, there are very few of them: light, warmth, clean air, healthy food, harmless drinking water, cleanliness...". That is why observing the rules of personal hygiene, keeping the bed and room clean are necessary for effective treatment.
The patient's position in bed should be comfortable, the bed linen should be clean, the mattress should be flat; If the bed has a net, it should be taut. For seriously ill patients and patients with urinary and fecal incontinence, an oilcloth is placed on the mattress pad under the sheet. For women with heavy discharge, a diaper is placed on an oilcloth, which is changed as it gets dirty, but at least 2 times a week. Seriously ill patients are placed on functional beds and headrests are used. The patient is given two pillows and a blanket with a duvet cover. The bed is made regularly before bed and after sleep. Underwear and bed linen are changed at least once a week after taking a bath, as well as in case of accidental contamination.
Rules for changing clothes
The first way to change bed linen(Figure 6-1)
1. Roll the dirty sheet into a roll in the direction from the head and foot ends
bed to lumbar region sick.
2. Carefully lift the patient and remove the dirty sheet.
3. Place a clean sheet rolled up in the same way under the patient’s lower back and straighten it.
Rice. 6-2. Change of bed linen at heavy ballroom (second method).
The second way to change bed linen(Fig. 6-2)
1. Move the patient to the edge of the bed.
2. Roll up the free part of the dirty sheet with a roller from the edge of the bed towards the patient.
3. Spread a clean sheet over the vacant space, half of which remains rolled up.
4. Move the patient onto the spread half of a clean sheet, remove the dirty sheet and straighten the clean one.
Change of underwear
2. Remove the shirt over the patient’s head (Fig. 6-3, A), and then from his hands (Fig. 6-3, b).
3. Put on the shirt in the reverse order: first put on the sleeves, then throw the shirt over the patient’s head and straighten it under his back.
4. Put a shirt on a patient who is on strict bed rest.
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Skin careand prevention of bedsores
The skin performs several functions: protective, analytical (skin sensitivity), regulatory (regulation of body temperature: heat loss through sweating in a healthy person is 20% of the total heat loss per day, and in febrile patients - much more), excretory. Water, urea, uric acid, sodium, potassium and other substances are released through the skin and its sweat glands. At rest at normal body temperature, about 1 liter of sweat is released per day, and in febrile patients - up to 10 liters or more.
When sweat evaporates, metabolic products remain on the skin, destroying the skin. Therefore, the skin must be clean, for which you should change your underwear more often, wipe the skin with cologne, water with 96% alcohol (1:1 ratio), disinfectant wipes or solutions (for example, 1 glass of water + 1 tbsp. vinegar + 1 tbsp camphor), wipe the skin with a dry, clean towel.
Particular attention should be paid to the condition of the skin of the groin area, armpits, and in women - the area under the mammary glands. The skin of the perineum requires daily washing. Seriously ill patients should be washed after each act of defecation, and in case of urinary and fecal incontinence - several times a day to avoid maceration and inflammation of the skin in the area of the inguinal and perineal folds. Women are washed more often.
Seriously ill patients may develop bedsores. Bedsore (lat. decubitus; syn. - decubital gangrene) - necrosis (necrosis) of soft tissues (skin involving subcutaneous tissue, the wall of a hollow organ or blood vessel, etc.), resulting from ischemia caused by prolonged continuous mechanical pressure on them. Bedsores appear most often on the sacrum, shoulder blades, heels, elbows from prolonged compression area of the skin and circulatory disorders in it (Fig. 6-4). First, redness and soreness appear, then the epidermis (surface layer of skin) peels off and blisters form. With deep bedsores, muscles, tendons, and periosteum are exposed. Necrosis and ulcers develop, sometimes penetrating to the bone. Infection penetrates through damaged skin, which leads to suppuration and blood poisoning (sepsis).
The appearance of bedsores is evidence of insufficient care for the patient!
If a localized area of skin redness appears, you should wipe it with a 10% camphor solution, a damp towel, and irradiate it 2 times a day. quartz lamp. If bedsores have formed, it is necessary to lubricate them with a 5% solution of potassium permanganate, apply a bandage with Vishnevsky ointment, syntomycin liniment, etc.
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The patient's position should be changed every 1.5-2 hours.
It is necessary to straighten the folds on the bed and linen.
You should wipe your skin with a disinfectant solution.
Wet or soiled linen should be changed immediately.
You should use backing rubber circles placed in a cover or covered with a diaper. The circle is placed in such a way that the place of the bedsore is located above the hole in the circle and does not touch the bed; also use special air mattress with corrugated surface.
It is necessary to wash and wash patients in a timely manner.
Currently, to prevent bedsores, a so-called anti-bedsore system has been developed, which is a specially designed mattress. Thanks to the automatic compressor, the mattress cells are filled with air every 5-10 minutes, as a result of which the degree of compression of the patient’s tissues changes. Massage of tissues by changing the pressure on the surface of the patient’s body maintains normal blood microcirculation in them, ensuring the supply of skin and subcutaneous tissue nutrients and oxygen.
Use of vessels and urinals
For patients on strict bed rest, if it is necessary to have a bowel movement, they are given a bedpan, and if they need to urinate, they are given a urinal (women usually use a bedpan when urinating, and men - a so-called duck). Vessels are made of metal with enamel coating, plastic and rubber. A rubber bed is used in weakened patients, as well as in the presence of bedsores, fecal and urinary incontinence.
Before giving a urine bag to the patient, the latter must be rinsed with warm water. After urination, having poured out its contents, the urinal is rinsed again with warm water.
Washing the sick (women)
Necessary equipment: a jug with a warm (30-35 °C) weak solution of potassium permanganate (antiseptic) or water, a forceps, a napkin, an oilcloth, a vessel, gloves (Fig. 6-5). Procedure:
1. Help the patient lie on her back; your legs should be slightly bent at the knees and spread apart.
2. Lay down an oilcloth and place a bedpan on it, placing it under the patient’s buttocks.
3. Stand to the right of the patient and, holding a jug in your left hand, and a forceps with a napkin in your right, pour an antiseptic solution onto the genitals, and wipe them with a napkin, making movements in the direction from the genitals to anus, i.e. top down.
4. Dry the skin of the perineum with a dry cloth in the same direction.
5. Remove the vessel and oilcloth.
Vessel delivery
Necessary equipment: vessel, oilcloth, screen, disinfectant solution. If a seriously ill patient has an urge to defecate or urinate, the following is necessary (Fig. 6-6):
1. Separate him with a screen from those around him, place him under the patient’s pelvis next to the leonka.
2. Rinse the vessel with warm water, leaving a little water in it.
3. Place your left hand under the patient’s sacrum from the side, helping him raise the pelvic area (while his legs should be bent at the knees).
4. With your right hand, move the vessel under the patient’s buttocks so that the perineum is above the opening of the vessel.
5. Cover the patient with a blanket and leave him alone for a while.
6. Pour the contents of the vessel into the toilet, rinsing the vessel hot water.
7. Wash the patient, dry the perineum, remove the oilcloth.
8. Disinfect the vessel with a disinfectant solution.
Oral care
Every person needs to follow basic rules of oral care:
Rinse your mouth with water after every meal;
Brush your teeth at night and in the morning, since during the night the surface of the mucous membrane of the mouth and teeth is covered with a soft coating consisting of epithelial cells, mucus and microorganisms. In patients, plaque formation accelerates, as metabolic products begin to be released through the oral mucosa: nitrogenous substances in renal failure, glucose in diabetes mellitus, mercury in mercury poisoning, etc. These substances contaminate the mucous membrane and often lead to intensive proliferation of microorganisms. Oral care for seriously ill patients should be more thorough; he is carried out by a nurse.
Oral examination
The patient opens his mouth. The nurse uses a spatula to pull back the patient’s lips and cheeks. When examining the palatine tonsils and back wall The throat is pressed with a spatula on the root of the tongue and the patient is asked to pronounce the sound “A-A-A”. When examining the oral cavity, tonsils and pharynx, enhanced lighting is necessary, for which you can use a reflector lamp.
Mouth rinse
After each meal, the patient is recommended to rinse his mouth with a 0.5% sodium bicarbonate solution (baking soda solution) or 0.9% sodium chloride solution (saline). After this, the tongue is wiped: a sterile gauze napkin is placed on the tip of the tongue, the tip of the tongue is pulled out of the mouth with the left hand, and with the right hand, using a damp cotton ball held in tweezers, the plaque is removed from the surface of the tongue and the tongue is lubricated with glycerin.
Oral rinsing
Rinsing the oral cavity is carried out using a syringe, a rubber balloon, an Esmarch mug with a rubber tube and a glass tip. Weak solutions are used: 0.5% sodium bicarbonate, 0.9% sodium chloride, 0.6% hydrogen peroxide, potassium permanganate (1:10,000), etc. The patient is seated or given a semi-sitting position with his head slightly tilted so that the liquid did not enter the respiratory tract. The neck and chest are covered with oilcloth, and a basin or tray is placed under the chin. The patient lying on his back should have his head turned; if possible, then the patient himself is turned on his side. The corner of the mouth is pulled back with a spatula and a stream of water under moderate pressure is used to wash first the vestibule of the oral cavity, and then the oral cavity itself. If a seriously ill patient has removable dentures, they should be removed (and washed) before the procedure.
