Nursing final exam question with answer

Nursing Final Exam Question with answer

Nursing 

Nursing-Nursing is organization of patient care.

Nursing includes three components:

  1. Providing a variety of patient needs. Patient needs: eating, drinking, washing, moving, help while defecation or urination.
  2. Creation necessary conditions for the patient stay at the hospital or at home.It means peace and quiet and also keeping beds and clothes clean.
  3. Alleviating the sufferings of the patient and prevention of complications.
  • Nursing is a part of the patient treatment.
  • It is performed by the nurse and hospital attendant (junior nurse).

The main types of nursing:

1.General  nursing – is a set of measures for the care without depending on the type of disease.

2.Special nursing – is a set of measures, which depends on the specifics of the disease, its symptoms.

Care is administered in medical institutions.

PATIENT

In the centre our subject – Patient.

PATIENT  (A  Latin word meaning to suffer or to bear) – Is a person who is waiting for or undergoing medical/nursing treatment and care.

TYPES OF MEDICAL INSTITUTIONS:

  1. Policlinic. Patients served by the policlinic and at home (without hospitalization), located in the city.
  2. Ambulatory. Patients served in the ambulatory and at home (without hospitalization), located in a small town.
  3. Medico sanitary department. Task – service workers of industrial enterprises, consists of a policlinic, hospital, health center, preventorium.
  4. Dispensary – specialized institutions in which receive treatment  patients with certain pathology (tuberculosis, skin and venereal diseases, cancer etc.)
  5. Station of  Ambulance – provides emergency specialized medical aid around the clock.
  6. Women’s Consultation – carry out control and treatment of women with gynecological diseases, and prenatal service.
  7. Hospital – carry out dynamic control and treatment of patients around the clock.
  8. Clinic – the hospital, which is composed of the Chair of Medical school.
  9. Military hospital – a hospital for sick soldiers and disabled veterans.
  10. Sanatorium – a hospital in the resort zone, where carry out therapy by natural and physical methods.

Hospital

The functions of the hospital:

  • Diagnosis of diseases
  • Treatment of diseases
  • Disease prevention

The structure of the hospital:

  • Admission department
  • Inpatient departments
  • Diagnostic department
  • Pharmaceutical department
  • Kitchen
  • Laundry
  • Administration rooms

Types of hospitalization in Hospital :

  1. Planned hospitalization.

The patient comes to the hospital in the direction of a doctor from the policlinic or comes to the hospital by yourself.

  1. Emergency hospitalization.

The patient is admitted to a hospital in an emergency (acute illness, trauma, injury and other)

  1. Transfer from another medical hospital.

Change the Doctor or Change the Diagnosis Center.

Admission Department

Admission Department
Admission Department

Functions of the admission department:

  1. Registration of patients.
  2. Medical examination of the patient.
  3. Determination department for hospitalization.
  4. Emergency medical aid (if necessary).
  5.  Sanitary treatment of patients.
  6. Transportation of patients.

THE STRUCTURE  OF ADMISSION DEPARTMENT:

1.Waiting room – a room for patients and relatives, which should be plenty of chairs, an information board.

2.Registry – special room where  to registration patients.

3.Two examination rooms – for inspection therapeutic and surgical patients.

4.Sanitary room – for sanitary treatment (Sanitary and hygienic processing of patients).

5.The treatment roomto perform the injection.

6.Small Operating room (bandaging room).

7.Isolator.

8.Laboratory.

9.Room for medical staff.

10.Toilet room (WC).

11.Warehouse for the storage patient’s clothes.

Registry-Registration of Patients:

Medical documents of admission department:

1.Medical hospital card (medical history/ case history)

2.Journal of registration of patients and refusal of  hospitalization.

3.Journal of examination for pediculosis.

4.Journal of registration infectious diseases.

5.Journal of telephone messages, etc.

Examination rooms. Medical examination:

  • Doctor examines the patient.
  • Doctor prescribes the minimum examination in accordance with the disease.
  • Doctor determines the indications for hospitalization to hospital.
  • Doctor provides first aid if the patient’s condition is severe (seriously ill).
  • Doctor determines the volume of sanitization (sanitary treatment).
  • Doctor determines the type of transportation .

Sanitary Room The structure of sanitary inspection room

  1. Dressing room 1 – a room where patients undress and are inspected.
  2. Dressing room 2 where patients dress in clean clothes.
  3. Shower or bathroom, where patients take a shower or bath.

Clothes of patients is delivered in a warehouse.

If the patient revealed an infection, his clothes is delivered in the disinfection chamber. The patient is placed in isolator or hospitalized to the infectious diseases hospital.

Sanitary treatment

(Sanitary and hygienic processing of patients):

Types of sanitary treatment :

  • Complete processing
  • Partial processing

Algorithm Сomplete sanitary treatment :

  • Examination of the hair and skin (detection pediculosis);
  • Gooming of nails and hair (if needed);
  • Shaving (if needed);
  • Take a shower or hygienic bath.

     Algorithm Partial sanitary treatment :

  • Examination of the hair and skin (detection pediculosis);
  • Partial wash and wiping the skin.

Partial processing is performed if the patient in critical condition.

Inspection of skin and hair of the patient

  • Examination of the skin and hair of the patient is carried out to detect lice.
  • Pediculosis – the lesions of skin and hair as a result of parasitism on the body lice.
  • Pediculosis – a specific parasitism of lice on human, which feed on its blood.
  • Lice – are vectors of typhus and relapsing fever and other rickettsial diseases.

Lice exist on our planet for about 40-50 million years.

The history of mankind has “only” about 2.5 million years.

There are about 250 species of lice.

On the body of human parasites three types of lice.

Types of lice

  • The head lice – louse affects the scalp;
  • Body (clothes) louse – is usually a parasite on the human clothes. However, she lives and lays eggs (nits) in clothing and feeds on temporarily moving from clothing on the skin.
  • Pubic lice – striking surface hairy pubic area, hairy underarms, and face – mustache, beard, eyebrows, eyelashes.
  1. a) Head lice; B) Body (clouthes) lice  C) Pubic lice
Type of Lice
Type of Lice

Signs of Pediculosis:

  • Presence of adult insects,
  • Their eggs (nits),
  • Skin itch,
  • Traces of scratching on the skin

Details 

  • Pediculosis is associated with poor hygiene, crowded living conditions and exposure to other individuals with pediculosis.
  • Lice can be transferred from person to person through direct contact. It gets easily transmitted from person to person perhaps sleeping together, sitting together etc. They can also be transmitted through clothing, bedding,combs etc.
  • The itching of the scalp is a source of discomfort to the client causing restlessness and insomnia.
  • The lice are blood suckers and cause anaemia.
  • They spread the disease e.g. typhus fever, relapsing fever,trench fever.
  • Itching of the scalp results in the scalp injury and the injured area is subjected to infection which lead to infected glands.

Prevention of Pediculosis

Prevention  is easier than controlling.  For this, proper personal hygiene concept should be practiced by everybody in their lives.

  • Do not wear other people’s hats, Do not use the comb of strangers.
  • Combing the hair daily, washing it frequently, keeping the skin and clothing clean will solve the problem.
  • Any client complaining of itching or if scratches the head,needs thorough examination of the hair and scalp,body and linen to discover lice.
  • If lice are found on the client’s head or body,follow the prescribed treatment.

Algorithm of actions:

  1. Wash hands. Wear protective clothes (gown mask and cap). Reason –  The gown and cap protect the nurse from the infestation with lice.
  2. Spread out oilcloth, seat the patient on a chair or couch.
  3. Part the hair into small sections and apply the parasiticide on the hair and scalp, rubbing gently. In long hair, the medicine is to be applied along the whole length of the hair.ReasonThorough application of the parasiticide ensure thorough destruction of the lice.
  4. Roll up the long hair to the top of the head and cover the had with the cap or triangular bandage or by a towel folded diagonally. Secure it with pins. Sustain the necessary time, according to methodical instructions on the medication. ReasonCovering the head with the towel prevents the spread of the lice to other areas of the body.
  5. Wash off medication with warm water and with shampoo.
  6. Rinse hair with warm water and 6% vinegar.
  7. Carefully comb out lice and nits louse with comb.
  8. Disinfect object of care and protective clothes.
  9. Make an entry in the patient’s medical document. Marking «P» on the title page of Medical hospital card (medical history).
  10.  10 . Process the room.

N.B. After 7 days to see the patient again. If necessary, repeat the procedure.

Parasiticides Used in the treatment of pediculosis

  1. Nitttifor
  2. Pedilin
  3. Couple plus
  4. Paranit

The instruction to the drug Nittifor

  • Method of application and dose:
    Hair is liberally moistened with a solution with a cotton swab, rubbing the drug into the hair roots. Consumption per person – 10 to 60 ml, depending on the density and length of hair. After the treatment the head is covered with scarf, and after 40 min drug wash off with warm running water with soap or shampoo. After washing a hair comb to remove dead insects. If live lice are found 7 days after treatment is recommended to repeat the treatment.
  • In the case of existing danger of re-infection in a group (school, kindergarten) medicine to apply after shampooing and leave it on the hair after drying. Applied to the hair, the drug retains its activity for approximately 2 weeks (does not allow to reproduce again caught hair lice). To repeat the treatment after every hair wash. The dead nits are removed from hair with a thick comb or one, because they are firmly attached to the hair.Solution. A bottle containing 24 ml of the drug, calculated on a three-day course of treatment. For ease of use on the bottle marks.
    Applied externally in the form of freshly prepared 0.4% aqueous emulsion, for which 1/3 of the contents of the vial (8 ml) is added to 100 ml of boiled water at room temperature. The finished emulsion 1 time a day (at night) thoroughly rubbed into the skin of the upper extremities, torso, and then lower extremities.
    Not be processed skin of the face and neck, and scalp. At the end of the treatment on the fourth day the patient should take a shower and to hold a change of underwear and bed linen.

Patient’s transport

    Method of transportation of the patient in the hospital:

  1. On a stretcher (gurney)
  2. A wheelchair
  3. On foot (accompanied by medical personnel – nurse!)

 REMEMBER

  • The doctor conducting the examination, determines the method of transportation of the patient.
  • Necessary take into account the patient’s condition.
  • Seriously sick (can not move) are transported to the office on a stretcher or in a wheel chair. Means of transport (wheelchairs, stretchers) are provided with sheets and blankets that must be replaced after each patient.
  • Patients that move independently from admissions go to the house accompanied by nurses.

Means of transport:

  • Wheelchairs
  • Gurney
  • Stretchers
Means of transport Patient's transport
Means of transport Patient’s transport

Algorithm. Transportation a patient on a stretcher (gurney)

1.Wear gloves.

2.Cover the stretcher with bedsheet.

3.Shifting the patient from bed to stretcher:

Put the head end of the stretcher perpendicular to the foot end of the bed (medical couch) (figure 1). If the area the house is small, put the stretcher parallel to the bed (figure b).

If three medical personnel: first nurse put hands under the head and shoulder of the patient, second the pelvis and the upper part of the hips, third – under the middle of the thighs and shins.

If  two medical personnel: first nurse put hands under the neck and shoulder of the patient, second under the lower back and knees.

  1. Raise the patient, turn in the direction of stretcher on 90 ° (perpendicular shifting) or on 180 ° (parallel shifting).
  2. Place the patient on a stretcher, cover him.
  3. Carry the stretcher (roll the gurney) in the department by head forward to evaluate possible changes patient’s condition.
  4. In the ward put the head end of the stretcher to the foot end of the bed.
  5. Shifting the patient from stretcher to bed (rules above).
  6. Process the stretcher.
  7. Put gloves in disinfectant.
  8. Wash hands.

Transportation on a stretcher

  • Carry a patient on a stretcher should be without haste and shaking. Carry the patient down the stairs feet forward. Carry the patient Up the stairs, the head forward.

