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Theoretical foundations of nursing. Section II

Manipulation

Sanitary treatment of the patient;

Preparation of disinfectant solutions;

Disinfection of patient care items;

Pre-sterilization cleaning of syringes, needles, instruments;

Packing dressings, clothing, and linen of surgical personnel into bins;

Using a sterile bix;

Hand disinfection;

Putting on sterile clothing and dressing the surgeon;

Covering the sterile table;

Transportation and repositioning of the patient;

Use of a functional bed;

Bed preparation;

Change of underwear and bed linen;

Patient's toilet;

Hygienic measures in bed;

Washing;

Prevention of bedsores;

Feeding the patient in bed;

Administration of the nutritional mixture through a tube;

Feeding the patient through a gastrostomy tube;

Treatment of the button tube and skin around the gastrostomy tube;

Body temperature measurement;

Plotting a temperature curve;

Pulse measurement;

Definition of number breathing movements;

Blood pressure measurement;

Determination of daily diuresis;

Setting up cans;

Installation of mustard plasters;

Applying a warm compress;

Using a heating pad and ice pack;

Preparation medicinal bath;

Oxygen supply;

Supply of vessel and urinal;

Installation of a gas outlet pipe;

Performing all types of enemas;

Catheterization bladder;

Maintaining documentation for medication records;

Application of ointment, patch, powder;

Instilling drops into the nose, ears, eyes, placing behind the eyelid;

Using an inhaler;

Insulin dose set;

Injections (all types);

Assembling the drip system;

Venipuncture;

Taking an ECG;

Taking a swab from the throat;

Sputum collection;

Blood test for hemoglobin, ESR, leukocytes;

Urinalysis according to Zimnitsky;

Fractional intubation of the stomach;

Probing of the gallbladder;

Collection of stool for examination;

Preparing the patient for radiation examinations, endoscopy;

Preparing the patient and participating in all types of punctures and outpatient operations;

Carrying out artificial respiration;

Application of all types of dressings;

Carrying out local anesthesia;

Immobilization;

Blood type determination, individual compatibility test;

Conducting premedication;

Stopping bleeding in superficial vessels.

Requirements of the State educational standard for the level of training of specialists in the field of fundamentals of nursing
for specialty 0406 Nursing, basic intermediate level vocational education

The nurse should:

Know the history of the development of nursing in the world and the Russian Federation;

Know the philosophy of nursing in the Russian Federation;

Know the daily vital needs of a person;

Know the basic provisions of some models of nursing (W. Henderson, D. Orem, N. Roper);

Know the structure of healthcare institutions;

Know the stages of the nursing process: initial assessment of the patient's condition, patient problems, planning nursing activities, implementing planned care, conducting ongoing and final assessments of nursing activities;

Know the principles of teaching the patient and his family about care and self-care;

Know the methods cardiopulmonary resuscitation;

Be able to ensure infection safety, including the ability to apply universal and standard precautions;

Be able to fill out medical documentation;

Be able to communicate with patients and colleagues during the process professional activities;

Be able to provide medical services (perform nursing procedures);

Be able to perform cardiopulmonary resuscitation;

Be able to provide safe environment for patients and staff in a healthcare facility;

Security test tasks

1. Colibacterin is intended for administration

a) intravenous

b) subcutaneous

c) oral

d) intramuscular

2. The BCG vaccine is administered for the purpose of immunization

a) intramuscularly

b) intramuscularly or subcutaneously

c) strictly subcutaneously

d) strictly intradermally

3. In the early postoperative period after abdominal gynecological surgery task nurse

a) give the patient hot sweet tea

b) feed the sick person

c) monitor hemodynamics and the condition of the postoperative suture

d) give painkillers at the patient’s request

4. The patient after a spinal puncture must be laid down

a) on the stomach without a pillow

b) on the back with the head end raised

c) on the side with knees brought to the stomach

d) half sitting

5. Crystalloid solutions before intravenous administration

a) warm to room temperature

b) heated to 50 0

c) heated to 37-38 0

d) administered cold in case of hyperthermia

6. A patient with typhoid fever with stool retention is advised to

a) foods rich in fiber

b) saline laxatives

c) abdominal massage

d) a small cleansing enema

7. Bite wounds caused by animals (possible sources of rabies) must be

a) treat with iodine

b) rinse with hydrogen peroxide

c) rinse with furatsilin solution

d) rinse soap solution

8. Method A.M. Often provides

a) reception daily dose medications against the background of antihistamines

b) administration of drugs in minimal dosages

c) first administering a small dose of the drug, and if there is no reaction - full dose

d) administration of daily doses of drugs at the largest possible intervals

9. The maximum volume of drugs administered intramuscularly into one place does not exceed

a) 5 ml

b) 10 ml

c) 15 ml

d) 20 ml

10. Monitoring of the patient after testing for antibiotic tolerance continues

a) within 2-3 minutes

b) within 5-10 minutes

c) up to 30 minutes

d) at least 2 hours

11. Emergency care anaphylactic shock begins to appear

a) in the treatment room

b) in the intensive care unit

c) in the intensive care ward

d) at the site of development

12. In case of anaphylactic shock caused by intravenous drip administration of drugs, the main thing is

a) remove the IV

b) close the IV, maintaining access to the vein

c) creating mental peace

G) oral administration antihistamines

13. When bleeding from it, the carotid artery is pressed against

a) corner lower jaw

b) transverse process of the 7th cervical vertebra

c) to the collarbone

d) to the sternocleidomastoid muscle

14. When using cardiac glycosides, you should monitor:

a) body temperature

b) heart rate

c) color of urine

d) sleep

15. Jet can be entered

a) blood components

b) rheopolyglucin

c) hemodesis

d) trisol

16. Enzymatic drugs (mezim, festal) are taken

a) regardless of food intake

b) strictly on an empty stomach

c) during meals

d) 2-3 hours after eating

17. A sharp drop in temperature, tachycardia, pallor skin at typhoid fever may indicate

a) the beginning of recovery

b) intestinal bleeding

c) reduced immunity

d) hypovitaminosis

18. Strong smell ozone in the air after quartzization indicates

a) reliable air disinfection

b) creating a favorable atmosphere for people

c) insufficient time for air disinfection

d) the need to ventilate the room and poor performance of the bactericidal lamp

19. It is not necessary to protect the respiratory organs with a mask when

a) taking blood from a vein

b) taking a swab from the throat and nose

c) caring for a patient with cholera

d) preparing chloramine solutions

20. In order to improve blood circulation in bronchopulmonary diseases, children are contraindicated

a) put mustard plasters

b) place banks

c) give a massage

d) apply a warm compress

21. Rags for general cleaning of the operating room should be

a) any

b) clean

c) disinfected

d) sterile

22. Insulin is stored

a) at room temperature

b) at a temperature of +1 -+ 10° C

c) at -1-+1 0 C

d) frozen

23. The type of transportation determines

a) nurse in accordance with the patient’s condition

b) a nurse in accordance with the patient’s well-being

c) a doctor in accordance with the patient’s well-being

d) doctor in accordance with the patient’s condition

24. When transporting a patient in a rocking chair, the presence of hands poses a danger.

a) on the stomach

b) in a crossed position

c) on the armrests

d) outside the armrests

25. If the temperature drops critically, you should not

a) report the incident to a doctor

b) remove the pillow from under the head and elevate the patient’s legs

c) leave one patient to create maximum peace

d) give the patient hot tea

26. Safety precautions when storing oxygen cylinders include everything except

a) prohibition of smoking in the room where cylinders are stored

b) storing cylinders near heat sources

c) storing cylinders in a well-ventilated area

d) contact of oxygen with fats and oils

27. Taking material for bacteriological culture from the rectum is prohibited

a) rubber catheter

b) rectal loop

c) rectal tampon

d) rectal glass tube

28. The main sign of shortness of breath in a child:

a) pallor of the skin

b) swelling and tension of the wings of the nose

c) bulging fontanelles

d) loud crying

29. Chloramine working solutions are used

a) once

b) during the shift

c) during the working day

d) until the color of the solution changes

30. After sublingual administration of clonidine during a hypertensive crisis, the patient should remain in a supine position for at least

a) 10-15 minutes

b) 20-30 minutes

c) 1.5-2 hours

d) 12 hours

31. When hit oil solutions and suspensions into a blood vessel may develop

a) embolism

b) phlegmon

c) bleeding

d) vasospasm

32. When intramuscular injection the patient needs chlorpromazine

a) be in a lying position for 1.5-2 hours

b) take antihistamines

c) place a heating pad on the injection site

d) eat food

33. When bright colors appear bloody discharge from the vagina of a pregnant woman at 10 weeks of gestation is necessary

a) refer the pregnant woman to a doctor antenatal clinic

b) urgently send the pregnant woman to the hospital by any passing transport

c) call ambulance

d) put the pregnant woman to bed at home and administer hemostatic drugs

34. Protection against HIV infection and other sexually transmitted diseases is

a) condoms

b) intrauterine devices

c) hormonal contraceptives

d) local contraceptives

35. On the first day after childbirth, the postpartum woman should be washed

a) on a gynecological chair

b) on the couch in the treatment room

c) in bed

d) in the toilet room, teaching her to perform the procedure independently

36. The nurse takes smears from the vagina

a) with sterile instruments in sterile gloves

b) sterile instruments without gloves

c) sterile instruments wearing clean gloves

d) disinfected instruments wearing sterile gloves

37. A nurse measures blood pressure in a pregnant woman with a severe form of gestosis.

a) in the treatment room, with the patient lying down

b) at the post, with the patient sitting

c) in bed, with the patient lying down

d) in the ward, with the patient sitting

13. The concept of the nursing process, its purpose and ways to achieve it

Currently, the nursing process is the core of nursing education and creates a theoretical scientific basis nursing care in Russia.

