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Other disorders and care for them
Intoxication; cough, bleeding, ulcers Ray; incontinence, edema, decubitus fistula; tracheostomy; Cystitis; Death
When strongly expressed intoxication (poisoning of the body decay products of the tumor) primarily requires careful patient care. When tumors outdoor locations should be 2-3 times a day to clear the cancer sores festering on the cover of their masses. It is best to wash them with a weak solution rivanola, warmed to body temperature. It is especially important to make washing the mouth, since accumulation of disintegrated tissue, and a sharp decrease appetite putrid odor and sick just refuse to eat. To remove toxic prescribe sodium chloride and magnesium sulfate. A good effect is the infusion of birch fungus - fungus - 1 tablespoon 4-5 times a day, injections krutsina, neotsid. Vomiting associated with intoxication, especially in patients who have had resection of the stomach and with metastasis, good antiemetic effect is the use of chlorpromazine injections.
Coughing is a protective reflex act aimed at the removal of airway foreign bodies, mucous and phlegm. Cough impulse consists of a sudden and dramatic exit with a closed glottis. In a sudden opening of the glottis, the air along with sputum and other foreign bodies that had accumulated in the respiratory tract (dust, mucus, etc.), with the power emitted through the mouth. Content from the respiratory tract does not come in through your nose, because when they cough, nasal cavity closes the soft palate. By the nature of the cough may be dry and humid. Dry cough is not accompanied by phlegm, and is found in dry pleurisy, pharyngitis and acute bronchitis, sometimes accompanied by bronchial asthma. Cough accompanied by phlegm. Thinner than the sputum, the easier it is expectorated. Cough with phlegm in a large number of change of body position is characteristic of diseases associated with the presence of cavities (abscess, bronchiectasis). Coughing that occurs in connection with food intake, indicates the presence of a fistula between the esophagus and the trachea or bronchi, which occurs, for example, the breakout of cancer of the esophagus to the bronchus. Cough accompanied by vomiting, is observed in patients with whooping cough, some forms of tuberculosis, and chronic sore throat when the viscous mucus irritates the delicate lining of the throat. Coughing can be a constant with the inflammation of bronchi, lungs, pleura, or periodic - chronic purulent diseases of the lungs and bronchial tubes. In these cases, the cough is usually a large amount of purulent sputum (mouth full).
When you cough in the first place should be treated with underlying disease. It is important to establish the patient the most comfortable position in bed. If you want an elevated position under the back enclose a 3.2 well-whipped a pillow. Give a warm drink in the form of milk with sodium bicarbonate (baking soda pinch - pinch to 1 cup of warm milk). Good acting inhalation of tincture of St. John's wort (1 tablespoon of herbs to 1 cup of boiling water, leave for 30 minutes, drain and inhale through the inhaler spray or manual), gargle eucalyptus, strong tea (1 teaspoon to 1 cup of boiling water).
To better provide patients with expectoration Elecampane root extract, herb Thermopsis, herb coltsfoot, mineral water, mineral water with warm milk. To delay the cough reflex prescribe pills for cough. To reduce the inflammation of the upper respiratory tract used diversionary facilities - mustard, banks, etc. All patients with cough, phlegm emit, should have a pocket spittoon with a glass stopper, which, after each discharge should be washed with warm soapy water and disinfect with a solution of 0.5% chloramine. Patients were forbidden to spit phlegm on the floor and into a handkerchief.
The collapse of the tumor is always accompanied by risk of bleeding. If you have any signs of bleeding should be given rest, and one or more of the following vehicles (irrespective of the location of the tumor), applying them in any order depending on the patient:
calcium lactate 0.5 g 3 times a day;
10% solution of calcium chloride to 1 tablespoon 3 times a day;
10% sodium chloride solution of 1 tablespoon 4-5 times a day;
intravenous injection of 10-15 ml of 10% solution of calcium chloride;
50 ml 20% sodium chloride solution;
10% solution of gelatin by 20-50 ml subcutaneously.
For exterior location of the tumor to the site of bleeding should be accompanied by hemostatic sponge, apply a pressure bandage and cold. When the decaying tumors of the rectum there is a danger profuse bleeding that may require immediate hospitalization for the ligation of vessels and hypogastric blood transfusion.
High risk of bleeding and tumors of the uterus and vagina, especially after an earlier unsuccessful radiation treatment when the primary tumor site has decomposing tumor. Still "sick contraindicated douching, which can cause bleeding. Start bleeding requires tight tamponade of the vagina, and with an increase in bleeding shown urgent hospitalization for surgery.
In radiation treatment of patients (outside of its use) there are skin lesions. There may come a redness (erythema), which corresponds to the blight of I degree. In the case of very large doses of radiation comes detachment of the outer layers of the skin, and finally necrosis of its corresponding III degree burn.
