The organization of care depends on where the patient is (at home or in the hospital). All medical workers, as well as relatives and relatives of the patient (especially if the patient is at home) should actively participate in the organization of patient care. The doctor organizes patient care regardless of where the patient is (in the hospital it is the attending physician, at home - the district doctor). It is the doctor who gives instructions regarding the patient’s physical activity regimen, nutrition, prescribes medicines, etc. The doctor monitors the patient’s condition, the progress and results of treatment, constantly monitoring the correctness and timeliness of the necessary medical and diagnostic procedures.

The decisive role in providing patient care belongs to the nursing staff. The nurse performs the doctor’s prescriptions (injections, dressings, mustard plasters, etc.) regardless of whether the patient is at home or in the hospital. Separate manipulations of general patient care in a hospital are performed by nurses, i.e. nurses (cleaning the premises, supplying a patient with a vessel or urinal, etc.).

Features of general patient care in a hospital.  A feature of inpatient treatment is the constant presence of a large group of people around the clock in the same room. This requires that patients and their loved ones comply with the internal routine of the hospital, the sanitary-epidemiological regimen, and the medical-protective regimen.

The implementation of the rules of the regime begins with the in-patient department of the hospital, where, if necessary, the patient is sanitized and dressed in hospital clothes (pajamas, a bathrobe). In the admission department, the patient and his relatives can familiarize themselves with the rules of the internal routine of the hospital: hours of sleep for patients, getting up, breakfast, going around the doctor, visiting relatives, etc. Relatives of the patient can familiarize themselves with the list of products allowed for transfer to patients.

One of the most important tasks of general patient care is the creation and maintenance of a medical and protective regime in a hospital.

Medical and protective regime called measures that are aimed at ensuring maximum physical and mental rest of patients. The medical and protective regime is provided by the internal routine of the hospital, compliance with the prescribed regime of physical activity, and a careful attitude to the patient’s personality.

Sanitary regime  - A set of measures aimed at preventing the occurrence and spread of infection within the hospital. These measures include sanitization of patients upon admission to the hospital, regular change of underwear and bed linen, measurement of body temperature for patients upon admission and daily during the patient’s stay in the hospital, disinfection, sterilization.

Features of general home care.  The organization of patient care at home has its own characteristics, since next to the patient during the day most of the time is spent not by medical workers, but by relatives of the patient. It is especially important to properly organize care for a long-sick home.

The caregiver is usually led by a community therapist. Nursing manipulations are performed by the district nurse, relatives and relatives of the patient under the guidance of the district doctor and district nurse. The doctor, as in a hospital, prescribes a regimen, diet, and medicines to a patient.

It is advisable that the patient is in a separate room. If this is not possible, then it is necessary to separate the part of the room where the patient is located with a screen. The patient's bed should be near the window, but not in a draft, since the room needs to be ventilated several times a day. It is advisable that the patient sees the door. The room should not have unnecessary things, but it should be comfortable. It is necessary to carry out wet cleaning in the room daily. At least twice a day, it is necessary to ventilate the room where the patient is. If the patient cannot be taken out of the room while airing, then it is necessary to shelter the patient.

An essential point of care is the proper preparation of the bed. First, a mattress in an oilcloth mattress cover spreads on the bed, then flannel bedding, a sheet over it. An oilcloth is placed on the sheet, and changing diapers are spread on top of the oilcloth as necessary. The pillow and blanket are stacked on top.

It is advisable to lay a small rug near the bed. Under the bed on the stand should be (if the patient is assigned to bed rest) the vessel and urinal.

Relatives and relatives of the patient should learn the methods of patient care (or invite a trained nurse).

Features of care for the elderly and senile patients.With age, changes gradually develop in all organs and systems of a living organism: visual acuity, hearing decrease, skin elasticity decreases, etc. The course of diseases in the elderly also has its own characteristics. Most often, elderly people develop diseases such as atherosclerosis, diabetes mellitus, hypertension, diseases of the musculoskeletal system, etc. Very often, such patients have a combination of several diseases. Many diseases occur in elderly and elderly patients hidden, without clear symptoms, with a tendency to complications. For example, in these patients, infectious diseases occur without a pronounced temperature reaction, which is due to a decrease in the reactivity of the body. Erased symptoms are also observed in acute surgical diseases (for example, appendicitis), which require immediate surgical intervention.

Medications act on the elderly more slowly. their effectiveness is lower. Drug therapy requires great care. Older people should not be given medicines all day. It should not be difficult to explain the effect of drugs, as the patient may forget this. The caregiver himself must give the patient medicine at a certain time. Elderly and elderly patients can often be disoriented in space and time (for example, the patient thinks that he is not at home, but on the street and he needs to go to the store). At such moments, one should not oppose him, but, on the contrary, try to “play along” with him, go with him to the “store” and after a while he will forget about his idea.

For the elderly and elderly patients, the medical and protective regime is of great importance. Therefore, it is very important for such patients to observe the sleep and wakeful regimen, not to disturb their peace with loud sounds, etc. Very often, the cause of night sleep disturbance is not only insomnia, but frequent urination at night because of age-related features of kidney function. Therefore, it is necessary that the ship was at hand with the patient at night.

Of great importance for elderly and elderly patients is the care of the skin. Dry skin should be lubricated with special creams, remove corns in a timely manner, etc.

Of particular importance is the care of the skin for diabetes, since one of its complications is the so-called diabetic foot, when a violation of the microcirculation due to changes in blood vessels in diabetes can lead to gangrene of the lower extremities. It is necessary to examine the skin of the feet of such patients daily (if it is difficult for the patient to do this himself due to impaired mobility of the limbs, then the patient can examine the feet using a mirror).

Patients with urinary incontinence need careful care. because they quickly develop pressure sores and diaper rash. To prevent them, it is necessary to wash the patient more often, wipe the skin of the perineum dry and lubricate the skin with cream (preferably for children).

Often, in elderly and elderly patients, intestinal function is impaired (constipation is observed in patients with a decrease in the motor activity of the gastrointestinal tract). In such cases, it is better to abandon enemas, since they irritate the intestinal mucosa. It is more advisable to regulate the stool with the help of a diet: you need to eat more fruits (apples, prunes, etc.), vegetables (beets), infusions of such medicines as buckthorn or senna bark, i.e. laxatives (they drink these herbs 1/4 cup per day 30 minutes before meals). With a laxative purpose, you can drink a glass of cold water daily on an empty stomach.

Sometimes, due to hemorrhoids, the bowel movement becomes painful. To prevent this, it is necessary to introduce candles with glycerin or belladonna into the anus before defecation, and wash the area of \u200b\u200bthe anus with soap after defecation.

Often, elderly people experience age-related changes in the oral cavity: various diseases of the oral mucosa, dental caries, etc. develop. Therefore, when caring for the elderly, special attention should be paid to oral care. They should use saline toothpastes, alternating them with fluoride pastes. It is good to use decoctions of herbs: sage, chamomile, Kalanchoe, etc. when rinsing the oral cavity. Floss or disposable wooden toothpicks can be used to remove food debris from tooth gaps. Especially carefully care should be taken of the oral cavity when using dentures. For the purpose of prevention and timely treatment, the patient needs to consult a dentist at least 2 ... 3 times a year.

Physical inactivity adversely affects health and well-being. Therefore, care for the elderly and the elderly must necessarily contain a set of physical exercises, if possible stay in the fresh air for 1.5 ... 2 hours (or at least frequent ventilation of the room where the patient is located).

The nutritional characteristics of the elderly and the elderly is a decrease in the energy value of the daily diet to 70 ... 80% of the daily diet of people of the age group of 20 ... 30 years by reducing the amount of carbohydrates (bread, sugar, confectionery, potatoes). Elderly should limit the intake of animal fats, salt (fluid is limited only with edema).

Personal hygiene of the patient

Personal hygiene measures of the patient largely depend on the position of the patient - active, passive, compelled. With an active position, the patient can arbitrarily and independently change the position of the body, with a passive position without assistance, the patient cannot change the position of the body. The patient accepts a forced position to improve his health, alleviate his suffering. The passive position of the patient greatly complicates the care of the patient.

Change of underwear and bed linen. Change of linen is necessary at least 1 time per week, as well as as it becomes soiled. Change of bed linen depends on the mode of physical activity, which the doctor prescribed to the patient. This regimen can be general (the patient is allowed to walk and climb the stairs), half-bed (the patient is allowed to accompany himself to the toilet in the ward), bed (when the patient is allowed to sit in bed and turn in bed) and strict bed (when the patient cannot even turning in bed). The methodology for changing linen (sheets) consists in rolling a dirty sheet into a roll and in the subsequent spreading of a clean sheet, also previously rolled into a roll. Patients with strict bed rest change linen in the transverse direction, from the head, carefully lifting the upper body. If the regimen is bed rest, then the sheet is changed in the longitudinal direction, rolling the dirty one by one, while straightening the clean sheet along the patient’s body, turning it on its side (Fig. 9.1).

Remove underwear (shirt) after rolling it to the back of the head, first freeing the head, then hands. Put on a clean shirt in the opposite direction (Fig. 9.2).

Care for skin, hair, nails. In order for the skin to function normally, it must be clean. To do this, it is necessary to carry out her morning and evening toilet. The skin is contaminated by sebaceous and sweat glands, keratinization of the skin epithelium, etc. Contaminated skin and secretions from the genitourinary organs and intestines.

Fig. 9.1. Change of bed linen for a seriously ill patient: a - rolling the sheet in length; b - rolling the sheet wide

Fig. 9.2. Sequential removal of a shirt from a seriously ill patient

The patient should be washed in the bath or in the shower at least 1 time per week. Every day, the patient must be washed, washed his hands, washed. If the bath and shower are contraindicated, then in addition to daily washing, washing, washing hands before each meal and after the toilet, it is necessary to wipe the patient daily with a cotton swab dipped in water, warm camphor alcohol or vinegar solution (1 - 2 tablespoons per 0.5 l of water ) After wiping, wipe the skin dry.

The skin of the perineum must be washed daily. Severely ill patients should be washed after each urination (Fig. 9.3). To wash, prepare a warm (30 ... 35 ° C) weak solution of potassium permanganate or water, oilcloth, a vessel, a napkin, tweezers or a clamp.

The sequence of actions is as follows:

lay the patient on his back, legs should be bent at the knees and divorced;

lay the oilcloth and place the vessel on it;

stand to the right of the patient and, holding a jug of water in his left hand, and a clip with a napkin in his right, pour water on the genitals, and with a napkin make movements from the genitals to the anus, i.e. from top to bottom;

dry the crotch skin in the same direction with a dry cloth;

clean the boat and oilcloth.

Fig. 9.3. Devices and methods

perineal care: a - bidet; b - method of washing the patient

Fig. 9.4. The method of washing the head of a seriously ill patient

The patient's hair must be combed daily, and once a week wash your hair. If necessary, you can wash the patient’s head in bed (Fig. 9.4).

Nails on hands and feet should be regularly cut, it is better to do this after a hygienic bath or shower, washing your feet. If necessary, feet can be washed in bed (Fig. 9.5). After washing the feet, wipe dry, especially the skin between the toes. Nails, especially on the feet (they are often thickened), should be cut very carefully, not rounding in the corners, but cutting the nail in a straight line (to prevent nail ingrowth).