Shifting the patient from bed to wheelchairs

Shifting the patient from bed to wheelchairs
Shifting the patient from bed to wheelchairs

INPATIENT DEPARTMENT

(therapeutic or surgical department)

The staff of the Inpatient department:

  • Head of Department
  • Doctors (clinical intern)
  • Senior nurse
  • Ward nurse
  • Treatment nurse (procedural nurse)
  • Junior nurse
  • Dressing nurse (surgical Department)

Types of Nurse and Function

SENIOR NURSE – the most experience nurse of department.

Functions:

  • Organize the work of Ward and Junior nurses;
  • Supply the drug, medical equipment, medical instruments in Inpatient department for nursing care
  • Strict accounting of narcotic and toxic drugs.

WARD NURSE

Functions:

  1. Admission patients.
  2. Carry out of nursing examination (weight, height, thermometry, blood pressure, pulse).
  3. Organization General nursing. The provision of hospital regimes, personal hygiene, motor activity, nutrition, pharmacotherapy.
  4. Organization Special nursing (depends on the disease).

TREATMENT  NURSE

Functions:

  1. Perform doctor’s appointments (parenteral methods of administration – subcutaneous, intramuscular, intravenous injections, intravenous infusion)
  2. Helps the doctor during manipulation (for example, determination of blood group).
  3. Take of a blood from a vein for biochemical research

JUNIOR NURSE

Functions:

  1. Regular wet cleaning of Inpatient department .
  2. Sanitary and hygenic processing of the patients.
  3. Transportation of patients.
  4. Implementation nursing for the seriously ill (Help to Ward nurse).
  5. Disinfection of used subjects of care for patient.
  6. Сollecting and disposing of medical waste.

The Structure of the Inpatient Department:

1.Nursing station (office)

2.Wards for patients.

3.Treatment room.

4.Manipulational room – Cabinet for medical procedures (such as enema, sensing and other manipulation).

5.Rooms for medical staff.

6.Dining  room.

7.Shower room.

8.WC (toilet room).

9.Dressing room (surgical Department)

Nursing station Organization the work of nursing station

Nursing station (office) – It is workplace of Ward nurse, located in the hall.

Equipment nursing station  

  1. 1.Table
  2. Chairs (2 – 3)
  3. Telephone.
  4. Capboard for medicines.
  5. Table lamp
  6. Clock.
  7. Refrigerator for foodstuff.
  8. Signalization.
  9. Device to measure blood pressure
  10. Medical scales
  11. Height meter

Admission patients is a process of receiving a new patient to an individual unit (ward) of the hospital.

Admission patients includes:

1.Check for orders of admission.

2.Assess the patient’s immediate need and take action to meet them. These needs can be physical (e.g. acute pain) or emotional distress, (upset).

3.Make introduction and orient the patient.

4.Perform baseline assessment of  patients:

  • Consciousness
  • Temperature
  • Respiration
  • Pulse
  • blood pressure.
  • Measure the weight of the patient
  • Waist size
  • Height is measured (if required)
  1. Documentation

An algorithm for the measurement of body weight

Equipment.

  • Medical electronic scales
  • Oilcloth (or disposabl napkin)
  • Gloves
  • Medical documentation (temperature sheet)
  • Сontainer for disinfection

Algorithm:

  • Explain to the patient the purpose and procedure course. Obtain patient’s consent.
  • Conduct hygienic washing hand and processing hand. Put the gloveson.
  • Put on the surface of scales the oilcloth (or disposable napkin).
  • The patient must remove their shoes.
  • The patient must carefully stand on the center platform on the oilcloth.
  • Remember result.
  • Ask the patient get off on the floor carefully.
  • Offer the patient put on shoes and walk to the ward.
  • Conduct disinfection used material (or utilization napkin).
  • Take the gloves off and put them in the container for disinfection.
  • Wash hands hygienic way.
  • Make a record of results in a medical documentation.

Algorithm measurement the growth of the patient

Equipment.

  • Medical stadiometer
  • Oilcloth (or disposabl napkin)
  • Gloves
  • Medical documentation (temperature sheet)
  • Сontainer for disinfection

Algorithm:

  • Explain to the patient the purpose and procedure course. Obtain patient’s consent.
  • Conduct hygienic washing hand and processing hand. Put the gloves on.
  • You must cover the platform of the stadiometer with an oilcloth (or disposable napkin). The patient must remove their shoes and cap.
  • Ask the patient to stand on a platform of stadiometer, covered with oilcloth.
  • Explain what patient must straighten your back during the measurement of growth, to touch vertical strips by four points: neck, shoulders, buttocks and heels.
  • Check the position of the patient’s head. The line connecting the external corner of the eye and upper edge of ear must be horizontal.
  • Lower the measuring bar on the top of the patient head. To fix the bar with hand.
  • Ask the patient get off on the floor.
  • Offer the patient put on shoes and walk to the ward.
  • Conduct disinfection used material (or utilization napkin).
  • Take the gloves off and put them in the container for disinfection.
  • Wash hands hygienic way.
  • Make a record of results in a medical documentation .

Anthropometry

  • Anthropometry – evaluation of human body by measuring height and body weight.
  • Today in clinical practice is widely used calculation of body mass index (BMI) which is calculated by the formula:

BMI=body weight (kg) / height2 (m).

  • The ideal BMI is 24.
  • In this BMI, the mortality rate of man minimum. A BMI of over 30 means obesity, less than 18 – underweight.

The waist size

  • In normal waist circumference (FROM) women should not exceed 80 cm, and for men 94 cm.
  • If the circumference of your waist is higher than normal, then you are at risk of cardiovascular diseases and type II diabetes.

«The bigger the waistline the shorter the life

Patient Care Unit

Patient Care Unit: is the space where the patient is accommodated in hospital or patient home where to receive care.

The patient unit in the hospital is of three types:

1.Private room – is a room in which only one patient be admitted

2.Semi private room – is a patient unit which can accommodate two patients

3.Ward – is a room, which can receive three or more patients.

Patient Care Unit сonsists of a hospital bed, bed side stand, chair, overhead light, waste container and others as needed and available.

Hospital Bed. Gatch bed: a manual bed which requires the use of hand racks or foot pedals to manipulate the bed into desired positions i.e. to elevate the head or the foot of the bed.

Types of  Hospital Regime:

1.Therapeutic protective regime

2.Individual  (motor ) regime

3.Hygienic regime

4.Sanitary and epidemiological regime.

2.Individual motor regime – the amount of patient`s physical activity.

Types:

  • Strict bed rest regime
  • Bed rest regime
  • Ward regime
  • Free regime

Strict bed regime  A patient must not move yourself and change position in bed.

For example: The strict bed regime
is  prescribed by the doctor during  the first hours after surgery, myocardial infarction, and others.

Bed rest regimeThe patient may move only in bed.

This regime is prescribed in order to increase motion activity while recovery.

Ward regimeThe patient may sit, stand, walk carefully in hospital ward.

Free regimeThe patient may move  freely within a ward or department.

 

3. Hygienic regime – a system of requirements for hygienic conditions at the hospital.

For example:

  • Walls in the wards must be painted with oil-based paint. No wallpaper on the walls. Such walls are difficult to wash.
  • Beds must be made ​​of metal, because beds made of wood can absorb blood, urine and so on.
  • Walls in the medical treatment room must be tiled.

Medical privacy

All information received by a medical worker about the patient – is a medical privacy.

Medical privacy includes:

  • information about the treatment in the hospital;
  • information about a person`s health status;
  • information about the diagnosis;
  • other information received during the examination and treatment.

A doctor in Russia can violate the medical secrecy in the following situations:

1) If a patient has mental disorders, therefore, they can not express their will;
2) if there is the threat  of infectious disease dissemination or poisoning;

3) if there is a criminal investigation;

4) If the patient is a child;

5) If the disease is a result of violent act.

For example, a knife wound.

Iatrogenic illnesses

An incompetent medical worker may do harm to the patient.

The consequences of the medical negative action are called  “Iatrogenic illnesses”.

Types of iatrogenic illnesses:

  • Psychogenic iatrogeny
  • Medicamental iatrogeny
  • Manipulation iatrogeny
  • Silent iatrogeny
  1. Psychogenic iatrogeny – the pathology, caused by careless words and actions of the doctor.
  2. Medicamental iatrogeny – is a result of drug effect.
  3. Manipulation iatrogeny – is a complication, appeared during medical procedures.
  4. Silent iatrogeny – a result of inaction of a medical worker.

 

Nosocomial Infection 

Nosocomial infections: (hospital) – is any clinical microbial disease, affecting the patient as a result of hospitalization or hospital visits in order to receive treatment.

Nosocomial infection is a disease developed in a patient 48 hours after admission, and healthcare worker involved in the treatment and care of patients in the hospital.

The problem of nosocomial infection and infection control is a priority for a number of reasons, which include the following:

  • mortality of nosocomial infection in medical hospitals took the first place;
  • infection acquired patients in the hospital, greatly increases the cost of his treatment, because it involves the use of costly antibiotics and increases the duration of hospitalization;
  • infection – the main cause of illness and death in newborns, especially premature (for example, 25% of premature infants in the intensive care unit develops sepsis, making the frequency of death 2 times higher and hospitalization longer);
  • disability due to nosocomial infection has significant financial problems for the patient and his family.
  • In the United States of 120000 or more patients infected with NI, killed about 25% of cases and, according to experts, NI represent the leading cause of deaths. Obtained in recent years evidence suggests that NI significantly lengthen the duration of stay of patients in hospitals, and caused damage every year is from 5 to 10 billion dollars in the United States.

 

Nosocomial infections
Nosocomial infections

What is Infection ?

  • «Infection» is a biological phenomenon characterized by the interaction of a pathogenic microorganism with a macroorganism (human).
  • «Infectious process» – a complex of adaptive reactions of the organism in response to the introduction and proliferation of the pathogen. (Reactions aimed at restoration of homeostasis and disturbed biological equilibrium with the environment).
  • Microorganism that can cause infectious disease is called a pathogen.

Properties of pathogen:

  • Invasiveness – the ability of the pathogen to penetrate through the skin and mucous membranes into the internal environment of a macroorganism.
  • Toxigenicity — the ability of microbes to produce toxins.

CHAIN OF INFECTION

Main Components of the chain of infection (simple version).

1)Infectious agent (pathogen)

2)Rout of transmission

3)Susceptible host.

 

CHAIN OF INFECTION

The presence of a pathogen does not mean that an infection will begin. The process resulting in an infection is referred to as the chain of infection.

Components of the chain include:

1)Infectious agent (pathogen). Reservoir – a place where microorganisms survive, multiply, and wait to transfer to a susceptible host. Common reservoirs are humans and animals, insects, food, water. Frequent reservoirs for health care-associated infections include health care workers (especially their hands), patients’ body excretions and secretions, equipment, and the health care environment. There are two types of human reservoirs: those with acute or symptomatic disease and who show no signs of disease but are carriers of the disease. Human can transmit microorganisms in either case. Portal of exit. After microorganisms find a site in which to grow and multiply, they must find a portal of exit if they are to enter another host. Microorganisms exit through a variety of sites such as skin and mucous membranes, respiratory tract, gastrointestinal tract, urinary tract, and in blood.

2)Rout of transmission. Many times there is little that you are able to do about the infectious agent or the susceptible host, but by practicing infection prevention and control techniques, such as hand hygiene, you interrupt the rout of transmission. Portal of entry. Organisms are able to enter the body through the same routes they use for exiting. Common portals of entry include broken skin, mucous membranes, genitourinary (GU) tract, gastrointestinal (GI) tract, and respiratory tract.

3)Susceptible host. Susceptible to an infection depends on the individual’ degree of resistance to pathogens. Although everyone is constantly in contact with large numbers of microorganisms, an infection does not develop until an individual becomes susceptible to the strength and numbers of those microorganisms.