Nursing process is a scientific method of nursing practice, a systematic way of identifying the patient and nurse situation and the problems that arise in that situation in order to implement a plan of care that is acceptable to both parties.

The nursing process is one of the basic and integral concepts of modern models of nursing.

The goal of the nursing process is maintaining and restoring the patient’s independence in meeting the basic needs of the body.

Achieving the goal of the nursing process carried out by solving the following tasks:

1) creating a patient information database;

2) determining the patient's needs for nursing care;

3) designation of priorities in nursing care, their priority;

4) drawing up a care plan, mobilizing the necessary resources and implementing the plan, that is, providing nursing care directly and indirectly;

5) assessing the effectiveness of the patient care process and achieving the goals of care.

The nursing process brings a new understanding of the role of the nurse in practical healthcare, requiring from her not only technical training, but also the ability to creatively relate to patient care, the ability to individualize and systematize care. Specifically, it means using scientific methods determining the health needs of the patient, family or community, and on this basis selecting those that can be most effectively met through nursing care.

The nursing process is a dynamic, cyclical process. Information obtained from assessing the results of care should form the basis for the necessary changes, subsequent interventions, and actions of the nurse.

14. Stages of the nursing process, their relationship and the content of each stage

I stage– nursing assessment or assessment of the situation to determine the patient's needs and the resources needed for nursing care.

II stage– nursing diagnosis, identification of patient problems or nursing diagnoses. Nursing diagnosis– this is the patient’s health status (current and potential), established as a result of a nursing examination and requiring intervention by the nurse.

Stage III– planning necessary assistance to the patient.

Planning must be understood as the process of forming goals (i.e. desired results care) and nursing interventions necessary to achieve these goals.

IV stage– implementation (implementation of the nursing intervention (care) plan).

V stage– outcome assessment (summary assessment of nursing care). Evaluating the effectiveness of the care provided and adjusting it if necessary.

Documentation of the nursing process is carried out in the nursing record of monitoring the patient's health status, an integral part of which is the nursing care plan.

15. Principles of record keeping

1) clarity in the choice of words and in the entries themselves;

2) brief and unambiguous presentation of information;

3) coverage of all basic information;

4) use only generally accepted abbreviations.

Each entry must be preceded by a date and time, and the entry must end with the signature of the nurse writing the report.

1. Describe the patient's problems in his own words. This will help you discuss care issues with him and help him better understand the care plan.

2. Call goals what you want to achieve together with the patient. Be able to formulate goals, for example: the patient will have no (or decreased) unpleasant symptoms(indicate which ones), then indicate the period during which, in your opinion, a change in health status will occur.

3. Compose individual plans patient care based on standard care plans. This will reduce the time it takes to write a plan and determine scientific approach to nursing planning.

4. Keep the care plan in a place convenient for you, the patient and everyone involved in the nursing process, and then any member of the team (shift) can use it.

5. Mark the deadline (date, deadline, minutes) for the implementation of the plan, indicate that assistance was provided in accordance with the plan (do not duplicate entries, save time). Sign the specific section of the plan and include any additional information that was not planned but was required. Correct the plan.

6. Involve the patient in keeping records related to self-care or e.g. water balance daily diuresis.

7. Train everyone involved in care (relatives, support staff) to perform certain elements of care and record them.

The period of implementation of the nursing process is quite long, so the following problems related to documentation may arise:

1) the impossibility of abandoning old methods of record keeping;

2) duplication of documentation;

3) the care plan should not distract from the main thing - “providing assistance.” To avoid this, it is important to view documentation as a natural progression of the continuum of care;

4) documentation reflects the ideology of its developers and depends on the nursing model, therefore it is subject to change.

16. Methods of nursing interventions

Nursing care is planned on the basis of disruption to the patient's needs, and not on the basis of a medical diagnosis, i.e. disease.

Nursing interventions can also be ways to meet needs.

It is suggested to use the following methods:

1) provision of first aid;

2) fulfillment of medical prescriptions;

3) creating comfortable conditions for the patient in order to satisfy his basic needs;

4) providing psychological support and assistance to the patient and his family;

5) performing technical manipulations and procedures;

6) implementation of measures to prevent complications and promote health;

7) organization of training in conducting conversations and counseling the patient and his family members. Planning of necessary care is carried out based on the classifier nursing actions according to IKSP (International Classification of Nursing Practice).

There are three types of nursing interventions:

1) dependent;

2) independent;

1) obtain a clear understanding of the patient before care planning begins;

2) try to determine what is normal for the patient, how he sees his normal state of health and what help he can provide himself;

3) identify the patient's unmet care needs;

4) establish effective communication with the patient and involve him in cooperation;

5) discuss care needs and expected care outcomes with the patient;

6) determine the patient’s degree of independence in care (independent, partially dependent, completely dependent, with the help of whom);

Transcript

1 basics of NURSING ALGORITHMS OF MANIPULATION TRAINING MANUAL FOR MEDICAL SCHOOLS AND COLLEGES Recommended by the State Educational Institution of Higher Professional Education “Moscow Medical Academy named after I.M. Sechenov" as a teaching aid for students of secondary vocational education institutions studying in the specialties "Nursing" and "General Medicine" in the discipline "Fundamentals of Nursing"

2 UDC (07) BBK 53.5 Registration 641 reviews from the Federal State Institution Federal Institute for Educational Development Team of authors: Shirokova N.V. teacher of nursing, Moscow Regional Medicine College 2. Ostrovskaya I. V. Associate Professor of the Department of Management nursing activities MMA I.M. Sechenov. Klyukova I.N. teacher of the fundamentals of nursing at the Lyubertsy Medical College. Morozova N. teacher of the fundamentals of nursing at the Mytishchi School of Medicine. Morozova G.I. teacher of the fundamentals of nursing at the Moscow Regional Medical College. Guseva I.A. teacher of the basics of nursing at Noginsk Medical University taught? 0-75 Fundamentals of nursing: Algorithms of manipulation: textbook / N.V. Shirokova and others - M.: GEOTAR-Media, p. ISBN Tutorial contains execution algorithms necessary procedures for patient care and is designed to improve the quality of medical care provided. The manual has been developed in accordance with Federal law Russian Federation December 18, 2002 “On technical regulation”; provisions of the state standardization system of the Russian Federation (GOST R GOST R); general requirements for specialists in the field of nursing. Recommended for students and teachers of medical schools and colleges, students of advanced training departments in the specialties “Nursing”, “Medicine” and medical workers. UDC "BBK53.5* The rights to this publication belong to LLC Publishing Group "GEOTAR-Media". Reproduction and distribution in any form of part or the whole publication cannot be carried out without the written permission of LLC Publishing Group "GEOTAR-Media". ISBN Team of authors, 2009 LLC Publishing Group "GEOTAR-Media", 2010 LLC Publishing Group "GEOTAR-Media", design, 2010