Care for the oral cavity, teeth, ears, nose, eyes. Oral care consists in the fact that after each meal the patient needs to rinse his mouth and brush his teeth at least twice a day. Seriously ill patients need to wipe their mouth and teeth with an antiseptic solution 2 times a day (Fig. 9.6). To do this, prepare: cotton balls, tweezers, a 2% solution of soda or a weak solution of potassium permanganate, or warm boiled water.

Fig. 9.5. The method of washing the feet of a seriously ill

The sequence of actions is as follows:

wrap the tongue with a napkin and gently pull it out of your mouth with your left hand;

moisten a cotton ball with a solution of soda and, removing plaque, wipe the tongue;

if the patient can, then rinse your mouth with warm water. If the patient cannot rinse his mouth independently, then it is necessary to carry out

Fig. 9.6. Tooth and tongue toilet

irrigation (rinsing) of the oral cavity, for which type in a rubber balloon a solution of soda or other antiseptic; turn the patient’s head to the side, cover the neck and chest with oilcloth, put the tray under the chin; pull the corner of the mouth with a spatula (instead of a spatula, you can use the handle of a cleanly washed tablespoon), insert the tip of the balloon into the corner of the mouth and rinse your mouth with a stream of liquid; wash the left and right cheek spaces alternately;

removable dentures should be removed before oral treatment. At night, prostheses must be removed and washed thoroughly under running tap water with soap. The prostheses are stored in a dry glass, and in the morning they are washed again before putting them on.

Ears should be washed regularly with warm water and soap. Sulfur that accumulates in the external auditory canal should be carefully removed with a cotton swab, after dropping 2 ... 3 drops of a 3% hydrogen peroxide solution into the external auditory canal. To drip drops into the ear, the patient's head must be tilted in the opposite direction, and the auricle is pulled back and up. After instillation of the drops, the patient should remain in this position for 1 ... 2 minutes.

Nasal discharge should be removed with cotton flagella, introducing them into the nose with light rotational movements. The resulting crusts in the nose can be removed with cotton flagella moistened with vegetable or liquid paraffin.

To instill drops in the nose, it is necessary to tilt the patient's head in the opposite direction and slightly tilt it back. Having instilled the drops into the right nasal passage, after I ... 2 min it is possible to instill them into the left nasal passage.

Discharge from the eyes should be wiped or washed with a solution of furatsilina or 1 ... 2% solution of soda. The sequence of actions when rubbing the eyes is as follows:

wash your hands thoroughly;

having moistened a sterile cotton swab in the antiseptic solution and, having slightly squeezed it, wipe it with eyelashes and eyelids in the direction from the outer corner of the eye to the inner one in one motion, after which the swab should be discarded;

take another swab and repeat rubbing 1 ... 2 times;

blot the remaining solution with a dry swab.

The sequence of actions when washing the eyes is as follows:

pour the solution prescribed by the doctor in a special glass (for washing the eyes) and place it on the table in front of the patient;

ask the patient to take the glass with his right hand by the leg and tilt his face so that the eyelids are in the glass, press it to the skin and raise his head, while the liquid should not leak;

the patient should often blink for 1 min; the patient must put the glass on the table without taking it from his face;

pour a fresh solution into a glass, ask the patient to repeat the procedure.

The laying of an eye ointment is performed using a glass rod in the patient's sitting position. The sequence of actions when laying the ointment from the tube into the eye is as follows:

pull the lower eyelid of the patient down;

keep the tube at the inner corner of the eye and advance it so that the ointment, extruding, is located along the entire eyelid on its inner side (Fig. 9.7, a);

release the lower eyelid so that the ointment is pressed against the eyeball.

When placing the ointment into the eye from the vial using a glass rod (see Fig. 9.7, a), it is necessary: \u200b\u200bto collect the ointment from the vial onto a sterile glass rod, pull the patient’s lower eyelid, lay the wand with ointment for the extended lower eyelid, release the lower eyelid, after which the patient should close his eyelids.

When instilling drops in the eye, the drops should be checked according to the doctor's prescription; draw the desired number of drops into a pipette (2 ... 3 drops

Fig. 9.7. The laying of an eye ointment (a) and the instillation of eye drops (b)

for each eye); the patient should throw his head back and look up; pull the lower eyelid and, without touching the eyelashes, drip drops on the lower eyelid (it should be remembered that you can not bring the pipette to the eye closer than 1.5 cm) (Fig. 9.7, b).

Prevention of pressure sores. Pressure ulcers - necrosis of the skin and soft tissues as a result of their prolonged compression between the bones of the patient and the surface on which he lies. Pressure ulcers occur in patients who have long been in the same position. In the position of the patient on the back, bedsores are most often formed in the area of \u200b\u200bthe shoulder blades, sacrum, elbows, heels, and the back of the head. In the patient’s position on the side, bedsores can form in the hip joint. Pressure ulcers are a serious problem for the patient, his family and medical staff. The presence of pressure sores gives the patient not only physical suffering, but also has a psychologically unfavorable effect on the patient, since most often patients perceive the presence of pressure sores as evidence of the severity and hopelessness of their condition.

Treating deep and infected pressure sores is a process that drags on for several months. Therefore, it is easier to prevent the occurrence of pressure sores. A number of other reasons also contribute to the occurrence of pressure sores: trauma to the skin, even the most insignificant (crumbs on the bed, scars and folds on the linen, adhesive plaster); wet clothes; poor nutrition (leading to a violation of the trophism of the skin); diabetes; obesity; thyroid disease, etc. Bad habits (smoking and alcohol) increase the likelihood of pressure sores. An infection quickly joins the bedsores. Pressure ulcers develop in several stages: white spot, red spot, bladder, necrosis (necrosis).

Prevention of pressure sores involves: changing the position of the patient every 2 hours; careful preparation of the bed without folds, scars and crumbs; checking the condition of the skin with each change in patient position; immediate change of wet or soiled laundry; compliance with the patient’s personal hygiene (daily washing of the skin in the places of the most likely occurrence of pressure sores with warm water, followed by massaging movements, treatment of the skin with antiseptic solutions - 10% camphor or 0.5% ammonia, or 1% - m solution of salicylic alcohol diluted with vinegar; washing after each urination and defecation); the use of special anti-decubitus mattresses; balanced diet of a patient with a high content of carbohydrates and fats to ensure maximum mobilization of proteins.

The use of the vessel and urinal. For patients who are in strict bed rest, a vessel is delivered to the bed to empty the intestines, and an urinal is used to empty the bladder (the vessel is also given to women during urination). The vessel may be enameled or rubber. In seriously ill patients, the ship is usually constantly under the bed.

When submitting a ship to bed, it should:

put an oilcloth under the patient's pelvis;

rinse the vessel with warm water, leaving a little water in it;

bring his left hand under the sacrum of the patient, helping him to raise the pelvis (the patient's legs should be bent at the knees);

with your right hand bring the vessel under the buttocks of the patient so that the crotch is above the opening of the vessel;

cover the patient with a blanket and leave him alone;

pour the contents into the toilet bowl, rinse the vessel with hot water (you can add Pemoxol powder to the vessel);

wash the patient, thoroughly drain the perineum, remove the oilcloth;

disinfect the vessel with a disinfectant solution (e.g. chloramine).

When using a rubber vessel, one should not inflate it tightly, since it can exert significant pressure on the sacrum.

Before serving the urinal, rinse it with warm water. To remove the smell of urea, the urinal can be rinsed with Sanitary-2 cleaning agent.

In the generally accepted interpretation, care is a set of measures that provide comprehensive service to a person, including the creation of optimal conditions and conditions for him, the implementation of procedures prescribed by a doctor, which, in turn, contributes to a more comfortable well-being of the patient and his quickest recovery.

Patient care and its basic principles

Care is divided into special and general - subtypes, which, in turn, have their own characteristics.

Consider each subtype individually:

• General care. This subtype includes responsibilities for maintaining the patient’s hygienic condition, as well as maintaining the ideal cleanliness of the room in which he is located, catering for the patient and the proper implementation of all procedures prescribed by the doctor. Also, general care involves assisting the patient with physical departures, eating, and a toilet. In addition, observation of the dynamics of the patient’s state and well-being can also be attributed to this.
• Special care, as a rule, is associated with the specifics of a particular diagnosis.

It is worth noting that care is not an alternative to treatment: it is part of a set of therapeutic measures. One of the main purposes of caring for a sick person is to maintain a comfortable psychological and domestic situation at every stage of treatment.

How is proper care built?

The basis for proper patient care can be called a protective regime, which is designed to protect and spare the patient's psyche:
- elimination of excessive irritants,
- ensuring peace / quiet,
- creating comfort.
When performing all these components, the patient feels comfortable, he has an optimistic attitude and confidence in a successful outcome of the disease.
It is especially worth noting that the effectiveness of caring for a sick person requires not only certain skills, but also a sympathetic attitude. After all, physical suffering, illnesses create feelings of anxiety in a person, often - hopelessness, irritability in relation to medical staff and even relatives. Tact, the ability to support a person in this difficult period for him, a sensitive and attentive attitude towards him, will allow the patient to escape from his painful situation and tune into an optimistic mood. That is why nursing is one of the essential sections of the medical staff. If the patient is treated at home, care is carried out by his relatives or medical staff, after consultation with the attending physician.

Basic care principles

1. Room. It should be light, airy, and, if possible, insulated and protected from noise. With any disease, the abundance of light, fresh air and a comfortable temperature in the room where the patient is located will have a beneficial effect on the person. Separately, it is worth saying about light: its power should be reduced if there is a patient with an ophthalmic disease or with a nervous system disease in the room. During the day, electric lamps should be covered with a matte lampshade, and at night only nightlights or other low-glow devices can be turned on.

2. Temperature. The optimal microclimate in the patient’s room should be as follows: temperature is within 18-20 °, air humidity is not more than 30-60%. It is very important that the room does not cool in the morning. If the air is too dry, to increase humidity, you can put a moistened rag on the battery, or put a vessel with water next to it. To reduce the humidity in the room, it is necessary to ventilate it. In a city, airing is best done at night, because during the day the city air is much more polluted by dust and gases. In other conditions, in the summertime you can ventilate the room around the clock, in the winter period, airing is worth no more than 3-5 times a day. To protect the patient from a cold stream of air during ventilation, it is necessary to cover him with a blanket, and his head - with a towel or scarf (face - open). Instead of airing, fumigating a room with flavoring agents is unacceptable!

3. Purity. The room in which the patient is located must be kept clean. So, cleaning should be done at least twice a day. Furniture, window frames and doors should be wiped with wet rags, the floor must be washed or wiped with a brush wrapped in a damp cloth. Items on which dust can accumulate (curtains, carpets) are most preferably removed, or often shaken / vacuum cleaned. The patient's room should be isolated from street, traffic and industrial noise. It is also recommended to lower the volume of radios, televisions, etc. Talk should be in an undertone.

