Ministry of Health and Social Development of the Russian Federation
GENERAL CHILD CARE
WITH SURGICAL DISEASES
Kirov
UDC 616-083-053.2+616-089-053.2(075.8)
BBK 57.3+54.5
Published by decision of the central methodological council of the Kirov State Medical Academy
dated 05/19/2011 (protocol No. 7)
General care for children with surgical diseases: A textbook for students of medical universities / Compiled by: Ignatiev S.V., Razin M.P. – Kirov State Medical Academy, 2011 - 86 p., ill.: 20 figures, 5 tables, bibliography: 10 sources.
The manual highlights modern concepts of general care for children with surgical diseases, examines the structure and organization of surgical care for children in modern Russia, the most important anatomical and physiological features of the child’s body, aseptic and antiseptic methods, formulates the functional responsibilities of personnel caring for children with surgical diseases, rules for working in the dressing room and operating room, a detailed description of the most important medical procedures and algorithms for preparing children for special methods of examination and surgical treatment are given. The manual is intended for students of medical universities studying in the specialty “Pediatrics”.
Reviewers:
Head of the Department of Pediatric Surgery of the Astrakhan State Medical Academy, Doctor of Medical Sciences, Professor A.A. Zhidovinov;
Professor of the Department of Surgical Diseases of Children of the Izhevsk State Medical Academy Doctor of Medical Sciences, Professor V.V. Pozdeev.
© S.V. Ignatiev, M.P. Razin, Kirov, 2011
© State Educational Institution of Higher Professional Education Kirov State Medical Academy of the Ministry of Health and Social Development of Russia, Kirov, 2011
| List of abbreviations | |||||
| Preface | |||||
| 1. | Structure and organization of surgical care for children in Russia | ||||
| 1.1 | Structure and organization of work of the children's surgical clinic | ||||
| 1.2 | Structure and organization of work in the surgical room of a children's clinic | ||||
| 1.3 | |||||
| 2. | Anatomical and physiological characteristics of the child’s body | ||||
| 2.1. | AFO of skin and subcutaneous fat | ||||
| 2.2. | AFO of the musculoskeletal system | ||||
| 2.3. | AFO of the respiratory system | ||||
| 2.4. | AFO of the cardiovascular system | ||||
| 2.5. | AFO of the nervous system | ||||
| 2.6. | AFO of the gastrointestinal tract | ||||
| 2.7. | AFO of the urinary system | ||||
| 2.8. | AFO of the endocrine system | ||||
| 2.9. | AFO of the immune system | ||||
| 2.10. | Test questions and test tasks | ||||
| 3. | Asepsis and antiseptics | ||||
| 3.1. | Test questions and test tasks | ||||
| 4. | Functional responsibilities of personnel caring for children with surgical diseases. Work in the dressing room and in the operating room | ||||
| 4.1. | Test questions and test tasks | ||||
| 5. | The most important medical procedures | ||||
| 5.1. | Test questions and test tasks | ||||
| 6. | Preparing children for special diagnostic and treatment methods | ||||
| 6.1. | Preparing children for special examination methods | ||||
| 6.2. | Preparing children for surgery | ||||
| 6.3. | Test questions and test tasks | ||||
| List of practical skills and abilities | |||||
| Situational tasks | |||||
| Standards of correct answers | |||||
| List of recommended literature | |||||
List of abbreviations
| Ig | immunoglobulins |
| AFO | anatomical and physiological features |
| GP | GP |
| VHO | secondary surgical treatment |
| Gastrointestinal tract | gastrointestinal tract |
| mechanical ventilation | artificial ventilation |
| CBS | acid-base state |
| CT | computed tomography |
| MRI | magnetic resonance imaging |
| ICU | intensive care unit |
| BCC | circulating blood volume |
| Surfactant | surfactants |
| PDS | polydioxanone |
| PHO | primary surgical treatment |
| SanPiN | sanitary rules and regulations |
| FAP | first aid station |
| CVP | central venous pressure |
| CSO | central sterilization department |
Preface
The basics of general care for children with surgical diseases have their own clearly defined characteristics in comparison with the care of an adult patient and the care of a somatically ill child.
The course in caring for pediatric surgical patients is very important, as it introduces students to the basic principles of working in a pediatric surgical hospital at the level of a paramedic. Students acquire not only theoretical knowledge, but also practical skills in caring for sick children of this profile, therefore the manual contains a list of practical skills that a student must master. In nursing, preoperative preparation for the operation and nursing of children after it are of great importance. The most postulative principles of these processes are highlighted on the pages of our publication.
This textbook is intended for junior students of medical universities. The authors took into account modern domestic and foreign literary data, as well as their personal many years of experience in practical pediatric surgery, so they hope that the material presented in the manual will contribute to a deeper understanding by students of pediatric faculties of the structure and organization of surgical care for children in modern Russia, anatomy -physiological characteristics of the child’s body, asepsis and antiseptics, functional duties of staff, work in the dressing room and operating room, the most important medical procedures, preparing children for special methods of examination and surgical treatment. All possible wishes and critical comments will be received by the authors with understanding and gratitude.
Department of Surgical Diseases of Children Presentation on the topic: “General care for children in the surgical department. Features of observation and care of patients after surgical interventions. Functional responsibilities of junior medical staff."
Slide 2
General care for children in the surgical department
In caring for children in the surgical department, their preoperative preparation, surgery and caring for children after it are important. Care also includes creating comfort for the patient, a favorable microclimate (a bright room, fresh air, a comfortable and clean bed, the necessary minimum of household items, in addition, drawings and paintings on stacks, a playroom), conditions for school activities. When caring for children, it is necessary : Strictly monitor compliance with the diet and natural bowel movements; Monitor the amount of fluid in and out (overhydration) or dehydration (dehydration); Monitor daily urine output (diuresis), which is one of the most important criteria for assessing the patient’s condition; Strictly monitor the temperature of the intravenously administered fluid and, if necessary, warm it up. The amount of care depends on the age and condition of the patient, the nature of the disease, and the regimen prescribed to him.
Slide 3
Monitoring patients after surgery
Observation of a postoperative patient includes: Assessment of appearance (facial expression, position in bed. Color of integument); Body temperature measurement; Pulse control; Blood pressure control; Breathing rate control; Control of the functioning of the excretory organs (bladder, intestines); Monitoring the bandage in the area of the postoperative wound; Monitoring the operation of drains with a note in the medical history; Attention to the patient’s complaints (timely pain relief); Control of drip infusions (in peripheral and central veins); Control of laboratory parameters.
Slide 4
Features of patient care after surgery:
Patient care is helping a patient in his frail state, the most important element of clinical and medical activity. In a surgical hospital, patient care is an extremely important element of surgical activity, which has a serious impact on the outcome of treatment. Care in the postoperative period is aimed at restoring the patient’s physiological functions, normal healing of the surgical wound, and preventing possible complications.