3 CONTENTS From the authors... 6 Chapter 1. Nursing examination... 7 Examination of the pulse on the radial artery... 7 Measurement of body temperature in the axillary region (in a hospital setting)... 8 Measurement of blood pressure... 10 Measurement of height patient...12 Weighing and determining body weight Chapter 2. Infectious safety. Infection control Carrying out disinfection and pre-sterilization cleaning of medical devices in one step manually...14 Chapter 3. Reception of the patient Treatment of a patient with lice...16 Chapter 4. Safe hospital environment. Therapeutic-protective regime Rotating the patient and placing him in the position on the right side...18 Transferring the patient from the supine position to the Sims position...20 Moving the patient with hemiplegia to the prone position...21 Placing the patient with hemiplegia in the Fowler position ...23 Placing the patient in a supine position...25 Chapter 5. Personal hygiene of the patient Changing bed linen in a transverse way...27 Changing bed linen in a longitudinal way Changing a shirt Help for a seriously ill patient patient in using a bedpan or urinal Care of the external genitalia of men... ".... :...32 Care of the external genitalia and perineum of women...34 Morning toilet of a seriously ill patient: washing Morning toilet of a seriously ill patient: toilet of the oral cavity. ..36 Application of medicinal effects on the oral mucosa...38 Morning toilet of a seriously ill patient: toilet of the eyes...39 Morning toilet of a seriously ill patient: toilet of the nose Morning toilet of a seriously ill patient: toilet of the ears Chapter 6. Feeding the patient Feeding the patient in bed using a sippy cup Feeding patient in bed using a spoon Feeding the patient through a nasogastric tube Caring for a nasogastric tube Feeding the patient through a gastrostomy Chapter 7. Methods of simple physiotherapy. Hirudotherapy Using mustard plasters Using a heating pad Using an ice pack Setting up a warm compress Setting up a cold compress... 56

4 Placement of cups Placement of leeches (hirudotherapy) Supply of humidified oxygen through a nasal catheter Chapter 8. Use of medications Instillation of oil drops into the nose Instillation into the nose vasoconstrictor drops Patient training in use pocket inhaler Introducing a suppository with a laxative effect to the patient. A set of medicine from an ampoule. Dilution of antibiotics. Performing an intradermal injection. Performing a subcutaneous injection. intramuscular injection Performing an intravenous injection Filling the infusion system Carrying out the infusion Chapter 9. Enemas. Gas outlet pipe. Glass Cleaning Heritage Enceptive Herkmas Oil Printing Hyperty Hypertonic Microclism of the Capelon Enkest The Patient Affairs Activities of the Patient Activities when Replacing the adhesive (adhesive) high -quality chapter 10. Catheterization of the bladder of the bladder of the woman’s bladder with a rubber catheter a man of a man with a rubber catheter setting and fixing permanent catheter...: Flushing the bladder Chapter 11. Punctures Participation of the nurse in performing pleural puncture Participation of the nurse in performing lumbar puncture Participation of the nurse in performing sternal puncture Participation of a nurse in performing an abdominal puncture Chapter 12. Laboratory and instrumental studies Guidelines “Rules and techniques for obtaining samples of clinical material for research in a clinical microbiology laboratory” Throat swab Nasal swab Taking blood from a peripheral vein Taking blood from a vein into vacuum containers Collecting sputum on clinical analysis Collection of sputum for bacteriological examination Collection of sputum for Mycobacterium tuberculosis Collection of sputum for tumor cells (atypical) Collection of stool for scatological research Taking stool for bacteriological research Taking stool for examination occult blood Stool collection to detect protozoa

5 5 Collection of stool for analysis for helminth eggs Collection of urine for general clinical analysis Collection of urine for sugar in daily quantity Urine collection for diastasis Urine collection according to Nechiporenko Urine collection according to Zimnitsky Preparing the patient for fibroesophagogastroduodenoscopy Chapter 13. Probe manipulations Gastric lavage with a thick probe Gastric lavage with a thin probe Taking gastric contents for examination secretory function stomach Duodenal intubation (fractional method) Chapter 14. Cardiopulmonary resuscitation outside medical institution Cardiopulmonary resuscitation by one rescuer Cardiopulmonary resuscitation by two rescuers Chapter 15: Tracheostomy tube handling Caring for a plastic tracheostomy tube with an indeflatable cuff Teaching the patient how to care for a tracheostomy tube

6 CHAPTER 1 NURSING EXAMINATION STUDY OF PULSE ON THE RADIAL ARTERY Purpose: diagnostic. Indications: doctor's orders, preventive examinations. Equipment: clock or stopwatch, temperature sheet, pen. I. Preparation for the procedure Establishing contact with the patient 1. Collect information about the patient. Introduce yourself kindly and respectfully to him. Clarify how to contact him if the nurse sees the patient for the first time 2. Explain to the patient the purpose and sequence of the procedure Psychological preparation patient 3. Obtain the patient's consent to the procedure Respect for the patient's rights 4. Prepare the necessary equipment Carrying out the procedure and documenting its results 5. Wash and dry hands P. Performing the procedure 1. Invite the patient to sit or lie down. In this case, the hands should be relaxed, the hand and forearm should not be suspended. 2. Press the radial arteries on both hands of the patient at the base of the thumb with the 2nd, 3rd, 4th fingers (the 1st finger should be on the back of the hand), feel the pulsation and lightly compress the arteries Ensuring the reliability of the result Determining the synchrony of the pulse. If the pulse is synchronous, then further research is carried out on one arm 3. Determine the pulse rhythm. If the pulse wave follows one after another at regular intervals, then the pulse is rhythmic, if not, it is arrhythmic. At severe arrhythmia conduct additional research to identify pulse deficiency. The rhythm of the peripheral pulse should coincide with the rhythm of heart contractions. The difference between the number of heart beats per minute and the peripheral pulse rate at the same minute is called the pulse deficit

7 4. Determine the pulse rate per minute: take a watch or stopwatch and count the number of pulse beats within 30 seconds. Multiply the result by two (if the pulse is rhythmic) and get the pulse frequency. If the pulse is arrhythmic, then the number of pulse beats should be counted within 60 s. Heart rate depends on age, gender, physical activity Ensuring accurate heart rate determination. Normal frequency pulse: from 2 to 5 years about 100 beats/min; from 5 to 10 years about 90 beats/min; adult men bpm; adult women bpm; pulse more than 80 beats/min, tachycardia; pulse less than 60 beats/min bradycardia 5. Determine the filling of the pulse: if the pulse wave is clear, then the pulse is full, if weak it is empty, if the pulse wave is very faintly palpable, then the pulse is thread-like. The filling of the pulse depends on the volume of circulating blood and the magnitude cardiac output 6. Determine pulse voltage. To do this, you need to press the artery harder than before against the radius. If the pulsation stops completely, the tension is weak, the pulse is soft; if the tension weakens moderately; if the pulsation does not weaken, the pulse is tense, hard. Ensuring the accuracy of determining the pulse voltage. It depends on the tone of the arterial vessels. The higher the blood pressure readings, the more intense the pulse 7. Inform the patient of the result of the study. The patient’s right to information III. End of procedure 1. Wash and dry hands 2. Make a note reflecting the results obtained and the patient's reaction Ensuring continuity of nursing care Note. To determine the pulse, you can use the temporal, carotid, subclavian, femoral arteries, and dorsal artery of the foot. MEASURING BODY TEMPERATURE IN THE AXILLAR REGION (IN A HOSPITAL CONDITION) Purpose: diagnostic. Indications: routine temperature measurement in the morning and evening, in patients with fever as prescribed by a doctor. Equipment: watch, medical maximum thermometer, pen, temperature sheet, towel or napkin, container with disinfectant solution. I. Preparation for the procedure 1. Collect information about the patient. Introduce yourself kindly and respectfully, clarify how to address him if the nurse sees the patient for the first time 2. If the patient does not know the purpose and sequence of the procedure, explain them to him Establishing contact with the patient Psychological preparation of the patient for the procedure 3. Obtain the patient’s consent to the procedure Respect for the patient’s rights

8 4. Wash and dry your hands Prevention of hospital-acquired infections 5. Prepare the necessary equipment. Make sure that the thermometer is intact and that the reading on the scale does not exceed 35 C. Otherwise, shake the thermometer so that the mercury drops below 35 C. Ensuring patient safety and the reliability of the temperature measurement result P. Performing the procedure 1. Examine the axillary area, if necessary, wipe it dry with a napkin or ask the patient to do this. Attention! In the presence of hyperemia, local inflammatory processes, temperature cannot be measured. Ensuring the reliability of the result 2. Place the thermometer reservoir in the axillary area so that it is in close contact with the patient’s body on all sides (press). shoulder to chest) Providing conditions for obtaining a reliable result 3. Leave the thermometer for at least 10 minutes. The patient should lie in bed or sit 4. Remove the thermometer. Assess the indicators by holding the thermometer horizontally at eye level Ensuring the reliability of the results Evaluating the measurement results 5. Inform the patient of the thermometry results Ensuring the patient's right to information III. End of the procedure 1. Shake the thermometer so that the mercury column drops into the reservoir. Preparing the thermometer for subsequent measurement of body temperature 2. Immerse the thermometer in a disinfectant solution 3. Wash and dry your hands 4. Make a note of the temperature readings on the temperature sheet. Report patients with fever to the doctor on duty Ensuring continuity of patient monitoring