Esmarch's mug is a special mug for enemas and douching. Proposed by the German physician Friedrich von Esmarch (1823-1908).
Personal hygiene- a branch of hygiene that studies the issues of preserving and strengthening human health by observing the hygienic regime of his life and activities. A patient treated in a hospital spends most of the time in bed, so an important condition bed comfort is essential for his well-being and recovery. Compliance with the rules of personal hygiene, keeping the room and bed clean create conditions for get well soon patients and prevent the development of many complications. Adequate care is the key to success in treating seriously ill patients. The more severe the patient’s condition, the more difficult it is to care for him, and the more difficult it is to perform any manipulations. It is necessary to clearly know the methods of manipulation and be able to perform them. All manipulations on the patient’s personal hygiene nurse must be performed with gloves. M/s helps the patient in meeting hygienic needs if it is impossible to fulfill them himself.
Independent nursing interventions:
personal hygiene procedures (change of bed and underwear, skin hygiene, morning toilet, etc.);
satisfaction physiological needs(feeding the patient, taking an adequate amount of fluid, etc.);
satisfaction of physiological functions (feeding of a vessel, urinal);
Dependent Nursing Interventions:
carrying out any manipulations as prescribed by a doctor (injections, dressings, distributing medications, physiotherapeutic procedures, administering enemas, administering urinary catheter and etc.).
Principles of patient care:
safety(preventing patient injury);
confidentiality(details of personal life should not be known
to outsiders);
respect for dignity(performing all procedures with the patient’s consent, ensuring privacy if necessary);
communication(disposition of the patient and his family members to talk, discussion
progress of the upcoming procedure and care plan in general);
independence(encouraging each patient to become independent);
infection safety(implementation of relevant activities).
The patient's personal hygiene includes daily morning and evening body care. It includes a set of measures to care for the face, perineum and entire body.
Caring for the eyes of seriously ill patients.
Target. Prevention purulent diseases eye.
Equipment. Sterile kidney-shaped tray with 8-10 sterile cotton balls; kidney-shaped tray for used balls; two sterile gauze pads; 0.02% solution of furatsilin (in the presence of purulent discharge from the eyes).
Ask the patient to close his eyes and rub one eye with a ball in the direction from the outer corner of the eye to the inner. The procedure is repeated with the other eye. To avoid transfer of infection from one eye to another, different balls and wipes are used for each eye.
Carebehindnoseseriously ill.
Target. Cleansing the nasal passages of mucus and crusts.
Equipment. Cotton wool, Vaseline or other liquid oil: sunflower, olive, or glycerin; two kidney-shaped trays: for clean and used turundas.
Turunda is inserted into the lower nasal passage with rotational movements and leave for 1-2 minutes, then remove with rotational movements, freeing the nasal passage from crusts. Repeat the procedure with the second nasal passage.
Caring for the ears of a seriously ill patient.
Target. Cleansing the auricle and ear canal.
Equipment. Two kidney-shaped trays - for clean and used material; sterile cotton wool (wicks); 3% hydrogen peroxide solution; dampened napkin warm water; towel.
Nurse bridges hands with soap. The cotton wool is moistened with a 3% solution of hydrogen peroxide, poured from a bottle above the tray for used material. The patient's head is turned to the side. With the left hand they pull back auricle up and back, and with the right hand, with a rotational movement, insert the turunda into the external auditory canal and, continuing to rotate, cleanse it of sulfur secretions. Repeat the procedure with the other ear.The algorithm will be studied in more detail during a practical lesson.
Instead of hydrogen peroxide, you can use petroleum jelly. It is strictly forbidden to use sharp objects (probes, matches) to clean the ear canal to avoid injury to the eardrum. During education sulfur plugs they are removed by ENT specialists.
Care of the oral cavity, teeth, dentures.
In weakened and feverish patients, plaque appears on the oral mucosa and teeth, which consists of mucus, desquamated epithelial cells, decomposing and rotting food debris, and bacteria. This contributes to the occurrence of inflammatory and putrefactive processes in the oral cavity, accompanied by unpleasant smell. The discomfort associated with this leads to decreased appetite, worsening general well-being. Bacteria that form in the mouth destroy teeth, contributing to the development of caries (translated as caries). In addition, the resulting plaque causes inflammation of the gums and periodontitis, which contributes to the destruction of the neck of the teeth, their loosening and loss.
If the patient is conscious, but helpless, oral care consists of:
Rinse your mouth after every meal or after every bout of vomiting;
Brushing your teeth (dentures) in the evening and in the morning;
Cleaning the spaces between the teeth once a day (preferably in the evening).
To brush your teeth, it is better to use toothpaste containing fluoride, which strengthens tooth enamel and prevents the development of caries. The toothbrush should be soft and not injure the gums. The brush should be changed as it wears out, once every 3 months. A worn-out brush does not thoroughly clean your teeth. Floss should be used lightly to clean the spaces between teeth, as this can damage the gums and cause bleeding. When finishing your oral care, be sure to brush your tongue, removing plaque containing bacteria from it. Before brushing the teeth, the patient’s oral cavity must be mentally divided into 4 parts (in half the upper and lower jaws) and begin brushing from the upper one.
If the patient is unconscious, he is not only unable to brush his teeth, but also to swallow saliva, open and close his mouth. In such patients, oral care should be performed every 2 hours, day and night.
Hand and foot care.
Nail care must be carried out very carefully, otherwise this procedure can lead to injury to the skin around the nail bed and subsequent infection (felon). There is no need to cut the patient's nails to the very base, otherwise the skin may be damaged. Particular care must be taken when cutting the nails of patients suffering from diabetes and other ailments accompanied by skin sensitivity.
Diaper rash- inflammation of the skin in natural folds due to maceration and friction skin surfaces. Maceration is the softening and loosening of tissues in a humid, warm environment.
Areas of diaper rash formation: under the mammary glands, in the armpits, inguinal folds, between the toes.
Development of diaper rash: skin irritation - bright hyperemia of the skin - small erosions, weeping, ulceration of the skin (wetting - separation serous exudate through epidermal defects during inflammatory processes in the skin). Prevention of diaper rash: timely hygiene care skin care, treatment of sweating. After washing the skin with soap, it must be thoroughly dried and treated with a powder containing talc (only for dry skin).
Personal hygiene- this is keeping a person’s body (skin, hair, mouth, teeth), his bed and underwear, clothes, shoes, and home clean. Maintaining personal hygiene contributes to recovery, preservation and promotion of health.
Rules for preparing a patient's bed. To prepare the bed, you must have a set of linen and bedding, which includes a mattress, two feather or down pillows with pillowcases, a sheet, a blanket with a duvet cover and a towel. A hair or cotton mattress with a smooth and elastic surface is placed on the bed. Place clean and ironed pillowcases on the pillows. The sheets and pillowcases should be straightened so that there are no wrinkles.
Rules for changing bed and underwear. Linen is changed after the next sanitary treatment, usually once every 7-10 days. In seriously ill patients this is done with great caution. The patient is carefully moved to the edge of the bed. If his condition allows, then he is laid on his side, the free half of the dirty sheet is rolled across the width to the back, and a clean sheet is spread on the free space, half of which is rolled up accordingly. Rolls of clean and dirty sheets lie side by side. Then the patient is transferred to a clean half of the sheet, the dirty one is removed, the clean one is unrolled and the restoring is completed (Fig. 30, b).
If the patient is prohibited from moving in bed, then the sheets are changed in another way. First, the patient’s head is slightly raised, and the head end of the sheet is folded toward the lower back, then the legs are raised and the other end of the sheet is gathered toward the lower back in the same way, after which it is carefully removed from under the patient. At the same time, on the other side, a clean sheet, rolled along the length with two rollers, is brought under the lower back, and then carefully straightened on both sides - to the head and legs (Fig. 30, a).
When changing underwear, a certain sequence is important: the shirt is lifted up from the back, removed first from the head, and then from the arms; put it on in the reverse order - first put the arms through, then the head and straighten it out. In case of diseases or injuries of the limbs, the underwear is first removed from the healthy limb, and then from the sick one. Put the underwear on in the reverse order, that is, on the injured limb first.
Rules for caring for the patient's skin. When caring for a patient, it is important to ensure that their skin is clean. If the patient's condition is satisfactory, then he takes a shower or a general hygienic bath with the entire body immersed in water, with the exception of the upper chest, in a semi-sitting position. Bedridden patients are given local baths with immersion of only some part of the body, for example, arms or legs. The water temperature should be +37...38°C, the duration of the procedure is no more than 15 minutes. Seriously ill patients wipe their face daily with cotton wool soaked in warm water (temperature +36...37°C). The body is wiped with a sponge or towel moistened with warm water and toilet soap, in parts, one by one, in a certain sequence: neck, chest, arms, stomach, thighs, legs, rubbing the wetted areas with a dry towel until you feel warm.
