Care Of Lying Patient PDF

BY DR BAJJI AYOUB 1. The role of proper care for seriously ill patients. 2. Features of caring for seriously ill patients. 3. The position of the patient in bed. 4. The design and purpose of the functional bed. 5. Preparing a bed for a seriously ill patient. 6. Morning toilet of the patient. 7. Th...

BY DR BAJJI AYOUB 1. The role of proper care for seriously ill patients. 2. Features of caring for seriously ill patients. 3. The position of the patient in bed. 4. The design and purpose of the functional bed. 5. Preparing a bed for a seriously ill patient. 6. Morning toilet of the patient. 7. The concept of "bedsore“ (Pressure ulcers); causes of formation and localization of bedsores. 8. Prevention and treatment of pressure bedsores. 9. The stage of formation of pressure bedsores; actions of a nurse with the threat of their appearance. 10. Ways to change bed and bed linen for seriously ill patients. 11. Rules for supplying the patient with a vessel and urinal. 12. Technique for washing the patient.  13. Receptions of the daily toilet of the oral cavity; ears nose; eye.  14. The methodology of irrigation, application, wiping of the oral cavity.  15. Actions of the nurse with nosebleeds.  16. Features of hair care.  20. Rules for washing the head of a seriously ill patient in bed.  Introduction Lot of patients, especially those in serious condition, cannot carry out personal hygiene activities in full. It should be remembered that patients are often shy, try not to resort to outside help, especially if the manipulations are intimate. Therefore, the nurse should be considerate, discuss joint actions with the patient when washing, giving him a bedpan, urinators. Caring for a seriously ill patient requires mercy, patience and professional skills from a nurse.  Precautionary measures. To prevent occupational infections, the nurse should use protective equipment to prevent contact with the patient’s secretions (gloves, mask). THE METHOD OF DELIVERY OF THE PATIENT FROM THE RECEPTION TO THE SPECIALIZED DEPARTMENT IS DETERMINED BY THE DOCTOR DEPENDING ON THE SEVERITY OF THE PATIENT'S CONDITION: ON A STRETCHER OR ON A GURNEY, ON A WHEELCHAIR, ON HANDS, ON FOOT.  + the gurney is placed perpendicular to the couch so that it  the head end approached the gentle end of the couch;  + three people stand around the patient on one side:  one brings hands under the patient’s head and shoulder blades,  the second - under the pelvis and upper thighs, the third – under mid thighs and lower legs;  + lifting the patient, together with him turn 90 degrees towards the gurney;  + the patient is laid on a gurney and covered with it;  + Report to the department that a patient in serious condition was sent to them;  + Together with the patient, his medical record is sent to the department. + the nurse tilts the wheelchair forward, stepping on footrest; + the patient is asked to stand on the footrest, then