4. Transportation. A very important point. If a person is seriously ill, he must be transported carefully, on a special chair, stretcher or gurney, while avoiding tremors. With a patient, stretchers are carried by two or four people. It is important that they do not keep up, in short steps. The transfer of the patient and carrying on the hands can be carried out by one, two or three people. If carrying out is carried out by one person, then it is necessary to act in the following order: one hand is brought under the shoulder blades of the patient, the other under the hips, while the patient must hold the carrier by the neck. In order to move a seriously ill patient from a stretcher to a bed, it is necessary to proceed as follows: put the stretcher at right angles to the bed so that their foot end is closer to the head of the bed. Before you transfer the seriously ill patient to bed, you must first check its readiness, as well as the availability of individual care items and bedside accessories.
A seriously ill person, among other things, will need:

Lining oilcloth,
- rubber circle
- urinal,
- bedpan.

The patient’s bed should be neat, comfortable, of sufficient length and width. For a patient’s bed, it is best to use a multi-section mattress, on top of which a sheet spreads. If necessary, put an oilcloth under the sheet. In special cases, for example, with lesions of the spine, a solid shield is placed under the mattress. It is worth remembering that the patient's bed should not be located near sources of heating. The best location will be one in which the patient will be conveniently approached from both sides.

A seriously ill patient must be helped to undress, take off his shoes, and in special cases, clothing is carefully cut.

5. Bed linen. With this procedure, it is impossible for the patient to create uncomfortable postures, forced muscle tension, and not cause pain. The patient should be pushed to the edge of the bed, and the freed part of the sheet, rolled up to the patient's body. Further on this part of the bed should be spread a clean sheet and shift the patient. With strict bed rest, the sheet rolls down from the legs to the head - first to the lower back, then near the upper body. The edges of the sheet are attached to the mattress with safety pins. At each change of linen, it is necessary to shake out the blanket.

6. Change of underwear. When changing a shirt for a seriously ill person,
you should first put a hand under his back, then raise the shirt to the back of the neck, remove one sleeve, then the other (in cases where one arm is damaged - start with a healthy one). After this, the patient should wear a shirt (start with a sore arm), then it is necessary to lower it over the head to the sacrum and straighten all the folds. If a strict bed rest is prescribed for a patient by a doctor, he should wear a vest. If the patient’s laundry was contaminated with blood or secretions, it should first be soaked in a solution of bleach, then dried, and only then sent to the laundry.

7. Mode. The doctor prescribes various modes for the patient, depending
from the severity of the disease:
Strict bed, in which it is forbidden to even sit.
Bed, in which you can move in bed, but it is forbidden to leave it.
Half-bed, where you can walk around the room.
General mode, in which, as a rule, the patient's motor activity is not significantly limited.

Features of patient care with bed rest

1. The patient carries out physiological administration in bed. A disinfected, cleanly washed bedpan (a specialized bowel movement device) is fed to a person, into which a little water is poured to absorb odors. The vessel is brought under the buttocks so that the patient's crotch is above a large hole, and the tube is between the hips. In this case, the free hand must be placed under the sacrum and raise the patient. After freeing the vessel, it must be thoroughly washed with hot water, and then disinfected with a 3% solution of chloramine or lysol. The urine collection vessel - urinal - also needs to be served well washed and warm. After each patient urination, the urinal is washed with solutions of sodium bicarbonate and potassium permanganate, or a weak solution of hydrochloric acid.

2. Tools and equipment necessary for maintenance must be stored in a strictly defined place. Everything necessary for the patient should be ready for use. Hot water bottles, bedpan vessels, urinals, rubber circles, ice bubbles should be washed with hot water, then rinsed with a 3% solution of chloramine and stored in specialized cabinets. Probes, catheters, vent tubes, enema tips are washed in hot water with soap and then boiled for 15 minutes. Enema tips must be stored in a labeled container designed for this purpose. Beakers and drinking bowls are prescribed to boil. If possible, it is worth using disposable items. Armchairs, wheelchairs, cupboards, beds, stretchers and other medical equipment must be periodically disinfected with a 3% solution of chloramine or lysol, and daily must be cleaned with a wet cloth or washed with soap.

3. Personal hygiene of the patient is of great importance in the rehabilitation period. Primary patients (with the exception of patients who are in critical condition) should be sanitized, which includes a bath, shower or wet wipe, and if necessary, a short haircut, followed by disinfection of the scalp. If the patient needs outside help when carrying out hygiene procedures, he should be lowered into the bathtub on a sheet, or put on a special stool in the bathtub and washed with a hand shower. If a person is seriously ill, bathing is replaced by rubbing the body with a swab dipped in warm water and soap. At the end of the procedure, it is necessary to wipe the patient's body with a swab dipped in warm water without soap and wipe it dry. Unless otherwise prescribed, the patient should take a shower or bath at least once a week. The nails on the feet and hands of the patient must be cut short.

4. It is recommended to wash hair in secondary or dispensary patients with warm water and soap (after the procedure, the hair is carefully combed). If a person is seriously ill, then head washing is indicated to be carried out in bed. As for the frequency of these hygienic procedures, it is this: the patient's hands should be washed before each meal, legs - every day before bedtime. The upper body, as well as the face and neck must be washed daily. The genitals and anus are also supposed to be washed daily. In cases where a person is seriously ill - washing the genitals is supposed to be carried out at least twice a day. The procedure is as follows: a vessel is placed under the buttocks of the patient (at this time the patient lies on his back, legs bent at the knees). For the washing procedure, it is also convenient to use Esmarch's mug, which is specially equipped with a rubber tube with a tip, which, in turn, has a clip or a tap. A stream of water or a weak solution of potassium permanganate is sent to the perineum. At the same time, a cotton swab is carried out in the direction from the genitals to the anus. Then, using another cotton swab, the perineal skin is drained. Such a procedure can also be performed using a jug into which a warm disinfectant solution is poured. Inguinal folds, axillary areas, as well as folds of skin under the mammary glands, especially if the patient is obese or prone to excessive sweating,
wash frequently to avoid diaper rash.

5. Exhausted patients, as well as those patients for whom bed rest lasts a large amount of time, need especially careful care of the body and skin in order to avoid the appearance of pressure sores. As a preventative measure, in addition to skin care, it is necessary to keep the bed in perfect order: regularly smooth the folds of the sheet and eliminate bumps. The skin of patients with a risk of pressure sores should be wiped once or twice a day with camphor alcohol, and powdered with talcum powder. In addition, it is necessary to use rubber circles wrapped in a pillowcase, placing them under the places that are most exposed to pressure (for example, the sacrum). A necessary preventive measure is also a frequent change in the patient's position on the bed. Care for the patient's legs is no less important - with insufficient care on the soles, thick horny layers can form, which are a manifestation of epidermophytosis in a scaly form. In these cases, removal of keratinized skin with subsequent treatment of the skin of the legs with antifungal agents is indicated.

6. Feeding seriously ill patients is an extremely important point in care. It is necessary to strictly observe the dietary regimen established by the doctor and diet. Bedridden patients while eating should be given the position that will avoid fatigue. As a rule, this is a slightly elevated or half-sitting position. The patient’s neck and chest should be covered with a napkin. Fevering and debilitated patients should be fed during a decrease in temperature / improvement. Such patients are fed with a spoon, rubbed or chopped food is given in small portions. For the purpose of feeding, do not interrupt daytime sleep, in cases where the patient suffers from insomnia. Serious patients are given a drink from a drinker. If a person cannot swallow food, he is shown artificial nutrition: probe.

7. Another necessary condition for successful treatment is monitoring the patient's condition. So, carers need to regularly inform the doctor about every change that occurs in the patient’s condition. It should take into account the state of the patient's psyche, a change in his body position, skin color, facial expression, cough, respiratory rate, change in the nature and color of urine, feces, sputum. In addition, on the instructions of a physician, it is necessary to measure body temperature, weigh, measure the ratio of fluid allocated to and drunk by the patient and make other prescribed observations. It is important to monitor the intake of prescribed medications for patients. For the medication procedure, clean beakers and a carafe of boiled water should be prepared.

Features of care for patients of senile and elderly

Care for such patients must be carried out, taking into account the characteristics of an aging organism and, as a result, a decrease in adaptive capabilities. It is also necessary to take into account factors such as age-related changes in the psyche, as well as the uniqueness of the course of diseases in the elderly. Among these features, the following can be distinguished:

Atypical sluggish course of the disease in the absence of a pronounced temperature reaction.
- relative imminent addition of complications of a severe nature.

Older people are susceptible to various kinds of infectious diseases and the appearance of inflammatory processes, and this feature requires increased hygiene care.

In addition, elderly people often show increased sensitivity to changes in diet and regimen, to changes in microclimate, and the appearance of noise. Among the peculiarities of the behavior and psyche of an elderly person one can single out slight vulnerability, emotional instability, and, in the case of vascular diseases, a sharp decrease in memory, criticism, intelligence, helplessness, and, often, untidiness. Such features require increased attention from the staff, as well as a patient and sympathetic attitude.

Strict bed rest for the elderly is recommended to be reduced as soon as possible. And as soon as possible, it is recommended to prescribe therapeutic physical culture and massage for the most rapid return to the motor regime. This will avoid hypokinesia. Also, it is recommended that elderly patients prescribe breathing exercises with
the goal of preventing congestive pneumonia.

Features of care for resuscitated patients

The peculiarity of care for resuscitated patients, as well as for patients who are in intensive care, is that here care includes both general and special elements, as applied to traumatological, surgical, neurological, as well as patients who are in an unconscious state.

Much attention should be paid to monitoring the patient's condition, including monitor monitoring, monitoring the physiological functions of the patient, including breathing, urination, blood circulation. In addition, it is necessary to monitor the status of perfusion tubes, catheters and guides from systems and devices connected to a person.
Special care is required for patients undergoing mechanical ventilation through a tracheostomy or through an endotracheal tube. In such cases, a thorough toilet of the tracheobronchial tree is necessarily indicated (in some cases, every 15-20 minutes).
Without this procedure, a violation of bronchial obstruction and, as a consequence, the development of asphyxia is possible. Removal of the secret from the bronchi and trachea must be carried out with sterile gloves, or after the hands have been treated with a disinfectant solution. To perform the procedure, a specialized angled catheter is used, which is connected to the vacuum pump through a tee. One tee elbow must be left open. The patient's head must be turned, then during inspiration, with one movement, insert the catheter into the tracheostomy or endotracheal tube and push it through the bronchi and trachea into the lung until it stops. After that, the tee hole is closed with a finger to ensure vacuum suction; then the catheter must be removed by carefully rotating it with your fingers. After that, the catheter is washed with an isotonic sodium chloride solution, or replaced and the procedure is repeated as many times as necessary. The effectiveness of the procedure will be doubled if you simultaneously carry out vibration massage of the chest.
In order to prevent the development of stagnation in the lungs and the appearance of pressure sores, the position of the patient must be changed every 2 hours. In addition, it is necessary to lay ring gauze pads under the bone protrusions and wipe the patient's skin with antiseptic solutions.
It is better if the patient will lie on an anti-decubitus mattress.
Feeding patients should also be given great attention, since eating alone is often impossible for them. The feeding process is carried out using a drinking bowl, to the outlet of which a rubber tube is connected from 20 to 25 cm long. The end of the tube is inserted into the posterior parts of the oral cavity. Food is introduced through the tube, portions are regulated by its compression. Solid food must be brought to a creamy consistency, first subjected to heat treatment, then grinded and diluted with liquid. Do not give the patient spicy or hot food. During feeding, the patient must be moved to a sitting position (in severe cases, raise his head), cover with an oilcloth apron so as not to stain bedding, clothes, dressings. The feeding procedure should be repeated on average 4 times. In case of impossibility of feeding the patient through a drinker, feeding is carried out using a nasogastric tube.

