Ear care. Caring for the ears and external auditory canal Caring for the patient’s nose algorithm
The nose is incredibly important for the human body. It supplies warmed and purified air to the lungs. With the help of the nose, a person distinguishes odors, thereby protecting himself from the danger of eating spoiled food. By causing an allergic reaction in the body, the nose warns a person about the presence of harmful substances near it. If we start talking about all the important functions of the nose for the human body, then the entire article will be devoted only to this topic... I would like to talk about how to properly care for the nasal cavity so that it in no way loses the sharpness of its talents.
The nose owes much of its sensitivity to the mucous membrane. It is incredibly gentle and equipped with sensitive receptors. The mucous membrane sanitizes the nasal cavity, clearing it of various types of impurities that form accumulations in the nose. A healthy nose takes care of clearing out mucus accumulations.
For various reasons, this ability may be impaired:
- trauma (septal fracture, foreign body, after surgery);
- inflammatory process (rhinitis, sinusitis);
- the presence of neoplasms in the nasal cavity (cyst, polyp);
- smoking (effect of nicotine and tar).
If lumps of mucus accumulate in the nasal cavity, it must be removed. This can be done using simple methods.
Nose care involves:
Saline ionized solution (Salin) or a solution based on sea water (Dolphin, Humer). They can be bought at a pharmacy or made at home. Rinsing is carried out using a special syringe; it also helps to moisturize the mucous membrane, which is an excellent protection against viruses and infections.
There is also a method of nasal rinsing used in yoga culture called jala lota. To do this, use a small neti lota teapot filled with saline solution. The head should be stretched forward and slightly tilted down and you should breathe slowly through your mouth. The solution should be poured from the teapot into one nostril so that it flows out of the other. You can’t hold your breath, as this could cause it to get into the paranasal sinuses. This washing should be done at least three times a day;
Cleansing with cotton swabs. It must be done daily, since the accumulation of lumps of pollution makes breathing difficult and, thereby, prevents oxygen from entering the lungs. To do this, you need to lubricate a cotton swab with slightly heated oil (refined vegetable oil, Vaseline) and first treat one nasal passage, then the other. This procedure will soften dried lumps of mucus. Then use a dry stick to remove them from the passages. If there is liquid mucus, suck it out of the nasal passage with a small syringe;
Inhalations using herbal decoctions (chamomile, sage, eucalyptus). Herbal enzymes have a beneficial effect on the mucous membrane. Inhalation can be done using an inhaler or breathing through the spout of a kettle. 
Newborn nose care
Caring for a newborn's nose involves helping to remove accumulated mucus to allow the baby to breathe freely. If the nasal passages are visually clean, they cannot be cleaned!
Basically, a newborn's nose cleans itself when the baby sneezes. Accumulated crusts must be removed very delicately and correctly so as not to harm the baby.
Every mother should have the following reminder for caring for her child:
- Twist a piece of sterile cotton wool into a rope, which should be lubricated with baby oil. The tourniquet should not be made too hard or replaced with cotton wool wound around a match - this can injure the baby’s delicate skin;
- Insert the flagellum into the nostril and remove the stuck crust with rotational movements. Clean the other nostril with another clean flagellum;
- If there is a large amount of accumulated mucus, you can drop a few drops of baby rinse solution into your nose, then suck out the mucus with a small syringe.
This procedure should be done every time you wash your face in the morning and before feeding, of course, if necessary. It should be remembered that you need to take care of your baby’s nose very carefully so as not to harm the delicate skin. 
After rhinoplasty
Currently, any cosmetic defects of the nose can be solved with the help of plastic surgery. The hands of surgeons work wonders and make people happier and more confident. But no matter how amazing the effect is, you need to remember that this is an operation. It is a great stress and severe trauma for the nasal cavity and for the entire body as a whole.
Needed after surgery a particularly thorough nasal care regimen. The patient should be encouraged to comply with the following rules:
- protect your nose from possible injuries;
- moisturize the nose with a special spray based on non-aggressive saline solution. Washing will also be an excellent prevention against infection;
- there is no need to specifically remove it. They will come out on their own as the wound surface heals and the patient will soon be able to breathe freely through his nose after rhinoplasty;
- reduce swelling using special compresses with a cooling effect and use high pillows during sleep. Swelling disappears completely three months after surgery;
- position of the patient's body. You cannot tilt your head down, and you can only sleep on your back;
- treat the nostrils at the entrance to the nose with hydrogen peroxide 3%;
- You should not wash your nose or use cosmetics in the first days after surgery;
- you cannot move actively and overwork for two weeks;
- You cannot take a steam bath or swim in a pool for a month after surgery.
Seriously ill patient
Target: maintaining personal hygiene, preventing otitis media.
Indications: the patient's stay on bed rest and strict bed rest, lack of care.
Equipment: sterile tray, pipettes, soap solution, gloves, 3% hydrogen peroxide solution, thermometer, gauze pads, tray for used material, cotton swabs or ear buds, cotton balls, towel.
Nurse's action algorithm:
I. Preparation for the procedure
1. Introduce yourself kindly and respectfully to the patient.
5. Wear gloves.
II. Executing the procedure
6. Help the patient find a comfortable position. Cover his neck and shoulders with a towel.
7. Heat a bottle with a 3% hydrogen peroxide solution in a water bath to 38 ° C.
8. Ask him to tilt his head in the direction opposite to the treatment.
9. Soak gauze napkins in soapy water and wipe the auricle.
10. Pour the 3% hydrogen peroxide solution into a beaker.
11. Soak a cotton pad in a solution of 3% hydrogen peroxide and squeeze lightly.
12. Insert 2-3 drops of 3% hydrogen peroxide into the ear with a rotational movement for 2-3 minutes or use a pipette and close the external auditory canal with a cotton ball.
13. Take a dry cotton wool and insert it into the external auditory canal with rotational movements, and then remove it.
III. End of the procedure
14. Place the used material in a container with disinfectant. solution.
15. Remove gloves and put them in a container with disinfectant. solution.
16. Wash (hygienic level) and dry your hands.
17. Make a record of the procedure in the medical documentation.
Possible complications: When treating the external auditory canal with sharp objects, injuries to the auditory canal may occur.
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Rice. 38. Care of the external auditory canal
Carrying out hygiene measures for the patient in bed
Target: maintaining personal hygiene.
Indications: self-care deficit.
Equipment: basin, oilcloth, warm water, jug, soap, sponge, towel, scissors, clean bed and underwear, waterproof bag, container with disinfectant. solution
Algorithm of the nurse's actions:
I. Preparation for the procedure
Introduce yourself to the patient in a friendly and respectful manner.
