Foreword ................................................................ ............................... eight

2.1. The main types of medical and preventive institutions and the principles of their work ................................... 19

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

2.2.1. Organization of the work of the reception department 21

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

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

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

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

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

A. M. Khokhlov, S. M. Muraviev................................. 234

17.1. The definition of the concept of "acute abdomen" ...... 234

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

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

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

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

18.1. Care of patients with bone fractures ....... 243

18.2. Caring for patients with skull injuries 249

18.3. Care of patients with closed injuries of soft tissues .............................................................. 251

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

Chapter 19 Care of the dying patient. Resuscitation and first aid for some emergency conditions........ 253

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

19.2. Resuscitation departments and principles of their work .............................................. ................. 255

19.3. Artificial respiration and chest compressions .............................................................. ................. 258

19.4. Resuscitation measures and first aid in case of poisoning .............................................. 262

19.5. Resuscitation and first aid for drowning .............................................................. 267

19.6. Resuscitation measures and first aid in case of heat and sunstroke, electrical injury.................................................................. ............ 268

19.7. First aid and care of patients with radiation damage .............................................. 271

19.8. Statement of death and rules for handling the corpse .............................................. ................. 272

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

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

Appendix................................................. ................................. 279

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

Blessed memory

A. L. Grebeneva

dedicated

FOREWORD

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

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

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

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

Head of the Department of Propaedeutics of Internal Diseases, Moscow Medical Academy named after. I.M. Sechenov Academician of the Russian Academy of Medical Sciences V.T.IVASHKIN

Department headgeneral surgery MML them. I. M. Sechenova Academician of the Russian Academy of Medical Sciences V.K.GOSTISCHEV

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

GENERAL ISSUES IN PATIENT CARE

Nursing and its importance

In everyday life, caring for the sick (compare caring, caring) is usually understood as helping the patient to meet his various needs. These include eating, drinking, washing, moving, emptying the bowels and bladder. Care also implies the creation of optimal conditions for the patient to stay in a hospital or at home - peace and quiet, a comfortable and clean bed, fresh underwear and bed linen, etc. In such volume care is carried out, as a rule, by the junior medical personnel, and also relatives of the patient.

In medicine, the concept of "care for the sick" is interpreted more broadly. Here it stands out as an independent discipline and represents a whole system of activities that includes the correct and timely implementation of various medical prescriptions (for example, the administration of drugs by injection, setting cans, mustard plasters, etc.), conducting some diagnostic manipulations (collection of urine, feces, sputum for analysis, gastric and duodenal sounding, etc.), preparation for certain studies (X-ray, endoscopic, etc.), monitoring the patient's condition (including respiratory systems, blood - imagination), providing the patient with first aid (gastric lavage, help with fainting, vomiting, coughing, suffocation, gastrointestinal bleeding, artificial respiration and chest compressions, etc.), maintaining the necessary medical documentation. Many of these manipulations are performed by nurses, and some (for example, intravenous injections, bladder catheterization) by doctors.

This chapter deals only with issues general care for the sick, carried out regardless of the nature of the disease. Peculiarities special care(for example, for newborn children, for patients with a surgical, dental Profile, etc.) are studied in the relevant courses.