For patients on strict bed rest, they are served in bed for morning toilet. warm water and a basin. With the help of a sanitary attendant, they wash their hands first, and then their face, neck and ears. Axillary areas, inguinal folds, folds under the mammary glands, especially in people with excessive sweating and in obese patients, wash especially thoroughly and wipe dry, otherwise diaper rash will develop in the folds of the skin.
The genital area and anus require careful care. For this purpose, walking patients use special toilets (bidets) with a vertical jet of warm water or are washed in another way, and bedridden patients are washed at least once a day. At the same time, an oilcloth is placed under the patient’s pelvis, a bedpan is placed and the patient is asked to bend his knees and spread his legs slightly. A stream of warm water or a weak solution of potassium permanganate is directed from a jug onto the perineum. Then, using a sterile cotton ball, clamped with a forceps, make several movements in the direction from the genitals to anus. Use another cotton ball to dry the perineum (the direction of these movements should be the same).
The appearance of bedsores in bedridden patients is evidence of poor care for them. A bedsore is a superficial or deep ulcer formed as a result of poor circulation and tissue necrosis. Their appearance is facilitated by an uncomfortable, uneven, rarely remade bed with folds and food crumbs; scars on a shirt and sheet, as well as maceration (wet softening) of the skin in seriously ill patients as a result of unsystematic washing and wiping of skin areas contaminated with feces and urine. Most often, bedsores are localized in the area of the sacrum, shoulder blades, coccyx, heels, back of the head, ischial tuberosities and other places with bony protrusions, where soft tissues are compressed by the bed.
Places that are most dangerous for bedsores are rubbed with a sterile gauze cloth moistened with camphor alcohol, cologne or a 0.25% solution of ammonia, at least 1 time per day, do light massage. Periodically change the patient's position in bed if there are no contraindications to this. Rubber circles, previously covered with fabric, are placed under the points of greatest pressure. Areas of redness (the first signs of the development of bedsores) of the skin are lubricated with a 5-10% solution of potassium permanganate or 1% alcohol solution brilliant green 1-2 times a day. The dense crust that forms prevents necrotic areas from moisture and infection. As prescribed by the doctor, bandages are made with Vishnevsky ointment, which helps speed up the healing process.
Rules for caring for a patient’s hair and nails. The head is washed with warm water and soap once every 7-10 days, after washing the hair is wiped dry and combed. You should not comb your hair with metal combs, as they irritate the scalp. Long hair comb in separate strands, gradually moving closer to the skin. Combs and combs should be kept clean at all times: washed in a hot 2% solution of sodium bicarbonate and periodically wiped with ethyl alcohol and vinegar. Fingernails and toenails are trimmed (trimmed) regularly.
Rules for caring for the patient’s oral cavity. Removal of plaque that forms on the oral mucosa and on the teeth, as well as food debris, is carried out using mechanical cleaning with a toothbrush or sterile gauze in the evening and in the morning. The movement of the toothbrush is made along the axis of the teeth in order to free the interdental spaces from food debris and the teeth themselves from plaque: on upper jaw- from top to bottom, and on the bottom - from bottom to top. Then toothbrush wash with warm, clean water and soap, lather and leave until next use.
While chewing solid food, the oral cavity self-cleanses. In seriously ill patients it is disrupted. Oral care consists of wiping, rinsing or irrigating to avoid damage to the gum mucosa when using a toothbrush.
Wiping the teeth and tongue is done using a cotton ball or gauze ball held with tweezers, moistened with a 2% solution of sodium bicarbonate, a 3% solution of hydrogen peroxide, a weak solution of potassium permanganate, and saline. Wipe each tooth separately, especially carefully near its neck. To wipe the upper molars, you need to pull the cheek well with a spatula so as not to introduce infection into the excretory duct of the parotid gland, located on the mucous membrane of the cheeks at the level of the back molars.
Rinsing the mouth, which in seriously ill patients should be done after each meal, is done using a rubber balloon. For this purpose the same medicinal solutions, as when wiping. The patient is seated with his head slightly tilted so that the liquid does not enter the respiratory tract. The neck and chest are covered with an oilcloth apron, and a kidney-shaped tray is placed under the chin. The corner of the mouth is pulled back with a spatula and a stream of liquid under moderate pressure is used to wash first the labial folds and then the oral cavity itself.
Rules for caring for the nasal cavity, ears and eyes. Crusts form from the discharge of the nasal cavity; disrupting nasal breathing. To remove them, insert a gauze pad soaked in water into the nasal passages. Vaseline oil, and after 2-3 minutes, remove the crusts with rotational movements. In children, the nasal passages are cleaned with a cotton wick.
Caring for your ears involves regularly washing them with warm water and soap and gently cleaning the outer ear canal of earwax using a cotton wick.
If discharge from the eyes sticks together the eyelashes and eyelids, then eye rinsing is required. For this purpose, use a 2% solution of boric acid, saline solution, and cooled boiled water. Washing is carried out using a glass undine vessel, a pipette, and a moistened sterile gauze ball. Before the procedure, the caregiver thoroughly washes his hands, and then, with a stream of liquid, first rinses the edges of the closed eyelids of the eye, then eyeball, using the fingers of the left hand to spread the eyelids and direct the stream from the temple to the bridge of the nose along the tear duct.
The concept of therapeutic nutrition for patients, feeding them and serving drinks to seriously ill patients. Medical nutrition provides a certain qualitative composition of food (proteins, fats, carbohydrates, vitamins, enzymes, microelements, mineral salts and water), quantity, timing and frequency of adoption. For a sick person, the best thing is to eat four meals a day, every day at the same hours. Disordered eating in different time with significant simultaneous overload of the stomach, it reduces the digestibility of food and leads to diseases of the gastrointestinal tract.
Food is served in the dining room, where patients are seated at the same table, receiving the same diet.
Seriously ill patients are spoon-fed in a sitting or semi-sitting position, and a napkin or towel is placed under the chin. Drinking should be done from a special sippy cup or small teapot (Fig. 31). The dishes used by the patient must be washed immediately after eating with hot water with mustard and soap intended for washing tableware, and then doused with boiling water.
Questions. 1. How to prepare a patient’s bed, change bed linen and underwear? 2. How is a patient’s skin cared for in the presence of bedsores and what are the measures to prevent them? 3. How is the patient’s mouth, nose, ears, eyes, hair and nails cared for? 4. How to feed and water seriously ill patients?
The patient's personal hygiene is always under the supervision of medical staff. Patients should do a morning and evening toilet every day, brush their teeth 2 times a day, while cleaning the back of the tongue with a toothbrush, rinse after each meal; If there are no contraindications, take a bath at least once a week. Bedridden patients are washed daily with the help of a nurse; seriously ill patients wipe their face and hands daily with cotton wool moistened with boiled or toilet water; eyelids are washed with 2% warm solution boric acid using a pipette and a cotton ball. Seriously ill patients should wipe their tongue, gums and teeth with cotton wool moistened with a 2% solution of boric acid, a weak solution, or then with a gauze pad moistened with a 1% solution of borax with the addition of a 10% solution of glycerin. Gauze and cotton wool are held with a forceps. Use a damp towel to wipe the neck, chest, armpits, then wipe dry. Hair is combed daily, and for women it is braided. Seriously ill and infectious patients are recommended to have their hair cut. After urination and defecation, seriously ill patients should be washed.
A rubber circle is placed under the sacrum for patients on long-term bed rest.
The circle is placed under a sheet or wrapped in a towel to prevent skin irritation from contact with the rubber.
Baths can be hygienic and therapeutic, as well as general or local (see Baths). It is better to immerse weakened patients in the bath slowly on a sheet, holding it at both ends. While in the bath, the patient is under the supervision of a nurse. Wet wraps are made from two sheets moistened with hot (up to 50°) water, they wrap the patient with them, then with oilcloth and two woolen blankets.
Principles of care Ø Ø Ø 1. Safety (prevention of injury) 2. Confidentiality (private details should not be known to others) 3. Respect for dignity (perform all procedures with the consent of the patient. Ensure privacy, if necessary) 4. Communication (location of the patient and his family members for a conversation, discussing the progress of the upcoming procedure and the care plan in general) 5. Independence (encouraging each patient to be independent) 6. Infection safety (implementation of appropriate measures)
Personal hygiene is a broad concept that includes the implementation of rules that contribute to the preservation and strengthening of human health. The first priority is to maintain cleanliness of the body.
For each patient, an individual regimen is prescribed by the attending physician. The individual regimen depends on the disease, its severity, condition and well-being of the patient. There are 5 types individual treatment patient: 1. Strict bed rest - with this regime, the patient is strictly forbidden to move in bed and get out of it. Self-care is prohibited. All patient care (feeding, changing clothes, hygiene procedures, assistance in meeting physiological needs) is carried out only with the help of nursing staff.
2. Bed rest - the patient is prohibited from getting out of bed. It is allowed to turn on your side in bed, bend and straighten your limbs, raise your head, sit in bed, and partially perform self-care. Nursing staff provide feeding (supplying food and drink), personal hygiene (supplying a bowl of water, comb, toothbrush, etc.), assistance in meeting physiological needs (supplying a duck, a boat). When caring for surgical patients, this regimen is prescribed a few hours after surgery for 2-3 days.
