ALGORITHMS FOR MANIPULATION ON THE BASIS OF SISTERNESS
BASIC OSD MANIPULATIONS
MEASUREMENT OF GROWTH No. 1/18
Purpose: Measure the patient's height and register in the temperature sheet.
Indications:
Contraindications: Severe condition of the patient.
Equipment:
Temperature sheet.
Possible patient problems:
The patient is agitated.
The patient is in serious condition or is physically damaged (blind, no limb), etc.
Disinfect the oilcloth in accordance with current orders and place it on the height meter.
Place the patient with his back to the rack so that he touches her neck, shoulder blades, buttocks and heels.
Tilt your head so that the outer corner of the eye is at the level of the upper edge of the tragus of the ear.
Lower the bar on your head and mark the growth in accordance with the divisions on the stand of the height meter.
Record the growth data in the temperature sheet.
The data on growth were obtained, the results are recorded in the temperature sheet.
DEFINITION OF BODY WEIGHT No. 2/19
Purpose: Measure patient weight and record in temperature sheet.
Indications: The need to study physical development and as directed by a doctor.
Contraindications: Severe condition of the patient.
Possible patient problems:
The patient is agitated.
Negatively set to intervene.
Severe condition.
Sequence of actions of a nurse with ensuring environmental safety:
Inform the patient about the upcoming manipulation and its progress.
Check the health of the balance.
Place a clean oilcloth on the weighing pad.
Open the shutter of the balance and balance it with the large and small weights.
Close the shutter.
Help the patient stand in the middle of the weighing pad (without shoes).
Open the shutter.
Balance patient weight with weights.
Close the shutter.
Help the patient get off the balance.
Record the results in the medical history.
Treat the oilcloth in accordance with the requirements of the sanitary epidemiological regime.
Assessment of the achieved results: The data on weight are obtained and the results are recorded in the temperature sheet.
Education of the patient or his relatives: Advisory type of intervention in accordance with the above sequence of actions of a nurse.
CALCULATION OF RESPIRATORY MOVEMENT No. 3/20
Indications:
Assessment of the physical condition of the patient.
Respiratory diseases.
Appointment of a doctor, etc.
Contraindications: Not.
Equipment.
Temperature sheet.
Clock with a second hand or stopwatch.
Possible patient problems: Psycho-emotional (arousal, etc.)
Sequence of actions of a nurse with ensuring environmental safety:
Prepare a watch with a stopwatch or stopwatch.
Wash your hands.
Ask the patient to lie down comfortably so that you can see the upper part of the front surface of the chest.
Take the patient’s hand, as for examining the pulse on the radial artery, so that the patient thinks you are examining his pulse.
Look at the rib cage: you will see how it rises and falls.
If you are unable to see the movement of the chest, place your hand on the chest of the patient, and you will feel these movements.
Count the frequency in 1 minute (only the number of breaths).
At the end of the procedure, help the patient sit more comfortably, remove all unnecessary.
Wash your hands.
Record the measurement data in the patient temperature sheet.
Assessment of the achieved results: The NPV is calculated, recorded in the temperature sheet.
Notes:
Normally, respiratory movements are rhythmic (i.e., repeated at regular intervals). The frequency of respiratory movements in an adult at rest is 16-20 per minute, and in women it is 2-4 breaths more often than in men. During sleep, breathing usually becomes less frequent (up to 14 - 16 beats per minute), breathing quickens with physical exertion, emotional excitement.
The increase in NPV is called tachypnea; reduction of NPV - bradypnea; apnea - lack of breathing.
Types of breathing: chest - in women, abdominal - in men, mixed - in children.
When calculating the NPV, pay attention to the depth and rhythm of breathing, as well as the duration of inspiration and expiration, clean the type of breathing.
PULSE STUDY No. 4/21
Purpose: Examine the patient's pulse and record the readings in the temperature sheet.
Indication:
Assessment of the state of the cardiovascular system.
Doctor's appointment.
Contraindications: Not.
Equipment.
Temperature sheet.
Possible patient problems:
Negative attitude to the intervention.
Physical damage.
Sequence of actions of a nurse with ensuring environmental safety:
Inform the patient about the study of his pulse, explain the meaning of the intervention.
Use the fingers of your right hand to grip the patient’s left forearm, and the fingers of your left hand to cover the patient’s right forearm in the wrist joint area.
Place the 1st finger on the back of the forearm; 2, 3, 4th sequentially from the base of the thumb on the radial artery.
Press the artery to the radius and feel the pulse
Determine the symmetry of the pulse. If the pulse is symmetrical, further research can be carried out on one arm. If the pulse is not symmetrical, conduct further research on each arm separately.
Determine the rhythm, frequency, filling and pulse rate.
Count pulse beats for at least 30 seconds. Multiply the resulting figure by 2. If there is an arrhythmic pulse, count at least 1 minute.
Pulse investigated. The data are recorded in the temperature sheet.
Education of the patient or his relatives: Advisory type of intervention in accordance with the above sequence of actions of a nurse.
Notes:
Heart rate locations:
radial artery
femoral artery
temporal artery
popliteal artery
carotid artery
artery of the rear foot.
More often, the pulse is examined on the radial artery.
At rest, an adult healthy person has a pulse rate of 60-80 beats per 1 minute.
An increase in heart rate (more than 90 beats per minute) is tachycardia.
A decrease in heart rate (less than 60 beats per minute) is bradycardia.
The level of independence during the intervention is 3.
MEASUREMENT OF ARTERIAL PRESSURE No. 5/22
Purpose: Measure the blood pressure with a tonometer on the brachial artery.
Indications: To all patients and healthy to assess the state of the cardiovascular system (during preventive examinations, in the pathology of the cardiovascular and urinary systems; in case of loss of consciousness of the patient, with complaints, Headache, weakness, dizziness).
Contraindications: Congenital malformations, paresis, fracture of the arm, on the side of the removed breast.
Equipment: Tonometer, phonendoscope, pen, temperature sheet.
Possible patient problems:
Psychological (does not want to know the value of blood pressure, is afraid, etc.).
Emotional (negativity to everything), etc.
Sequence of actions of a nurse with ensuring environmental safety:
Inform the patient about the upcoming manipulation and its progress.
Put the patient’s hand correctly: in the unbent position, palm up, the muscles are relaxed. If the patient is in a sitting position, then for better extension of the limb, ask him to put a clenched fist of the free hand under his elbow.
Place the cuff on the patient’s bare shoulder 2-3 cm above the elbow; clothing should not squeeze the shoulder above the cuff; tighten the cuff so that only one finger passes between it and the shoulder.
Connect the pressure gauge to the cuff. Check the position of the gauge needle relative to the zero mark on the scale.
Feel for a pulse in the ulnar fossa and place a phonendoscope in this place.
Close the valve on the pear and pump air into the cuff: pressurize the air until the pressure in the cuff, according to the pressure gauge, exceeds 25-30 mm Hg of the column the level at which the pulsation of the artery ceased to be detected.
Open the valve and slowly bleed the cuff. At the same time, listen to tones with a phonendoscope and follow the gauge scale.
Note the systolic pressure when the first distinct sounds appear above the brachial artery,
Note the value of diastolic pressure, which corresponds to the moment of complete disappearance of tones.
Record blood pressure measurement data in the form of a fraction (systolic pressure in the numerator and diastolic pressure in the denominator), for example, 120 \\ 75 mmHg. Art.
Help the patient lie down or sit comfortably.
Remove all unnecessary.
Wash your hands.
Record the data in the temperature sheet.
Remember!Blood pressure should be measured 2-3 times on both hands at intervals of 1-2 minutes for reliable take the smallest result. The air from the cuff must be released every time completely.
Assessment of the achieved results: Blood pressure measured, data recorded in the temperature sheet.
Note. Normally, in healthy people, blood pressure figures depend on age. Indications of systolic pressure fluctuate normally from 90 mm Hg. up to 149 mm Hg; diastolic pressure - from 60 mm Hg; up to 90 mm Hg An increase in blood pressure is called arterial hypertension. Lowering blood pressure is called hypotension.
Education of the patient or his relatives: Advisory type of intervention in accordance with the above described sequence of actions of a nurse.
PROCESSING HANDS BEFORE AND AFTER ANY MANIPULATION No. 7/33
Purpose: Ensure the infectious safety of the patient and medical staff, the prevention of nosocomial infections.
Indications:
Before and after performing the manipulation.
Before and after examination of the patient.
Before eating.
After visiting the toilet.
After putting on and after taking off the gloves.
Contraindications: Not
Equipment:
One-time soap.
Individual dry towel.
Gloves
Disinfectant: ethyl alcohol 70 degrees or other, proposed by the institution in accordance with regulatory documents (AHD - 2000, AHD - special, etc.).