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

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

The problems of health promotion, disease prevention and care have been of concern to all mankind since time immemorial. It is appropriate here to quote a few quotes from Florence Nightingale (1820-1910), an eminent English nurse, one of the most educated and outstanding personalities of the Victorian era:
“In the vast majority of cases, those who are entrusted with the care of the sick, both in family homes and in hospitals, are accustomed to considering all the complaints and demands of the patient as inevitable features of his illness: in reality, the complaints and whims of patients are often due to completely different reasons: lack of light , air, warmth, tranquility, purity, appropriate food, untimely eating and drinking; in general, the dissatisfaction of the patient very often depends on improper care for him. Ignorance or frivolity on the part of those around the patient are the main obstacles to the correct course of the process called illness: as a result, this process is interrupted or complicated by various features, all kinds of pains, etc. So, for example, if a recovering person complains of chills or fever, if he feels unwell after eating, if he has bedsores, then this should not be attributed to illness at all, but exclusively to improper care.
“The word “care” has a much deeper meaning than is commonly thought; in the hostel, care is the giving of medicine, correcting pillows, preparing and applying mustard plasters and compresses, etc.
In fact, care should be understood as the regulation of all hygienic conditions, the observance of all the rules of public health, which are so important both in preventing diseases and in curing them; care should be understood as the regulation of the flow of fresh air, light, warmth, care for cleanliness, tranquility, the right choice of food and drink, and we should not lose sight of the fact that saving the strength of an organism weakened by illness is of paramount importance.
“But the question is, does it really depend on our will to eliminate all the suffering of the patient? This question cannot be answered unequivocally in the affirmative. Only one thing is certain: if all conditions complicating the disease are eliminated through proper care, then the disease will take its natural course, and everything side, artificial, caused by mistakes, frivolity or ignorance of others, will be eliminated.
General patient care is an integral part of the treatment process. It includes measures that help alleviate the patient's condition and ensure the success of treatment. Basically, patient care is carried out by a nurse, who may involve junior medical personnel in some manipulations. Considering that general care is an integral part of the treatment process, we believe that the doctor should also clearly understand all the subtleties of its implementation, since according to existing legislation, it is he who is fully responsible for the patient's condition.
All care is based on the principle of the so-called protective regime. It includes the elimination of various irritants, negative emotions, providing silence, peace, creating a cozy atmosphere and a sensitive attitude towards the patient. Nursing care is not limited to the fulfillment of medical prescriptions. Proper care also provides for the creation of a sanitary and hygienic environment in the ward, medical procedures, patient care, monitoring all changes in his condition.
Nursing at the same time is often a preventive measure. So, oral care in a weakened patient prevents the development of stomatitis (inflammation of the oral mucosa) or parotitis (inflammation of the parotid salivary glands), and skin care prevents the formation of bedsores. General care of patients in the clinic and at home is mainly carried out by relatives, under the strict guidance of nurses.
Carrying out all the activities that contribute to the preservation and restoration of strength, alleviate suffering, careful monitoring of the functions of all its organs, the prevention of possible complications, a sensitive attitude towards the patient - all this constitutes the concept of patient care. Patient care is a therapeutic measure, and it is impossible to distinguish between two concepts: “treatment” and “care”, since they are closely interconnected, complement each other and are aimed at achieving the same goal - the recovery of the patient.
The famous Polish doctor Wladyslaw Begansky wrote the following on this subject: “Whoever is not touched by human need, who does not have gentleness in handling, who does not have enough willpower to dominate himself everywhere and always, let him better choose another profession, for he will never be a good health worker.
However, in addition to love for the cause and attentive attitude to the patient, it is necessary to have the necessary medical knowledge. The doctor must not only know all the rules of patient care and skillfully perform medical procedures (put cups, prepare a bath, make an injection, etc.), but also clearly understand the mechanism of action of a medicine or procedure on the patient's body. Observation is of great importance in patient care. And it's very difficult to learn. However, constant fixation of attention on the smallest changes in the patient's condition gradually develops this quality.
Nursing care is divided into general and special.
General care includes activities that can be carried out regardless of the nature of the disease. AT special care includes additional measures carried out only for certain diseases - surgical, gynecological, urological, dental, etc.
The complex of measures for patient care includes:
1. Fulfillment of medical appointments - distribution of medicines, injections, setting cans, mustard plasters, leeches, etc.
2. Carrying out personal hygiene measures: washing the sick, preventing bedsores, changing clothes, etc.
3. Creation and maintenance of a sanitary and hygienic situation in the ward.
4. Maintaining medical records.
5. Participation in the conduct of sanitary and educational work among patients.
6. Making a comfortable bed for the patient and keeping it clean.
7. Assistance to seriously ill patients during the toilet, eating, physiological functions, etc.
In this textbook, the authors tried to outline the methods of caring for patients in a hospital, using all the modern technical achievements that have entered modern medicine.

The basis of general care is to create a hygienic environment and an appropriate regimen in a medical institution, direct individual patient care, proper nutrition and accurate fulfillment of medical prescriptions, constant monitoring of the condition of patients. Patient care begins with the correct and quick organization of the necessary assistance in the admissions department of a medical institution.

