How to correctly position a bedpan for a bedridden patient. Rules and use of the vessel for bedridden patients. Round boats are not as comfortable

If the patient is prohibited from walking even to the toilet, he must perform all physiological functions in bed. To empty the bowels (defecation), bedpans are used, which can be enameled, earthenware or rubber.

A bedpan is given to a bedridden patient. Before serving, the vessel should be rinsed with hot water, as it should be clean and warm. The vessel should be handled very carefully. The left hand is brought under the patient’s sacrum and at the same time lifted, and with the right hand, a vessel is carefully placed and brought under the sacrum with the cape forward, so that the buttocks hang slightly over its opening. Then the patient is covered with a blanket, and after bowel movements, the vessel is immediately taken away. It is advisable to isolate the patient with a screen during bowel movements. After defecation, the bedpan is carefully removed from under the patient so as not to spill the contents, covered with oilcloth or newspaper and taken to the toilet room. The patient is washed and the anus area is wiped dry.

The contents of the vessel are poured into the toilet. In patients with intestinal infections feces are poured with a disinfectant solution for disinfection and only then poured into the sewer. Use a 10% solution of bleach, a 3% solution of chloramine, a 3% solution of Lysol or dry lime at a ratio of 1:2. Intestinal secretions are mixed with double the amount of disinfectant solution, left for 2 hours and poured into the toilet. After this, the vessel is thoroughly washed with hot water, detergents and in all cases disinfected with the above solutions.

Weak patients with a small subcutaneous fat layer, a tendency to form bedsores, and also with fecal incontinence should be given inflatable rubber bedpans, which, due to their elasticity, exert the least pressure on the sacrum and at the same time protect the skin from contact with secretions and ensure the prevention of bedsores. The vessel should not be tightly inflated.

It is necessary to place an oilcloth under it, and not place it directly on the sheet. Caregivers should empty the bedpan regularly and promptly.

Men and patients with urinary incontinence are given urinals (“ducks”) to empty their bladder. They are placed between the patient's legs and the penis is lowered into the hole. These urinals can be glass, plastic or enamel. After each urination, they are emptied and washed well with one of the detergents. To remove sediment from the walls and eliminate the persistent unpleasant odor of urea, it is necessary to periodically wash the urine bag with a weak solution of hydrochloric acid. Before giving it to the patient, the urine bag should be rinsed with warm water.

Updated: 2019-07-09 20:56:35

In severe, weakened patients who are forced to lie on their back for a long time, in places of the body that are constantly in contact with the bed

One of the most important points in caring for patients is the supply of a vessel or duck, as well as perineal hygiene after emptying. This is a delicate process that has its own subtleties and requires special skills. The main aspects are the quality of the vessel and the cleat.

A number of requirements are imposed on these items for maximum comfort of the patient and the person caring for him.

What is the difference from medical duck?

Vessels and ducks are medical equipment for treating the natural needs of bedridden patients. With the help of this equipment, patients can defecate without getting out of bed.

Important! What is the difference between a ship and a duck? Because it is intended only for emptying the bladder. A vessel is used for defecation.

Duck- this is a reservoir with a volume of one and a half liters with (in most cases) a wide neck. This is a urine bag made of plastic, glass or cellulose (if the product is disposable). This name comes from the shape, which resembles a bird.

Vessel- the item is more universal and is intended for both defecation and minor needs. This is a container in the form of an anatomically shaped tray with low sides.

What types of ships are there?

There are several types of medical students, which differ in:

Form (the gender of the patient must be taken into account).
Material.
Price.

Requirements

Emptying trays are manufactured according to the anatomy of the human body.

They should be:

Ergonomic and comfortable.
Do not injure the patient.
Resistant to chemical treatment.
Be easy to wash.
Correspond to the patient's weight.

Form

The most popular shape is scaphoid in various modifications.

This form is the most comfortable for both the patient and the staff. Use does not stain clothes and bedding. The most comfortable models are those with low sides. This makes it easier to feed the vessel and empty the patient.

Important! A significant drawback is the small capacity. Therefore, if a patient needs to give an enema, such a container will not be suitable. In other cases, a flat scaphoid container is an ideal option for immobile patients.

Round boats are not as comfortable:

Firstly, when using them, there is a high probability that its contents will spill out.
Secondly, a round vessel creates inconvenience for the patient, since its walls are quite high, and not every patient can cope with emptying.

Such a reservoir is best used for patients with partial mobility, as well as during enemas.

Materials

How to use semolina correctly in the hospital and at home?

Rubber products

This tank is inflated with air, it is soft and light. Perfect for home use and easy to care for. When using a rubber tray, the patient is provided with maximum comfort.

The container is flat, round, with soft edges, a round hole and a lid.

How to use:

When used, the tray is carefully placed under the patient, while the pelvis is raised up, the legs are spread apart and slightly bent at the knees.
The reservoir is placed so that the patient's buttocks are strictly above the hole.
The vessel is moved so that the rounded part is directed towards the patient.
If a patient has diarrhea or urinary incontinence, a rubber bedpan is exactly what is needed. Due to soft material the patient can stay on the boat for a long time without developing bedsores or injuring the sacrum. This product is also used instead of a backing circle.

Important! A rubber bed is the most suitable option for patients suffering from bedsores, injuries to the sacrum or buttocks.

