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Frequent hygiene and therapeutic procedures
Warmer, bladder catheterization, enema, cleaning the patients; douching.
Since the thermal procedures are contraindicated for cancer, you can apply a heating pad only after permission of a doctor.
Heater is used for the resolution of the inflammatory process, warm the body and as a painkiller. Heaters are rubber, and electrical. Rubber hot water bottle is a reservoir with a capacity of 1-1.5 l with a tight stopper screwable. Pour hot water bottle should be a 3-4 volume that it was not too hard, then let the air by pressing the hot-water bottle, well-Screw the cork stopper to overturn the heater down (to check for leaks), it wiped dry, wrapped in a towel and put the patient. You should check the degree of heating of the skin under the hot water bottle. To prevent pigmentation, can lubricate the skin under the hot water bottle with Vaseline or grease. Very hot water bottle placed first on the blanket under the sheet and, finally, directly on the body. Hot water bottle to keep cool.
Weak and very sick do not always react quickly to thermal stimulation, so they have hot water bottles can cause burns. A special, caution is needed with regard to patients who are unconscious and lost skin sensitivity. In these patients, caregiver checks the degree of heating of the skin and ensures the correct position of heaters.
Instead of a water heater can be used electric, heating power is regulated by a rheostat. The regulator is located on the junction of the cord with a pillow. Need to use it intermittently.
Contraindications to hot water bottles: acute inflammation of the abdomen (appendicitis, cholecystitis, pancreatitis), bleeding, bruising (in the first few hours).
Catheterization - the introduction of a catheter into the bladder. Catheterization to make removal from the bladder urine in the therapeutic and diagnostic purposes and irrigation of the bladder. Catheterization requires special precautions to avoid, to the bladder infection, as the mucosa it has a weak resistance to infection. Therefore, catheterization is not entirely safe for the patient and should be done only when necessary. Catheterization using soft and hard catheters.
Soft catheter is a flexible rubber tube length of 25-30 cm and a diameter of 0.33 to 10 mm (№ № 1 - 30). End of the catheter, which is injected into the bladder, rounded, blind, with an oval hole at the side, outer end of the funnel-shaped obliquely cut or expanded to make it easier to insert the tip of the syringe when injected into the bladder of the medicinal solution.
Prior to the use of catheters, boil for 10-15 minutes after boiling water after use thoroughly washed with warm soapy water and wipe with a soft cloth. Store rubber catheters in long enamel and glass boxes with a lid, filled with 2% boric or carbolic acid, because otherwise they dry out, lose their elasticity and become brittle. In hospitals there are special sterilizers for storing rubber catheters. At the bottom of the sterilizer is placed formalin tablets, which provide a pair of sterile catheters.
Hard catheter (metal) consists of a handle, the rod and beak. Urethral end of the blind, a rounded oval with two lateral holes. The length of the catheter 30 cm in male, female, 12-15 cm with a slight bent beak.
The introduction of solid catheter carries a doctor or nurse. The soft catheter is inserted by a nurse or (at home) is specially trained in this technique caretaker relative.
Catheter woman. Before the procedure, caring wash their hands with soap and warm water, rubbing alcohol, nail phalange and tincture of iodine or urge to advance women douche, if you have vaginal discharge. Caring is the right of the patient, who lies on his back with half-bent knees and feet divorced. With his left hand pushing the labia, and right from the top down (towards the anus), carefully wiped the vulva and urethral opening with a disinfectant solution (a solution of mercuric chloride 1:1000 solution oksitsianistoy furatsillina or mercury). Then take tweezers catheter, bathed in a sterile mineral oil, and gently introduce it into the urethral opening. The appearance of urine from the external opening of the catheter indicates its location in the bladder.
When urine stops yourself go, you can gently push through the abdominal wall to the bladder for excretion of a residual urine of women urethra is short (4-6 cm), so the catheter does not pose much difficulty. If you want to take a urine culture, the edges of a sterile tube passed over a flame and, after filling the cover with sterile cotton plug. For the prevention of ascending infection caregiver must strictly follow the rules.
Catheter for men is much more complicated, because the urethra has a length from 22-25 cm and forms a two physiological restrictions, which create obstacles to the passage of the catheter. Patient during the catheterization, lying on his back with knees slightly bent and your feet divorced, is placed between the feet of the drainage bag, tray or cup, where the catheter to drain urine. Generating manipulation takes in his left hand the penis and carefully rubs his head, foreskin and urethral opening with cotton wool moistened with a solution of boric acid. Then the left hand pushes the sponge meatus, and the right hand with forceps or a sterile gauze pad with a little effort enters a soft catheter, a sterile pre-watered vegetable or mineral oil. Once the catheter enters the bladder, the urine appears. If you are unable to carry out flexible catheter, used metal. Hard men catheter enters a doctor.