9 MEASUREMENT OF BLOOD PRESSURE Purpose: diagnostic. Indications: doctor's prescription, preventive examinations. Equipment: tonometer, phonendoscope, alcohol, swab (napkin), pen, temperature sheet. I. Preparation for the procedure Establishing contact with the patient 1. Collect information about the patient. Introduce yourself kindly and respectfully to him. Clarify how to contact him if the nurse sees the patient for the first time 2. Explain to the patient the purpose and sequence of the procedure Psychological preparation for the manipulation 3. Obtain consent for the procedure Respect for the patient's rights 4. Warn the patient about the procedure 15 minutes before its start, if the study is being carried out as planned Ensuring the reliability of the result 5. Prepare the necessary equipment Provision effective implementation procedures 6. Wash and dry your hands 7. Connect the pressure gauge to the cuff and check the position of the pressure gauge needle relative to the zero mark of the scale Checking the serviceability and readiness of the device for work 8. Treat the phonendoscope membrane with alcohol P. Performing the procedure 1. Sit or lie down the patient, ensuring the position of the hand, in which the middle of the cuff is at the level of the heart. Place the cuff on the patient's bare shoulder 2-3 cm above the elbow (clothing should not compress the shoulder above the cuff); fasten the cuff so that 2 fingers are placed between it and the shoulder (or 1 finger in children and adults with small arms). Attention! You should not measure blood pressure on the arm on the side of the mastectomy, on the weak arm of a patient after a stroke, on a paralyzed arm. Elimination of possible unreliability of the results (every 5 cm of displacement of the middle of the cuff relative to the level of the heart leads to an overestimation or underestimation of blood pressure readings by 4 mm Hg) . Elimination of lymphostasis that occurs when air is pumped into the cuff and the vessels are compressed. Ensuring the reliability of the result 2. Invite the patient to place his hand correctly: in an extended position with the palm up (if the patient is sitting, ask to place the clenched fist of the free hand under the elbow) Ensuring maximum extension of the limb 3. Find the place of pulsation brachial artery in the area of the elbow cavity and lightly press the membrane of the phonendoscope to the skin in this place (without any effort). Ensuring the reliability of the result

10 4. Close the valve on the bulb, turning it to the right, and pump air into the cuff under the control of a phonendoscope until the pressure in the cuff (according to the pressure gauge) exceeds 30 mm Hg. the level at which the pulsation disappeared 5. Turn the valve to the left and begin to release air from the cuff at a speed of 2-3 mm Hg/s, maintaining the position of the phonendoscope. At the same time, listen to the sounds on the brachial artery and monitor the pressure gauge scale. Eliminate discomfort associated with excessive compression of the artery. Ensuring the reliability of the result Ensuring the reliability of the result 6. When the first sounds (Korotkoff sounds) appear, “mark” the numbers on the pressure gauge scale and remember them; they correspond to the systolic pressure indicators. Ensuring the reliability of the result. The systolic pressure values should coincide with the pressure gauge readings at which pulsation disappeared during the process of pumping air into cuff 7. Continuing to release air, note the diastolic pressure readings corresponding to the weakening or complete disappearance of loud Korotkoff sounds. Continue auscultation until the pressure in the cuff decreases by mm Hg. relative to the last tone Ensuring the reliability of the result 8. Round the measurement data to 0 or 5, record the result as a fraction (systolic pressure in the numerator; diastolic pressure in the denominator), for example 120/75 mm Hg. Release the air from the cuff completely. Repeat the procedure for measuring blood pressure two to three times with an interval of 2-3 minutes. Record the average values 9. Inform the patient the measurement result. Attention! In the interests of the patient, reliable data obtained during the study is not always reported. Ensuring reliable blood pressure measurement results. Ensuring the patient’s right to information III. End of the procedure 1. Treat the phonendoscope membrane with alcohol 2. Wash and dry your hands 3. Make a note reflecting the results obtained and the patient’s reaction Ensuring continuity of observation Note. At the patient’s first visit, you should measure the pressure on both arms, then only on one, noting which one. If persistent significant asymmetry is detected, all subsequent measurements should be carried out on the hand with higher values. Otherwise, measurements are carried out, as a rule, on the “non-working hand”.

11 MEASUREMENT OF PATIENT GROWTH Purpose: Assessment physical development. Indications: admission to hospital, preventive examinations. Equipment: stadiometer, pen, medical history. Problem: The patient cannot stand. I. Preparation for the procedure 1. Collect information about the patient. Kindly introduce yourself to him. Clarify how to contact him if the nurse sees the patient for the first time. Explain the upcoming procedure to the patient and obtain consent. Assess the patient's ability to participate in the Establishing contact with the patient procedure. Ensuring the patient’s psychological preparation for the upcoming procedure. Respect for the patient's rights 2. Prepare a stadiometer: place an oilcloth or disposable napkin under your feet. Invite the patient to take off his shoes and relax; women need to let their hair down. Ensuring the prevention of nosocomial infections. Security reliable indicators II. Performing the procedure 1. Invite the patient to stand on the stadiometer platform with his back to the stand with the scale so that he touches it with three points (heels, buttocks and interscapular space) Ensuring reliable readings 2. Stand to the right or left of the patient Ensuring a safe hospital environment 3. Slightly tilt the patient's head so that the upper edge of the outer ear canal and the lower edge of the orbit were located on the same line, parallel to the floor. Ensuring reliable indicators” 4. Lower the tablet onto the patient’s head, fix it, ask the patient to lower his head, then help him get off the stadiometer. Determine the indicators corresponding to the numbers located at the level of the bottom edge of the tablet. Providing conditions for obtaining results. Ensuring a protective regime 5. Communicate the received data to the patient Ensuring the patient's rights III. End of the procedure 1. Record the received data in the medical history Ensuring continuity of nursing care Note. If the patient cannot stand, the measurement is taken in a sitting position. I should offer the patient a chair. The fixation points will be the sacrum and interscapular space. And measure your height while sitting. Record the results.

12 WEIGHING AND DETERMINATION OF BODY WEIGHT Purpose: assessment of physical development, effectiveness of treatment and care. Indications: preventive examinations, diseases of the cardiovascular, respiratory, digestive, urinary and endocrine systems. Equipment: medical scales, pen, medical history. Problems: serious condition patient. I. Preparation for the procedure 1. Collect information about the patient. Politely introduce yourself to him. Ask how to address him if the nurse sees the patient for the first time. Explain the procedure and rules (on an empty stomach; in the same clothes, without shoes; after emptying the bladder and, if possible, bowel movements). Obtain patient consent for the procedure. Assess the possibility of his participation in it Establishing contact with the patient. Respect for the patient's rights 2. Prepare the scales: align, adjust, close the shutter. Place oilcloth or paper on the scale platform. Ensuring reliable results. P. Performing the procedure 1. Ask the patient to take off his outer clothing, take off his shoes and carefully stand on the center of the scale platform. Open the shutter. Move the weights on the scales to the left until the level of the rocker matches the control level Ensuring reliable indicators 2. Close the shutter Ensuring the safety of the scales 3. Help the patient get off the weight platform Ensuring a protective regime 4. View the data. Remember that a large weight fixes tens of kilograms, and a small gram within a kilogram. Using the Ketele index body mass index, you can determine the correspondence of height to body weight. To do this, the weight must be divided by the squared height and compared with the indices below: 18 19.9 less than normal; 20 24.9 ideal body weight; 25 29.9 pre-obesity; over 30 obesity 5. Communicate data to the patient Ensuring patient rights III. End of the procedure 1. Remove the napkin from the site and throw it into the trash container. Wash and dry your hands Prevention of nosocomial infections 2. Record the findings in the medical history Ensuring continuity of nursing care Note. If it is not possible to weigh the patient at the moment, the manipulation can be postponed, since it is not vital. In intensive care units and hemodialysis, patients are weighed in bed using special scales.

13 CHAPTER 2 INFECTION SAFETY. INFECTION CONTROL DISINFECTION AND PRE-STERILIZATION CLEANING OF MEDICAL DEVICES IN ONE STAGE MANUAL Purpose: effective disinfection and removal of protein, fat, mechanical contaminants) drug residues to ensure the effectiveness of subsequent sterilization. Indications: contact of instruments and medical devices with biological > bones, wound surfaces and medications. Equipment: containers with tight-fitting lids, measuring cups or dispenser. syringes and needles, thick or “chainmail” gloves, medical instruments, trays, i chemical compounds approved for use as detergents and disinfectants, cotton-gauze swabs, brushes, brushes, napkins. Conditions: presence of a ventilated room, strict adherence to guidelines (instructions regarding the timing of use of drugs and rules for working with each of them I. Preparation for the procedure 1. Put on protective clothing Preserving the health of personnel 2. Prepare equipment Efficiency of the procedure 3. Prepare a detergent and disinfectant complex, for example, based on amixan: add to a container with drinking water using a measuring container amixan at the rate of 30 ml per 1 liter of water. Stir P. Performing the procedure 1. Immerse the used instruments in the resulting 3% working solution: complex disassembled; having a locking part with open locks. Fill the internal channels of needles and tubular products with the resulting solution using a syringe. Make sure that the liquid level border rises above the instruments by more than 1 cm. Close the lid. Attention! Piercing and cutting instruments must be soaked in separate containers Ensuring a disinfection cleaning regime Ensuring the effectiveness of disinfection and cleaning. Environmental protection. Ensuring personnel safety 2. Maintain exposure of products for 15 minutes. Ensuring a disinfecting effect.