Nosocomial infections Root of Transmission
Nosocomial infections Root of Transmission

Types of Nosocomial Infection

There are TWO FORMS OF NOSOCOMIAL INFECTION (classification):

  1. Endogenous infection (self-infection, or auto infection).
  • The causative agent of the infection is present in the patient at the time of admission to hospital but there are no signs of infection. The infection develops during the stay in hospital as a result of the  patient’s  altered resistance

ü hematogenic way – infection spreads with blood flow.

ü lymphogenic  way – infection spreads with lymph flow.

  1. Exogenous infection (Cross-contamination followed by  cross-infection):
  • During the  stay  in hospital  the  patient  comes  into  contact  with  new  infective  agents, becomes contaminated, and subsequently develops an infection.

Sources of Exogenous hospital infectionsick man:

1) patients with acute or chronic form of infectious diseases.

2) infection carriers (carriers do not get sick, but they can pass the infection to others);

3) medical staff.

THE PREVENTION  OF  NOSOCOMIAL  INFECTION:

Two basic principles govern the main measures that should be taken in order to prevent the spread of nosocomial infections in health-care facilities:

1.early detection of source of infection:

  • Identification of infectious patients on admission
  • Isolation of infectious patients
  • Preventive medical examination of medical personnel
  1. Cut off any route of transmission of infection (Aseptic techniques):
  • Clinical hygiene of medical staff
  • Collection and disposal/decontamination of waste
  • Cleaning of premises
  • Disinfection
  • Sterilization
  • ASEPSIS

Efforts to minimize the onset and spread of infection are based on the principles of Aseptic technique. Aseptic technique is an effort to keep the patient as free from exposure to infection-causing pathogens as possible. The term asepsis means the absence of disease-producing microorganisms. The two types of aseptic technique are medical asepsis and surgical asepsis.

  • Medical asepsis includes procedures used to reduce the number of and prevent the spread of microorganisms. Hand hygiene, barrier techniques, and routine environmental cleaning are examples of medical asepsis.
  • Surgical asepsis, or sterile technique, includes procedures to eliminate all microorganisms from an area. Sterilization destroys all microorganisms and their spores.

Nurses in the operating room, labor and delivery, and at the bedside practice sterile technique when using sterile instruments and supplies for patients care.

Surgical asepsis demands the highest level of asepsis technique and requires that all areas be kept free of infectious microorganisms.

Health care workers are responsible for providing a safe environment for patient. It is easy to forget key procedural steps or to take shortcuts that break aseptic procedures when hurried. Failure to follow proper techniques place patients at risk for an infection that can seriously impair their recovery and may even lead to death.

CLINICAL HYGIENE OF MEDICAL STAFF

  • Keep your body clean.
  • Wear special clothes: a medical bathrobe, a medical cap, shoes.
  • Use protectors: gloves, mask, goggles, safety glasses.
  • Wash your hands

Medical gown (bathrobe)

  • Special clothes of a modern medical worker – a medical gown
  • There are many microbes on clothes. Caps, bathrobe, trousers and shoes are most contaminated with microbes.
  • On medical bathrobe the hospital microbes can be found in a few hours of wearing, especially on the sleeves, on the area of abdomen and on the hips.
  • It is necessary to have a special room where a doctor can change clothes.
  • Work clothing and personal clothing must be kept separately.
  • Doctors must wear a bathrobe over their own clothes and it must fully cover personal clothes of a doctor.
  • Sleeves must be short in order to make hand wash easier.

Medical cap

  • Hair – is a huge area that can collect and then distribute microorganisms.
  • It is necessary to wear a cap in the surgical department. The hair must be hide under the medical cap.
  • It is necessary to replace medical cap daily.

Shoes (footwear)

  • Footwear must be closed in order to protect feet against contact with blood and other biological fluids. Shoes must be made of nonwoven fabric, so that it can be exposed to cleaning and disinfection.

Protectors

  • Working in aseptic and infected areas medical staff should wear protective disposable masks. Mask should be replaced every 2 hours, and after each surgery.
  • All the dirty work must be done in oilcloth aprons. Apron is worn over the bathrobe.
  • In case of contact with the patient doctors must wear rubber disposable gloves.

HAND WASHING

  • Hands – are the most likely source of infection. It is necessary for every medical worker to care for them.
  • Skin microflora

         Resident microflora (constant). It is impossible to destroy completely this microflora.

        Transient microflora (temporary). It is received through any contact with the environment.

  • As the hands of health-care workers are the most frequent vehicle of nosocomial infections, hand hygiene—including both hand washing and hand disinfection—is the primary preventive measure. Thorough hand washing with adequate quantities of water and soap removes more than 90% of the transient, i.e. superficial, flora including all or most contaminants. An antimicrobial soap will further reduce the transient flora, but only if used for several minutes.

The points to be kept in mind while washing hands are:

  • Cut short nails. A long nail will give roof to the dirt and microorganisms.
  • Remove the jewelry of any type. Open the tap and wet hands and forearm. Always hold the hands below the elbow level, because hands are considered to be more contaminated then the elbows, hence the water should flow from the area of least contamination (the elbows) to the area of more contamination (the hands).
  • Apply soap or detergent.
  • Wash hands thoroughly. Make sure that the interdigital space are cleaned by washing each finger separately. Use brush to dislodge the dirt from under the nail beds.
  • Rinse hands by keeping the hands well below the elbow level. The water flows from elbow to the hands.
  • Repeat the procedure (application of soap and rinsing with water) to ensure thorough cleanliness.
  • Dry the arms and hands, starting at the elbows and working towards the hands.
  • Discard the towel.
  • Turn off the water tap using a paper towel because the handle is contaminated.
  • While washing, if the hands touch the sink or other objects accidentally, the whole procedure needs to be repeated.

Algorithm hygenic washing of hands:

  • Moisten hands with water. To take of a little liquid soap, to lather his hands.
  • Рosition of the hands – palm to palm. Rub together 10 seconds.
  • Рosition – right palm over back of the left hand with intertwined fingers. Rub 10 seconds.
  • Рosition – left palm over back of the right hand with intertwined fingers. Rub 10 seconds.
  • Рosition of the hands – palm to palm. Rub the interior surface of the fingers. Rub 10 seconds.
  • Рosition – the back of the fingers to the palm of the other hand. Rub 10 seconds.
  • Rub the thumb with the palm of the other hand by rotational movement.
  • Рosition. Circular motion with the tips of the fingers on the palm.
  • Repeat each movement not less 5 times.

Technique putting on sterile gloves

Equipment: pack of sterile gloves.

Algorithm:

  1. Pull out and unfold the package with gloves.
  2. Take the glove for a top with left hand so that the fingers touched the inner surface of the glove.
  3. Fingers of the right hand connect and to enter them into a glove.
  4. Enter the fingers into glove, not breaking her lapel (cuff).
  5. Enter the 2nd, 3rd and 4th fingers of the right hand under a lapel (cuff) of left glove from the outer side. The first finger of the right hand should be pointing towards the 1-st finger of the left glove.
  6. Keep the left glove by 2-nd, 3-rd and 4-th fingers the of the right hand vertically. Fingers of the left hand connect and to enter them into a glove.
  7. Straighten the lapel of left glove, having pulled it on a sleeve.

Enter the 2nd, 3rd fingers of the left hand under a lapel (cuff) of right glove from the outer side, straighten the lapel of right glove, having pulled it on a sleeve.

!! If one glove was damaged, it is necessary change both, because you can’t take off one glove, not contaminating another.

Removal of  Gloves

Equipment: pack of sterile gloves.

Algorithm:

  1. To make a lapel by fingers of the right hand on left glove, touching only of the outer side.
  2. To make a lapel by fingers of the left hand on right glove, only of the outer side.
  3. To take off a glove from the left hand, turning inside out, pulling by the lapel.
  4. Hold the removed glove right hand.
  5. Take the right glove for the lapel on the inside.
  6. To take off a glove from the right hand, turning it inside out, pulling by the lapel.
  7. To place gloves in the container with a disinfectant.

MEDICAL WASTE, classification

  • CLASS “A”. Not dangerous waste.
  • CLASS «B”. Dangerous waste.
  • CLASS «C». Extraordinarily dangerous waste.
  • CLASS «D”. Toxicologically dangerous waste.
  • CLASS «E». Radioactive waste

MEDICAL WASTE

CLASS “A”. Not dangerous waste

It is non-toxic waste, not having contact with body fluids of patients, infectious patients.

Not dangerous CLASS “A” is formed:

  1. In the wards in all structural units of hospital.
  2. In administrative quarters
  3. In the buffet, in the nutrition unit.
  4. In the territory of hospital

!!! Territory  infectious, dermatovenerologic, tuberculous  hospitals  is exception.

Not dangerous CLASS «A» is collected in a disposable package (packages, cans) white colour.

CLASS «B”. Dangerous waste. Dangerous waste is potentially infected waste, contaminated by secretions and blood of patients.

            Places of formation:

  • Waste from any inpatient Department contaminated biological fluids
  • Treatment rooms,
  • Dressings rooms,
  • Manipulation rooms
  • Operating rooms
  • Pathoanatomical department
  • Diagnostic Department (laboratory)
  • Food waste from infectious disease department

Dangerous waste CLASS «B» is collected in a disposable hermetic package (packages, cans) yellow colour.

Marking – Dangerous waste. Class «B», code of department, name of the  hospital, date, name of the responsible for collection of waste.

CLASS «C». Extraordinarily dangerous waste

CLASS «C» is waste contacted with sick of especially dangerous infections.

Places of formation waste CLASS «В»:

Departments  for patients with especially dangerous and quarantine infections:

  • Tuberculosis hospital and departments
  • Infectious and dermatovenerologic departments
  • Mycological hospitals
  • Materials from patients with anaerobic infection.

Waste CLASS «В» is collected in a disposable hermetic package red colour (packages and hard packing).

Marking – “Extraordinarily dangerous waste. Class C,code of department, name of the hospital, date, name of the responsible for collection of waste.

CLASS “D” – Toxicologically dangerous waste

Waste CLASS «D» is

  • Expired medicines
  • Toxic drugs (cytostatic drug and other chemicals, mercury-containing objects,
  • Used disinfectants,
  • Medical apparatus and equipment.

Waste CLASS «D» is collected in a disposable hermetic package (packages, cans) black colour.

Marking – Waste. Klass D, code of department, name of the hospital, date, name of the responsible for collection of waste.

CLASS «E». Radioactive waste

 
Waste CLASS «E» is all kinds of waste containing radioactive components.

Places of formation:

  1. Diagnostic laboratories or departments
  2. Radioisotope laboratory
  3. X-ray rooms

Collection, storage and removal waste of this class carry out in accordance with the rules for work with radioactive substances.

Collection and disposal decontamination of medical waste 2 ways centralized way and decentralized way

Collection and disposal decontamination of medical waste 2 ways centralized way and decentralized way
Collection and disposal decontamination of medical waste 2 ways centralized way and decentralized way

Disinfection

  • Disinfection – is the destruction of pathogenic and conditionally pathogenic microorganisms in the air, on-site equipment and medical products in the treatment-and-prophylactic institution.

Objectives of disinfection:

  1. Prevention of nosocomial infections.
  2. Interruption ways of transmission infection, the destruction of the infectious agent.

OBJECT of DISINFECTION

1.All types  of surfaces in hospital (walls, floor, furniture, etc.).

2.Medical products.

3.Hands of medical personnel.

4.Skin of the patient.

5.Objects for nursing.

6.Indoor air.

7.Bed linen.

8.Tableware.

9.Medical waste and other objects that may be factors of transmission of nosocomial infections.

TYPES OF DISINFECTION:

1.PREVENTIVE DISINFECTION is aimed at preventing the occurrence of infections, in the absence of the focus of infection. It is provided in the treatment-prophylactic institution, is carried out by medical personnel (orderlies, junior medical personnel, nurses).