3. Semi-bed rest - the patient is prohibited from moving outside the room or ward. It is allowed to sit in bed and on a chair at the table for eating and spending time hygiene procedures. It is allowed to use a sanitary chair to perform physiological needs. The rest of the time the patient should remain in bed. When moving the patient, it is advisable to monitor his condition.
4. Ward mode - the patient is allowed to spend half of his waking time in a sitting position in a room or ward outside the bed. For eating, self-care and hygiene procedures, the patient can independently move around the room or ward. 5. General regime - the patient is not limited in movement around the apartment and outside its boundaries or hospital department or hospital territory.
Rules for changing linen The first way to change bed linen is to roll up a clean sheet halfway in the transverse direction; -raise the upper half of the patient’s body, remove the pillow; -roll up the dirty sheet from the head of the bed to the lower back; -spread a clean sheet on the vacant part of the mattress; - place the pillow, change the pillowcase on it, and lower the patient onto it; - lifting the pelvis and then the patient’s legs, remove the dirty sheet and spread a clean one in its place; - tuck the edges of the sheet under the mattress; - remove dirty laundry; -Wash the hands.
The second way to change bed linen is to roll up a clean sheet halfway lengthwise; - remove the pillow; - turn the patient on his side, moving him to the edge of the bed (the assistant holds the patient so that he does not fall); -roll the free edge of the dirty sheet towards the patient; -spread a clean sheet on the vacant part of the mattress; - turn the patient on his back, and then on the other side, on a clean sheet (those making the bed and holding the patient change roles); -remove the dirty sheet and place a clean one in its place; - tuck the edges of the sheet under the mattress; - place a pillow under your head, changing the pillowcase on it; - it is convenient to place the patient on the bed, cover with a blanket, having previously changed the duvet cover; - remove dirty laundry; -Wash the hands.
Changing underwear to raise the upper half of the patient’s torso; -carefully roll up the dirty shirt to the back of the head; -raise both the patient’s arms and move the shirt rolled up at the neck over the patient’s head; -remove the sleeves. If the patient’s arm is injured, first remove the shirt from the healthy arm and then from the sick arm. Dress the patient in the reverse order: first you need to put on the sleeves (first on the sore arm, then on the healthy arm, if one arm is injured), then throw the shirt over your head and straighten it under the patient’s body. -
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Hair care Hair should be combed daily, and once a week be sure to check for lice and wash your hair. Equipment: basin, oilcloth, gloves, roller, shampoo (or soap), towel, jug, comb. Algorithm of action: 1. Wash your hands, put on gloves. 2. Place the basin at the head end of the bed. 3. Place a cushion under the patient’s shoulders and an oilcloth on top. 4. Raise the patient's head slightly and tilt it back slightly. 5. Pour warm water from a jug onto your hair, lather your hair and wash gently. 6. Then rinse your hair, dry it with a towel and comb it. 7. Remove gloves and wash your hands. Note: special headrests can be used to wash the hair of a seriously ill patient in bed.
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Handing the vessel to the patient Equipment: vessel, oilcloth, screen, gloves. Algorithm of action: 1. Put on gloves. 2. Separate the patient with a screen. 3. Rinse the vessel with warm water, leaving a little water in. 4. Place your left hand under the sacrum on the side, helping the patient raise the pelvis. In this case, the patient's legs should be bent at the knees. 5. Place an oilcloth under the patient’s pelvis. 6. With your right hand, move the vessel under the patient’s buttocks so that the perineum is above the opening of the vessel. 7. Cover the patient with a blanket and leave him alone for a while. 8. After defecation is completed, remove the pan with your right hand, while helping the patient to lift the pelvis with your left hand.
9. After examining the contents of the vessel, pour it into the toilet and rinse the vessel with hot water. If there are pathological impurities (mucus, blood, etc.), leave the contents of the vessel until examined by a doctor. 10. Clean the patient by first changing gloves and using a clean vessel. 11. After completing the manipulation, remove the vessel and oilcloth. 12. Disinfect the vessel. 13. Cover the vessel with oilcloth and place it on a bench under the patient’s bed or place it in a specially retractable device of a functional bed. 14. Remove the screen. 15. Remove gloves, wash your hands. Sometimes the method described above for bed support cannot be used because some seriously ill patients cannot sit up. In this situation, you can do the following.
Algorithm of action: 1. Put on gloves. 2. Separate the patient with a screen. 3. Turn the patient slightly to one side, with the patient's legs bent at the knees. 4. Place the bedpan under the patient's buttocks. 5. Turn the patient onto his back so that his perineum is above the opening of the bedpan. 6. Cover the patient and leave him alone for a while. 7. Once the bowel movement is complete, turn the patient slightly to one side. 8. Remove the bedpan. 9. After inspecting the contents of the vessel, drink it into the toilet. Rinse the vessel with hot water. 10. After changing gloves and using a clean vessel, wash the patient. 11. After completing the manipulation, remove the vessel and oilcloth. 12. Disinfect the vessel.
13. Remove the screen. 14. Remove gloves, wash your hands. In addition to enameled vessels, rubber ones are also widely used. A rubber bed is used for weakened patients, those with bedsores, and urinary and fecal incontinence. Do not inflate the vessel too tightly, as it will put significant pressure on the sacrum. The inflatable cushion of the rubber bedpan (that is, the part of the bedpan that will come into contact with the patient) must be covered with a diaper. Men are given a urine bag at the same time as the bedpan.
Using a urine bag For emptying Bladder Patients are provided with urine bags. Urinals for men and women differ in the design of the funnel. The male urinal has a pipe directed upward, while the female urinal has a funnel at the end of the pipe with bent edges, located more horizontally. But women often use a bedpan when urinating. Before giving the urine bag to the patient, you should rinse it with warm water. The contents of the urine bag are poured out and rinsed with warm water. To remove the strong ammonia odor of urine, urinals are rinsed with a weak solution of hydrochloric acid or potassium permanganate. For urinary incontinence, permanent rubber urine receptacles are used, which are attached to the patient's body with ribbons. After use, urine bags must be disinfected.
Not all patients can urinate or have bowel movements freely in bed. To help the patient, you must: Ask everyone who can to leave the room, leaving the patient alone for a while. Separate the patient with a screen. Give the patient only a warm bedpan and urine bag. Give the patient, if there are no contraindications, a more comfortable position for urination and defecation using a functional bed or other devices (sitting or semi-sitting). To facilitate urination, you can open the water tap. The sound of flowing water reflexively causes urination.
Care of the external genitalia and perineum Severely ill patients should be washed after each act of defecation and urination, as well as several times a day in case of urinary and fecal incontinence. Equipment: gloves, oilcloth, screen, vessel, forceps, cotton swabs, gauze napkins, Esmarch jug or mug, tray, water thermometer, antiseptic solutions (furatsilin solution 1: 5000, faint pink solution of potassium permanganate). Algorithm of action 1. Wash your hands, put on gloves, isolate the patient with a screen. 2. Lay the patient on his back, his legs should be bent at the knees and spread apart. 3. Place an oilcloth under the patient and place a bedpan. 4. Take in right hand forceps with a napkin or cotton swab, and in left hand a jug with a warm antiseptic solution (a weak pink solution of potassium permanganate or a solution of furatsilin 1: 5000) or water at t W 0 -35 ° C.
Instead of a jug, you can use an Esmarch mug with a rubber tube, clamp and tip. 6. Pour the solution onto the genitals, and use a napkin (or tampon) to move from top to bottom (from the genitals to the anus), changing the tampons as they become dirty. The sequence of washing the patient: -first, the genitals are washed (labia in women, penis and scrotum in men); - then the inguinal folds; - lastly, wash the area of the perineum and anus. 7. Dry in the same sequence: with a dry swab or napkin. 8. Remove the vessel, oilcloth and screen. 9. Remove gloves, wash your hands.
If it is impossible to wash the patient in the manner described above due to the severity of his condition (you cannot turn him or lift him to position the bedpan), you can do the following. Using a mitten soaked in warm water or an antiseptic solution, wipe the patient’s genitals (labia, around the genital opening in women, penis and scrotum in men), inguinal folds and perineum. Then dry. In patients with urinary and fecal incontinence, after washing, the skin in the groin area is lubricated with fat (vaseline or sunflower oil, baby cream, etc.). You can powder your skin with talcum powder. REMEMBER! When caring for the external genitalia and perineum Special attention It is necessary to pay attention to natural folds. Women are washed away only from top to bottom!
Caring for the skin and natural folds The skin must be clean to function properly. Contamination of the skin with secretions of sebaceous and sweat glands, dust and microbes that settle on the skin can lead to the appearance of a pustular rash, peeling, diaper rash, ulcerations, and bedsores. Washing the patient For patients on bed rest, the nurse assists with morning toileting. Equipment: oilcloth, basin, jug, soap, towel, warm water. Algorithm of action: Place the basin on a chair next to the bed. Turn the patient onto his side or sit him on the edge of the bed if there are no contraindications. Place an oilcloth on the edge of the bed or on the patient's lap (if he is sitting). Give the patient soap in his hands.