Sequence of actions of a nurse with ensuring environmental safety:
Open the tap and adjust the water
Wash the lamb tap.
Soap your hands with soap, starting at the wrist.
Wash your right palm with your left, and then your left with your right.
Wash the interdigital spaces of the back of the left hand with your right hand and vice versa.
Make a lock of the fingers on the palm side and rub them, washing the nail bed.
Rub each finger in a circular motion on the left hand, then on the right.
Rinse your hands with warm running water, starting at the wrist.
Close the tap.
Dry your hands with an individual or disposable towel, starting at your fingertips.
Throw away used disposable towels.
Wear clean gloves if handling requires.
Assessment of the achieved results: Hands are washed and ready for manipulation.
Notes.
Hands are washed twice with soap.
If you need to carry out invasive procedures, then the hands immediately after washing are treated with one of the disinfectants (70% ethyl alcohol, AHD 2000, AHD 2000 special) and wear gloves.
Education of the patient or his relatives: Advisory type of intervention in accordance with the above sequence of actions of a nurse.
PREPARATION OF WASHING AND DISINFECTING SOLUTIONS OF DIFFERENT CONCENTRATION No. 8/35
Purpose: Prepare a 10% solution of bleach.
Indications. For disinfection.
Contraindications: An allergic reaction to chlorine-containing drugs.
Equipment:
Rubber gloves.
Scales or measured capacity.
Dry bleach 1 kg.
Enamelled container with a lid.
Dark glass bottle with ground stopper.
Wooden spatula.
Label.
Cold water -10 liters.
Gauze napkin or sieve.
Long surgical gown.
Rubber apron.
Respirator (or 8-layer mask).
Sequence of actions of a nurse with ensuring environmental safety:
Wear a second bathrobe, oilcloth apron, rubber gloves, a respirator or an eight-layer mask.
Take 1 kilogram of dry bleach
Pour it carefully into an enameled container, grind it with a wooden spatula.
Mix everything and carefully pour in cold water to the level of 10 liters.
Close the lid and set for 24 hours (during this time, mix several times) to release active chlorine, you will get a mother liquor.
After 24 hours, pour the resulting solution through 4 layers of bandage (gauze) into a dark glass bottle labeled "10% bleach solution."
Close the cork.
Put on the label the date of preparation of the solution, its concentration, your position and surname.
Remove protective clothing.
Wash your hands with soap.
Assessment of the achieved results. Prepared 10% solution of bleach (clarified).
Note:
10% solution can be stored for 5-7 days in a dark place.
The solution must be stored out of the reach of the patient.
Preparation of working solutions of bleach:
0.5% - 500 ml of a 10% solution of bleach per 9.5 liters of water;
1% - 1 liter of a 10% solution of bleach per 9 liters of water;
2% - 2 liters of a 10% solution of bleach per 8 liters of water;
The formula for the preparation of bleach:
Y \u003d (% number of liters). Y is the amount of clarified bleach solution.
Chloramine working solution (prepared before use)
1% -10 g of chloramine per 990 ml of water;
2% - 20 g of chloramine per 980 ml of water;
3% - 30 g of chloramine per 970 ml of water;
5% - 50 g of chloramine per 950 ml of water.
CARRYING OUT WET CLEANING OF THE ROOM FACILITY WITH APPLICATION OF DISINFECTING SOLUTIONS No. 10/37
Purpose: Clear-out the treatment room.
Indications: According to the schedule (once a week).
Contraindications: Not.
Equipment:
Cleaning equipment (bucket, mop, rag, rags) with the corresponding marking.
Disinfectant and detergent solution (prepared in accordance with applicable regulatory documents on SER).
Dressing gown marked "for cleaning".
Gloves.
Sequencing:
Wear a bathrobe, gloves, mask and comfortable shoes.
Prepare 10 l of 0.5% detergent (50 g CMC per 10 l of water).
Prepare 10 l of 1% chloramine and add 40 ml of ammonia (to activate chlorine).
Free the room as much as possible from the equipment.
Wash the walls, floor with a cleaning solution.
Wash walls, floors, skirting boards with 1% activated chloramine solution.
Wipe the walls and floor after an hour with a clean, dry cloth.
Add UV light for 2 hours.
Soak the cleaning equipment in a 1% chloramine solution for 60 minutes (in the same bucket used for cleaning), rinse and dry.
Take off your robe, gloves, mask.
Wash your hands.
Evaluation of the result: General cleaning was carried out in accordance with order No. 408, 720. OST 42-21-2-85.
Notes:
The chambers are cleaned at least 2 times using a 0.5% solution of detergent.
The pantry and dining room are cleaned after each distribution of food.
INSPECTION AND IMPLEMENTATION OF SANITARY TREATMENT WHEN IDING PEDICULOSIS No. 15/43
Purpose: Inspect the patient's scalp and, if pediculosis is detected, perform sanitization.
Indications: Prevention of nosocomial infection.
Contraindications:
Patient Arousal
Extremely serious condition of the patient.
Equipment: 3 styling.
Hair clipper.
Machine for shaving.
Alcohol
A basin or a baking sheet.
Table vinegar 6% -9%.
2 bags (cotton and oilcloth).
For the nurse: bathrobe, gloves, scarf.
For the patient: drape, 2 scarves (cotton, plastic), oilcloth.
For processing: karbofos 0.15% solution (1 ml of 50% solution per 200 ml of H20) or other insecticides.
Toilet soap or shampoo.
Possible patient problems: Negatively set to intervene.
Sequence of actions of a nurse with ensuring environmental safety:
Inform the patient about the upcoming manipulation and its progress.
Examine the scalp of the patient.
Put on a second coat, scarf, gloves when revealing pediculosis in the patient.
Set the patient on a chair or couch covered with oilcloth,
Put the drape on the patient.
Treat the patient's hair with one of the disinfectants.
Coat the patient’s hair with a plastic scarf and then normal for 20 minutes.
Rinse the patient's hair with warm water.
Rinse the patient's hair with 6% -9% vinegar solution.
Comb the patient's hair with a frequent comb (above the pelvis or baking sheet).
Rinse your hair with warm water and wipe it.
Inspect the hair for nits (if single ones are found, then remove them mechanically, if there are a lot of them, treat the hair with 9% vinegar solution and cover the hair with a headscarf for 20 minutes), then repeat from step 6.
Collect the patient’s underwear in one bag, the nurse’s bathrobe in another and send it to the disinfection chamber.
Remove gloves and handle them in accordance with sanitary and epidemiological requirements.
Wash your hands.
Make a note on the title page of the medical history of detected pediculosis, (P (+)) and write down the epid. number.
Assessment of the achieved results: Upon examination of the patient revealed pediculosis, sanitized.
Education of the patient or his relatives: Advisory type of intervention in accordance with the above sequence of actions of a nurse.
IMPLEMENTATION OF COMPLETE OR PARTIAL SANITARY TREATMENT OF PATIENT No. 16/44
Purpose: To carry out full or partial sanitization of the patient.
Indications: As prescribed by the doctor.
Contraindications: Severe condition of the patient, etc.
Equipment:
Marked containers for clean and dirty washcloths.
Clean underwear for the patient.
Towel.
Water thermometer.
Soap or shampoo.
CMC, 1% chloramine solution.
Bags - 2 (cotton, oilcloth).
Foot rest
Temperature sheet.
The apron is oilcloth.
Gloves - 2 pairs.
Possible patient problems: Inability to self-service.
The sequence of actions of a nurse with ensuring environmental safety during the preparation and conduct of a hygienic bath for a patient:
Inform the patient about the upcoming manipulations and the progress of its implementation.
Determine the air temperature in the bathroom (it should be at least 25 degrees Celsius).
Wear gloves and an apron.
Wash the bath with a brush with any washing solution, then treat with a 1% chloramine solution. Rinse the bath with hot water.
Take off the gloves.
Fill the bathtub first with cold water, and noticeably hot to 1/2 the volume of the bathtub. Water temperature should not be lower than 36-37 degrees Celsius.
Help the patient to sit comfortably in the bathtub so that the patient does not slip, put a stand for stopping the legs,
Put on gloves.
Wash the patient: first the head, then the torso, upper and lower limbs, inguinal region and perineum.
Help the patient get out of the bath.
Wipe the patient and put on.
Wash your hands.
Take the patient to the room.
Make a note in the medical history, temperature sheet.
The sequence of actions in the preparation and conduct of a hygienic shower.
Inform the patient about the upcoming manipulation and its progress.
Wear gloves and an apron.
Treat the bath with disinfectants.
Take off the gloves.
Put a bench in the bathtub and seat the patient on it.
Put on gloves.
Help the patient wash in the following sequence: head, trunk, upper and lower limbs, and perineum.