  • Preventive planned disinfection is carried out in the hospital continuously; is carried out according to the plan maked accordingly with peculiarity of hospital departments.
  • Preventive disinfection on epidemic indications is carried out with the occurrence of nosocomial infection in one from hospital departments (or in one from chambers). For example, the patient is ill by the influenza in the one ward. Purpose – prevent the spread of infectious agents in other departments.
  • Preventive disinfection on sanitary and hydenic indications is carried out once at the contamination.
  1. FOCAL DISINFECTION:
  • Focal current disinfection – is conducted constantly in a treatment-prophylactic institution or at home surrounded by the patient after detection in a patient of nosocomial infection and before discharge (or transfer to another Department/hospital).
  • Focal final disinfection – is carried out once after discharge or death, the hospitalization the patient in an infectious hospital.

Methods of disinfection:

1.Mechanical method (soil removal):

  • wet cleaning rooms and equipment
  • tapping out of clothes, bedclothes
  • dust removal, repair of rooms
  • scrubbing the hands of personnel.
  1. Chemical method – with using disinfectants.
  • irrigation
  • wiping
  • total immersion
  • spraying
  1. Physical method – thermal, most reliable and harmless to personnel.
  • using of sunlight
  • bactericidal lamp
  • ironing, calcination by high temperature
  • incineration of waste
  • boiling
  • pasteurization
  • tyndalization (fractional pasteurization)
  • air method (in a dry-heat tool cabinet)
  • steam method (steam treatment – autoclaving)
  • processing the objects in special chamber by high pressure.
  1. Combined method – a different combination of physical and chemical methods of disinfection.
  2. Biological method – the destruction of pathogens using microbies-antagonists (bacteriophages).

Disinfection efficiency depends on:

  1. the stability of the microorganism
  2. quantity of microbies
  3. concentration of disinfectant
  4. presence of organic substances on the objects (blood, feces, sputum)
  5. exposition
  6. method of processing (wiping, irrigation, total immersion in disinfectant)
  7. texture of processed objects

Quality control of disinfection

  1. Visual control – the assessment of sanitary condition of the rooms, result current and general cleaning.
  2. Chemical control – determination of the concentration of ready disinfectants, express test – paper test-strips and control color scale.
  3. Bacteriological control – taking wash-out and inoculation. This analysis is conducted by laboratorian from Hygiene and Epidemiology Center.

Types of disinfectants:

1.For disinfection of medical products.

  1. For disinfection of rooms, furniture and objects of nursing for patients.
  2. Dermal antiseptics.

Requirements for disinfectants:

  1. Wide spectrum of actions
  2. low toxicity
  3. Good solubility in water
  4. Activity in small concentrations
  5. Minimum time of effective exposure
  6. Stability at the storage (expiration date)
  7. Convenient transportation
  8. Disinfectant should not damage

processed objects.

Safety rules when working with disinfectants

  1. Proper storage of disinfectants.
  2. Labelling – the name, appointment, date of manufacture and expiration date.
  3. Observance the rules of personal hygiene (a special gown, kerchief, respirater, goggles, rubber gloves, removable shoes)
  4. Use ventilation at the preparing solutions

First aid for poisoning by disinfectants

  1. After contact with skin – wash them immediately with water.
  2. Eye contact – rinse immediately with water, to inject drops into the eye (30% albucid, 2% novocaine solution – 1-2 drops.
  3. In case of irritation of the respiratory tract – to go to another room or fresh air, rinse the mouth and nasopharynx with water (if necessary appoint hearty, soothing, antitussives remedies).

STERILIZATION

Sterilization – is the complete destruction of microorganisms and their spores by exposure to physical factors and chemicals matters.

All products are subjected to sterilization in contact with a wound surface, blood, certain types of medical instruments.

Scheme of processing of medical equipment
Scheme of processing of medical equipment

The main stages of MEDICAL TOOLS processing :

1 Stage. disinfection

2 Stage. pre-sterilization processing

3 Stage. control of sterilization processing

4 Stage. sterilization

1 STAGE. DISINFECTION OF INSTRUMENTS OF MEDICAL APPOINTMENT

Equipment:

  • disinfectant solution
  • 1 сontainer (for lavage)
  • 2 сontainer (for disinfection)
  • medical trays
  • instruments after use in assembled form

1 STAGE. DISINFECTION OF INSTRUMENTS OF MEDICAL APPOINTMENT

Equipment:

  • disinfectant solution
  • 1 сontainer (for lavage)
  • 2 сontainer (for disinfection)
  • medical trays
  • instruments after use in assembled form

1 STAGE. DISINFECTION OF INSTRUMENTS OF MEDICAL APPOINTMENT

Equipment:

  • disinfectant solution
  • 1 сontainer (for lavage)
  • 2 сontainer (for disinfection)
  • medical trays
  • instruments after use in assembled form

Some solutions allow to wash off and disinfect the tools in 1 сontainer (2 properties at the same time).

Indispensable condition – сonduct disinfection immediately after manipulation.

  • Performance the procedure. Algorithm

1.Dress the special clothing (gown, mask, gloves).

2.Prepare a disinfectant solution, pour it in the containers.

3.In first сontainer (for lavage) washed the instrument without disassembling.

4.Disassemble all instruments, immerse in 2 сontainer (for disinfection) with disinfectant solution, filling internal channels of instruments.

5.Close the container by lid. Leave at the time required for disinfection.

6.Take off the gloves, immerse in a container with disinfectant.

7.Put on other gloves, derive the instrument at the end of the exposition time.

8.Put on instrument in the medical tray.Wash out the instrument under running water.

  1. To prepare reusable instruments for further processing (for sterilization).
  2. Disposable syringes put into packet yellow colour for utilization.
  3. Pour out used disinfectant in sewerage.
  4. Take off the gloves and put in disinfectant solution, wash and dry your hands.
  • 2 STAGE. PRE-STERILIZATION PROCESSIING

If the instrumentation has been in contact with mucous membranes and wounds, including operating, the disinfection insufficiently. Sterilization is required. Pre-sterilization processing is carried out before sterilization.

The purpose of pre-sterilization processing – remove all small particles, medicinal products and protein contamination remaining after the operation or manipulation.

Specially prepared solutions uses during pre-sterilization processing.

The solution includes:

  • water,
  • hydrogen peroxide,
  • cleaning agent.

Medical instrumentation  are soaked in disassembled, all items are completely submerged in the solution with the filling of all cavities.

Pre-sterilization processing. Algorithm

Equipment:

  • special solution
  • medical trays
  • brush for washing tools
  • сontainer with distilled water
  • dry-heat Cabinet
  • instruments after use in assembled form

Algorithm:

  • Dress the special clothing (gown, mask, gloves).
  • Prepare a disinfectant solution
  • Immerse the instruments in special solution.
  • Process the instruments by brush.
  • Wash out the instrument under running water.
  • Rinse tools in distilled water.
  • To dry in a dry-heat cabinet.
  • To reduce the time of processing surgical instruments can be used are special solutions. They allow perform the disinfection and pre-sterilization processing at the same time.
  • The method of physical processing can be used to lighten the work of nurses, reduce the risk of infection contamination, reduce the processing time of surgical instruments.
  • For example, apparatus of ultrasound processing.

3 STAGE. СONTROL OF STERILIZATION PROCESSING.

Quality control disinfection and pre-sterilization processing is carried out daily, under the guidance of senior nurse (biological and chemical analysis).

  • 1 test. Phenolphthalein test – for the presence of detergent (pink coloration).
  • 2 test. Amidopyrine test – for the occult blood (blue-green color).

If tests on blood or on the remnants of detergents is positive, the medical instruments cleans again (to negative results).

4 Stage. Sterilization

  • Sterilization – is the destruction of microorganisms and their spores by exposure to physical factors and chemicals matters.
  • Medical device and instruments, penetrating into sterile tissue or the vessels, contacting with blood or injectable solutions is “critical” items. They must to undergo sterilization in order to all kinds of microorganisms were destroyed.

Methods of sterilization:

1.Physical method:

  • Steam,
  • Air,
  • Glasperlenovy,
  • Ultrasonic,
  • Ultraviolet radiation,
  • Infra-red.
  1. Chemical method:
  • Chemical solution,
  • Gas.

Sterilization of medicine products is carried out in a centralized sterilization departments.

In clinical practice most commonly used physical method of sterilization.

  • Physical steam method sterilization (аutoclaving) – processing with hot steam under overpressure.

All products are sterilized by steam under pressure, is put in special packaging:

Sterilization packaging:

1.Reusable metal sterilizing box

2.Package of two layers cotton cloth

3.Kraft paper-bags of dense paper.

All kinds of special packages are marking.

Aautoclaving 

Two regimes of sterilization (for autoclaving) are recommended use in treatment-and-prophylactic institution:

1.First regime sterilization is designed for products of  fabric, glass, corrosion-resistant metal. Temperature 132 ° C, pressure of 2 atm, time 20 minutes.

2.Second regime sterilization (sparing regime) is recommended for the products of  thin rubber, latex and certain types of polymers. Temperature of 120° C, pressure  of 1.1 atmospheric, time 45 minutes.

Hot air sterilization (in a dry-heat cabinet)

Dry-heat method – the influence of dry air; use hot-air-sterilizer with different modifications.

This type of sterilization is recommended for metal products and glass. Temperature – 180 ° C, exposition – 60 min.

Control of sterilization is carried out by indicators of temperature and pressure control.

Conduct a journal of sterilization.

Chemical method – sterilization of chemical solutions.

  • This is a helper method because of a medical product cannot be sterilized in the package, after sterilization, the instruments must be rinsed by sterile fluid.
  • This method is used for sterilization of thermolabile products from the material.
  • For example, eye pipettes, rubber balloon for enemas.

Terms of sterility.

1.Metal sterilizing box without filter – keep 3 days.

2.Metal sterilizing box with filter – 20 days.

3.Package of two layers cotton or kraft paper-bags –  to 3 days, in sterile conditions.

 

Nutrition 

Organization of nutrition in medical institution

Organization of nutrition:

Rational nutrition is an important condition of preserving and maintaining of health.

  • Throughout the whole life metabolism and energy exchange is constantly happening in the human body.
  • Sources of building materials and energy are the nutrients coming with food.

The main components of food

  • Proteins,
  • Fats,
  • Carbohydrates,
  • Minerals,
  • Vitamins
  • Water

Proteins Function:

  • Building material for new cells and tissues.
  • Building material for enzymes, hormones, hemoglobin, immune bodies.
  • Regulation of metabolism.
  • Perform transport function (for example, transport bilirubin, hemoglobin).

Proteins are not formed in the body, they come with food.

The source of protein is meat, fish, dairy products, cereals, pasta, eggs.

Fats Function:

  • Provide 25-30 percent of the energy needs of the organism;
  • Take part in thermal regulation;
  • Conductors of vitamins A, D, E;
  • Provide the intestinal absorption of certain food substances.

There are animal and vegetable fats.
Sources of fats are vegetable oils, animal oils, cream, sour cream, meat fat, legumes.

Сarbohydrates Function:

  • main source of energy in the body (55-58%)

Types of carbohydrates:

  • Simple carbohydrates
  • Complex carbohydrates

Simple carbohydrates have a sweet taste and they are easily digested by the body. Glucose is used by the body as a source of energy for muscle contractions, including the heart muscle, and for nutrition of brain.

Complex carbohydrates are fiber, starch and pectin substances. Fiber is practically not digested in the body. These carbohydrates stimulate bowel function and create conditions for the reproduction of beneficial microorganisms in the intestine.

Sources of carbohydrates are vegetables, fruit, honey, confectionery, bread, sweet drinks, cereals, legumes, nuts, wheat bran.

Nutrients Perform functions: Three Function

1) Plastic function. Provision of development and continuous updating of cells and tissues.

2) Energy function. Input of energy which  is required at rest and at any stress.

3) The regulatory function. Delivery of nutrients necessary for the formation of enzymes, hormones and other regulators of metabolic processes.