If you are caring for these patients is very important to preventing infection in radiation ulcers. In most cases there is a mild dermatitis. Common to all the local radiation reactions is their favorable outcome. In order to eliminate local reactions used various ointments, emulsions and creams, which contain aloe emulsion or a thesis, linolenic, tsigerol, gekserol, oil of sea buckthorn berries, vitamins A and E, high-quality fats. The reaction of the mucous membrane of the rectum or vagina these drugs are administered as a micro enemas and tampons. A few weeks later the inflammation disappears completely, although this pigmentation persists for a long time part of the skin. More severe radiation damage, as indurativity edema, require long-term specific treatment.
Patients should promptly carry out radiation therapy, because permit procedures may adversely affect treatment outcomes. When conducting a deep X-ray very carefully watching the blood picture and the overall condition of the patient. General weakness, fatigue, nausea, vomiting, headache, upset bowel function, loss of appetite, fever, in some cases mean the beginning of radiation sickness.
Urinary incontinence - involuntary urination. Urine extracted from the bladder constantly drop by drop or occasionally serving involuntarily without urge to urinate. The causes may be diseases of the urinary tract, relaxation of the sphincter of the bladder, congenital defects of the spine and spinal cord trauma, etc. For walking in patients with incontinence, there are special urinals, which are tied up with straps to the thighs and emptied by the accumulation of urine in them. Patients should monitor the accumulation of urine, clean urinals, wash frequently and disinfect them to prevent odor of urine. Caring ensures that patients with urinary incontinence who are in bed, under a sheet on the mattress was oilcloth, protecting it from pollution. If possible, the patient is placed on a special mattress in the middle part of which provides space for the ship. Under the sacrum to the patient enclose an inflatable rubber boat, which also serves as a bed-and round about the penis in men can be placed in the drainage bag - "duck", which resides between the legs. Patients should be frequently undermine and carry out prevention of bedsores. After cleaning the skin in the groin area thoroughly and wipe the grease (vaseline or vegetable oil, baby cream, etc.). You can skin powder talc baby powder. Linen change often, so from a patient not smell of urine, which irritates others. Bed-rubber boat washed with a disinfectant solution, and glass urinals washed with a solution of potassium permanganate (1:5000), bleached bleach solution or a solution of hydrochloric (HCl) acid.
Edema - accumulation of fluid in the cavities and tissues due to violations of water metabolism. In the development of edema play a major role increasing the diffusion of fluid from blood vessels into the tissue and tissue fluid retention. Edematous fluid is characterized by low relative density and low protein content.
The appearance of overt edema preceded the latent period of fluid retention, which manifests a decrease in the number of urine and the growth of body weight (determined by daily weighing). In severe cases, there are massive swelling of the legs and torso. The skin becomes dry, smooth, pale, scaly, it is insensitive to heat. Therefore, giving the patient warmers, care should be taken to avoid burns. When pressed on the skin in areas of edema is not disappearing for long hole. Imprinted on the skin folds of linen. In patients with edema observed tendency to pressure sores, so they must often change positions in bed (the best half-sitting position to give the patient). On the sheet should not be wrinkles and crumbs. Under the buttocks and sacrum enclose an inflatable rubber circle, covered with a diaper. Wetted surface of the skin (under the breasts in women, in the inguinal folds) powder talc or paving between the gauze. Patient skin rubbed with an aqueous solution of alcohol, cologne or other disinfectants.
The protective properties of skin swelling go down. Therefore, if after the injection in the skin is a hole from which the edematous fluid leaking, you should lubricate it with iodine and put a sterile gauze to prevent infection and abscesses.
The patient with edema and should be weighed daily to measure its daily water balance, ie, the ratio of liquid you drink per day and the amount of urine. Drunk includes liquid and liquid food (soup, pudding). The daily urine collected in a separate bowl, which is in the toilet (most often three-liter bottle). On the morning of summarizing and entered it in the diary. The daily consideration of these data and the daily weighing of patients give evidence of the dynamics of swelling - to decrease or increase.
Edematous fluid accumulates normally in most low-lying parts of the body. In the upright body swelling appeared on the legs and increases in the evening. I lie swelling in the first place appear at the lumbar region. Kidney swelling appear on the face below the eyes due to looseness of the subcutaneous tissue.
All patients with edema should be under the supervision of a physician, who appoints a diet with restriction of salt and fluid.
(See also "Mastectomy and other operations involving removal of regional lymph nodes")
Bedsores - ulcerous-necrotic degenerative processes that occur in debilitated patients who are long in bed. Bedsores are formed at places where the soft tissues of the compressed surface of the bed. Most often it is the sacrum, shoulder blades, the greater trochanter and elbows. Education contributes to poor pressure sores skin care, uncomfortable bed, a rare perestilanie. The first sign of pressure sores - pale skin, followed by redness, swelling and peeling of the epidermis. Then there are blisters and skin necrosis. In severe cases, gangrene are not only soft tissue but also the periosteum and the superficial layers of bone material. Accession infection can lead to sepsis and cause of death.
