Руководство к практическим занятиям по общему уходу за хирургическими больными (стр. 10 )

Hygiene of parcels & visits.

Additional foodstuffs can come to patients with parcels from relatives and friends. The parcels should meet certain requirements. The number of parcels is not specially regulated, but it should not exceed reasonable limits. It is necessary to mind the patient’ s opportunity to eat all that is given to him. The congestion of products in a patient’s bed-side table and fridge is inadmissible. Empty containers should be thrown away or given back to relatives regularly to prevent blocking up of bed-side tables and fridges.

Transmitted foodstuffs can be dangerous to patients. It is necessary to instruct relatives carefully about the diet prescribed to the patient, regime of food taking/ meal, products harmful to the patient. Parcels with perishable food (for example, sausages and other meat products, salads, pies, cakes) are absolutely inadmissible. It’s better not to send meat and fish canned food, tinned mushrooms, salty and smoked fish to patients. Practically all patient are contra-indicated to irritating components of food (pepper, mustard, horse-radish). To maintain the normal feeding the best way is to give juices, fresh and tinned fruit, fresh vegetables, cookies. Fresh vegetables and fruit are to be washed up at home. It is necessary to deliver them in packages, plastic containers. The patient should wash them again before meal. As for drinks, water, juices and cranberry water are desirable. Alcoholic drinks are strictly forbidden.

Visiting patients by their relatives and friends is an important medical factor having medical value. Therefore the organization of visits is very important. They say, a hospital passes 2-3 times more visitors than patients a month. Visitors are considered as an additional source of infection in a hospital. But studies have shown recently that the insignificant number of infectious illnesses only are transferred from visitors. So, it is impossible to limit/ cut or absolutely forbid visits of patients (except for occurrence of any specific conditions at treatment of a patient). Visits have favourable effect on patients, especially children. At a long stay in a hospital patients can develop “mental hospitalism”, which negatively influences the pport by relatives is really important in such cases.

Time for visits should be convenient both for personnel, patients and relatives. On week-days visitors can come only after 4 p. m. (after dinner-rest of patients). In the first half of the day they may interfere with realization of medical diagnostic process in a department. The visits should be finished at 7 p. m.; after that the evening medical procedures and rounds begin.

The question about the number of visiting days a week can be solved differently. In some medical establishments 1-2 days a week are allowed only. It is explained by the following: visitors are a potential source of infection. They interfere with and break the rhythm of work. However on the correct organization of visits these arguments seem to be groundless. It is necessary to allow daily visiting of patients. At cutting visiting days many visitors can sharply worsen sanitary condition of a department and create problems in changing rooms.

Not more than 1-2 visitors at once may come to one patient. A lot can complicate the work of the medical personnel. Certainly, visitors are obliged to meet some hygienic requirements. The outer clothes and hats are to be necessarily left in a changing room. Traditionally before entering the department, the medical gown is offered to visitors (a gown for every visitor). Even if they don’t bring superfluous microbes themselves, they may come into contact with microflora existing in a hospital, carrying it to their houses. In the departments with high bacterial contamination (such as purulent, burn) these requirements should be followed strictly. Each visitor should use bootee (plastic cover on footwear). Patients with the common regime can spend time with relatives in specially equipped places: rooms, halls for reception of visitors, halls. In this case many problems connected with sanitary-hygienic condition of department are removed. Rooms for reception of visitors should be equipped with corresponding furniture (chairs, sofas, armchairs, tables), ventilation and illumination according to existing sanitary-hygienic norms. These rooms are exposed to damp cleaning daily before reception of visitors and after it.

If the patient is prescribed a bed regime, it is necessary to admit relatives to wards. Visitors are to be warned not to sit down on a patient’s bed, therefore there should be enough chairs and stools. It is necessary to limit the number of visitors (1-2). It is necessary to warn relatives about rules of a department.

The question on the relatives admission is closely connected with the problems of visiting of seriously ill patients (for care). This question is solved in each case individually. At deficiency of junior medical staff relatives can give very big help in care for the seriously ill patients, therefore at presence of indications this care should be definitely allowed. The certain share of contingent in the surgical department is made up of dying patients. In this case it is necessary to be guided by principles of humanism and not to limit access of relatives and friends to the patients.