14 3. Remove the lid from the container and rinse each product in the solution using a sponge, brushes, napkin or cotton-gauze swab, channels using a syringe Removing contaminants from joints on instruments, from gaps, cavities, gaps 4. Raise the perforated tray with instruments over the container, allow the solution to drain. Place the tray with tools in the sink under running water and rinse each product for 5 minutes 5. Rinse each product with distilled water (channels using a syringe or electric suction) for 0.5 minutes Removing detergent residues from treated products Desalting the surface of products and prevention pyrogenic reactions 6. Dry the instruments with hot air in an air sterilizer at a temperature of 85 C until the moisture completely disappears Reducing the risk of contamination of products III. End of procedure 1. Remove gloves, wash hands with soap and running water Note. To carry out disinfection and pre-sterilization cleaning in one stage you can use: alaminol, lysetol AF, veltolen, disinfectant, deconex dental, dulbak, septabic, septodor, septodor forte, virkon, peroximed, blanisol, anolytes from an ECHO installation, Vex-side, nika -exta M, lysofin and other approved products.

15 CHAPTER 3 RECEPTION OF A PATIENT TREATMENT OF A PATIENT WITH PEDICULOSIS Purpose: therapeutic and preventive. Indications: presence of pediculosis. Equipment: additional robe, headscarf, 2 waterproof aprons, gloves, oilcloth tires with warm water, anti-pediculosis agent, shampoo, 2 towels, comb (comb basin, cellophane cape, shower cap. I. Preparation for the procedure 1. Collect information about the patient before meeting him. Introduce him kindly and respectfully. Clarify how to contact him if the nurse sees the patient for the first time. Find out whether he is familiar with this manipulation, when, for what reason, how he underwent it Establishing contact with the patient 2. If you do not know. explain the goals and sequence of the upcoming procedure to the patient Psychological preparation for the manipulation 3. Obtain his consent Respect for the patient's rights 4. Prepare the necessary equipment Ensuring the effective implementation of the procedure 5. Wash and dry your hands, put on an additional robe, apron, gloves Lay an oilcloth on the floor and. put a chair on it 6. Help the patient put on an apron and sit (if condition allows) on a chair, cover the patient’s shoulders with a cellophane drape 7. Give the patient (if possible) a towel and ask him to close his eyes. If the patient is unable to hold a towel, an assistant will do this for him, who should also have an additional robe, scarf and gloves. Dilute the pediculocide in accordance with the instructions for use II. Performing the procedure 1. Wet the patient’s hair with a small amount of water from a jug (water temperature C) Ensuring safety infectious patient Preventing the fagot from getting into the patient's eyes. Ensuring the procedure and organizing the safety of the nurse and patient. Providing conditions for nag pediculocidal agent

16 2. Treat the patient’s hair evenly with the prepared anti-pediculocidal agent (t 27 C). Cover the patient's head with a cap for min (exposure depends on the product used) 3. Rinse the patient's hair with warm water, rinse it with a 6% solution table vinegar(t 27 C). Divide hair into strands and comb each strand with a fine comb. Remove the towel covering your eyes. Dry and examine the patient's hair. Attention! If there are flat spots, the hair in armpits and the pubic area is shaved or treated with the same pediculocidal agent. Ensuring the quality of anti-pediculosis treatment. Quality control of the treatment. Ensuring quality treatment 4. Ask the patient how he is feeling Determine the patient's response to the procedure III. End of the procedure 1. Place the patient’s linen and clothes in a bag and send them to the disinfection chamber. Remove apron, robe, gloves, place in a bag for disinfestation. Wash and dry your hands 2. Make a note about head lice: on the title page in the right Ensuring continuity in the upper corner " Medical card inpatient” control and observation of the patient, put the letter “P” in red pencil 3. Fill out an emergency notification about the detection of an infectious disease and report to the branch of the Federal State Health Institution “Center for Hygiene and Epidemiology” (F. 058/U), register the patient’s data in the "Accounting Journal" infectious diseases» (F. 060/U) Compliance with nosocomial infection control requirements Note. If the hair is treated not with organophosphorus preparations, but with a soap-powder emulsion, the nits remain unharmed, so additional treatment is required with a 30% solution of table vinegar heated to 27 C (20 min). If head lice is detected in men, the hair can be cut short (with the patient's consent). The cut hair is collected in a bag and burned. Used instruments and care items, the room where the patient was treated, are disinfected with the same means.

17 TRANSFERING THE PATIENT FROM THE SUPINE POSITION TO THE SIMS POSITION Purpose: to place the patient in a physiological position (done by one or two nurses; the patient can only help partially or cannot help at all). Indications: forced or passive position, change of position if there is a risk of developing bedsores or bedsores. Equipment: extra pillow, footrest or sandbag, bolsters, half a rubber ball. Note: the procedure can be performed on either a functional or a regular bed. I. Preparation for the procedure 1. Collect information about the patient. Introduce yourself kindly and respectfully to him. Clarify how to contact him if the nurse sees the patient for the first time Establishing contact with the patient 2. Explain the purpose and sequence of the procedure Ensuring the patient’s psychological preparation for the procedure 3. Obtain the patient’s consent to perform the procedure Respecting the patient’s rights 4. Prepare equipment Ensuring the effectiveness of the procedure 5. Wash and dry your hands. If there is a risk of contact with biological fluid put on gloves II. Performing Procedure 1. Apply the bed brakes. Raise the bed to the maximum comfortable height for working with the patient 2. Lower the side rails (if any) on the left side of the patient. Move the head of the bed to a horizontal position (or remove the pillows) 3. Ask the patient to cross his arms over his chest, move him closer to the left edge of the bed 4. Inform the patient that he can help the nurse in the following way: put his left leg under his right. If the patient himself is not capable of such actions, the nurse needs to clasp the back of the patient's foot with one hand and move it towards the pelvis, sliding it along the bed. At the same time, with the other hand, located in the popliteal cavity, the nurse lifts the patient’s leg up. Prevention of nosocomial infections. Ensuring the safety of the patient and the correct biomechanics of the nurse’s body. Ensuring access to the patient and his safety. Ensuring that the patient's body is properly erect Providing sufficient space for the patient to turn onto their side Ensuring the patient's active participation. Reducing physical stress on the nurse 5. Raise the side rails. Stand to the right of the bed and lower the grab bars 6. Place the protector on the bed next to the patient. Stand as close to the bed as possible, bend one leg at the knee. Place your knee on the protector. The second leg is a support if the bed level is not adjustable Ensuring the safety of the patient Ensuring the correct biomechanics of the nurse's body. Ensuring nurse and patient safety

18 7. Place your left hand on the patient’s left shoulder, and right hand on his left thigh and move the patient in a position lying on his side and partially on his stomach (only part of the patient’s abdomen is on the mattress) 8. Push the right “lower” shoulder back and release the “lower” arm from under the patient’s body, placing it along the body. Place a pillow under the patient's head 9. Place a pillow under the bent “upper” arm at shoulder level. Place the relaxed hand on half of the ball 10. Place a pillow under the bent “upper” leg so that the leg is at hip level. Ensuring correct biomechanics of the nurse’s body. Reducing the risk of falls and skin friction when moving the patient towards the nurse Ensuring that the patient's body is straightened. Reduce lateral neck flexion Prevent shoulder internal rotation. Maintaining the necessary straightness of the body Preventing internal rotation of the hip and placing the “upper” leg on the “lower” leg. Prevention of hyperextension of the leg. Reducing the pressure of the mattress on the knee and ankle 11. Provide support for the lower foot at an angle of 90 Ensuring dorsiflexion of the foot. Preventing foot drop. Ensuring the prevention of bedsores 12. Make sure that the patient is lying comfortably, straighten the sheet. Raise the side rails. Lower the bed to its previous height III. End of the procedure 1. Disinfect and further dispose of gloves if they have been used. Wash and dry hands Ensuring patient safety 2. Record the procedure and the patient's response Ensuring continuity of nursing care MOVEMENT OF A PATIENT WITH HEMIPLEGIA INTO THE PRODUCT POSITION Purpose: to place the patient in a physiological position (performed by one or two nurses as directed by the doctor, the patient cannot help) . Indications: forced or passive position, change of position if there is a risk of developing bedsores or bedsores. Equipment: extra pillow, footrest or sandbag, bolsters, footrest, half a rubber ball, napkin. Note: the procedure can be performed on either a functional or a regular bed. I. Preparation for the procedure 1. Collect information about the patient. Introduce yourself kindly and respectfully to him. Clarify how to contact him if the nurse sees the patient for the first time Establishing contact with the patient 2. Explain the purpose and sequence of the procedure Ensuring the patient’s psychological preparation for the upcoming procedure