If the patient is in an unconscious state, it is necessary to carry out parenteral feeding, as well as parenteral administration of fluid. Before introducing the solution into the oral cavity or vascular bed, it is necessary to warm it to the patient's body temperature. Upon completion
feeding, the patient’s oral cavity is washed with a solution of sodium bicarbonate, and then with a solution of potassium permanganate in a ratio of 1: 5000, or another disinfectant solution.

Under patient care  it should be understood that the patient is assisted in meeting their various needs - eating, drinking, washing, moving, releasing the intestines and bladder. Nursing  It also implies the creation of optimal conditions for the patient to stay in a hospital or at home - peace and quiet, a comfortable and clean bed, fresh underwear and bedding, etc.

In medicine concept "nursing"  interpreted more widely. Patient care stands out  into an independent discipline and represents a whole system of measures, including the correct and timely execution of various medical prescriptions (for example, performing intravenous injections, intramuscular injections, setting cans, mustard plasters

Etc.), conducting some diagnostic manipulations, preparing for certain studies, monitoring the patient’s condition, providing first aid to the patient, maintaining the necessary medical documentation. At patient care  many manipulations are performed by nurses.

care can be divided into specialized and general. General patient care is, first of all, the creation of a favorable psychological and domestic environment at all stages of patient treatment. The concept of general care also includes monitoring the implementation of the doctor’s prescriptions (as well as assistance in their implementation - enemas, injections, droppers, taking medications, and so on), monitoring changes in the patient’s well-being. Specialized - each disease has its own

The organization of surgical departments is based on one of the basic principles of asepsis - the division into "clean" and "purulent" patients. Any modern methods of preventing and combating infection will turn out to be ineffective if there is a clean postoperative (juvenile and a patient with purulent-septic disease) next to one ward. The rule for separating patients into “clean” and “purulent” applies both when the patient is admitted to hospital, and the course of treatment, when determining the sequence of operations, dressings or other manipulations.Depending on the type of medical institution, this issue can be solved in different ways, but the maximum section is fundamental these categories of patients. If there is one surgical department in the hospital, chambers for purulent patients are specially allocated in it. Be sure to organize two dressing rooms: clean and purulent, and purulent are located in the same wing as the chambers for purulent patients. with this category of patients, special personnel are allocated, a separate nursing post is organized, and if there are several surgical departments in a hospital, a purulent department must be allocated. Accordingly, already during hospitalization, there is a "separation of patients, which prevents mutual infection among them. The separation of patients into" clean "and" purulent "occurs inside the department. First, cleaner surgical interventions are performed, dressings are performed taking into account the infection of patients.

In the operating unit, an ideally favorable environment for operations is indispensable. Therefore, the location of the operating unit, its arrangement and provision should ensure that it is kept in such accuracy that it prevents the possibility of infection, and also create calm conditions for operations.

The operating unit should be located as far as possible from the chambers and other rooms of the surgical hospital, especially from the sanitary facilities. The operating unit is located under the supervision of a senior nurse, who is obliged to ensure his condition on a daily basis, timely cleaning and mandatory compliance with asepsis rules. The volume and number of rooms in the operating unit depend, first of all, on the volume of surgical operations. Consequently, the standard projects of healthcare institutions provide for a whole system of premises of the operating unit for various hospitals. Namely: for 25 beds of the surgical department, the presence of an operating hysterical

For 50 beds, it is necessary to have an operating room, preoperative and sterilization room, for 75 beds it is necessary to have an operating room, preoperative, sterilization room, surgeon's office. It is desirable to have 3 operating rooms, respectively: for " cleaner"Operations," emergency "and" purulent ". If this is not possible, then clean emergency operations must be carried out with a clean operating room, and purulent operations are performed in the dressing room. If necessary, an autoclave, a room for storing tools and a material room. The dressing room should be located outside the operating unit.

The largest and brightest room is always reserved for the operating room, the height should be at least 4 meters, with smooth walls painted with enamel paint, and ideally, the walls should be tiled. The operating room should be provided with good ventilation. To ensure perfect light, the operating windows must be located on the north side. With the help of a special, necessarily closing window, the operating room must communicate with the sterilization room, this greatly simplifies the supply of tools. On the walls of the operating room, several sockets are installed for electrical appliances, lamps and other devices, and the electrical wire must be hidden inside the walls of the operating room. The floor of the operating room should be tiled or linoleum. The furniture in the operating room should be smooth, easy to clean, and best painted with light paint.

The temperature of the room should not be more than 21-23 °. Operating room equipment: operating table. operating lamps, mobile reflector lamp, screw chairs, sterile instrument table, movable lifting instrument table, medicine table, sterile bix with stands, anesthesia apparatus, basins for used instruments and materials, oxygen cylinders, suction device fluid apparatus Mechanical ventilation. Emergency lighting, thermometer, rollers, straps for fixing the patient, holder for the patient's legs, foot benches. Bactericidal lamps are also needed to sterilize the air in the operating room and other specialized tools for more complex operations.

Also, in the operating room everything is needed for local anesthesia and general anesthesia, blood transfusion, as well as the following medications: ethyl alcohol, iodine solution, antibiotics and antiseptics, cardiac drugs, lobelin and other drugs necessary for emergency assistance to patients in case of complications. The current cleaning of the operating room is carried out immediately after the end of the surgery and consists in washing the floor and mopping up all the furniture. Before the operation, the furniture and lamps are wiped with slightly damp cloths moistened with any disinfectant solution. Once every 8–9 days, a general cleaning is carried out, at the same time: all objects, walls, floor and ceiling are thoroughly washed with disinfectant solutions and plain hot water with detergents. At least 1, and preferably 2, once a month, the air in the operating room should be subjected to bacteriological examination.

Patient care - a set of measures providing comprehensive care for patients and the implementation of medical prescriptions for their treatment.

Care is inextricably linked with treatment (see); they complement each other and serve a common purpose. Organization of care and its implementation are an integral part of the medical staff of medical institutions.

Patient care is largely vested in the nursing staff, especially in inpatient facilities, where most of the time patients are under the direct supervision of nurses. Successful implementation of numerous care measures by them requires not only good professional skills, but also high moral principles in their attitude to patients. Sensitivity, caring and emotional contact with patients ensure the patient's confidence in medical measures, support his faith in recovery. The Soviet people are distinguished by the principles of humanism, selflessness and the high duty of service to the socialist homeland, which is reflected in the daily work of medical institutions. At all stages of treatment, proper care provides an optimally favorable living and psychological environment for the patient. It is extremely important to protect the patient from negatively influencing factors, as well as from excessive attention to his, sometimes serious, condition.

The nurse helps patients to adapt to the regimen of the medical institution. Accommodation of patients in multi-bedded wards should be based on individual characteristics: age, intellectual and professional data, etc. The nurse should individualize the approach to patients depending on their level of development, character traits; be sensitive to the patient’s suffering, take care of satisfying his needs, learn to patiently tolerate increased reactions and requirements, often even whims, bearing in mind the mild excitability and irritability of patients. In order to avoid iatrogenic diseases (see), the medical staff should be very careful in talking with the patient on medical topics. A happy and caring attitude of a nurse gives the patient great moral, often physical relief. The ability to create an optimistic mood in a patient is a big contribution to recovery. At the same time, caring should not be replaced by familiarity, since in these cases the loss of authority of the nurse is inevitable. Restrained and calm treatment allows you to subordinate patients to the regime of a medical institution, the reasonable requirements of medical staff.

This should be favored by the appearance of the medical staff: a fit and sized buttoned-up medical gown, a scarf or hat that covers the hair — these are mandatory requirements for medical staff clothing. Shoes are preferably worn soft. Nails should be cut short, hands are spotlessly clean. Before each manipulation, you should wash your hands with a brush and soap, and, if necessary, with a disinfectant solution. Facial expression should always be quite serious, at the same time friendly, without shades of distraction and inattention.

Patient care is divided into general and special.

Each disease, especially severe and prolonged, is accompanied by the appearance of various symptoms (fever, pain, shortness of breath, loss of appetite), limited physical activity and self-care ability, impaired ability to meet basic necessities of life (eating, drinking, relieving the intestines, bladder).

Along with measures aimed at combating the disease, the patient needs to ensure the correct regimen, proper care for him (physical regimen, sanitary and hygienic conditions, nutrition, help with physiological needs and various procedures aimed at reducing the manifestations of the disease).

In addition, the course of many chronic diseases can be aggravated or provoked by the presence of bad habits (smoking, alcohol, tea, coffee, certain foods) and negative psychoemotional influences. It is important to identify these factors and try to eliminate them. This is also part of the task of caring for the sick.

Physical activity modethe patient depends on the severity of the disease. The patient’s position in bed can be active if the patient is able to independently turn, get out of bed, walk, and passive if the patient cannot move himself and maintains the position that was given to him, which is most often observed with an unconscious state or with a violation of cerebral circulation.

Often patients take a forced position, trying to alleviate their suffering, for example, sitting or half-sitting with shortness of breath, especially paroxysmal. For various diseases, strict or non-strict bed rest is prescribed, semi-bed or free, with a varying degree of activity.

In some diseases, patients need a long, even constant, bed rest. This mode provides not only a more economical use of the patient’s strength while reducing the reserve capabilities of vital organs, but also uniform and constant heat, which is important for inflammatory diseases.

However, compliance with prolonged physical rest is associated with a number of negative consequences. Long-term immobility causes a decrease in muscle tone, a violation of physiological reflexes, a slowdown in blood flow, and an increase in blood coagulation, which contributes to complications such as pneumonia of stagnant origin, venous disease, vascular obstruction, muscle atrophy, joint changes, impaired intestinal and bladder function, and formation pressure sores, etc.

Thus, excessively strict regimen of physical rest instead of benefit can do harm, slowing down and making it difficult to restore or maintain health. Therefore, at present, doctors are reducing the time of bed rest, including early expansion of the volume of physical activity, self-care and physical training, even with a disease such as myocardial infarction. With such active management, the condition of patients is restored faster and the above complications do not develop. Of course, only the doctor decides on the choice of the motor regimen and the volume of loads, but you should still know that even with a strict regimen, the patient is outside the period of deterioration (an attack of pain or suffocation, etc.) in most cases able to wash and shave on her own, take food, comb your hair, read literature, etc. Of course, the appropriate conditions must be created for this (headrest, folding table).

With a half-bed regimen of a chronically ill patient, they are more widely involved in the performance of some simple self-service duties, gradually expanding them. Physiotherapy exercises (for example, respiratory gymnastics), hygienic gymnastics at home are carried out under the control of the patient's well-being. The responsibilities of the caregiver are much more complicated in those cases when the patient cannot move and takes a passive or forced position, for example, in an unconscious state, paralysis, severe weakness.

Patient care at home not only supports the physiological functions of the body and facilitates the patient’s condition, but also actively participates in the process of restoring his state of health and ability to work.