The nurse helps the seriously ill to undress, if necessary, very carefully cuts clothes and shoes. Clothes are placed in a special bag. After the patient is put on a hospital gown and transferred to the ward, accompanied by a nurse. Seriously ill patients are transported on gurneys or chairs, accompanied by a nurse. In the emergency department, often helps in providing emergency care. Seriously ill patients are transported inside the medical institution, observing the general rules, as quickly and carefully as possible, avoiding shocks. The stretcher with the sick is carried by 2 or 4 people, walking "out of step", with short steps. When climbing the stairs, the patient is carried head first, when descending the stairs - feet first, in both cases the foot end of the stretcher is raised. Carrying and shifting the patient in their arms can be done by 1, 2 or 3 people. If the patient is carried by 1 person, then he brings one hand under the shoulder blades, the other under the patient's hips; at the same time, the patient holds the carrier with his hands by the neck. A nurse must be involved in carrying and shifting the sharply weakened and seriously ill patients. When shifting seriously ill patients from a stretcher to a bed, the stretcher is placed at a right angle to the bed so that the foot end of the stretcher is closer to the head end of the bed (or vice versa). Nurses should learn the rules of carrying patients well in order to be able to instruct junior medical staff if necessary.

In the ward, the nurse checks the readiness of the bed, bedside accessories, personal care items and alarms. For a seriously ill patient, a lining oilcloth, a urinal, a rubber circle, bedside attachments are needed. Familiarization of the patient with the daily routine and regime of the hospital should be done immediately upon admission. The mode of separation and the individual mode of the patient requires strict adherence to the daily routine and the correct behavior of patients and medical staff.

Depending on the nature and severity of the disease, patients may be prescribed strict bed rest (not allowed to sit), bed rest (you can move in bed without leaving it), semi-bed rest (you can walk around the ward and to the toilet room) and the so-called general regime, which does not significantly limit the patient's motor activity. A nurse, ward or sentry, ensures that patients carefully follow the rules of the internal regulations and the prescribed regimen. The performance of manipulations and the issuance of drugs should not coincide with the hours of eating, sleeping and resting patients, with the exception of emergency care or hourly medical appointments. It is necessary to ensure that there is no noise in the department: one should speak in an undertone, move furniture quietly, the operation of medical equipment, the movement of gurneys should be silent, etc.

A hygienic environment is achieved by careful observance of the cleanliness of the premises. The wards are cleaned with a wet method 2 times a day: in the morning after the patients wake up and in the evening before going to bed. Walls, window frames, doors, furniture are wiped with a damp cloth; the floor is washed or wiped with a brush wrapped in a damp cloth. The contents of the bedside tables are checked daily, avoiding the accumulation of products and unnecessary things. should be stored in the refrigerator in cellophane; bags, to which a note with the name of the patient is attached. The contents of the refrigerator are controlled at least once a week by the head nurse. The air in the wards should always be fresh, which is ensured by supply and exhaust ventilation and ventilation (in winter, transoms are opened 3-4 times a day for 10-15 minutes, in summer windows can be open around the clock). In winter, when airing, you need to warmly cover the patient with a blanket, cover your head with a towel, leave your face open, except in cases where the influx of cold air causes irritation of the upper respiratory tract. The temperature in the room should be constant, within 18-20 °, air humidity - 30-60%. To increase humidity in the wards, open vessels with water are placed, to reduce it, they increase ventilation. Electric lamps should be covered with frosted lampshades; low-glow lamps (night lamps) are lit at night.

Patient care - a set of measures that provide comprehensive care for patients and the implementation of medical prescriptions for their treatment.

Care is inextricably linked with treatment (see); they complement each other and serve a common purpose. The organization of care and its implementation are an integral part of the activities of the medical staff of medical institutions.

Nursing is largely the responsibility of nursing staff, especially in hospitals where most of the time patients are under the direct supervision of nurses. The successful implementation of their numerous care activities requires not only good professional skills, but also high moral principles in their attitude towards patients. Sensitivity, caring and spiritual contact with patients ensure the patient's confidence in medical measures, support his faith in recovery. The Soviets are distinguished by the principles of humanism, disinterestedness and a high duty of service to the socialist Motherland, which is reflected in the daily work of medical institutions. At all stages of treatment, proper care provides an optimally favorable domestic and psychological environment for the patient. It is extremely important to protect the patient from negative factors, as well as from excessive attention to his, sometimes difficult, condition.