Minerals (Macro-and Microelements)

Macronutrients

  • Calcium.
  • Phosphorus
  • Potassium
  • Sodium and chlorine
  • Magnesium

Microelements

  • Iron
  • Iodine
  • Fluorine
  • Copper

Details in Minerals (Macro-and Microelements)

Calcium.

  • Calcium regulates the exchange of nutrients between the cell and intercellular space, providing the transmission of nervous excitement, and muscle contraction.
  • Calcium is a “construction material” for bones and teeth, it is involved in blood clotting, it reduces the permeability of the vascular wall. Sources of calcium are dairy products.

Phosphorus

  • Phosphorus provides normal growth of bone and tooth tissues, takes part in metabolic processes in the nervous and muscular tissues, liver and kidneys.
  • Phosphorus is contained in cheese, cottage cheese, eggs, meat, fish, caviar.

Potassium

  • Potassium is involved in the regulation of water-salt metabolism, the functioning of the muscle tissues, including the heart.

Potassium is contained in dried fruits, sea cabbage, potatoes, legumes, peaches, oatmeal.

Sodium and chlorine

  • Sodium and chlorine. Sodium plays an important role in the process of intracellular and intercellular exchange.
  • Sodium and chlorine also play an important role in the secretion of hydrochloric acid in the gastric juice.

Sodium and chlorine enter the body in the form of common salt.

Magnesium

  • Magnesium – provides normal metabolism of about 300 enzymes. Especially actively magnesium is involved in the processes of energy use.
  • Magnesium stabilizes the bone structure and gives hardness to the bones.

The sources of мagnesium are wheat bran, dried fruit, wheat, oatmeal, legumes.

Iron

  • Iron is involved in hematopoiesis, breathing, redox reactions and immune-biological processes.
  • Iron is part of the hemoglobin in red blood cells, muscle myoglobin, the most important enzymes.
  • Sources of iron are meat products, cereals, legumes, bread, eggs, fruits (little).

Iodine

  • Iodine – more than 60 % of received iodine consumes the thyroid gland and uses in the synthesis of hormones.
  • Sources of Iodine are sea fish and seafood (shrimps, mussels, seaweed, etc).

Fluorine

  • Fluorine – determines the condition of the bone tissue (its strength and hardness, the proper formation of bones); state of dental tissue, growth of hair and nails.

Copper

  • Copper is necessary for the normal process of blood formation, tissue respiration and work of the immune system.
  • Sources of copper are meat, fish, seafood, cereals, potatoes, apricots, pears, gooseberry

Vitamins

  • Vitamins are the regulators of metabolism. Most vitamins are not formed in the body or they are formed in small quantities (e.g. by intestinal microflora).
  • An insufficient supply of one vitamin occurs hypovitaminosis,
  • An insufficient supply of several vitamins – it leads to polyhypovitaminosis.
Organization of nutrition in medical institution
Organization of nutrition in medical institution

CLASSIFICATION OF VITAMINS

Water-soluble vitamins:  

  • C,
  • P,
  • B1,
  • B2,
  • B6,
  • B12,
  • Niacin (vitamin PP),
  • folic acid,
  • Pantothenic acid,
  • Biotin, and choline

Fat soluble vitamins:

  • vitamin A (retinol),
  • vitamin D,
  • vitamin E (tocopherol),
  • vitamin K.

Vitamin-like substance: 

  • Pangamic acid (B15),
  • Orotic acid (B13),
  • lipoic acid,
  • Myoinositol,
  • Vitamin U and others.

Vitamin C (function)

  • Participates in the exchange processes;
  • Increases the body’s resistance to infections;
  • Provides collagen formation;
  • Effects on the nervous and endocrine system, liver;
  • Regulates cholesterol metabolism;
  • Promotes digestion of protein, iron and other substances.

Sources of vitamin C are berries, vegetables, fruits.

 

  • Vitamins В Regulate the function of the cardiovascular, digestive, endocrine, central and peripheral nervous systems.     Sources meat, fish.
  • Vitamin B12 is necessary for normal blood formation.  Source – livers of fish and animals.
  • Vitamin A is necessary for skin and view. Source – liver of animals and fish, eggs, caviar.
  • Vitamin D regulates the exchange of calcium and phosphorus. Source – cod-liver oil, butter, etc.
  • Vitamin К is involved in blood clotting. Spinach, sorrel, cabbage, pumpkin, tomatoes, and liver are rich with vitamin K.

Principles of Rational Nutrition for a Healthy Person

  • Rational nutrition – provides growth, normal development and human activity, improves health and prevents disease
  • The First Principle: Energy Balance.
  • The Second Principle:Balanced Diet.
  • The Third Principle: Dietary Regime.
  • The Fourth Principle: The Variety of the Diet.

 

The First Principle: Energy Balance.

  • Energy value of a daily ration depends on sex ( for women it is 10 % lower), age (in older it is lower), physical activity, profession.
  • For example, energy consumption in person of mental labour is about 2000 – 2600 kcal, in sportsmen – 4000 – 5000 kcal per day.

The Second Principle:Balanced Diet.

  •       Proteins, fats, carbohydrates should enter the body in strict ratio (1:1:4).

The Third Principle: Dietary Regime.

Nutrition Should be:

  • Divided (3 – 4 times a day),
  • Regular (at the same time),
  • The intervals between meals are 2-3 hours,
  • The last meal should be not later than 2 – 3 hours before bedtime.
  • The daily ration should be distributed as follows: Breakfast – 25%, lunch – 30%, snack – 20%, dinner – 25% of the daily ration.

The Fourth Principle: The Variety of the Diet.

  • Daily, the organism should get about 70 ingredients, many of which are irreplaceable, i.e. they are not synthesized by the body, but come only with food.

The principles of clinical nutrition

Dietology – the science of clinical nutrition

  • Nutrition of patients received considerable attention at all times. Hippocrates believed that at different stages of the disease, we must choose the right food.
  • A major contribution to the science of nutrition and dietetics was made by Russian scientists. They identified many of the main principles of modern nutritional science.

DIET THERAPY – Method of treatment of various diseases by a special diet.

There are 15 diets for various diseases.

DIET – the daily amount of food for the patient for the period of the disease or to prophylaxis.

Clinical nutrition should  be based on the principle of rational nutrition  for a healthy person.

The principles of clinical nutrition:

  1. Increase of frequency of eating to 5 – 6 times a day.
  2. Various menu (Monotonous food reduces appetite).
  3. Correct cooking of foods:
  • Mechanical sparing – crushing of food
  • Chemical sparing – exception annoying and indigestible products (smoked food, marinades, spicy and fatty meals)
  • Thermal sparing – exception of very cold or very hot- food. Temperature of the food 15 ° C to 60 ° C.
  • Heat treatment process – boiling in water or by steam.

Organization of nutrition in the hospital

  • General management of nutrition is performed by the chief doctor. Dietitian or dietary nurse are responsible for organization of nutrition.
  • Doctor prescribes the diet to the patient. He writes the number of the diet in the medical history (medical card) and treatment sheet.
  • Every day nurse makes a list of patients for the canteen and the senior nurse.

She indicates in list :

  • Surname Name
  • Room Number
  • Diet Number
Scheme there are Several Types of Nutrition
Scheme there are Several Types of Nutrition

Organization of Feeding of Patients

Active nutrition

  • The patient is taking food independently in canteen or in the hospital ward (if the patient has ward regime).

Passive nutrition

  • Food intake is carried out with the help of a nurse.
  • Contingent: seriously ill and weakened patients, old patients, patients in strict bed regime, psychoneurological patients.
  • Feeding seriously ill patients, a nurse performs at the bedside of the patient.

Artificial nutrition

Artificial nutrition

  • Artificial nutrition is the introduction of food through the gastrointestinal tract or intravenously into the organism of the patient.

Types of Artificial nutrition:  There are several 

  • Enteral nutrition
  • Parenteral nutrition

Enteral nutrition

Enteral nutrition – nutrients enter through the gastro-intestinal tract with the help of gastric tube.

The ways of the introduction of nutrient mixtures:

  • Nutrition with the help of nasogastral tubes.
  • Nutrition with the help of stoma (this hole, created surgically, this hole connects the hollow organ with the environment):
  • Gastrostoma (hole in the stomach),
  • Duodenstoma (hole in the duodenum),
  • Jejunostoma (hole in the jejunum).

Indications for enteral nutrition are almost all situations when a patient with a functioning gastrointestinal tract cannot meet the needs for protein and energy in a usual oral way.

Indications for enteral nutrition:

  • Neoplasms, especially localized in a head, neck and stomach.
  • Disorders of the Central nervous system: coma, stroke and others.
  • Radiation and chemotherapy in case of Oncology.
  • Gastrointestinal tract diseases: Crohn’s disease, malabsorption syndrome, short bowel syndrome, chronic pancreatitis, ulcerative colitis, liver and biliary tract
  • Nutrition in pre- and early postoperative periods.
  • Trauma, burns, acute poisonings.
  • Infectious diseases (botulism, tetanus and others).
  • Mental disorders: anorexia nervosa, severe depression.
  • Acute and chronic radiation injuries.

 

Сontradictions to enteral nutrition

  • Clinically expressed shock.
  • Intestinal ischemia.
  • Full bowel obstruction.
  • Refusal of a patient or his guardian from holding enteral nutrition.
  • Ongoing gastrointestinal bleeding.
  • Acute pancreatitis.
  • Severe forms of malabsorption.
  1. Gastrostoma. This hole connects the stomach with the environment
  • Parenteral nutrition- introduction of nutrients intravenously.
    There are two Types of Parenteral Nutrition:
  1. Partial Parenteral Nutrition
  2. Full Parenteral Nutrition
  • Partial Parenteral nutrition is appointed for a short time in addition to the normal diet of the patient.
  • Full Parenteral nutrition provides the entire volume of the daily needs of the body in plastic and energy substrates.

Indications for full parenteral nutrition

  • The preoperative period in patients with gastrointestinal tract diseases with the expressed indigestion.
  • The postoperative period after extensive operations on the organs of abdominal cavity.
  • Post-traumatic period (severe burns, multiple injuries).
  • Neuropsychic disorders.

Contraindications for parenteral nutrition:

  • Shock
  • Allergic reactions to components of parenteral nutrition.
  • Refusal of a patient (or his guardian).
  • Terminal cancer patients.
  • Currently the following ways of introduction are used:
    Through a peripheral vein.
    Through the subclavian vein with the help of the central catheters.

Medications for parenteral nutrition are divided into two groups:

1.Donor of energy – solutions of carbohydrates – monosaccharides and spirits, fatty emulsions

2.Donor of plastic material – amino acid solutions

Remedies for parenteral nutrition compose from the following components:

1.Carbohydrates and spirits – the main sources of energy.

2.Sorbite 20%  and xylite – additional sources of energy with glucose and fat emulsions.

3.Fats – the most effective energy substrate is introduced in the forme of a fat emulsion.

4.Proteins – an important part to build tissues, blood, synthesis of hormones, enzymes.

5.Saline solutions – simple and complex, introduced for normalize water-electrolytic and acid-base balance.

6.Vitamins, microelements, anabolic hormones also include in complex of parenteral nutrition.

Feeding the critically ill with a spoon or drinking bowl

Algorithm of action:

  1. Hygienic processing of hands.
  2. Inform the patient about the procedure and get his consent.
  3. Ventilate the room, fix bedside table.
  4. Give the patient a comfortable position – half-sitting (Fowler’s position).
  5. Wash hands of patient, put on chest napkin.
  6. Wash hands and bring food to the patient (temperature of the food 50 ° C). Bring the spoon to his mouth, to feed in small portions, slowly.
  7. Offer a drinking, drink from a invalid’s cup small portions.
  8. Wipe the patient’s lips with a napkin after eating.
  9. Offer to rinse mouth after eating.
  10. Remove dishes.
  11. Give the patient a comfortable position.
  12. Wash hands.

Feeding the patient by a Nasogastric Probe

Purpose: Provide the patient with the nutrition .