supporting him, they sit in a chair; + return the wheelchair to its original position; + during transportation, make sure that the patient’s hands do not went beyond the armrests of Wheelchairs. BED COMFORT IS AN IMPORTANT ELEMENT OF THE TREATMENT REGIME. THE MAIN PURPOSE OF THE FUNCTIONAL BED IS THE ABILITY TO GIVE THE PATIENT THE MOST COMFORTABLE AND FUNCTIONAL POSITION. MESH SHOULD BE ELASTIC, THE LEGS OF THE BED ARE EQUIPPED WITH WHEELS FOR EASE OF MOVEMENT. SEVERELY ILL (PARALYZED ,IMMOBILIZED) PUT OILCLOTH ON THE SHEET, OVER IT — A DIAPER; FLATTEN FOLDS AND FOLD THE EDGES. GIVE THE PATIENT A FUNCTIONAL POSITION BY USING THE MOVABLE SECTIONS OF THE FUNCTIONAL BED. POSITION OF THE PATIENT IN BED MAY BE ACTIVE, PASSIVE AND FORCED. IN AN ACTIVE NOTE: POSITION, PATIENTS ARE ABLE TO INDEPENDENTLY TURN IN BED, SIT DOWN, The nurse must constantly monitor that GET UP, EAT, WASH, ETC. IN A PASSIVE the position of the patient is functional, POSITION, PATIENTS ARE INACTIVE, CANNOT improves work one or another affected TURN INDEPENDENTLY, RAISE THEIR HEADS, organ. The easiest way to achieve this is ARMS. MORE OFTEN IN TOTAL THEY ARE IN by placing the patient on a functional AN UNCONSCIOUS STATE. FORCED POSITION bed. THE PATIENT TAKES TO FACILITATE THEIR CONDITION AND REDUCE THE PAINFUL SYMPTOMS OF SHORTNESS OF BREATH, COUGH, PAIN.  IT IS NECESSARY TO REGULARLY CHANGE THE BED AND CHANGE THE BEDDING. REMEMBER THAT FOLDS ON THE SHEET CAN CAUSE THE PATIENT GREAT INCONVENIENCE AND CAUSE PRESSURE BEDSORES. IN CASES WHERE THE PATIENT’S CONDITION IS VERY SERIOUS, WHEN INCONTINENCE OF URINE OR FECES TAKES PLACE AND WHEN HE SWEATS HEAVILY, A WATERPROOF OILCLOTH SHOULD BE PUT UNDER THE SHEET. THE BEDDING AND UNDERWEAR FOR A SERIOUSLY ILL PATIENT ARE CHANGED AS THEY BECOME SOILED. BEDDING AND UNDERWEAR CHANGE IN THE DEPARTMENT IS MADE 1 TIME IN 7-10 DAYS. IF ONE OF THE PATIENT’S HANDS IS DAMAGED OR PARALYZED, FIRST REMOVE THE SLEEVE OF THE SHIRT FROM A HEALTHY HAND, AND THEN FROM THE PATIENT, AND WEAR IT THE OTHER WAY AROUND. EACH TIME YOU CHANGE UNDERWEAR, INSPECT THE SKIN FOR PRESSURE BEDSORES. FOR DEBILITATED PATIENTS, AS WELL AS THE DECENCY OF BEDSORES, FECAL INCONTINENCE AND URINE, A RUBBER BEDPAN IS USED.  PUT A WARD SCREEN BY THE BED; FOLD BACK THE BLANKET, ASK THE PATIENT TO BEND HIS KNEES AND SPREAD HIS HIPS. IF HE IS NOT ABLE TO DO THIS, HELP HIM; TAKE A GAUZE NAPKIN IN YOUR LEFT HAND, WRAP IT WITH IT THE GENITALS OF THE PATIENT; TAKE THE URINAL IN YOUR RIGHT HAND. INSERT THE GENITALS INTO THE OPENING OF THE URINAL, PUT IT BETWEEN THE PATIENT’S LEGS, REMOVE THE GAUZE NAPKIN; COVER THE PATIENT WITH A BLANKET AND LEAVE ONE; REMOVE THE URINAL, OILCLOTH, COVER THE PATIENT, REMOVE THE WARD SCREEN; DISINFECT THE URINAL; TO REMOVE SHARP AMMONIA SMELL OF URINE, RINSE THE URINAL WITH (SANITARY-2) CLEANER OR ANY OTHER. PREPARE: BEDPAN AND URINAL, CONTAINER WITH MARKING AND COVER, APRON, CLEANING BRUSHES, RUBBER