Remove gloves and handle in accordance with sanitary / epidemiological requirements.
Wash your hands.
Help the patient dry themselves with a towel and get dressed.
Make a note in the medical history sheet, temperature sheet.
The sequence of actions when wiping the patient (partial sanitization)
Inform the patient about the upcoming manipulation and its progress.
Fence off the patient with a screen, put on gloves.
Place the oilcloth under the patient.
With a “mitt” or a sponge dipped in water, wipe the patient's neck, chest, arms.
Dry these parts of the body with a towel and cover it with a blanket.
Then wipe the abdomen, then the back and lower limbs and wipe them dry and cover them with a blanket.
Remove oilcloth, screen, remove gloves.
Handle the sponge, gloves, oilcloth in accordance with the sanitary and epidemiological requirements.
Assessment of the achieved results. Partial or complete "patient sanitation" is given.
Education of the patient or his relatives: Advisory type of intervention in accordance with the above sequence of actions of a nurse.
Notes:
The method of sanitization is determined by the doctor.
The presence of a nurse during patient sanitation is mandatory.
Provide first aid in case of worsening condition and inform your doctor.
Control the temperature of the water with your hand while pointing it at the patient.
REGISTRATION OF THE TITLE SHEET OF THE “MEDICAL CARD” OF STATIONARY PATIENT No. 17/45
Purpose: Gather information about the patient and draw up the title page of the educational and inpatient medical history.
Indications: To register a newly admitted patient to the hospital.
Equipment: Educational history of the disease, medical history of the hospital.
Possible patient problems: If it is not possible to collect information from the patient (deaf-mute, in a coma, etc.), to collect information from the patient’s documentation, accompanying persons and others are requested a medical card from the clinic.
Sequence of actions of a nurse with ensuring environmental safety:
Inform patient about medical history.
Date and time of admission (for emergency patients accurate to the minute), medical history number,
Full Name.
Year of birth.
Home address and telephone.
Who lives with or address and phone number of relatives.
Profession and place of work, work phone.
From where and by whom it was delivered, the telephone number of the hospital
Diagnosis of the sending institution.
Where the patient was sent from the admission department.
Does it have an allergic reaction and what.
Contact with other patients at home or elsewhere.
There is a whole direction in psychology called the psychology of influence. And there is also the concept of manipulation. Manipulation - this is a hidden effect on a person, the purpose of which is to force him to do what the manipulator needs contrary to the interests of the person. The essence of manipulation is to ensure that a person himself wants to fulfill your will.
What is manipulation
Manipulation is classified as hidden psychological tricks. Psychologists consider manipulation to be an unethical and dishonest method, because in the case of manipulation by other people, a person exploits them for their own purposes. According to Wikipedia, manipulation is classified as passive-aggressive behavior.
How exactly manipulators affect their the victims? This can be positive and negative reinforcement. Punishment, or even traumatic one-time experiencesuch as a flash of anger, insult, or any other behavior that might scare you. Even one unpleasant experience can discourage the priesthood from resisting manipulators. All these methods of manipulation are brought by a scientist. Harriet breaker (Harriet B. Braiker).
At the same time Simon revealed much more methods of manipulative control. In particular, a lie or silence of the truth. The silence of truth is encountered, for example, in the business world, when a bank is silent about all the conditions of a loan agreement in the hope that the client will not see or pay attention to the small print.
Also Simon says there are also the following types of manipulation: rationalization of one’s behavior, minimization of harm, selective attention or inattention, distraction from the topic, excuse, hidden threats, assigning a victim false guilt, shaming, condemning the victim, pretending to be an injured party, playing the role of a minister, seducing, blaming others, pretending to be innocent pretending to be a fool. Simon also says that a flash of aggression and anger can be a manipulative means.
Manipulators often have personality disorders. As Robert Hare and Paul Babiak write, psychopaths are especially prone to manipulation.
Often, manipulation involves moral qualities manipulators who are not afraid of their lies, aggression or other hidden tactics to damage their victim. Often the manipulator examines his victim and its weaknesses in order to understand exactly what feelings or psychological characteristics can be played?
Often, manipulation techniques are used by superiors in relation to their subordinates, business partners, and even women in relation to their young people. In some cases, manipulation can benefit everyone. For example, when a doctor tries to manipulate a patient so that he revises his lifestyle (for a complete cure).
Techniques and methods of manipulation
Manipulations are widely used, including in the business world, as we wrote above. Knowledge of the methods of manipulation will successfully resist such manipulations. For example, when you at least work a little as a sales manager and learn some tricks to manipulate customers, then later as a consumer it will be almost impossible for you to catch such hooks.
First of all, you need to understand that an experienced manipulator seeks to establish contact with his victim - he seeks common interests, studies the psychological characteristics of a person, interests, beliefs and even habits. In addition, the manipulator takes into account the psychological state of the victim at the moment to pick up manipulation techniquewhich will act most effectively.
- False interrogation. The manipulator, as if to clarify one or another aspect of the dialogue, asks again the thoughts voiced before this, but puts emphasis differently in such a way that the general meaning changes in favor of the manipulating person. To counter this method of manipulation, you need to carefully listen to what they say to you and if you heard a substitution of concepts, then immediately correct the person you are talking to.
- Emphasized indifference and carelessness. Suppose the victim is trying to prove his case. But there is no reaction to his arguments. The calculation is based on the fact that when trying to prove his case, the victim will give out information that was not originally intended to be said. In this case, one should not give in to provocation.
- Hasty jumping on another topic. The manipulator moves on to another topic, preventing the victim from properly challenging the first one or comprehending it, having time to think it over or doubt it. Such manipulation is carried out in order to fix information that is not always reliable. That is, they try to inspire you with some kind of false message in this way. To counter this method of manipulation, you need to be critical and attentive to everything that you are told.
- Quoting the words of the interlocutor. The manipulator unexpectedly for his partner begins to quote his words. And sometimes distorting the phrase. You can protect yourself from such manipulations in the same way - by quoting the manipulator.
- Tidy up. When the manipulator shows his weakness, he wants to provoke self-pity or condescension. In such cases, the victim dulls the attention and no longer perceives the interlocutor as a serious competitor. Do not underestimate the partners. We must always see strong people in them. Only in this case can you protect yourself from this method of manipulating you.
- Flattery. People can confess to you in love, admire your qualities, flatter, say that they respect you. This way of communication works much better than a regular request. You are first flattered, and then they ask for something, and it is already inconvenient for you to refuse. In this case, you can resist flattery only with a cold mind and a head on your shoulders.
- Anger, rage and aggressive pressure. Showing an attack of unmotivated aggression, the manipulator expects that you will want to calm him down and make serious concessions on a particular issue. Psychologists advise to ignore the psychotic behavior of colleagues, because it can confuse him. Another way to counter the frantic genve and furious pressure is to use the same method yourself - quickly increasing the degree of aggressiveness and pressure. And here you will already dictate your conditions to the manipulator.
- False rush and fast pace of speech. When the manipulator pretends that he does not have time and speaks at a very high pace, in the expectation that you will not have time to think and give an answer to a particular thesis. Your silence will be perceived as tacit consent. may issue a manipulator in your interlocutor. Countering this tactic is interrogation. You can also briefly go away for a phone call. All these tricks help cool the pace of communication to a normal level.
- Raise excuses by expressing suspicion. The manipulator pretends to be suspicious in order to provoke a victim's excuse reaction. Such a distraction allows you to weaken the so-called protective barrier of the psyche, then to push your ideas. help you counteract this manipulation tactic. You should show the manipulator that you do not care about his suspicions and that you will not tear your shirt on yourself to prove the opposite.
- Pretended fatigue.The interlocutor lets you know that he is supposedly very tired. Do not give anyone discounts. If you want to object to him - mind, because a man is trying to make you agree to everything and not mind.
- Pressure by authority. The manipulator uses his authority and tries to crush them. However, his advice goes beyond the scope of his authority. Let's say I can understand the nutritionist’s recommendation for adjusting my diet. But do not assume that a good car mechanic is also well versed in computers, house building and management.
- Reverse Psychology. Often we observe that we want to do exactly what is forbidden to us. No wonder they say that the forbidden fruit is sweet. Sometimes manipulators use this feature of the psyche to their advantage. You can protect yourself from this type of manipulation only if you constantly remember your interests and do not give in to manipulations.
- Minor particulars. Sometimes the manipulator draws your attention to the small and not very significant detail of the object, not allowing to consider the situation in general. Due to this, conclusions are drawn that, of course, cannot be correct. This is the same as talking on the basis of 2-3 random cases about a statistical regularity, while for reliable statistics there should be an examination of at least a hundred “measurements”. Manipulators take advantage of the fact that many people judge events and phenomena without knowing the subject thoroughly and are guided by the opinions of other people. But what if the opinion of another person is the opinion of a manipulator? Try to rely on your knowledge, and not on the superficial judgments of other people.