The nurse assists patients in adjusting to the regime of the medical institution. The placement of patients in multi-bed wards should be carried out taking into account individual characteristics: age, intellectual and professional data, etc. The nurse should individualize the approach to patients depending on their level of development, character traits; be sensitive to the suffering of the patient, take care of meeting his needs, learn to patiently endure increased reactions and demands, often even whims, mindful of the slight excitability and irritability of patients. In order to avoid iatrogenic diseases (see), the medical staff must be very careful in talking with the patient on medical topics. The sympathetic and caring attitude of the nurse gives the patient great moral, often physical relief. The ability to create an optimistic mood in a patient is a great contribution to recovery. At the same time, a caring attitude should not be replaced by familiarity, since in these cases the loss of the nurse's authority is inevitable. Restrained and calm treatment allows patients to be subordinated to the regime of a medical institution, to the reasonable requirements of the medical staff.

This should be facilitated by the appearance of the medical staff: a fitted and buttoned medical gown, a scarf or a cap that covers the hair are mandatory requirements for the overalls of the medical staff. It is preferable to wear soft shoes. Nails should be cut short and hands should be spotlessly clean. Before each manipulation, hands should be washed with a brush and soap, and, if necessary, with a disinfectant solution. The facial expression should always be quite serious, at the same time benevolent, without shades of absent-mindedness and inattention.

Patient care is divided into general and special.

In the generally accepted interpretation, care is a set of activities that provide a comprehensive service to a person, including the creation of optimal conditions and environment for him, the implementation of procedures prescribed by a doctor, which, in turn, contributes to a more comfortable state of health of the patient and his speedy recovery.

Nursing and its basic principles

Care is divided into special and general - subtypes, which, in turn, have their own characteristics.

Let's consider each subtype separately:

• General care. This subtype includes the duties of maintaining the hygienic condition of the patient, as well as maintaining the ideal cleanliness of the room in which he is located, catering for the patient and the proper implementation of all procedures prescribed by the doctor. Also, general care involves helping the patient with physical functions, eating, toileting. In addition, this also includes monitoring the dynamics of the patient's condition and his well-being.
• Special care, as a rule, is associated with the specifics of a particular diagnosis.

It is worth noting that care is not an alternative to treatment: it is included in the complex of therapeutic measures. One of the main purposes of caring for a sick person is to maintain a comfortable psychological and domestic environment at each stage of treatment.

How is proper care built?

The basis of proper patient care can be called a protective regime, which is designed to protect and spare the patient's psyche:
- elimination of excessive irritants,
- providing peace / quiet,
- creating comfort.
When all these components are performed, the patient feels comfortable, he has an optimistic attitude and confidence in the successful outcome of the disease.
It is especially worth noting that the effectiveness of caring for a sick person requires not only certain skills, but also a sympathetic attitude. After all, physical suffering and illness create feelings of anxiety in a person, often - hopelessness, irritability in relation to the medical staff and even relatives. Tact, the ability to support a person in this difficult period for him, a sensitive and attentive attitude towards him, will allow the patient to escape from his painful situation and tune in to an optimistic mood. That is why care is one of the mandatory sections of the activity of medical personnel. If the treatment of the patient takes place at home, care is provided by his relatives or medical staff, after consultation with the attending physician.

Basic principles of care

1. room. It should be bright, spacious, and, if possible, insulated and protected from noise. With any disease, the abundance of light, fresh air and a comfortable temperature in the room where the patient is located will have a beneficial effect on the person. Separately, it is worth mentioning about the light: its strength should be reduced if there is a patient in the room with an ophthalmic disease or with a disease of the nervous system. During the day, electric lamps should be covered with a frosted lampshade, and at night only nightlights or other low-intensity devices can be turned on.

2. Temperature. The optimal microclimate in the patient's room should be as follows: temperature within 18-20 °, air humidity no more than 30-60%. It is very important that the room does not cool down in the morning. If the air is too dry, to increase the humidity, you can put a moistened rag on the battery, or put a vessel with water next to it. To reduce the humidity in the room, it is necessary to ventilate it. In urban conditions, it is better to ventilate at night, since during the day the city air is much more polluted with dust and gases. In other conditions, in the summer, it is possible to ventilate the room around the clock, while in the winter, it is worth airing no more than 3-5 times a day. To protect the patient from the cold air flow during ventilation, it is necessary to cover him with a blanket, and his head with a towel or scarf (his face is open). Instead of airing, fumigating a room with flavoring agents is unacceptable!