2. Explain to the patient the purpose and course of the upcoming procedure, obtain his consent.
3. Wash and dry your hands and put on gloves.
4. Prepare the necessary equipment.
5. Wear gloves.
II. Executing the procedure
6. At the head end of the bed, roll the mattress up to the patient’s subscapular area.
7. Place an oilcloth on the bed net and place a basin.
8. Tilt the patient's head slightly back over the pelvis.
9. Wash the patient's hair using warm soapy water from a jug.
10. Rinse your hair with clean water, dry it, and cover your head with a scarf.
11. Remove everything, return the upper body to its original position.
12. Pour warm water into the tray, lay an oilcloth with a diaper under the patient.
13. Expose the upper part of the patient’s body and, after wetting one end of the towel, wring it lightly, wipe the patient in the same sequence and cover with a sheet.
14. Use the dry end of the towel to wipe the patient’s body and cover with a sheet.
15. In the same way, wipe the stomach, thighs, legs and wipe dry.
16. Roll the mattress under the patient’s knees with a roller.
17. Lay oilcloth on the mesh and place a basin with warm water.
18. Wash the patient’s legs in the basin using a sponge and soap.
19. Wipe your feet, trim your nails, put everything away.
20. Change underwear and bed linen.
III. Completing the procedure
21. Place the towel, used underwear and bed linen in a waterproof bag.
If the patient is weak and cannot clear the nasal passages on his own, the caregiver must remove the crusts that have formed daily. To do this, turundas soaked in vaseline oil, glycerin or any oil solution are carefully inserted into the nasal passages with rotational movements and left for 2-3 minutes, after which they are removed with rotational movements, removing the contents of the nose with them. The patient is asked to blow his nose into a tissue. If your nose is stuffy, you can first drip 2-3 drops of adrenaline or another vasoconstrictor.
3.1.6. Skin care
The presence of infectious foci in the area of the proposed incision serves as a contraindication for elective surgery, and in case of emergency interventions significantly worsens the prognosis. Often, especially in elderly patients, dermatitis caused by fungal flora is observed in the skin folds, armpits and perineum. In the preoperative period, all these processes should be cured by performing daily hygienic baths, wiping the affected skin folds with alcohol, and dusting with powders containing finely ground nystatin or levorin. To prevent bedsores in seriously ill patients, it is necessary to change the position of their body every 4 hours so that the same areas of the body are not subjected to prolonged compression.
Nail care. Nails are cut short with small scissors treated with alcohol or a 0.5% chloramine solution.
3.1.7. Washing the patient
Patients who do not take a weekly hygienic bath, as well as those suffering from urinary and fecal incontinence, need to be washed several times a day. To wash the patient you need: warm water, a disinfectant solution (a weak solution of potassium permanganate, furatsilin, rivanol, etc.); Esmarch's water jug or mug; clamp or forceps, sterile cotton balls; oilcloth; bedpan.
A solution is pre-prepared at a temperature of 30-35 °C, the patient is positioned on his back with his knees bent, a wide oilcloth and a bedpan are placed under the buttocks. With his left hand, the caregiver holds a jug, from which he pours a disinfectant solution over the perineal area. The holder with a cotton ball held in place with the right hand is passed 1-2 times in the direction from the genitals to the anus, then the cotton balls are thrown away. The procedure is repeated 2-3 times. Use dry cotton balls to wipe the skin in the same direction. The inguinal folds are treated with petroleum jelly or baby powder. Diaper rash is lubricated with Vaseline or baby cream
5. Prepare disinfectant solutions for cleaning the operating unit, postoperative ward and general wards.
When creating a surgical department, the expected volume of surgical care and the patient population are taken into account.
To sterilize the air in the wards and corridors of the surgical department, stationary bactericidal lamps are installed at the rate of 1 for every 6 square meters. meters. For one patient in a hospital, at least 6.5-7.5 m^ of area is allocated with a room height of at least 3.0 m and a width of at least 2.2 m. Any orientation of the windows of wards and treatment and diagnostic rooms is acceptable, but the ratio of the area windows and floor - 1:6 or 1:7. The air temperature in the rooms should be within 18-20 ° C, humidity 50-55%. All departments have a ventilation schedule, which significantly reduces the level of bacterial contamination in the air (up to 30%).
The surgical department must be adapted to perform repeated wet cleanings using antiseptic agents. Wet cleaning of the premises is carried out every morning and evening; wash and wipe the walls once every three days; Once a month, clean the upper parts of the walls, ceilings, lamps, door and window frames from dust. In this regard, to facilitate cleaning of the premises, the floors in the surgical department should be covered with linoleum, tiles or plastic; The walls are tiled or painted. In operating rooms and dressing rooms, the same requirements apply to ceilings. Furniture in most cases is made of metal or plastic, and the amount of furniture should be limited to the required minimum.
Operating unit
Fundamental to the operation of the operating unit is the strictest adherence to the principles of asepsis. In this regard, there are different types of operating rooms: planned, urgent; clean and purulent.
When scheduling upcoming operations, the following rule must be followed: first, “clean” operations with a minimum level of bacterial contamination are performed, and then all the others, in order of increasing bacterial contamination.
It is advisable to place the operating unit in an isolated room with windows oriented to the north or northwest, connected by a passage to the department and intensive care or resuscitation wards. The walls, floor, and ceiling of the operating room must be accessible for constant treatment with antiseptic agents.
In the operating room and dressing room, the air temperature should be no more than 24 ° C, humidity 50%.
The operating unit should contain only the most necessary furniture and technical equipment. Movements and movement of personnel in the operating room are reduced to a minimum whenever possible to avoid creating turbulent air flows. There should be no unnecessary people in the operating room. After the operation, the number of microbes in 1 m^ of air increases by 3-5 times, and in the presence, for example, of an additional 6-7 people as observers - by 25-30 times or more. The optimal way for students and trainees to view operations is to organize special domes or use a synchronous video surveillance system.
An important point is to limit conversations. So, at rest in one hour a person secretes 10-100 thousand microbial bodies, and when talking - up to 1 million or more.
When conducting operations, it is necessary to strictly and clearly divide operating rooms into zones:
sterile area(operating room, sterilization room);
high security zone(preoperative, anesthesia, hardware);
restricted area(instrumental and material, laboratory for urgent tests, room for nurses, surgeons, protocol room);
general hospital area.
Persons participating in the operation must undergo regulated sanitary and hygienic training (showering, changing into surgical suits, shoe covers, aprons, putting on a mask)
It is unacceptable to visit operating rooms wearing woolen items.