- Irony and mockery. Manipulators often try to swing the interlocutor into emotions with the help of irony or a grin. This is because when a person goes into emotions, his state of consciousness becomes altered and the person becomes more easily susceptible to suggestion. In negotiations, you should have a cold mind and not revel in emotions.
- Lost in thought. Manipulators are constantly trying to distort the thread of the conversation in such a way as to confuse you with thoughts. Do not give in - you should bend your line.
- False recognition of the beneficial conditions. The manipulator exaggerates the favorable conditions in which the victim allegedly is. As a result, the victim begins to make excuses and becomes more driven. Do not make excuses, but admit your superiority - self-development sites are advised.
- Imitation of bias. The victim is placed in such conditions that he himself has to ward off suspicions of the manipulator that he is biased. Thus, the victim gives himself the installation not to react critically to the words of the manipulator. Once in a similar situation, refute your bias, but do not praise the manipulator.
- Lies through special terms.As we wrote above, one of the favorite tactics of manipulators is lying and misleading. In this case, the manipulations are carried out by the method of misleading using specialized terms. As a result, the victim, hearing incomprehensible terms, does not ask again, being afraid to seem stupid or incompetent. If you hear an unfamiliar word, then you need to ask again - there is nothing wrong with that.
- Imposing False Stupidity. The method is reduced to the humiliation of the victim, his merits below the plinth. In this case, the manipulation takes place with the help of hints. May work on people with and temporarily confuse them.
- Imposing thoughts through repetition. As in the American programs and books the same thought is repeated in speech many times, in the end it can become your thought. That is why it is so important. Just don’t pay attention to it and that’s it. Therefore, it is useful to fix the agreement on paper in the form of a signed contract.
- Three yes in a row. This technique of manipulation is used by sales managers who call you on the phone. The conversation script is intentionally built in such a way that you say yes several times in a row. As a result, the psyche is tuned to constantly agree, and here they slip you a proposal, which you must agree to.
- False inattention. The manipulator deliberately pretends to be a fool, supposedly he did not see something, did not notice. However, he “does not notice” exactly what is beneficial not to notice him.
- Observation and search for similar traits. The manipulator seeks or invents common characteristics and qualities with his victim. Thereby increasing the level of trust. This reduces psychological defense. You can protect yourself from this by telling the manipulator that you are not like him.
- Imposing your choices.The manipulator sets the condition so that you choose between two or three options offered by the manipulator, without considering other alternatives. For example, a waiter in a restaurant asks what kind of wine you will drink red or white, and maybe you just wanted to pull a cup of coffee. Always pursue your interests, then no manipulation on you can work.
- "Pickling". The meeting is specially delayed in order to exhaust the partners and get everything you need from them.
Manipulation protection
Not everyone is easy to manipulate. Smart and wise people are difficult for any tricks. If you feel that the manipulator wants to do some difficult work at your expense, ask yourself, are you Mother Teresa? For example, one time my work colleague asked me to go out and hold him on Saturday at 8 in the morning, explaining that his father had a birthday. However, I never saw a response service. The question arises - why did I do this? Perhaps he wanted to like a colleague at work or just purely humanly entered into a position. However, without any benefit to themselves.
It will be nice if you study the book Roberta Childini about the psychology of influence. Understanding the mechanics of the work of human psyche, you will have a serious immunity to any manipulations.
The irony is that the manipulators themselves have many weaknesses and their egocentrism and vanity can also be used for their own purposes 🙂
The first step in protecting against manipulation is that you realize that you are trying to solve goals that are alien to you. The second thing to keep in mind is to clearly be aware of your interests and compare everything that you are offered to match your personal interests.
Next - do not revel in emotions. No wonder in psychology there is such a method as. When making important decisions, you need to try to drown out emotions and make decisions in a clear state. At the same time, decision should not be made. Limited time plays into the hands of the manipulator. Learn to say “No” when something is not interesting to you. Do not try to like it. On the contrary, if you feel that you are being asked a question with a subtext, you need to clarify it - for what purpose does the manipulator ask this and what does it want to achieve? Thus, you reveal his intentions and throw the ball to the other side. Now the manipulator will make excuses for losing psychological protection in front of you.
Give a signal to any manipulation that she was noticed. It can be a mockery or a critical assessment. This can offset the full strength of the manipulative impact. There are passive-aggressive methods of protection against manipulation. For example, ignoring. The upper class is when you understand manipulation and don't give a look. At the same time, in the process of negotiating, you are leading everything in the direction that is beneficial to you.
Another controversial way to counter manipulation is to unpredictability. For example, the boss yelled at you in the hope that you would stay after the end of the working day and do all the dirty work, and you sent him to your colleagues and threw a letter of resignation. As they say, an unpredictable person is simply invulnerable. Allows people to behave relaxed, confident and almost completely protects against manipulation.
Read also:
Reading: Robert Childini - Psychology of Influence
GAOU SPO Volsky Medical College
them. Z.I. Mareseva
Algorithms for performing obstetric-gynecological manipulations
Educational medical aid
Volsk 2014
The algorithm for performing obstetric-gynecological manipulations.Methodical manual.
This manual is recommended for use in the independent preparation of students of medical colleges and schools for intermediate certification in II-III courses for all specialties in the disciplines "Obstetrics" and "Gynecology" and in preparation for the final state certification, as well as for students of the college and advanced training departments of nurses .
Compiled by a teacher at the Volsky College of Medicine Vera Kochetova.
GAOU SPO "VMK 2014
Obstetrics
Collection of anamnesis in a pregnant woman ……………………………………………………… 4
Measurement of the external dimensions of the pelvis ……………………………………………………… 4
Ways to determine the true conjugate ……………………………………… 6
Measurement of the circumference of the abdomen and the height of the uterine fundus ……………………… ..6
Leopold's Receptions ……………………………………………………………………… 8
Listening to the fetal heartbeat ………………………………………………… ..10
Determination of gestational age, expected term of labor .............................. 11
Determination of the expected fetal mass in the later stages .............................. 12
Technique for measuring blood pressure, counting PS and labor at the woman in childbirth ............................... 12
Sanitation of a woman in childbirth .............................................. 13
Technique for conducting a cleansing enema .............................................. 13
Signs of separation of the placenta …………………………………………………………… 14
Methods of external isolation of the afterbirth ………………………………………………… 16
Manual separation of the placenta and isolation of the placenta …………………………………… 18
Determination of the integrity of the placenta and the magnitude of blood loss ...................................... 20
Postpartum hemorrhage control …………………………………… ..20
The fight against bleeding in the early subsequent period .......................................... 21
Determination of edema .............................................. 22
Determination of protein in urine ………………………………………………………………… 22
Emergency care for eclampsia ………………………………………………… ..23
Care for sutures in the perineum .............................................. 23
Gynecology
1. Inspection and assessment of the condition of the external genital organs …………………………… ..25
2. Research using mirrors …………………………………………………………… 26
3. The methodology of bimanual research .............................. 28
1. Stand to the right of the woman face to face.
2. Put the palms of both hands on the bottom of the uterus.
3. Determine the height of the uterine fundus, the large part of the fetus located in it, and the gestational age.
4. Move both hands on the lateral surface of the uterus to the level of the navel and palpate them alternately.
5. Determine the position, position and type of the fetus.
6. Position the right hand in the suprapubic part so that the thumb grasps the present part on one side, and all the others on the other side
7. Determine the pre-existing part of the fetus, its mobility and attitude towards the entrance to the small pelvis
8. Turn around at the woman’s legs.
9. Place the palms of both hands in the region of the lower segment of the uterus on the anterior part of the fetus.
10. Grasp with the ends of the fingers the present part of the fetus.
11. Determine the ratio of the present part to the entrance to the pelvis.
Listening to the fetal heartbeat.
1. The pregnant woman lies on her back on the couch.
2. Install an obstetric stethoscope at one of eight points. Note: manipulation is carried out after Leopold's receptions.
3. Attach an ear to a stethoscope and remove your hands.
4. Listen to the fetal heartbeat for 60 seconds.
5. Evaluate the number of strokes, clarity, rhythm of the heartbeat.
6. Fix the result.
7. Determination of gestational age, estimated term of labor.
Indications:
fix the gestational age at the first appearance;
contribute to the social protection of the pregnant woman;
identify critical periods in pregnancy pathology;
give out antenatal maternity leave in a timely manner;
diagnose overexposure.