Pour warm water from a jug over a basin onto the patient's hands until he washes his face. Give the patient a towel. Remove the basin, oilcloth, and towel. Place the patient comfortably in bed. Some patients cannot wash themselves even with the help of others. In this case, the nurse washes the patient herself. Equipment: basin, mitten or sponge, towel, gloves, warm water. Algorithm of action: Wash your hands, put on gloves. Soak a mitten or sponge in warm water poured into a basin (you can use the end of a towel). Wash the patient (sequentially - face, neck, hands using a sponge or mitten). Dry your skin with a towel. Remove gloves, wash your hands.
CARRYING OUT A HYGIENIC SHOWER INDICATIONS: skin contamination, lice. CONTRAINDICATIONS: severe condition of the patient. EQUIPMENT: bath bench or seat, brush, soap, washcloth, gloves, bath treatment products. PERFORMANCE OF MANIPULATION: - wear gloves; - wash the bathtub with a brush and soap, rinse with a 0.5% solution of bleach or 2% chloramine solution, rinse the bathtub with hot water (cleaning and disinfecting agents can be used household products); - place a bench in the bath and seat the patient; - wash the patient with a washcloth: first the head, then the torso, upper and lower limbs, groin and perineum; -help the patient dry himself with a towel and get dressed; -remove gloves; - escort the patient to the room.
CARRYING OUT A HYGIENIC BATH. EQUIPMENT: brush, soap, washcloth, gloves, bath cleaning products, foot rest. PERFORMANCE OF MANIPULATION: - wear gloves; - wash the bathtub with a brush and soap, rinse with a 0.5% solution of bleach or 2% chloramine solution, rinse the bathtub with hot water (you can use household cleaners and disinfectants); - fill the bath with warm water (water t 35 -37); -help the patient accept comfortable position in the bathroom; - wash the patient with a washcloth: first the head, then the torso, upper and lower limbs, groin and perineum; -help the patient get out of the bath, dry himself with a towel and get dressed; -remove gloves; - escort the patient to the room. The duration of the bath is no more than 25 minutes.
Rubbing the skin Patients on a general regimen, if there are no contraindications, take a bath or shower at least once every 7-10 days. The skin of a seriously ill patient must be wiped daily, at least 2 times. Equipment: gloves, a basin with warm water, a mitten or cotton swab, a towel. Algorithm of action: Wash your hands, put on gloves. Soak a mitten or cotton swab (you can use the end of a towel) in warm water. Wipe the patient's chest and abdomen in sequence. Then pat your skin dry with a towel. Especially carefully wipe and dry the folds of skin under the mammary glands in women (especially obese women), and the armpits. Turn the patient on his side and wipe his back while giving a gentle massage. Then dry. Lay the patient comfortably and cover with a blanket. Remove gloves, wash your hands.
Washing the feet The feet of a seriously ill patient are washed once a week. Equipment: gloves, oilcloth, basin, jug with warm water, towel. Algorithm of action: Wash your hands, put on gloves. Place oilcloth at the foot end of the bed. Place the basin on the oilcloth. Place the patient's legs in the pelvis (legs slightly bent at the knees). Pour warm water from a jug onto your feet, wash them (you can first pour water into a basin). Remove the basin. Dry the patient's feet with a towel, especially between the toes. Remove the oilcloth. Cover the patient's legs with a blanket. Remove gloves, wash your hands.
Nail trimming Seriously ill patients need to trim their fingernails and toenails regularly, but at least once a week. Nails must be trimmed so that the free edge is rounded (on the hands) or straight (on the feet). You should not cut your nails too short, as your fingertips will be overly sensitive to pressure. Equipment: scissors, nippers, nail file, towel, oilcloth, basin with hot soapy solution. Algorithm of action: Place an oilcloth under the patient's arm or leg (depending on where you will cut the nails). Place a bowl of hot soapy water on the oilcloth. Dip your fingers in a hot soapy solution for 10-15 minutes to soften your nails. Then dry your fingers one by one with a towel and shorten your nails to the required length using scissors or clippers.
Using a nail file, give the free edge of your nails the required form(straight - on the legs, rounded - on the arms). You should not file your nails deeply from the sides, as you can injure the skin of the side ridges and thereby cause cracks and increased keratinization of the skin. Repeat the same steps with the other limb. ATTENTION! Places of accidental cuts must be treated with a 3% solution of hydrogen peroxide or iodine.
Shaving your face Equipment: shaving machine, soap foam or shaving cream, napkin, container (tray) with water, towel, gloves. Algorithm of action: Wash your hands, put on gloves. Wet the napkin in hot water and squeeze it out. Place the napkin on the patient's face for 5-7 minutes. Apply soap lather or shaving cream to your face. While pulling the skin in the opposite direction to the movement of the machine, gently shave the patient. Wipe the patient's face with a damp cloth. Dry your face with a towel. Remove gloves, wash your hands.
Removing mucus and crusts from the nasal cavity Most patients independently care for the nasal cavity during the morning toilet. Seriously ill patients who are unable to independently monitor nasal hygiene must daily clear the nasal passages of secretions and crusts that form that interfere free breathing through the nose. Equipment: gloves, 2 trays, cotton pads, petroleum jelly (or vegetable oil, or glycerin). Algorithm of action: Wash your hands, put on gloves. While lying down or sitting (depending on the patient's condition), tilt the patient's head slightly. Soak cotton pads with Vaseline or vegetable oil, or glycerin. Insert the turunda into the nasal passage with a rotational motion and leave it there for 2-3 minutes. Then remove the turunda and repeat the manipulation. Remove gloves and wash your hands. Note: you can first drip one of the listed oils into your nose, and then clean your nasal passages with cotton wool. Mucus from the nasal cavity can also be removed with dry cotton swabs.
Rubbing the eyes If discharge appears from the eyes, eyelashes and eyelids stick together during the morning toilet, it is necessary to wash the eyes. Equipment: sterile gloves, 2 trays (one sterile), sterile cotton balls, antiseptic solution (furatsilin solution 1: 5000, 2% soda solution, 0.5% potassium permanganate solution), tweezers. Algorithm of action: Wash your hands thoroughly, put on sterile gloves. Place 8-10 sterile balls in a sterile tray and moisten them with an antiseptic solution (furatsilin 1: 5000, 2% soda solution, 0.5% potassium permanganate solution) or boiled water. Lightly wring out the swab and wipe your eyelashes with it from the outer corner of the eye to the inner. Repeat wiping 4-5 times (with different tampons!). Blot the remaining solution with dry swabs. Remove gloves, wash your hands.
Cleansing the external auditory canal Equipment: gloves, 3% hydrogen peroxide solution, pipette, cotton pads, 2 trays. Algorithm of action: Wash your hands, put on gloves. Sit the patient down, if there are no contraindications, tilt your head to the opposite shoulder or turn your head to the side while lying down. By pulling the pinna back and up, drop a few drops of warm 3% hydrogen peroxide solution into the patient's ear. Using rotational movements, insert the cotton wool into the external auditory canal. The ear is also pulled back and upward. After changing the turunda, repeat the manipulation several times. Repeat the same steps with the other external ear canal. Remove gloves, wash your hands. REMEMBER! Do not use hard objects to remove wax from your ears to avoid damaging the eardrum.
Oral care Name Manipulation equipment Rinsing Towel, 1. oral oilcloth, 2. cavity glass, 3. tray, solutions 4. antiseptics (furacilin 1: 5000, 2% 5. solution 6. soda, 0.5% solution 7 . potassium permanganate) gloves. Algorithm of action Wash your hands, put on gloves. Make the patient sit down. Place a towel or oilcloth on the patient's chest and neck. Give the patient a glass of antiseptic solution or warm boiled water. Place your chin tray. Invite the patient to rinse the mouth. Remove gloves, wash your hands.
Processing 2 spatulas, 1. Wash your hands, put on gloves. mucous membranes are sterile 2. Place a towel or oral cotton balls or oilcloth on the patient’s chest and neck. cavity and clamp or 3. Ask the patient to open his mouth wide and lips tweezers, two stick out his tongue. tray, solutions 4. With a sterile cotton ball on a sterile antiseptic clamp or in tweezers, moistened with a solution (antiseptic solution, carefully remove plaque from the tongue, furatsilina while changing the balls. 1: 5000, 2% 5. With sterile cotton balls moistened with a soda solution, antiseptic solution, thoroughly wipe the teeth with a 0.5% solution on the inside and outside, using a spatula to permanganate the teeth, potassium), 6. After completing the procedure, offer the patient gloves to rinse the mouth. oilcloth, 7. Dry the skin around the mouth with a towel. towel, 8. Apply petroleum jelly to a sterile napkin with a spatula, petroleum jelly (you can use baby cream) sterile 9. Treat the patient’s lips with petroleum jelly (or napkins. cream). 10. Remove gloves, wash your hands.
Brushing teeth Tooth 1. brush, 2. toothpaste, 3. towel, oilcloth, 4. glass of boiled 5. water, tray, gloves, 6. spatula 7. Wash your hands, put on gloves. Make the patient sit down. Place a towel or oilcloth on the patient's chest and neck. Instruct the patient to rinse the mouth once. Apply a small amount of toothpaste to your toothbrush. Ask the patient to open his mouth wide. Using a spatula to expose teeth, brush sequentially outer surface teeth, making sweeping movements (from top to bottom), then chewing and inner surface teeth (also clean the inner surface with sweeping movements from top to bottom). 8. Instruct the patient to rinse their mouth thoroughly with water. 9. Dry the skin around your mouth with a towel. 10. If necessary, treat the patient's lips with Vaseline or cream. 11. Remove gloves, wash your hands.