GLOVES, DISINFECTANT SOLUTION: 0.5% DESECON-1, CLARIFIED BLEACH, 1% CHLORAMINE. HOW TO ACT: PUT ON AN APRON, GLOVES; PLACE THE BEDPAN IN THE TANK, FILL IT WITH DISINFECTANT SOLUTION, CLOSE THE LID, MARK THE TIME; GLOVES AND REMOVE THE APRON. EXPOSURE TIME: DESECON-1 0.1% - 30 MIN; CLARIFIED BLEACH 0.5% - 60 MIN; CHLORAMINE 1% - 60 MIN AFTER 1 H PUT ON GLOVES AND AN APRON AGAIN, TAKE BEDPANS FROM TANK AND RINSE THEM WITH HOT WATER USING CLEANING BRUSHES. REMOVE GLOVES AND AN APRON, WASH THEM, DRY THEM.  NOTE: URINALS OR URINATORS ARE ALSO DISINFECTED WITH THE SAME WAY. CLEAN SANITIZED BEDPANS STORED IN TOILET ROOMS IN SPECIAL NUMBERED CELLS. FOR SERIOUSLY ILL PATIENTS, A CLEAN BEDPAN IS CONSTANTLY UNDER THE BED ON THE BENCH. SKIN THINS WITH AGE AND CAN BECOME VERY WEAK. OLDER SKIN MAY INJURE EASILY AND TAKE LONGER TO HEAL. NOT EATING AND DRINKING ENOUGH, NOT BEING ACTIVE, MEMORY AND THINKING PROBLEMS, PAIN AND INCONTINENCE CAN LEAD TO SKIN DAMAGE OR SORES. DURING A STAY IN HOSPITAL, PATIENT’S SKIN MAY BE AFFECTED BY THE HOSPITAL ENVIRONMENT, STAYING IN BED OR SITTING IN ONE POSITION FOR TOO LONG, WHETHER PATIENT IS EATING AND DRINKING ENOUGH AND HIS PHYSICAL CONDITION. HOSPITAL MEDICAL STAFF SHOULD REGULARLY CHECK PATIENT’S SKIN, PARTICULARLY IF HE FEELS ANY PAIN.  INFLAMMATORY DISEASES - DERMATITIS A- FURUNCULOSIS B- CARBUNCLES WIPING OFF IS INDICATED IN A SERIOUS CONDITION OF THE PATIENT, STRICT BED REST. PREPARE: WARM WATER, SPONGE, LINER, BLANKET, ANTISEPTIC AGENTS: CAMPHOR ALCOHOL, ETHYL ALCOHOL, SALICYLIC ALCOHOL, VINEGAR, ETC. HOW TO ACT: PLACE AN OILCLOTH UNDER THE PATIENT; SPONGE MOISTENED WITH WATER OR A WASHING SOLUTION, WIPE OFF THE NECK, CHEST, HANDS; DRY THESE PARTS OF THE BODY WITH A TOWEL, COVER THEM WITH A BLANKET; TREAT THE ABDOMEN, THEN ROTATE THE PATIENT ALTERNATELY ON THE LEFT AND RIGHT SIDE, AND WIPE THE BACK AND LOWER LIMBS. WIPE THE SKIN UNTIL IT DRIES AFTER WIPING. SPECIAL ATTENTION DEVOTE TO AXILLARY AND INGUINAL AREAS, SKIN FOLDS UNDER THE MAMMARY GLANDS, FOR THE OBESE WOMEN WITH PROFUSE SWEATING, DIAPER RASH IS FORMED. NOTE: BATHING MEN, IT IS NECESSARY TO VERY CAREFULLY REMOVE THE FORESKIN FROM THE GLANS PENIS AND WASH THOROUGHLY WITH WARM WATER OR A WEAK (PINK) POTASSIUM PERMANGANATE SOLUTION USING COTTON SWABS. DRY WITH A SOFT CLOTH, GETTING WET, BUT IN NO CASE WITHOUT WIPING! PRESSURE ULCERS ARE OFTEN FORMED IN DEBILITATED PATIENTS WHO ARE FORCED TO LIE ON THEIR BACK AND SIDE FOR A LONG TIME. PARTICULARLY LIKELY IS THE OCCURRENCE OF PRESSURE SORES IN PATIENTS WHO ARE UNCONSCIOUS, AS WELL AS IN PATIENTS WITH URINARY OR FECAL INCONTINENCE. TO PREVENT PRESSURE SORES, IT IS OFTEN NECESSARY TO CHANGE THE PATIENT’S BODY POSITION AND MAINTAIN CLEAN SKIN. PRESSURE ULCER - NECROSIS OF THE SKIN WITH INVOLVEMENT SUBCUTANEOUS TISSUE AND OTHER SOFT TISSUES DUE TO PROLONGED COMPRESSION, LOCAL CIRCULATORY DISORDERS AND NERVOUS TROPHISM WITH PARALYSIS. FIRST, A BLUISH-RED AREA APPEARS