Slide 5
When caring for postoperative patients, it is necessary to: Monitor the condition of the bandage (sticker), do not let it slip off and expose the postoperative suture; If drainage tubes are installed, it is necessary to monitor the nature and amount of discharge through them, the tightness of the drainage system, etc.; Observe any change in the condition of the patient’s surgical field (swelling, redness of the skin in the wound area, increased body temperature, etc. indicate the beginning of suppuration of the wound); Monitor the function of the patient’s respiratory organs, if necessary, teach the postoperative patient to breathe deeply, cough and ensure that he lies in bed with his torso elevated; Take timely measures to detoxify the patient’s body (drinking plenty of fluids, oxygen therapy, ensuring the outflow of decay, etc.); Take the most active measures to eliminate physical inactivity, using a variety of methods of active and passive movements of the patient - physical therapy, massage, devices that help the patient sit down, etc.; Maintain patient hygiene.
Slide 6
Physical rehabilitation of patients after surgery Observation of a patient after surgery
Slide 7
Functional responsibilities of Junior Medical Staff
Junior medical personnel include junior nurses, housekeepers and nurses. The junior nurse (nursing nurse) helps the ward nurse in caring for the sick, changes linen, ensures that the patients and the hospital premises are kept clean and tidy, participates in the transportation of patients, and monitors patients’ compliance with the hospital regime. The housewife sister deals with household issues, receives and issues linen, detergents and cleaning equipment and directly supervises the work of the nurses. Nurses: the range of their responsibilities is determined by their category (ward nurse, barmaid, nurse, cleaner, etc.).
Slide 8
The general responsibilities of junior medical personnel are as follows: 1. Regular wet cleaning of premises: wards, corridors, common areas, etc. 2. Assisting nurses in caring for patients: changing linen, feeding seriously ill patients, hygienic provision of physiological functions of seriously ill patients - feeding, cleaning and washing vessels and urinals, etc. 3. Sanitary and hygienic treatment of patients. 4. Accompanying patients for diagnostic and treatment procedures. 5. Transportation of patients.
View all slides
Basic literature:
1. Dronov A.F. General care for children with surgical diseases [Text]: textbook. allowance / A.F. Dronov. -2nd ed., revised. and additional -Moscow: Alliance, 2013. -219 p.
2. Caring for a healthy and sick child [Text]: textbook. allowance / [E. I. Aleshina [etc.]; edited by V. V. Yuryeva, N. N. Voronovich. - St. Petersburg: SpetsLit, 2009. - 190, p.
3. Gulin A.V. Basic algorithms for pediatric resuscitation [Text]: textbook. manual for students studying in the specialty 060103 65 - Pediatrics / A. V. Gulin, M. P. Razin, I. A. Turabov; Ministry of Health and Social Services development of Russia Federation, Northern state honey. University, Kirov. state honey. acad.. -Arkhangelsk: Publishing house of SSMU, 2012. -119 p.
4. Pediatric surgery [Text]: textbook. for universities / edited by Yu. F. Isakov, A. Yu. Razumovsky. - Moscow: GEOTAR-Media, 2014. - 1036 p.
5. Kudryavtsev V.A. Pediatric surgery in lectures [Text]: textbook for honey. universities / V. A. Kudryavtsev; North state honey. univ. -2nd ed., revised. - Arkhangelsk: IC SSMU, 2007. -467 p.
Further reading:
1. Petrov S.V. General surgery [Text]: textbook. for universities with CD: textbook. allowance for medical universities/ S.V. Petrov. -3rd ed., revised. and additional -Moscow: GEOTAR-Media, 2005. -767 p.
2. Surgical diseases of childhood [Text]: textbook. for medical students universities: in 2 volumes / Ed. A.F. Isakov, rep. ed. A.F. Dronov. - Moscow: GEOTAR-MED, 2004.
3. Pediatric surgery [Electronic resource]: textbook / ed. Yu. F. Isakov, A. Yu. Razumovsky. - M.: GEOTAR-Media, 2014. - 1040 p. : ill. - Access mode: http://www.studmedlib.ru/.
4. Drozdov, A. A. Pediatric surgery [Text]: lecture notes / A. A. Drozdov, M. V. Drozdova. - Moscow: EKSMO, 2007. - 158, p.
5. Practical guide to outpatient orthopedics in children [Text] / [O. Yu. Vasilyeva [and others]; edited by V. M. Krestyashina. - Moscow: Med. information agency, 2013. - 226, p.
6. Makarov A.I. Features of examination of a child to identify surgical and orthopedic pathology [Text]: method. recommendations / A.I. Makarov, V.A. Kudryavtsev; North state honey. univ. - Arkhangelsk: Publishing house. center SSMU, 2006. - 45, p.
Electronic publications, digital educational resources
I. Electronic version: Surgical diseases in children: Textbook/" Edited by Yu.F. Isakov. - 1998.
II. EBS “Student Consultant” http://www.studmedlib.ru/
III. EBS Iprbooks http://www.iprbookshop.ru/
AGREED" "APPROVED"
Head Department of Pediatric Surgery, Dean of the Faculty of Pediatrics,
Doctor of Medical Sciences Turabov I.A. Doctor of Medical Sciences_Turabov I.A.
WORKING CURRICULUM
Elective course
By discipline _ Pediatric surgery
In the area of training__ Pediatrics _____063103______________
Course ____6_______________________________________________
Practical training - 56 hours
Independent work -176 hours
Type of intermediate certification ( test)_ __11th semester
Department of _Pediatric Surgery________
The labor intensity of the discipline is _232 hours
Arkhangelsk, 2014
1. The purpose and objectives of mastering the discipline
The specialty was approved by order of the Ministry of Education of the Russian Federation (order of the State Committee for Higher Education of the Russian Federation dated March 5, 1994 No. 180). Graduate qualification - Doctor. The object of professional activity of graduates is the patient. A doctor who is a graduate of the specialty “060103 Pediatrics” has the right to perform therapeutic and preventive activities. He has the right to occupy medical positions not related to the direct management of patients: research and laboratory activities in theoretical and fundamental areas of medicine.
The area of professional activity of specialists includes a set of technologies, means, methods and methods of human activity aimed at preserving and improving the health of the population by ensuring the appropriate quality of pediatric care (therapeutic and preventive, medical and social) and dispensary observation.
The objects of professional activity of specialists are:
children aged 0 to 15 years;
teenagers aged 15 to 18 years;
a set of tools and technologies aimed at creating conditions for maintaining health, ensuring the prevention, diagnosis and treatment of diseases in children and adolescents.
Specialist in the field of training (specialty) 060103 Pediatrics prepares for the following types of professional activities:
preventive;
diagnostic;
medicinal;
rehabilitation;
psychological and pedagogical;
organizational and managerial;
scientific research.
I. Goals and objectives of the discipline
The purpose of teaching the elective in pediatric surgery at the Faculty of Pediatrics: deepening students' theoretical and practical knowledge and skills on semiotics, clinical practice, diagnostics, differential diagnosis, treatment tactics and emergency care for developmental defects, surgical diseases, traumatic injuries, tumors, critical conditions in children of various age groups.