Before entering the operating unit, it is mandatory to comply with the “Red Line Rule”, i.e., everyone entering the “red line” must put on a gown, cap, mask and shoe covers.
Types of operating room cleaning hall:
1. Preliminary - carried out daily in the morning before the start of the operating day.
2. Current- during the operation, remove objects that have fallen on the floor, wipe the floor contaminated with blood and other liquids.
At the end of the operation, the operating table, the floor around the table, etc. are treated.
3. After each operation - removing waste materials from the operating room, treating the operating table with an antiseptic solution, changing linen, washing the floor if necessary, preparing instruments, equipment and a sterile table for the next operation.
4. Final- carried out after the end of the operating day and includes: washing the floor, walls to the height of human height, wiping furniture and equipment. All dressings and linen are taken to other rooms.
5. Spring-cleaning - washing the operating room once every 7-10 days with hot water, soap and antiseptics, including the ceiling.
Wipe down furniture and equipment.
Operating rooms are cleaned using a wet method (1% solution of chloramine B, 3% solution of hydrogen peroxide with 0.5% solution of detergents, etc.).
To disinfect the air in the operating room and dressing room, it is recommended to use bactericidal ultraviolet lamps, which help reduce microbial contamination by 50-80% in 2 hours compared to the initial state.
Ventilation of operating rooms is carried out through air conditioning units and bacterial filters. Air exchange is performed 7-10 times per hour under low pressure. Recently, installations that provide a laminar flow of sterile air with exchange up to 500 times per hour have become increasingly used.
Operating according to the level of sterility can be divided into 3 classes:
first grade- no more than 300 microbial cells in 1 cubic meter of air.
second class - up to 120 microbial cells (cardiovascular operating room).
third grade~ no more than 5 microbial cells per cubic meter of air (absolute asepsis class). This can be achieved in a sealed operating room, with ventilation and air sterilization, with the creation of a high-pressure zone inside the operating room (so that air flows out of the operating rooms) with special airlock doors.
Hygiene rules in the surgical department must be strictly followed by both patients and all employees of the department. Control rests with the head of the department and the head nurse. The main work of ensuring the sanitary and hygienic regime falls on the orderlies and nurses of the department.
Disinfecting solutions for treating premises and equipment are prepared, as a rule, at the beginning of the working day.
Preparation and indications for use of various disinfectant solutions
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Type of solution |
Preparation of the solution |
Indications To application |
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3% Bleach solution |
30 g of dry lime is added to a liter of water, mixed, allowed to settle, and the top layer is poured into a separate container for use. |
For processing bathrooms, sinks, toilets |
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5% Bleach solution |
50 g of dry lime is diluted to a liter with water. Items to be processed are soaked for an hour, washed and dried. |
For processing patient care items (bedpans, urinals, etc.) |
|
1% solution of chloramine B |
10 g of powder is added to a liter with water, the objects are wiped twice |
For disinfection of oilcloth linings, aprons, cleaning of wards in purulent departments |
|
3% chloramine B solution |
30 g of dry powder is added to a liter with water. Items are soaked for an hour |
For disinfection of thermometers, examination and auxiliary instruments, patient care items, scissors, shaving machines, impregnation of disinfectants mats and other medical supplies |
|
6% hydrogen peroxide solution |
218 g of perhydrol is diluted to a liter with water; if a washing solution is being prepared, add 5 g of washing powder or 5 ml of 10% ammonia. Wipe twice or soak for an hour |
For disinfection of examination and auxiliary instruments, treatment of treatment rooms, manipulation rooms, dressing rooms, medical equipment, etc. |
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2% Virkon solution |
20 g of powder is diluted to a liter with water. Wipe twice or soak for 10 - 12 minutes |
For cleaning premises and processing medical equipment, furniture, etc. |
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0.5% alcohol solution chlorhexidine bigluconate |
The original 20% chlorhexidine solution is diluted with 70% ethyl alcohol in a ratio of 1:40 |
For hand treatment |
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"Perform", 1, 1,5,2% solutions | ||
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"Gigasect" 1, 1,5,2% solutions |
According to the attached instructions. Wipe twice |
For all types of cleaning |
|
"Deochlor" (weak solution) |
1 tablet is diluted in 10 liters of water. Wipe twice |
For all types of cleaning of premises in TB departments |
|
"Deochlor" (concentrated solution) |
2 tablets are diluted in 7 liters of water. Soak for 30 minutes |
For disinfection of care items |
|
"Klorcent" (working solution) |
150 ml of 44.3% solution is diluted to a liter with water. Pour for 15 minutes |
To disinfect discharge from any infection |
Safety precautions
Disinfectant solutions are not toxic, but if safety precautions are not followed, they can get on the skin and mucous membranes, causing irritation and even poisoning when absorbed.
Before starting to work with disinfectants, the host sister is required to provide protective equipment, and the head nurse is required to provide safety instructions.
The preparation of solutions and their storage are carried out in a sanitary room, where there are sinks, a toilet, bathtubs and shelves for storing care items.
To prepare solutions, soak instruments and care items for disinfection, use special marked containers (indicate the purpose, name and concentration of the solution). Labeled containers with disinfectant solutions and containers for treating premises should be on stands or shelves. No manipulations with patients are performed in these rooms. The prepared solutions are good for 24 hours.
Rooms in departments are cleaned twice a day using a wet method. In aseptic departments, a 2% soap-soda solution is used (20 g of washing powder per 10 liters of water); in purulent-septic departments, use a 1% solution of chloramine, or a 3% solution of hydrogen peroxide with detergent. The air is sterilized twice a day with ultraviolet irradiation.
6. Dispose of used systems and syringes.
After use, syringes and needles are washed with running water, soaked in a 3% chloramine solution for 2 hours, and then rinsed with running water; The cannula is filed off and handed over to the head nurse to be sent for destruction. Reusable needles and syringes, which can only be used in operating rooms and dressing rooms, after use are washed with running water, disassembled, and soaked for 2 hours in a 6% solution of hydrogen peroxide with detergent. Wash again with running water, complete processing and sterilization according to OST.
7. Changing the patient’s underwear and bed linen
The patient's bed linen and underwear must be changed at least once a week after a hygienic bath and additionally as needed. Depending on the patient’s condition, there are different ways to change bed linen.
Patients who are allowed to sit are transferred from bed to chair and bed linen is changed. Pay attention to the fact that there are no folds or seams on the bed, and that the edges of the sheet are tucked under the mattress. In seriously ill patients, with heavy discharge from a wound, etc. You need to put an oilcloth under the sheet. Changing bed linen for bedridden patients is usually performed by two people, using longitudinal or transverse ways.