ON THE SKIN WITHOUT CLEAR BOUNDARIES, THEN THE EPIDERMIS (THE SURFACE LAYER OF THE SKIN) IS PEELED OFF, AND BUBBLES FORM. THE DEEP FORM BEDSORES CAN BE EXPOSED IN MUSCLES, TENDONS, PERIOSTEUM. WITH A LONG POSITION THE PATIENT'S BACK BEDSORES ARE MOST OFTEN FORMED IN THE AREA SACRUM, SHOULDER BLADES, ELBOWS, HEELS, NAPE. IN THE POSITION OF THE PATIENT ON THE SIDE, BEDSORES APPEAR IN THE AREA OF ​THE HIP JOINTS. PREVENTION OF PRESSURE SORES BEGINS WITH GIVING THE PATIENT COMFORTABLE POSITION IN BED (PIC. 4). THE MATTRESS SHOULD BE RESILIENT ENOUGH, AND THE SHEETS ARE SOFT AND SMOOTH.IT IS NECESSARY TO MAINTAIN CLEAN SKIN. IT IS BETTER TO TURN THE PATIENT TOGETHER. FIRST, THE PATIENT NEEDS TO BE SLIGHTLY RAISED, AND THEN CAREFULLY ROTATED TO THE OTHER SIDE. CHART 4. BEDSORES RISK ASSESSMENT (SCORES) WATERLOW METHOD.  Physical Mental Condition Activity Mobility Incontinence Name of Condition the patient and date CHART 5. THE NORTON SCALE BEDSORES RISK ASSESSMENT; NOTE: SCORES OF 14 OR LESS RATE THE PATIENT AS "AT RISK" Good 4 Alert 4 Ambulant 4 Full 4 Not 4. Fair 3 Apathetic 3 Walk/help 3 Slightly 3 Occasional 3 Limited Poor 2 Confused 2 Chairboud 2 Very Limited 2 Usually-urine 2 Bad 1 Stupor 1 Bedridden 1 Immobile 1 Doubly 1 Total Results  Bedsores Stages Symptoms Treatment 1st stage The appearance of areas with cyanotic red color Skin treatment with antiseptic solutions (10% camphor alcohol solution, 1% salicylic alcohol solution, mixture without clear boundaries. 70% ethyl alcohol with water), light massage, rubber circle, Ultraviolet Blood Irradiation (UBI) Chart. 6. Signs and 2nd stage The appearance of bubbles Lubrication of the bubbles with a 1-2% solution brilliant green, 5-10% solution potassium permanganate. Leather processing treatment of pressure sores are given with antiseptic solutions (10% solution camphor alcohol, 70% ethyl alcohol floors with water), UBI, rubber circle 3rd stage Bubbles burst, ulcers appear UFO, ointment dressings with 1% sintomycetin emulsion, 10% streptocid ointment, sea ​buckthorn oil and other, rubber circle. 4th stage Develops necrosis of the skin, subcutaneous tissue and After limiting necrosis, the dead the tissue is removed, a bandage is applied to the wound with a 0.5% solution of potassium other soft tissues. permanganate or furatsilina 1: 5000. In the presence of pus washed with antiseptic solutions furatsilina solution 1: 5000; 3% solution hydrogen peroxide; 0.5% potassium permanganate solution, dressings with antiseptic solutions). As the wounds are cleansed, they completely switch to ointment dressings that contribute to healing of ulcers (solcoseryl, apilak, etc.)  