Removing the catheter should not once come out urine, and a little earlier so that urine flow washed urethra after removal of the catheter.
Enema - an introduction to the lower segment of the colon of different fluids for therapeutic and diagnostic purposes. Enemas are cleaning, siphon, nutritional, medicinal and drip. To place an enema mainly use the mug Esmarch, which is a reservoir (glass, enamel, rubber) with a capacity of 1-2 liters. at the bottom of which there is a nipple, which put a thick rubber tube 1.5 m long and 1 cm in diameter with a crane at the end of the tubes regulate flow of fluid into the intestine. At the free end of the tube put on glass, ebony or plastic tip length of 8-10 cm tip must be an integer, with smooth edges. After eating tip well washed with soap under running warm water and boil. Store in a tip jar with a disinfectant solution.
Cleansing enemas are used to cleanse the lower intestine of stool and gas at a delay of a chair to prepare for the X-ray examination of stomach, intestines, kidneys, before surgery, before the introduction of medicinal enemas.
Contraindications are acute inflammatory diseases of the anus, bleeding hemorrhoids, tumors of the rectum in the process of disintegration, gastric and intestinal bleeding.
To place a cleansing enema, except a mug Esmarch, you must have a tripod to hang her, a thermometer to measure the temperature of injected fluid (water at room temperature, the solution of chamomile, etc.), oilcloth, pelvis, bedpan.
Enema puts on a doctor or a nurse (at home) by specially trained family member. The patient was placed on a couch or a bed close to the edge on the left side with legs bent and tightened to the stomach down. If the patient can not move, it is laid on his back. Under the buttocks substituted bedpan and enclose oilcloth, the free edge of which is immersed in a bucket in case the patient does not hold water. In a cup pour Esmarch 1-1.5 liters of boiled water at room temperature, lift it up and down the tip down to release a small amount of water, and with it - the available air. Fill the system (displays a little liquid from the tube) and then, without lowering the cup, close the valve on the rubber tube. Check, whether the tip is broken, smeared it with Vaseline and, apart buttocks patient is injected into the rectum with light circular movements. The first tip is introduced 3-4 cm toward the umbilicus, followed by 5-8 cm parallel to the coccyx. If there are obstacles and the handset rests in the intestinal wall or solid stool, the tube removed at 1-2 cm and open the faucet. Esmarch mug raised to a height of 1-1.5 m, and the pressurized water enters the large intestine.
When plugging the tip of his stool extract, clean and enter again. If the rectum is filled with feces, try to dilute it with water. Sometimes stool can be so hard that an enema is not possible. In such cases, the feces from the rectum removed his finger, wearing rubber glove, greased with Vaseline.
In the presence of gas and the emergence of a sense of fullness in the patient should immediately drop the mug below the bed and passing flatus gradually raise it again. Leaving at the bottom of a little water to the intestine did not hit the air, close the valve regulating the flow of fluid, and extract the tip.
It is desirable that the patient kept in water for 10 minutes. To do this he must lie on your back and breathe deeply. After the procedure, a mug Esmarch washed, wiped dry, and cover the top with gauze or a towel. Enema of plain water does not always lead to bowel movements. To strengthen its actions to the water you can add 1 / 2 teaspoon crushed into powder baby soap, 2-3 tablespoons of glycerine, 1-2 tablespoons of salt, 1 cup of infusion or decoction of camomile, etc. If the enema did not work, after a few hours it can be repeated. In formulating cleansing enema to make sure that at one time that not more than 1.5-2 liters of fluid.