19 3. Obtain the patient’s consent for the procedure Respecting the patient’s rights 4. Prepare equipment Ensuring the effectiveness of the procedure 5. Wash and dry hands. If there is a risk of contact with biological fluid, wear gloves P. Performing the procedure 1. Secure the bed brakes. Raise the bed to the height that is most comfortable for working with the patient 2. Lower the side rails of the bed (if any) on the side facing the paralyzed part of the patient’s body. Move the head of the bed to a horizontal position (or remove the pillows) 3. Cross the patient's arms over his chest. Move the patient towards the paralyzed side of the body Ensuring the safety of the patient and proper body mechanics of the nurse Ensuring access to the patient and his safety. Ensuring that the patient's body is properly straightened. Providing sufficient space to turn the patient onto his stomach. Prevention of injury to the paralyzed side 4. Place the patient's paralyzed leg on the healthy leg. Reduce physical stress on the nurse 5. Raise the side rails. Move to the other side of the bed and lower the rails 6. Place a thin pillow over the area where the patient's abdomen will be located. Ensuring the safety of the patient Preventing sagging of the abdomen. Reducing hyperextension of the lumbar vertebrae and tension in the lower back muscles 7. Straighten the elbow of the paralyzed arm. Press it along its entire length to the body. Place your healthy hand in. Eliminate the danger of your hand being crushed when moving the patient! on the stomach 8. Place the protector on the bed next to the patient. Stand as close to the bed as possible, bend one leg at the knee and place your knee on the protector. The second leg is a support if the bed level is not adjustable. Ensuring correct biomechanics of the nurse's body. Ensuring Nurse and Patient Safety 9. Place your left hand on the patient's "far" shoulder and your right hand on the patient's "far" thigh. Turn the patient on his stomach towards the nurse 10. Turn the patient's head to the side (towards the paralyzed side of the body). Place a thin pillow under the patient's head and neck 11. Bend the arm towards which the patient's head is facing, elbow joint at 90. Place the relaxed hand on half of the ball covered with a napkin. Extend the other arm along the body. Ensuring the correct biomechanics of the sister’s body. Reducing the risk of falls and skin friction when moving the patient towards the nurse Reducing flexion and hyperextension of the cervical vertebrae of the neck muscles Preventing the risk of limiting the ability of the arm to perform external rotation around shoulder joint

20 12. Bend both knees of the patient and place a pillow under Preventing prolonged hyperextension knee joints. Prevention of the lower leg so that the fingers do not touch the bed for the development of bedsores on the toes 13. Provide support for the feet at an angle of 90. Ensure dorsiflexion of the foot 14. Make sure that the patient is lying comfortably, straighten the sheet. Raise the side rails. Lower the bed to its previous height III. End of procedure 1. Disinfect and further dispose of gloves if they have been used. Wash and dry hands Ensuring patient safety 2. Record the procedure and the patient's response Ensuring continuity of nursing care POSITIONING A PATIENT WITH HEMIPLEGIA IN THE FOWLER POSITION Goal: Place the patient in a physiological position (performed by one nurse). Indications: feeding (eating independently), performing procedures requiring this provision; risk of developing bedsores and contractures. Equipment: set of pillows, bolsters, footrest, rubber ball halves (2 pieces), 2 napkins. Note: the procedure can be performed on either a functional or a regular bed. I. Preparation for the procedure 1. Collect information about the patient. Introduce yourself kindly and respectfully to him. Clarify how to contact him if the nurse sees the patient for the first time 2. Explain to the patient the purpose and sequence of the procedure Establishing contact with the patient Ensuring the patient’s psychological preparation for the upcoming procedure 3. Obtaining the patient’s consent to perform the procedure Respecting the patient’s rights 4. Prepare equipment Ensuring the effectiveness of the procedure 5. Wash and dry your hands. If there is a risk of contact with biological fluid, wear gloves P. Performing the procedure 1. Secure the bed brakes. Raise the bed to the height that is most comfortable for working with the patient. Prevention of nosocomial infections. Ensuring the safety of the patient and the correct biomechanics of the nurse’s body. 2. Lower the side rails (if any) on the side where the nurse is. Ensuring access to the patient and his safety.

21 3. Make sure the patient is lying on his back in the middle of the bed. Remove pillows 4. Raise the head of the bed at an angle (or place three pillows) Position the patient in a position convenient for movement Ensuring the patient's comfort. Improving pulmonary ventilation Ensuring patient relaxation. 5. Sit the patient as high as possible. Place a small pillow under the head (if the headboard is raised) 6. Slightly lift the patient's chin up. Move the patient's upper limbs away from his body and place small pillows under the elbows and hands 7. Place the hands on halves of rubber balls covered with napkins. Place a thin pillow under the patient's lower back. Bend the patient’s legs at the knee and hip joints, placing a pillow or folded blanket under the lower third of the thigh. 8. Place a bolster under the lower third of the patient’s shin so that the heels do not touch the mattress. Reducing the likelihood of the patient “falling over” on the paralyzed side of the body. Improving ventilation of the lungs, heart function, reducing intracranial pressure. Ensuring comfortable eating and liquids. Prevention of aspiration of food, liquids, and vomit. Prevention of neck muscle tension Reducing the load on the cervical spine. Prevention of flexion contracture of muscles upper limb and overstretching of the shoulder joint capsules. Preservation of functional damage to the hands. Prevention of contracture of the joints of the hands. Reducing the load on the lumbar spine. Prevention of prolonged hyperextension of the knee joints and compression of the popliteal artery. Prevention of bedsores in the heel area. 9. Provide support for the feet at an angle of 90. Ensuring dorsal flexion of the foot. Prevention of foot drop. Maintaining muscle tone 10. Make sure that the patient is lying comfortably, straighten the sheet. Raise the side rails. Lower the bed to its previous height III. End of the procedure 1. Disinfect and further dispose of gloves if they have been used. Wash and dry hands Ensuring patient safety Preventing hospital-acquired infections 2. Record the procedure and the patient's response Ensuring continuity of nursing care.

22 PLACEMENT OF THE PATIENT IN A SUPRINE POSITION Purpose: to give the patient a physiological position (performed by one nurse). Indications: forced or passive position; risk of developing bedsores; hygiene procedures in bed. Equipment: extra pillow, bolsters, footrest, two rolled sheets, towel. Note: the procedure can be performed on either a functional or a regular bed. I. Preparation for the procedure 1. Collect information about the patient. Introduce yourself kindly and respectfully to him. Clarify how to contact him if the nurse sees the patient for the first time Establishing contact with the patient 2. Explain the purpose and sequence of the procedure Ensuring the patient’s psychological preparation for the upcoming procedure 3. Obtain the patient’s consent for the procedure Respecting the patient’s rights 4. Prepare equipment Ensuring the effectiveness of the procedure 5 . Wash and dry your hands. If there is a risk of contact with biological fluid, wear gloves P. Performing the procedure 1. Secure the bed brakes. Raise the bed to the height that is most comfortable for working with the patient Ensuring the safety of the patient and the correct biomechanics of the nurse’s body 2. Lower the side rails (if any) on the side where the nurse is 3. Lower the head of the bed (remove excess pillows), giving the bed a horizontal position . Remove the blanket. Make sure that the patient is lying in the middle of the bed Ensuring access to the patient and his safety Ensuring the correct position of the patient 4. Give the patient the correct position: a) put a pillow under the head (or adjust the remaining one); b) place your arms along your body, palms down; c) place the lower limbs in line with the hip joints 5. Place a small pillow under top part shoulders and neck Ensuring a comfortable position for the patient Ensuring proper distribution of the load on the upper body. Preventing tension in the neck muscles 6. Place small pillows under the forearms to facilitate the outflow of blood. Preventing swelling of the hand 7. Place a small towel rolled up under the lower back, without folds. Preventing hyperextension of the lumbar spine.