DENTURE CARE DENTURES ARE A COMMON CAUSE OF IRRITATION OF GUMS AND ULCERATIONS. THEY ALSO SERVE AS A RESERVOIR FOR CANDIDA. IF NOT CLEANED REGULARLY, THEY CAN BE A SOURCE OF HALITOSIS. THESE PROBLEMS ARE ESPECIALLY OFTEN OBSERVED IN EMACIATED PATIENTS, AS THEIR PROSTHESES DO NOT HOLD WELL OR NEED UPDATING. IN PATIENTS WITH CANDIDIASIS, DRY MOUTH OR AN UNHYGIENIC CONDITION OF THE ORAL CAVITY, PROSTHESES ARE REMOVED EVERY NIGHT; THEY ARE THOROUGHLY CLEANED AND SOAKED OVERNIGHT IN A 1% SOLUTION SODIUM HYDROCHLORIDE. IF SUCH A SOLUTION IS NOT AT HAND, DENTURES MUST REMAIN DRY FOR 8 HOURS, WHICH HELPS REDUCE THEIR COLONIZATION OF CANDIDA.  HALITOSIS THE TERM "HALITOSIS" MEANS AN UNPLEASANT ODOR FROM THE MOUTH. IT INTERFERES WITH CLOSE COMMUNICATION WITH FRIENDS AND RELATIVES, GENERATES SELF-DOUBT AND DEPRIVES PLEASURE FROM FOOD INTAKE. APHTHOUS ULCERS APHTHOUS ULCERS ARE OFTEN VERY PAINFUL. REASONS FOR THEM DIVERSE. FOR DIFFERENTIAL DIAGNOSIS USUALLY SOWING.  WIPING WIPE EYELASHES AND EYELIDS WITH WARM WATER EVERY DAY, CONDUCTING A MORNING TOILET. IN THE PRESENCE OF DISCHARGE FROM THE EYES USE AN ANTISEPTIC SOLUTION.  WASHING EYE WASHING REQUIRES THE ACTIVE PARTICIPATION OF THE PATIENT; THEREFORE, THIS PROCEDURE IS NOT PERFORMED AFTER THE POSTOPERATIVE AND SERIOUS PAIN - IMMOBILIZED, PARALYZED, LOCATED IN THE TERMINAL STAGE OF CACHEXIA.  EAR CARE REGULAR CARE OF THE EXTERNAL AUDITORY CANALS PREVENTS THE ACCUMULATION OF SULFUR IN THEM. EARS SHOULD BE WASHED REGULARLY WITH WARM WATER AND SOAP. TO REMOVE SULFUR FROM EARS CANNOT USE HARD OBJECTS THAT IT IS EASY TO DAMAGE THE EARDRUM OR THE EAR CANAL. THIS CAN LEAD TO HEARING LOSS OR OTITIS MEDIA (INFLAMMATION OF THE MIDDLE EAR). NOSE CARE A SERIOUSLY ILL PATIENT HAS NATURAL DISCHARGE FROM. NOSE OFTEN LEAD TO THE FORMATION OF CRUSTS. PREPARE: COTTON TURUNDS (WICKS), PETROLEUM JELLY OIL, TWEEZERS, TRAY. HOW TO ACT: REMOVING DRY CRUSTS: MOISTEN USING TWEEZERS. TURUNDAS VASELINE OIL; ASK THE PATIENT TO BREATHE THROUGH THE MOUTH; ENTER TURUNDS FOR 2-3 MINUTES INTO THE NASAL PASSAGES; MAKE ROTATIONAL MOVEMENTS WITH TURUNDAS, REMOVE THEM. REMOVAL OF MUCUS AND PUS: PREPARE DRY COTTON TURUNDS; UNDER THE CONTROL OF VISION, ENTER THEM INTO THE NASAL PASSAGES WITH LIGHT ROTATIONAL MOVEMENTS - ALTERNATELY RIGHT AND LEFT; REMOVE THE TURUNDAS. REMOVAL OF LIQUID DISCHARGE: PREPARE A STERILE PEAR-SHAPED BALLOON A SMALL SHOCK TANK; SQUEEZING THE BALLOON, ALTERNATELY ENTER IT TO THE UPPER THIRD RIGHT AND LEFT NASAL PASSAGES; SUCK OUT THE CONTENTS OF THE NASAL PASSAGES.  HYGIENIC BATH A HYGIENIC BATH IS CARRIED OUT WHEN PATIENTS ARE ADMITTED TO HOSPITAL AND IN THE MEDICAL DEPARTMENT, WITH PROLONGED BED REST. THE PATIENT SHOULD BE WASHED IN A BATH OR SHOWER AT LEAST 1 TIME PER WEEK. ATTENTION! DURING A HYGIENIC BATH, THE NURSE SHOULD MONITOR THE PATIENT'S WELL- BEING, HIS APPEARANCE, AND PULSE. IF YOU FEEL WORSE, YOU SHOULD STOP TAKING A HYGIENIC BATH, PROVIDE FIRST AID AND IMMEDIATELY INFORM THE DOCTOR. GIVEN THE PATIENT'S CONDITION, THE HYGIENE BATH OR SHOWER CAN BE REPLACED BY RUBBING OR WASHING.  HYGIENIC SHOWER IS A COMPONENT OF SANITARY TREATMENT IN THE ADMISSION DEPARTMENT UPON ADMISSION TO THE HOSPITAL, IN THE TREATMENT DEPARTMENT 1 TIME IN 7-10 DAYS.