Siphon enema. In cases where conventional cleansing enema is not given effect, intestinal obstruction, and for the removal of intestinal food fermentation, in the administration of poisons and gases to remove the best way to wash the intestine is the siphon method (multiple intestinal lavage), which uses principle of communicating vessels: one is the intestine, the other - crater on the outer end of the rectum with a rubber tube. Enemas are needed to siphon sterilized tube length of 100-120 cm and 1.5 cm in diameter with a plastic funnel at the outer end that holds about 0.5 liters of fluid, pitcher, 10 - 12 liters of disinfectant liquid (weak solution of potassium permanganate, sodium bicarbonate) or boiled water, heated to 38 ° C, and a bucket to drain the water. The patient was placed on the left side or back, under your buttocks enclose oilcloth, and put a bucket beside the bed to drain and a pitcher of liquid. The tube is introduced into the rectum, heavily greased with petroleum jelly and pushed a 20-30 cm Be sure that the tube is not curled up in the ampulla of the rectum, controlling its position, if necessary, with a finger. The funnel should be kept slightly above the patient's body in an inclined position. Then, gradually filling it with liquid, lift over the body at a height of 1 m. The water begins to pass into the intestine. As soon as the water level decreases to reach narrowing funnel, the latter immersed over the basin, not turning up until the water from the bowel does not fill the funnel. In this situation, the crater are clearly visible air bubbles and lumps of feces. All the content is poured into the bowl, refill funnel with water and repeat the process several times until it stopped passing flatus and the funnel will not come clean water. To siphon enema may take up to 10-12 liters of water. After the procedure the funnel is removed, washed and boiled, and left a rubber tube in the rectum for 10-20 minutes, lowering its outer end in a basin to drain the remaining liquid and flatus.
Enemas cause hypertensive good laxative action without a sharp intestinal peristalsis. Typically use 5-10% solution of sodium chloride (table salt), 20-30% solution of magnesium sulfate or sodium sulfate. In the rectum is administered 100-200 ml of warm solution through a rubber balloon - "Pears". Contraindications are inflammatory and ulcerative processes in the lower colon.
Oil enemas are used for refractory constipation. To do this, use vegetable oils: sunflower, olive, hemp, vaseline. To take one enema 50-100 ml warmed to 37-38 ° C oil. Enter oil usually with a rubber balloon, a syringe or catheter, advancing it into the rectum by 10 cm oil spreads on the intestinal wall, envelops the feces, relaxes the intestinal muscles and promotes the excretion of feces. The patient must lie still for 10-15 minutes, so that the oil does not.
Enemas emulsion. Pre-prepared two glasses of chamomile (chamomile 1 tablespoon to 1 cup of boiling water), then whisk the yolk of one egg with 1 teaspoon of sodium bicarbonate (baking soda) and fill in with chamomile extract, add 2 tablespoons of vaseline oil or glycerin.
Medicinal enema. If the introduction of drugs by mouth is impossible or contraindicated, you can enter them through the rectum, where they are absorbed through the hemorrhoidal veins, and quickly enter the bloodstream, bypassing the liver. Drugs are divided into enema enema of the local and general. The first use of inflammatory processes in the large intestine, and second - for the introduction of drugs into the body or nutrients.
30-40 minutes to put a cleansing enema drug, and after a bowel movement is administered medication. Medicinal enemas are mostly microclysters, since their contents must not exceed 50-100 ml. Gaining drugs in 20-gram syringe, a syringe or a Janet rubber bulb with a capacity of 50 to 100 g. The temperature of the drug should not be less than 40 ° C, since at lower temperatures occur urge to defecate and medicine do not have time to be absorbed. The patient lies on her left side, legs bent at the knees and pulled up to his stomach. Pushing the buttocks with his left hand and right rotational motion is introduced with a sterile liquid paraffin lubricated catheter 15-20 cm into the rectum. Then connect the catheter with a syringe or a spray, which contains a medicinal substance, and slowly squeeze the solution into the catheter in small portions under slight pressure. Then, holding and squeezing the outer end of the catheter to prevent it from going out the opposite of the liquid, carefully remove the syringe or container with a catheter, type in the air, once inserted into the catheter and flushed to push the remaining liquid in it. In order not to cause mechanical, thermal and chemical stimulation of the intestine, it is necessary to introduce a drug in a relatively low concentration, diluted in warm isotonic sodium chloride solution or with shielding material (50 g starch broth). Most often administered micro clyster painkillers, sedatives and hypnotics matter.
Starch enema is used to reduce the motility and enveloping as emollient in acute colitis. To do this, 5 g starch (potato, rice, corn, wheat) diluted in 100 ml of cold water and stirring, gradually add 100 ml of boiling water. Then the cooled solution to 40 ° C and injected into the rectum.
Hloralgidratnye enema administered in convulsions and sudden excitement. Chloral hydrate (1 g) diluted in 25 ml of distilled water and 25 ml of brewed starch (at the rate of 1:50), chloral hydrate as an irritant to the mucous membrane of the rectum.