Preventing pressure ulcers:
1) turn the patient on his side several times a day if it allows the state;
2) every day several times a day to shake off the sheet, to avoid crumbs in the bed;
3) ensure that in bed and there was no underwear and folds a patch;
4) Seriously ill, long-term are in bed, put a rubber inflatable range, which is wearing a pillowcase, so that the sacrum was over the opening of the circle;
5) daily to wipe the skin with a disinfectant solution: a mixture of camphor, camphor spirit, vodka, cologne, vinegar solution (1 tablespoon per 300 ml of water), and in their absence to wipe the skin with a towel soaked in warm water and wipe dry with a few rubbed with skin;
6) the appearance of redness of the skin rubbed dry with a towel is the place to improve local blood circulation, skin kvartsevat;
7) the skin in areas of maceration wash cold water and soap and wipe with alcohol, then powder.
Towels to wipe the wet end of the disinfectant, a little squeeze and rub the neck, behind ears, back, buttocks, anterior surface of the chest and armpits. Particular attention should be paid to the crease under the breasts, where the obese women can develop diaper rash. Then wiped dry skin in the same manner.
When the bubbles of their cuticles with an alcoholic solution of brilliant green, then placing a dry dressing. When necrosis is separated, dead tissue is removed and the wound closed with sterile cloth soaked in 1% potassium permanganate solution, change the bandage 2-3 times a day. As the purification of a wound ointment bandages go on, applying ointment , a mixture of Peruvian and pine oil emulsion sintomitsinovoy, etc. The appearance of pressure ulcers in patients suggests a poor and inadequate health care culture. Therefore, caring for seriously ill patients must follow a daily basis and proactively manage pressure ulcers.
Nursing care is complicated by the imposition of a fistula. In severe cases, it is not possible to introduce food into the stomach gastric fistula impose (gastrostomy). With massive gastric tumors fistula for feeding the patient and impose. small intestine (eyunostoma). Feeding produced a rubber tube introduced into the lumen of the stomach or intestine, high-calorie liquid food by injecting it into the funnel, standing lennuyu the lumen rubber tube. After feeding tube lumen was washed with water and a pipe clamp is closed. Additional nutrients can be administered in enemas, subcutaneously and intravenously.
Need to worry about clean skin in the sinus openings. Typically, these holes are surrounded by pink mucosa directly in contact with the edges of the surrounding skin stomach. Gastric and intestinal juice, pus constantly irritate the skin. Macerate the skin, ulcers appear, and comes from dressing sharp putrid smell. Needed careful treatment of the skin, lubricating ointments, frequent changes of dressings. To impose an unnatural anus and strengthen the special incontinence bag, and the opening of the extracted outside the ureter - the drainage bag.
When tumors in the upper airway, breathing violate produce a tracheostomy (opening of the trachea and its introduction into the lumen of a special tube to restore breathing.) Care fistula is a frequent change of dressings thorough washing of the skin around the fistula opening 96% alcohol. If the bronchi and trachea accumulated a lot of mucus and phlegm, then through the tracheostomy, a narrow catheter sterile and produce suction. In these cases, it is also useful to create a flow of phlegm, lowering the head end of the patient's bedside.
Careful monitoring and care for a debilitated patient with a tracheostomy, unable to independently extract and clean the inside tracheotomy tube. When signs of difficulty breathing and anxiety the patient must bring to the opening of Durham's tube a piece of cotton wool, gauze or a strip of hand and determine the strength of the air stream during inhalation and exhalation. If it is weakened, it means that the inner tube is clogged with mucus or dried crusts, and it has to be extracted. The air jet should be immediately increased dramatically.
The tube is clean, rinse, dry, brush with mineral oil and paste. If after removing the inner tube a stream of air is not amplified and the patient continues to experience difficulty breathing, then the obstacle below tracheotomy tube, or it fell out of the trachea and is about her. Need assistance of a specialist.
If you are caring for inoperable patients should consider the possibility of developing cystitis (bladder inflammation) depending on the retention of urine in the bladder compression by tumor masses or from germination of the latter in the bladder wall.
Necessary to systematically check the transparency of urine, producing a clinical analysis. With the development of IC prescribed diuretic and disinfectant. In some cases, produce catheterization of the bladder with the obligatory washing after handling a 1% solution of boric acid or 0.02% solution furatsillina. For special indications pose a permanent catheter.
Death (biological) - irreversible cessation of vital activity. Signs of biological death: the complete cessation of breathing, lack of pulse, palpitations, loss of reflexes, deathly pale skin, relax muscles, including the omission of the lower jaw, loss of luster eye, numbness, gradual cooling of the body up to a full, dilated pupils with absence response to light.
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