Objectives of studying an elective course in pediatric surgery at the Faculty of Pediatrics are to develop students’ skills:
Examine children with various surgical pathologies;
Diagnose developmental defects, surgical diseases, traumatic injuries, tumors, critical conditions in children;
Provide emergency assistance to them;
Resolve questions about the tactics of further treatment and observation;
Solve issues of preventing the occurrence of surgical pathology and its complications in children.
2. The place of discipline in the structure of the educational program
The program is compiled in accordance with the requirements of the State Educational Standard for Higher Professional Education in the field of training Pediatrics, studied in the eleventh semester.
The elective “Selected Issues in Pediatric Surgery” refers to an elective discipline
The basic knowledge necessary to study the discipline is formed by:
- in the cycle of humanitarianand socio-economicdisciplines(philosophy, bioethics; psychology, pedagogy; jurisprudence, history of medicine; Latin language; foreign language);
- in the cycle of mathematical, natural science, medical and biological disciplines(physics and mathematics; medical informatics; chemistry; biology; biochemistry, human anatomy, topographic anatomy; histology, embryology, cytology, histology; normal physiology; pathological anatomy, pathophysiology; microbiology, virology; immunology, clinical immunology; pharmacology);
- in the cycle of medical, professional and clinical disciplines(medical rehabilitation; hygiene; public health, healthcare, healthcare economics; operative surgery and topographic anatomy, radiation diagnostics and therapy, general, faculty and hospital surgery, traumatology and orthopedics, anesthesiology and resuscitation, pediatrics).
3. Requirements for the level of mastery of the discipline content
As a result of mastering the discipline, the student must:
Know:
1. Etiopathogenesis of surgical diseases, developmental defects, traumatic injuries and critical conditions in children of various age groups.
2. The clinical picture of the listed pathological conditions and its features depending on the age of the children.
3. Diagnostics (clinical, laboratory, instrumental) and differential diagnostics.
4. Surgical tactics of the pediatrician, rational terms of treatment.
5. Methods and techniques for feeding healthy and sick young children
6. Methodology for examining patients with certain pathologies
7 Features of emergency care and intensive care for surgical diseases and critical conditions in children of various age groups.
8. Clinical observation and medical rehabilitation for the diseases being studied.
Be able to:
1. Collect an anamnesis of the child’s life and illness.
2. Conduct a physical examination of children of various age groups.
3. Be able to carry out psychological and verbal contact with healthy and sick children.
4. Make a plan for a clinical examination.
5. Interpret data from clinical, laboratory, and instrumental examination methods.
6. Make a preliminary diagnosis and determine treatment tactics.
7. Determine the ward mode, treatment table, optimal dosage regimen, frequency and duration of drug administration for the pathology being studied.
8. Provide emergency care for surgical diseases and critical conditions in children of various age groups.
9. Provide resuscitation assistance at the prehospital and hospital stages.
10.Plan individual dispensary observation and medical rehabilitation for sick children;
11. Work independently with information (educational, scientific, normative reference literature and other sources);
own(in accordance with the objectives of the discipline in the field of developing practical skills):
1. a professional algorithm for solving practical problems of diagnosis, differential diagnosis, treatment and prevention of acute and chronic diseases in children of different age and gender groups;
2. medical ethics and deontology;
3. skills to properly build your relationship with the parents of a sick child;
4. questioning technique (complaints, medical history, life history);
5. clinical research methods (examination, palpation, percussion and auscultation of the lungs and heart);
6. skills in assessing the results of instrumental research methods;
7. skills in assessing the results of clinical laboratory and microbiological examination of sputum, peripheral blood, gastric contents, bile, urine, feces;
8. prepare and evaluate the results of x-ray examination of the respiratory system, cardiovascular system, gastrointestinal tract, kidneys and urinary tract;
9. evaluate the results of biochemical studies of peripheral blood, urine, bile;
10. master the principles and techniques of emergency care and intensive care for various diseases in children.
4. Scope of discipline and types of academic work:
4.1Semester and type of reporting for the elective.
| Semester | Reporting type |
| 11 | Test |
p/p
Section Contents
1
2
3
1.
Surgical neonatology (NEC, abdominal cysts, gastrostomy) (KPZ lecture)
Surgical neonatology (anorectal anomalies, diaphragmatic hernias) lecture KPZ)
2.
Minimally invasive ultrasound-guided operations in children (KPZ lecture)
Echography of the hollow organs of the gastrointestinal tract in children (KPZ lecture)
3.
Pediatric urology-andrology
Urinary disorders in children (KPZ lecture)
4.
Pediatric oncology
Bone sarcomas in children (KPZ lecture)
Germ cell tumors (KPP lecture)
5.
Intensive care of the perioperative period (KPP lecture)
5.2. Sections of disciplines and types of classes
| № p/p | Name of the discipline section | Lectures (labor intensity) | Practical exercises |
| 1 | 2 | 3 | 7 |
| 1. | Emergency neonatal surgery | 4 | 10 |
| 2. | Ultrasound in the diagnosis and treatment of surgical diseases in children | 4 | 10 |
| 3. | Pediatric urology-andrology | 2 | 5 |
| 4. | Pediatric oncology | 4 | 10 |
| 5. | Borderline issues of pediatric surgery and anesthesiology-reanimation | 2 | 5 |
| 16 | 40 |
5.3. Thematic planning
| № p/p | Name of the discipline section | lectures | Practical exercises |
| 1 | 2 | 3 |
|
| 1. | Emergency neonatal surgery | Surgical neonatology (NEC, abdominal cysts, gastrostomy) Surgical neonatology (anorectal anomalies, diaphragmatic hernia) | 1. Surgical neonatology (NEC, abdominal cysts, gastrostomy) 2. Surgical neonatology (anorectal anomalies, diaphragmatic hernia) |
| 2. | Ultrasound in the diagnosis and treatment of surgical diseases in children | Minimally invasive ultrasound-guided surgeries in children Echography of the hollow organs of the gastrointestinal tract in children | 1.Minimally invasive ultrasound-guided operations in children 2.Echography of the hollow organs of the gastrointestinal tract in children |
| 3. | Pediatric urology-andrology | Urinary problems in children | 1.Difficulty urinating in children |
| 4. | Pediatric oncology | Bone sarcomas in children Germ cell tumors | 1. Bone sarcomas in children 2.Germ cell tumors |
| 5. | Borderline issues of pediatric surgery and anesthesiology-reanimation | Intensive care of the perioperative period | 1. Intensive care of the perioperative period |
7. Extracurricular independent work of students
| № p/p | Name of the discipline section | Types of independent work | Forms of control |
|
| 1. | Emergency neonatal surgery |
|||
| | Oral (speech presentation) |
|||
| 2. | Ultrasound in the diagnosis and treatment of surgical diseases in children | Preparation of a report on the topic of the lesson in the form of a presentation | Oral (speech presentation) |
|
| | Oral (speech presentation) |
|||
| 3 | Pediatric urology-andrology | Analysis of a clinical case in the form of a presentation | Oral (speech presentation) |
|
| 4. | Pediatric oncology | Preparation of a report on the topic of the lesson in the form of a presentation | Oral (speech presentation) |
|
| Analysis of a clinical case in the form of a presentation | Oral (speech presentation) |
|||
| 5 | Borderline issues of pediatric surgery and anesthesiology-reanimation | Analysis of a clinical case in the form of a presentation | Oral (speech presentation) |
|
8.Forms of control
8.1. Forms of current control
Oral (interview, report)
Written (checking tests, essays, notes, solving problems).
