Руководство к практическим занятиям по общему уходу за хирургическими больными (стр. 7 )

Various tube drainages are used insurgery practice very often. Medical personnel must treat with drainages very carefully. Accidental pulling of this tubes can lead to severe complications after operation. For example moving off tube from common bile duct (after operation on biliary tract) can be the cause of bile peritonitis and moving off the tube from pleural cavity can lead to pneumothorax.

To the gross technical errors the leaving of foreign bodies in tissues and cavities during operations and bandagings concerns. This foreign bodies can be gauze napkins, fragments of rubber drainages and even surgical tools. They are the cause of such complications as purulent processes, bleedings, peritonitis, pleuritis, bowel obstruction, etc.

Mistakes of the same sort at operations have no direct relation with the general care of patients, however in their preventive maintenance the role of junior medical staff is great enough.

Principal cause of the common leaving of foreign bodies in wounds or cavities during operation is thoughtless treatment of executable procedure. Also insufficient qualification of operation participants (surgeons, his assistants and operational sisters); insufficient anesthesia and, as result, restless behavior of the patient take place; small cuts giving insufficient access to object of operation; bad illumination of an operational field; presence of plenty of tools and dressings on operation field.

Junior medical personnel should be an active participant of dressings and operations. Immutable rule at the performance of any operation should be careful supervision and control calculation of tools and dressing.

Chapter 6

BODY HYGIENE OF THE SURGICAL PATIENT

The hygienic condition of a surgical patient body has the major value in prophilaxis and treatment of purulent postoperative complications. This is the basic compound part of the patient hygienic regimen.

There are two basic kinds of the patient hygienic regimen: the common regimen and bed regimen.

The common regimen doesn't limit moving of patients. The same order is to the persons, suffering not severe diseases, having satisfactory condition (for example the patients requiring for observation during preparation for the scheduled operation, recovering patients).

The bed care provides the staying of the patient in bed. There can be three kinds: strict bed; usual bed and active bed. The strict bed care is appointed to the patient with such diseases as gastroenteric bleeding, thromboembolic postoperative complications, in a sharp phase of cardiac infarction, etc. Patients at such regimen lay in bed in the certain position. Change of position should be made by the medical personnel. Independent active turns of a trunk are forbidden. A feeding and physiological needs are carried out with the help of medical workers. The basic purpose of this regimen – is prevention of complications, creation of conditions for tissues regeneration and the greatest possible function reduction of the affected organ. Usual bed care is appointed to the majority of patients with sharp surgical diseases and traumas, and also in the first days after many operations. Patients are allowed to turn sideways, to accept convenient position. Some patients can rise in bed and sit. Active bed regimen is appointed to patients with diseases, requiring rest and stay in bed the greatest part of a day (chronic arterial obliterating diseases of lower extremities, stomach (duodenum) ulcer in the stage of exacerbation, etc.). Patients may get up the bed, leave the ward to go to the canteen and toilet.

Hygiene of a body of the surgical patient provide: physiotherapy exercises, a morning toilet, hygienic baths or showers, care of hair, fingers, a mouth, a perineum, etc.

Body hygiene of the patient with the common regimen

The primary aim of clinical hygiene body actions is maintenance of the skin cleanness. It is known, that the human skin represents a complex organ which carries out functions of protection of an organism from adverse environment influences, regulation functions of metabolism, thermoregulation. Sweating and sebaceous glands excrete sweat and fat adsorbing dust, microbes. Skin folds collect these products which cause an itch. Skin scratches are the cause of dermatitis, pustules, furuncles.

Patients must wash his hands and face with soap in the morning and in the evening, clean a teeth, comb hair daily. If a patient has grave condition this procedures must be provided by sisters and nurses.

The important hygienic action is wiping off the body of patient in grave condition. It is recommended to carry out one time daily. Procedure is the following: the nurse wipes all body from hands to foot with the wet warm sponge. It doesn’t need to use spirits or something like cologne. One may use deodorants.

Every 7-10 days patients must take a hygienic bath or douches. Optimum time for this purpose is the period after day time mon regimen patients can wash themselves. If patient is forbidden to get up sisters can move his to bath-room on wheel-stretcher. If it is possible patient is set to bath with the help of medical staff. Otherwise sisters can wash his directly on wheel-stretcher using a shower.