Of course, the goals can be different: restoration of professional suitability in the conditions of previous or facilitated work, or only the ability to self-care, to perform homework, etc. The experience of medical rehabilitation shows that about 80% of patients who have had myocardial infarction gain work capacity. This indicates the great compensatory capabilities of the body, which must be used and developed.

Home care and supervision

Sickroom

It is always advisable to provide a separate room for the patient, especially if an infectious disease is suspected, including flu or acute respiratory disease. If this is not possible, it is necessary to allocate for him the best part of the room, fencing it with a curtain or closet.

The room should always have fresh and clean air and an optimum temperature (18–20 ° C). To do this, the room is regularly ventilated. In the cold season, the window is opened at least 3-4 times a day for 20-30 minutes, the patient is warmly covered at this time. In summer, the window or window should be constantly open, but care must be taken to ensure that there is no draft in the room. In winter, the south side of the house is preferable, in summer, the north side. The room should be well lit when performing various procedures. To prevent dust accumulation, it is necessary to carry out wet cleaning of the room and wipe the furniture at least 1 time per day. The window or window should be open.

Bed

It is advisable to place the patient’s bed with the headboard against the wall in the middle of the room (not along the wall and not in the corner) in order to provide a free approach to the body from all sides. On one side of the bed, at the head of the bed, put a table for medicines, a thermometer, a decanter with water, dishes for eating, and on the other - a bedside table with reading literature, a table lamp. In the bedside table you can store items of care, toilet, medicine.

The patient’s bed should always be clean and fresh. Seriously ill under the sheet put oilcloth.

Usually positionthe patient in bed is horizontal, with a slightly raised upper body.

With shortness of breath, especially with suffocation, the patient’s half-sitting position, for which a headrest or boards are placed under the pillow. To prevent the patient from slipping, use an emphasis for legs. Sometimes an elevated position of the legs is required, for example, with inflammation of the veins. In this case, pillows are placed under the legs. The most comfortable position should always be ensured. However, the patient should not be left for a long time in one position, he needs to turn on the other side from time to time, and with the permission of the doctor - sit down.

Bed linenshould be done at least 1 time per week. The condition of some patients allows them to be temporarily transferred to another bed, which makes it possible not only to change pillowcases and sheets, but also to fix and clean the mattress. One person can shift the patient, bringing his right hand under the shoulder blades, and the left - under the hips.

It is better to carry overweight patients together: one puts his hands under his head and shoulder blades, the second under his lower back and hips, they lift the patient at the same time.

For changing a sheet in a seriously ill patient, as a rule, 2 people are required. This can be done in many ways.

1st method: raise the patient’s head, the head end of the sheet is collected with folds to the lower back. Then they lift their legs and folds the other end of the sheet, then carefully pull it out from under the patient.

A clean sheet is rolled under the lower back, rolled up in width by two rollers, and spread it alternately in 2 directions - to the head and legs.

2nd method: the patient is turned on his side closer to the edge of the bed. From the free edge of the bed, a sheet is rolled along its length with a roller. A rolled-up clean sheet is also put on the vacated spot. The patient is turned on the other side, laying on a clean sheet. A dirty sheet is cleaned, and a clean sheet is spread on the other half of the bed. If the patient can be planted, first change the head half of the sheet, then the foot.

Patient hygiene

It is necessary to care for the skin, hair, nails, oral cavity, ears, eyes, perineum of the patient.

Every day, morning and evening, the patient should wash his face, neck and hands with water at room temperature with soap. If the condition allows, they put him in bed and he makes the toilet on his own. Bedridden patients are wiped with tampons or sponges, wetting them with water with the addition of vodka or cologne.

In addition, seriously ill patients should be wiped with camphor alcohol, especially folds in the groin, armpits, and under the mammary glands in women. Do not forget to wash the patient’s hands with soap before each meal and shortly cut the nails on his hands and feet. After any wet treatment, wipe the skin with a clean and dry towel. Patients of moderate severity are washed at least 1 time per week in a bath or shower in accordance with the recommendations of a doctor. The bath is filled to half with water at a temperature of 35–37 ° C. The patient is helped to wash his head, back, etc. When washing in the shower, the patient is seated on a bench or stool, while a flexible hose is used. Severe, weakened patients are washed in bed, placing an oilcloth under the sheet.

Washing is carried out in parts, using a sponge, warm water and soap, first the upper half of the body, then the stomach, hips and legs.

An important task of home care is prophylaxis, which can occur in seriously ill patients most often in the sacral region, less often in the area of \u200b\u200bthe shoulder blades, heels, nape, buttocks and in other places where soft tissues are squeezed between the bone and the bed.

To prevent bedsores, it is necessary to change the position of the patient in bed every 2 hours; wash the possible places of the formation of pressure sores with warm water and soap, and then wipe with camphor alcohol; to make a bed carefully so that there are no folds and crumbs on the sheet; to improve blood circulation in the limbs, make passive or (better) active movements; in case of reddening of the skin, wash this place and grease it 1-2 times a day with a 5-10% solution of potassium permanganate, put an inflatable rubber circle so that the bedsore is above the opening of the circle and does not touch the bed.

It is important to maintain a neat appearance for the patient. It is recommended to cut the patient briefly and shave daily. Many can shave with an electric razor on their own. Hair needs to be combed daily. Rinse eyesbetter with a ball of sterile cotton soaked in a solution of boric acid (1 tsp. in a glass of warm boiled water). When appearing in the earsaccumulations of earwax should be instilled into the external auditory meatus several drops of a warm 3% solution of hydrogen peroxide, and then carefully dry the ear with a cotton flagellum. In difficulty nasaldue to the formation of dry crusts, a flagellum with boron vaseline or vegetable oil is introduced into the nostril - this causes softening and falling of the crusts.

For bedridden patients, the intestines and bladder in bed are freed using an urinal and a vessel, and an enema is given if necessary. It is important to keep hygiene items clean and serve warm. If urination or defecation is delayed, consult a doctor. Each person caring for the patient should be able to correctly measure and evaluate the temperature, pulse rate and respiration.

Temperaturebody normally ranges from 36 ° C in the morning to 36.9 ° C in the evening. With the disease, it can both increase and decrease. An increase in temperature (fever) is usually accompanied by headache, malaise, a feeling of aches in the body, there may be chills and excessive sweating. With a decrease in temperature, sharp weakness and cooling of the skin are usually observed. The increase in temperature matters, even by a few tenths of a degree.

Before measuring the temperature, the thermometer is shaken vigorously so that the column drops to a level of 35 ° C. Then it is placed in a dry armpit. The patient presses his shoulder to the chest and holds the thermometer for 8-10 minutes. After use, the thermometer should be wiped with alcohol or cologne and placed in a case.

The temperature is usually measured 2 times a day, at 8 and 19 hours. In severely weakened patients, as well as in children, it is sometimes necessary to measure the temperature in the anus. For children, the end of the thermometer is lubricated with petroleum jelly and injected to a depth of 2-3 cm. It should be noted that the temperature in the rectum is 1 ° C higher than in the armpit. With a significant and rapid increase in temperature, chills are sometimes observed, the skin turns pale and cold. In this case, the patient should be put to bed, covered with warmth, warmed with heating pads, given hot tea, a tablet of acetylsalicylic acid (aspirin). In the case of a rapid (critical) drop in temperature with profuse sweat and weakness, you should wipe the patient’s body dry and change underwear, give strong hot tea.

To determine the pulse, the tips of the index, middle and ring fingers of the right hand are easily pressed at the beginning of the forearm from the side of the thumb, find the pulsating artery and count the number of strokes in 15 s, multiply the found value by 4. With some skill, you can establish the nature of the pulse (correct or irregular full or small).

To count the number respiratory movementsyou should put your palm to the epigastric region, count the respiratory movements for 30 s, multiply the resulting number by 2. When assessing the heart rate and respiration, it should be borne in mind that it naturally increases after physical exertion, excitement, in case of febrile conditions. Therefore, the calculation of the pulse and respiration is carried out in a state of complete rest, before performing any procedures. With a temperature increase of 1 ° C, the pulse rate increases by 8–10 beats, respiration - by 3-4 times per minute. You should know that in a healthy adult at rest, the pulse rate does not exceed 70–80 per min, and respiration - 14–18 per min. Data on daily measurements of temperature, pulse and respiration should be recorded, this will help the attending physician. In the presence of edema, the amount of liquid drunk (including in the form of soups, jelly, fruits, etc.) and the amount of urine excreted (diuresis) per day should be measured.

Basic Technique

The caregiver should know the technique for performing basic procedures.

Banksmedical cause a rush of blood to the skin, distracting it from internal tissues and organs, and contribute to the reduction or elimination of inflammatory processes in them.

Before putting the cans, the skin is lubricated with liquid paraffin, so that they better stick, and also to avoid burns. A cotton swab on a metal stick is moistened with alcohol, lighted and inserted into the cavity for 1-2 seconds to dilute the air in it, then quickly remove the burning swab and immediately press the jar tightly against the skin. Banks are placed one after another every 3-4 cm. Then the patient is covered with a blanket and left for 10-15 minutes.

The cans are removed as follows: with the fingers of one hand press the skin near the very edge of the can, and the other slightly deflect it in the opposite direction, after which it easily disappears. Banks are effective only when their good suction is ensured and when they cause severe reddening of the skin due to hemorrhage.

In satisfactory condition, the patient takes general hygienic baths in a half-sitting position, immersed in water to the upper chest. Bedridden patients can do local baths (for arms, legs). The water temperature should be 36–38 ° C, the duration of the bath should not exceed 30 minutes. Weakened patients are washed in the shower.

Bathtubsmedicinal are taken only as prescribed by the doctor. They can be simple (fresh) and complex, with the addition of various salts, gases, liquids. Simple baths - of an indifferent temperature (34–36 ° C), lasting 10–15 minutes - act as a refreshing or tonic procedure. Warm baths (37 ° C) lasting 30 minutes or more have a calming effect, contribute to the onset of sleep, they are indicated for increased irritability, neurosis, and some skin diseases.

Longer warm baths (up to 1 hour) are useful for chronic bronchitis, kidney disease, bronchial asthma. In this case, a constant water temperature should be maintained.

Warm (38–39 ° C) and hot (40–42 ° C) baths cause increased perspiration, enhance metabolism, and relax smooth muscles. They are prescribed for obesity, gout, some chronic diseases of the joints and nerves, with liver and kidney failure, colic and only in the absence of diseases of the cardiovascular system and active inflammatory processes. Common cold baths (20 ° C) dramatically excite the nervous system and enhance heat transfer. This is a tempering procedure for healthy people who are accustomed to the cold.

It should be borne in mind that both hygienic and therapeutic baths are far from indifferent to the body procedure. They are prescribed by the doctor, indicating the temperature, duration, frequency and method of administration.

Mustard plasters- sheets of paper coated with a thin layer of mustard powder. Mustard plasters are moistened with warm water and firmly applied to the skin on the side where the mustard is spread, tied with a towel and covered with a blanket.

The duration of the procedure is about 10–20 min until a clear manifestation of skin irritation (burning, redness) occurs, without leading to burns and blistering. Mustard plasters can be prepared by themselves, using a mixture of equal parts of mustard powder and flour, diluted with warm water to a mushy mass. The last is spread between 2 layers of a clean, dense cloth or paper. After removing mustard plasters, the skin should be wiped with a wet swab, and with severe irritation, lubricate with petroleum jelly.