Longitudinal method(used in cases where the patient is allowed to turn). The patient is moved to the edge of the bed. Roll the dirty sheet lengthwise into a roller, spreading a clean one in its place. Shift or turn the patient to the other side of the bed. They remove the dirty sheets and straighten out the clean sheets.
Transverse method(used in cases where the patient is prohibited from active movements in bed). Raise the patient's head and upper torso. Remove the pillow. A dirty sheet is folded into a roll, and in its place a clean sheet is placed and straightened to the middle of the bed, pillows are placed, and the head is lowered. Raise the patient's pelvis, rolling up the dirty sheet, and put a clean one in its place. Lower the patient's pelvis. They raise their feet - completely remove the dirty one, replacing it with a clean sheet.
Change of underwear for seriously ill patients.
Underwear is changed at least once every 7-10 days and additionally when soiled. A change of underwear for a seriously ill patient is carried out as follows. They roll up the dirty shirt to the waist and carefully move it to the back of the head. Raise both the patient's arms. Release the head and then the patient's hands. If an arm is injured, the shirt is first removed from the healthy arm, then from the sore arm. When changing linen, be sure to inspect the skin for bedsores and other features. Dress the patient in reverse order.
8. 9. Treatment of bedsores.
Bedsores(gangrene of soft tissues - skin, subcutaneous tissue, etc.) are formed as a result of neurotrophic changes or circulatory disorders in weakened and severely ill patients (especially with spinal cord injuries) in those parts of the body that are subject to prolonged compression, most often due to forced prolonged immobile stay of the patient in bed.
In a significant number of cases, pressure ulcers can be considered a complication of insufficient quality care.
When the patient lies on his back for a long time, the soft tissues in the area of the sacrum, heels, and back of the head are first compressed, where bedsores most often form. Bedsores often appear in other places where bony protrusions are located directly under the skin (scapulae, greater trochanters of the femurs, etc.).
Other predisposing factors for the development of bedsores are: obesity or exhaustion of the patient; dysproteinemia; anemia; dry skin with cracking; increased sweating; fecal and urinary incontinence; any factors causing increased humidity in the bed; any form of peripheral circulatory disorder.
In addition, bedsores are dangerous because they are an entry point for infection, which can lead to the development of wound infection and sepsis.
The formation of bedsores occurs gradually. The patient may complain of pain in the lumbar region. Visually, initially, redness, cyanosis appear on the surface of the skin in places of tissue compression, and swelling of the skin develops due to stagnation of venous blood (ischemia stage). This is a reversible stage in the development of a pressure sore, when the elimination of the compressive factor and the minimum amount of treatment aid normalizes changes in the skin. Then, due to gross disturbances of microcirculation, mainly at the level of arterioles, the epidermis begins to peel off (maceration), the skin becomes necrotic, despite its fairly high resistance to hypoxia (stage of superficial necrosis). Later, fatty tissue and fascia become necrotic, followed by separation of necrotic tissue and the formation of a deep wound. In some cases, an area of exposed bone is identified at the bottom of the wound. When a wound infection occurs, the wound becomes purulent (stage of purulent melting).
To objectify the degree of risk of developing pressure ulcers, the Waterlow scale and the Norton scale have been proposed.
Bedsores are quite difficult to treat, and therefore prevention of this complication is of paramount importance.
Measures for the prevention and treatment of bedsores are regulated by the OST “Protocol for the management of patients. Bedsores" and approved by order of the Ministry of Health of the Russian Federation No. 123 dated April 17, 2002.
The nurse should examine the patient daily and, if they detect the slightest signs of bedsore formation, notify the doctor. In many clinics, disposable patient care items and skin care products have become widespread. According to the Norton scale, the patient's condition is assessed using a 4-point system based on 5 criteria. The total number of points indicates the magnitude of the individual risk. Patients with a score of 14 points and below are classified as high-risk. in patients forced to stay in bed for a long time.
The best known is the EURON disposable sanitary hygiene system, which includes various pads with absorbent layers of varying degrees of absorbency; cellulose sheets that do not form wrinkles; wet bactericidal wipes, etc.
Prevention of bedsores
To prevent bedsores, it is necessary to:
Eliminate the presence of crumbs and folds on the bed; prolonged skin contact with wet laundry;
Bed linen must be free of scars, patches, and buttons;
The area of the back and sacrum should be wiped with camphor or salicylic alcohol 1-2 times a day;
It is necessary to place rubber circles wrapped in a rough cloth, cotton-gauze and foam rubber pillows, cushions, etc. under the bony protrusions. When the patient is in a wheelchair or wheelchair for a long time, foam rubber or other pads are placed under the patient’s buttocks, back and feet. It is best to use functional beds and special foam or anti-decubitus mattresses filled with water, air or helium;
Several times a day (preferably every 2 hours), it is necessary to turn the patient over, change the position of the body (on one side, the other, Fowler's position with a foot rest, etc.); to change the position of the patient’s body, you cannot move it - only lift it, roll it, etc.;
When turning the patient, the skin in places where bedsores may form is non-traumatically massaged; when washing the skin, avoid rubbing with bar soap, use only liquid soap; if the skin is dry, lubricate it with protective creams or ointments (for example, Panthetol ointment); if the skin is excessively damp, wipe it with a soft cloth and treat it with preparations such as “Bepanten”, “Vase-foam”;
For urinary and fecal incontinence, use effective urine and colostomy bags, absorbent pads, sheets, diapers, etc.;
Teach relatives the rules of caring for the patient, teach the patient the technique of changing body position, including the use of technical techniques and special aids.
At the first signs of bedsores: 1-2 times a day, lubricate the reddened areas with camphor alcohol, lemon cut in half, an alcohol solution of brilliant green, a 5-10% solution of potassium permanganate, and carry out quartz treatment.
When a bedsore develops, it is treated with a 0.5% solution of potassium permanganate. When an infection occurs, the wound is treated with antiseptic drugs, including ointments; enzymes; substances that stimulate reparative processes (solcoseryl, acerbine, iruksol, argosulfan, bepanten plus, bactroban, etc.). The use of a solution or gel of zinc hyaluronate (curiosin) has proven itself. The drug has analgesic, antibacterial effects, stimulates healing processes, prevents drying of the dressing material and injury to granulations. With a pronounced necrotic component, surgical necrectomy is indicated. In the presence of abundant purulent discharge and a decrease in reparative processes, carbon sorption dressings (Carbonicus S, etc.) can be used. With proper treatment, the bedsore heals by secondary intention.
