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 the 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 the creation of optimal conditions for staying in a hospital, 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.

State budgetary educational institution of higher education
vocational education
"Siberian State Medical University" Ministry of Health and Social Development of Russia

Department of Pediatric Surgery

Abstract on the topic:
“General care for sick children in a hospital”

Completed:
Student
Faculty of Pediatrics, 1st year group 2103
Shevtsova Yulia Andreevna

Tomsk 2012
Content.

1.Introduction. 3
2. General patient care in the pediatric surgical department. 4
3.Preparing patients for emergency and planned surgery. 9
4. List of references. 13

1.Introduction.

Care for patients in a hospital is carried out by nursing staff, and at home - by the patient’s relatives and a nurse.

Care should be understood as:

Closely related to care is round-the-clock monitoring of the patient: changes in the manifestations of the disease, physical symptoms, and the patient’s mood. The nursing staff informs the doctor about all noticed changes, helping him to form a correct idea of the patient’s condition and correctly manage treatment.

Timely recognition of the disease, good care and proper treatment ensure the patient’s recovery.

2. General patient care in the pediatric surgical department.

Patient care (sanitary hypurgia - from the Greek "hipur-geo" - to help, to provide a service) is a medical activity to implement the requirements of clinical hygiene in a hospital, it is the implementation of components of the personal hygiene of the patient and the environment that the patient is not able to provide himself due to illness or surgery.
For this purpose, medical personnel use physical and chemical methods based mainly on manual labor. Physical methods of clinical hygiene include washing the body and surrounding objects, ventilating rooms, burning, using dry heat or water steam, boiling, and irradiation. Dressing material, drainages, tampons from purulent patients are destroyed by burning. When burning, there must be safe transportation of contaminated material and a special device for burning. Specially trained personnel must work in combustion plants and when assessing the material to be burned. Chemical methods include acids, alkaloids, heavy metals, oxidizing agents, halogens, phenol and its derivatives, chlorhexidine, quaternary ammonium and phosphonium compounds, surfactants, alcohols, aldehydes, dyes. All disinfectants allowed for use are listed in order 720 - chloramine B 0.5% solution, chloramine B with 0.5% detergent, 3% hydrogen peroxide solution, hydrogen peroxide with 0.5% detergent products, dezoxon-1, dezoxon-1 with 0.5% detergent, dichlor-1 (1%), sulfochloranthine (0.1%), 70% ethyl alcohol, chlordesine (0.5%). Washing powders are used as detergents.
Nursing 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 patient treatment.
Patient care includes:
1. accurate and timely implementation of doctor’s prescriptions;
2. assistance in satisfying the patient’s natural needs (eating, drinking, movement, emptying the bladder, etc.)
3. compliance with the principle of a protective regime (elimination of various irritants, negative emotions, ensuring silence and peace);
4. creation of a sanitary and hygienic environment in the ward, observation;
5. carrying out preventive measures (prevention of bedsores, mumps, etc.).

General care includes activities that can be carried out regardless of the nature of the disease. Special care includes additional measures carried out only for certain diseases - surgical, urological, etc.
Basic elements of general care:

