Руководство к практическим занятиям по общему уходу за хирургическими больными (стр. 11 )

After use bedpan is washed out a hot detergent and is disinfected immersing for 2 hours in a disinfectant (1% chloramine, 0,2% sulfochlorantine, etc.). Medical staff must use rubber gloves.

Features of female hygiene

Anatomical features of female body (folded structure of a perineum, communication of abdominal cavity with an environment through genital tracts, menses, more direct and short (than mail) urethra) create danger of an ascending infection and development of inflammatory diseases of genitals and urinal tracts. Preventive maintenance of the given complications is observance by each woman of rules of personal hygiene. These rules provide, a daily hygienic toilet of genitals.

In surgical departmentes it is desirable to have a special hygienic room, in which woman could carry out a hygienic toilet of genitals (a room of femail hygiene).

The specified room should be equipped bidet or a cabin with ascending douch. In this room it is necessary to have a tank with boiled water, a jug, crystal potassium permanganate (for preparation of a solution), hygroscopic cotton wool, Esmarch’s irrigator, vaginal irrigators.

Each woman should daily wash with soap external genitals and anal area by warm water (30-50°C) with the subsequent dry perineums a hygroscopic tampon. Thus movements of hands should be carried out at front to back (from a vulva to anus) to not bring a bacterium to urinogenital area. During a menses 3 times day are necessary to make a hygienic toilet not less often. It is necessary to use boiled water, and it is better - a weak solution antiseptics (0,01% solution of potassium permanganate; boric acid - 1 teaspoon on 1 glass of water, etc.).

The patient with bed regimen hygienic procedures do with help medical staff. The medical worker dresses gloves and an oil-cloth apron. 2 times day are necessary to wash away the patient not less often: in the morning and in the evening before dream. If necessary the toilet of external genitals is carried out (intimate washing of patient) more often. Before an intimate washing of patient for preservation of cleanliness of bed under a basin of the patient enclose an oilcloth. An intimate washing of patient is made on bedpan.

Except an intimate washing of patient at women frequently is carried out vaginal syringing (irrigation). Syringing is carried out with the help of Esmarch’s irrigator, a rubber tube, crane (or forceps) and a sterile vaginal tip. The vaginal tip represents the bent tube in length approximately 15 sm and thickness about 1 sm with several apertures on lateral surfaces on the end. There are glass and plastic tips. For syringing it is used antiseptic liquids (with temperature 35-36°C, at hot syringings - 39-40°C): the weak solution of potassium permanganate, solution of sodium hydrocarbonate (2 teaspoons on 1 l waters), boric acid (3-4 spoons on 0,5 l waters) which pour in Esmarch’s irrigator, suspended on a support on 70 sm is higher than a level of a bed. The patient lays on bedpan with bent legs. In the beginning wash external genitals. Then cautiously enter a tip in a vagina and carry out it deep into on 6-7 sm in a direction up and behind. Holding with one hand the entered tip, another open the crane, starting up a liquid with the greater or smaller speed. After some medicinal syringings the patient should lie down, that the solution could have longer an effect. Upon termination of procedure perineum is dried carefully.

After use irrigator needs to wash up well, in the beginning warm water, then a disinfectant solution.

The tip is disinfected with 3 % chloramines or a boric acid, before the use is sterilized.

Chapter 10.

HYGIENE OF TRANSPORTATION OF THE SURGICAL PATIENT

Medical transportation is a moving of patient with various aims (first-aid, performance of medical and diagnostic actions).

In hospital it is necessary to transport patient from an reception to surgical department, from surgical department to diagnostic cabinets and back. In surgical department there is a necessity of patient transportation from ward to dressing, procedural, operation theatre and from these rooms to ward. There are not problems if the patient can walk. Then he can moves in hospital independently. However, in some cases it is necessary to attend patients by the junior or average medical personnel (for example aged patients). Bed patients are transported on a stretcher, wheelstretcher and wheelchair.

Need two or four persons for bear stretcher with the patient. They should not go march in step that a stretcher were not swings. At rise on a stairs it is necessary to bear patient a head forward, and at descent - foots forward. The patient’s head must be up during transportation.

For transportation medical staff must know techniques moving of the patient: 1) from a bed on a wheelstretcher, 2) from a wheelstretcher on an operation table, 3) from an operation table on a wheelstretcher, 4) from a wheelstretcher on a bed.