Watch a video that explains how to choose a bedpan for a bedridden patient:

Metal

When using a metal container, the patient is turned on his side, a bedpan is placed, and then returned to his back. The tray is installed so that in a supine position the patient’s buttocks are located in the middle of the hole .

After defecation, the patient is washed, the perineum is treated with baby cream or powder, and, if necessary, treated with a weak solution of potassium permanganate. After this, the vessel is freed from secretions, washed with a brush, and disinfected.

Reference! The metal tray must be heated before serving. To do this, pour warm water into it and leave for a few minutes. This will provide the patient with comfort and allow him to relax.

Metal is a rather hard material and can cause bedsores in the patient. If possible, it is better to cover the container with disposable covers. They will provide comfort, make the vessel warmer, and protect against infection.

Plastic

A plastic boat is the most popular and least expensive option.

It is quite convenient, but there are cases when it is not recommended to use it:

If the patient suffers from constipation, diarrhea or urinary or fecal incontinence.
If the patient has bedsores in the sacral area.
The patient needed an enema. Due to the low sides, contents may spill.

In all other cases, a plastic product is not only appropriate, but also convenient.

Reference! Typically, one side of a plastic vessel is narrow and slightly pointed, and the other is rounded. It is on this side that the hole is located.

When feeding, the container is carefully slipped with its narrow end under the patient’s sacrum and placed so that the buttocks of the tweezers are above the hole. The plastic tank is equipped with a handle and a lid. After emptying, it can be easily removed using the handle, closed with a lid and taken out.

Watch the video in which the doctor shows how to give, pick up and not capsize the vessel:

Disposable

Made from waterproof cellulose material (thick paper), it is designed for one use only and can be disposed of immediately after use.

Material for disposable vessels - 100% recycled newsprint. They are inexpensive and convenient, and their use reduces the risk of infections. Such products can retain moisture for 4 hours. Suitable for both men and women.

Important! If the patient suffers from incontinence, then it is better not to use a disposable product.

Duck

Duck is a urine bag. It is lightweight, comfortable, and can be used in any body position. The main advantage is a minimum of anxiety for the patient.

The weft is so comfortable that patients with partial mobility can use it independently. It has a convenient compact shape, equipped with a handle and a lid. Material – plastic, glass, stainless steel.

Reference! Ducks come in various modifications and are suitable for men and women.

Male and female versions differ in design in accordance with the structure of the reproductive system:

Containers for men have a round neck for the penis.
The women's version is equipped with a wider neck shaped like a willow leaf. Such a container is placed close to the vagina, and the patient can empty the bladder without any problems.
There are also universal products, in which case the kit includes a special attachment for men.

You can make a duck yourself. How to do this is shown in the video:

Care

If the product is not disposable, it must be disinfected. To do this, you can use a chloramine solution of 1%, a solution of Lysol 5%, a weak solution of hydrochloric acid to neutralize the odor.

For washing, be sure to use brushes or washcloths.
Emptying trays are stored separately in cabinets with closed doors.
To get rid of an unpleasant odor, use a solution of potassium permanganate.
After washing and processing, the container should be wiped dry.

Important! The vessel should be thoroughly washed, disinfected and wiped down each time after use!

A properly selected vessel or duck will allow the patient to defecate in comfortable conditions.

When selecting them, you need to pay attention to the design of the product, material, service life, and the severity of the patient’s condition.

But the most important thing is the wishes of the patient. After all, he should relax and calmly relieve himself. At the same time, he should not experience discomfort, embarrassment or cause inconvenience to neighbors.

Most often, the vessel is round, has a large hole at the top and a small one at the bottom in the tube, which serves to empty the vessel from its contents. The upper large hole is equipped with a lid. A clean vessel is usually located under the patient’s bed on a special bench.

Vessel submission rules

When submitting a vessel, you need to follow a number of simple rules. When a patient needs to empty his bowels, he should be separated from other patients with a screen, then the vessel should be rinsed with warm water, leaving a little water at the bottom.

The patient's blanket is pulled back, asking him to bend his legs, and they help him raise his pelvis with his left hand. A live-in nurse for a bedridden patient holds the bedpan by the tube with her right hand, bringing it under the patient’s buttocks.

After installing the vessel, the patient's perineum should be above the upper hole, and the tube should be between his legs. After this, the patient can be covered with a blanket and left alone for a while. After this, the vessel is removed from under the patient and taken to the toilet for pouring, covering it with a lid.

After emptying the vessel, it should be disinfected with a bleach solution (1-2%) or chloramine solution (3%), and also washed with a brush. Then the vessel should be rinsed and stored under the patient’s bed on a bench.

There are also special machines for washing vessels. According to the rules of some hospitals, vessels are stored in a special cabinet in numbered cells.

Using a urine bag

With strict bed rest, patients also have to urinate in bed. There is a special device for this - a urinal. They are made oval in shape with an elongated hole in the shape of a metal or glass tube, so that patient care is carried out competently.

However, the shape of this tube in urinals for men and women is different. Women also often use a bedpan to urinate.

The urine bag and bedpan must be individual. They are served to the patient in a clean and heated form, and after performing their function they are immediately emptied and cleaned.

Cleaning a urinal is different in that it is washed from time to time with a weak concentration of hydrochloric acid solution, since urine produces a sediment that easily sticks to the walls of the urinal and leaves an unpleasant odor.