The main officials providing care for patients in a hospital: nurse, barmaid, junior nurse. sister, nurse.
Hygiene of medical personnel.
Medical personnel of all ranks are the main object and subject of clinical hygiene. Hygiene of medical personnel is the strict observance by employees of medical institutions, especially surgical ones, of the rules of personal hygiene, aimed at preventing various complications in patients before and after operations. Medical staff can serve as a source of infection in a surgical hospital, spread it within the hospital, and also carry the infection beyond its boundaries.
The purpose of personal hygiene of medical staff is to protect personal clothing and the body of personnel from nosocomial surgical infection, protect the patient from the threat of infection, and protect people who come into contact with medical staff outside the hospital from nosocomial infection. The main objects of personal hygiene for personnel in surgery are: body and head (hair should be clean, cut short, carefully hidden under a cap or headscarf). There should be no discharge from the nose, eyes, ears, in the mouth - carious teeth, ulcers, inflammation, on the skin - rashes, wounds, abrasions, purulent-inflammatory diseases, especially on the hands. Fingernails and toenails must be cut short and painting is not permitted.
Environmental hygiene.
The importance of maintaining the necessary hygienic regime in a surgical hospital cannot be overestimated. The main environmental objects include indoor air, furniture, plumbing, and honey. equipment. There are natural and artificial methods of air disinfection in the hospital. These include regular ventilation of premises, the use of air filters with forced ventilation, chemical and physical (radiation) disinfection of air. The air temperature in the room should be between 17-21 degrees (“comfort zone”). The degree of humidity is of great importance. The air temperature in the wards rises in the summer. In such cases, the practice is to frequently mop the floors with a wet method, cover open windows with wet sheets, and use general and table fans.
Patient hygiene.
The main object of clinical hygiene is the patient, who is unable to ensure the hygiene of his body with his own resources and means in the hospital. Activities for the hygiene of the patient’s body should be planned and regular. The main measures and requirements for the hygiene of the patient’s body: cleanliness and absence of the threat of damage to the skin and mucous membranes. Depending on the disease and condition of the patient, there is a general regimen, strict bed, semi-bed and individual. Strict bed rest in the supine position should be observed by patients with profuse gastric bleeding after major operations on the abdominal organs. Active bed rest with turning on the side, bending the legs at the knee joints, raising the head is indicated for most patients in the first days after operations on the abdominal organs. The patient should get up after surgery in the presence of a sister and with her help. A nurse or nurse should also accompany the patient to the toilet.
Hygienic care for patients with bed rest.
Carried out by a nurse or a nurse under the guidance of a nurse.
Semi-bed rest is prescribed to persons whose acute abdominal pain has subsided, emergency assistance has not been provided to them and they are subject to observation. An individual regimen includes the concept of an exception to the rules of the general regimen (walking in the air, staying on the balcony, a bath or shower before bed, etc.). Skin care under the general regimen can be carried out by the patient himself. In all cases, the patient must wash his hands before and after eating, and after visiting the toilet. Frequent hand washing is an important principle of hospital hygiene. The patient washes in the shower or bath at least once every 7 days. The water temperature in the bathroom should not exceed 37-39.
The duration of stay in the bathroom is determined by the patient’s condition and averages 15-20 minutes. The patient should not be left alone while taking a bath, even if his condition is satisfactory. At the same time, underwear and bed linen are changed. For washing, the patient receives a clean washcloth. If soiled, linens are changed more often. After washing, the washcloth and bath should be disinfected. After each patient, the bathtub is washed with running water and disinfected with a 2% chloramine solution or a clarified 0.5% bleach solution. Hand brushes, washcloths, rubber or foam sponges are disinfected by boiling for 15 minutes, or soaking for 30 minutes in 0.5% detergent solution and 3% hydrogen peroxide solution. After this, washcloths and sponges are rinsed with running water and dry.
All patients in the department must wash their face in the morning, wash their ears, brush their teeth, and comb their hair. Before going to bed, the patient should also brush his teeth and rinse his mouth. Once a week, while taking a shower or bath, patients need to wash their hair. During long-term hospital stays, it is better for both men and women to cut their hair short. Each patient should have their own comb for combing hair. Fingernails and toenails are cut with scissors or bitten with nail clippers, or filed with a nail file. In this case, it is necessary to protect the periungual ridges from injury and the formation of hangnails. Disinfection of scissors, cutters, files is carried out by boiling for 15 minutes or soaking in a “triple solution” for 45 minutes, followed by rinsing in running water. Men should shave their facial hair daily.
The razor is disinfected by boiling for 15 minutes. or by soaking in a triple solution for 45 minutes, followed by rinsing with water.
Hygiene of seriously ill patients.
Hygienic care of the skin, eyes, ears, nasal cavity and mouth of a surgical patient in an extremely critical or unconscious state has its own characteristics and is very important. The success of treatment often depends on this. Maintaining healthy skin is an important part of treatment.
When lying for a long time, as a result of compression of the soft tissues covering the bony protrusions, a local circulatory disorder occurs, which can result in the formation of bedsores. Bedsores are necrosis of the skin and subcutaneous tissue with a tendency to spread deeper. They usually occur in the area of the sacrum, shoulder blades, greater trochanters, elbows, heels, and spinous processes. The first sign of bedsores is pallor or redness and swelling of the skin, followed by detachment of the epidermis and the appearance of blisters. Accompanying infection can lead to infection and death. Therefore, preventing bedsores in seriously ill patients is the key to successful treatment.
Elements of pressure ulcer prevention:
1). Changing the patient’s body position several times a day if his condition allows;
2). Daily shaking off crumbs from sheets, straightening wrinkles on bed linen and underwear;
3). Placing an inflatable rubber circle placed in a pillowcase under the sacrum and buttocks;
4). Daily wiping of the skin in places of bone protrusions with camphor alcohol, 40% alcohol solution, cologne, vinegar solution (1 tablespoon per 1 glass of water) or warm water, followed by wiping dry;
5). When hyperemia occurs, brushing to improve local blood flow;
6) Washing the skin during maceration with soap and water, drying and dusting with powder;
7). Carrying out hygienic and breathing exercises according to indications.