The list of topics for essays, reports, collections of tests and situational problems are given in section 4 of the Educational and Methodological Complex of the discipline “C
8.2. Forms of intermediate certification (test)
Stages of the test
| Semester | Interim certification forms |
| 11 | test |
Questions for testing are given in section 4 of the educational and methodological complex of the discipline “Tools for assessing competencies”.
9. Educational and methodological support of the discipline
9.1. Basic literature
1. Outpatient surgery of children: textbook / V.V. Levanovich, N.G. Zhila., I.A. Commissioners. – M.- GZOTAR-Media, 2014 – 144 p.: ill.
2. Pediatric surgery: textbook / edited by Yu.F. Isakova, A.Yu. Razumovsky. – M.: GZOTAR-Media, 2014.– 1040 pp.: ill.
3. Pediatric surgery: national hands/Association of medical quality organizations: edited by Yu.F. Isakova, A.F. Dronova – M.: GEOTAR – Media. 2009 – 1164 pp. (24 copies) 4. Isakov Yu.F. Surgical diseases of childhood: studies in 2 t – M.: GEOTAR – MED. 2008 – 632 p.
5. Kudryavtsev V.A. Pediatric surgery in lectures. Studies for medical universities, SSMU - Arkhangelsk: IC SSMU. 2007 – 467 p.
4. Anesthesiology and resuscitation: a textbook for students of medical universities / ed. O.A. Dolina – M.: GEOTAR-Media, 2007. – 569 p.
9.2. Further reading
1. Pediatric oncology. National leadership / Ed. M.D. Alieva V.G. Polyakova, G.L. Mentkevich, S.A. Mayakova. – M.: Publishing group RONC, Practical Medicine, 2012. – 684 p.: ill.
Durnov L.A., Goldobenko G.V. Pediatric oncology: Textbook. – 2nd ed. reworked and additional – M.: Medicine. 2009.
Podkamenev V.V. Surgical diseases of childhood: a textbook for medical universities - M.: Medicine. 2005. – 236 p. 3..F.Shir.M.Yu.Yanitskaya (Scientific editing and preparation of text in Russian) Laparoscopy in children. Arkhangelsk, Publishing center of SSMU, 2008.
5. Oncological and tumor-like diseases of childhood: a textbook for students of medical universities/ I.A. Turabov, M.P. Razin. – Arkhangelsk; From the Northern State Medical University, 2013. – 105 p.: ill.
6. Ultrasound examination of the hollow organs of the gastrointestinal tract in surgical pathology in children. Hydroechocolonography: monograph / M.Yu. Yanitskaya, I.A. Kudryavtsev, V.G. Sapozhnikov et al. – Arkhangelsk: Publishing house of the Northern State Medical University, 2013. – 128 p.: ill.
7. Hydroechocolography - diagnosis and treatment of colon diseases in children, methodological recommendations / M.Yu. Yanitskaya. – Arkhangelsk; From the Northern State Medical University, 2013. – 83 p.: ill.
9.3.
Software and Internet resources
CONCEPT OF CARE FOR SURGICAL PATIENTS
Surgery is a special medical specialty that uses mechanical effects on body tissue or surgery for the purpose of treatment, which causes a number of serious differences in the organization and implementation of care for surgical patients.
Surgery- this is a complex, targeted diagnostic or, most often, therapeutic action associated with the methodical separation of tissues aimed at accessing the pathological focus and its elimination with the subsequent restoration of the anatomical relationships of organs and tissues.
The changes that occur in the body of patients after surgery are extremely diverse and include functional, biochemical and morphological disorders. They are caused by a number of reasons: fasting before and after surgery, nervous tension, surgical trauma, blood loss, cooling, especially during abdominal operations, a change in the ratio of organs due to the removal of one of them.
Specifically, this is expressed by the loss of water and mineral salts, the breakdown of protein. Thirst, insomnia, pain in the wound area, impaired intestinal and stomach motility, impaired urination, etc. develop.
The degree of these changes depends on the complexity and volume of the surgical operation, on the initial state of health of the patient, on age, etc. Some of them are easily expressed, while in other cases they seem significant.
Natural deviations from normal physiological processes most often represent a natural response to surgical trauma and partially do not require elimination, since the homeostasis system independently normalizes them.
Properly organized patient care sometimes remains the only important element in postoperative surgery, which may be quite sufficient for a complete and rapid recovery of the patient.
Professional care for patients after operations requires knowledge of both natural changes in their general condition, local processes, and the possible development of complications.
CARE is one of the important elements in the treatment of a patient, it is organized on the basis of professional knowledge of possible changes or complications in patients after operations and is aimed at timely prevention and elimination of them.
The amount of care depends on the patient’s condition, his age, the nature of the disease, the scope of surgery, the prescribed regimen, and complications that arise.
Nursing is helping a patient in his frail state and is the most important element of medical activity.
In severe postoperative patients, care includes assistance in satisfying their basic life needs (food, drink, movement, bowel movements, bladder, etc.); carrying out personal hygiene measures (washing, preventing bedsores, changing linen, etc.); assistance during painful conditions (vomiting, coughing, bleeding, breathing problems, etc.).
In surgical practice, for patients suffering from pain and fearful before or after surgery, care requires an active position on the part of the staff. Surgical patients, especially severe postoperative patients, do not ask for help. Any care activities bring them additional painful and unpleasant sensations, so they have a negative attitude towards any attempts to activate the motor mode and perform the necessary hygienic procedures. In these situations, staff must exercise caring, patient persistence.
An important component of nursing care is to create as much physical and mental peace as possible. Silence in the room where patients are, a calm, even, friendly attitude of medical personnel towards them, the elimination of all unfavorable factors that can traumatize the patient’s psyche - these are some of the basic principles of the so-called therapeutic and protective regime of medical institutions, on which the effectiveness largely depends treating patients. For a good outcome of the disease, it is very important that the patient is in a calm, physiologically comfortable position, in good hygienic conditions, and receives a balanced diet.
The caring, warm, attentive attitude of the medical staff contributes to recovery.
SANITARY PREPARATION OF THE PATIENT FOR OPERATION
The preoperative period occupies an important place in the treatment system and its organization. This is a certain period of time necessary to establish a diagnosis and bring vital functions of organs and systems to vital levels.
Preoperative preparation is carried out to reduce the risk of surgery and prevent possible complications. The preoperative period can be very short during emergency operations and relatively extended during planned operations.
General preparation for planned operations includes all studies related to establishing a diagnosis, identifying complications of the underlying disease and concomitant diseases, and determining the functional state of vital organs. When indicated, drug treatment is prescribed, aimed at improving the functioning of various systems in order to lead to a certain readiness of the patient’s body for surgical intervention. The outcome of the upcoming treatment largely depends on the nature and conduct, and ultimately on the organization of the preoperative period.