It is carried out:
by the date of the last menstruation - to identify the first day of the last menstruation, add two weeks to conception and from this period on the calendar count weeks to the date of appearance at the antenatal clinic;
according to the date of the first fetal stirring - the first pregnant woman feels the first stirring for a period of 20 weeks, re-pregnant - at 18 weeks;
according to objective data:
howling attendance at the antenatal clinic;
b) measuring the height of the uterine fundus and abdominal circumference in late pregnancy;
c) the size of the head and the length of the fetus. An additional method is ultrasound.
Determination of the expected date of birth
Find out the first day of the last menstruation. From this day, count back three months and add 7 days. Antenatal maternity leave is issued for a period of 30 weeks.
8. Determination of the expected fetal mass in the later stages.
Indications:
Determine the gestational age;
Identify fetal growth retardation (exclude fetal malnutrition);
Determine the correspondence between the dimensions of the pelvis and the fetal head.
Algorithm of actions:
1) lay the pregnant woman on the couch in a horizontal position. The legs bend slightly in the knee and hip joints;
2) measure with a centimeter tape the circumference of the abdomen and the height of the uterine fundus;
According to the formulas:
a) (abdominal circumference) x (height of the bottom of the uterus);
b) (abdominal circumference) + (uterine fundus height) / 4 x 100;
According to the results of ultrasound.
9. Technique for measuring blood pressure, counting PS and labor in the woman in labor.
Blood Pressure Measurement Technique
Indications:
determination of systolic and diastolic pressure;
fixation of the initial blood pressure;
determination of the difference in blood pressure on the left and right hand;
detection of increased blood pressure in childbirth;
determination of pulse pressure.
measure on both hands;
place the cuff on the upper third of the shoulder and determine the blood pressure using a manometer.
Heart rate
Indications:
determine the state of the cardiac activity of the woman in labor;
identify a complication of cardiac activity during childbirth.
put three fingers of the right hand on the inner surface of the forearm in the wrist joint;
to press the left radial artery and determine the frequency, rhythm, clarity and strength of heart contractions.
Determination of the duration of the bout and pause
Indications:
exercise control over labor activity;
timely identify anomaly of labor.
the midwife to sit next to the woman in labor;
put your hand on the bottom of the uterus;
feel the beginning of an increase in uterine tone and fix the start of a fight by a stopwatch;
feel the relaxation time of the uterine tone and fix the end of the contractions and the beginning of a pause.
10. Sanitation of women in labor.
1) Trim your nails
2) Shave pubic and axillary hair
3) Put a cleansing enema
4) Take a shower using a solid soap (after bowel movement in
within 30-40 minutes)
5) Put on sterile underwear
6) Treat the nails of the hands, feet with iodine, nipples with a solution of brilliant green.
11. Technique of a cleansing enema.
Indication:
The first period of childbirth.
Enema is contraindicated:
in the period of exile;
with bleeding from the genital tract;
in severe condition of the woman in childbirth.
Algorithm of actions:
fill the mug with water and hang at a height above the level of the pelvis of the woman in labor
fill the rubber tube and tip with water, close the clamp, grease the tip with liquid paraffin;
to lay a woman in labor on her left side, bend her legs;
with the left hand to part the gluteal folds;
through the anus into the rectum, enter the tip first towards the navel, then parallel to the spine;
open the clamp, pour in water, and ask for deep breathing movements;
close the clamp after water infusion;
remove the tip, rinse in a separate container and put in a basin with des. solution;
12. Signs of separation of the placenta.
13. Methods of external isolation of the placenta.
Indication:
Infringement of the placenta;
Bleeding in the subsequent period.
Reception Abuladze
Algorithm of actions:
2) remove the uterus through the anterior abdominal wall of the abdomen in the middle and perform an external massage;
3) grab the front abdominal wall with both hands in the longitudinal fold so that both rectus abdominis muscles are tightly grasped by the fingers and ask the woman in labor to push. The separated afterbirth is easily born.
Genscher's Reception
Algorithm of actions:
remove the uterus through the anterior abdominal wall of the abdomen to the middle and conduct an external massage;
stand on the side of the woman in labor facing her legs;
the hands of both hands, clenched into fists, put on the bottom of the uterus in the area of \u200b\u200bthe tube angles;
put pressure on the bottom of the uterus from the bottom to the inside. In this case, the placenta may be born;
if the results of these techniques are negative, perform the obstetric operation “Manual removal of the placenta”.
Algorithm of actions:
1) carry out catheterization of the bladder;
2) remove the uterus through the anterior abdominal wall of the abdomen to the middle and perform an external massage;
3) grasp the bottom of the uterus with the hand so that the thumb is located on the front wall, the palm on the bottom, and four fingers on the back of the uterus;
4) simultaneously press on the bottom of the uterus in the anteroposterior direction and down to the pubis. The last is born at the same time.
14. Manual separation of the placenta and the allocation of the placenta.
purpose: violation of the independent separation of the placenta.
Algorithm of actions:
empty the bladder;
treat the external genital organs with an antiseptic solution;
give inhalation or intravenous anesthesia;
with your left hand to part the sexual gap;
enter the conically folded right hand into the vagina, and then into the uterus. At the time of insertion of the right hand into the uterus, move the left hand to the bottom of the uterus. In order not to mistakenly take the edematous edge of the throat for the edge of the placenta, keep the arm adhering to the umbilical cord;
then enter the hand between the placenta and the uterine wall and the sawtooth movements to gradually separate the entire placenta; at this time, the outer arm helps the inner by gently pushing on the bottom of the uterus.
after separation of the placenta, reduce it to the lower segment of the uterus and remove it with the left hand by attraction to the umbilical cord;
with the right hand remaining in the uterus, once again carefully check the inner surface of the uterus to completely eliminate the possibility of delaying parts of the placenta. After complete removal of the placenta, the walls of the uterus are smooth, with the exception of the placental site, which is slightly rough, fragments of the decidual membrane may remain on it;
after a control examination of the walls, the hand is removed from the uterine cavity. Introduce pituitrin to pituitrin or oxytocin, put cold on the lower abdomen.
15. Determination of the integrity of the placenta and the magnitude of blood loss.
Algorithm of actions:
after separation of the newborn from the mother, put the end of the umbilical cord into the tray for collecting placental blood;
monitor the state of the woman in labor (measure blood pressure, pulse), and discharge from the genital tract;
monitor signs of placental separation (sign of Schroeder, Alfeld, Chukalov-Küstner);
with positive signs of separation of the placenta, ask the mother to push and slightly pull on the umbilical cord. When the placenta erupts, take it with both hands and gently rotate to release and remove the entire placenta with membranes;
carefully examine the born placenta: place the placenta on a smooth tray or on the palms of the midwife with the maternal surface up. Inspect all lobules, edges of the placenta and membranes: to do this, turn the placenta with the maternal side down, and the fetal one up, straighten all the membranes and restore the cavity where the fetus was located along with the waters;
drain the blood accumulated in the tray into a special graduated flask. Count blood loss during childbirth. Physiological blood loss is a maximum of 300 ml, that is, there is no reaction to this blood loss from the part of the puerperal organism;
permissible blood loss is the amount of blood loss when a short-term reaction occurs on the part of the puerperal body (weakness, dizziness, decreased blood pressure, tachycardia, blanching of the skin, etc.). The compensatory mechanisms of the body are quickly connected and the condition normalizes. Calculation of allowable blood loss:
0.5% by weight of a healthy postpartum woman;
0.2-0.3% of the puerperal mass for diseases of the cardiovascular system, gestosis, anemia, etc.
16. The fight against bleeding in the subsequent period.
Causes of bleeding:
violation of the separation of the placenta;
infringement of the placenta.
catheterize the bladder;
examine the soft tissues of the birth canal - the cervix, vaginal wall, vulvar tissue and perineum with the help of mirrors and cotton balls in order to eliminate tears;
if trauma is found in soft tissues of the birth canal, accelerate the course of the subsequent period and suture;
with the integrity of the tissues of the birth canal, check the signs of separation of the placenta to determine the separation of the placenta from the walls of the uterus;
with positive signs of placenta separation, apply external methods of placenta isolation (methods of Abuladze, Crede-Lazarevich, Genter), and in the absence of results, perform the operation "Manual separation of the placenta";
in the absence of signs of placenta separation, perform the obstetric operation "Manual separation of the placenta and placenta."
17. The fight against bleeding in the early subsequent period.
Causes of bleeding:
soft tissue injuries of the birth canal;
delay of the elements of the fetal egg in the uterine cavity;
uterine hypotension-atony;
coagulopathy.
Algorithm of actions:
catheterize the bladder;
examine the soft tissues of the birth canal - the cervix, vaginal wall, vulvar tissue and perineum (using mirrors and cotton balls);
if trauma to the soft tissues of the genitals is detected, stitch.