Mustard plasters cause skin irritation, a rush of blood to it, which reduces pain and helps to calm the inflammatory process. Mustard plasters are used for bronchitis, pneumonia (on the chest), hypertension (on the back of the head), and muscle pain. They are contraindicated in skin diseases.

Heating padthey do not completely fill with hot water and squeeze out air before screwing the cork, which ensures its best fit to the surface of the body. Check to see if water is leaking. To avoid swelling, the heating pad is wrapped with a towel or other cloth. Typically, heating pads are applied to the arms or legs with a sharp cooling of the body, chills, or as a distraction, for example, with toothache, high blood pressure.

Instead of a heating pad, you can use hot water bottles. You can use special electric heating pads.

Inhalation- inhalation for therapeutic purposes of various substances in a vaporous, liquid or suspended state.

At home, in the absence of an inhaler, simple steam inhalation can be carried out as follows. Boiling water is poured into an open vessel, the patient leans over it so as not to burn his face, covers his head with a towel or napkin, and breathes vapors for 5–10 minutes.

In boiling water, you can add a few drops of turpentine, eucalyptus oil or other aromatic substances. This procedure is recommended for inflammatory diseases of the respiratory tract, bronchitis. For inhalation of drugs, pocket inhalers or aerosol bottles are used. In any case, it is important that the moment of spraying exactly matches the act of inspiration.

Oxygen pillow- a rubberized bag equipped with a rubber tube with a tap and mouthpiece. Before supplying oxygen, the mouthpiece is wiped with alcohol, wrapped with gauze soaked in water and pressed to the patient's mouth. The oxygen supply is regulated by a tap and pressure on the pillow. The duration of the procedure is 5-10 minutes with interruptions. When using a pillow, large losses of oxygen inevitably occur.

Enemasused to cleanse or flush the intestines. Cleansing enemas are done for constipation, food and other poisonings, in preparation for an X-ray examination of the gastrointestinal tract.

For an enema, a metal, glass or rubber vessel with a capacity of 1.5–2 l with a rubber tube 1–1.5 m long, usually ending with a plastic tip with a tap or clamp, is used. Pure warm water with a temperature of 25–30 ° C in the amount of 4–6 glasses (800–1200 ml) is poured into a vessel, raised to a height of 1–1.5 m. The tip is lubricated with petroleum jelly or glycerin, the tap is opened to let out a little water and air from a rubber tube. The patient lies on an oilcloth on his left side at the edge of the bed, pulls his legs to his stomach. The edges of the oilcloth are lowered into a nearby bucket or basin. The buttocks are pushed apart with the fingers of the left hand, and the tip is carefully inserted with the right hand through the anus into the rectum to a depth of 6-8 cm. At the same time, it is first introduced at an acute angle in the longitudinal axis of the body, and then along it.

When the tip is inserted to the proper depth, a tap or clamp is opened and water enters the intestine. The vessel with water is lifted up gradually so that water is not introduced into the intestine too quickly. During the introduction of the liquid, there may appear urges to the bottom, and sometimes mild abdominal pains.

The patient should be warned in advance about the need to retain water in the intestine for several minutes, so that it can enter the overlying sections of the large intestine and soften the feces for as long as possible.

If fluid intake is difficult, you need to enter the tip deeper and try different heights for lifting the mug. After an enema, the tip is washed and boiled. For chronic constipation and solid feces, enemas are made from vegetable oil (sunflower, linseed or provence), which in the amount of 50-100 ml is injected into the rectum using a rubber bulb. Such an enema is usually done at night, counting on the appearance of a stool in the morning.

Enema can be used for therapeutic purposes for the introduction of various medicinal substances for diseases of the lower intestine or for general effects on the body, for example, with persistent vomiting, unconsciousness, with the aim of introducing nutrient fluids (glucose solution, sodium chloride). Enemas cannot be given for certain diseases of the rectum, bleeding hemorrhoids, bleeding from the intestines and abdominal pain. In these cases, consult your doctor.

Compressescan be dry, wet (cold or warming) and medicinal.

A dry compress, consisting of several layers of gauze or non-absorbent cotton, is used to protect the affected part of the body from cooling or other effects.

A cold wet compress is a soft tissue folded several times soaked in cold water, which is applied for 2-3 minutes to a sore area of \u200b\u200bthe body: to the head (with headache), to the heart region, stomach, more often with bruises. As the compress warms, it is changed.

For a warming compress, a folded cloth or towel is moistened with room temperature water, applied to a sore spot, covered with wax paper or oilcloth, and then with a thick layer of cotton wool, a woolen shawl or a jar. Each layer should be larger than the previous one and completely cover it. Such a compress should be tightly bandaged to the body so that it does not move, but also does not constrain the patient. The duration of the procedure is 10-12 hours. After removing the compress, the skin should be warm and moist, it should be wiped dry. You can reapply the compress after an hour.

With a large compress, for example on the chest or abdomen, the patient should always be in bed. Instead of water, you can use vodka or alcohol, but they dry out faster and require a more frequent change. With a warming compress, the blood vessels dilate and, consequently, the blood flow increases not only to the skin, but also to the underlying tissues, which contributes to the resorption of inflammatory processes and the relief of pain.

Rubdown- medical and hygienic procedure. A piece of coarse cloth or a rubber sponge soaked in water at a temperature of 30–32 ° C, weakened patients in parts successively (hands, chest, stomach, legs), then quickly rubbed with a moistened surface, then rubbed with a dry towel until it feels warm. Gradually, the water temperature can be reduced to 20–18 ° C. Apply this procedure in the recovery period, with neurasthenia.

For therapeutic, prophylactic and hygienic purposes mouth rinseclean water.

When the tongue is coated, the accumulation of mucus is better to use weak alkaline solutions (for example, 1 tsp. Soda in a glass of water). In inflammatory diseases of the tonsils or oral mucosa, various disinfectant solutions are used: potassium permanganate (2 crystals per glass of water), hydrogen peroxide (1 tbsp. Per glass of water).

With severe inflammation, it is better to irrigate the oral cavity from a rubber balloon under slight pressure. In this case, the patient should tilt his head slightly forward so that the liquid does not enter the airways. A seriously ill patient is wiped daily with an oral cavity, tongue, gums, teeth with a piece of cotton wool wound on the handle of a spoon and moistened with warm water or a solution of soda (1 tsp. In a glass of water).

For gastric lavageat home, the patient is given 5-6 glasses of water to drink, then, irritating the posterior wall of the pharynx with the introduction of a finger, they cause vomiting. This procedure can be repeated several times in a row.

After washing, rinse your mouth and give the patient a few sips of hot tea.

Gastric lavage is contraindicated in cases of gastric bleeding, severe abdominal pain, heart and coronary insufficiency, and high blood pressure. An exception is acute poisoning, which threatens the patient's life.

Ice bubble, snow or cold water is used for bruises, inflammatory processes, bleeding. They put it on his head, stomach and other places: put a towel under the bubble. Hold for 20-30 minutes, after which they take a break for 10-15 minutes.

The bubble should not be filled to the brim, by twisting the cork, air should be squeezed out of it, then it will fit more tightly to the body.

Shipthere are enameled, earthenware and rubber. The latter is inflated with air through a special hole in a metal frame, which is treated with alcohol. They are most convenient.

Before use, the vessel is heated, a little water is poured into it and rinsed to facilitate subsequent washing of the vessel. A hand is brought under the sacrum of the patient, they raise it a little (if the patient cannot do it himself) and quickly bring the vessel with a flattened end to the sacrum. After use, the vessel is washed with hot water, and if an intestinal infection is suspected, it is disinfected with a 2% solution of lysol (13% solution of chloramine or 12% solution of bleach).

Patient Nutrition

When organizing meals for patients at home, you need to determine the following:

1) the required number of food components (proteins, fats, etc.);

2) an appropriate set of foods;

3) the nature of the cooking;

4) the time, frequency and method of eating.

The body needs a physiological ratio of proteins, fats and carbohydrates. It is believed that under the conditions of bed or half-bed regimes, the need for food is approximately 30–35 kcal per 1 kg of body weight, of which 60% are carbohydrates, 15% are proteins and 25% are fats. Almost 1 kg of body contains 1 g of proteins and fats and 5-6 g of carbohydrates.

Depending on the nature of the disease, the ratio of proteins, fats and carbohydrates and the set of food products may vary. This also applies to the amount of fluid (about 1.5 l) and salt (8-10 g), which is limited in the presence of edema, obesity, high blood pressure. According to indications, food is taken in liquid, semi-liquid or puree form, excluding irritating or poorly digested products. The regularity of food intake and the correct quantitative and qualitative distribution of the daily diet are important. The most rational is 4 meals a day with 3-4 hour intervals, every day at the same hours. Such nutrition contributes to the formation of a conditioned reflex, improves appetite, digestion and assimilation of food. Proper organized nutrition of the patient in accordance with the recommendations of the doctor not only meets the needs of the body, but is also an active means of influencing the course of the disease.

Home care for major diseases of the internal organs

Respiratory diseases

The main diseases of the respiratory system are bronchitis, pneumonia, abscess, bronchial asthma (BA), malignant neoplasms. After discharge, many patients need aftercare. During this period, it is necessary to observe a hygienic regimen. Sleep should be sufficient, nutrition varied and complete. Hygienic gymnastics is required, including breathing. The simplest breathing exercises are lengthening and enhancing inspiration. It is important to stop smoking, because it contributes to the development and aggravates the course of chronic lung diseases.

Monitoring the patient includes measuring the temperature and determining the frequency of respiration and pulse, collecting and monitoring the nature of sputum, and in the presence of edema, measuring the amount of fluid drunk and excreted urine (daily urine output).

Coughusually occurs with irritation of the bronchi, larynx, trachea, their inflammation, the presence of mucus or the ingestion of a foreign body. It can be dry or wet, with the release of various amounts of mucous or purulent sputum. With thick, poorly expectorant sputum, you can recommend drinking warm alkaline mineral water or hot milk with soda (0.5 tsp. Soda per glass of milk) or honey.

With abundant liquid sputum, the patient should be given less liquid, and also give him for 20-30 minutes 2-3 times a day in such a position that a cough occurs and the accumulated sputum is removed. A small hemoptysis usually does not require any emergency measures, but you need to inform your doctor about it. With abundant hemoptysisor sudden pulmonary hemorrhage, you must immediately call an ambulance.

So that the patient does not suffocate, and the spilled blood does not enter the neighboring bronchi and lung areas, before the doctor arrives, the patient should be laid on his stomach, the foot end of the bed should be raised 40-60 cm, while the patient’s legs should be tied to the back of the bed so that he crawled, you need to keep your head on weight.

At shortness of breaththe patient should be given a half-sitting position, open a window or window, free his chest from constraining clothes and heavy blankets. If possible, use an oxygen pad. Coughing and shortness of breath, as well as chest pain, are alleviated by setting up jars or mustard plasters, the use of which should be alternated.

With a significant increase in temperature, the patient may experience severe headache, anxiety, even delirium. In this case, put an ice bubble on your head, use cold compresses. With a sharp chill, the patient needs to be covered and overlaid with warmers. With a rapid decrease in temperature and increased sweating, it is necessary to change bed linen more often, to water the patient with strong hot tea.