The surgical department is supplied with so-called functional ch bed will consist of four parts: head, two average and foot. With the help of special adaptations it is possible to lift and lower separate parts of a bed, giving to the patient the necessary position. Functional beds have wheels for their easier moving. On small distances the patient can be transported directly on a bed.

It is expedient to use the next way of patient moving. The wheelchair is put along a bed near to it. The head end of a wheelchair should be at the head end of a bed. Two or three persons settle down so that the wheelchair was between them and a bed. One brings hands under a head and a thorax of the patient, another - under a waist and the hips. If there are three persons one brings hands under a head and the top third of the thorax, the second - under the bottom third of thorax and under a waist, the third - under the hips. All together pull the patient on a wheelchair.

If it is impossible place wheelstretcher along bad the wheelstretcher is put perpendicularly beds so that the foot end of a wheelstretcher was at the head end of a bed. Two or three persons stay along the edge of a bed, lift the patient, turn round him on 90 ° and put on a wheelstretcher.

Moving of the patient from a wheelstretcher on an operation table. The personnel settles down along a table from the opposite side from a wheelchair. Under the patient hands bring and pulling him on itself, put on a table. Technique of patient moving from a table on a wheelstretcher usually is same as moving from a bed on wheelstretcher.

In ward shift the patient on a bed, applying one of the ways described above. In all cases we must pull patients to wheelstretcher but don’t push.

Grave condition patients are quite often transported (from the reception, from operation theatre, etc) with infusion system. To not damage vein wall during transportation it should immobilize upper limb with help any splint (for example Kramer's splint). The separate medical worker should keep infusion bottle and watch infusion system (to avoid tension of tubes).

At transportation of patients having intubation tube it is necessary to fix this tube by an adhesive plaster to a head. In this case the doctor - anaesthesiologist must observes of transportation. He should have portable device for artificial lungs ventilation as there is dangerous of patient breath stopping. If patient transportation after operation is fulfiled in the elevator medical staff must be ready for unexpected incidents (stopping of the lift, etc.). In the lift together with such patients there must be a doctor – anaesthesiologist and sister having all necessary tools for intensive care (set of medicines, intubation tubes, laryngoscope, gag, the device for artificial lungs ventilation).

Transportation of patients having tubular drainages. Tubular drainages are usually entered at performance of operations on pleural and abdominal cavities. The pleural cavity is frequently drained at a pneumothorax, hemopneumothorax, pleurisy. Tubular drainages in the abdominal cavity are left after operations concerning a peritonitis, cholecystitis, pancreatitis more often. At operations on bile ducts it can be applied the external drainage of the common bile duct.

The key in such cases is closing of this tubes. Usually it is used clips, stoppers, forceps. One can to tie in a bungle. Otherwise discharge from drainage tubes dirty environment (pus, blood, bile, etc.). Pleural drainage tubes must be closed very carefully. Tube hermiticity disturbance lead to pneumothorax (air accumulation in pleural cavity) and lung collapse.

Furthermore there is dangerous of casual removing of drainage tubes during transportation. Loss of the tubes can be reason of severe complications. So early extraction of the tube from the common bile duct can lead to the bile peritonitis which requires second operation (relaparotomy).

It is necessary to watch closely also that drainage tubes during moving the patient did not stretch, did not get under a body of the patient. The extremely undesirable is casual removal of drainages at patient transportation.

Before transportation of patients a wheelchair is covered with a clean bedsheet or a blanket. A bedsheet is changed after each patient. After work the wheelchair must be washed up with the help of a detergent and disinfected by two-multiple wiping.

Chapter 11

OBSERVATION & CARE OF SURGICAL PATIENTS BEFORE OPERATION & IN THE NEAREST POSTOPERATIVE PERIOD

Mechanical treatment on tissues and organs of the patient, made with the medical or diagnostic purposes refers to as plications are possible after operations and the qualified care of patients is the major factor of the prevention and treatment of complications.

Care of surgical patients in a reception ward.

The volume and matter of care of surgical patients in a reception ward depends on operation emergency. Urgent operation is an operation made soon after examination of a patient who has a life threatening state. Scheduled (planned) operations can be performed in a certain day and are delayed without damage for patient’s health. Mostly, scheduled patients enter a hospital in a satisfactory condition. Usually they are examines in a polyclinic. Therefore after the examination, a nurse draws up the documents (case history), carries out sanitary processing (if it is necessary) and directs him to the surgical department.