V. Reference basis of action

Previous preparation of the operating field.

In eve the operation to the patient do shaving of hair in the area of the future operating field by a dry method. After shaving a blade and machine-tool for shaving is disinfected by proper antiseptic, a blade will utilize. A patient gets hygienical bath or shower, then to him the linen worn and bed next to the skin is replaced.

At presence of wound the preparation of the operating field takes place as follows. A bandage is taken off, a wound is covered by a sterile serviette, and wipe a skin round a wound by a petrol or ether and shave a hair by a dry method. All motions – wiping of skin out, shaving of hair – must be conducted in direction from a wound, that to decrease the degree of its contamination. After shaving of hair a serviette is taken off, oil a skin round a wound by solution (betadin, Jodobac, Jodonat, alcoholic solution of chlorhexidine, and others like that) antiseptic and cover a wound by a sterile napkin.

It not impossible to shave a hair in the area of the future operating field before niches 6 hours prior to the operation.

Patients must be operated on an empty stomach, therefore day prior to the operation they get a lightly meal only (clear soup, liquid soup and others like that). At the urgent operations, if between the reception of meal and beginning of operation passed less than 5 hours, it is necessary to wash a stomach through a probe. It warns vomiting and regurgitation during anesthesia. The day before and in the day of operation for 3-4 hours it is necessary to clean a thick intestine by means cleansing enema.

Washing of stomach by a thick probe.

Contra-indications to this manipulation are: gullet and gastric bleeding (ulcer, cancer, varicose expansion of veins of gullet and stomach), heavy cardio-vessels diseases (aneurysm of aorta, stenocardia, heart attack of myocardium, violation of cerebral circulation of blood).

The necessary following equipment: thick probe (long 100-120 sm), rubber tube (long 70-80 sm), glass tube, watering-can by volume of 0,5-1 l, sterile tray, group, 10 l of the overcooked water of room temperature, bucket, bowl for washing waters, apron, sterile gloves. If at a patient there are dentures, they must be deleted. A patient sits down on a chair, conducts knees. On a patient an apron is dressed. Between the feet of patient to put a bowl for collection of washing waters. Holding a sterile probe for both ends in vertical position, to define distance on which it follows to enter him - from the bridge of the nose to the belly-button. On a thick probe are present mark which can be a reference point at introduction of him to the stomach: it is well-aimed 45 sm - answers distance to cardial part of stomach, 55 sm - to the bottom of stomach, 65 sm - to the goalkeeper of stomach. To moisten 20-30 sm of probe (from a rounding end) in the warm overcooked water. To become to the right from a patient. To suggest to the patient to open a mouth and prolonged say the “A-a-a sound”. The end of tube put on root of patient’s tongue and ask him close his mouth and made deep breathing and made one swallow. At the same time since swallow put in tube in pharynx. To explain to the patient, that during introduction to the probe the nausea and urges on vomiting is possible, which it is possible to crush down, if deeply to breathe through a nose. It is impossible to squeeze education to the probe by lips and pull up him. If at introduction to the probe at a patient there was a strong cough, it means that a probe got in the larynx and he needs to be immediately taken out. To repeat introduction of probe since a patient will calm down. Ask a patient gradually to do swallowing motions during which slowly and evenly to stick a probe to the necessary mark (on the average on distance 45-55 sm). to make sure in that a probe is found in a stomach: to add the Gane syringe to free his end and draw aside a piston on itself. If during aspiration syringe the maintenance of stomach enters - it testifies to the correct location to the probe. To the free end to the probe to add glass transitional, rubber tube and to fasten a watering-can.

To drop a watering-can to the level of knees of patient, to pour at her a 500-600 ml water. Slowly levitating a watering-can upwards, to continue continuously to infuse into at her the water (simultaneously no more than 1 l). As soon as a water level in a watering-can will attain a tube, to drop her to the level of knees of patient. The table of contents of stomach, divorced by water, will begin to act to the watering-can. When quantity of liquid, that went out, will approximately equal the quantity of entered it can incline a watering-can and outpour its maintenance in a bowl. Washing of stomach takes place to appearance of “clean washing waters”. If a blood appeared in washing waters, washing follows to halt and reveal to the doctor. After procedure to disconnect a watering-can, to fish out a probe from a stomach, wiping him by a napkin. A probe and tube must be dipped in disinfecting solution for disinfection.

Method of conducting of cleansing enema.