Fingernails and toenails should be regularly cut off with scissors or bitten with pliers as they grow, protecting the periungual ridges from damage and hangnails.
Hair, as already noted, must be washed once a week, combed and styled in a hairstyle or braid. In seriously ill patients, it is preferable to have short haircuts. In seriously ill patients, it is necessary to wash the eyes to remove secretions that stick together the eyelashes.
Skin care consists of daily washing of the face, neck and hands with soap, daily wiping of the entire body with warm water and drying with a dry towel. The entire body should be washed at least three times a week. Nails are washed in a basin, the interdigital spaces are thoroughly cleaned of dirt, and overgrown nails are cut. In obese patients, especially women, special attention should be paid to the prevention of dermatitis and diaper rash on the mammary glands, in the inguinal folds and in the perineal area. These areas must be washed daily with weak disinfectant solutions (potassium permanganate, boric acid), dried and powdered with talc or special powder. Women undergo hygienic washing daily at night and in the morning. To do this, you need to have an oilcloth, a vessel, a jug with warm water and a disinfectant solution (30-35 degrees), a forceps and sterile cotton balls. The nurses place an oilcloth under the patient’s pelvis, on top of which a bedpan is placed between the thighs. Patients lie on their backs, legs bent and slightly spread. A disinfectant solution is poured from a jug onto the external genitalia and a cotton ball on a forceps is used to make cleaning movements from the genitals to the anus. After this, the skin is wiped with a dry swab from top to bottom.
Hygiene of the patient's linen.
Pajamas, dressing gowns, colored underwear are soaked in a 0.2% solution of chloramine B (240 min), 0.2% solution of sulfachlorantine (60 min.), 1% solution of chlordesine (120 min.), 0.5% solution of dichloro-chlorine 1 (120 min), 0.05 dezoxon-1 solution (60 min.), followed by washing in the laundry. Underwear and bed linen are washed in the laundry with boiling water. Underwear and bed linen are changed at least once every 7 days (after hygienic washing). In addition, linen must be changed if soiled. When changing underwear and bed linen, it is carefully collected in bags made of thick cotton fabric or containers with a lid. It is strictly forbidden to throw used laundry on the floor or into open receptacles. Sorting and dismantling of dirty linen is carried out in a special dedicated room outside the department.
After changing linen, items in the room are wiped with a disinfectant solution.
Mattresses, pillows, blankets are disinfected in paraformalin chambers using the steam-formalin and steam-air methods. It is preferable to use sterile linen during surgery. Clean linen is stored in the closets of the housewife, guard sister and nurse. The department should have a supply of linen for a day. Depending on the patient's condition, there are different changes of bed linen. A walking patient can change the bed himself.

3.Preparing patients for emergency and planned surgery.