Thus, correct organization of patients nutrition, parcels and visits demands rather significant efforts on the part of medical staff and administration of the hospital, assumes sufficient financing of medical establishments and reasonable designing of hospitals.

Chapter 9.

HYGIENE DISCHARGES OF THE SURGICAL PATIENT

Hygiene discharges from a mouth and a nose

Patients who are disturbed with cough with discharges of a phlegm, it is necessary to supply with the individual spittoons representing a glass vessel with the screwed up cover. It is necessary to watch, that spittoons were in due time released from a phlegm with their subsequent washing and processing by a disinfectant (chloramine, sulfochloratine, dezoxone, etc.). At patients with lungs chronic suppurative processes it is necessary to find body position which allow the phlegm from a tracheobronchial tree better removed (postural drainage). At unilateral process is a position on healthy side. The position drainage is carried out of 2-3 times day for 20-30 minutes.

Involuntary ejection of a stomach contents through mouth (sometimes and through nose) refers to as vomitting. The medical staff should not leave the patient during vomitting without supervision as loss of vomit mass in respiratory ways (aspiration) with development of an suffocation (asphyxia) is possible. At vomitting it is necessary to set conveniently the patient, to cover a forward surface of his body with an oilcloth, to put before him on a floor a basin. If the patient cannot sit, him lay sideways or turn on one side a head, to a mouth bring a tray. It is possible to replace one with a towel, a bedsheet, a napkin.

The patients who are in unconsciousness, sometimes have regurgitation - a passive outflow of gastric contents in a mouth. Owing to absence of a cough reflex gastric contents can be aspirated. At a regurgitation the head of the patient should be turned on one side and to release the oral cavity from contents with help gauze napkins or a suction device.

Vomitting and regurgitation frequently are consequence of gastric (intestinal) contents stagnation because of various pathological conditions (stenosis of an stomach output, intestinal obstruction, a gastroenteric paresis after abdominal operations). In this case there can be indications for gastric probe introduction. A thick gastric probe it can enter through a mouth or nose. After a gastric evacuation a probe is deleted. If necessary procedure is repeated. The thin probe intended for prolonged stay in a stomach, is entered through nasal ducts. After introduction the probe is attached by an adhesive plaster to a nose. The probe is joined to a tube, and tube free end falls to glass vessel for gathering and measurements of gastric contents. One can suck away gastric contents each 2-3 hours (with help a Jean’s syringe). Sisters must take stock of discharge quantity and its nature (the technics of probing is described in chapter 15).

At plentiful discharges of slime from a nose the patientt is supplied with disposable paper nasal napkins. Crusts can be deleted from nasal courses with the help gauze with vaseline which is entered in a nasal course, and then by rotary movements it is taken.

Hygiene of urination

The urinal is necessary for an evacuation of a bladder with a bed rest for the patient. Under laying patient it put oilcloth. It used mail bedpan and femail bedpan. Upon termination of a urination the bedpan and oilcloth it removed. After each urination junior nurse releases urinal from urine, washs out with the help a detergent and disinfects (chloramine and other disinfectants). For removal of a sediment from urinal walls it washed with help the weak solution of hydrochloric acid periodically. Before use a urinal rinse with warm water.

Patients with a urine retention (ischuria) can have indications to a catheterization of a bladder (see chapter 15).

At an enuresis special urinals are applied. Them carry constantly or put on night (at a night enuresis). The urinal should be washed out and disinfected daily.

Hygiene anal discharges

At an evacuation of intestines at the bed patient it used bedpans. Bedpans are metal, faience and rubber. Before use it is necessary to rinse a bedpan hot water. One hand of the patient is raised, and another is brought the bedpan under buttocks. The patient is covered with a blanket. After defecation nurse takes from under the patient the bedpan, covers patient with an oilcloth or a paper and take out in a toilet. The patient is washed away with warm 0,01 % a solution of potassium permanganate or any other antiseptic. For this purpose under buttocks again it put bedpan. From a vessel it run water on a perineum, simultaneously processing its with gauze napkin, directing napkin from genitals to anus. After washing patient perineum it wiped a napkin.