At pleuritefluid often accumulates between the pleura sheets, while pain appears, intensifying with deep breathing, coughing, body movement, shortness of breath. In such cases, the condition is eased in a half-sitting or lying position on the sore side.

Bronchial asthma- A respiratory disease of an allergic nature associated with an increased sensitivity of the body to various substances of plant, animal, including microbial, or inorganic origin.

At home, a patient with asthma needs particularly strict hygienic conditions. From his room you need to remove everything that can cause allergies: pillows and feather-beds from feathers and down, flowers, cologne, perfumes, eliminate kitchen odors, stop smoking. The room where the patient is located should be well ventilated, cleaned only with a wet method, often change bedding. Of great importance is breathing exercises.

What to do with an attack of asthma?

To seat the patient, to ensure the flow of fresh air (open the window, window), give oxygen, you can put mustard plasters, make hot foot baths.

It is very important to take the medicine recommended by your doctor in a timely manner. When using inhaled drugs, usually 1-2 inhalations are sufficient. Longer use of the medicine can be dangerous. If there is no effect, you should call a doctor.

When caring for a patient with tuberculosis, personal and public hygiene measures should be followed. It is necessary to ventilate the patient's room more often, to carry out cleaning only in a wet way. A tuberculosis patient should have a separate towel, linen, dishes, which should be washed and washed separately. The patient's sputum should be collected in a closed cuspidor and disinfected with a 2% chloramine solution.

Circulatory diseases

The most common diseases of the circulatory system are atherosclerosis, arterial hypertension, coronary heart disease (CHD), rheumatic heart disease, which may be accompanied by heart failure of varying degrees and shapes and other serious complications. The main symptoms of this disease: heart pain, palpitations, interruptions, shortness of breath, swelling, headache, dizziness.

The caregiver should be able to count the pulse and determine its basic qualities, count the number of breaths and ensure their registration. Blood pressure numbers should be recorded. With heart failure, it is necessary to measure the daily amount of drunk fluid and excreted urine daily. It is necessary to pay attention to possible changes in the skin (blue, redness, pallor).

Ischemic heart diseasemanifests itself in the form of periodic attacks of pain in the region of the heart (angina pectoris, angina pectoris) or myocardial infarction with impaired heart rhythm and the development of heart failure.

With coronary heart disease, it is necessary to achieve a hygienic regime of work and life, weight loss in obesity, eliminate smoking and treat hypertension. With excess body weight, the calorie content of the daily diet should be limited, primarily due to easily digestible carbohydrates, as well as due to animal fats. It is advisable to hold fasting days (milk, fruit).

When combining obesity with high blood pressure, it is recommended to limit salt and fluid. It is necessary to monitor the patient's body weight, periodically weighing him. It is important that the patient has regular stools, timely sleep. To facilitate intestinal activity, vegetable fiber (brown bread, vegetables, prunes) is included in the diet, light laxatives (isafenin, purgen) can be used, and, if necessary, cleansing enemas. Along with this, careful motor training should be carried out in accordance with the instructions of the doctor. The fulfillment of all types of loads should take place primarily under self-control: the appearance of pain, shortness of breath or palpitations should serve as a signal to stop the load.

First aidin case of an attack of pain in the heart region to the patient - complete physical and psychological rest, immediately give nitroglycerin under the tongue, put to bed.

Additionally, you can put mustard plasters on the heart area, as well as a heating pad to the left shoulder blade or hand, the left hand can be lowered into hot water. Usually an attack of angina pectoris lasts 10-15 minutes. With a more prolonged attack of severe pain and inefficiency of ordinary measures, it is necessary to call an ambulance, because in these cases, myocardial infarction may occur. Patients with suspected myocardial infarction are subject to urgent hospitalization in special intensive care units.

At hypertensionthe level of blood pressure largely depends on the functional state of the central nervous system, as well as on physical activity.

Patients with hypertension need primarily neuropsychological rest and sufficient sleep. They are prescribed a diet with a restriction of salt and liquid, fasting days, smoking is prohibited.

With a sharp increase in blood pressure, which is accompanied by headache, dizziness, tinnitus (hypertensive crisis), you need to go to bed, the head end of the bed should be raised.

You can make hot foot baths with a variable temperature (2 basins), and put mustard on the back of the head. You can take previously prescribed medications and then call a doctor.

Heart failurecan develop with various diseases, including with coronary heart disease, heart defects, chronic lung diseases. Patients with chronic heart failure, in addition to treatment, require serious care. It is necessary to create conditions for ensuring the activity of the heart: physical rest and reduction of edema. Sometimes you need a long bed rest in a comfortable position with a raised headboard and emphasis for legs. Peace should not be absolute. To prevent pressure sores, congestive pneumonia, and blockage of blood vessels from the first days of the disease, it is often necessary to change the position of patients in bed. Patients need careful skin care and regulation of bowel activity.

In the room where the patient is, there should be clean fresh air. In the fight against edema and fluid congestion in the internal organs, diet and drinking are of great importance.

The diet should be sufficiently high-calorie, easily digestible, but with the inclusion of plant fiber, a high content of vitamins and a limitation of salt and fluid. Food should contain foods rich in potassium salts (potatoes, cabbage, dried apricots, figs) and calcium (milk and dairy products), which have a diuretic effect. Partial nutrition is advisable - 5-6 times a day. Against the background of chronic heart failure, acute heart failure can develop, which manifests itself in the form of attacks of cardiac asthma or pulmonary edema.

In the event of a severe attack of suffocation, accompanied by bubbling breathing, fast, often irregular, pulse, the patient takes a forced position while sitting or half-sitting. In such cases, you must immediately call a doctor and provide first aid: seat the patient, unfasten clothing, open a window or window. For pain in the heart, give nitroglycerin, an oxygen pillow. In other cases, acute vascular insufficiency (collapse, shock) may occur. Shock, which can be a complication of the early stage of myocardial infarction, is expressed by lethargy, lethargy, pallor, cyanosis and cooling of the extremities, a cold, shallow sweat, a frequent weak pulse.

This condition also requires the help of a doctor. Before his arrival, the patient should be put to bed, warm him - give a hot drink, a heating pad to his feet, try to calm him down.

At arterial hypotension, often a manifestation of general neurosis, if there are no other diseases, tonic measures are recommended: a cold shower, rubdowns, hygienic gymnastics, staying in the fresh air, taking measures to improve appetite.

Diseases of the gastrointestinal tract and liver

The main diseases of the digestive system are chronic gastritis, peptic ulcer of the stomach and duodenum ( Jabzh), chronic intestinal diseases and malignant neoplasms, as well as diseases of the liver and biliary tract.

With these diseases, the main thing is proper nutrition, which is achieved by various types of diets, regular food intake.

Patient Nutrition gastritismust be differentiated. In all cases, mechanical gastric sparing is required - cooking in crushed, puree or semi-liquid form with the exception of coarse, indigestible products.

With a reduced secretion of gastric juice, food should contribute to its increase, therefore, the diet includes meat and fish broths, meat, fish, soaked herring, some seasonings (in limited quantities).

With increased secretion, the diet is built, as for patients with UBI (see below). Various mineral waters affect the secretion and acidity of gastric juice - lower or increase them. In the first case, they should be taken long before meals (1–2 hours), in the second - 15–20 minutes before meals.

Treatment of ulcer disease requires compliance with bed rest and diet with mechanical, chemical and thermal gastric sparing, fractional food intake. In addition, various medications (antacids) are used. Such treatment is carried out mainly in a hospital.

The diet at home already provides for gentle mechanical and chemical sparing, food is cooked, mainly in the form of mashed dishes, 5–6 times a day, with the restriction of salt to 7–8 g. White and gray wheat bread in dry form is allowed , crackers, dairy, cereal and boiled soups, steam cutlets, boiled chicken and fish, mashed potatoes and pudding, soft-boiled eggs, milk and dairy products, sweet fruit varieties. Coarse vegetable fiber is limited, fried foods, strong broths, spices, and coffee are excluded.

As the patient's condition improves, the diet expands, but regular meals and the exclusion of spicy foods, pickles, alcohol and smoking are always necessary. It is very important to observe a diet, sleep should be calm and sufficient, bowel activity - regular. The patient needs to create mental peace. If there is pain in the epigastric region, you can put a warm heating pad (if in the past there were no bleeding), a warming compress. For prolonged and severe pain, consult a doctor. The most severe and excruciating pains are observed during perforation of a stomach ulcer: there is a paroxysmal dagger pain, accompanied by tension in the abdominal muscles. The patient should be placed in bed half-sitting, with legs bent at the knees and urgently calling a doctor.

When vomiting the patient, it is better to plant, substituting the pelvis, after vomiting, give water to rinse the mouth. Vomit should be left before the arrival of the doctor.

The main signs of chronic bowel disease are diarrhea or constipation, abdominal pain, rumbling, transfusion.

With diarrheait is necessary to maintain a clean body and linen, the patient’s bed. With an exacerbation, such a patient needs a diet according to the type of diet for YBJ.

With the predominance of fermentation processes, they mainly use a protein diet (boiled fish or steam dishes from lean meat, poultry, cottage cheese) with a restriction of carbohydrates.

With putrefactive dyspepsia for 2–3 days, a carbohydrate diet is prescribed (cereals, flour products, potatoes). With profuse watery diarrhea, limitation of fluid and salt is required. You should exclude milk, vegetable fiber (vegetables, brown bread, mushrooms), spices, pickles, raw juices, meat of ducks, geese, lamb. As the condition improves and the diarrhea stops, the diet expands. Uncrushed meals, raw sweet berries, fruits are allowed. All these measures for diarrhea are carried out at home only if a medical examination reliably excluded intestinal infections (dysentery, salmonellosis).

To combat constipationin addition to medicines, laxatives, and enemas, the following measures may be recommended. With constipation of atonic nature - morning exercises, sports, exercises to strengthen the abdominal press, the fight against obesity.

It is advisable to include foods rich in plant fiber (vegetables, prunes) in food. The absence of stool for more than 2 days should not be allowed. In this case, a laxative or cleansing enema should be used. With spastic constipation, often accompanied by pain, thermal procedures on the abdomen (heating pads, warming compresses) are advisable.

With severe paroxysmal pain in the abdomen (intestinal colic), you must call a doctor.

Chronic liver disease(chronic hepatitis and cirrhosis) are the result of inflammatory lesions of the liver of an infectious nature or eating disorders, alcoholism. Treatment and care are aimed at stopping the inflammatory process, sparing the liver, improving the function of liver cells and bile ducts.

This is achieved by an appropriate diet: limiting animal fats, increasing carbohydrates and vitamins. Soups of vegetables, cereals, dairy or fruit, boiled lean meat, fish, vegetables, greens, fruits, honey, milk and dairy products are recommended. In the presence of ascites and edema, a restriction in the diet of liquid and salt is required, an increase in the content of high-grade proteins in a well-digestible form.

You should monitor the regularity of intestinal activity, as well as ensure a sufficient outflow of bile from the liver and biliary tract, for which, among other choleretic, you should take a solution of magnesium sulfate in the morning. Be sure to exclude alcohol, fried and spicy dishes. With pain in the liver, heat can be used (heating pad). Observe the color of urine and feces. The appearance of intensely colored urine (the color of beer) and light feces indicates a delay in bile pigments and incipient jaundice.