10. Preparation of the surgical field
Before the operation (with the exception of emergency surgical interventions, in case of a serious condition of the patient), as part of the preoperative preparation, a complete sanitary and hygienic treatment of the patient is carried out: washing in the bath, changing bed and underwear. On the operating table, the surgical field is treated with antiseptic drugs (organic iodine-containing drugs, alcohol solution of chlorhexidine bigluconate, 70° ethyl alcohol, sterile adhesive films, etc.).
Principles of preparing the surgical field:
Treatment of a wide area, and not just the zone in the projection of the upcoming incision (to ensure additional sterility, including in cases where an unscheduled expansion of surgical access is required during surgery);
Treatment of the surgical field is carried out according to the principle; “from the center to the periphery”;
More contaminated areas are treated last;
Compliance with the Filonchikav-Grossikh rule - repeated treatment of the skin: treatment of the skin before limiting the surgical field with sterile linen; processing immediately before the cut; according to indications - treatment during the operation; treatment before and after skin suturing.
11. Oral care
In patients who are unable to brush their teeth and rinse their mouth daily on their own, it is necessary to regularly sanitize the oral cavity. The patient is given a comfortable half-sitting position or turned to his side; an oilcloth is laid on the chest and covered with a diaper; They put the tray on their knees. Using a napkin, clamped in a forceps and generously moistened in one of the solutions, the teeth are treated with movements from left to right and from top to bottom. Use a spatula to move the root of the tongue downwards and treat the pharynx and tongue. If the patient is conscious, he is asked to spit the solution into a tray, given water to rinse his mouth and repeat the procedure. If the patient is unconscious, drain the mouth and pharynx with a napkin. In all cases, lubricate the lips, tongue and throat with oil (vegetable, sea buckthorn, rose hip, etc.). If the patient cannot extend the tongue, take it by the tip with a napkin, pull it out and carry out the procedure in full.
After each feeding of the patient, remove food debris from the mucous membrane of the mouth and teeth using a cotton ball, clamped with tweezers or a forceps, moistened with a weak solution of potassium permanganate, boric acid, soda or boiled water. The tongue and teeth are wiped with a gauze swab, after which the patient rinses his mouth. You can also rinse the mouth while sitting using a syringe without a needle or a rubber balloon. Removable dentures are removed at night, washed with soap and stored in a glass of water. To rinse the mouth, use solutions of soda (sodium bicarbonate), sodium bicarbonate, boric acid, hydrogen peroxide (solution no more than 3%), potassium permanganate (1:1000) and mineral water. The temperature of the liquids used for rinsing should be 20-40 "C, the patient is given a special dish for spitting. The oral mucosa and tongue are wiped with a piece of gauze soaked in a 1% solution of borax with the addition of glycerin or chamomile infusion. In addition to rinsing, applications can be used and irrigation. Application - Applying sterile gauze napkins for 3-5 minutes, soaked in a disinfectant solution (2% chloramine solution or 0.1% furatsilin solution). This procedure is repeated several times a day. Irrigation is carried out using an Esmarch mug or a Janet syringe . In a semi-sitting position, an oilcloth is covered on the patient's chest, a tray is given into the patient's hands, which he holds near the chin for swelling of the washing liquid. Moving away alternately the left and right cheek with a spatula or the handle of a spoon, the caregiver inserts the tip and irrigates the oral cavity. Esmarch's mug should be at a distance of 1 meter above the patient’s head.
13. Gastric lavage
Gastric lavage is prescribed to the patient for therapeutic and diagnostic purposes. To lavage the stomach, prepare a thick gastric tube 1-1.5 m long, a glass funnel with a capacity of 0.5-1 liters, a jug of water, a 1% soda solution or a weak solution of potassium permanganate, a bucket and an oilcloth apron for the patient. Removable dentures are removed from the patient's mouth.
The patient is seated on a chair, the chest is covered with an apron, and a bucket is placed between the legs. They calm the patient down and explain that when vomiting occurs, one should breathe deeply through the nose. The nurse should stand to the right of the patient. The patient opens his mouth wide and breathes deeply through his nose. The nurse quickly inserts the probe into the root of the tongue, and at this time the patient must close his mouth and make several swallowing movements.
If the probe gets into the larynx, the patient coughs, chokes, and turns blue. In this case, you should immediately remove the probe and begin inserting it again.
The probe is inserted to a length greater than 5-10 cm from the distance from the umbilical ring to the front teeth. After the probe passes into the stomach, a funnel is put on its upper end and, initially holding it at the level of the abdomen, liquid is poured in, gradually raising the funnel above the patient’s mouth. The volume of liquid for the first injection is about 1 liter. The liquid from the funnel quickly passes into the stomach. When the liquid level drops to the neck of the funnel, the latter is lowered down. In this case, the funnel is filled with gastric lavage water, which is poured into a bucket.
The procedure is repeated several times until the rinsing waters become clear. Typically, 8-10 liters of liquid are required for rinsing. At the end of the procedure, remove the funnel and quickly remove the probe. For weakened patients, gastric lavage is performed in bed.
In this case, the patient lies on his side, his head is low and turned to the side. After use, the probe is washed with hot running water inside and out, and boiled for 15-20 minutes.
If the patient is unconscious, then the stomach can be rinsed using a thin probe inserted into the stomach through the lower nasal passage. Previously, 2-3 additional holes are made on the probe. The patient is placed with the torso tilted down and the head turned to the side. A swab is used to remove mucus and vomit from the mouth and nasal cavity, and a probe is inserted. Evacuate the contents with a syringe and make sure that the probe is in the stomach. Next, water is injected into the stomach with a syringe through the tube and evacuated back with the syringe.
If gastric lavage was performed due to poisoning, then at the end of the procedure, a saline laxative (for example, 60 ml of a 25% solution of magnesium sulfate) is administered through a tube.
14. Technique for measuring body temperature
Before using the thermometer, it is necessary to disinfect it, for example, with a chloramine solution, rinse it with water, wipe it with a towel, be sure to ensure the integrity of the thermometer, and shake the mercury down. Inspect the armpit for diaper rash, skin rashes, wipe off sweat, place the thermometer reservoir in the armpit so that there is no clothing between it and the skin, press your shoulder to your body. After 10 minutes, remove the thermometer, determine the body temperature reading, enter the data into the list of patients or into the temperature sheet (morning or evening), complete the graph of the temperature curve.