It is advisable to postpone planned operations during menstruation, even with a slight rise in temperature, a mild cold, the appearance of pustules on the body, etc. Sanitation of the oral cavity is mandatory.
The responsibilities of junior and mid-level personnel include sanitary preparation of the patient. It usually starts the evening before surgery. The patient is explained that the operation must be performed on an empty stomach. In the evening, patients receive a light dinner, and in the morning they are not allowed to eat or drink.
In the evening, in the absence of contraindications, all patients are given a cleansing enema. Then the patient takes a hygienic bath or shower, his underwear and bed linen are changed. At night, as prescribed by the doctor, the patient is given sleeping pills or sedatives.
In the morning, immediately before the operation, hair is shaved widely from the future surgical field and its circumference, taking into account possible expansion of access. Before shaving, the skin is wiped with a disinfectant solution and allowed to dry, and after shaving, it is wiped with alcohol. These measures cannot be carried out in advance, since abrasions and scratches obtained during shaving may become infected. A few hours are enough to turn them into a source of infection with subsequent development of postoperative complications.
In the morning the patient washes his face and brushes his teeth. The dentures are taken out, wrapped in gauze and placed in the nightstand. A cap or scarf is put on the scalp. Women with long hair have their hair braided.
After premedication, the patient is taken to the operating room on a gurney, accompanied by a nurse dressed in a clean gown, cap and mask.
For patients admitted for emergency reasons, the amount of sanitary preparation depends on the urgency of the required operation and is determined by the doctor on duty. Mandatory measures include emptying the stomach using a gastric tube and shaving the hair of the surgical field.
HYGIENE OF THE BODY, LINEN, DISCHARGE OF THE PATIENT
IN THE POSTOPERATIVE PERIOD
The postoperative period is a period of time after the operation, which is associated with the completion of the wound process - wound healing, and stabilization of the reduced and damaged functions of life-supporting organs and systems.
In patients in the postoperative period, active, passive and forced positions are distinguished.
The active position is typical for patients with relatively mild diseases, or in the initial stages of severe diseases. The patient can independently change position in bed, sit down, stand up, and walk.
A passive position is observed when the patient is unconscious and, less commonly, in cases of extreme weakness. The patient is motionless, remains in the position that was given to him, the head and limbs hang down due to their gravity. The body slides off the pillows towards the lower end of the bed. Such patients require special monitoring by medical staff. It is necessary to change the position of the body or its individual parts from time to time, which is important in the prevention of complications - bedsores, hypostatic pneumonia, etc.
The patient takes a forced position to stop or weaken the painful sensations he has (pain, cough, shortness of breath, etc.).
Caring for patients with a general regime after surgery comes down mainly to organizing and monitoring their compliance with hygienic measures. Seriously ill patients with bed rest need active assistance in caring for the body, linen, and performing physiological functions.
The competence of medical personnel includes creating a functionally advantageous position for the patient that promotes recovery and prevention of complications. For example, after surgery on the abdominal organs, it is advisable to position yourself with the head end raised and the knees slightly bent, which helps to relax the abdominal press and provides rest to the surgical wound, favorable conditions for breathing and blood circulation.
To give the patient a functionally advantageous position, special headrests, bolsters, etc. can be used. There are functional beds consisting of three movable sections, which allow you to smoothly and silently give the patient a comfortable position in bed using handles. The legs of the bed are equipped with wheels for moving it to another place.
An important element of caring for seriously ill patients is the prevention of bedsores.
A bedsore is a necrosis of the skin with subcutaneous tissue and other soft tissues, which develops as a result of prolonged compression, disturbances of local blood circulation and nervous trophism. Bedsores usually form in severe, weakened patients who are forced to remain in a horizontal position for a long time: when lying on the back - in the area of the sacrum, shoulder blades, elbows, heels, on the back of the head, when the patient is positioned on the side - in the area of the hip joint, in the projection of the greater trochanter femur.
The occurrence of bedsores is facilitated by poor patient care: untidy maintenance of the bed and underwear, uneven mattress, food crumbs in the bed, long stay of the patient in one position.
When bedsores develop, the skin first appears as redness and pain, then the epidermis peels off, sometimes with the formation of blisters. Next, necrosis of the skin occurs, spreading inward and to the sides, exposing muscles, tendons, and periosteum.
To prevent bedsores, change the position every 2 hours, turning the patient, while the places where bedsores may appear are inspected, wiped with camphor alcohol or another disinfectant, and a light massage is performed - stroking, patting.
It is very important that the patient’s bed is neat, the mesh is well stretched, with a flat surface; a mattress without bumps or depressions is placed on top of the mesh, and a clean sheet is placed on it, the edges of which are tucked under the mattress so that it does not roll or gather in folds.
For patients suffering from urinary and fecal incontinence, or with copious discharge from wounds, it is necessary to place an oilcloth over the entire width of the bed and bend its edges well to prevent soiling of the bed. A diaper is placed on top, which is changed as needed, but no less than every 1-2 days. Wet, soiled linen is changed immediately.
A rubber inflatable circle covered with a diaper is placed under the patient’s sacrum, and cotton-gauze circles are placed under the elbows and heels. It is more effective to use an anti-decubitus mattress, which consists of many inflatable sections, the air pressure in which periodically changes in waves, which also periodically changes the pressure on different areas of the skin in waves, thereby producing a massage and improving blood circulation in the skin. When superficial skin lesions appear, they are treated with a 5% solution of potassium permanganate or an alcohol solution of brilliant green. Treatment of deep bedsores is carried out according to the principle of treating purulent wounds, as prescribed by a doctor.
Bed and underwear are changed regularly, at least once a week, after a hygienic bath. In some cases, linen is changed additionally as needed.
Depending on the patient’s condition, there are several ways to change bed and underwear. When the patient is allowed to sit, he is transferred from the bed to a chair, and the junior nurse makes his bed.
Changing a sheet under a seriously ill patient requires a certain skill from the staff. If the patient is allowed to turn on his side, you must first carefully lift his head and remove the pillow from under it, and then help the patient turn on his side. On the vacant half of the bed, located on the side of the patient’s back, you need to roll up a dirty sheet so that it lies in the form of a cushion along the patient’s back. In the vacated space you need to put a clean, also half-rolled sheet, which in the form of a roller will lie next to the roller of the dirty sheet. Then the patient is helped to lie on his back and turn on the other side, after which he will find himself lying on a clean sheet, turning his face to the opposite edge of the bed. After this, remove the dirty sheet and straighten the clean one.
If the patient cannot move at all, you can change the sheet in another way. Starting at the bottom end of the bed, roll the dirty sheet under the patient, lifting his legs, thighs and buttocks in turn. The roll of the dirty sheet will be placed under the patient's lower back. A clean sheet rolled up in the transverse direction is placed on the foot end of the bed and straightened towards the head end, also lifting the patient’s lower limbs and buttocks. The roll of the clean sheet will be next to the roll of the dirty one - under the lower back. Then one of the orderlies slightly raises the patient’s head and chest, while the other at this time removes the dirty sheet and straightens a clean one in its place.
