Hygiene of the patient. Prevention of pressure sores.
Before entering the hospital patient gets sanitization. The department provides the patient with a set of clean bed linen. In the morning after the night of sleep walking patients get washed at the special toilet, and lying patients get washed by nurses: patients who can sit in bed, get poured water from a pitcher on their hands and they wash themselves, brush their teeth, and lying patients get wiped only (face, hands ) with moistened towel or cloth. Severely ill patients after surgery should have inspected the mouth, nose, eyes. Mouth is rinsed with 1% solution of potassium permanganate or sodium bicarbonate, and the teeth and gums nurse get rubbed with a cotton-gauze ball.
Eyes of patients are washed with cotton-gauze ball, dipped in digested water or isotonic sodium chloride solution, and in case of presence of bacterial inflammation of the conjunctiva in the bag last are instilled solution or made an ointment containing sulfonamides (eg, 20-30% sulfatsil-sodium) or antibiotics. Walking patients shave themselves independently, and lying patients get shaved by barber, keeping all preventive measures against infection. For walking patients at the toilets (separate for men and women) are created conditions for washing after defecation and for washing in the evening and morning of the genital area. Lying patients get washed by nurses. Along with cleaning the skin from contamination, seriously ill patients get washed in areas of bone appearances - buttocks, shoulder blades, spine, five - rubbed with camphor alcohol (ethyl or 60%). This prosedure, as well as frequent patient turning in bed, smoothing out the sheets underneath (smoothing out the wrinkles on it), etc. are important steps to prevent bed sores.
Weekly patients get new clean underwear and bed sheets and get washed. Linen, contaminated by traumatic or other secretions, change by request. Patients should always be based on clean and dry laundry. To prevent bed sores seriously ill patients, especially of elder age, patients with diabetes need to underlay under the buttocks, rubber wheels, and under five - cotton-gauze or foam pads, it's necessary often turn them, changing body position. In recent years, to prevent bedsores widely used special air mattresses and other multi sectional. Patients, especially with obesity, must be observed and prevented dermatitis and infection of the skin by rubbing inguinal folds, the folds on the abdomen and under the breasts by 56-70% ethyl alcohol, to sprinkle these places with talc or tooth powder or - by the appearance of skin disease - get lubricated with ointment zinc oxide paste or paste of Lassar.
The positioning of patient in bed should be physiological, i.e., to provide the most relaxation of all muscle groups. This reduces the energy costs of his body and promotes optimal performance of the functions of all organs and systems. This meets the requirements of the position on the back with a slight lifting of the head and feet. It's forbidden to put leg across another leg for laying patients, because it promotes the development of thrombosis of leg vessels. In some states the patient with prolonged nausea and vomiting, especially after anesthesia, is put on his back, with a little turning aside his head. In the horizontal position (without raising the head end of the bed) should also be patients with bleeding and anemia after bleeding. This position promotes blood flow (oxygen) to the brain and heart. Conversely, patients with respiratory failure shoud have half-sitting position (orthopnea). With increased head lay also patients after operations on organs of the oropharynx and neck.
Hygiene to the patients can be properly granted only if thee is hygiene of his bed, bedding, clothes, apparel, equipment care and transportation, that is all that surrounds the patient. Bedside daily are wiped clean with wet cloth and periodically disinfected with 3% solution of bleach or lizolom. Winders and litters should be cleaned, and in case of contamination of fluids should be disinfected. An important and technically complex is the change of underwear and bed linen of seriously ill patients. It's often done by nurses. Hygiene of the lying patient also means providing support to the special dishes for the timely implementation of the physiological acts - bowel movements and urination, retention of which negatively affects the physical condition of the patient, especially in the nervous and cardiovascular systems, as well as mental state.
Urinal dish in a pure condition is kept under the bed of the patient so that he could use it himself (and especially for the seriously ill - even on a single bedside table), covered with clean cloth. Bedpans are stored in a desinfected way in special cabinets or on shelves in the toilet. Nurses, who are serving patients during defecation or urination, work the appropriate attire - oilcloth or plastic apron, rubber or plastic gloves. After finishing the nurse immediately removes the vessel or urinal and, covering with the oilcloth, refers to the bathroom, where immediately pour into the toilet or leave to review by physician or get disinfected. After this same sister is washing the patient, wipes around the anal opening the skin and then removes the oil cloth. In the absence of patient of self-defecation he needs a cleansing enema. This procedure is done by the nurse. After the enema defecation occurs at the same sanitation provision as an independent.
Patients, especially older men, after abdominal surgery often have delayed urination. In cases where the patient has the urge to urinate, and urine can not be produced more than 6 hours, should be entered the bladder catheter to withdraw it. But this procedure should be directed by a doctor. It should strictly observe the rules of asepsis. Nurses during patient care in the implementation of defecation and urination use oilcloth, aprons and disposable gloves, which are then destroyed. Important role in ensuring of the quality of care play a teaching of nurses by more experienced nurses with special education, respectful attitudes for them from the doctors, caring for them.