3. Purity. The room in which the patient is located must be kept clean. So, cleaning should be done at least twice a day. Furniture, window frames and doors should be wiped with damp cloths, the floor should be washed or wiped with a brush wrapped in a damp cloth. Items that can accumulate dust (curtains, carpets) should preferably be removed or frequently shaken out/vacuumed. The patient's room should be isolated from street, transport and industrial noise. It is also recommended to reduce the volume of radios, televisions, etc. You should speak in a low voice.

4. Transportation. A very important point. If a person is seriously ill, he must be transported carefully, on a special chair, stretcher or gurney, while avoiding jolts. With the patient, the stretcher is carried by two or four people. It is important that they walk out of step, with short steps. Shifting the patient and carrying on hands can be carried out by one, two or three people. If the carrying is carried out by one person, then it is necessary to act in the following order: one hand is brought under the patient's shoulder blades, the other under the hips, while the patient must hold the carrier by the neck. In order to move a seriously ill patient from a stretcher to a bed, it is necessary to proceed as follows: put the stretcher at a right angle to the bed, so that their foot end is closer to the head of the bed. Before transferring a seriously ill patient to a bed, it is necessary to first check its readiness, as well as the availability of individual care items and bedding accessories.
A seriously ill person, among other things, will need to:

Lining oilcloth,
- rubber circle
- urinal,
- bedpan.

The patient's bed should be neat, comfortable, of sufficient length and width. For the patient's bed, it is best to use a multi-section mattress, on top of which a sheet spreads. If necessary, put an oilcloth under the sheet. In special cases, for example, with lesions of the spine, a solid shield is placed under the mattress. It is worth remembering that the patient's bed should not be located near heating sources. The best position will be one in which it will be convenient to approach the patient from both sides.

A seriously ill person needs to be helped to undress, take off his shoes, and in special cases, the clothes are carefully cut.

5. Change of bed linen. With this procedure, it is impossible for the patient to create uncomfortable postures, forced muscle tension, and not cause pain. The patient should be moved to the edge of the bed, and the released part of the sheet should be rolled up to the patient's body. Next, on this part of the bed, you should spread a clean sheet and shift the patient. With strict bed rest, the sheet rolls in the direction from the legs to the head - first to the lower back, then at the upper body. The edges of the sheet are attached to the mattress with safety pins. With each change of linen, it is necessary to shake out the blanket.

6. Change of underwear. When changing the shirt of a seriously ill person,
you should first bring your hand under his back, then raise the shirt to the back of the head, remove one sleeve, then the other (in cases where one arm is damaged, you should start with a healthy one). After that, the patient should put on a shirt (start with a sore arm), then it is necessary to lower it over the head to the sacrum and straighten all the folds. If a patient is prescribed strict bed rest by a doctor, he should wear an undershirt. If the patient's linen was contaminated with blood or secretions, it should first be soaked in a bleach solution, then dried, and only then sent to the laundry.

7. Mode. The doctor prescribes different regimens for the patient, depending
on the severity of diseases:
Strict bed, in which it is forbidden even to sit.
Bed, in which you can move in bed, but it is forbidden to leave it.
Semi-bed, in which you can walk around the room.
The general mode, in which, as a rule, the patient's motor activity is not significantly limited.

Features of caring for a patient with bed rest

1. The patient performs physiological functions in bed. The person is given a sanitized, cleanly washed bedpan (a specialized defecation device) in which a little water is poured to absorb odors. The vessel is brought under the buttocks in such a way that the patient's perineum is above the large hole, and the tube is between the thighs. In this case, the free hand must be placed under the sacrum and lift the patient. Having freed the vessel, it must be thoroughly washed with hot water, and then disinfected with a 3% solution of chloramine or lysol. A vessel for collecting urine - a urinal - must also be served well washed and warm. After each urination of the patient, the urinal is washed with solutions of sodium bicarbonate and potassium permanganate, or a weak solution of hydrochloric acid.

2. Necessary tools and equipment for maintenance must be stored in a strictly designated place. Everything necessary for the patient should be ready for use. Heating pads, bedpans, urinals, rubber circles, ice packs must be washed with hot water, then rinsed with a 3% chloramine solution and stored in specialized cabinets. Probes, catheters, gas outlet tubes, enema tips are washed in hot water and soap, and then boiled for 15 minutes. Enema tips must be stored in a labeled container designed for this purpose. Beakers and drinkers are prescribed to boil. Wherever possible, care products designed for single use should be used. Chairs, wheelchairs, cabinets, beds, stretchers and other medical equipment must be periodically disinfected with a 3% solution of chloramine or lysol, and daily wiped with a wet cloth or washed with soap and water.