23 8. Place rolls of rolled sheets along outer surface hips from the area greater trochanter femur and further 9. Place a small pillow or cushion under the lower leg in the area of its lower third. Preventing the hip from rotating outward. Prevention long-term pressure mattress on the heels and formed] bedsores 10. Provide support to support the feet at an angle of 90 Ensure dorsiflexion of the feet Prevent foot drop 11. Make sure the patient is lying comfortably. Straighten the sheet and cover the patient with a blanket. Raise the side rails. Lower the bed to its previous height Ensuring patient safety III. End of procedure 1. Disinfect and dispose of gloves if they have been used. Wash and dry hands 2. Make a record of the procedure and the patient's response Ensuring continuity of nursing care

24 CHAPTER 5 PERSONAL HYGIENE OF THE PATIENT CHANGING BED LINEN BY THE CROSS-WAY METHOD Purpose: maintaining personal hygiene, preventing hospital-acquired infections (the procedure is performed by a nurse and an assistant, the patient is in bed). Indications: deficiency of self-care. Equipment: a set of clean linen, a bag for dirty linen, gloves, a container with a disinfectant solution. I. Preparation for the procedure 1. Collect information about the patient. Introduce yourself kindly and respectfully to him. Clarify how to contact him if the nurse sees the patient for the first time. Explain the sequence of the procedure to the patient and obtain his consent. Attention! If relatives or other members of the medical team are involved in the procedure, the extent of each intervention should be determined in advance 2. Prepare a set of clean linen. Roll up a clean sheet like a bandage (in the transverse direction) 3. Wash your hands, and in case of possible contact with biological fluids, wear gloves II. Performing the procedure 1. Stand on both sides of the bed, lower the head of the bed. Establish contact with the patient. Ensuring the patient’s psychological preparation for the upcoming procedure. Respect for the patient's rights and hygienic comfort Ensuring the patient's safety and correct body biomechanics 2. The nurse place his hands under the patient's shoulders and head, slightly lift him up; Ensuring the effectiveness of the procedure; assistant remove the pillow from under the head 3. Lower the patient onto the bed. Change the pillowcase Ensuring a safe hospital environment 4. Remove the blanket from the patient, cover it with a small sheet Reduce discomfort in the patient without underwear 5. The nurse raises the patient's head and shoulders, the assistant rolls the dirty sheet from the side of the head to the middle of the bed. On the freed part, lay and spread a prepared and rolled up clean sheet for hygienic comfort.

25 6. Place a pillow at the head and lower the patient’s head and shoulders onto it 7. Raise the patient’s pelvis (ask the active patient to lean on his legs and rise above the bed), move the dirty sheet in the direction of the feet, then straighten the clean one, lower the patient onto it Ensuring physical comfort Ensuring the patient's comfort and infectious safety (the patient's active participation in care helps to increase self-esteem) 8. Place the dirty sheet in a laundry bag 9. Tuck the edges of a clean sheet under the mattress on all sides Ensuring comfort 10. Remove the duvet cover from the blanket, put on a clean one. Place the dirty duvet cover in the bag. Cover the patient. Tuck the blanket and hygienic comfort 11. Ensure that the patient feels comfortable Ensuring psychological comfort 12. Remove dirty linen from the room III. End of the procedure 1. Disinfect and further dispose of gloves if they have been used. Wash and dry your hands 2. Make a note about the change of linen in the documents Ensuring continuity of patient care CHANGING BED LINEN IN A LONGITUDINAL WAY Purpose: maintaining personal hygiene, preventing hospital-acquired infections (the procedure is performed by a nurse and an assistant, the patient is in bed). Indications: deficiency of self-care. Equipment: a set of clean linen, a bag for dirty linen, gloves, a container with a disinfectant solution. I. Preparation for the procedure 1. Introduce yourself kindly and respectfully to the patient. Clarify how to contact him if the nurse sees the patient for the first time. Explain to the patient the purpose and sequence of the upcoming procedure and obtain his consent. Assess the patient's ability to participate in the procedure. Attention! If relatives or other members of the medical team are involved in the procedure, the extent of each intervention should be determined in advance 2. Prepare a set of clean linen. Roll up half the sheet into a roll along its entire length Establishing contact with the patient. Psychological preparation of the patient for the upcoming procedure. Respect for patient rights. Ensuring careful procedure and hygienic comfort

26 3. Wash and dry your hands, if there is a risk of contact with biological fluid, wear gloves II. Performing the procedure 1. Stand on both sides of the bed, lower the head of the bed. Prevention of nosocomial infections. Ensuring the safety of the patient and correct body biomechanics 2. The nurse put his hands under the patient’s shoulders and head and slightly lift him, the assistant removes the pillow from under the head. Lower the patient onto the bed (without a pillow). Remove the pillowcase from the pillow and place it in the laundry bag. Put on a clean pillowcase Ensuring the procedure is effective 3. The nurse removes the blanket from the patient and covers him with a small sheet 4. The nurse turns the patient on his side, facing the edge of the bed, and holds him in this position. At the same time, monitor his condition. Reduce psychological discomfort. Provide the opportunity to change linen. Preventing the patient from falling 5. For the assistant to roll up the dirty sheet with the roller towards the back. Ensure the possibility of changing the patient’s linen and lay out a previously prepared and half-rolled clean sheet, covering the vacated part of the bed 6. For the assistant, turn the patient on his back, then carefully on the other side so that he is on the clean sheet. Keep the patient in a lateral position Ensure hygienic comfort. Preventing Patient Falls 7. The nurse rolls up the dirty sheet and places it in a laundry bag. Roll out a clean sheet and tuck its edges under the mattress 8. Turn the patient and lay him on his back. Place a pillow under your head and shoulders 9. Have your assistant remove the dirty duvet cover and put it in a dirty laundry bag. Wear a clean one. Cover the patient. Tuck the blanket and hygienic comfort Ensuring bed comfort and hygienic comfort 10. Ensure that the patient feels comfortable Ensuring psychological comfort III. End of the procedure 1. Remove the bag with dirty linen from the room. Disinfect and further dispose of gloves if they have been used. Wash and dry your hands 2. Make a note about the change of linen Ensuring continuity of patient care

1. Collection of urine for laboratory tests. Formulation of directions. 2. Clinical death. Diagnostics. Signs. Cardiopulmonary resuscitation techniques (carrying out indirect massage heart and artificial

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Nursing Basics Cheat Sheet

Section 1. Introduction to the discipline “Fundamentals of Nursing”

1. State organizational structures dealing with nursing issues

Russia has a healthcare system with different forms of ownership: state, municipal And private. It resolves issues of social policy and has three levels of management organization.

1. Ministry of Health of the Russian Federation, in which there are departments:

1) organization of medical care;

2) protection of maternal and child health;

3) scientific and educational medical institutions;

4) personnel, etc.;

2. Ministry of Health of the region (territory);

3. health department under the city administration.

The task of social policy is to achieve a level of health that will allow a person to live productively with the longest possible life expectancy.

The main priority areas of social policy in the field of healthcare:

1) development of laws to implement reforms;

2) protection of motherhood and childhood;

3) financing reform (health insurance, the use of funds from various funds to support and treat relevant categories of the population - pensioners, the unemployed, etc.);

4) compulsory health insurance;

5) reorganization of primary health care;

6) drug provision;

7) personnel training;

8) healthcare informatization.

The basic basis of the healthcare system should be the adoption of the laws of the Russian Federation “On State system healthcare”, “On the rights of the patient”, etc.

Already today, markets for medical services are being formed, medical and preventive institutions are being created with various forms of ownership, day-care hospitals, hospices, palliative medicine institutions, i.e., institutions where care is provided to the hopelessly ill and dying. In 1995 there were already 26 hospices in Russia, in 2000 there were already more than 100.

2. Main types of treatment and preventive institutions

There are two main types of treatment and prevention institutions: outpatient And stationary.

Outpatient facilities include:

1) outpatient clinics;

2) clinics;

3) medical units;

4) dispensaries;

5) consultations;

6) ambulance stations.

Inpatient institutions include:

1) hospitals;

2) clinics;

3) hospitals;

4) maternity hospitals;

5) sanatoriums;

6) hospices.

In order to improve the quality of medical and preventive work, since 1947, Russia has been merging clinics with outpatient clinics and hospitals. This organization of work helps to improve the qualifications of doctors, and thereby improve the quality of service to the population.

3. Structure and main functions of hospitals

There are general, republican, regional, regional, city, district, rural hospitals, which are often located in the center of the service area. Specialized hospitals(oncological, tuberculosis, etc.) are located depending on their profile, often on the outskirts or outside the city, in a green area. There are three main types of hospital construction:

2) centralized; 1) pavilion;

3) mixed.