A bedpan is not a whim, but an important and necessary means of caring for a bedridden patient; on the website you will learn how to choose it correctly. The normalization of a patient’s life directly depends on the quality, form and features of this medical item. Using disposable diapers is not always advisable, but it also has a significant impact on the budget. In this case, the way out of a sticky situation is a properly selected vessel.

When choosing a medical device, you need to take into account the gender of the elderly person. For a man, a special urinal is used.

Standard vessel sizes:

43×35 cm, volume – 0.7 l;
48×37 cm, volume – 1.0 l;
54×45 cm, volume – 1.5 l.

Modern devices are most often scaphoid and round in shape. Medical vessels must be:

resistant to aggressive agents and disinfectants;
non-traumatic;
convenient for the elderly person and their caregivers.

Various materials are used to make the vessel - rubber, metal, plastic.

Which vessel (duck) is better to choose for an elderly person

When choosing a vessel, you need to take into account all its advantages and disadvantages. The boat-shaped shape is more preferable, since when using such equipment the risk of staining the laundry is minimal.

Round-shaped devices are more likely to leak.

If an elderly person suffers from constipation and has to use enemas for emptying, then it is better to choose large-volume metal products.

Advantages of a plastic vessel:

the material easily accepts the temperature of the human body;
light weight of the device;
shape – the height of the product for the sacral area is lower than for other areas;
indicated for patients who cannot elevate the sacrum on their own;
the product is resistant to frequent washing and treatment with any disinfectants;
does not retain or accumulate unpleasant odors;
the presence of a measuring scale, which allows you to control the volume of bowel movements;
the color range of products allows you to study the color of feces or urine;
there is a cover.

The disadvantages of plastic products include the small volume of the vessel, which does not allow its use after an enema.

The metal product is more durable and is more often used in medical institutions. It should not be constantly under the patient.

Advantages of stainless steel products:

unlimited service life;
hygiene – the smooth surface does not retain feces particles;
resistance to septic tanks and frequent washing;
large bowl volume;
shape, many models are equipped with side handles.

Metal models should not be used for patients with bedsores, as the sharp sides can injure the skin. In addition, it is difficult to see the color of feces or urine.

Operating rules

Before using a medical device, you need to prepare a towel or oilcloth, talc or baby powder, toilet paper or wet wipes, rubber gloves.

Algorithm of actions when using the vessel:

Wash your hands, put on gloves.
Place a towel or waterproof napkin under the elderly person's basin.
Pour hot water into the vessel. This will warm the product.
Treat the edges with talcum powder or baby powder. This will make it easier to install the vessel under the basin. It is prohibited to use these products for bedsores.
Ask the bedridden patient to turn over on his side and bend his legs. If independent movement is impossible, then it is turned over.
Place the bedpan as close to the patient as possible. Next, ask him to lift the pelvis while supporting the patient under the sacrum. Use your other hand to guide the medical equipment under the older person.
Make sure the boat is positioned correctly and the hole is in the right place.
If the patient can perform the necessary actions independently, there is no threat to life and health, then it is better to leave him alone with the medical equipment. Ask to report the end of bowel movement or urination.
Pull out the vessel.
Remove the medical device and carry out the necessary hygiene procedures.

Sequencing

1. Before serving the vessel, rinse it with warm water and leave a little warm water in it;

2. Place your left hand under the sacrum, helping the patient raise the pelvis (the patient’s legs should be bent at the knees);

3. With your right hand, bring the vessel under the patient’s buttocks so that the perineum is above the hole;

4. After defecation and urination, wash the patient;

5. Pour the contents of the vessel into the toilet, rinse the vessel with hot water, and disinfect it with a 10% chloramine solution;

6. Wash your hands.

In patients with urinary incontinence, permanent urinals are used (photo series)

For bedridden patients, bed urinals (glass or plastic) - ducks - with a capacity of 1 - 2 liters are used.

The bed of a patient with involuntary urination and fecal discharge should have special devices. The mattress and pillow are covered with oilcloth. In addition, for such patients, special mattresses consisting of 3 parts are used; the middle part has a device (niche) for a vessel. Bed linen for such patients is changed more often than usual - as it gets dirty. If a sick woman has copious vaginal discharge, then to keep the bed clean, an oilcloth and a small soft pad are placed under the patient. Diapers are widely used in caring for bedridden patients. (photo series)

CHAPTER 7. Basic hygienic procedures

Skin care

Personal hygiene is a broad concept that includes the implementation of rules that contribute to the preservation and strengthening of human health. The first priority is to maintain cleanliness of the body.

The skin of the body performs a protective function (protects the body from mechanical damage, penetration of harmful and toxic substances and microorganisms from the external environment), participates in metabolism (respiratory, excretory functions), and is a component of one of the sense organs - the skin analyzer.

During physical activity, with an increase in body temperature, with diseases of the kidneys, liver, respiratory system, digestive tract and the skin itself, the excretory function of the skin is in a state of tension. Gas exchange through the skin increases, and the amount of substances released by the skin increases many times. At the same time, products of impaired metabolism begin to be released through the skin.

Obviously, in order for the skin to function normally, it must be kept clean and protected from damage.

Patients on a general regime wash themselves in a bath or shower at least once every 7 days. The nurse should maintain a schedule for administering a hygienic bath to walking patients with a note in the medical history. After washing, the patient changes bed and underwear.