Both methods of changing a sheet, with all the dexterity of the caregivers, inevitably cause a lot of anxiety to the patient, and therefore sometimes it is more expedient to put the patient on a gurney and remake the bed, especially since in both cases two people have to do this.
If there is no gurney, the two of you need to move the patient to the edge of the bed, then straighten the mattress and sheet on the vacant half, then transfer the patient to the removed half of the bed and do the same on the other side.
When changing underwear in seriously ill patients, the nurse should place her hands under the patient’s sacrum, grab the edges of the shirt and carefully bring it to the head, then raise both of the patient’s arms and move the rolled up shirt at the neck over the patient’s head. After this, the patient's hands are freed. Dress the patient in the reverse order: first put on the sleeves of the shirt, then throw it over the head, and finally straighten it under the patient.
For very seriously ill patients, there are special shirts (vests) that are easy to put on and take off. If the patient's arm is injured, first remove the shirt from the healthy arm, and only then from the sick one. First they dress the sore hand, and then the healthy one.
In severely ill patients who are on bed rest for a long time, various skin disorders may occur: pustular rash, peeling, diaper rash, ulceration, bedsores, etc.
It is necessary to wipe the skin of patients daily with a disinfectant solution: camphor alcohol, cologne, vodka, alcohol half and half with water, table vinegar (1 tablespoon per glass of water), etc. To do this, take the end of a towel, moisten it with a disinfectant solution, wring it out lightly and begin to wipe behind the ears, neck, back, front surface of the chest and in the armpits. You should pay attention to the folds under the mammary glands, where obese women can develop diaper rash. Then wipe the skin dry in the same order.
A patient on bed rest needs to wash his feet two or three times a week, placing a basin of warm water at the foot end of the bed. In this case, the patient lies on his back, the junior nurse soaps his feet, washes, wipes, and then trims his nails.
Seriously ill patients cannot brush their teeth on their own, so after each meal the nurse must clean the patient’s mouth. To do this, she alternately removes the patient’s cheek from the inside with a spatula on each side and wipes the teeth and tongue with tweezers with a gauze ball moistened with a 5% solution of boric acid, or a 2% solution of sodium bicarbonate, or a weak solution of potassium permanganate. After this, the patient thoroughly rinses his mouth with the same solution or just warm water.
If the patient is unable to rinse, then he should irrigate the oral cavity using an Esmarch mug, a rubber bulb or a Janet syringe. The patient is given a semi-sitting position, the chest is covered with oilcloth, and a kidney-shaped tray is brought to the chin to drain the washing liquid. The nurse alternately pulls back the right and then the left cheek with a spatula, inserts the tip and irrigates the oral cavity, while washing away food particles, plaque, etc. with a stream of liquid.
In severely ill patients, inflammation often occurs on the mucous membrane of the mouth - stomatitis, gums - gingivitis, tongue - glossitis, which is manifested by redness of the mucous membrane, salivation, burning, pain when eating, the appearance of ulcers and bad breath. In such patients, therapeutic irrigation is performed with disinfectants (2% chloramine solution, 0.1% furatsilin solution, 2% sodium bicarbonate solution, weak potassium permanganate solution). Applications can be made by applying sterile gauze pads soaked in a disinfectant solution or analgesic for 3-5 minutes. The procedure is repeated several times a day.
If your lips are dry and cracks appear in the corners of your mouth, it is not recommended to open your mouth wide, touch the cracks, or pick off the crusts that have formed. To alleviate the patient's condition, use hygienic lipstick, lubricate the lips with any oil (vaseline, butter, vegetable).
Dentures are removed at night, washed with soap, stored in a clean glass, washed again in the morning and put on.
If purulent discharge appears that sticks the eyelashes together, the eyes are washed with sterile gauze swabs soaked in a warm 3% boric acid solution. The tampon is moved in the direction from the outer edge to the nose.
To instill drops into the eye, use an eye pipette, and there should be different sterile pipettes for different drops. The patient throws back his head and looks up, the nurse pulls back the lower eyelid and, without touching the eyelashes, without bringing the pipette closer to the eye than 1.5 cm, instill 2-3 drops into the conjunctival fold of one and then the other eye.
Eye ointments are applied with a special sterile glass rod. The patient's eyelid is pulled down, ointment is placed behind it and rubbed over the mucous membrane with gentle finger movements.
If there is nasal discharge, they are removed with cotton swabs, inserting them into the nasal passages with light rotational movements. When crusts form, you must first drop a few drops of glycerin, vaseline or vegetable oil into the nasal passages; after a few minutes, the crusts are removed with cotton wool.
Wax that accumulates in the external auditory canal should be carefully removed with a cotton swab, after dropping 2 drops of a 3% hydrogen peroxide solution. To put drops into the ear, the patient's head must be tilted in the opposite direction, and the auricle must be pulled back and up. After instilling the drops, the patient should remain in a position with his head bowed for 1-2 minutes. Do not use hard objects to remove wax from your ears due to the risk of damaging the eardrum, which can lead to hearing loss.
Due to their sedentary state, seriously ill patients require assistance in carrying out their physiological functions.
If it is necessary to empty the intestines, a patient who is on strict bed rest is given a bedpan, and when urinating, a urinal is provided.
The vessel can be metal with an enamel coating or rubber. A rubber bed is used for weakened patients, those with bedsores, and fecal and urinary incontinence. Do not inflate the vessel too tightly, otherwise it will put significant pressure on the sacrum. When placing the vessel into the bed, be sure to place an oilcloth under it. Before serving, the vessel is rinsed with hot water. The patient bends his knees, the nurse places his left hand on the side under the sacrum, helping the patient to raise the pelvis, and with his right hand he places the vessel under the patient’s buttocks so that the perineum is above the hole of the vessel, covers the patient with a blanket and leaves him alone. After defecation, the vessel is removed from under the patient, its contents are poured into the toilet. The vessel is thoroughly washed with hot water and then disinfected with a 1% solution of chloramine or bleach for an hour.
After each act of defecation and urination, patients should be washed, since otherwise maceration and inflammation of the skin are possible in the area of the inguinal folds and perineum.
Washing is done with a weak solution of potassium permanganate or other disinfectant solution, the temperature of which should be 30-35 ° C. To wash, you need to have a jug, forceps and sterile cotton balls.
When washing, a woman should lie on her back, bend her knees and slightly spread them at the hips, and place a bedpan under her buttocks.
In her left hand, the nurse takes a jug with a warm disinfectant solution and pours water on the external genitalia, and uses a forceps with a cotton swab clamped in it to make movements from the genitals to the anus, i.e. top down. After this, wipe the skin with a dry cotton swab in the same direction so as not to spread the infection from the anus to the bladder and external genitalia.
Washing can be done from an Esmarch mug equipped with a rubber tube, a clamp and a vaginal tip, directing a stream of water or a weak solution of potassium permanganate to the perineum.
It is much easier to wash men. The patient is positioned on his back, legs bent at the knees, and a bedpan is placed under the buttocks. Using cotton wool clamped in a forceps, wipe the perineum dry and lubricate it with petroleum jelly to prevent diaper rash.