Equipment: Sterile: Janet’s syringe volume, tray. Non sterile: phonendoscope, nutrient mixture (38 – 40° C), warm boiled water 100 ml, waste container class «A» and «B».

Algorithm of actions:

  1. Warn the patient about the procedure, to obtain the consent.
  2. Give to the patient a comfortable position – position of Fowler.
  3. Conduct hygienic processing of hands, put on gloves.
  4. Сarrying out auscultatory test. Dial into the Jane syringe 10 to 15 ml of air. Connect the syringe to the nasogastric probe and enter the air. Listen sounds in epigastrium using the stethoscope. (If the probe is in stomach, we hear gurgling sounds).
  5. Prepare the nutrient mixture (temperature 38 – 40 °C)
  6. Dial into the Janet‘s  syringe the nutrient mixture (300 ml), connect syringe with the probe. Raise it to 50 cm Above the patient’s body.
  7. Provide the gradual flow of nutritive mixture (300 ml). Nutrient mixture must  be introduced during 10 minutes.
  8. After evacuation of the syringe  to disconnect the syringe from the probe, to close the probe by lid.
  9. Fill the Jane‘s syringe with 50 ml with boiled water.
  10. Remove the lid, connect the Janet’s syringe to the probe, rinse the probe.
  11. Disconnect the syringe, close the distal end of the probe by lid.
  12. Fix the probe, give the patient a comfortable position.
  13. Remove gloves, wash hands.

Care for Nasogastric Probe

Purpose: prevent irritation of the mucous membranes of the nose, ensuring the patency of the probe.

Equipment. Sterile: Jane syringe, gauze napkins, tray, glycerin (vaseline), saline or a special solution for washing probe, tray. Non-sterile gloves, stethoscope, tray, adhesive plaster.

Algorithm of actions:

  1. Warn the patient about the procedure, obtain the consent.
  2. Conduct hygienic processing of hands, put on gloves.
  3. Сontrol the location of the probe: ask the patient to open the mouth (probe should be visible in the throat).
  4. Сarrying out auscultatory test. Dial into the Jane syringe 10 to 15 ml of air. Connect the syringe to the nasogastric probe and enter the air. Listen sounds in epigastrium using the stethoscope. (If the probe is in stomach, we hear gurgling sounds).
  5. Take care of the oral cavity: moisten with saline mouth and lips (to make every 3-4 hours).
  6. Rinse the probe with of saline. Fill the syringe with saline (20-30 ml). Connect the syringe to the probe, slowly introduce the liquid into the probe. Aspirate the liquid, to pay attention to her appearance and pour in a separate container (to make every 3 hours or prescription of doctor).
  7. Inspect the place of insertion of the probe (nasal passage), reveal for signs of irritation of the skin.
  8. Clear outer nasal passages by gauze napkins, moistened with saline.
  9. Apply glycerin (vaseline) on the mucous membrane of the nose of the contact area with the probe.
  10. If fixative adhesive plaster has peeled off or heavily soiled, replace it.
  11. Disinfect and dispose of used materials.
  12. Remove gloves, wash hands.

Feeding by Gastrostomy

Purpose: to provide the nutrition  of patient

Equipment. Sterile: Jane’s syringe 300 ml, gauze napkins, tray. Non sterile: gloves, phonendoscope, nutrient mixture 38 – 40 ° C, warm boiled water 100 ml, water with soap,  ointment or paste, waste container class «A» and «Б».

Algorithm of actions:

  1. Warn the patient about the procedure, obtain the consent.
  2. Give to the patient a comfortable position – position of Fowler.
  3. Conduct hygienic processing of hands, put on gloves.
  4. Heat up nutrient mixture to a temperature of 38 – 40° C.
  5. Put a gauze napkins under the outer part of the gastrostomy tube in epigastric area.
  6. Conduct a visual inspection of the outer part of the gastrostomy tube and skin, surrounding the gastrostomy.
  7. Remove the lid of gastrostomy tube, connect the Janet’s syringe with nutrient mixture to distillation foramen of gastrostomy tube.
  8. Introduce the nutrient mixture in stomach by small portions.
  9. After the introduction of the nutrient mixture, rinse gastrostomy tube with boiled water: Fill the syringe with boiled water (100 ml). Connect the syringe to the tube, slowly introduce the liquid into the tube.
  10. Disconnect the syringe, cover the foramen of the tube with a sterile napkin, apply a lid (forceps).
  11. Conduct toilet of gastrostomy: Wash skin with soap and water around the gastrostomy, dry with napkin, apply a layer of ointment or paste, apply a sterile napkin around the gastrostomy tube.
  12. Remove gloves, wash hands.

Characteristics of Medical Diet

Diet N 1

Indications: diseases of the stomach with increased secretion of gastric juice (gastric ulcer and duodenal ulcer)

Purpose: Chemical, mechanical and thermal sparing the gastrointestinal tract with good nutrition, limitation of stimulation of secretion, gastric mucosal irritants; reduction of inflammation, improvement of healing of ulcers.

General characteristics: Food is prepared mashed, boiled in water or by steam (Bland diet). Eating 5 – 6 times a day.

Exclude or reduce: very hot and cold dishes, all spicy and fried foods.

Diet N 2

Indications: chronic gastritis with insufficient secretion of gastric juice, enteritis and colitis in the recovery period.

Purpose: stimulate the secretory function of the stomach, normalize motor function of the stomach and intestines, decrease putrefactive and fermentation processes in the gastrointestinal tract.

General characteristics: Bland diet. Eating 4 – 5 times a day in small portions.

Exclude or reduce: foodstuff that irritate the mucous membrane and hard to digest, very cold and hot meals.

Diet N 3

Indications: bowel disease with constipation

Purpose: stimulate peristalsis and defecation (bowel movements)

General characteristics: physiologically complete diet with foods which intensify motor function and defecation; food is not crushed, boiled or steamed, baked, vegetables and fruits (raw or cooked), drinks at night – sour-milk products.

Exclude or reduce: foodstuff which intensify fermentation and putrefaction in the intestine, eating – 4 – 6 times a day.

Diet N 4

Indications: acute diseases and exacerbation of chronic intestinal diseases with frequent diarrhea

Purpose: reduce inflammation and fermentation in the intestine

General characteristics: Bland diet. Significant  mechanical, chemical, thermal sparing of gastrointestinal tract, prepared liquid, semi-liquid, pureed meals, cooked in water or steamed.

Recommended plentiful drink, eating 5 – 6 times a day in small portions.

Exclude or reduce: products which intensify secretion of the digestive system, processes of fermentation and putrefaction in the intestine.

Diet N 5

Indications: liver disease (hepatitis, cirrhosis); gallbladder disease

Purpose: normalization of the liver and gall bladder.

General characteristics: Bland diet. Small limitation of fats. It is recommended plenty of vegetables and fruits. Dishes are boiled and baked and steamed

Exclude or reduce: stimulants of secretion, spice, infusible fats, fried foods, foods rich in cholesterol.

Diet N 6

Indications: gout and kidney stones (urolithiasis) with formation of urine acid calculus.

Purpose: normalization of protein metabolism, decrease in the formation of uric acid.

General characteristics: Increase the consumption of vegetables, dairy products.

Exclude or reduce: limit salt, protein and fat (meat and fish). Exclude spices.

Diet N 7

Indications: acute and chronic nephritis

Purpose: reducing the burden on the kidneys.

General characteristics: Low protein/

Low salt. Protein content is limited, fats and carbohydrates in the normal range, with moderate chemical sparing.

Exclude or reduce: limit salt, protein. Amount of liquid is reduced to 1 liter. Exclude spices.

At the acute glomerulonephritis and chronic nephritis with renal deficiency recommended diet without salt, with a limitation of proteins. Conduct strict control for the amount of fluid and the amount of urine.

Diet N 8

Indications: adiposity as an basic disease or concomitant at the other diseases.

Purpose: normalize body weight.

General characteristics: Low caloric diet.

Increased the content of protein; vegetables and fruits in enough amount. Use sugar substitutes for sugary foods and drinks. Meals are boiled, steamed, baked. Temperature of meals is usual. Eating 5 – 6 times a day.

Exclude or reduce: limitation of carbohydrates and fats, limitation of salt, flavoring spices, extractives which increase  appetite;

Diet N 9

Indications: diabetes of mild and moderate severity.

Purpose: the normalization of carbohydrate metabolism

General characteristics: Low caloric diet. Proteins above the physiological norm. Increased content of vitamins, vegetables.

Exclude or reduce: Moderate limitation of carbohydrates and fats, cholesterol. Exclude sugar and sweets.

Cooked boiled, baked and stewed meals.

Immediately after insulin injection the patient must receive the food containing carbohydrates.

Diet N 10

Indications: Cardiovascular disease (heart failure, hypertension)

Purpose: normalization of cardiac function.

General characteristics: Fat free and salt free diet. Content of protein – physiologically norm. Increased content of vitamins, potassium, magnesium and dietary fibers. Food is crushed, boiled. Temperature of food is usual.  Eating – 5 – 6 times a day in small portions.

Exclude or reduce: Reduced content of animal fat, limited salt, free liquid (maximum – 1.2 liters), cholesterol.

Diet N 11

Indications: tuberculosis at the absence of internal diseases.

Purpose: stimulation of immunity.

General characteristics: high-caloric diet with high content of protein and vitamins, moderate increase fats and carbohydrates, vitamins, mineral substances. Salt and fluid is in the normal range. Usual cooking with saving of extractives; spices is allowed. Eating 4 – 5 times a day.

Exclude or reduce: Infusible fats, pastry.

Diet N 12

Indications: Functional diseases of the nervous system

Purpose: Restoration of normal functioning of the nervous system.

General characteristics: full nutrition. Recommended dishes from the liver, tongue, dairy products and legumes containing salts of phosphorus

Exclude or Reduce: Hot spices, strong broth, smoked meat, fatty and fried foods, alcohol, strong tea, coffee, limit meat and salt.

Diet N 13

Indications: acute infectious diseases during the fever

Purpose: Reduction of irritating action of food on the inflamed tissue of the pharynx and larynx, reducing the load on the digestive system during intoxication, fever and bed rest, increased immune protection, creating favorable conditions for recovery.

General Characteristics: content of protein at the lower boundary of the physiological norm, moderate limitation of fats, carbohydrates; fluid in large amount (2 liters and more ) in the form of drinks with vitamins (juice). Food is prepared mashed, boiled in water or steamed.

Exclude or Reduce: fatty, salty, crude cellulose. Increase the salt at the profuse sweating, profuse vomiting.

Diet N 14

Indications: Kidney stones (urolithiasis) with alkaline reaction of urine

Purpose: Acidification of the urine.

General characteristics: the content of proteins, fats, carbohydrates is normal. Introduced in the diet products which changes the reaction of urine in acid side (bread, baked food, cereals, meat, fish). Free liquid 1,5 – 2 liters.

Exclude or reduce: most vegetables and fruits, dairy products

Diet N 15 (Common Table)

Indications: various diseases in the absence of indications for special diets and at the normal condition of the digestive system.

Purpose: provide physiological needs in nutrients and energy.

General characteristics: the content of proteins, fats, carbohydrates and calories correspond to nutritional standards of a healthy person not engaged in physical labor. Vitamins – in higher amount. Food consists of a various  products. Spices is in moderate amount. Eating 4 times a day.

Excluded fatty meals, pastry.

Diet N 0 –Surgical Diet

Indications: after surgery on the gastrointestinal tract

Purpose: sparing of the digestive tract

Diet 0А – only liquid (water, juice, tea, defatted meat broth, Liquid fruit jelly  (kissel)

Diet 0Б – in food added liquid kasha (porridge).

Diet 0В – add in food white crackers, fermented milk product .

Free liquid  2 liters. Eating  6 times a day.