Of the chronic diseases of the biliary tract, the most common chronic gallbladder inflammation and gallstone disease.

Patient care is aimed at preventing spasms of the smooth muscles of the bladder and ducts and, consequently, pain attacks; improving the outflow of bile, inhibition of bile formation and increasing the body's resistance. For this purpose, use a diet similar to the diet for liver diseases.

In gallstone disease and obesity, it is necessary to limit the calorie intake due to not only fats, but also carbohydrates. To improve the activity of the gallbladder, the intake of vegetable oil and mineral water is mandatory. It should include the inclusion of products with a laxative effect (vegetables, prunes), as well as containing vitamins.

Along with this, it is necessary to exclude fried and fatty dishes, smoked meats, spicy seasonings. The patient needs adequate sleep, stay in the fresh air, hygienic gymnastics. With an attack of hepatic colic, the patient must observe strict bed rest, occupy a comfortable position in bed. The usual position is half-sitting, with legs bent at the knees. You can apply thermal procedures (heating pads, warming compresses). If you have a protracted attack, you should call a doctor.

Kidney and urinary tract diseases

Nephritis- An inflammatory kidney disease in the origin of which streptococcal infection (tonsillitis, tonsillitis) and altered body reactivity are important. The disease can take a chronic course with periodic exacerbations. The main goal of care is to prevent an exacerbation of the inflammatory process, increase the body's resistance, take measures to eliminate edema and reduce blood pressure. During the period of exacerbation, bed rest is necessary, which reduces the level of metabolic processes and provides uniform and constant heat. Without exacerbation, the regime is free.

Particular attention should be paid to the prevention of colds: dress accordingly to the weather, avoid drafts, communicate with patients with the flu, tonsillitis.

In the presence of foci of chronic infection (tonsillitis, carious teeth), treatment is necessary. Nutrition in the absence of renal failure should be complete and varied, with the obligatory inclusion of products containing vitamins. In the presence of edema without an increase in blood pressure, but a high protein content in the urine, the patient requires an increased amount of complete protein (meat, fish, cottage cheese). Periodic urine tests and blood pressure measurements are needed.

With the development of renal failure (uremia), which is manifested by a deterioration in appetite, dry mouth, nausea, vomiting, headache, weakness, lethargy, the patient is hospitalized. However, in some cases, this condition can be observed for a long time, even for years, which requires certain knowledge of caring for such a patient at home. In these cases, the patient is shown bed rest.

To reduce the formation of toxic products of protein metabolism, a sharp restriction of the protein content in food is necessary, up to about 0.5 g per 1 kg of body weight. Food should mainly consist of fats and carbohydrates. To improve the excretion of toxic products by the kidneys, in the absence of edema and high blood pressure, a heavy drink (water, mineral water, juices) should be given up to 2-3 liters per day, adding baking soda to it (10-20 g per day). Toxic products are also secreted through the mucous membrane of the gastrointestinal tract, therefore it is advisable to regularly rinse the stomach, put enemas, give the patient saline laxatives. In the absence of edema, salt can not be limited.

Chronic pyelonephritis- inflammation of the urinary tract with subsequent transition to the renal tissue. The development of the disease is facilitated by all conditions in which the outflow of urine is impaired.

To prevent exacerbation of the inflammatory process, hypothermia should be avoided, as well as regularly washing the perineum. It is necessary to monitor timely urination. To facilitate the act of urination, you can use heating pads on the lower abdomen, general or local thermal baths, enemas from warm water. Sometimes the urine reflex is caused by the sound of a jet flowing from a tap. If these measures are ineffective, it is necessary to seek medical help for catheterization of the bladder. Sometimes the opposite phenomenon of urinary incontinence is observed. In such cases, a glass urinal (for men) or a rubber vessel (for women) should be used in bed, washed thoroughly at least 3-4 times a day with warm water and soap.

For walking patients, there are urinals made of elastic material.

Kidney stone diseasemay be the result of a violation of the outflow of urine, metabolic disorders, especially mineral, malnutrition.

The diet prescribed by the doctor is important for the treatment. It depends on the chemical structure of the stones.

With oxalaturia (the presence of oxalates in the urine), sorrel, spinach, beets, beans, parsley, plums, strawberries, gooseberries, tea, coffee, cocoa, chocolate should be excluded.

In the presence of urates (salts of uric acid), meat, fish and dairy products, broth and sauces, mushrooms, legumes are limited. In addition, urine may have an acidic or alkaline reaction, which requires the use of either oxidizing (lemons, hydrochloric acid, sour berries and fruits), or alkalizing (soda) agents.

With renal colic, thermal procedures are done, hot compresses and heaters for the lumbar region, general hot baths, if there are no contraindications. With a prolonged attack of pain, you should call a doctor.

Endocrine system diseases

Diabetesdevelops due to a lack of pancreatic hormone insulin in the body, which leads to impaired absorption of sugar (glucose) by the liver and tissues and an increase in its content in the blood and urine.

In the treatment of diabetes mellitus (DM), a large role is played by diet and monitoring the state of water and carbohydrate metabolism. With a mild course of the disease, especially in middle-aged and elderly patients with increased body weight, treatment with one diet is possible. In this case, a restriction of fats and especially carbohydrates is required (2-3 times less than normal). Sugar, sweets and confectionery are excluded. Sugar is replaced with other substances with a sweet taste (sorbitol, xylitol). In sufficient quantities they give meat, fish, milk and dairy products, vegetables (preferably boiled), unsweetened fruit varieties, butter, and restrict bread, potatoes and cereals.

When disease compensation is achieved, the diet is gradually expanded, but in any case, its calorie content should not exceed the values \u200b\u200bcorresponding to the proper body weight and type of daily activity. When drug treatment is turned on, the diet for patients with moderate to severe diabetes and with a severe course of the disease should comply with the physiological norm (see “Nutrition for Patients”), but with the exception of easily digestible carbohydrates (sugar and sweets).

In all cases, regular nutrition should be provided, and insulin injections must be done exactly at the time indicated by the doctor.

With any treatment for patients with diabetes, systematic monitoring of sugar in the urine is necessary. The deterioration of carbohydrate metabolism is evidenced by an increase in thirst for the amount of fluid drunk and excreted urine, the appearance of weakness, lethargy.

The motor regime of a patient with diabetes with a mild course and the absence of complications is not limited. Moderate physical work and exercise are even beneficial, because they contribute to better absorption of sugar. With diabetes, there is a decrease in the patient's resistance to infection. Most often, the skin and mucous membranes suffer.

Much attention should be paid to body hygiene (regular washing with hot water and soap, washing), especially in the area of \u200b\u200bphysiological folds, including under the mammary glands. Patients with diabetes require special attention for various types of congestion (pregnancy, childbirth, acute diseases, operations), which can lead to the development of coma.

Hyperglycemic comadevelops with a lack of insulin, more often with improper treatment. It is characterized by slow development, usually within a few days: increasing weakness, lethargy, drowsiness, headache, nausea, vomiting, dryness and cooling of the skin, muscle weakness, appetite worsen, there may be a smell of acetone (ripe apples) from the mouth, in subsequent - impaired consciousness. This condition requires emergency medical attention.

At home, you should give the patient as much fluid as possible, including alkaline drink (add soda). The main method of treatment is the administration of insulin under appropriate control.

Another type of coma is hypoglycemic coma- develops with an overdose of insulin or physical overload. At the same time, the blood sugar level sharply decreases, which immediately affects the state of the central nervous system: suddenly there is a feeling of hunger, chills, profuse sweat, the face turns red and loss of consciousness develops.

Acute development and moist skin distinguishes this condition from hyperglycemic coma. In this case, help depends primarily on the patient himself or others. A timely piece of sugar, sweet tea or bread completely and quickly restore the patient's well-being.

Each patient with diabetes should always keep a certificate of illness and treatment received among his personal documents. In addition, the patient should always have a few pieces of sugar or cookies with him in order to take them at the first sign of a hypoglycemic condition. When treating with insulin, you should not skip the usual meals.

Rheumatism and joint diseases

Rheumatism is an inflammatory disease of an infectious-allergic nature.

The causative agent of it is streptococcus, so the disease often occurs (or worsens) after a sore throat, upper respiratory tract disease or other focal infection.

The main task in rheumatism is to prevent a return (relapse) and further progression of the disease.

This requires the elimination of all foci of infection, good nutrition, careful hardening, avoidance of hypothermia, drug prevention. In chronic joint diseases after the elimination of exacerbation, which is carried out in a hospital, the main task of care is pain relief, further restoration of joint function and prevention of exacerbations. In addition to medical treatment, pain relief is achieved by the convenient and physiological position of the limbs in bed and the use of thermal procedures (heating pads, warming compresses). The restoration and development of the functions of the affected joints is the second important area of \u200b\u200bcare. For this, it is necessary to carry out gymnastics of the joints: first passive, then active movements of the joints and atrophic muscles. As the condition improves and the inflammatory process is eliminated, the patient must walk, fully service himself. Massage is recommended to prevent muscle atrophy.

Diet is important for metabolic-dystrophic polyarthritis and is aimed at reducing body weight and eliminating metabolic disorders. For example, with gout, it is necessary to limit the calorie intake and exclude foods rich in purines (liver, brain, kidneys, sprats, fried meat and fish, broths, sorrel, spinach, mushrooms, legumes).

Caring for a sick child

The first sign of any disease in a child is a change in his behavior. There is lethargy, drowsiness or anxiety, agitation, the child cries, refuses to eat. Most often, children have fever, cough, runny nose, gastrointestinal upsets - abdominal pain, nausea, vomiting, diarrhea or constipation.

For any disease, it is necessary to call a doctor at home; you cannot carry a sick child to the clinic. Before the doctor arrives, put the child in a clean, warm bed, isolate him from other children and measure the temperature. In young children, the temperature is best measured in the anus. With diarrhea and vomiting, you can only give your child boiled water or tea, and infants with expressed breast milk. Remember that a timely visit to a doctor allows you to make the correct diagnosis, prevent complications and reduce treatment time. A sick child often has a poor appetite, so he is fed more often, choosing tasty and beloved by the child dishes allowed by the doctor. It is better to give food in liquid, semi-liquid and puree form, adding butter, cream, mashed meat, juices.

In infectious diseases, the child’s dishes are boiled for 15–20 minutes with soda or chloramine. Medicines should be given to children in liquid form or in the form of a powder dissolved in water with sugar syrup. To prevent diaper rash, you need to regularly wash the skin, especially in the crease area, wipe dry and dust with talcum powder. Mustard plasters are put through cheesecloth soaked in warm water. Keep them for 3-8 minutes. Babies are better off doing mustard wraps. For this, 2 tbsp. l dry mustard is diluted in a glass of warm water and warm water is added up to 1 liter. A soft diaper is moistened in the resulting solution, squeezed, put on a dry sheet with a blanket underneath. A soft diaper is placed in the perineum, then the child is quickly wrapped in a blanket. The duration of the procedure is 10-12 minutes. After that, they wash the child with warm water, put on warm linen and put him to bed.