Procedure is conducted in a procedural room. Facilities are needed for her: the Esmarch mug, overcooked water, sterile tip, Vaseline butter, oilcloth, diaper, bedpan at a necessity, toilet paper, stand-bar, apron of glove of the non-permanent use, warm running water, toilet soap, individual towel. Ask a patient to lie down on a couch on left with arcuated in knees and brought to the stomach feet. Under the buttocks of patient an oilcloth is underlain, on her - diaper, near an oilcloth put into a bowl or ship. Lower part of body of patient is freed from clothes. To add a sterile tip to the rubber tube. To close a valve, to fill a mug by Esmarh water in a quantity 1-1,5 to l (30-35^o C). To bring to the Esmarch group on a stand-bar on a height 1 m from the level of couch. To open a valve to fill a rubber tube and tip by water, the same to remove air from the system. To close a valve. To smear a tip by a Vaseline butter. By the first and second fingers of the left hand porazdvinut the buttocks of patient. Carefully by easy revolving motions of right hand to bring a tip into a rectum, moving forward him on a depth 10-12 sm (at first in the direction of belly-button 3-4 sm, and then - parallel to the spine on a depth 7-8 sm). Rough and rapid introduction of tip is impermissible, because it is possible to scotch the wall of rectum. After introduction of tip slowly to open a valve and in these to be instrumental to the receipt of liquid in an intestine. To adjust intensity of receipt of liquid so that not to cause the sudden feeling of repletion of intestine and pain at a patient. At appearance of discomfort and stomach-ache it is needed to drop the Esmarch mug below, that to decrease pressure of acting liquid. To close a valve, abandoning a little water on the bottom of mug (that air did not get in a bowel). Carefully to fish out a tip. If after introduction of liquid to the rectum and drawing of tip out, a liquid begins to be outpoured it is backwards necessary to take the buttocks of patient by the left hand on 5-7 minutes. Ask a patient to lie down on the back, deeply to breathe and detain water in an intestine during 5-10 minutes. At appearance of urges on defecation, to help a patient to sit up from a couch and reach to the rest room or put a ship. It is needed to undermine after procedure of patient.

Transporting of patient in an operating-room.

Transporting of patient in an operating-room is carried out only by means wheel-stretch which cover by polyethylene tape or oilcloth, wipe by the rag moistened by a 3% solution hydrogen peroxide with a 0,5% cleanser. Over an oilcloth a clean sheet or blanket is covered. Transporting must be careful with the exception of shoves. To carry and translate a patient 2 or 3 men can on hands. In the first case one of them tricks into hands under shoulder-blades nearer to the neck and small of the back, second, - under buttocks and shins. If sick heavy or participation needs the very careful shifting adopt 3 men: one holds a head and heaps, second - small of the back and thighs, third - shins. If at a patient the put right system for intravenous infusion, additionally in shifting a medical sister which carries responsibility for its saving and capacity takes part. In before operation translate a patient into wheel-stretch of operating block and deliver to operating table.

Complex prophylaxis of bedsores.

At the loosened, immobile patients, especially at those which occupy passive position abed, the feed of soft fabrics is violated, bedsores can appear as a result. Appearance of bedsores testifies to the insufficient care of patient.

Elements of prophylaxis of bedsores:

To teach patient to care of itself as far as it is possible. To teach relatives to the receptions of care of seriously sick with the purpose of prophylaxis of bedsores. To place a patient comfort in a bed. To recommend to use one of mattresses: porolonic, inflatable, aquatic or the mattress filled by the seeds of millet. To change position of patient abed every 2 hours, to encourage a patient to change position abed by means the cross-beams, rails and other adaptations. To use adaptation for the removal of pressure of body on the damaged soft fabrics (porolonic gaskets in cuffs, the sacs filled by the seeds of millet or flax). To check up the state of bed during replacement of position of patient (every 2 hours). Bed linen must be clean, dry, without folds, scars. After every reception of meal - to shake off a sheet, that in a bed there were no crumbs. To do an easy massage during the change of position of sick. The most vulnerable areas, in relation to the origin of bedsores, to wash by warm water, to wipe by a soft towel by the method of “soaking”, and then wipe by a 10% solution of camphor alcohol, 40% ethyl alcohol, or weak solution of vinegar. To control the regular emptying of intestine. To recommend to the patients of declining and old age, and also to the patients with incontinence of urine to use pampers. Pampers change every 4 hours, each time undermining a patient. At incontinence of excrement pampers is changed after the act of defecation, undermining a patient.

Care of patient with bedsore.

To execute the measures of prophylaxis of bedsores. At removing of epidermis and formation of bubbles of them a layer by a layer it follows to process by a 1% solution of diamond green and impose an aseptic bandage. Since bubbles burst, the area of bedsore is washed by solution of antiseptic, drying by a sterile napkin, around process a skin by a 1% solution of diamond green and lay on an aseptic bandage.

The feed of seriously sick is produced by the following methods: enteral introduction of food products (by means the probes, fistulas, enemas) after renewal of peristalsis, parenteral introduction to the organism of nutritives (walking around a digestive channel).