POST-OPERATIVE WOUND CARE
The local result of any operation is a wound, which is characterized by three important signs: gaping, pain, bleeding.
The body has a perfect mechanism aimed at wound healing, which is called the wound process. Its purpose is to eliminate tissue defects and relieve the listed symptoms.
This process is an objective reality and occurs independently, passing through three phases in its development: inflammation, regeneration, reorganization of the scar.
The first phase of the wound process - inflammation - is aimed at cleansing the wound of non-viable tissue, foreign bodies, microorganisms, blood clots, etc. Clinically, this phase has symptoms characteristic of any inflammation: pain, hyperemia, swelling, dysfunction.
Gradually, these symptoms subside, and the first phase is replaced by a regeneration phase, the meaning of which is to fill the wound defect with young connective tissue. At the end of this phase, the processes of constriction (tightening of the edges) of the wound begin due to fibrous connective tissue elements and marginal epithelization. The third phase of the wound process, scar reorganization, is characterized by its strengthening.
The outcome of surgical pathology largely depends on proper observation and care of the postoperative wound.
The wound healing process is absolutely objective, occurs independently and is worked to perfection by nature itself. However, there are reasons that interfere with the wound process and inhibit normal wound healing.
The most common and dangerous reason that complicates and slows down the biology of the wound process is the development of infection in the wound. It is in the wound that microorganisms find the most favorable living conditions with the necessary humidity, comfortable temperature, and an abundance of nutritious foods. Clinically, the development of infection in the wound is manifested by its suppuration. Fighting an infection requires a significant effort of the macroorganism, time, and is always risky with regard to the generalization of the infection and the development of other severe complications.
Infection of the wound is facilitated by its gaping, since the wound is open for microorganisms to enter it. On the other hand, significant tissue defects require more plastic materials and more time to eliminate them, which is also one of the reasons for the increase in wound healing time.
Thus, it is possible to promote the speedy healing of a wound by preventing its infection and by eliminating the gap.
In most patients, the gaping is eliminated during surgery by restoring the anatomical relationships by layer-by-layer suturing of the wound.
Caring for a clean wound in the postoperative period comes down primarily to measures to prevent its microbial contamination from secondary, hospital infections, which is achieved by strictly following well-developed asepsis rules.
The main measure aimed at preventing contact infection is sterilization of all objects that may come into contact with the surface of the wound. Instruments, dressings, gloves, linen, solutions, etc. must be sterilized.
Directly in the operating room, after suturing the wound, it is treated with an antiseptic solution (iodine, iodonate, iodopirone, brilliant green, alcohol) and covered with a sterile bandage, which is tightly and securely fixed by bandaging or using glue or adhesive tape. If during the postoperative period the bandage becomes loose or wet with blood, lymph, etc., you must immediately notify the attending physician or the doctor on duty, who, after examination, instructs you to change the bandage.
During any dressing (removal of a previously applied dressing, examination of the wound and therapeutic manipulations on it, application of a new dressing), the wound surface remains open and comes into contact with air for a more or less long time, as well as with instruments and other objects used in dressings. Meanwhile, the air in dressing rooms contains significantly more microbes than the air in operating rooms, and often in other hospital rooms. This is due to the fact that a large number of people are constantly circulating in the dressing rooms: medical staff, patients, students. Wearing a mask when changing dressings is mandatory to avoid droplet infection from splashing saliva, coughing, or breathing onto the wound surface.
After the vast majority of clean operations, the wound is sutured tightly. Occasionally, between the edges of a sutured wound or through a separate puncture, the cavity of the hermetically sutured wound is drained with a silicone tube. Drainage is performed to remove wound secretions, residual blood and accumulated lymph in order to prevent wound suppuration. Most often, drainage of clean wounds is performed after operations on the mammary gland, when a large number of lymphatic vessels are damaged, or after operations for extensive hernias, when after removal of large hernial sacs pockets remain in the subcutaneous tissue.
There are passive drainage, when wound exudate flows by gravity. With active drainage or active aspiration, contents are removed from the wound cavity using various devices that create a constant vacuum in the range of 0.1-0.15 atm. As a vacuum source, rubber cylinders with a sphere diameter of at least 8-10 cm, industrially produced corrugations, as well as modified MK aquarium microcompressors are used with equal efficiency.
Postoperative care for patients with vacuum therapy, as a method of protecting uncomplicated wound processes, comes down to monitoring the presence of working vacuum in the system, as well as monitoring the nature and amount of wound discharge.
In the immediate postoperative period, air may be sucked in through skin sutures or leaky joints between tubes and adapters. If the system depressurizes, it is necessary to create a vacuum in it again and eliminate the source of air leakage. Therefore, it is desirable that the vacuum therapy device have a device for monitoring the presence of vacuum in the system. When using a vacuum of less than 0.1 atm, the system stops functioning on the first day after surgery, since the tube becomes obstructed due to thickening of the wound exudate. When the degree of vacuum is more than 0.15 atm, clogging of the side holes of the drainage tube with soft tissues is observed, involving them in the drainage lumen. This has a damaging effect not only on the fiber, but also on young developing connective tissue, causing it to bleed and increase wound exudation. A vacuum of 0.15 atm allows you to effectively aspirate discharge from a wound and have a therapeutic effect on surrounding tissues.
The contents of the collections are evacuated once a day, sometimes more often - as they are filled, the amount of liquid is measured and recorded.
Collection jars and all connecting tubes are subject to pre-sterilization cleaning and disinfection. They are first washed with running water so that no clots remain in their lumen, then placed in a 0.5% solution of synthetic detergent and 1% hydrogen peroxide for 2-3 hours, after which they are washed again with running water and boiled for 30 minutes.
If suppuration of the surgical wound has occurred or the operation was initially performed for a purulent disease, then the wound must be treated in an open manner, that is, the edges of the wound must be separated and the wound cavity drained in order to evacuate the pus and create conditions for cleansing the edges and bottom of the wound from necrotic tissue .
When working in wards for patients with purulent wounds, it is necessary to adhere to the rules of asepsis no less scrupulously than in any other department. Moreover, it is even more difficult to ensure the asepsis of all manipulations in the purulent department, since you need to think not only about not contaminating the wound of a given patient, but also about how not to transfer the microbial flora from one patient to another. “Superinfection,” that is, the introduction of new microbes into a weakened body, is especially dangerous.
Unfortunately, not all patients understand this and often, especially patients with chronic suppurative processes, are untidy, touch the pus with their hands, and then wash them poorly or not at all.
It is necessary to carefully monitor the condition of the dressing, which should remain dry and not contaminate the linen and furniture in the room. Bandages often have to be bandaged and changed.
The second important sign of a wound is pain, which occurs as a result of organic damage to nerve endings and itself causes functional disorders in the body.
The intensity of pain depends on the nature of the wound, its size and location. Patients perceive pain differently and react to it individually.
Intense pain can be a trigger for collapse and the development of shock. Severe pain usually absorbs the patient's attention, interferes with sleep at night, limits the patient's mobility, and in some cases causes a feeling of fear of death.
The fight against pain is one of the necessary tasks of the postoperative period. In addition to prescribing medications, elements of direct impact on the lesion are used for the same purpose.