PHARMACOTHERAPY

  • Pharmacotherapy – treatment with drugs or pharmacological agents.
  • A medication is a substance administered for the diagnosis, cure, treatment, or relief of symptom or for prevention of disease

TYPES OF PHARMACOTHERAPY

  • Etiotropic therapy
  • Pathogenetic therapy
  • Symptomatic therapy
  • Substitution therapy
  • Preventive therapy

Etiotropic therapy

  • This type of therapy eliminates the cause of disease.
  • This is the ideal type of pharmacotherapy.
  • For example. Etiotropic therapy is a treatment by antimicrobial means of infectious patients, the use of antidotes for the treatment of patients poisoned by toxic substances.

Pathogenesis therapy is aimed at elimination or suppression of mechanisms of the disease

Most of the currently used drugs belong to a group of medicines of pathogenetic therapy.

For example, antiarrythmic, anti-inflammatory, psychotropic and many other drugs inhibit certain mechanisms of disease.

Symptomatic therapy is aimed at the elimination or restriction of specific manifestations of the disease

  • Painkillers can be attributed to symptomatic medications. They do not affect the cause or the mechanism of the disease. Antitussives is a good example of symptomatic remedies.

Preventive therapy – is carried out for the prevention of disease.
Preventive tools include some antiviral agents (for example, while influenza epidemic – rimantadine). The use of anti-TB drugs can be considered as preventive therapy. A good example of preventive therapy is the use of vaccines.

 

Substitution therapy is used at the deficit of natural nutrients. Means of substitution therapy include enzymes for pancreas (pankreatin, panzinorm and others).

  • Hormone medication (insulin for treatment of diabetes mellitus, tireoidin – at hypothyroidism). Vitamins (vitamin D – at rickets).
  • Replacement therapy drugs do not eliminate the cause of the disease. But they can provide a normal life of the organism for many years. Not by chance diabetes is considered a special style of life among Americans. Diabetes is not a disease, it is a lifestyle.

Effects of drugs on the body

  • Therapeutic Effects
  • Local Effects
  • Systemic Effects
  • Side Effects

Therapeutic Effects

  • It is the effect which is desired or the reason а drug is prescribed. Therapeutic effects are the medication’s desired and intentional effects. These effects vary with the nature of medications, the length of time the client has been receiving

Local Effects

  • Local effects of а drug аге expected when they аге applied topically to the skin or mucus membrane.

Systemic Effects

  • А drug used for systemic effect must be absorbed into the blооd stream to produce the desired effect in the various systems аnd parts of the body.

Side (Adverse) Effects

  • Adverse effect is аny effect other than the therapeutic effect. Some adverse effects are minor, whereas some other mау cause very serious health problems. Adverse effects mау bе morе in а very seriously ill client or а client who receives moге medications.

Effects of drugs on the body depends from drug  dosage.

  • A dose is the amount of drug administered at one time.
  • The “minimum dose” is the smallest quantity of the drug that will produce an effect in the body.
  • The “maximum dose” is the largest quantity of the drug that can be administered at one time without producing harm to the body.
  • Lethal dose” is larger than the maximum dose which will have poisonous effect on the client (cause death of the client).

Safety Measures

  • The “Five Rights” ensures safety in giving drugs:
  • Right Client
  • Right Drug
  • Right Dose
  • Right Time
  • Right Method

Right Client
Read the physician’s orders to make sure for whom the medicine is ordered.

  1. Read the client’s name on the client’s chart and on the medicine card.
  2. Call the client by and ask name him to repeat his name. Be very careful it the clients is deaf or otherwise does not understand your language.

Right Drug

Read the physician’s orders to study the correct name of the drug. If the order is not clear consult the physician or at least seniors.

  1. Select the right drugs from the cupboard. Read the label of the medicine container and the name of the medicine in the medicine card thrice.

–  Before taking the drug from the shelf.

–  Before measuring it.

–  When returning the container to the shelf and before removing the hand from the container.

3. Look for the colour, odour and consistency of the drug, check the expiration date.

4.Administer medicine only from a clearly labelled container.

  1. Always identify the client before giving medication

Right Dose
Read the physician’s orders to know the correct dose.

3. Know the minimum and maximum dose of the medicine administered. Calculate the fraction of dosage correctly.

4.Know the abbreviations and symbols used.

5.Help the client to take all the medicine that is ordered for him.

Right Time

1.Give the medicine near the time ordered – 15 min before or after the designated time.

2.Give the medicine as ordered in relation to the food intake e.g., before food or after food.

3.Give the medicines according to the action expected e.g., sleeping pills are given at bedtime, the diuretics are given in the morning hours, so that the client will not be disturbed in the night.

Right Method

1.Read the physician’s orders to determine the route of administration.

2.Know (to own) the method of giving drugs e.g., orally, parenterally, rectally, etc.

METHODS OF DRUG ADMINISTRATION:

  1. External administration
  2. Enteral administration
  • Sublingual,
  • Buccal,
  • Oral
  • Rectal
  1. Inhalation administration
  2. Parenteral administration
  • External administration – is the use of drugs to the skin and mucous membranes

The forms of drugs for External  administration:

Ointment: applying ointment to the skin, rubbing ointments

Patches: attachment to the body

Drops: Instill drops in the eyes, nose, ears.

– Powders: application to the skin

Mixtures: for mouth rinsing, for skin wiping

Advantage of external administration:

– Ease of use

– Direct effect on lesion focus

– Reduced side effects

Disadvantages of external administration:

– only for local effect

Enteral  administration – is the introduction of drugs through the gastrointestinal tract.

Types of enteral administration:

– Through the mouth (oral),

– Under the tongue (sublingual)

– To cheek (buccal administration)

-Through the rectum (Rectal)

The forms of drugs:
Tablet

– Dragee

– Capsule

– Powders

– Pills

– Drops

– Medicine (mix)

-Candles: an introduction into the vagina, the introduction into the rectum

Advantages of enteral administration:

  • Most convenient
  • Usually least expensive
  • Safe, does not break skin barrier
  • Administration usually does not cause stress
  • Some new oral medications are designed to rapidly dissolve on the tongue, allowing for faster absorption and action
  • Systemic effect

 

Disadvantages of enteral administration

  • Inappropriate for clients with nausea or vomiting
  • Drug may have unpleasant taste or odor
  • If client cannot swallow or is unconscious
  • Cannot be used before certain diagnostic tests or surgical procedures
  • Drug may discolor teeth, harm tooth enamel
  • Slow absorption
  • Partial destruction in the gastrointestinal tract by the action of digestive juices The inability to foresee the drug concentration in the blood and tissues
  • Limitation of the admission in case of emergency

Inchoative administration – the administration of drugs through the respiratory tract by inhalation (breathing).

Advantage of the Inhalative administration:

  • Introduces drug throughout respiratory tract
  • Rapid Local effect
  • Drug can be administered to unconscious client
  • Lower dose of the drug is required
  • Risk of side effects is reduced

Disadvantages of the Inhalative administration:

  • Local effect
  • Of use only for the respiratory system
  • You need special devices – inhalers for inhalative method of use of medicines

Inhalers are distinguished into:

  • stationary,
  • portable,
  • pocket.

The parenteral administration

  • Parenteral method – the introduction of drugs avoiding the gastrointestinal tract.

Advantages of parenteral administration:

  • Rapid effect («on the needle»)
  • Dosing accuracy
  • Delivery of the drug into the bloodstream unchanged

Disadvantages of parenteral administration:

  • well-trained staff is required
  • compliance with aseptic and antiseptic is required
  • Breaks skin barrier

Methods of the parenteral administration

  • In the tissue: intradermally, subcutaneously, intramuscularly, intraosseously.
  • In vessels: intravenously, intraarterially, in lymph vessels
  • In the cavity: the pleural cavity, the abdominal cavity, intracardiac, into the joint cavity
  • In the subarachnoid space.

Intradermal Injection

Definition: It is an injection given into the dermal layer of the skin (corneum).

Purpose:

For diagnostic purpose:

  1. a) Fine test (mantoux test);
  2. b) Allergic reaction

For therapeutic purpose: Intradermal injection may also be given like in vaccination.

Site of injection:

  • The inner part of the forearm (midway between the wrist and elbow).
  • Upper arm, at deltoid area for BCG vaccination

Subcutaneous  Injection
Definition: Injecting of drug under the skin in the sub – cutaneous tissue, (under the dermis)

Site of injection:

  • Outer part of the upper arm
  • The abdomen below the costal margin to the iliac crest.
  • The anterior aspect of the thigh
  • The suprascapular site.
  • upper ventral or dorsogluteal area
  • In most cases Subcutaneous injection make in outer part of the upper arm
  • The volume of the used syringe – 2 ml
  • Needle – 30 mm
  • Subcutaneous route of administration of drugs is used when you want a slow, steady absorption of drug in the blood. For this purpose, 1-2 ml of drug is injected under the skin. This route of administration is ideal for such drugs as insulin, which requires uniform release.
  • Traditionally, subcutaneous injection is carried out by the puncture of needle at an angle of 45 degrees into the skin fold. however, with the introduction of shorter insulin needles, insulin injections are now recommended to perform with the puncture needle at an angle of 90 degrees.

 

  • INTRAMUSCULAR INJECTION
  • Muscles have a wider network of blood and lymphatic vessels, which creates conditions for rapid and complete absorption of drugs.
  • To perform intramuscular injections in certain areas of the body where there is a considerable layer of muscle tissue and do not pass near large vessels and nervous trunks.

Intra-Muscular Injection

Definition: It is an introduction of a drug into a body’s system via the muscles.

Injection area:

  • the upper external quadrant of the buttocks,
  • the deltoid,
  • wide lateralis muscle thigh.
  • For intramuscular injection in the gluteal region used only its upper outer part. This is due to the anatomical structure of the human body. This is the safest place possible to perform intramuscular injections. It should be remembered that accidental exposure to a needle in the sciatic nerve can cause partial or complete paralysis of the limbs. It is also close to a bone (sacrum) and the large vessels. In patients with flabby muscles, this place is localized very difficult.

The volume of the used syringe -5 ml, 10 ml

Needle – 40 mm

  • Elderly and malnourished patients have less muscle mass than younger people, so before you perform an intramuscular injection should be assessed whether it is enough for this muscle mass. If the patient has little muscle, you must take the muscle in the crease prior to injection

INTRAVENOUS INJECTION

  • Intravenous injections provide the introduction of the drug directly into the bloodstream. The main condition in this method of administering medicines is strict compliance with the rules of asepsis (washing and treatment of the hands, the skin of the patient, etc.).
  • The volume of the used syringe – 10 ml, 20 ml
  • Needle – 40 mm

Intravenous injections

Definition:  It is the introduction of a drug in solution form into a vein. Often the amount is not more than 10.ml. at a time.

Sites for injection:

  1. Dorsal Venous network
  2. Dorsal metacarpal Veins
  3. Cephalic Veins
  4. Radial vein
  5. Ulnar vein
  6. Baslic vein
  7. Median cubital vein
  8. Greater saphenous vein

Factors complicating intravenous injection:

  • excitement and fear of the patient;
  • cold;
  • re-puncture;
  • veins sclerotic changes in patients of elderly and senile age;
  • thin veins ( women and children);
  • a “floating” veins;
  • dehydration;
  • shock;
  • long-term use of steroids;
  • cachexia.
  • Possible complications after injection
  • Infiltrate
  • Abscess
  • Long-term complications
  • Thrombophlebitis
  • Hematoma or hemorrhage
  • Needle breakage
  • Necrosis
  • Air embolism
  • Nerve damage
  • Allergic reaction

Infiltrate – local inflammation of the soft tissues.

Causes:

  • violation of the rules of asepsis
  • multiple injections in one place.

Clinic:

  • redness at the injection site,
  • induration
  • swelling pain
  • local temperature rise.

Nursing care:

  • tell your doctor
  • stop injections into this area,
  • hot compress or hot water bottle into the place of infiltration
  • physiotherapy

Abscess – purulent inflammation of soft tissue with formation of a cavity filled with pus.