The preoperative period is the time from the moment the patient is admitted to the surgical hospital until the start of surgical treatment. At the stage of immediate preoperative preparation, healing measures are carried out in order to identify the underlying disease and a favorable phase for surgical intervention, heal other existing diseases and prepare vital systems and organs.
A set of healing measures carried out before surgery to transfer the underlying disease to a more favorable phase, healing concomitant diseases and preparing vital organs and systems for the prevention of postoperative complications is called preparing patients for surgery.
The main goal of preoperative preparation is to reduce operational risk and create good prerequisites for a favorable outcome.
Preoperative preparation is carried out for all patients. It is carried out to the smallest extent only for patients undergoing surgery on the basis of emergency and emergency certificates.
On the eve of a planned surgical operation, public preoperative preparation is carried out. Her target:
1. Eliminate contraindications to surgery by examining the patient’s vital organs and systems.
2. Preparation of the patient psychologically.
3. thoroughly prepare the patient’s body systems, on which the intervention will have the greatest load during the operation and in the postoperative period.
4. prepare the surgical field.
General inspection.
Every patient admitted to a surgical hospital for surgical treatment must be undressed and the skin of all parts of the body examined. In the presence of weeping eczema, pustular rashes, boils or new traces of these diseases, the operation is temporarily postponed and the patient is sent for outpatient follow-up treatment. The operation of such a patient is performed a month after complete healing, because infection can manifest itself at the site of surgery in a patient weakened by surgical trauma.
Anamnesis collection.
Collecting an anamnesis makes it possible to find out and clarify previous diseases, to determine whether the patient suffers from hemophilia, syphilis, etc. In women, it is necessary to clarify the date of the last menstruation, since it has a huge impact on the vital functions of the body.

Laboratory research.
Planned patients are admitted to the surgical hospital after a laboratory examination at the clinic at their place of residence. They carry out a general blood and urine test, a urine test for sugar, the biochemical composition of the blood and the necessary X-ray examinations of the chest and abdominal organs.
Clinical observation.
It is necessary for the patient to get to know the attending physician and to establish relationships between them. To completely eliminate contraindications to surgery, choose a method of pain relief and take measures to prevent the following complications, it is necessary for the patient to fully open up to the doctor. If special preparation of the patient for the operation is not required, then the preoperative period of the patient in the hospital is traditionally 1-2 days.
Psychological preparation of the patient.
Trauma to the psyche of surgical patients begins in the clinic, when the doctor advises surgical treatment, and continues in the hospital during the immediate appointment of the operation, preparation for it, etc. Therefore, a sensitive, attentive attitude towards the patient on the part of the attending physician and staff is absolutely essential. The authority of the doctor contributes to the establishment of close contact with the patient.
On the day of the operation, the surgeon is obliged to pay maximum attention to the patient, encourage him, ask about his health, examine how the surgical field is prepared, listen to the heart and lungs, examine the pharynx, and reassure him.
The surgeon is fully prepared to wait for the patient, and not the other way around. During an operation under local anesthesia, a conversation must take place between the surgeon and the patient. With his calmness and encouraging words, the surgeon has a beneficial effect on the patient’s psyche. Harsh remarks addressed to the patient are unacceptable.
After the operation is completed, the surgeon must examine the patient, feel the pulse and reassure him. In this the patient will take care of him.
Everything in the ward must be ready to receive the patient. The main thing in this case is the elimination of pain with the use of painkillers, the implementation of measures aimed at improving breathing and cardiovascular activity, which prevents a number of complications. The surgeon is obliged to visit the patient he operated on more than once.
In a conversation with a patient, a doctor is obliged to explain to him the essence of the disease. If a patient with a malignant tumor continues to doubt and stubbornly refuses surgical treatment, then it is permissible to say that his disease may turn into cancer after some time. Finally, if there is a categorical refusal, it is advisable to tell the patient that he has an early stage of the tumor and delaying the operation will lead to advanced disease and an unfavorable outcome. The patient must understand that in this situation surgery is the only type of healing. In some cases, the surgeon is obliged to explain to the patient the true essence of the operation, its consequences and prognosis.

