General care of the terminally ill
Create a hygienic environment for the patient include: the selection of a separate room or part of it that can be provided the necessary conditions of his detention, the daily cleaning wet (by relatives or asset of the Red Cross). In necessary cases, in the presence of decaying tumor, repeated vomiting, urinary incontinence, fecal room ventilation is performed several times a day, and dry cleaning - with 1% or 2% solution of chlorine bleach. All items of care - feeding cup, tableware, bedpan, urinal - must be kept clean and periodically cleaned with a disinfectant solution.
Wash the patient (face, ears, hands) need daily. Periodically wash the whole body is in the shower or bath. If a patient as it can not produce at least 1 time per week full-body rubdown, in part, a towel soaked in warm water. After drying, the skin should be wiped with a weak solution of vinegar or cologne. Perineum, groin, axillary, and obese women folds under the breasts smeared with baby cream. At least 1 time in 10 days should cut his nails on the hands and feet. Hair should be combed daily. No matter how hard the patient's condition, these elements of care should be carried out systematically. They are sanative, prevention of complications and for effective psychotherapy, always to improve the mood of patients. Bedside should be neat and comfortable for him (not packed pillow, a blanket is not hanging, its edges tucked under the mattress, blanket well adjacent to the blanket, sheet straightened smoothly, without wrinkles).
In patients with urinary incontinence, fecal between mattress and bed sheets are laid oilcloth. Change of bed linen should be performed every 5-7 days. When pollution discharges - often, sometimes daily and immediately. Change of bed linen and bed perestilanie best done by shifting the patient to an adjacent bed or the couch, then they are combined with ventilation and drying of the mattress. If this is impossible due to lack of helpers or as a patient (metastases in the spine, etc.), the sheet can be changed as follows: Carefully turn the patient on his side to the edge of the bed, the vacant half of the sheet roll to roll back patient and in its place trail clean sheet, half of which is the same roll, roll it close to the roller removed sheets. After that, the patient again gently rotated on the other side through the two rollers to clean half of the bed. Clean old bed sheet and, spreading skatok new, turn the patient on his back. The change of shirt in such patients produce this: gathering it up, removed from the head first, and then with hands. Putting on a shirt in reverse order.
The position of heavy patient in bed is essential: it can help with his condition, or, conversely, heavier. A prolonged stay in a horizontal position, especially elderly patients, leads to lung function, promotes the development of congestive pneumonia, disorders of the cardiovascular system. For these patients, more appropriate to lift the Half-upright position or at 15-20 cm of the cerebral end of the bed (1.2 feet podkladyvanie under bricks or special support). Metastatic nodes in the pelvic cavity, axillary lymph stagnation areas are accompanied by persistent swelling and limb. In these cases it is necessary to create an elevated position limbs podkladyvaniem pillows or a special device. Relatives of the patient should check with the oncologist recommended the patient's position in bed and monitor the implementation of its recommendations.
Necessary to monitor the condition of the oral cavity, which can be a source of infection and dangerous complications in critically ill patients (lymphadenitis, suppurative parotitis and even sepsis). After each meal should rinse your mouth with weak antiseptic solutions or herbal extracts (solutions of sodium bicarbonate, hydrogen peroxide, potassium permanganate, infusions of sage, chamomile). If the self-rinsing the mouth can not produce several times a day treatment swab dipped in these solutions, mouth and tongue. Furred tongue dry cuticles several times a day with a mixture of glycerol with 2% sodium bicarbonate solution or Lugol.
Feeding critically ill make sure to set time, better than 4 times a day. Dishes and utensils should contribute to the appetite (cleaning supplies, food processing and herbs, etc.).
You should always monitor the condition of the intestine, providing a regular chair. Constipation prescribe the proper diet: sugar beet, fruit, prunes. If an independent chair is not the case, it causes a cleansing enema. If necessary, a patient should be planted vessel (preferably rubber). The patient remains on a rubber boat to complete a bowel movement. Prescribed by a doctor enema can be replaced by a laxative or the introduction of glycerin suppositories. After washing of the chair are required of the anus with warm water and drying with a towel special. If you have hemorrhoids ointment smeared their assigned Vaseline or impose a candle.
Debilitated patients IV clinical group to have increased predisposition to the formation of bedsores. Prevent this complication in these difficult but possible and necessary. To cure the resulting pressure sore - is impossible. Happy New Year necrosis of the skin subjected to prolonged compression of face very slow rejection of non-healing ulcers to form and is a threat of infection, of damp gangrene. To avoid this, skin necrosis with signs of beginning a few times a day smeared a concentrated solution of potassium permanganate.
Bedsores usually occur in malnourished patients, but they are not guaranteed and mast still sick. The latter often occurs maceration of the skin of the perineum, inguinal folds, axillary regions, and under the breasts with the risk of subsequent ulceration.
Preventing these complications is to comply with the purity of the body of patients, and careful daily inspection of the skin, especially areas subjected to pressure. Such inspections may be complete when you turn the patient on his side.
The first sign of incipient bedsores - redness limited area of the skin or blue in her sacrum, shoulder blades, the calcaneal tuber, the nape, with the patient on his side - of the greater trochanter, iliac spine, the outer ankle.
Suspicious sites on a daily basis and treated with soap and water, dried and cleaned with a dilute solution of vinegar and camphor alcohol or cologne. Twice a day you need to turn the patient to relieve pressure on the skin, where bedsores occur most frequently, and massaging them.
The best mattress for heavy patients are foam and inflatable. Body weight is distributed evenly among them in all areas of the skin. They allow you to have a bed in the required hygienic conditions, especially in patients who have urinary or intestinal fistulas.
For patients with metastases in the spine or long bones are soft and spring mattresses enhance pain. These patients need hard, do not bend the bed, a thin foam is best, or a hair mattress on a wooden board or a wooden couch. Sheets should be seamless. Underwear - a free, easy to remove.