If the thermometer is damaged, the spilled mercury must be collected with wet paper or adhesive tape, together with the destroyed thermometer, it must be placed in a glass container with a lid, the contents of one thermometer (1 g of mercury) should be filled with one gram of dry potassium permanganate and poured with 5 ml of hydrochloric acid, then handed over to the head nurse for transfers for decontamination.
15. Determination of the properties of the pulse on the radial artery and technique for measuring blood pressure
The patient takes a comfortable position sitting or lying down, the forearm is freed from clothing. The medical worker covers the patient's forearm above the wrist joint so that the 2nd, 3rd, 4th fingers of the hand lie on the radial artery, and the first serves as a support. The same is done on the patient’s second hand. Both hands are brought to the patient's chest wall at the level of the heart. The radial arteries are compressed with your fingers until shocks appear, the pulse in both hands is counted separately and the pulse impulses are compared. If the nature of the pulse is the same in both arteries, it is determined on one of the limbs; if it is different, on the side where the pulse waves are more pronounced.
Initially, the rhythm of the pulse is determined: if pulse waves appear at regular intervals, the pulse is rhythmic; if the pulse waves are erratic - arrhythmic. The heart rate is calculated for 30 seconds and multiplied by 2; for arrhythmias, the pulse is counted within a minute. The filling of the pulse is determined by squeezing the artery with different forces. To detect pulse tension, the radial artery is compressed until it disappears: if it is not tense, a sufficiently moderate force; if this requires significant effort, the pulse is regarded as tense; if the artery is compressed very easily - soft.
Blood pressure measurement technique
Prepare a tonometer and a phonendoscope (when using automatic tonometers, a phonendoscope is not needed). Give the patient a comfortable position, free the elbow bend from clothing. Place a blood pressure cuff on your shoulder and secure it. Determine the pulsation of the brachial artery in the cubital fossa and apply the head of the phonendoscope to this place. Make sure the tonometer needle is at zero, close the valve and pump air into the cuff with a bulb. Record the moment when the pulse tones disappear and further increase the pressure by another 30-40 mmHg. Slowly release air from the cuff, recording the pressure gauge readings at the moment the pulse appears (systolic blood pressure) and disappears (diastolic blood pressure).
16. Determination of respiratory rate
The patient takes a comfortable position sitting or lying down. The patient's hand is taken as when counting the pulse on the radial artery to distract him. The other hand is placed on the chest (for thoracic breathing) or on the stomach (for abdominal breathing). Count the number of breaths in one minute. The data is entered into the registration sheet.
18. Ice pack
An ice pack is used for longer local cooling. It is a flat rubber bag with a wide opening and a lid, which is filled with pieces of ice before use.
Indications: first hours after injury, internal bleeding, second period of fever, initial stage of some acute abdominal diseases, bruises.
Contraindications: cramping abdominal pain, collapse, shock.
Necessary equipment: ice, ice pack, towel (sterile oilcloth).
How to perform the procedure
1. Fill the bubble 2/3 of the volume with pieces of ice and close it tightly.
2. Hang the bubble over the corresponding area of the body (head, stomach, etc.) at a distance of 5-7 cm or wrap it in a towel and apply it to the sore spot.
3. If a long procedure is necessary, take cooling breaks of 10 minutes every 30 minutes.
Target. Cleansing the nasal passages from crusts.
Indications. Accumulation of crusts in the nasal cavity in patients in a passive position.
Equipment. Cotton turundas; Vaseline or other liquid oil: sunflower, olive, or glycerin; two kidney-shaped basins: for clean and used turundas.
Execution technique.
1. The patient’s head is elevated and a towel is placed on the chest.
2. Moisten the turundas with the prepared oil.
3. Ask the patient to tilt his head back slightly.
4. Take the moistened turunda, squeeze it lightly and insert it with a rotational movement into one of the nasal passages.
5. Leave the turunda for 1 - 2 minutes, then remove it with rotational movements, freeing the nasal passage from crusts.
6. Repeat the procedure with the second nasal passage.
7. Wipe the skin of the nose with a towel and help the patient lie down comfortably.
Caring for the hair of a seriously ill patient.
Target. Maintaining the patient’s personal hygiene; prevention of head lice and dandruff.
Indications. Patient's bed rest.
Equipment. A basin of warm water; jug with warm water (+35...+37 C); towel; comb; shampoo; scarf or scarf.
Execution technique.
1. Ask the nurse to lift the patient’s torso, supporting him by the shoulders and head.
2. Remove the pillows, roll the head end of the mattress with a roller towards the patient’s back, and cover it with oilcloth.
3. Place a basin of water on the bed frame.
4. Wet the patient’s hair, wash it with shampoo, and rinse thoroughly in a basin.
5. Rinse your hair with warm water from a jug.
6. Dry your hair with a towel.
7. The basin is removed, the mattress is laid out, pillows are placed, and the patient’s head is lowered.
8. Comb the hair with a comb belonging to the patient. Comb short hair from the roots, and long hair from the ends, gradually moving towards the roots.
9. They tie a scarf or scarf around their head.
10. Help the patient lie down comfortably.
Notes If the patient does not have his own comb, you can use a common one, which is pre-treated with 70% alcohol, rubbing 2 times with an interval of 15 minutes. Patients need to comb their hair daily. While washing the hair, the nurse must support the patient at all times.
Prevention of bedsores, implementation algorithm
Manipulation: prevention of bedsores.
Target. Prevention of necrosis of soft tissues in places of prolonged compression.
Indications. Bed rest for the patient.
Equipment. Anti-bedsore mattress; cotton-gauze backing circles; rubber circle in a pillowcase; petrolatum; 1% solution of table vinegar; portable quartz lamp; clean soft terry towel.
Technique for preventing bedsores.
1. Wash and dry your hands, put on gloves.
2. The patient is turned on his side.
3. Treat the skin of the back with a napkin moistened with warm water or a vinegar solution.
4. Dry the skin with a dry towel.
5. Massage the areas where bedsores often form.
6. Lubricate the skin with sterile Vaseline or boiled vegetable oil.
7. The resulting bedsores are treated with quartz treatment, starting from 1 - 2 minutes and gradually increasing the exposure time to 5 - 7 minutes.
8. Place cotton-gauze circles or rubber circles in a pillowcase under the places where bedsores form.
9. Inspect the patient’s bed, remove crumbs after eating.
10. Wet and soiled bed linen and underwear are changed immediately.
12. When changing bed and underwear, make sure that there are no seams, patches, or folds on them in places where bedsores form.
13. Areas of skin redness are treated with a weak solution of potassium permanganate. Treatment of the skin of seriously ill patients.