Preparation of the patient's vital organs for surgery.
Respiratory preparation
Respiratory organs account for up to 10% of postoperative complications. Therefore, the surgeon must pay special attention to the patient’s respiratory system.
In the presence of bronchitis and emphysema, the risk of complications increases several times. Acute bronchitis is a contraindication to elective surgery. Patients with chronic bronchitis are subject to preoperative sanitation: they are prescribed expectorants and physiotherapeutic procedures.
Preparing the cardiovascular system.
With normal heart sounds and no changes in the electrocardiogram, special preparation is not required.
Preparation of the oral cavity.
In all cases, before surgery, patients require sanitation of the oral cavity with the assistance of a dentist.
Preparation of the gastrointestinal tract.
Before a planned operation on the abdominal organs, the patient is given a cleansing enema the evening before the operation. When preparing patients for surgery on the large intestine, it must be cleaned. In these options, 2 days before the operation, a laxative is given 1-2 times, the day before the operation the patient takes liquid food and is prescribed 2 enemas, in addition, another enema is given in the morning on the day of the operation.
Preparing the liver.
Before the operation, liver functions such as protein synthesis, bilirubin secretion, urea formation, enzymatic function, etc. are examined.
Determination of kidney function.
During the preparation of patients for surgery and in the postoperative period, the condition of the kidneys is traditionally assessed by urine tests, functional tests, isotope renography, etc.
Direct preparation of patients for surgery and rules for its implementation.
On the eve of the operation, the patient takes a bath. Before washing, the doctor pays attention to the skin, looking for pustules, rashes, and diaper rash. If detected, the planned operation is cancelled. The surgical site is shaved on the day of surgery to avoid cuts and scrapes that are prone to infection.
In accordance with the type of anesthesia, premedication is given 45 minutes before the operation as prescribed by the anesthesiologist. Before transporting the patient to the operating room, the patient is transported on a gurney. The operation is performed in the strictest silence. The conversation can be about the operation.
Preparing the patient for emergency surgery.
The patient is prepared for surgery as soon as possible. As directed by the doctor, if necessary, an urgent blood test, urine test and some other studies are done. Carry out sanitary treatment (washing or wiping) of contaminated areas of the body. A hygienic bath and shower are contraindicated. Sometimes, as directed by a doctor, the stomach is emptied through a tube. The skin in the area of the surgical field is shaved dry without soaping.
Method of preparing a wound for surgery. In case of injury, the surgical field is treated as follows: remove the bandage, cover the wound with a sterile napkin, shave the hair around the wound dry, treat the skin around the wound with medical gasoline and then with alcohol. Treatment and shaving are carried out in the direction from the edges of the wound (without touching it) to the periphery. Lubricate the surgical field with an alcohol solution of iodine twice: first after mechanical cleaning of the skin, and then again immediately before the operation.
Patients with acute appendicitis, strangulated hernia, intestinal obstruction, perforated gastric ulcer, ectopic pregnancy, as well as penetrating wounds of the chest, abdomen and some other injuries require emergency operations.

4. List of references.

State educational institution of higher professional education of the Federal Agency for Health and Social Development

"Amur State Medical Academy".

Department of General Surgery

L. A. Volkov, A. S. Zyuzko

NURSING FUNDAMENTALS

SURGICAL PROFILE

TEACHING MANUAL FOR SECOND YEAR STUDENTS

Blagoveshchensk - 2010

The tutorial was prepared by:

L. A. Volkov - K.M.N., Honored Doctor of the Russian Federation, assistant at the Department of General Surgery of the ASMA.

A. S. Zyuzko- K.M.N., assistant at the Department of General Surgery of ASMA.

Reviewers:

V.V. Shimko - D.M.N., Professor, Department of Faculty Surgery, ASMA.

Yu.V. Dorovskikh - Associate Professor, Department of Hospital Surgery, ASMA.

The methodological manual was prepared in accordance with the program for caring for patients in a surgical clinic and is aimed at creating a theoretical basis for the effective development of theoretical material. The manual consists of 15 topics of practical lessons, which outline the organization and regime of a surgical hospital, deontological and ethical issues of patient care, aspects of clinical hygiene of the patient and staff, methods of using medications, features of preparing patients for diagnostic studies and surgical interventions; The basic principles of care for patients with various surgical pathologies and victims of trauma are covered.