In a bathing room there should be a following equipment: a couch; a storage for pure cloth, tanks for dirty cloth; a table with subjects for shaving and haircutting; a soap; brushes; disposable basts. At absence of the last one it is possible to use usual basts after rely disinfected basts and dirty basts must be kept separately. The internal surface of a bath before use is cleared mechanically (a brush, a bast) and with the help of washing-up liquids.

If the bath is contra-indicated for the patient, he washes under the shower by the same rules, as at washing in a bath.

After using the bath it is processed with the help of cleaning compositions and solutions of disinfectants. As the last one it is possible to use chloramin, hydrogen peroxide with detergents, sulfochloratine, etc.

Shaving things should be kept clean and after each application to be processed by spirit. Now overwhelming majority of patients use own individual shaving things. It is better to advise applying disposable shaving-sets.

Hygiene of a body of the patient with a bed care

Hygienic (morning) and respiratory gymnastics are obligatory. The respiratory gymnastics will be, that the patient makes on 5-6 deep breaths of 1 times within each hour. Breaths can be carried out in bed without movements or in a combination to movements of hands, legs, trunks.

The personnel actively helps the patient with a bed care at washing of hands and face, rinsing of a mouth and cleaning of a teeth. At a strict bed care it is necessary not less often than 3 times a week to carry out washing patient body.

For washing the patient in bed use a jug with warm water, a toilet soap and a basin. At washing a head the basin is put on a bed in its head end. The patient raise, having his head above a basin so as water flew down in a basin. A head is washed a soap, then a soap wash off. Upon termination of washing a head carefully wipe a towel. And limbs and trunk are washed with use of similar receptions.

It is possible to wash some bed patients in a bath. For this patient put in a bath on a bedsheet which hold for the head and foot ends. At this procedure it is necessary to watch constantly a condition of the patient in time to help to him.

Patients with a bed care require special care of perineum area. At a defecation they should use a rubber or metal bedpan. Individual bedpans are placed on special shelf under the patient’s bed. For patients who can sit, but are not capable to move, are used portable bedpan in the armchair form and a chair with the hole on chair-bottom.

After each defecation and urination medical worker carries out a toilet of perineum area of patient (washing). The technique of a washing will be described below (chapter 9).

Body wiping is made by a damp towel or napkin. It is possible to use a disinfectant solution. First wipe a neck, skin behind ears, back, waist, forward surface of a thorax, axillary areas, limbs, then skin folds in groin areas and perineum. After wiping skin in the same order dry up a towel.

Eyes at the patients who are taking place in a unconsciousness, wash out with the help of the sterile napkin with a warm solution of a boric acid. Ears clear of earwax. For this purpose in acoustic duct by a pipette it is dropped solution of hydrogen peroxide. In an ear put for some minutes and then take out together with earwax a cotton ball.

In case of need remove crusts from a nose of the patient. With this purpose in nasal passages enter the gauze turunda with mineral oil or any other oil. In 2-3 minutes turunda with the crusts take from nasal passages.

The great value is care of oral cavity. Patients with severe condition can not do usual hygiene procedures often. They can have dry mouth, evident dental deposit; it is worsen drain function of mouth. As the consequences are gingivitis, stomatitis and, perhaps, acute parotiditis. It is necessary wipe patient’s mouth (teeth, tongue, gums) with help gauze and antiseptics (weak liquid of potassium permanganate, 0.5% water chlorhecxidine). If patient can he must to gargle..

At dryness and cracks of lips on them impose a napkin moistened with water. Then lips grease mineral or any other oil.

Heavy patients need the prophilaxis of decubitus ulcers (see chapter 5).

Chapter 7

HYGIENE OF CLOTH, FOOTWEAR, BED-CLOTH AND PERSONAL THINGS OF PATIENTS.

Hygiene of hospital clothes and footwear

The hospital clothes should be:

- made from cotton or synthetic fabric (woolen things, fur products allocating superfluous quantity of a dust in an environment are not allowed;

- easy, convenient, easily removed and put on;

- reasonable style and color.

In surgical departments there are such specificities as high bacterial pollution, pollution of clothes by the blood and discharge from wounds and cavities. Therefore it is expedient to offer patients the hospital clothes which we can expose to careful disinfection. The standard complete set of clothes includes underwear, a pyjamas (for men) and a dressing gown (for women). However it is allowed own patients clothes which should be clean. After change clothes must exposed of disinfection. A cotton domestic dressing gown for women and a sports suit for men are the most convenient form of personal patients clothes in a hospital.