For patients on a regimen with limited physical activity, the nurse helps carry out elements of personal hygiene.

Carrying out a hygienic shower

Indications: skin contamination, pediculosis.

Contraindications: The patient's serious condition.

Equipment: bath bench or seat, brush, soap, washcloth, gloves, bath treatment products.

Sequencing

1. Put on gloves;

3. Place a bench in the bath and seat the patient;

4. Wash the patient with a washcloth: first the head, then the torso, upper and lower limbs, groin and perineum;

5. Help the patient dry himself with a towel and get dressed;

6. Remove gloves;

7. Escort the patient to the room.

CARRYING OUT A HYGIENIC BATH

Indications: skin contamination, pediculosis.

Contraindications: The patient's serious condition.

Equipment: brush, soap, washcloth, gloves, footrest, bath treatment products.

Sequencing

1. Put on gloves;

2. Wash the bathtub with a brush and soap, rinse with a 0.5% bleach solution or 2% chloramine solution, rinse the bathtub with hot water (you can use household cleaners and disinfectants);

3. Fill the bath with warm water (water temperature 35 – 37 0 C);

4. Help the patient take a comfortable position in the bath (the water level should reach the xiphoid process);

5. Wash the patient with a washcloth: first the head, then the torso, upper and lower limbs, groin and perineum;

6. Help the patient get out of the bath, dry himself with a towel and get dressed;

7. Remove gloves;

8. Escort the patient to the room.

The duration of the bath is no more than 25 minutes.

Possible complications: deterioration of health – pain in the heart, palpitations, dizziness, change in skin color. If such signs appear, it is necessary to stop taking the bath, transport the patient on a gurney to the ward, and provide the necessary assistance.

SKIN CARE FOR SERIOUSLY ILL PERSONS

For patients who are prescribed bed rest or strict bed rest, the use of a hygienic bath or shower is contraindicated due to the severity of the condition and the high risk of complications. However, maintaining skin hygiene in this category of patients is also necessary.

These patients daily, at least 2 times, wipe the patient's skin with a swab or the end of a towel moistened with warm water or an antiseptic solution (10% camphor alcohol solution, vinegar solution - 1 tablespoon per glass of water, 70% ethyl alcohol in half with water, 1% salicylic alcohol). Then wipes it dry.

The nurse washes the patient (face, neck, hands) using a sponge moistened with warm water. Then he dries the skin with a towel. The patient’s feet are washed 2-3 times a week, placing a basin on the bed, after which the nails are cut short if necessary.

With poor skin care, diaper rash, bedsores and other complications can occur that worsen their condition.

Especially thoroughly wash and dry the folds of skin under the mammary glands in women (especially obese women), armpits, and inguinal folds, since otherwise there is a high risk of developing diaper rash. At the same time, the protective properties of the skin are reduced, and microorganisms are able to penetrate through damaged skin.

In order to prevent diaper rash, it is necessary to examine the folds of skin under the mammary glands, armpits, and inguinal folds daily. After washing and drying, these areas of the skin must be powdered with powder.

A bedsore is a necrosis of the skin and underlying soft tissues that develops as a result of prolonged compression and impaired local circulation. Features of skin care for patients with pressure ulcers or a high risk of developing them are described in the industry standard for the management of patients with pressure ulcers (see Appendix 1).

Washing feet in bed

Equipment: rubber oilcloth, basin, warm water at a temperature of 34-37 degrees 0 C, washcloth, soap, towel, Vaseline or softening cream.

Sequencing

Wear gloves;
Place the oilcloth on the mattress;
Place the basin on the oilcloth;
Pour water up to half the basin;
Lower the patient's legs into the pelvis with minimal physical exertion for the patient;
Lather your feet well, especially the interdigital spaces and nail beds;
Rinse the patient's legs with clean water, raising them above the pelvis;
Dry your feet with a towel;
Lubricate the soles and heels with cream;
Remove the oilcloth;
It is convenient to place your feet on the bed and cover them with a blanket;
Wash the hands.

Washing the patient

Patients who can care for themselves wash themselves with boiled water and soap every day, preferably in the morning and evening.

Seriously ill people who are in bed for a long time and are unable to regularly take a hygienic bath should be washed after each act of defecation and urination. Patients suffering from urinary and fecal incontinence must be washed several times a day, since the accumulation of urine and feces in the perineum and inguinal folds can cause diaper rash, bedsores or infection.

Indications: perineal hygiene.

Equipment: 8-16 cotton swabs, an oilcloth, a vessel, a forceps, a jug, an Esmarch mug with a rubber tube, a clamp and a tip with an antiseptic solution (a slightly pink solution of potassium permanganate or a solution of furatsilin 1:5000)

Sequencing

1. Put on gloves;

2. Lay the patient on his back, his legs should be bent at the knees and spread apart;

3. Lay an oilcloth under the patient and place a bedpan;

4. Take a forceps with a napkin or cotton swab in your right hand, and a jug with a warm antiseptic solution or water at a temperature of 30-35 degrees in your left hand. Instead of a jug, you can use an Esmarch mug with a rubber tube, clamp and tip;

5. Pour the solution onto the genitals, and use a napkin (tampon) to move from the genitals to the anus (from top to bottom).

The sequence of washing the patient:

First, wash the labia minora (with two different tampons or one large one, but on different sides), then wash the labia majora, inguinal folds, and lastly, wash the anus area, changing tampons each time.