Nursing. Types of care. Design, equipment, operating mode of the reception and diagnostic department. Reception of patients, registration, sanitary treatment, transportation. Deontology in surgery.

Patient care– sanitary hypourgia (Greek hypourgiai – to help, to provide a service) – medical activity aimed at alleviating the patient’s condition and promoting his recovery. During patient care, components of the personal hygiene of the patient and his environment are implemented, which the patient is not able to provide himself due to illness. In this case, physical and chemical methods of exposure are mainly used based on the manual labor of medical personnel.

Nursing care is divided into general And special.

General care includes measures that are necessary for the patient himself, regardless of the nature of the existing pathological process (nutrition of the patient, change of linen, ensuring personal hygiene, preparation for diagnostic and therapeutic measures).

Special care– a set of measures applied to a certain category of patients (surgical, cardiological, neurological, etc.).

Surgical care

Surgical care is a medical activity for the implementation of personal and clinical hygiene in a hospital, aimed at assisting the patient in satisfying his basic life needs (food, drink, movement, bowel movements, bladder, etc.) and during pathological conditions (vomiting, cough, breathing problems, bleeding, etc.).

Thus, the main objectives of surgical care are: 1) providing optimal living conditions for the patient, conducive to a favorable course of the disease; 2) fulfilling doctor’s orders; 3) accelerating the patient’s recovery and reducing the number of complications.

Surgical care is divided into general and special.

General surgical care consists in organizing sanitary-hygienic and medical-protective regimes in the department.

Sanitary and hygienic regime includes:

Organization of cleaning of premises;

Ensuring patient hygiene;

Prevention of nosocomial infection.

Therapeutic and protective regime is:

Creating a favorable environment for the patient;

Providing medications, their correct dosage and use as prescribed by a doctor;

Organization of high-quality nutrition for the patient in accordance with the nature of the pathological process;

Proper manipulation and preparation of the patient for examinations and surgical interventions.

Special care is aimed at providing specific care for patients with a certain pathology.

Features of caring for surgical patients

Features of caring for a surgical patient are determined by:

dysfunctions of organs and body systems arising as a result of a disease (pathological focus);

the need and consequences of pain relief;

surgical trauma.

Particular attention in this group of patients should be directed, first of all, to accelerating the processes of regeneration and preventing infection.

The wound is an entrance gate through which pyogenic microorganisms can penetrate into the internal environment of the body.

In all actions of nursing and junior medical personnel in the process of caring for patients, the principles of asepsis must be strictly observed.

Organization of the work of the reception department

Reception department of a multidisciplinary hospital

The emergency department (emergency room) is intended to receive patients delivered by ambulance, referred from clinics and outpatient clinics, or who sought help on their own.

The reception department performs the following functions:

Conducts round-the-clock examinations of all sick and injured persons delivered or applied to the emergency department;

Establishes a diagnosis and provides highly qualified medical and advisory assistance to everyone in need;

Conducts an examination and, if necessary, assembles a council of several specialists to clarify the diagnosis;

If the diagnosis is unclear, provides dynamic monitoring of patients;

Performs triage and hospitalization in specialized or specialized departments of the hospital;

Transfers non-core patients and victims after providing them with the necessary assistance to hospitals and departments according to the profile of the disease or injury or refers them to outpatient treatment at the place of residence;

Provides constant round-the-clock communication with all operational and duty services of the city.

The reception department includes a waiting room, a registration desk, an information desk, and examination rooms. The admissions department has close functional contacts with laboratories, diagnostic departments of the hospital, isolation wards, operating rooms, dressing rooms, etc.

the admission department should be located on the lower floors of the medical institution;

it is necessary that there are convenient access roads for ambulance transport from the street;

Elevators should be located near the emergency department to transport patients to medical departments;

The reception area should be decorated with moisture-resistant materials (tiles, linoleum, oil paint) for ease of sanitary processing.

