Fedding of patients (along with special medical measures) is an important therapeutic measure, a prerequisite for effective treatment. The disease always leads to metabolic disorders, in particular, to enhancing of catabolic processes - the processes of decomposition and vice versa, to decrease anabolic, restorative. Shift of the the equilibrium exchange toward disintegration and material flow reduces the functional capacity of cells, organs and body tissues, including protective and causes accumulation in the body of harmful intermediate decomposition products and residual substances, creating unfavorable conditions for overcoming illness and recovery.
Therefore, energy consumption of the body due to illness should be compensated in any way. There are two ways. The main of them for most patients are natural, enteral (flow of nutrients through the mouth and intestines). The second way is extraintestinal or parenteral nutritional energy substance that is introduced, bypassing the intestines, in the bloodstream, intravenously. The last way is stimulated. It is used when a patient can not eat because of severe condition or it is contraindicated food given the nature of the illness and surgery (because it can lead to complications, such as food intake in the first days after surgery on the esophagus, stomach or intestines). Along with it, so many patients because of violations of various body functions, including digestion, so high energy costs and poor appetite that even possible enteral nutrition is insufficient for last recharge deficit. In this case, additionally prescribe parenteral nutrition.
Parenteral nutrition is performed by nurses s intended and under strict medical supervision. Medical (ward) nurses hold a special type of enteral nutrition - throughzonding. It is based on entering the stomach or small intestine, even in a tube of liquid supplements - broth, milk, a mixture of glucose and milk and eggs and more. It is prescribed to patients who have bowel function, but interferes with normal eating pathology esophagus or stomach or duodenum (stricture or esophageal burns, stomach ulcers, particularly with stenosis, duodenal fistula or even jejunum), and patients in serious condition (faint etc.). Walking patients eat in hospital cafeterias. Lying patients eat with help of ward nurses at the bedside. Staff who cares for them, should be disciplined, to work in special robe, put on a mask and rubber gloves, to observe strict sanitation. After each contact with a patient snurse have to disinfect hands (2% solution of chlorine bleach, 0.02% chlorhexidine or 70% ethyl alcohol) and then thoroughly wash them with soap and water. In modern hospitals, especially large (clinical) are increasingly used utensils and disposable instruments (polymer and plastic products), which is much easier for nursing and prevents the spread of hospital infection.
Asepsis and antisepsis.
Observations of the Hungarian obstetrician-gynecologist Ignaz Zemelveis and the great Russian surgeon M.I.Pirohov allowed to conclude "that patrurient’s fever" is caused by cadaverous poison, the cause of suppurations is "miasma" that are transmitted from one patient to another through the laundry, air, bondage material. They suggested methods of prevention: handwashing obstetricians with bleach solution before the test, sorting separating patients with purulent wounds and clean wounds, ethanolic solution of iodine, silver nitrate. English surgeon Joseph Lister proposed use of 3% solution of carbolic acid to reduce germs in the wound, at the hands.
Antisepsis is a complex of facilities and activities aimed at killing germs in the wound tissues and cavities that surround it. Chemical antisepsis - is the use of chemicals to prevent infection and control it. Characteristics of the main antiseptic substances: - Halides (iodine solution 3-5% alcohol, iodofores (yodopiron, povidone-iodine) are used for treatment of surgical field, hands, wounds). A solution of 2-10% chlorine bleach is used to disinfect instruments and gloves, 0.5% chlorhexidine is used to treat wounds; - Oxidizing agents (hydrogen peroxide 3.1% potassium permanganate is used for washing wounds ulcers, burn surfaces);
- Dyes - brylliant green 2.1% metelen blue; - 70-90% ethyl alcohol; - Acids and bases of boric acid 2-3%, formic; - The last in a mixture of hydrogen peroxide is a part of the solution C4. - Salts of heavy metals (nitric acid 1-5% silver, protargol solution); - Nitrofurans (furatsilin, furamagum) are used to treat local infections; - Sulfanilomid drugs, fluoroquinolones, antibiotics, large groups of drugs are used mainly for chemotherapy in the form of local, oral and paranteral treatment.
Antiseptic solutions should be used taking into account the sensitivity of microorganisms, the reaction of adjacent tissues. Work of surgery department and operating room shall march strictly to operating requirements of Sanitary and Epidemiological which controls for sterility premises, equipment, bondage and suture materials, instruments and current control of sterilization and more.
Asepsis is a system of measures to prevent getting of pathogenic organisms in the wound cavity, blood vessels, and development of infection in the body during operations, research and medical procedures. It includes a range of different measures: organizational and technical, hygienic, physical and chemical. Depending on the source of penetration of pathogenic microflora is divided into exogenous and endogenous. Exogenous is air, drip, airborne, contact (implantation). Prevention of exogenous infection consists of rational construction and location of hospitals, organizational, technical and safety measures. The basis of chemical and physical aseptic disinfection and sterilization are all in contact with the operating wound (of things and tools).
6. Plan and organizational structure of the lesson.
¹
Main stages of classes, their functions and content
Educational objectives
Learning and control methods
Materials of methodological support
Time
². The preparatory stage
Organization of classes.
15 min
Defining of educational goals and motivation.
1. Definition of "surgery"; 2. Main stages of surgery; 3.Ddefinition and basic principles of ethics 4. Structure of surgical clinics 5.Basis of hygiene of body and clothes of the patient in the admission department. 6. Elements of care in the admission department 7. Tactics of treatment of patients with head lice in the admission department and medications used for this 8. Order number 720
²-²²
Express-interviewing
Visual tools, equipment
9. Student should know: types of antiseptics, the basic antiseptic substances
10. usage of antiseptic means
²-²²
Express-interviewing
11. the work of surgical clinics, operating room
²-²²
Express-interviewing
Dressing, manipulation, operating unit
12. rules of sterilization (autoclave), sterilization of bandages, linen, sutures, surgical instruments
²²-²²²
The written test control
13. the rules of sterilization of the hands of the surgeon before the operation, control sterilization of bandages, surgical instruments
²²-²²²
Individual, oral questioning
Working in the operating unit
²². Main stage
Formation of professional skills
120 mins
²²
1. Plan of measures on prevention of nosocomial infections 2. Inspect the patient in the admission department for the presence of lice, itching, pyoderma 3. Master the use of antiseptic methods, depending on the patient, disease, sensitivity of microflora
²²
The practical part, training
Equipment surgical department, operating unit
4. master the rules of dressing sterile gowns, masks and gloves
²²
The practical part, training
Equipment surgical department, operating unit
5. master the rules of work with autoclave
²²
The practical part, training
Equipment surgical department, operating unit
²²². Final stage
Controlling the level of professional skills