Sequencing

6. Dry in the same sequence, constantly changing tampons;

7. And at the end of the procedure, remove the vessel and oilcloth;

5. Wash your hands.

ORAL CARE

Oral care is a necessary procedure for all patients, since microorganisms accumulate in the oral cavity, causing bad breath and causing inflammatory changes in the teeth, mucous membranes of the oral cavity, and the excretory ducts of the salivary glands. Assistance in such care should be provided to patients who are not able to do this themselves.

Patients should brush their teeth thoroughly, especially near the gums, 2-3 times a day, preferably after each meal. If it is impossible to do this, you should rinse your mouth after eating with lightly salted water (1/4 teaspoon of table salt per glass of water) or a solution of baking soda (1/2 teaspoon per glass of water). This procedure is also necessary for people who have no teeth.

For seriously ill patients who cannot brush their teeth themselves, a nurse should clean the oral cavity after each meal. Patients rinse their mouth. After this, the gums are carefully and thoroughly wiped with a cotton ball or gauze, secured with a clamp or forceps and moistened with an antiseptic solution.

Rinsing the mouth.

To do this, you need to prepare a towel, tray, glass, antiseptic solutions (furatsilin solution 1:5000, 2% soda solution, 0.5% potassium permanganate solution, 5% boric acid solution). It is necessary to sit the patient down and place a towel on his chest and neck. It is necessary to give a glass of antiseptic solution in your hand. Place a tray under your chin. Invite the patient to rinse the mouth.

WIPPING THE ORAL CAVITY.

Indications: regular oral care.

Equipment: spatula, cotton balls, clamp or tweezers, tray, antiseptic solutions listed earlier, gloves.

Sequencing

1. Put on gloves;

2. Ask the patient to open his mouth wide;

3. Using a cotton ball on a clamp or tweezers, moistened with an antiseptic solution, carefully remove plaque from the tongue, teeth, gums, changing the balls. When wiping the upper molars and gums, you need to pull back the cheek with a spatula so as not to introduce infection into the excretory duct of the parotid salivary gland. To treat the tongue, ask the patient to stick it out, and if this is not possible, then wrap the tip of the tongue in a sterile gauze cloth and pull it out of the mouth;

4. Ask the patient to rinse his mouth with boiled water.

During this manipulation, the mouth, tongue, and gums are carefully examined.

If inflammatory changes occur in the oral cavity, rinse and treat the gums with a solution of furatsilin 1:5000, 2% solution of boric acid. Sometimes applications with the same solutions are applied and removed after 1-2 hours. Treatment is carried out under the guidance of a dentist.

As a first aid, areas of inflammation of the mucous membranes can be treated with a solution of brilliant green. This procedure is repeated 2-3 times a day. Sometimes this procedure in the early stages allows the patient to be completely cured long before the dental consultant arrives.

In patients who are on bed rest for a long time and consume few vitamins, stomatitis may develop: round ulcers appear on the red mucosa. Then they turn yellow and pain in the mouth appears. Sometimes ulcers appear along the edge of the tongue, on the gums, inside the lips and cheeks.

Local treatment - applications or irrigation of the oral cavity with antiseptic solutions listed earlier are used. The ulcers are lubricated with specially prepared ointments or vegetable oil.

The medicinal effect on the oral mucosa consists of application or irrigation.

ORAL IRRIGATION.

Indications: phenomena of stomatitis.

Equipment: spatula, cotton balls, clamp or tweezers, tray, antiseptic solutions, gloves, oilcloth, pear-shaped balloon or Janet syringe.

Sequencing

1. Put on gloves;

2. Place a warm antiseptic solution into a pear-shaped balloon or into a Zhanna syringe;

3. Turn the patient’s head to the side so that the solution does not enter the respiratory tract (if possible, sit the patient down);

4. Place an oilcloth (or diaper) on the patient’s chest and neck and place a tray under the chin;

5. Pull back the corner of the mouth with a spatula, insert the tip into the vestibule of the mouth;

6. Rinse the left and right cheek space alternately with a stream of liquid under moderate pressure.

Manipulation of oral irrigation is not used in seriously ill patients due to the risk of fluid entering the respiratory tract and sudden death of the patient.

Application is the application of sterile gauze wipes soaked in some disinfectant solution (0.1% furatsilin solution) to the mucous membrane for 3-5 minutes. This procedure is repeated several times a day. You can make applications with painkillers.

Patients who have impaired nasal breathing and who breathe almost entirely through their mouths often suffer from dry lips and mouth. After some time, cracks form in the corners of their mouth, which is very painful, especially when talking, yawning, or eating. The patient must be taught not to touch these wounds with his hands and not to open his mouth wide. The lips are carefully wiped with a swab moistened with a solution of furatsilin 1:4000, and then lubricated with vegetable oil, sea buckthorn oil, olive or petroleum jelly.

For patients in a coma with artificial ventilation of the lungs, to prevent the formation of cracks and drying of the lips, apply a gauze cloth moderately moistened with a solution of furatsilin, which is replaced as it dries.

In patients with high fever, suffering viral infection or severe circulatory disorders, aphthous stomatitis sometimes develops, in which a strong odor from the mouth appears. In order to get rid of this smell, it is necessary to treat, first of all, the underlying disease. Be sure to rinse your mouth with disinfectants (0.2% sodium bicarbonate solution, 1% sodium chloride solution or dental elixir).