3. Personal hygiene of the patient is of great importance in the rehabilitation period. Primary patients (with the exception of patients who are in extremely serious condition) should be subjected to sanitization, which includes a bath, shower or wet rubdown, and, if necessary, a short haircut, followed by disinsection treatment of the scalp. If the patient needs outside help during hygiene procedures, he should be lowered into the bath on a sheet, or put on a special stool placed in the bath and washed with a hand shower. If a person is seriously ill, taking a bath is replaced by rubbing the body with a swab dipped in warm water and soap. Upon completion of the procedure, it is necessary to wipe the patient's body with a swab dipped in warm water without soap and wipe dry. Unless otherwise prescribed, the patient should take a shower or bath at least once a week. The patient's toenails and fingernails should be cut short.

4. Secondary or dispensary patients are recommended to wash their hair with warm water and soap (after the procedure, the hair is carefully combed). If a person is seriously ill, then shampooing is indicated in bed. As for the frequency of these hygiene procedures, it is as follows: the patient's hands should be washed before each meal, legs - every day before going to bed. The upper body, as well as the face and neck, must be washed daily. The genitals and anus are also supposed to be washed daily. In cases where a person is seriously ill, washing the genitals is supposed to be carried out at least twice a day. The procedure is as follows: a vessel is placed under the buttocks of the patient (at this time the patient lies on his back, legs bent at the knees). For the washing procedure, it is also convenient to use an Esmarch mug, which is equipped with a specially designed rubber tube with a tip, which, in turn, has a clamp or tap. A stream of water or a weak solution of potassium permanganate is directed to the perineum. At the same time, a cotton swab is held in the direction from the genitals to the anus. Then, using another cotton swab, the skin of the perineum is dried. This procedure can also be performed using a jug into which a warm disinfectant solution is poured. Inguinal folds, axillary areas, and skin folds under the mammary glands, especially if the patient is obese or prone to excessive sweating,
should be washed frequently to avoid chafing.

5. Emaciated patients, as well as those patients for whom bed rest lasts a large amount of time, need especially careful care of the body and skin in order to avoid the appearance of bedsores. As a preventive measure, in addition to skin care, it is necessary to keep the bed in perfect order: regularly smooth out the folds of the sheets and eliminate irregularities. The skin of patients at risk of bedsores should be wiped once or twice a day with camphor alcohol, and also powdered with talcum powder. In addition, it is necessary to use rubber circles wrapped in a pillowcase, placing them under the places that are most subject to pressure (for example, the sacrum). A necessary preventive measure is also a frequent change in the position of the patient on the bed. Caring for the patient's feet is no less important - with insufficient care, thick horny layers can form on the soles, which are a manifestation of epidermophytosis in a scaly form. In these cases, removal of keratinized skin is indicated, followed by treatment of the skin of the legs with antifungal agents.

6. Feeding the seriously ill is an extremely important point in care. It is necessary to strictly follow the diet and diet prescribed by the doctor. Lying patients during meals should be given the position that will avoid human fatigue. As a rule, this is a slightly elevated or semi-sitting position. The neck and chest of the patient must be covered with a napkin. Febrile and debilitated patients need to be fed during a decrease in temperature / improvement. Such patients are fed with a spoon, mashed or chopped food is given in small portions. For the purpose of feeding, you should not interrupt daytime sleep, in cases where the patient suffers from insomnia. Seriously ill people are given a drink from a sippy cup. If a person cannot swallow food, he is shown artificial nutrition: probe.

7. Another necessary condition for successful treatment is monitoring the patient's condition. Thus, caregivers should regularly report to the doctor about every change in the patient's condition. It is necessary to take into account the state of the patient's mentality, the change in the position of his body, the color of the skin, facial expression, the presence of cough, respiratory rate, changes in the nature and color of urine, feces, sputum. In addition, on the instructions of the doctor, it is necessary to measure body temperature, weigh, measure the ratio of the fluid excreted and drunk by the patient, and perform other prescribed observations. It is important to monitor the intake of prescribed medications by the patient. For the procedure of taking medications, clean beakers and a decanter of boiled water should be prepared.