Target. Maintaining personal hygiene of a seriously ill patient; prevention of bedsores.
Indications. Patient's bed rest. Patients on semi-bed rest take care of themselves.
Equipment. A basin marked “For washing”; a jug or kettle with warm water (+35...+38 °C) marked “For washing”, a basin with hot water (+45...+50 °C); napkin or piece of cotton wool; towel; powder, sterile oil; 10% camphor alcohol or 1% vinegar solution.
Technique for performing skin treatment for seriously ill patients:
1. Place the basin on a stool at the edge of the patient’s bed.
2. If the patient himself can turn on his side, then ask him to do this and help the patient wash his hands over the basin, brush his teeth, and wash himself. The nurse holds a jug, gives toothpaste, a glass of water, and a towel.
3. If the patient cannot turn on his side. then perform the following manipulations: Wash one of the patient’s hands in a basin with soap and water. Transfer the basin to the other side of the bed and wash the other hand. Fingernails are cut oval.
Perform facial toilet: wipe it with a damp cloth, then with a dry towel. The pillows are removed and the patient's shirt is removed. Wet the napkin in a bowl of hot water and wring it out. They wipe the front surface of the patient's body, paying attention to the natural folds of the skin on the neck, under the mammary glands, in the armpits, and in the groin folds. Dry the skin thoroughly with a towel. Skin folds are treated with powder or lubricated with sterile oil to prevent diaper rash.
The patient is turned on his side. If necessary, the nurse helps and supports the patient. Wipe the skin of the back with a damp, hot cloth, paying special attention to the places where bedsores form (the back of the head, shoulder blades, sacrum, buttocks). The skin is thoroughly dried with a towel and rubbed, if there are no violations of its integrity or pain. The warmth of the wipe and rubbing will cause a rush of blood to the skin and underlying tissues.
If the patient cannot be turned on his side, he is placed on a sectional mattress. Skin care is carried out by removing one section after another.
Notes. Patients' skin should be washed daily. Also, the patient’s feet should be washed every night at night, placing a basin of water on the bed frame. The mattress is first wrapped with a cushion towards the feet and covered with oilcloth. Toenails are cut straight.
If the patient is immobile for a long time, it is necessary to take preventive measures to prevent the formation of bedsores.
Washing up patients.
Target. Maintaining hygiene; prevention of bedsores, diaper rash.
Indications. Preparing the patient for urine collection for examination, bladder catheterization; gynecological manipulations. All patients on bed rest are washed in the morning, at night and after each bladder and bowel movement.
Equipment. Oilcloth lining; metal or plastic vessel; Esmarch's jug or mug marked “For washing”; warm water (+35...+38 °C); 5% potassium permanganate solution; forceps; cotton wool; kidney-shaped coxa; latex gloves.
Technique for washing patients:
1. Pour water into a jug (Esmarch mug) and add a few drops of 5% potassium permanganate solution until a pale pink color is obtained.
2. Put on gloves.
3. Ask the patient to lie on her back, bend her knees and spread them at the hips.
4. Lay down oilcloth and position the vessel.
5. A piece of cotton wool is fixed in a forceps so that its sharp edges are covered on all sides.
6. Take a jug with a warm disinfectant solution in your left hand and, after pouring a small amount of the solution onto the patient’s thigh, ask: “Are you not feeling hot?” If the water temperature is acceptable, continue manipulation.
7. Irrigate the genitals with a warm disinfectant solution. With your right hand, take a forceps with cotton and wash the genitals in the direction of the stream towards the anus, so as not to cause an infection. First, the labia minora are washed, then the labia majora, inguinal folds, and pubis. Lastly, wash the anus from top to bottom.
8. Remove the dirty cotton swab from the forceps, secure a clean piece of cotton wool and dry the genitals in the same sequence.
9. They remove the bedspread and help the patient take a comfortable position in bed.
Men are washed for the same indications. When washing, the important rule is “from the center to the periphery,” that is, from the head of the penis to the groin area.
Notes. Patients on semi-bed rest should be taught to use a bidet, if one is available on the ward.
Algorithm for performing oral toileting in a seriously ill patient
2)Target: maintaining the patient’s personal hygiene, preventing stomatitis.
Indications: serious condition of the patient.
Prepare: sterile tweezers, spatula, tray, oilcloth, towel, forceps, 3% hydrogen peroxide, 2% sodium bicarbonate solution, furatsilin solution 1: 5000, sterile cotton swabs, sterile napkins, sterile gloves.
Performing the manipulation:
1.Wash your hands with hot running water and soap, put on gloves.
2. Place the patient in a semi-sitting position (head slightly tilted forward).
3.Put an oilcloth on your chest and a towel on top.
4. Using tweezers or a forceps, take a cotton swab, open the furatsilin solution and pour it onto the swab over the tray, squeeze it against the edge of the tray.
5. Take a spatula in your left hand, a swab in your right hand, ask the patient to open his mouth, pull the cheek to the side with the spatula and first treat the buccal surface of the teeth, then from the inside.
6. Repeating the procedure, wipe each tooth with a separate ball in the direction from the gums, carefully treat the upper molars, since the ducts of the parotid salivary glands open there.
7. Using a fresh swab, treat the oral mucosa in the same way using blotting movements.
8.Take a fresh tampon in your right hand, a napkin in your left and ask to show your tongue.
9.Cover your tongue with your left hand and use a cotton swab to remove the plaque from your tongue using blotting movements. Using another cotton swab, lubricate your tongue with glycerin (using a blotting motion).
Note: Place dirty tampons in a tray marked “dirty balls.”
4) Conclusions: manipulation “Carrying out oral toileting in a seriously ill patient” mastered.
1) Master manipulation "Care for the patient's eyes" according to the algorithm.
Algorithm for caring for the patient's eyes
2) Purpose: maintaining the patient’s personal hygiene, preventing conjunctivitis.
If there is discharge from the eyes, sticking of eyelashes and eyelids during the morning toilet, it is necessary to rinse the eyes.
Indications: serious condition of the patient.
Performing the manipulation:
1.Wash your hands thoroughly.
2. Place 8 - 10 sterile balls in a special tray and moisten them with an antiseptic solution (furacillin 1:5000, 2% soda solution, 2% boric acid solution, 0.5% potassium permanganate solution) or boiled water.
3. Slightly wring out the swab and wipe your eyelashes with it in the direction from the outer corner of the eye to the inner.
4.Repeat wiping 4-5 times (with different tampons!).
5. Blot the remaining solution with dry swabs.
3) Results: recording the manipulation algorithm in the workbook.