Proctoclysis used to compensate for the loss of blood or fluid. Typically, the drip is administered 5% glucose solution with isotonic sodium chloride solution. For proctoclysis use the same instruments as for the cleaning, only the rubber tube connecting the head with a mug of Esmarch, insert an IV with a clamp. His screwed so that the fluid came out of the tube into the rectum do not spray, and drops. Clamp and adjust the frequency of drops (usually 60-80 drops per minute, ie 240 ml per hour). At night you can enter the drip method to 3 liters. Mug with a solution of suspended to a height of 1 m above the bed. Caregiver should closely monitor the patient to lie in order to not to bend the tube and did not stop the current of liquid. Injected solution has a temperature of 40-42 ° C, for this to the back of the mug Esmarch attached water bottle and watch, that she was always warm.
Nutrient enemas. In cases where you can not enter the nutrients through the mouth, they can be administered through the rectum, which is a type of artificial feeding. The use of nutrient enemas are very limited, as in the lower segment of the large intestine, which receives the content, which was introduced with the help of an enema, only absorbed water, isotonic sodium chloride solution, glucose solution and alcohol. Partially absorbed by proteins and amino acids. Nutrient enemas can only be added by the introduction of nutrients.
30 - 40 minutes to put nutritional cleansing enemas prior to a full bowel movement. The volume of nutrient enemas should not exceed 1 cup. Warm solutions are gaining in rubber bulb, smeared with vaseline oil spray nozzle, produce available in the air and its nose is inserted into the rectum. Click on the balloon to slowly and gradually entered the liquid in the intestines and does not irritate the mucosa. After that the patient must lie still to avoid the urge to defecate.
Cleaning the patients
Patients who are long in bed and do not take a bath every week, hygiene, and incontinence of urine and feces, it is necessary several times a day to wash away, as the accumulation of urine and feces in the inguinal folds may violate the integrity of the skin and the formation of bedsores. Cleaning the produce with a weak solution of potassium permanganate or other disinfectant. The solution should be warm (30-32 ° C). For cleaning the need to have a pitcher, and a sterile dressing forceps cotton balls. Most often tempted to women.
When cleaning the buttocks under enclose the vessel. The patient should lie on his back, bending his legs at the knees slightly apart and the hips. In the left hand take a jug of warm water with a disinfectant solution and on the vulva with a cotton swab wash genitals gradually at first moving to the anus (top down) once, then a dry cotton swab wipe the skin in the same direction and throw the swab so as not to carry infection from the anus to the bladder. Convenient to carry out cleaning the mug Esmarch with a rubber tube, and vaginal clamp tip, directing a jet of water on the perineum or a dilute solution of potassium permanganate.
Men to wash away much easier. Position of the patient and on his back, legs bent at the knees, under your buttocks enclose vessel and sent a stream of water on the perineum and inguinal folds. Cotton swab rubbed the skin, then wipe dry with a cotton swab it dry, and if there is chafing in the inguinal folds, they smeared with Vaseline or any oil.
Douching - a method of vaginal lavage with curative intent with water or water solutions of medicinal substances. In this case there is a mechanical wash vagina content. Depending on the drug can produce burning of the vaginal mucosa, astringent, tonic and disinfectant action on it. Not recommended squirt women in the second half of pregnancy and the postpartum period.
To prepare 2 liters of irrigation water or medicinal solution suitable temperature, mug Esmarch and vaginal tip, ship and chock oilcloth. Most often used a weak solution of potassium permanganate (5-6 grains per 2 liters of water), 0.9% isotonic sodium chloride solution, sodium bicarbonate (baking soda 2 teaspoons per 1 gallon of water), boric acid (2-4 teaspoons to 0 5 liters of water).
Vaginal caps are glass and plastic. They are slightly curved tube 15 cm long and about 1 cm thick with one hole at the end or a few holes on the sides near the end. Glass tips to use sterilized by boiling, the plastic is washed with antiseptic solutions. Esmarch mug hung on the stand at 70-100 cm above the bed and poured into it no more than 1 liter of solution. During irrigation the patient lies on a bed in a bedpan with legs bent at the knees and hips divorced. Washing with soap and water clean vulva, pushing two fingers of his left hand labia, gently introduce the tip of a crack sex and slowly pushing in the direction of upward and backward at a depth of 6-7 cm Then, holding one hand entered the tip, another open tap or clamp, releasing the liquid to a greater or lesser rate. Removing the tip at the end of the procedure should be cautiously in the direction of forward and downward so as not to hurt the urethra area.
Gynecological patients spend as irrigation treatments. Sometimes, after a medicinal douches are sick for some time that the solution had a longer effect. After drinking a cup should be washed first Esmarch warm water, then disinfectant tip dipped in the jar with a 3% solution of bleach or boric acid.
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