Features of care for patients of senile and elderly age

Care for such patients must be carried out, taking into account the characteristics of an aging organism and, as a result, a decrease in adaptive capabilities. It is also necessary to take into account such factors as age-related changes in the psyche, as well as the peculiarity of the course of diseases in the elderly. Among these features are the following:

Atypical sluggish course of the disease in the absence of a pronounced temperature reaction.
- relative rapid accession of severe complications.

Elderly people are prone to various kinds of infectious diseases and the appearance of inflammatory processes, and this feature requires increased hygiene care.

In addition, older people often show increased sensitivity to changes in diet and regimen, to changes in the microclimate, and the appearance of noise. Among the features of the behavior and psyche of an elderly person, one can distinguish slight vulnerability, emotional instability, and, in the case of vascular diseases, a sharp decrease in memory, criticism, intelligence, helplessness, and, often, untidiness. Such features require increased attention from the attendants, as well as a patient and sympathetic attitude.

Strict bed rest for the elderly, if possible, is recommended to be reduced as early as possible. And as soon as possible, it is recommended to prescribe therapeutic physical culture and massage for the fastest return to the motor regime. This will avoid hypokinesia. Also, elderly patients are advised to prescribe breathing exercises with
for the prevention of congestive pneumonia.

Features of care for resuscitated patients

A feature of care for resuscitated patients, as well as for patients who are in intensive care, is that care here includes both general and special elements, in relation to traumatological, surgical, neurological, as well as patients who are unconscious.

Much attention should be paid to monitoring the patient's condition, including monitoring monitoring, monitoring the physiological functions of the patient, including breathing, urination, blood circulation. In addition, it is necessary to monitor the condition of perfusion tubes, catheters and conductors from systems and devices connected to a person.
Special care is required for patients who are on mechanical ventilation through a tracheostomy or through an endotracheal tube. In such cases, a thorough toilet of the tracheobronchial tree is necessarily shown (in some cases, every 15-20 minutes).
Without this procedure, a violation of bronchial patency is possible and, as a result, the development of asphyxia. Removal of secretions from the bronchi and trachea must be carried out with sterile gloves, or after the hands have been treated with a disinfectant solution. To perform the procedure, a specialized angled catheter is used, which is connected to a vacuum pump through a tee. One elbow of the tee must be left open. The patient's head must be turned, then during inhalation, in one motion, insert the catheter into the tracheostomy or endotracheal tube and advance it through the bronchi and trachea into the lung until it stops. After that, the hole of the tee is closed with a finger to ensure the vacuum suction action; then the catheter must be removed by gently rotating it with your fingers. After that, the catheter is washed with isotonic sodium chloride solution, or replaced and the procedure is repeated as many times as necessary. The effectiveness of the procedure will be doubled if vibration massage of the chest is carried out at the same time.
In order to prevent the development of stagnation in the lungs and the appearance of bedsores, the position of the patient must be changed every 2 hours. In addition, it is necessary to put ring gauze pads under the bone protrusions and wipe the patient's skin with antiseptic solutions.
It is better if the patient lies on an anti-decubitus mattress.
Great attention should also be paid to feeding patients, since eating on their own is often impossible for them. The feeding process is carried out with the help of a drinker, to the outlet of which a rubber tube 20 to 25 cm long is attached. The end of the tube is inserted into the posterior sections of the oral cavity. Food is introduced through the tube, portions are regulated by clamping it. Solid food must be brought to a creamy consistency, first subjecting it to heat treatment, then grinding and diluting it with liquid. Do not give the patient spicy or hot food. During feeding, the patient must be transferred to a sitting position (in severe cases, raise his head), cover with an oilcloth apron so as not to stain bed linen, clothes, bandages. The feeding procedure should be repeated an average of 4 times. If it is impossible to feed the patient through a cup, feeding is carried out using a nasopharyngeal tube.

If the patient is unconscious, it is necessary to carry out parenteral feeding, as well as parenteral fluid administration. Before introducing the solution into the oral cavity or vascular bed, it is necessary to warm it up to the patient's body temperature. Upon completion
feeding, the patient's oral cavity is washed with a solution of sodium bicarbonate, and then with a solution of potassium permanganate in a ratio of 1: 5000, or with another disinfectant solution.