4) Conclusions: manipulation "Care for the patient's eyes" mastered.
1) Master manipulation "Care for the patient's ears" according to the algorithm.
Ear care algorithm
2) Purpose: maintaining personal hygiene.
Patients on bed rest should periodically clean the external auditory canals.
Performing the manipulation: Sit down or raise the head of the bed. Place a few drops of a 3% hydrogen peroxide solution into the patient's ear, pull the ear back and up, and insert the cotton wool into the external auditory canal with a rotating motion. After changing the turunda, repeat the manipulation.
Remember: Do not use hard objects to remove wax from your ears to avoid damaging the eardrum.
3) Results: recording the manipulation algorithm in the workbook.
4) Conclusions: manipulation "Care for the patient's ears" mastered.
1) Master manipulation according to the algorithm.
Algorithm for caring for the nasal cavity
2) Purpose: maintaining personal hygiene.
Seriously ill patients who are unable to independently monitor nasal hygiene must daily clear the nasal passages of secretions and crusts that form.
Prepare: sterile cotton wool, pasteurized vegetable oil in a small container (50 ml), tray, tweezers, rubber gloves.
Performing the manipulation:
1.Sit the patient down or raise the head end of the bed. Wash your hands with hot water and soap, wear gloves.
2.Use tweezers and place 3-4 cotton wool pads into the tray.
3. Take 1 turunda in your right hand, dip the end in the prepared oil and lightly squeeze it against the edge of the bottle with oil. With your left hand, slightly lift the tip of your nose, and with your right hand, carefully, with rotational movements, insert the turunda into the lower nasal passage not completely, make blotting movements along the corresponding half of the nose, pressing on the wings of the nose.
4.Carefully remove the turunda. Repeat the procedure on the other side. The crusts will get wet and come off on their own. Place used turundas in a marked tray (dirty balls). Mucus, pus, and other fluid secretions can be removed using a balloon.
Note: instead of vegetable oil, you can take glycerin and petroleum jelly.
3) Results: recording the manipulation algorithm in the workbook.
4) Conclusions: manipulation "Care for the patient's nasal cavity" mastered.
1) Master manipulation "Hair care" according to the algorithm.
Hair care algorithm
Preparation for the procedure:
4. Wear a disposable apron.
5. Place a chair at the head of the bed on the working side; Place an empty water container on a chair.
6. Fill another container with warm water and place it nearby. Measure the water temperature.
7. Undress the patient to the waist and cover the exposed part of the body with a sheet.
Performing the procedure:
8. Remove all hairpins and hairpins. Take off your glasses. Comb the patient's hair.
9. Place an oilcloth under the patient’s head and shoulders, the end of which is lowered into a container standing on the chair; along the edge of the oilcloth, place a rolled towel around your head.
10. Cover the patient’s eyes with a towel or diaper.
11. Fill the jug with water and gently wet the patient’s hair.
12. Apply a little shampoo and wash the hair with both hands, gently massaging the patient’s scalp.
13. Pour water into the jug and rinse off all the shampoo (if the patient asks, wash his hair with shampoo again).
14. Unfold a clean, dry towel, lift the patient's head and wipe his hair dry. If he is cold, wrap his head in a towel or scarf.
End of the procedure.
15. Place the oilcloth and towel lying under your head in a waterproof bag.
16. If necessary, change the sheet.
17. Comb the patient's hair. Offer him a mirror.
18. Treat hands hygienically and dry.
19. Make an appropriate entry about the procedure performed in the medical documentation.
3) Results: recording the manipulation algorithm in the workbook.
4) Conclusions: manipulation "Hair care" mastered.
1) Master manipulation according to the algorithm.
Algorithm for the prevention of bedsores
· Inspect the skin daily in areas where bedsores may form.
· Change the patient’s position every 2 hours if his condition allows.
· Use anti-decubitus mattresses (made of flaxseed; made of rubberized fabric, consisting of a series of air chambers with an automatic device that changes the degree of filling of the chambers)
· When changing linen, make sure there are no crumbs on the bed, and no rough seams or folds on the sheets.
· Constantly change wet underwear to dry.
· At least 2 times a day, wash with warm water and neutral soap those areas of the patient where bedsores most often form (occipital region, heels, shoulder blades, sacrum) and wipe with a cotton swab moistened with a 10% solution of camphor alcohol or a 40% solution of ethyl alcohol.
· Regularly perform light massage (rub soft tissues in places where bedsores may form, do not massage in the area of protruding bone areas) and quartzing areas.
· Place a rubber circle wrapped in a diaper under the sacrum (since prolonged use of the circle can cause the formation of bedsores, it is used intermittently and for no more than 2 hours).
3) Results: recording the manipulation algorithm in the workbook.
4) Conclusions: manipulation “Prevention of bedsores” mastered.
1) Master manipulation according to the algorithm.
Algorithm for caring for the nails of a seriously ill patient
Preparation for the procedure:
1. Fill the container with warm water, help the patient wash his hands with soap. Prepare the necessary equipment.
2. Introduce yourself to the patient, explain the process and purpose of the procedure. Make sure that the patient has informed consent for the upcoming procedure.
3. Treat hands hygienically and dry. Wear gloves.
4. Place the patient's hands on a towel and wipe them dry.
Performing the procedure:
5. Trim the patient's nails with scissors.
6. Apply the cream to the patient's hands.
7. Place the towel in the laundry bag.
End of the procedure:
9. Place the scissors in a container for disinfection.
10. Remove gloves and place them in a container for disinfection.
11. Treat hands hygienically and dry.
3) Results: recording the manipulation algorithm in the workbook.
4) Conclusions: manipulation “Nail care for a seriously ill patient” mastered.
1) Master manipulation “Shaving a seriously ill patient” according to the algorithm.
Algorithm for shaving a seriously ill patient
Preparation for the procedure:
1. Prepare everything necessary for the procedure, close the windows, provide the patient with confidentiality conditions.
2. Introduce yourself to the patient, explain the process and purpose of the procedure. Make sure that the patient has informed consent for the upcoming procedure.
3. Treat hands hygienically and dry. Wear gloves.
Performing the procedure:
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. Offer the patient to use aftershave lotion.
6. Offer the patient a mirror after the procedure.
End of the procedure:
7. Place the machine and shaving brush in a container for disinfection, and dispose of the disposable machine.
8. Position the patient comfortably in bed.
9. Remove gloves and place them in a container for disinfection.
10. Wash your hands and dry them.
3) Results: recording the manipulation algorithm in the workbook.
4) Conclusions: manipulation “Shaving a seriously ill patient” mastered.