Algorithm of actions:
with the integrity of the tissues of the birth canal, carefully examine the placenta on the integrity of the placental tissue and membranes;
in case of a defect in the placental tissue and doubts about the integrity of the placenta, perform a “Manual examination of the uterine cavity” in order to remove parts of the placenta from the uterine cavity.
Algorithm of actions:
conduct external massage of the uterus;
put cold on the lower abdomen
introduce intravenously reducing drugs (methylergometrine, oxytocin);
in the absence of effect, conduct a "Manual examination of the uterine cavity and combined external-internal massage";
insert a swab with ether into the posterior vaginal fornix;
in the absence of effect, deploy the operating room and prepare the postpartum for operation "Laporotomy";
in parallel, conservative methods to combat bleeding:
apply clamps to the lateral vaginal arches,
apply clamps to the lateral walls of the uterus in the lower segment,
suture the cervix according to Lositskaya,
apply an electric stimulator,
press the aorta to the spine with your fist for 10-15 minutes,
carry out infusion therapy.
ligation of the great vessels of the uterus,
Extirpation of the uterus (with significant hypotension of the neck tissue, the left neck can become a source of further bleeding).
Coagulopathy
Algorithm of actions:
1) intravenous transfusion:
freshly frozen plasma of at least 1 liter;
6% hydroxyethylated starch-infucol solution;
fibrinogen (or cryograftspitant);
platelet-erythrocyte mass;
10% solution of calcium chloride;
1% vicasol solution;
18. Determination of edema.
a) On the legs
Seat or lay the pregnant.
Press with two fingers in the middle third of the tibia (the legs should be bare).
Rate the result.
"Seat or lay the pregnant.
Measure the circumference of the ankle with a measuring tape.
Commit the result.
19. Determination of protein in the urine.
The study must be carried out in the antenatal clinic before each appearance of the pregnant woman at the reception, as well as upon admission to the maternity ward.
Indication: Detect the presence of protein in the urine.
Methods
Sulfosalicylic acid test.3-5 ml of urine is poured into a test tube and 5-8 drops of sulfosalicylic acid are added. In the presence of protein, a white precipitate appears.
Boiling urine.If protein is present, white flakes appear.
Express method.Used indicator strip - biofan. The strip drops for 30 seconds into warm urine and is compared with a color scale.
20. Emergency care for eclampsia.
purpose: Prevention of a recurrence of an attack.
Algorithm of actions:
1) lay the patient on a flat surface, turn his head to the side, hold it during convulsions;
clear the airways by carefully opening the mouth with a spatula or spoon handle;
aspirate the contents of the oral cavity and upper respiratory tract;
when breathing is restored, give oxygen. If you hold your breath, immediately start assisted ventilation (using the Ambu apparatus, mask) or intubate and transfer to artificial lung ventilation;
when cardiac arrest stops, in parallel with mechanical ventilation, conduct an indoor cardiac massage and perform all cardiovascular resuscitation techniques;
to stop seizures intravenously, simultaneously inject 2 ml of a 0.5% solution of seduxen, 5 ml of a 25% solution of magnesium sulfate;
start infusion therapy (plasma, albumin, rheopolyglykin);
deploy the operating room and the patient to prepare for the operation "Caesarean section".
21. Care for sutures in the perineum.
Purpose:
exclusion of suture infection;
contributing to better suture healing.
Algorithm of actions:
lay the puerpera on the couch, bend the legs in the knee and hip joints and part;
wash the external genitalia and perineal tissue from top to bottom with an antiseptic solution;
dry with gauze sterile napkins;
treat the seams with 5% potassium permanganate solution.
22. Postpartum care after cesarean section.
Purpose: timely detection of postoperative complications.
Algorithm of actions:
monitor the restoration of respiratory function after exiting anesthesia, as upon exit from anesthesia, vomiting, aspiration by vomit and, as a result, asphyxiation may occur;
monitor for signs of internal bleeding since possible slipping of the ligature from the vessels in the depth of the surgical wound;
monitor the temperature reaction (in uncomplicated course, the temperature should normalize on the 5th day);
bed rest: after 12 hours turn on its side. In a day - you can walk. Apply to the breast of the newborn - individually (for 2-3 days);
follow:
on the 1st day - only drinking;
2 days - broth;
3 days - porridge, cottage cheese;
4 days - broth, porridge, cottage cheese, crackers;
5-6 days - a common table;
for bladder function,
for bowel function:
for 3-4 days put a hypertensive enema;
5-6 days - a cleansing enema;
control ligation for 3 days,
on the 7th day - removed through the seam,
Gynecology
Inspection and assessment of the external genitalia.
Indications:
assessment of the external genitalia;
identification of existing pathology.
put the patient on a gynecological chair after the bladder is empty;
wear sterile gloves;
inspect the external genitalia, while taking into account:
the degree and nature of the development of the hairline (by female or male type);
development of the labia minora and labia majora;
the state of the perineum (high, low, trough-like);
the presence of pathological processes (inflammation, tumors, ulceration, condylomas, fistulas, scars in the perineum after ruptures). Pay attention to the gaping of the genital gap, inviting the woman to push, to determine if there are no prolapse or loss of the walls of the vagina and uterus.
examine the anus in order to identify possible pathological processes (varicose nodes, cracks, warts, blood, pus or mucus from the rectum).
parting the labia minora with fingers, examine the vulva and the vaginal opening, taking into account:
b) the nature of the secret,
c) the condition of the external opening of the urethra and excretory ducts of the bartholin glands,
d) the form of hymen or its remains.
Research with the help of mirrors.
The procedure for the study of women using the mirror of Cuzco
Indications:
study of the cervix and vaginal walls;
taking smears.
lay a liner;
put a woman on a chair;
wear gloves;
with your right hand enter the folding mirror closed in direct size to the middle of the vagina;
rotate the mirror to the transverse dimension and advance to the arches;
open the valves and examine the cervix;
removing a mirror to inspect the walls of the vagina;
put the mirror in a container with a disinfectant solution.
The procedure for the study of women with spoon-shaped mirrors
Indications:
examination of the cervix;
taking smears;
removal, introduction of Naval Forces;
surgical interventions.
Equipment: spoon-shaped mirrors; lift.
Action algorithm
wear gloves;
move the labia minora with your left hand;
with your right hand, carefully enter the mirror with an edge along the back wall of the vagina, and then turn it across, pushing the perineum back to the posterior fornix;
with your left hand enter the elevator and raise the front wall of the vagina;
expose the cervix;
removing the mirror, examine the walls of the vagina;
place the mirror and the lift in a container with a disinfectant solution.
The technique of bimanual research.
Preventive examinations;
Diagnosis and determination of pregnancy in the early stages;
Examination of gynecological patients.
Contraindications: menstruation, virginity.
Execution algorithm:
ask a woman to empty her bladder;
lay a liner;
put the woman on a chair or on a couch (at the same time put a roller under the sacrum so that the pelvic end is raised);
treat the external genital organs only with significant contamination with their blood or secretions;
wear sterile gloves;
with the index and thumb of the left hand, part the labia minora and labia minora;
examine the vulva, the mucous membrane of the entrance to the vagina external the opening of the urethra, excretory ducts of the bartholin glands and perineum;
insert the index and middle fingers of the right hand into the vagina, with the back of the ring finger and little finger rest against the perineum, large
fingers inserted into the vagina to examine: the condition of the muscles of the pelvic floor, walls and vaults of the vagina, the shape and texture of the cervix, the state of the external pharynx (closed, open);
then transfer the fingers of the right hand into the anterior vaginal fornix;
fingers of the left hand through the abdominal wall of the abdomen to palpate the body of the uterus. Bringing the fingers of both hands together to determine the position, shape, size,
12) then move the fingers of the examining hands from the corners of the uterus alternately into the lateral arches of the vagina and examine the condition of the appendages on both sides;
13) at the end of the study, probe the inner surface of the pelvic bones and measure the diagonal conjugate;
14) remove the fingers of the right hand from the vagina and pay attention to the color, smell of secretions.
The method of taking a smear for the degree of purity.
Indications:
examination before vaginal surgery;
inflammatory diseases of the genitals;
examination of pregnant women.
Algorithm of actions:
lay a liner;
put a woman on a chair;
wear gloves;
move the labia minora with your left hand;
insert a mirror into the vagina;
volkman spoon to take the material from the posterior fornix of the vagina to apply a smear on a glass slide;
place the tools in a container with a disinfectant solution.
Gn smear test (gonorrhea)
diagnosis of inflammatory processes and sexually transmitted diseases;
examination of pregnant and gynecological patients.
slide.