Cleaning requirements:

Cleaning of the premises of the reception department must be carried out at least 2 times a day using a wet method using detergents and disinfectants approved for use in the prescribed manner. Cleaning equipment must be labeled and used for its intended purpose. After use, it is soaked in a disinfectant solution, rinsed in running water, dried and stored in a specially designated room. After examining each patient, couches, oilcloths, oilcloth pillows are treated with a rag moistened with a solution in accordance with the current instructions. The sheets on the couch in the examination room are changed after each patient. In the treatment room, dressing room, as well as in the small operating room, wet cleaning is carried out 2 times a day using a 6% hydrogen peroxide solution and a 0.5% detergent solution or disinfectant solution. After use, gurneys are treated with a disinfectant solution in accordance with the current instructions.

Waiting room intended for patients and their accompanying relatives. There should be a sufficient number of chairs, armchairs, and gurneys (for transporting patients). On the walls are posted information about the work of the medical department, hours of conversation with the attending physician, a list of products allowed for transfer to patients, and the telephone number of the hospital helpline. The days and hours during which patients can be visited should be indicated here.

The duty nurse's office. It registers incoming patients and prepares the necessary documentation. There should be a desk, chairs, and forms of necessary documents.

Examination room is intended for examination of patients by a doctor and, in addition, here a nurse conducts thermometry, anthropometry, examination of the pharynx, and sometimes other studies (ECG) for patients.

Examination room equipment:

A couch covered with oilcloth (on which patients are examined);

Height meter;

Medical scales;

Thermometers;

Tonometer;

Spatulas;

Hand wash sink;

Desk;

Case history forms.

Treatment room intended for providing emergency care to patients (shock, visceral colic, etc.).

Treatment room equipment:

Couch;

A medical cabinet containing: an anti-shock first aid kit, disposable syringes, disposable systems, anti-shock solutions, antispasmodics and other medications;

Bix with sterile dressing material, sterile tweezers in a disinfectant solution (for working with the band);

Bix with sterile gastric tubes, rubber urinary catheters, tips for enemas.

Surgical dressing room is intended for minor operations (primary surgical treatment of an accidental wound, reduction of a dislocation, reposition of simple fractures and their immobilization, opening of small abscesses, etc.).

Sanitation checkpoint, his tasks include:

Carrying out sanitary treatment of sick and injured people;

Acceptance of clothes and other things of patients, inventory of clothes and things and transfer for storage;

Issuance of hospital clothes.

To treat seriously ill and injured patients, a bathroom with portable shower sinks is provided. The sanitary checkpoint must have an appropriate set of toilets, sinks, and showers, provided for by sanitary standards, taking into account the possibility of a mass influx of victims. For the deceased, a room with a separate entrance should be allocated in the reception department, where several corpses can be stored simultaneously for a short time (until the morning).

Responsibilities of the admission department nurse:

registration of a medical card for each hospitalized patient (filling out the title page, indicating the exact time of admission of the patient, the diagnosis of the referring medical institution);

examination of the skin and hairy parts of the body to identify head lice, measuring body temperature;

fulfilling doctor's orders.

Responsibilities of the emergency department doctor:

examination of the patient, determining the urgency of surgical intervention, the required amount of additional research;

filling out a medical history, making a preliminary diagnosis;

determining the need for sanitary treatment;

hospitalization in a specialized department with mandatory indication of the type of transportation;

in the absence of indications for hospitalization, provision of the necessary minimum of outpatient medical care.

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. 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 by 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.

4. Shiryaev N.D., Kagantsov I.M. Essays on reconstructive surgery of the external genitalia in children Part 1, Part 2. Monograph. – Syktyvkar, 2012. – 96 p.

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 meeting 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 medical 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 middle staff 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 bedpan under the patient’s buttocks so that the perineum is above the hole of the bedpan, 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.

The nurse takes a jug with a warm disinfectant solution in her left hand 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 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 gap 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 immediate examination by a surgeon and active action in terms of revision of the wound in order to finally stop the bleeding.