If a patient on bed rest can brush his teeth himself, assist him in this. Provide him with everything he needs and give him a comfortable position in bed. REMEMBER! Rinsing the mouth should be done after each meal, brushing your teeth at least 2 times a day (morning and evening). Treatment of the oral mucosa and teeth of seriously ill patients is also carried out 2 times a day. If there is a lack of personal hygiene, the nurse must: Explain the need for personal hygiene measures in a hospital setting. Assess self-care ability. Help with morning and evening dressing, shaving in the morning. Carry out partial sanitization daily. Provide opportunities for hand washing before eating and after using the toilet. Help with washing (at least once a day). Ensure hair and feet are washed once a week. Provide oral care, rinsing your mouth after every meal. Provide nail trimming once a week. Provide care for natural skin folds daily. Ensure linen is changed when soiled.
ATTENTION! Teach the patient to take care of himself to the best of his ability. Develop the patient's self-help skills and encourage him to act independently. Personal contact with the patient, careful observation and listening to the patient will help you best manage the care of each patient. Seriously ill patients can also stay at home. Therefore, it is necessary to teach relatives the elements proper care for the skin and natural folds, for mucous membranes, measures to prevent bedsores.
Rubbing the patient.
If the patient cannot take a bath or shower, he is given a wet rubdown.
Preparation for the procedure:
First, the patient is explained what procedure will be performed, and they try to involve him to some extent in participating in it.
Then prepare the equipment:
. if necessary, a screen is installed to isolate the patient from others;
. large, approximately 220 * 140 cm, oilcloth;
. gloves and an apron for the person performing the procedure;
. body shampoo;
. a basin with water at a temperature of 35-37 degrees;
. shampoo and soap mitt;
. sheet and towel.
Procedure:
1. The patient is fenced off with a screen, an apron and gloves are put on.
2. An oilcloth is placed under the patient’s body.
3. Place a basin with warm water next to the bed.
4. Wipe parts of the patient’s body in the following order: neck, chest, stomach, arms, back, buttocks, legs, groin area, perineum. When wiping any part of the body with a damp mitten moistened with water and shampoo diluted in it, rinse the mitten and wipe again. The washed part of the body should be thoroughly rubbed with a towel and covered with a sheet so that the patient does not become hypothermic.
5. Remove the oilcloth, put clean underwear on the patient, take away the water, remove the apron and gloves.
After the procedure, you should always make sure that the patient feels well and that there is no cooling or deterioration in health.
Washing feet.
Bedridden patients cannot wash their feet on their own, so the procedure is performed by a nurse. The essence of the procedure is explained to the patient, and consent should be obtained for it.
Prepare the equipment: gloves, oilcloth, a basin with water at a temperature of 35-37 degrees, body shampoo, a terry towel.
The patient can lie or sit during the procedure.
Treatment of skin folds.
Patients, especially those who are overweight and prone to sweating, should frequently wash the folds of skin under the mammary glands and on the abdomen, groin folds and axillary areas to prevent diaper rash. Through damaged skin due to diaper rash, microbes can penetrate into an already weakened body. Especially if there is increased skin moisture, restriction motor activity, urinary and fecal incontinence, the patient’s inability to act independently.
The patient should be explained why they are being carried out. regular checkups problematic areas.
Procedure:
. remind the patient about the need for the procedure;
. inspect all of the above problematic folds and depressions;
. prepare powder, a basin of water, put on gloves;
. wash problem areas and dry them thoroughly with a terry towel;
. show the patient a container with powder, read its name aloud, then open the jar and powder the skin through small holes with shaking movements;
If the patient is contraindicated from taking a bath or shower, wipe the patient with a cotton swab moistened with a solution of fruit or wine vinegar (50 g per liter of water), warm camphor alcohol or warm water. The skin is wiped dry and, if necessary, powdered with powder.
Washing the patient.
It is carried out both for hygienic purposes and to increase vitality and improving the patient's well-being. It is carried out in cases where motor activity is absent or independent skills are lost.
The patient is explained how the procedure will be performed, asked about the desired water temperature, and told about the sequence of movements.
. Prepare a mitten, a basin, water at the desired temperature, and a towel.
. They wash their hands.
. Put a mitten on your hand, moisten it with water and squeeze it out.
. Use a damp mitten to wipe the patient's face, ears, and neck.
. Dry the skin with a towel.
. They take away the water and wash their hands.
You should make sure that the patient is not inconvenienced. If he himself wants to take part in washing, encourage the desire for self-care.
Oral hygiene.
This an important part care: after all, many patients cannot clean the oral cavity on their own, especially if there are stationary or removable dentures.
During the procedure, the patient sits or reclines. His chest is covered with waterproof material. Rinsing is done using a special mug with a removable individual tip or a rubber balloon. First, the oral cavity is treated with a weak solution of sodium bicarbonate ( baking soda) - 1 tbsp. for 1 liter of water. The cheek is held with a wide spatula so that the stream of liquid can be directed into posterior sections jaws, through the interdental spaces - into the oral cavity. A mug is brought to the patient into which he can spit. Then all oral cavity treated with a pale pink sodium bicarbonate solution.
Rinsing is carried out in the morning (along with washing) after each meal and before going to bed. Removable dentures must be removed and processed. They are washed in front of the patient with a toothbrush with toothpaste or soap, rinsed, and then put in place.
Shaving.
It helps create emotional comfort and makes washing your face easier.
You should prepare:
. napkin;
. latex gloves;
. an individual electric razor or safety razor, a brush and shaving cream (if the patient has aftershave cream, they take that out too);
. a bowl of warm water;
. towel.
The essence of the procedure is explained to the patient. He should be in a semi-sitting position.
Performing the procedure:
1. Bring a bowl of water (heated to about 40 degrees), lay out the equipment, and put on gloves.
2. The napkin is moistened, wrung out and applied to the patient’s face for 1-2 minutes.
3. After removing the napkin, the patient’s face is either shaved with an electric razor, or after applying foam (cream) with a brush, shaving is performed, while the free hand slightly stretches the skin in the direction opposite to the movements of the razor.
4. The face is wiped with a damp cloth, then dry; at the patient’s request, after shaving cream is applied to the facial skin.
5. Equipment is taken away, gloves are removed, hands are washed.
Washing head.
It is carried out by a nurse when the patient’s motor activity is limited or independent skills are lost. The essence of the procedure should be explained to the patient.
Preparation for the procedure:
. a headrest is installed or the upper headboard is removed, the patient is placed comfortably;
. gloves, a basin and a jug are prepared;
. Shampoo and terry towel are placed nearby.
The head is moistened, shampoo is applied to the hair with massaging movements, carefully so as not to soak the patient, the water is drained from the jug and the hair is washed. Then they are immediately wrapped in a terry towel and dried thoroughly so that the patient does not catch a cold. Then comb it with an individual comb. If there are no contraindications, your hair should be washed at least once a week.
Haircut.
The patient is explained what procedure will be performed. Then the equipment is prepared:
. oilcloth apron and gloves;
. ethanol (70% solution);
. scissors and individual comb;
. hair clipper;
. brush for sweeping the head and neck;
. basin for burning hair and matches.
Performing the procedure:
1. Put on an apron and gloves.
2. The patient is seated on a stool or couch covered with oilcloth. The patient's shoulders are covered with a sheet or hairdresser's peignoir.
3. Pull up a table with the equipment laid out.
4. Women's hair is cut with scissors and a comb; men's hair is cut with a machine. If there is a skin disease or nits are noticed when examining the patient’s head, the patient bends over and the procedure is performed over the basin.
5. Remove the peignoir from the shoulders and place the patient comfortably.
6. Take the basin out of the room and burn the hair.
7. Remove apron and gloves, wash hands.
Nail care.
This is important both from the point of view of hygiene and safety of the patient, and in order to improve his mood.
If the patient cannot cut his nails himself, this procedure is performed by a nurse. Just be sure to explain to the patient the essence of the procedure.
To trim your fingernails, you need: a bowl of water with liquid soap added; rubber gloves, individual scissors, hand cream. To trim your toenails, you need a basin (water with liquid soap), individual nail clippers, and foot cream. Should be at hand disinfectant to treat possible wounds caused by cutting.
The patient's hands (or feet) are placed in warm soapy water for 2-3 minutes. One hand (foot) is placed on a towel, dried, the nails are cut one by one with scissors or tweezers. After the haircut, you should dry the skin again and treat your hands (feet) with cream. Fingernails are cut oval, toenails are cut crosswise. If the skin is accidentally damaged, it is lubricated with an antiseptic.
You can then remove the gloves and wash your hands.
Indications: Bed rest, semi-bed rest.
Equipment: basin, oilcloth, warm water, jug, soap, sponge, towel, scissors, clean linen.
Performing the procedure:
The procedure is carried out as planned once every 7-10 days and additionally if necessary.