Algorithm of actions:
to lay the processed undercloth oilcloth;
put the woman on a gynecological chair;
wear gloves;
with your right hand enter the folding mirror, closed in a direct size to the middle of the vagina, then rotate the mirror to the transverse size and advance to the arches, opening the wings, as a result of which the cervix is \u200b\u200bexposed and becomes available for examination;
at one end of Volkman's spoon, take the material from the cervical canal and apply a smear to the slide in the form of a Latin letter C;
remove the mirror;
with the index finger of the right hand, massage the urethra through the front wall of the vagina;
wipe the first drop of urethral discharge with a cotton ball, then take the second end of Volkman's spoon to take a smear from the urethra and apply a smear in the form of the Latin letter "U" on a glass slide;
take the third smear with the second spoon of Volkman from the rectum and put on a glass slide in the form of the Latin letter "R";
take the fourth smear from the lateral vaginal fornix and put on a glass slide in the form of the Latin letter “V”;
put tools in a basin with a disinfectant solution.
Method of taking a smear for oncocytology.
diagnosis of precancerous and malignant processes of the female genital organs;
preventive examinations.
slide.
Algorithm of actions:
lay a liner;
put a woman on a chair;
wear gloves;
to spread the large and small labia with the index finger and thumb of the left hand;
with your right hand enter a folding mirror, closed in direct size, to the middle of the vagina. Next, turn the mirror in the transverse dimension and advance it to the arches, revealing the wings, as a result of which the cervix is \u200b\u200bexposed and becomes available for examination;
at one end of Volkman's spoon, take the material by scraping from the outer surface of the cervix and apply a smear in the form of a horizontal line on the glass slide;
at the other end of the spoon, take material from the inner wall of the cervical canal and apply a smear on a glass slide in the form of a vertical smear;
write a direction to the laboratory, where it should be noted: Name, age, address, clinical preliminary diagnosis;
put tools in a basin with a disinfectant solution.
Instrument preparation and sounding technique.
determination of the relief of the inner surface of the uterus;
measurement of the length of the uterus;
determination of the position of the uterus;
suspected presence of a tumor in the uterine cavity;
suspicion of abnormalities in the structure of the uterus;
determination of patency of the cervical canal, atresia, stenosis;
before the expansion of the cervical canal during curettage of the uterine cavity.
acute and subacute inflammatory diseases of the uterus and appendages;
established and suspected pregnancy.
Algorithm of actions:
lay a sterile diaper;
put the patient on a chair;
treat the external genitalia with an antiseptic solution;
wear sterile gloves;
with your left hand to part the labia minora;
enter spoon-shaped mirrors into the vagina;
to capture the neck with bullet forceps;
carefully insert the probe into the cervical canal and uterine cavity.
Instrument preparation and puncture technique.
Indications:
diagnosis of intra-abdominal bleeding;
suspected accumulation of inflammatory fluid in the Douglas pocket.
spoon-shaped mirrors
forceps,
bullet forceps
a syringe with a long needle,
70% alcohol
5% alcohol solution of iodine,
cotton balls, gloves.
put a sterile diaper under the buttocks;
wear gloves;
using a forceps with a solution of alcohol and iodine, treat the neck and posterior vaginal fornix;
fix the cervix behind the back lip with bullet forceps and lift it up;
strictly along the midline 1.5-2 cm below the neck, puncture with a needle through the posterior arch and suck the contents;
if there is non-clotting blood in the syringe, the suspicion of intra-abdominal bleeding is confirmed, in the presence of inflammatory fluid - pelvioperitonitis;
place tools in a basin with a disinfectant solution.
Tool kit and diagnostic technique
Indications:
diagnosis of a malignant tumor of the uterus;
delay in the elements of the ovum;
endometrial tuberculosis;
ectopic pregnancy;
menopausal bleeding;
bleeding of unknown etiology.
acute infection in the body;
temperature rise.
Algorithm of actions:
put the patient on a gynecological chair;
thoroughly treat the pubis, external genitalia, inner thighs with an antiseptic solution;
wear gloves;
apply general anesthesia: inhalation anesthesia (nitrous oxide + oxygen), intravenous anesthesia (calypsol, sombrevin);
open the vagina with spoon-shaped mirrors. First enter the rear mirror, place it on the back wall of the vagina, slightly press on the perineum. Then, parallel to it, enter the front mirror (elevator), raising the front wall of the vagina;
capture the cervix with bullet forceps;
conduct a probe of the uterus;
to expand the cervical canal, introducing sequentially Geghar expanders to No. 10;
curette to cure the uterine cavity;
remove bullet forceps;
treat the cervix with 5% alcohol solution of iodine;
the resulting tissue is placed in a glass container, pour 70% ethyl alcohol and write a direction to the histological laboratory, where it is necessary to note patient, age, address, date, presumptive clinical diagnosis;
Tool kit and cervical biopsy technique.
pathological processes (ulceration, tumors, etc.);
suspicious of malignancy and localized in the cervix.
spoon-shaped mirrors;
forceps;
bullet forceps;
scalpel;
needle holder;
needles
scissors;
70% alcohol;
5% alcohol iodine solution;
suture material (special scissors - konhotom);
gloves.
put the patient on a gynecological chair;
thoroughly treat the external genitalia, inner thighs with an antiseptic solution;
under the buttocks to lay a sterile diaper;
wear gloves;
insert a spoon-shaped mirror into the vagina and place it on the back wall, slightly press on the perineum;
parallel to him, introduce a lift that raises the front wall of the vagina;
treat the cervix and vaginal wall with 70% ethanol and 5% alcohol solution of iodine;
put two bullet forceps on the cervical lip so that the area to be biopsied is located between them. From the suspicious area, cut a wedge-shaped piece, sharpening deep into the tissue. This piece should contain not only the affected, but also a part of healthy tissue (tissue for research can be obtained using special forceps-nippers - conchotomes);
knotted seams should be applied to the resulting tissue defect;
place the cut piece of tissue into a jar with 10% formalin solution or 70% alcohol solution; in the direction indicate full name patient, age, address, date, presumptive clinical diagnosis; the material should be sent for histological examination;
immerse tools in a basin with a disinfectant solution.
The technique of vaginal douching.
Indications:
colpitis;
pathology of the cervix;
inflammatory processes of the uterus, appendages of the uterus and perinephric fiber.
infected wounds of the perineum, external genitalia, vagina;
acute inflammation of the uterus and uterine appendages.
Algorithm of actions:
lay a liner;
put the patient, put a vessel under the basin;
fill Esmarch's mug with a sterile solution of the drug (antiseptic, etc.) in an amount of 1-1.5 l;
hang the mug on a tripod to a height of 1 m from the level of the couch;
wear gloves;
first, wash the external genitalia with a solution, then insert the tip along the back wall of the vagina to a depth to the middle of the vagina and open the faucet-clamp and douch with a stream of the drug solution;
after the procedure, immerse the tip in a disinfectant solution.
The technique of vaginal baths and tampons.
vaginal diseases;
diseases of the cervix.
acute colpitis;
menstruation.
Algorithm of actions:
lay a liner;
put the woman on a gynecological chair or on a couch (at the same time put a roller under the sacrum so that the pelvic end is raised);
wear sterile gloves;
with the index and thumb of the left hand, part the labia minora and labia minora;
with your right hand enter the Cuzco mirror to the vaginal arches in closed form, then open the flaps, withdraw the neck and use the lock to lock the mirror;
first remove the mucus from the cervical canal with a cotton swab moistened with a solution of sodium bicarbonate;
pour a small portion of the medicinal solution into the vagina (collargol, protargol, furacilin, etc.) and drain it. Pour the second portion in such an amount that the neck is completely submerged;
drain the solution after 10-20 minutes and introduce a swab with an ointment (syntomycin emulsion, prednisolone ointment, fish oil, sea buckthorn oil, etc.) until it comes in contact with the neck. The woman herself removes the tampon after 10-12 hours;
immerse tools in a container with a disinfectant solution.
First aid for a patient with bleeding from
The reasons:
delay in the elements of the fetal egg after a spontaneous or artificial abortion;
ovarian dysfunction;
interruption of uterine pregnancy;
termination of an ectopic pregnancy;
cystic drift;
genital injuries;
decay of a malignant neoplasm.
lay the patient, calm;
call a doctor;
lower the head end;
put a cold, a load on the lower abdomen;
introduce hemostatic agents;
introduce reductions;
prepare tools for examining the genitals and curettage of the uterine cavity.
- History of manipulation and management of people.
- Secrets of manipulation of the KGB, FSB and FBI special services.
- The ancient secrets of managing humanity.
- Manipulation of people, psychology.
- Magical manipulation of the human matrix.
- Manipulation of human consciousness.
- Proven ways to manipulate people.
- Where to start learning how to manipulate people.
- How to manage a person?
- How to learn to manipulate the consciousness of another person?
- Methods of covert human manipulation.