If the patient has removable dentures, they are removed at night, washed thoroughly with running water and stored in a dry glass. In the morning, before putting it on, rinse again.

EAR CARE

Patients on a general regimen wash their ears themselves during the morning daily toilet.

Patients on bed rest need to periodically clean the external auditory canals.

Removal of dirt, sulfur, including cerumen plug is carried out by a nurse in the following way:

Sequencing

1. Put on gloves;

2. Make the patient sit;

4. Place a few drops of a 3% hydrogen peroxide solution into the ear (the solution should be warm);

5. Pull the auricle back and up and, using rotational movements, insert the cotton wool into the external auditory canal;

6. After changing the turunda, repeat the manipulation.

Do not use hard objects to remove wax from your ears to avoid damaging the eardrum.

PLAYING OINTMENT INTO THE EAR

Sequencing

1. Put on gloves;

2. Make the patient sit;

3. Tilt the patient's head in the opposite direction;

4. Apply the required amount of ointment to a sterile cotton swab;

5. pull the auricle back and up and, using rotational movements, insert the turunda with ointment into the external auditory canal;

INSTALLING DROPS INTO THE EARS.

Sequencing

1. Put on gloves;

2. Make the patient sit;

3. Tilt the patient's head in the opposite direction;

4. Take the required number of drops into the pipette (the drops must be warm);

5. pull the auricle back and up and introduce drops into the external auditory canal;

6. Upon completion of the procedure, place a cotton swab into the external auditory canal.

NOSE CARE.

Walking patients take care of their nose on their own during the morning toilet. Seriously ill patients who are unable to independently monitor nasal hygiene must daily clear the nasal passages of secretions and crusts that form. The nurse cleans the patient's nasal passages daily.

TREATMENT OF THE NASAL PASSES

Sequencing

1. Put on gloves;

2. In a lying or sitting position (depending on the patient’s condition), slightly tilt the patient’s head back;

3. Moisten cotton pads with Vaseline or vegetable oil, or glycerin;

4. Insert the turunda into the nasal passage with rotational movements and leave there for 2-3 minutes;

5. then remove the turunda and repeat the manipulation;

Another way to clean the patient's nose is by instilling drops.

INSTALLATION OF DROPS INTO THE NOSE.

When instilling drops into the nose, use a sterile pipette. Patients are in a sitting or lying position (depending on the patient’s condition), their head is tilted to the opposite shoulder and slightly thrown back. The nurse should check that the drops comply with the doctor’s prescription by sitting the patient down and drawing the required number of drops into the pipette. The drops are instilled first into one, and then after 2-3 minutes into the other nasal passage, after first changing the position of the head.

HELP WITH NOSELEEDINGS.

The causes of nosebleeds are varied. Bleeding can be the result of local changes (trauma, scratching, ulcers of the nasal septum, skull fractures), as well as various diseases (blood diseases, infectious diseases, influenza, hypertension, etc.).

When a nosebleed occurs, blood flows not only out through the nasal openings, but also into the pharynx and oral cavity. This causes coughing and often vomiting (when blood is swallowed). The patient becomes restless, which increases bleeding.

TACTICS FOR NOSE BLEEDING:

Sequencing

1. Sit or lay the patient down and calm him down;

3. Press the wings of the nose to the nasal septum;

4. Place a cold compress or ice pack on the septum;

5. If the bleeding does not stop, insert cotton balls (dry or moistened with 3% hydrogen peroxide) into the nasal passages;

6. If nosebleeds recur or the bleeding is massive, consultation with an otolaryngologist is indicated.

EYE CARE

Walking patients take care of their eyes independently during the morning toilet. Seriously ill patients often develop discharge from the eyes, sticking together the eyelashes and making it difficult to see. Such patients need to wipe their eyes daily with sterile gauze or cotton swabs soaked in disinfectant solutions. It is necessary to remember that a separate sterile swab is taken for each eye. After manipulating the treatment of the patient’s eyes, the nurse should thoroughly wash her hands with soap and wipe them with alcohol.

RUBBING THE EYES

Indications: eye hygiene.

Equipment: sterile tray, sterile gauze balls, antiseptic solutions, gloves.

Sequencing

Wear gloves;
Place 8-10 sterile balls in a sterile tray and moisten them with an antiseptic solution (furatsilin solution 1:5000, 2% soda solution, 2% boric acid solution, 0.5% potassium permanganate solution), 0.9% sodium chloride solution or boiled water;
Lightly squeeze the swab and wipe the eyelashes with it in the direction from the outer corner of the eye to the inner;
Repeat rubbing 3 - 4 times;
Blot the remaining solution with dry swabs;
Wash the hands.

EYE WASHING

Indications: disinfection of the conjunctival sac, removal of mucus and pus from it, first aid in case of eye burns with chemicals.

Equipment: tray, sterile rubber can, antiseptic solutions, gloves.

Sequencing

Wear gloves;
Lay the patient down;
Tilt the patient's head back slightly;
Place a tray on the temple side;
Fill a rubber can with an antiseptic solution;
Spread both eyelids with the thumb and index finger of your left hand;
Rinse the eye with a stream from a spray can, directing the stream from the temple to the nose;
Wash the hands.