1. At the head end of the bed, roll the mattress towards the patient’s scapular area.
2. Lay an oilcloth on the bed net and place a basin.
3. Tilt the patient's head slightly over the pelvis).
4. Wash the patient’s hair by pouring warm water from a jug using soap.
5. Rinse your hair with clean water, dry it, and cover your head with a scarf.
6. Remove everything, return the upper body to its original position.
7. Pour warm water into the tray and place an oilcloth with a diaper under the patient.
8. Expose the upper part of the patient’s body, moisten one end of the towel, wring it slightly, wipe the patient in the following sequence: neck, arms, back, chest.
9. Use the dry end of the towel to wipe the patient’s body in the same sequence and cover with a sheet.
10. In the same way, wipe the stomach, thighs, legs and wipe dry.
11. Roll the mattress under the patient’s knees with a bolster.
12. Lay oilcloth on the mesh and place a basin with warm water.
13. Wash the patient’s legs in the basin using a sponge and soap.
14. Wipe your feet, trim your nails, put everything away.
15. Change your underwear and bed sheets.
Vessel delivery.
Equipment: vessel, 2 marked oilcloths - “for ships” and “backing oilcloth”, diaper, screen, toilet paper, 2 pairs of gloves, regulated disinfectant solution in containers, marked: “disinfection of gloves”, “disinfection of oilcloths”, “disinfection of vessels”.
Performing the procedure:
1. At the patient’s request, ensure a comfortable position in bed.
2. Place a cloth with a diaper under the patient’s pelvis.
3. Rinse the vessel with warm water and leave a small amount of water in it.
4. Separate the patient with a screen (if necessary).
5. Ask the patient to bend his knees or help him do so.
6. Place your left hand under the sacrum, helping the patient lift the pelvis. With your right hand, move the vessel under the patient’s pelvis so that the perineum is above the opening of the vessel.
7. Make sure that the surface of the vessel in contact with the skin is dry.
8. Cover the patient with a blanket or sheet and leave him alone.
9. Remove gloves, discard in disinfectant solution.
10. After the patient has emptied his bladder or bowels, put on gloves.
11. Remove the vessel, cover it with oilcloth, and place it in a specially designated place (or next to the bed).
12. Place the patient in a comfortable position and cover with a blanket.
13. Take out the oilcloths, the vessel, pour the contents of the vessel into the sewer, rinse, immerse in a disinfectant solution.
14. Wash the patient, dry the perineum.
15. Remove the diaper and diaper, straighten the bed linen.
16. Remove gloves and place them in a container for disinfection.
17. Wash and dry your hands.
Supply of urine bag.
Equipment: A clean, warm urinal, oilcloth, gauze, screen.
Performing the procedure:
1. Place a screen by the bed.
2. Throw back the blanket, ask the patient to bend his knees and spread his hips (if he is not able to do it himself, then help).
3. Take a gauze napkin in your left hand, wrap it around the patient’s penis, take the urinal bag in your right hand.
4. Insert the penis into the opening of the urinal, place it between the patient’s legs, and remove the gauze pad.
5. Cover the patient with a blanket and leave him alone.
6. After emptying the bladder, remove the urinal, oilcloth, cover the patient, remove the screen.
7. Pour the contents of the urinal into the drain, rinse, and immerse in a disinfectant solution.
8. Wash and dry your hands.
Washing women.
Target. Maintain personal hygiene, prevent ascending infection.
Equipment. Sterile: tray, forceps, napkins, oilcloth, diaper, soap, vessel, Esmarch jug or mug with water (water temperature 35-38 o), gloves.
Preparation for the procedure:
1. Establish a friendly relationship (if the patient can perform the procedure on her own, invite her to do it).
2. Place an oilcloth and a diaper under the patient’s pelvis.
3. Ask the patient to bend his knees or help him do so.
4. Place your left hand under the sacrum, helping the patient raise the pelvis. With your right hand, move the vessel under the patient’s pelvis so that the perineum is above the opening of the vessel.
5. Make sure that the surface of the vessel in contact with the skin is dry.
6. Prepare a soap solution (make shavings from a piece of laundry soap, beat the foam in the water).
7. Take the rubber tube from Esmarch’s mug or a jug in your left hand, and the forceps with a gauze cloth soaked in a soapy solution in your right hand.
Performing the procedure:
1. treat the external genitalia and perineum in the following sequence: pubic area, external genitalia, perineum, anal area. (It is necessary to change the wipes in the same sequence as the treatment. (Throw used wipes into the disinfection tray).
2. Spread the labia with one hand and wash one labia, change napkins.
3. Wash the perineum in the direction from the pubis to the anus.
4. Rinse the patient’s perineum in the same sequence as washing. (Wipe the skin dry in the same sequence and direction, changing napkins).
5. Wash, rinse and thoroughly dry the patient’s perineum and anal area.
End of the procedure.
1. Remove the vessel, oilcloth, and remove gloves.
2. Straighten the bed linen and cover the patient.
3. Wash and dry your hands.
Washing men.
Preparation for the procedure: the same as a woman's.
Execution of the procedure.
1. Take the penis with one hand and move it foreskin.
2. Wash the head of the penis in a circular motion away from urethra to the pubic area, dry. (It is necessary to change napkins as consistently as the treatment).
3. Return the foreskin to its natural position.
4. Carefully treat, rinse and dry the rest of the penis, the skin of the scrotum, and anus.
End of the procedure: the same as a woman's.
Nail cutting.
Target. Maintain personal hygiene.
Equipment. Gloves, water container, liquid soap, hand and foot cream, scissors, tweezers, nail file, nail brush, tray, towel.
Execution of the procedure.
1. Treat hands hygienically and dry. Wear gloves. Ask the patient to lower the hand for 2-3 minutes. In a tray with warm water, add a little liquid soap to the water.
2. Remove your little finger from the water, dry it and carefully trim the nail.
3. Remove your fingers from the water one at a time, wipe and carefully trim your nails. When there's only one left in the water thumb, place the patient’s second hand in the water. Repeat the procedure with the second brush.
4. Treat your nails with a nail file and a soft brush. Apply the cream to the patient's hands.
5. When completing the treatment of fingernails, place the patient’s foot in a basin with a warm soapy solution for 3-5 minutes.
6. Remove the patient's foot from the water and dry it and place it on a diaper or towel. Place the other foot in a bowl of water for this time.
7. Trim your nails with special tweezers, being especially careful in the corners of the nail.
8. Treat your nails with a nail file and brush. Apply the cream to the patient's feet.
9. Treat the patient’s nails on the second leg in the same way.
10. Remove the basin, pour the contents into the drain, put a towel in a bag for dirty laundry, remove gloves, disinfect tools. Remove gloves, place them in a container for disinfection, and wash your hands.
Shaving.
The patient should be shaved as needed.
Equipment. Water container, compress cloth, towel, safety razor, shaving cream. All items must be for individual use by the patient.
Execution of the procedure.
1. Treat hands hygienically and dry. Wear gloves.
2. Help the patient take a “half-sitting” position.
3. Wet a large napkin with hot water (40-45 o), wring it out and place it on the patient’s face, leaving him the opportunity to breathe.
4. Apply shaving cream to the patient's skin. Using the fingers of one hand, stretch the skin of the face, and with the other, shave with straight movements from the chin to the cheeks.
5. After shaving, pat your face with a damp cloth, then dry.
6. Wash and put away care items in the patient’s bedside table.
7. Remove gloves, place them in a container for disinfection, and wash your hands.
Oral care.
After each meal, rinse your mouth with salted water (¼ tsp salt per 1 glass of water).
Help a patient on bed rest brush his teeth 2 times a day (morning and evening).
Target. Prevention of the development of inflammatory and putrefactive processes in the oral cavity.
Equipment. Sterile: trays, 2 tweezers, napkins, 2 spatulas, pear-shaped can or Janet syringe, beaker. Vaseline, furacillin 0.1%, 1% solution of brilliant green. Towel, glass of water, tray for used material, container with disinfectant solution.
Preparing for the procedure.
1. Treat hands hygienically and dry.
2. Place the patient lying on his back, turning his head to the side. Cover the neck and chest with oilcloth, a towel, and place a tray under the chin.
3. Ask the patient to close his teeth (remove dentures, if any). Pour one of the prepared solutions into a beaker.
4. Move the patient’s cheek with a spatula and use tweezers with a gauze ball soaked in an antiseptic solution to brush the teeth, starting with the back teeth, and sequentially clean the inner, upper and outer surfaces of the teeth, moving up and down (from the gums) in the direction from the back to front teeth. Repeat the same steps on the other side of the mouth. The procedure is repeated at least two times. (Processing begins from the molars to the incisors, on the left, then on the right in the same sequence, changing the gauze balls).
5. Treat the tongue of a seriously ill patient: Ask the patient to stick out his tongue; if he cannot do this, then take the tip of the tongue with your left hand with a sterile gauze napkin and pull it out of the mouth.