- The use of human manipulation in life.
- Historical background on the manipulation of the masses.
- Literature on manipulating people.
- Films about manipulating people.
- The secrets of successful human manipulation.
- Psychotechnics, NLP for manipulation and control of human consciousness.
- Training in techniques of manipulation and management of people.
- Psychological techniques of manipulation
- Manipulation Course: Secrets of Jewish Hypnosis for Love and Business. + Kabbalah course as a gift.
There are 14 methods of hidden manipulation, which are divided into 7 complex and 7 simple tricks, which of them may be applied to you, we will consider in this article.
Simple manipulation of people
1. A method of manipulation using resentment or guilt. One of the most common methods. The image of the unfortunate victim provides the carrier with the right of unspoken authority. Some people, in this image, live for several years, but others do not try to help him, on the contrary, such a person can cause aggression and irritation. As a rule, it is the victim who runs the family pyramid and is at the top of power.
How to resist:
The best option would be a rule that can be developed in such a family - to forget grievances, not to remember past quarrels and conflicts. If an unpleasant situation has occurred, you should immediately discuss it with a partner so that you do not return to it in the future, as well as avoid further repetitions. Let this rule become mandatory for your family.
2. Hidden manipulation of anger. There are people who specifically lose their temper, thus forcing you to obey. Such manipulators resort to so-called tactical anger.
How to resist:
You will need determination. Do not allow shouting at yourself and try not to yield. If a person also continues to speak in a raised tone and breaks down in a cry, leave the room. In subsequent conflicts, when the opponent is angry and angry, continue to behave this way. Until a person begins to treat you rationally.
3. Silence is one way of manipulating. Some people resort to prolonged silence than show their resentment. In their opinion, other behavior will make the problem insignificant. Silence is a way to arouse guilt and show how upset this person is.
How to resist:
Try not to play silence, otherwise the manipulator will resort to this method constantly. Behave as if nothing had happened, wait for the silent person to speak first. If a conversation arises, listen to it in a friendly way, explain that this behavior is not reasonable.
4. Hidden manipulation with a feeling of love. “If you love me, then ...”, such manipulation is intended for close and dear people who have warm feelings for the manipulator.
How to resist:
Love is the result of relationships, not the subject of bargaining. If you notice that someone is trying to exploit your feelings, think about how important this is for you.
5. Hope is a way of manipulation. Great promises often hide the immediate benefits.
How to resist:
Do not trust opinions, reliable results are facts. Before making any decision, rely on real experience, and ignore assumptions and someone else's stories.
6. Manipulation of vanity. Small hooks that can hold a swollen ego tightly can hide behind innocent comments. For example, “You do very well with reports! Surely you will make this one the best! ”
How to resist:
Think about whether your plans included this assignment? Does the plan fit your possibilities and interests.
7. Sarcasm or irony. In order to manipulate people, a person resorts to an ironic tone, remarks or criticisms, which are accompanied by provocative comments or jokes.
How to resist:
Without your participation, no one can make you offended. Do not give in - try to be offended by "make-believe", and not by anything specific. If you resist the manipulator, you can maintain emotional balance, accuracy of wording and clarity of thought.
Complex manipulation of people
1. Emphasis is one way of manipulating, such people deliberately shift the main accents in the material presented, thereby relegating them to the background, if they are not important or not entirely desirable. This way of manipulation is often used by the media.
How to resist:
Feel free to ask your questions, specify details, check information.
2. Emotional infection. This method of manipulation is based on the property of the human psyche (emotional infectivity). The well-known fact that a person poses certain protective barriers that help to avoid receiving unwanted information. In order to circumvent these barriers, it is necessary to direct manipulative actions to the senses. As a result of which, having “charged” the necessary emotions with the necessary information, it is possible to overcome the obstacles of the mind, thereby causing emotions and an explosion of passions about what is heard. After that, emotional infection comes into play. This technique is very often used in many television programs and reality shows.
How to resist:
It is necessary to separate the message of an emotional nature and the content of information. For example, before you buy any item under the pressure of the seller, think about what your desires, goals, planned expenses before this information / situation appeared, what exact properties and qualities of the product you are interested in, whether you really need them.
3. Psychological tricks. It all depends on the supply of material, with different methods, you can get a completely different result. In other words, a certain event can be specially “not noticed”, and some should be given the opposite, increased attention.
How to resist:
Learn to return yourself to your primary goal before external influence is embedded in it. Check if your current position matches your priorities and strategic principles. Analyze the importance, relevance and reliability of information brought from outside.
4. Hidden in questions and suggestions, teams. Some manipulators, under the guise of a request, hide their team.
How to resist:
Clearly define your “coordinate system” and goals. Try to find out the interests and motives of the interlocutor. If such cases recur, it will be much easier for you to track the tactics of their achievement.
5. Avoiding discussion is one of the methods of covert manipulation. These manipulative actions are carried out using demonstrative resentment. For example, "... it is very difficult to discuss serious issues with you ..." or "I will continue our conversation only after you calm down ...".
How to resist:
6. Artificial displacement of the dispute. In this case, during the dispute, the manipulator tries not to resort to arguments, but proceeds immediately to refute them. As a result, there is no room for criticism of the position of the manipulator, thereby, the dispute is shifted to the opposite side (argumentation).
How to resist:
Return the conversation to the desired direction. Remember, you have your own “football field”. Do not give the initiative to the manipulator, return to the position of your choice.
7. The flow of questions. This method of manipulation consists in the fact that at the same time the object is asked several different questions on one topic at once. The subsequent actions depend on his answer: if a person did not answer the question or did not understand the essence of the problem, then he can be misled.
How to resist:
Tell your opponent that you prefer to answer questions in sequence (sequentially). In the event of an aggressive reaction, follow-up questions should be ignored or pause until the flow of questions stops.
In this article, we told you in detail about 14 methods of covert manipulation, perhaps one of them is periodically applied to you, check out our tips on how to resist the manipulator.
Manipulation is called psychological techniques that help to achieve the desired behavior from people through hidden influence.
When manipulating and influencing another person, it is important that he himself wants to perform certain actions. Knowledge of manipulation techniques makes life easier, helps to succeed and resist other manipulators.
The complexity of many manipulation techniques is such that it will require long training, other methods are easier to use. But in any case, preliminary preparation for influencing a person will be required.
To the question "What is manipulation?" most often you can get an answer about the psychological impact in order to achieve a certain personal benefit. Moreover, such an influence is often hidden.
What is manipulation
Manipulation is a kind of purpose which is to force a person to certain actions contrary to his desire. Moreover, the influence is not carried out explicitly, but hidden. The essence of the manipulation is that the person who is under pressure must herself want to perform certain actions, even if it is not beneficial for her.
They resort to when they are afraid of refusal or knowingly confident in the negative outcome of a particular enterprise. Perhaps even those individuals who do not fully understand what manipulation is, without realizing it, quite often use this psychological device to achieve their goals. Even children's whims can be attributed to some extent to manipulation.
Why do people resort to this
In order to perform a certain manipulation, there must be a reason, which can be both conscious and subconscious. So, for such receptions people are forced by the following:
- the danger of being in difficulty or (in this case, the person begins to use others in order to circumvent uncomfortable moments);
- lack of self-confidence often leads to the fact that a person subconsciously tries to influence others;
- public pressure, as well as stereotypes associated with a specific situation, often induce manipulation, the purpose of which is to conceal or justify certain actions;
- negative attitude to a certain personality, as well as a desire for revenge often becomes the cause of psychological impact;
- manipulation often becomes an unscrupulous method of achieving selfish ends.
How to neutralize manipulation
Having understood what manipulation is, it is important to become familiar with the methods of neutralizing it. So, to avoid psychological impact, it is recommended to use the following techniques:
- recognizing the manipulation, it is worth immediately and openly declaring the inadmissibility of such an impact on you (if it is caused by self-doubt, such a sharp answer will immediately discourage the opponent);
- disclosing the intentions of the manipulator and exposing it to others (the publication of uncomfortable facts will make the impact ineffective and inappropriate);
- if you feel pressure from the opponent, call him for a frank conversation in order to clarify the situation and determine the motives of behavior (a compromise may be found during the conversation);
- a fairly effective method of dealing with manipulation is to criticize a person who is trying to put pressure on you;
- if you understand that diplomatic methods did not help you get rid of pressure from the outside, show resistance to your opponent by engaging in open confrontation with him (the confrontation will knock him out of his rut);
- try to respond by manipulation to manipulation.
How to understand that you are being manipulated?
Manipulation (exposure) can have a variety of manifestations, and in order to effectively resist it, it is important to be able to recognize it. So, it is accompanied by the following situations:
- a feeling of psychological discomfort and lack of logic in the sequence of events;
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