For seriously ill patients whose eyelids do not close during sleep for one reason or another, it is necessary to apply gauze pads moistened with warm saline solution to the eyes (to prevent drying out of the conjunctiva).

1. Put on gloves;

2. Sit or lay down the patient;

3. Place ointment on a sterile glass rod so that it covers the entire shoulder blade;

5. Place a spatula with ointment behind the lower eyelid so that the ointment is directed towards the eyeball, and the free surface towards the eyelid;

6. Lower the lower eyelid and ask the patient to close his eyelids;

7. Remove the spatula from under the closed eyelids and then lightly press the ointment onto the eyeball;

8. Remove excess ointment with a cotton ball;

9. Wash your hands.

SIMPLE MANIPULATIONS IN EYE CARE

EVERION OF THE UPPER EYELID

Indications

Diseases of the conjunctiva of various etiologies (bacterial, viral, allergic) ( rice. 1).

Foreign body.

Wearing contact lenses.

Contraindications Fig.1. Conjunctivitis

Pronounced cicatricial fusion of the conjunctiva of the eyelids with the conjunctiva of the eyeball.

Consequences of injuries.

Consequences of burns.

Pain relief methods

Not required.

Equipment

Desk lamp.

Glass rod.

Magnifying glass 20x.

Binocular loupe (if necessary).

When inverting and examining the conjunctiva of the upper eyelid, ask the subject to look down at his knees.

Execution technique

Y way.

Everting the upper eyelid with your fingers. The subject looks down. Doctor:

a) raises the upper eyelid with the thumb of the left hand;

b) with the thumb and forefinger of the right hand, fixes the eyelid by the edge and eyelashes, pulling it down and forward;

c) with the thumb or index finger of the left hand, moves the upper edge of the cartilage down;

d) press the inverted eyelid by the eyelashes to the upper edge of the orbit and hold it in this position until the end of the examination.

Y way.

Inversion of the upper eyelid using a glass rod.

All stages are performed in the same way as in method 1, only when performing step “c”, a glass rod is used, onto which the upper eyelid is turned out. To examine the conjunctiva of the upper transitional fold with the upper eyelid inverted, it is necessary to lightly press on the eyeball through the lower eyelid. In this case, the conjunctiva of the upper transitional fold, loosely connected with the underlying tissues, becomes

Possible complications

Infection of the conjunctival cavity,

If the procedure is performed roughly, corneal erosion may occur.

INSTILLATION OF EYE DROPS

Indications

Treatment.

Diagnostics.

Anesthesia during various manipulations.

Contraindications

Drug intolerance.

Pain relief methods

Not required.

Equipment

Instilled solution.

Pipette.

Raise your chin.

Fix your gaze upward and inward.

Execution technique

Wear gloves. Sit or lay down the patient. Immediately before the procedure, it is necessary to check that the medication being administered is correct. Ask the patient to tilt their head back slightly and look up. With your left hand, take a cotton ball, place it on the skin of the lower eyelid and, holding the cotton wool with your thumb, pull the lower eyelid down, and hold it with the index finger of the same hand upper eyelid. Without touching the tip of the pipette to the eyelashes and edges of the eyelids, inject 1 drop of solution into the space between the eyelids and the eyeball closer to the inner corner of the palpebral fissure. Remove any portion of the medication that leaks from the eyes with a cotton ball. You can also instill drops on the upper half of the eyeball - when the upper eyelid is retracted and when the patient is looking down. When instilling potent drugs (for example, atropine) into the eyes, to avoid getting them into the nasal cavity and to reduce the overall effect, you should press the area of the lacrimal canaliculi with your index finger for 1 minute. At the end of the procedure, wash your hands.

Close your eyes and gently press on the inner corner of the eye for 3-5 minutes.

Possible complications

Allergic reaction to the drug.

Damage to the conjunctiva.

Damage to the cornea due to careless manipulation.

PLAYING EYE OINTMENT

Indications

Introduction of a soft drug into the conjunctival sac for inflammatory diseases of the anterior segment of the eye of various etiologies.

Contraindications

Drug intolerance.

Suspicion of a penetrating injury to the eyeball.

Pain relief methods

Not required.

Equipment

Ointment used.

Sterile glass rod.

Raise your chin.

Fix your gaze upward.

Execution technique

Wear gloves. Sit or lay down the patient. Draw ointment onto a sterile glass rod so that it covers the entire scapula and, holding it parallel to the eyelids, place the tip of the stick behind the lower eyelid with ointment to the eyeball, and free surface by the century. After the patient closes his eyes, remove the stick from the palpebral fissure. Perform circular stroking with a cotton ball over closed eyelids to evenly distribute the ointment over the eye. Remove excess ointment with a cotton ball. The ointment can be administered directly from a tube specially produced by industry. At the end of the procedure, wash your hands.

REMOVAL OF SUPERFICIAL FOREIGN BODIES FROM THE CONJUNCTIVAL

Indications

Foreign body of the cornea or conjunctiva.

Contraindications

Pain relief methods

When removing a foreign body from the conjunctiva, anesthesia is not required.

When removing from the cornea, installation anesthesia with a 0.25% solution of dicaine (or another anesthetic).

Equipment

Anesthetic solution.

Cotton swab.

Injection needle or spear.

Slit lamp or binocular loupe.

Fix your gaze at the request of the doctor.