With the pavilion system, small separate buildings are located on the hospital premises. The centralized type of construction is characterized by the fact that the buildings are connected by covered above-ground or underground corridors. Most often in Russia, mixed-type hospitals were built, where the main non-infectious departments are located in one large building, and infectious diseases departments, outbuildings, and the like are located in several small buildings. The hospital site is divided into three zones:

1) buildings;

2) utility yard area;

3) protective green zone.

The medical and economic zones must have separate entrances.

The hospital consists of the following facilities:

1) a hospital with specialized departments and wards;

2) auxiliary departments (X-ray room, pathology department) and laboratory;

3) pharmacies;

4) clinics;

5) catering unit;

6) laundry;

7) administrative and other premises.

Hospitals are for permanent treatment and care for patients with certain diseases, for example surgical, therapeutic, infectious, psychotherapeutic, etc.

The hospital inpatient setting is the most important structural unit, where they admit patients who require modern, sophisticated diagnostic methods and treatment, and provide treatment, care and other cultural and everyday services.

The structure of a hospital of any profile includes wards for accommodating patients, utility rooms and a sanitary unit, specialized rooms (procedural, treatment and diagnostic), as well as a resident’s room, a nursing room, and the office of the head of the department. The equipment and facilities of the wards correspond to the profile of the department and sanitary standards. There are single and multi-bed wards. The ward has:

1) bed (regular and functional);

2) bedside tables;

3) tables or table;

4) chairs;

5) a wardrobe for the patient’s clothes;

6) refrigerator;

7) washbasin.

The beds are placed with the head end to the wall at a distance of 1 m between the beds for the convenience of transferring the patient from a gurney or stretcher to the bed and caring for him. Communication between the patient and the nurse's station is carried out using an intercom or light alarm. In specialized departments of the hospital, each bed is provided with a device for centralized oxygen supply and other medical equipment.

The lighting of the wards complies with sanitary standards (see SanPiN 5.). It is determined in the daytime by the light coefficient, which is equal to the ratio of the window area to the floor area, respectively 1: 5–1: 6. In the evening, the chambers are illuminated with fluorescent lamps or incandescent lamps. In addition to general lighting, there is also individual lighting. At night, the wards are illuminated by a night lamp installed in a niche near the door at a height of 0.3 m from the floor (except for children's hospitals, where lamps are installed above the doorways).

Ventilation of the rooms is carried out using a supply and exhaust system of ducts, as well as transoms and vents at the rate of 25 m3 of air per person per hour. Concentration carbon dioxide in the air environment of the room should not exceed 0.1%, relative humidity 30–45%.

The air temperature in the rooms of adults does not exceed 20 °C, for children – 22 °C.

The department has a distribution room and a canteen, providing simultaneous food intake for 50% of patients.

The department corridor must ensure the free movement of gurneys and stretchers. It serves as an additional air reservoir in the hospital and has natural and artificial lighting.

The sanitary unit consists of several separate rooms, specially equipped and designed to carry out:

1) personal hygiene of the patient (bathroom, washroom);

2) sorting dirty laundry;

3) storage of clean linen;

4) disinfection and storage of vessels and urinals;

5) storage of cleaning equipment and overalls for service personnel.

Infectious diseases departments of hospitals have boxes, semi-boxes, regular wards and consist of several separate sections that ensure the functioning of the department when quarantine is established in one of them.

Each department has, in accordance with the established procedure, an internal departmental routine that is mandatory for staff and patients, which ensures that patients comply with the medical and protective regime: sleep and rest, dietary nutrition, systematic observation and care, implementation of medical procedures, etc.

The functional responsibilities of a hospital nurse include:

1) compliance with the medical and protective regime of the department;

2) timely implementation of medical prescriptions;

3) patient care;

4) assistance to the patient during examination by a doctor;

5) monitoring the general condition of patients;

6) provision of first aid;

7) compliance with the sanitary and anti-epidemic regime;

8) timely transmission of an emergency notification to the Center for State Sanitary and Epidemiological Surveillance (State Sanitary and Epidemiological Surveillance Center) about an infectious patient;

Nursing process - one of the basic concepts of modern nursing grandfather. First introduced in the United States by Lydia Hall in 1955. The term “nursing process” emphasizes its connection with nursing care aimed at protecting the “health of individuals, their families or groups of the population. It involves the use of scientific methods to determine the health care needs of the patient (family or society) and on this basis selecting those that can be most effectively satisfied through nursing care" (WHO, 1995).

The nursing process is focused on the person as a unique, inimitable individual and on the family as the basis of the life of each person and society. This process includes a new understanding of the role of the nurse in health care, requiring from her not only good technical training, but also the ability to think logically, to work with the patient as an individual, and not as an object of “manipulative equipment.”

Definition. The nursing process is a dynamic process of managing a person’s adaptation to the environment and effectively meeting the physiological, psychological and social needs of a patient (family) or social group related to health, i.e. the provision of medical and social care by a nurse working as part of a multidisciplinary team specialists in the field of health and social sphere. This process involves mobilizing the necessary resources of the health system and society as a whole. It includes methods for determining the needs, goals and objectives of interventions, their priority, and the type of nursing care. This process is planned and implemented with the active and interested cooperation of all participants in the process, it is ultimately aimed at achieving best quality the patient's life in specific conditions.

Tasks nursing process:

identification of violated needs and problems caused by them (existing and potential) both in a specific person and in his family, group of people or society;
identifying the capabilities of a person, family, group of people in satisfying their life important needs, i.e., the needs necessary to maintain the chosen social, family, professional roles, etc.;
establishing the reasons for the violation of needs and the occurrence of problems, reasons that reduce the capabilities of a person, family (group), society in realizing, restoring and maintaining their capabilities and solving health-related problems;
building and implementing a nursing care plan that will be accepted by all participants in the nursing process;
maintaining and restoring in an individual, family, or group of persons the greatest possible independence, autonomy in the implementation and satisfaction of vital needs, regardless of illness;
providing the patient, family, group of people (despite the persistence of health problems, the incurability of the disease, the inevitability of death) with a decent quality of life.

The need to implement the nursing process

in nursing education and practice

The nursing process is an approach to standardizing the activities of clinical nurses. Standardization of the work of nursing staff serves to improve the quality of nursing care, its assessment and control.

When performing the nursing process, it is necessary to adhere to the principle holistic approach to the patient as an individual, which is reflected in the principle of domestic medical school: treatment not of the disease, but of the patient in all his unity and diversity of connections with the environment (S. P. Botkin). In modern foreign literature a holistic approach to personality in the unity of physical, mental and spiritual components is called holistic.

The principle of integrity that the nurse must use in her work is combined with the fundamental concept and principles of homeostasis.

Homeostasis(from the Greek homoios - similar and stasis - standing, immobility) - a type of dynamic balance characteristic of complex self-regulating systems, such as a living person, and consisting in maintaining the relative constancy of physiological indicators that are essential for the preservation of the system (health, human life).

The use of the nursing process as a scientifically based method is impossible without the nurse understanding and using the principles of integrity and homeostasis in her work. Knowing them allows her, when working with a healthy person, a sick person, and his family, to identify those signs that indicate a loss of stability, balance, the threat of illness, its relapse, changes in the family, and its medical and social problems. The principles of integrity and homeostasis will help the nurse use those evidence-based nursing practices that, when incorporated into the overall plan of care, will ensure stability or return of the disturbed system to a state of stable equilibrium of both the biological (person) and social (family) systems. The principles of the integrity of homeostasis have universal significance both in the study, observation and assessment of human health, and in the analysis of external environmental factors, working and living conditions of a person, i.e. factors that can contribute to deterioration of health, development of disease and changes in lifestyle .

The method, called the “nursing process,” is the scientific basis for the organization of nursing, nursing education and practice..

Advantages methodology nursing process For nursing education and practice:

the safety of medical care is guaranteed, standards of nursing care are formed and implemented;
the principle of individual and systematic approach when providing nursing care, the efforts of all participants in the process are coordinated and coordinated;
the patient and his family actively participate in the planning and implementation of the nursing care program;
it becomes possible to use standards of professional activity in broad clinical practice, professional terminology and the language of professional communication in training and practice;
in practice, the principle of continuity in the provision of medical care in the work of nurses and nursing services is implemented;
time and resources are effectively used to address the basic needs and problems of the patient, family and group of people;
the quality, timeliness of nursing care provided and the professionalism of the nurse are documented;
demonstrates the level of professional competence, responsibility and reliability of not only an individual nurse, but also the entire nursing service of a particular medical post, departments, medical institutions;
it becomes possible to analyze the work of each nurse, nursing service, generalize work experience, concretely evaluate new technologies of care, training programs and recommend them for wide practice;
the approach allows you to protect the professional interests of the nurse in cases of unfounded claims about the quality of her work, the level of her professional training and give an objective assessment in conflict situations;
the approach is scientifically based and universal.