During the first 12 hours after surgery, an ice pack is placed on the wound area. Local exposure to cold has an analgesic effect. In addition, cold causes contraction of blood vessels in the skin and underlying tissues, which promotes thrombus formation and prevents the development of hematoma in the wound.
To prepare “cold”, water is poured into a rubber bladder with a screw cap. Before screwing the cap on, the air must be forced out of the bubble. The bubble is then placed in the freezer until completely frozen. The ice pack should not be placed directly on the bandage; a towel or napkin should be placed under it.
To reduce pain, it is very important after surgery to give the affected organ or part of the body the correct position, which achieves maximum relaxation of the surrounding muscles and functional comfort for the organs.
After operations on the abdominal organs, a position with a raised head end and slightly bent knees is functionally advantageous, which helps to relax the muscles of the abdominal wall and provides rest to the surgical wound, favorable conditions for breathing and blood circulation.
The operated limbs should be in an average physiological position, which is characterized by balancing the action of antagonist muscles. For the upper limb, this position is shoulder abduction to an angle of 60° and flexion to 30-35°; The angle between the forearm and shoulder should be 110°. For the lower limb, flexion at the knee and hip joints is carried out to an angle of 140°, and the foot should be at right angles to the lower leg. After surgery, the limb is immobilized in this position using splints, splints or a fixing bandage.
Immobilization of the affected organ in the postoperative period significantly facilitates the patient’s well-being by relieving pain, improving sleep, and expanding the general motor pattern.
With purulent wounds in the 1st phase of the wound process, immobilization helps to limit the infectious process. In the regeneration phase, when inflammation subsides and pain in the wound subsides, the motor mode is expanded, which improves blood supply to the wound, promotes rapid healing and restoration of function.
Controlling bleeding, the third important sign of a wound, is a major challenge in any operation. However, if for some reason this principle was not implemented, then in the next few hours after the operation the bandage becomes wet with blood or blood leaks through the drains. These symptoms serve as a signal for an immediate examination by a surgeon and active action in terms of revision of the wound in order to finally stop the bleeding.
Preface…………………………………………………………………………………4
Introduction………………………………………………………………………………………..5
Chapter 1. General care for sick children……………………………………..6
Chapter 2. Procedures and manipulations of a nurse ……………………20 Chapter 3. Skills of a surgical nurse………………39 Chapter 4. First aid in emergency conditions …………………... 55
Appendix…………………………………………………………………………………...65
References……………………………………………………………...67
PREFACE
Industrial practice of students is the most important part of the training of a pediatrician; in the structure of the educational program of higher medical educational institutions, much attention is paid to this section of training.
The purpose of this teaching aid is to prepare 2nd and 3rd year students of the Faculty of Pediatrics for practical training.
The objectives of the educational manual are to improve students’ theoretical knowledge, provide information on the correct and high-quality performance of functional duties of junior and nursing staff, ensure the development of practical skills in caring for sick children, performing nursing manipulations and procedures, providing emergency first aid, filling out medical documentation .
The content of practical training of a specialist, set out in the manual, corresponds to the state educational standard of higher professional education in specialty 040200 “Pediatrics”, approved by the Ministry of Education of the Russian Federation on March 10, 2000, materials of the final state certification of graduates of medical and pharmaceutical universities in specialty 040200 “Pediatrics”, approved by the Ministry of Health of the Russian Federation (2000).
The need to publish this educational and methodological manual is due to the development at NSMA of a new end-to-end practical training program for students of the pediatric faculty with a list of skills necessary for mastering during the internship period. The peculiarity of this publication is the generalization and systematization of modern literary material, a clear presentation of the content of all practical skills in accordance with the approved program. No such publications have been previously published by NGMA.
The manual outlines the content of practical skills and abilities during practical training as an assistant to a ward and procedural nurse of a therapeutic and surgical profile, an emergency medical assistant, and indicates measures to provide first-aid care for the most common emergency conditions in children. The proposed manual is intended for self-training of students when studying the discipline “General child care” and undergoing practical training.
INTRODUCTION
This educational manual consists of 4 chapters.
The first chapter is devoted to the general care of a sick child as an essential part of the treatment process. The importance of care can hardly be overestimated; the success of treatment and the prognosis of the disease are often determined by the quality of care. Caring for a sick child is a system of activities, including creating optimal conditions for a hospital stay, providing assistance in meeting various needs, correct and timely implementation of various medical prescriptions, preparation for special research methods, carrying out some diagnostic procedures, monitoring the child’s condition, providing care to the patient. first aid.
The decisive role in providing proper care is given to junior and nursing staff. The junior nurse cleans the premises, daily toilets and sanitizes sick children, assists in feeding the seriously ill and taking care of natural needs, monitors the timely change of linen and the cleanliness of care items. A representative of the mid-level medical level - a nurse, being a doctor's assistant, accurately carries out all assignments for examination, treatment and monitoring of a sick child, and maintains the necessary medical documentation. The chapters “Procedures and Manipulations of a Nurse” and “Skills of a Surgical Nurse” include information about various methods of using medications, collecting material for research, methods of conducting therapeutic and diagnostic manipulations and procedures, and rules for maintaining medical records. Some aspects of caring for surgical patients are covered.
The effectiveness of a complex of therapeutic effects depends not only on the proper organization of care and professional training of medical workers; it is also important to create a favorable psychological environment in the medical institution. Establishing friendly, trusting relationships, showing sensitivity, care, attention, mercy, polite and affectionate treatment of children, organizing games, walking in the fresh air have a positive impact on the outcome of the disease.
In emergency situations, a medical worker must be able to provide first aid correctly and in a timely manner. The chapter “First aid in emergency conditions” outlines emergency measures, the implementation of which in full, in the earliest possible time and at a high professional level is a decisive factor for saving the lives of injured and sick children.
At the end of each chapter there are control questions for students to independently test their knowledge of theoretical material.
The application contains a list of practical skills and abilities of 2nd and 3rd year students of the Faculty of Pediatrics during practical training.
Chapter 1. GENERAL CARE FOR SICK CHILDREN
Carrying out sanitary treatment of patients
Sanitary treatment of sick children is carried out in the emergency department of a children's hospital. Upon admission to the hospital, if necessary, patients take a hygienic bath or shower (for more details, see “Hygienic and therapeutic baths”). If pediculosis is detected, a special disinsection treatment of the child and, if necessary, underwear is performed. The scalp is treated with insecticidal solutions, shampoos and lotions (20% benzyl benzoate suspension, Pedilin, Nix, Nittifor, Itaks, Anti-bit, Para-plus, Bubil, Reed ", "Spray-pax", "Elko-insect", "Grincid", "Sana", "Chubchik", etc.). To remove nits, individual strands of hair are treated with a solution of table vinegar, the head is tied with a scarf for 15-20 minutes, then the hair is thoroughly combed with a fine comb and the hair is washed. If scabies is detected in a child, clothing and bedding are disinfested, the skin is treated with a 10-20% benzyl benzoate suspension, sulfur ointment, Spregal, Yurax aerosol.