Causes:

  • gross violation of the rules of asepsis
  • the weakening of the immune system
  • multiple injections in one place
  • violation of the injection techniques

Clinic:

  • Severe pain at the injection site,
  • Induration,
  • Edema
  • Limited accumulation of pus
  • Total temperature rise.

Nursing care:

  • Tell your doctor
  • Follow the important doctor’s prescriptions
  • Stop injection in this area
  • Dissection of abscess if necessar

Long-term complications:

  • Sepsis (infection in the blood),
  • blood hepatitis (B, C),
  • HIV infection

Thrombophlebitis – acute inflammation of the veins and the formation of an infected thrombus.

Causes:

  • gross violation of the rules of asepsis
  • multiple injections in one place

Clinic:

  • Redness of the skin at the injection site,
  • Swelling of the skin at the injection site,
  • Painful and tight vienna at a palpation,
  • the local temperature rise.

Nursing care:

  • to tell the doctor,
  • follow the important doctor’s prescriptions
  • stop injections in this area,
  • apply a hot compress,
  • physiotherapy,
  • ointment, improving blood rheology

Hematoma – bleeding under the skin. most often  this is the result of the intravenous injection.

Causes:

  • Violation of intravenous injection technique (insertion of the needle into the vein at an angle more 15° and the perforation of the two walls of the vein).

Clinic:

  • Painful in site of injection
  • Bluish skin in site of injection.

Nursing care:

  • Injection stop.
  • Press the damaged vein for a few minutes with a cotton ball with alcohol.
  • Hot compress
  • Introduction of the drug into another vein.

Needle breakage.

Causes:

  • sharp contraction of the muscle during an intramuscular injection in the standing position,
  • inserting of the needle at the entire depth.

Nursing care:

  • Quickly remove chip of the needle from the tissue with your fingers.
  • If the needle is completely in the tissue – immediately call a physician, preferably a surgeon.
  • Surgical intervention is required at such complication

Necrosis – tissue death.

Causes:

  • insertion the drug substance with irritating properties in the soft tissue.

Clinic:

  • a sharp pain,
  • burning,
  • swelling at the injection site
  • blisters or ulcers

Nursing care:

  1. Stop injection.
  2. Introduce 0.5% solution of novocaine into injection site.
  3. Put the ice pack on the injection site.
  4. Tell your doctor.

Air embolism – obstruction of vessels of the pulmonary circulation with air bubble. As a result of disturbed nutrition and surrounding tissue necrosis develops.

Causes:

  • insertion the drug substance with

Clinic develops rapidly (within 1 minute). Symptoms of pulmonary vascular embolism:

  • Sudden attack of breathlessness
  • Cough
  • Pain in chest
  • blue upper body (cyanosis).

Treatment: absence of treatment.

  • Nerve damage

Causes:

  • Incorrect selection of injection site.

Clinic:

  • Pain,
  • violated function.

Treatment: Call a physician to perform the prescribing physician.

Allergic reaction:
Type:

  • local reaction (urticaria),
  • general reaction (anaphylactic shock)

Urticaria

Clinic:

  • red itchy rash in various sizes.
  • The rash may be at the injection site or spread throughout the body.

Treatment:

Stop injection.

Call a physician.

Perform the prescribing physician

Anaphylactic shock. This is the most severe allergic reaction.

Clinic:

  • weakness,
  • shortness of breath,
  • decreased blood pressure,
  • increase heart rate.
  • Death can occur from acute respiratory failure, sometimes within a few minutes.

First aid:

  • Call emergency medical help.
  • Use an epinephrine, if available.
  • Make sure the person is lying down and elevate his or her legs.
  • Check the person’s pulse and breathing and, if necessary, administer CPR or other first-aid measures.

CARE  for elderly and old people, seriously ill

Modern age standards were adopted by the European regional Office of WHO (World Health organization) in 1963:

  • Elderly age – 60-74
  • Gerontal (senil) age – 75-89
  • Long-livers – 90 and older

The FEATURES of elderly and senile age:

1.Involutional functional and morphological changes in the various organs and systems. Back development and aging come with age.

2.Several  diseases.

3.Mostly chronic diseases.

4.Atypical clinical course of the disease.

5.The presence of «senile diseases» (osteoporosis, benign prostatic hyperplasia, prostate cancer, Alzheimer’s disease and others).

6.Disorder protective, immune responses.

7.Disorder of  the social and psychological status. The main causes of social disadaptation. Anxiety, depression, hypochondriac syndrome often develop against this background.

PRINCIPLES FOR THE NURSING CARE of elderly patient:

  1. Injury prevention
  2. Control pharmacotherapy
  3. Diet nutrition
  4. Prevention of chronic constipation
  5. Prevention of colds
  6. Control of physical inactivity
  7. Prevention of insomnia
  8. Providing personal hygiene of the patient

INJURY PREVENTION.

Bruise and fracture bones are the most common injury in the elderly Patient.

Bruise and fracture bones (especially fracture of neck of femur)  violate  movement of patients, inevitably lead to complications, such as pneumonia, pulmonary thromboembolism, lead to death.

Injury Prevention:

1.Use of aids for movement if patients has movement violation( cane, auxiliary means for movement- support for hands, wheelchair).

2.Do not clutter the room with furniture.

3.Illumination in the night time should have in the corridors and wards.

4.Floor must be dry (puddles wiped immediately).

5.Assistance  to patients at the bathroom. A nurse is present and helps while bathing; to maintain the patient while getting in and out of bath.

CONTROL PHARMACOTHERAPY:

  • Dosage of medication
  • Frequency of intake drugs
  • Regular intake of medicinal preparation
  • Features pharmacokinetics (some drugs are taken before a meal, the other drugs after eating)
  • Optimal combination drugs with food, the other drugs

The nurse should monitor  these moments.

Characteristic of diet for elderly Patient:

  • Low content of calories
  • Reduced fat
  • A small volume of food
  • Nutrition should be divided (4 – 5 times a day),
  • High content of fruit and vegetables.

PREVENTION OF CHRONIC CONSTIPATION

The nurse should Provide (monitor):

  • Regulation of defecation by diet
  • Regular intake of Purgative Preparation
  • Cleansing enema or oily enema (for chronic constipation)

PREVENTION OF COLDS

Duties of a nurse:

  • The ward should be empty during the ventilation.
  • Patients should be dressed in accordance with the temperature of environment.
  • Infectious patients should be isolated.

Elderly and old people are more sensitive to cold drafts.

CONTROL OF PHYSICAL INACTIVITY

  • Medical gymnastics if there are no contraindications
  • Keep the individual motor mode

PREVENTION OF INSOMNIA

  • Walk before bedtime
  • Limit fluid intake before bedtime
  • Empty the bladder before going to sleep
  • A warm shower before bedtime
  • Intake of hypnotics if necessary

PROVIDING PERSONAL HYGIENE OF THE PATIENT

Patients who need help the nurses to provide personal care:

  • Seriously ill clients.
  • Paralysed clients.
  • Unconscious patient.
  • Malnourished patients.

The nurse performs:

  • Eyes care (daily),
  • Ears care (daily),
  • Nose care (daily),
  • Care of the oral cavity (daily),
  • Hair care (1 time per seven days),
  • Skin care (1 time per seven days),

Care of the perineum (daily and after each defecation)

Types of the patient positions (in the bed)

The main place of staying of the patient in a hospital is bed.

Depending on the patient’s condition and doctor’s prescriptions the following types of  the patient positions can be :

  • Active position – the patient can move freely and easily.
  • Passive position – in the case of impossibility of active movements of patients (in a state of unconsciousness, severe weakness).
  • Forced position – the patient is taken to reduce the severity of symptoms.

Example of Forced position.

  • Disease – bronchial asthma. The main manifestation – dyspnea and asphyxia.
  • Forced position. Patient sits, leans with hands. In the result the auxiliary respiratory muscles are involved in the process of breathing. Severity of dyspnea is reduced.

Example of Forced position

  • Disease – abdominal pain.
  • Forced position. «The fetal position» – patient lies on his side, hands and feet pressed against the abdomen. In the result the  pressure is decreasing in the stomach. Severity of pain is reduced.

PERSONAL HYGIENE

Oral Hygiene

  • Oral hygiene means brushing the client’s teeth or cleaning the dentures according to the integrity of the client’s teeth, gums, mucus membrane and lips. Oral cavity is an ideal place for bacterial growth by providing warms, moisture, food supply from the residual foods on and between the teeth and a protected environment. The number of bacteria in the mouth depends upon the degree of cleanliness of the mouth. A neglected mouth can cause various types of infection in the oral cavity.
  • Infection of the mouth can spread to neighboring structures leading to the following: parotitis, sinusitis, otitis media, adenitis, tonsillitis)
  • Systemic infections

The streptococci which is a normal inhabitant of the oral cavity enter into pulp cavity of the teeth. Pus is formed in the pulp cavity which becomes a focus of infection and spread to the distant parts of the body via blood stream causing various systemic diseases such as following: Rheumatic arthritis, Bacterial endocarditis, Nephritis, Gastritis, Anorexia)

  • Prevention of Complications

1.A clean mouth makes a person feel clean and comfortable. The mouth should be rinsed after every meal to dislodge any food particle left between the teeth.

2.All persons who are unable to attend the mouth should be assisted to clean the mouth. The following client’s should have  mouth care. They may be given mouth care every 2 hours or 4 hours:

Seriously ill clients.

Paralysed clients.

Unconscious patient.

Patients breathing through the mouth.

Malnourished and dehydrated patients.

Patients who are not taking oral feed.

3.Prevent dehydration of the tissues by the administration of enough fluids.

Сare of eyes

  • A common problem of the eyes are secretions that dry on the lashes as crusts. This may need to be softened and wiped away under sterile conditions. Eyes are cleaned from the outer to the inner canthus. When sterile procedure is required, each eye is cleaned with separate swabs, swabbing each eye once only. This prevent spread of infection from one eye to other and to avoid possible recontamination of the same eye.

Care of nose and ears

  • The nose and ears require minimal care in the daily life. Excessive accumulation of secretions make the client sniff or blow the nose. The secretions can become crusted and obstruct the airway (another nares).
  • For patients who cannot remove the secretions, assistance is necessary to clear the congestion and protect the nasal mucosa. External crusted secretions can be removed with a wet wash cloth or a cotton applicator moistened with oil, normal saline or water.
  • When there is poor hygiene of the ears, debris may accumulate behind the ear and the anterior aspect of the external ear. This can lead to ulceration of the skin. A common problem of the ears is the collection of cerumen or ear wax in the external auditory canal. This may cause a person some difficulty in hearing.
  • It can cause discomfort when it hardens. Many people remove wax from their ears by using sharp objects which can traumatize the ear drum. Warm liquid or a vegetable oil instilled into the ear can soften the wax and it can be easily removed.

Pressure ulcer

Care of the Perineum

  • Perineal hygiene involves cleaning the external genitalia and surrounding area. The perineal area is conducive to the growth of pathogenic organisms because it is warm, moist and is not well ventilated. Since there are many orifices (urinary meatus, vaginal orifice and the anus) situated in this area, the pathogenic organisms can enter into the body. Thorough cleanliness is essential to prevent bad odour and to promote comfort.
  • The most pertinent principle for the perineal care is to clean the perineum from the cleanest to the less clean area. The urethral orifice is considered as the dirtiest area. Because the orifices in the perineal area are in proximity, cross contamination is potential problem.The normal flora of the urinary system is different from that in the gastrointestinal system. Entry of organisms from the anal orifice can cause urinary tract infections, because these organisms are foreign to the urinary tract.
  • When implementation of personal hygiene all movements should be performed in the direction from the urethra to anus. This is necessary for the prevention of urinary tract infections pathogens which are most likely to be microorganisms are natural inhabitants of the intestine.

The following clients require special attention to the perineal area:

  • