Руководство к практическим занятиям по общему уходу за хирургическими больными (стр. 12 )

Patients requiring an emergent operation need the greatest attention and care. More often they are the patients who cannot do without the intensive help of the medical personnel. The main role in carrying out diagnostic actions and examination over these patients belong to a surgeon. The junior medical personnel follows the instructions of the surgeon under the control over the patient’s condition, participates in patient’s examination and renders help. The nurses take the body temperature; fill in analyses forms; call laboratory assistants, other specialists; transport a patient to diagnostic rooms (X-ray, endoscopic, ultrasonic), the sanitary room, bandaging station; assist the doctor at performance of bandaging and medical manipulations (submits tools, dressings, gloves); give enemas; perform injections and infusions.

Sanitary processing (hygienic cleansing) of patients is carried out at pollution of a body and clothes considered his general condition and a kind of disease. Patients are necessarily examined on dermatozoonoses. It is occur pediculosis (parasitogenic skin disease, infestation of lice) and scabies (itch, infestation of scabies acarus). In this case one may cut hair and take special drugs (insect killer). There are following insecticides:

- benzylbenzoate (ointment 10-20%, emulsion 20%)

- malathion (1% shampoo)

- permetrin (solution "Nittyfor")

- phenotrin (solution)

- "Pedilin" (emulsion with tetrametrin and shampoo with malathion).

There are old simple medicines: 10% emulsion of soap and petroleum, 5% boric ointment (only for adults). After applying washing of hair with 9% acid acetate for destruction of nits (parasites eggs) is recommended.

After anti-parasitic processing the patient washes himself. His clothes is placed in a special bag and is sent to disinfector. People take a shower. If the patient is not capable of washing himself, a nurse helps him. During washing it is necessary to watch the patient as he can fall, hit or choke with water. Seriously ill patients are rubbed down by a sponge with soap water or other detergents. Patients can be in a very poor condition requiring emergent operation. In this case sanitary processing is not carried out (if there is a direct threat for their life, for example, wound of heart), or carried out in the reduced volume: washing the dirty parts of a body, fast preparation of a place for operation.

After sanitary processing the patient is dressed in clean cloth and is transported to a ward. The way of transportation is determined by the doctor. If the patient can go, the nurse, having taken the history case, accompanies him to a ward. If the patient cannot go, he is transported on a wheelchair or wheel-stretcher. In the surgical department the patient must be transferred directly by a nurse on duty with his history case. She determines a place in a ward and follows the doctor’s prescriptions. Sometimes a patient is transported to an operation theatre at once from a reception (for example if he has trauma of internal organs and persistent hemorrhage).

Care of the patient before operation in the surgical department

In urgent cases (when emergent operation is needed), the patients undergo short-time preoperative preparation. Some patients need intravenous infusions of solutions or hemocorrectors, injections of cardiovascular medicines, etc. Some patients need gastrostolavage (through mouth or nose). The time needed for this preparation can be different and depends on patient’s condition but usually it takes no more than 3 hours.

Preparation of a patient’s operational field is one of nurse’s functions. Operational field is a part of body which the doctor will operate on. A nurse shaves hair in a zone of the future incision (without any detergents). After shaving she treats it with alcohol, anesthetic ether, chlorhexidine. In some surgical departments an operational field is closed with a sterile bandage after shaving. After premedication (injection of the medicines raising efficiency of anesthesia) the patient is transported into an operation theatre.

Before scheduled operations the patient spend from 1 till 10 days in the department and more depending on the number of examinations and preparation for operation. Functions of the nurse include performance of the examination plan prescribed by the doctor. She fills in forms for blood and urine analyses, biochemical researches; makes orders for examination by tool methods of investigation (X-ray, endoscopic methods) of cardiovascular system, lung, liver, kidneys; transports seriously ill patients to diagnostic rooms; calls doctors-advisers; prepares patients for tool researches. So before X-ray research of a gastroenteric tract and urinary system the nurse gives an enema to the patient in the evening before analysis and in the morning on the day of analysis.

She also carries out medical disposals of the doctor: distributes tablets and liquid medical products, makes intravenous, intramuscular and hypodermic injections, feeds severe patients, checks performance of sanitary and hygienic norms by patients.

The nurse should warn the patient, that in the evening before operation he should eat much. The patient can take y a glass of tea or juice with a bit of white bread only for supper. In the morning on day of operation the patient must not eat and drink. Besides in the evening and in the morning it is necessary to give cleansing enema. Colon purge is obligatory before any scheduled operation especially for aged patients. Before operation the patient should take a bath or shower and to replace underwear. On the day of operation it is necessary to prepare an operational field. It is done in the same way for emergent surgical interventions.

In case of gastric evacuation impairment (for example a stenosis of gastric outlet) on the eve and on day of operation it is necessary to remove gastric contents from a stomach and to make gastrostolavage with sodium bicarbonate. A probe is applied for this purpose(see chapter 15).

The patient preparing for operation should be given a sedative to sleep well before an operation. the patient should urinate before an operation.

The medical personnel must also remember deontology rules. In accordance with particularity of a used method of treatment (surgical operation) at patients before operative intervention usually is great psychic and emotional excitement. Medical personnel should make verbal contact with a patient and explain him his diagnosis. It is necessary to allow patients to interpret in their own way each word of a doctor and a nurse.

Care of the patient after operation in surgical department

Time from the termination of operation and till its outcome is called the postoperative period. The nearest or early postoperative period is the first 10-12, sometimes more days after the operation when the patient is kept in a hospital. At this time patients need much care.

From an operational table the patient is put on a wheel-stretcher and is transported into a ward. Bed for patients should be ready beforehand. It is covered with clean bedclothes. It should be warm. The body temperature can decrease during the operation because of blood loss and other reasons. The patient is covered with a warm blanket.

The first 2-3 days of the postoperative period the patient should spend in resuscitation unit or in intensive care ward where constant supervision is provided (and in case of need - the emergency help). It is important to place the patient in bed in a correct position. The last is determined by the type of operation. There are special functional beds for changing of patient's position.

There are many complications in the early postoperative period. In the earliest hours the patient (especially after narcosis) can vomit. Therefore there should be a basin, napkins and tools for the toilet of an oral cavity in a ward. Danger of vomit consists of the patient who can choke if gastric contents will get in respiratory ways.

The difficult breathing and asphyxia (suffocation, choking) can be a consequence tongue retraction. At occurrence of respiratory frustration the nurse is obliged to call a doctor immediately.

The nurse should take care of the pulse, rhythm and depth of breathing, body temperature, blood pressure.

There can be a retention of urine (ischuria) after operations. Thus, the bladder is overflown. The nurse should take the elementary measures on elimination of this complication. Urination can be adjusted, if the patient will try to sit himself down or be up near bed. The positive effect can be received, having applied a hot-water bottle on a bladder area. If this actions do not help, it is necessary to apply bladder catheterization (see chapter 15). The nurse should be able to make bladder catheterization with soft urinary catheter. Rigid (metal) catheters should be applied by doctors only. Some patients need constant urinary catheter (Foley's catheter) after operation. It is necessary to wash out this catheter and bladder periodically with antiseptic solutions (furacilline 1:5000, water solution chlorhexidine 0.5% ).

The supervision over a bandage of an operational wounds is also very important. If the wound is sutured completely (without drainages and tampons), the bandage should be dry. It drenches in such cases with blood, pus, serous liquid or can indicate a complication. It is necessary to watch the bandage was not dislocated from the place. In such case the nurse should apply a new bandage (a sterile dressing). After some operations tampons are left in a wound, drainages enter a zone of intervention. Features of supervision over such wounds and care of drainages depend on the character of pathology and kind of the operation.

Now in the majority of surgical clinics active conducting of the postoperative period is accepted. At once after operation the patient is suggested moving within beds. Generally earlier rising of patients is practised. The patient should be engaged in respiratory exercises and physical exercises. This work is very useful for prevention of postoperative complications.