Execution technique

Foreign bodies are removed from the conjunctiva using a small cotton swab moistened with some disinfectant eye drops.

To remove foreign bodies located on the conjunctiva of the upper eyelid, you must first turn it out. After removing the foreign body, a 0.25% solution of chloramphenicol is instilled into the conjunctival sac. In case of a corneal foreign body, a local anesthetic solution is instilled into the eye. Superficial foreign bodies are removed with a damp cotton swab. Foreign bodies embedded in the surface layers of the cornea are removed with an injection needle or spear (this procedure is performed by a doctor).

FOREIGN BODY IN THE CONJUNCTIVAL SAC

The search for a foreign body should begin by retracting the lower eyelid. If detected, it can be removed using a cotton swab. If there is no foreign body behind the lower eyelid, then you need to look for it on the inner surface of the upper eyelid, for this you must first turn it out. It is important to remember that a foreign body in the conjunctival sac should be looked for without prior anesthesia. After

To remove a foreign body, drops containing an antibiotic are instilled into the affected eye.

CHEMICAL EYE BURNS

If a powdery chemical substance gets behind the eyelids, it is necessary to remove it with a dry “bath”, and only after that you can start rinsing the eye. For burns caused by liquid chemicals, eye rinsing should begin as soon as possible. It is better to rinse with a weak stream of water for 10-15 minutes. If the burn is caused by alkali, a 2% boric acid solution or a 0.1% acetic acid solution is used for rinsing. For acid burns, use 2% sodium bicarbonate solution or isotonic sodium chloride solution. In no case should you limit yourself to 1-2 minutes of rinsing, especially for burns with powdered chemicals. After irrigation, the burned skin of the eyelids and face is lubricated with an antibiotic-containing ointment: 1% tetracycline ointment, 1% erythromycin ointment, 10-20% sodium sulfacyl ointment. A 0.25% solution of dicaine or a 3% solution of trimecaine is instilled into the conjunctival sac and an antibiotic-containing ointment is applied. 1500-3000 IU of antitetanus serum is injected subcutaneously. For burns of 2, 3 and 4 degrees, urgent hospitalization is required.

Specific antidotes

Lime, cement - 3% solution of disodium salt of ethylenediaminetetraacetic acid (EDTA).

Iodine - 5% sodium hyposulfite solution.

Potassium permanganate - 10% sodium thiosulfate solution or 5% ascorbic acid solution.

Aniline dyes - 5% tonin solution.

Phosphorus - 0.25-1% solution of copper sulfate.

Resins - fish oil, vegetable oil.

THERMAL EYE BURNS

The substance that caused the burn is carefully removed from the skin of the face, eyelids and mucous membrane of the eyes with tweezers or a stream of water. The conjunctival sac is washed with water, a 3% solution of trimicaine, a 0.25% solution of dicaine, a 20% solution of sulfacyl sodium, and a 0.25% solution of chloramphenicol are instilled into the eye. 1% tetracycline or erythromycin ointment is applied behind the eyelids. If there are blisters on the skin, they must be cut off and

generously lubricate the wound surface with antibiotic-containing ointments. Antitetanus serum (1500-3000 IU) is injected subcutaneously. An aseptic bandage is applied to the eye.

TRANSPORTATION AND HANDLING OF THE PATIENT

The severity of the condition determines the method of transporting the patient. The doctor decides how the patient will be transported: on a stretcher, manually, on a wheelchair, or on foot. Patients who are in satisfactory condition are sent to the department on foot, accompanied by medical personnel. personnel. Weakened patients, disabled people, elderly and senile patients are often transported in a wheelchair. Seriously ill patients are transported on a stretcher (manually or on a gurney) while lying down.

There are no contraindications for transportation within the hospital.

For transportation on a stretcher, you should prepare

· sheet

· pillow, oilcloth.

The patient must be explained the peculiarities of his behavior during transportation.

Transportation on a gurney

Sequencing:

1. Prepare the gurney for transportation, check its serviceability.

2. Place a sheet (oilcloth if necessary) on the gurney, a pillow and a blanket.

3. Place the gurney with the foot end at an angle to the head end of the couch or in another way that is more convenient in this situation.

4. Raise the patient - one healthcare worker places his hands under the patient's neck and torso, the other - under the lower back and legs.

5. Place the patient on the gurney.

6. Cover the patient with the other half of the blanket or sheet.

7. Stand: one health care worker is in front of the gurney with his back to the patient, the other is behind the gurney facing the patient.

8. Inform the department that a patient is being transported to them.

9. Transport the patient to the department with medical history.

10. Place the gurney next to the bed, depending on the area of the room.

11. Remove the blanket from the bed.

12. Place the patient on the bed.

It is necessary to monitor the patient's condition during transport. When lifting or lowering a patient on a stretcher down the stairs, the stretcher is held with the head end forward when ascending and the foot end forward when descending.

Transporting the patient to the department on a wheelchair

Sequencing:

1. Prepare the wheelchair for transportation, check its serviceability.

2. Tilt the wheelchair forward by stepping on the footrest.

3. Ask the patient to stand on the footrest, sit him down, supporting him in the chair, and cover him with a blanket.

4. Place the wheelchair in its original position.

5. During transport, ensure that the patient’s arms do not extend beyond the armrests of the wheelchair.

The patient can be transported on a wheelchair in a sitting, reclining or lying position, changing the position of the backrest and foot panel.

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