6. Wrap a sterile spatula in a sterile napkin and moisten it in an antiseptic solution.
7. Use this spatula to remove plaque from the tongue in the direction from the root of the tongue to the tip.
8. Irrigate the patient's mouth or help rinse the patient's mouth.
9. Take sterile tweezers with a napkin and treat the palate, inner surfaces of the cheeks, gums, and the area under the tongue. (You need to change the napkin every time it becomes covered with mucus or sticky saliva).
10. Drop the tweezers into the tray.
11. Help the patient rinse his mouth or irrigate using a pear-shaped can: pull back the corner of the mouth with a spatula and alternately rinse the left and then the right cheek space with a stream of solution under moderate pressure.
End of the procedure.
1. Wipe the skin around the mouth with a dry cloth, lubricate your lips with Vaseline. (If there are cracks, treat with a 1% solution of brilliant green).
2. Clean dentures, if any, and help the patient put them on. (Clean with a toothbrush and toothpaste, holding it over the sink.
3. Disinfect instruments and gauze wipes.
4. Remove gloves, place them in a container for disinfection, and wash your hands.
Note: If the patient is in unconscious, then wrap a napkin around your index finger, holding it with your thumb, fix it securely and moisten it in an antiseptic solution. We place a spatula or mouth opener between the teeth. Treat the palate, the inner surface of the cheeks, teeth, gums, tongue and the space under the tongue, then lips. (Change napkins as they become contaminated with mucus, plaque, and sticky saliva).
Eye care.
Indications.Serious condition patient.
Equipment. Sterile: tray, tweezers, gauze balls, 0.02% furacillin solution, petroleum jelly, saline solution, pipettes, gloves, containers with disinfectant solutions.
Preparation for the procedure.
4. Pour Vaseline oil into one beaker and into another - furacillin solution.
5. Using tweezers, moisten the ball in Vaseline oil, lightly squeezing it against the walls of the beaker.
Executing the procedure.
1. Take the ball in your right hand and wipe one eyelid in the direction from the outer corner of the eye to the inner.
2. Rub the eyelid with a dry ball in the same direction.
3. Moisten the ball in the furacillin solution in the same way and repeat wiping in the same direction. Repeat rubbing 4-5 times with different balls.
4. in the presence of purulent discharge in the corners of the eyes: rinse the conjunctival cavity with saline solution, spreading the eyelids with the index and thumb with your left hand, and with your right hand, irrigate the conjunctival sac using a pipette.
5. Rub the eyelid with a dry ball in the same direction.
6. Treat the second eye in the same way.
Completion of the procedure. Place the used balls, tweezers, beakers, pipettes in a container with a disinfectant solution. Remove gloves, place them in a container for disinfection, and wash your hands.
Nose care.
Target. Prevention of nasal breathing disorders.
Indications. The patient's condition is serious, there is discharge from the nasal cavity.
Equipment. Sterile: tray. Beaker, tweezers, Vaseline oil, cotton pads. Gloves. Tray, container with disinfectant solution.
Preparing for the procedure.
1. Establish a trusting relationship with the patient (or his relatives).
2. Explain to the patient the purpose of the procedure and obtain his consent.
3. Wash and dry your hands and put on gloves.
4. Pour sterile Vaseline oil into one beaker.
5. Take the turunda with tweezers, moisten it in Vaseline oil, and squeeze it lightly.
Execution of the procedure. 1. Transfer the turunda to your right hand and insert it into the nasal passage with rotational movements for 1-3 minutes, lifting the tip of the patient’s nose with your left hand.
2. Remove the turunda from the nasal passage with rotational movements. 3. treat the other nasal passage in the same way.
Completion of the procedure.
Note.
Ear care.
Target. Prevention of hearing loss due to wax accumulation.
Indications. The patient is in serious condition and is on bed rest.
Contraindications. Inflammatory processes in the auricle, external auditory canal.
Equipment. Sterile: tray, tweezers, beaker, cotton pads, gloves. 3% hydrogen peroxide solution, tray, container with disinfectant solutions.
Preparing for the procedure.
1. Establish a trusting relationship with the patient (or his relatives).
2. Explain to the patient the purpose of the procedure and obtain his consent.
3. Wash and dry your hands and put on gloves.
4. Pour a 3% hydrogen peroxide solution into a sterile beaker.
5. Prepare a container with soap solution.
Execution of the procedure.
1. Moisten a napkin in a soapy solution and wipe the auricle, dry with a dry napkin.
2. Take a cotton swab with tweezers and moisten it in a 3% hydrogen peroxide solution.
3. put the turunda in your right hand, pull back the auricle with your left hand, so as to align the ear canal.
4. Insert the turunda with rotational movements into the external auditory canal to a depth of no more than 1 cm for 2-3 minutes.
5. Remove the turunda using rotational movements from the external auditory canal.
6. Treat the other ear canal in the same way.
Completion of the procedure.
Place the used turundas, tweezers, and beaker in a container with a disinfectant solution. Remove gloves, place them in a container for disinfection, and wash your hands.
Note. Do not use sharp care items.
Prevention of bedsores.
Bedsore- These are deep lesions of the skin and soft tissues up to their necrosis as a result of prolonged compression. Predisposing factors include disorders of local blood circulation, innervation and tissue nutrition.
Three main factors leading to the formation of bedsores have been established:
- Pressure – tissue compression occurs under the influence of its own weight.
- "Shear"- destruction and mechanical damage tissue is caused by tissue displacement relative to the supporting surface.
- Friction- is a component of the “cutting” force, it causes detachment of the stratum corneum of the skin and leads to ulceration of its surface.
Signs of bedsores: the appearance of pale areas of the skin, then a bluish-red color without clear boundaries, then the epidermis peels off, blisters form. Next, tissue necrosis occurs, spreading deep into the tissue and to the sides.
Very important the conditions in which the sick person is located influence the course and outcome of diseases. First of all, it is necessary to observe simple rules of personal hygiene and cleanliness in the ward; it is also necessary to provide the patient with proper and timely nutrition. There should be a comfortable position for the patient in bed, the bed linen should be clean, and the mattress should be flat; if the bed has a net, then it should be in a taut position. For patients with urinary incontinence and seriously ill patients, it is necessary to place an oilcloth under the sheet on the mattress pad. Women with heavy discharge It is necessary to put the diaper on oilcloth, which must be replaced at least twice a week.
Seriously ill patients are placed on functional beds with headrests. The patient is given a blanket with a duvet cover and 2 pillows. The bed must be changed regularly: before going to bed and after waking up. Bed and underwear should be changed at least once a week after each bath.
It is very important to take care of the skin of a seriously ill patient.
The skin is designed to perform several functions; regulatory, analytical, protective and excretory. Excreted through the skin and sweat glands uric acid, potassium, sodium, urea, water and many other substances. At normal temperature at rest, approximately a liter of sweat is released per day, and in patients with fever up to 10 liters or more.
When sweat evaporates, metabolic products remain on the skin, which have a destructive effect on the skin. In this regard, the skin must be clean, and for this it is necessary to frequently change linen, wipe the skin with cologne, disinfectant wipes, and wipe the skin with a clean, dry towel.
Particular care should be taken to monitor the skin in the groin area, armpits, and under the breasts in women. Daily washing is necessary for the perineum. Seriously ill patients should be washed after each bowel movement to avoid inflammatory processes skin. Also, seriously ill patients may develop bedsores, which are soft tissue necrosis that occurs as a result of ischemia.
Most often, bedsores occur on the shoulder blades, elbows, heels, and sacrum. First there is pain and redness, then blisters form. In the presence of deep bedsores, tendons and muscles become visible. Ulcers form, sometimes reaching the bone. An infection passes through the wounds, leading to blood poisoning and suppuration.
If bedsores appear, it means that the personal hygiene of the seriously ill patient is not being performed sufficiently.
If redness occurs skin It is necessary to wipe it twice a day with a camphor solution and a wet towel. When bedsores form, you need to lubricate them with a solution of potassium permanganate, apply a bandage with Vishnevsky ointment, etc.
It is also necessary to take care of your oral cavity, because every person needs it and there is nothing difficult about it.
It is enough to rinse your mouth with water after meals and brush your teeth twice a day, in the morning and before bed.
It is necessary to take care of your eyes. You need to rinse your eyes to remove purulent formations solution of boric acid, potassium permanganate or rivanol with a gauze swab. If there are inflammatory processes in the eyes, you need to instill medications or rub in eye ointments.
Also, a seriously ill patient needs to clean their ears twice or thrice a week to prevent the formation of wax plugs, which reduce hearing, in similar cases It is necessary to rinse the ear canal.
It is necessary to remove crusts from the nose.
Care must be taken to ensure that dandruff does not form in the hair of seriously ill patients. To do this, you need to wash your hair well once a week using shampoo and toilet soap. Seriously ill people wash their hair right in bed. For this procedure, it is necessary to place the pelvis at the head of the bed, and the patient must tilt his head over the pelvis. He needs to rinse his hair very well, lathering his hair, then rinse with warm water, wipe dry and comb well. After this procedure, tie a towel or scarf on your head.
Every day you need to comb your hair; for this you need to use a personal comb dipped in a vinegar solution. This is a great way to get rid of dandruff. It is necessary to keep the scallops clean, wipe them with alcohol and rinse them in hot water and soda. After this, the nurse trims your toenails and fingernails.
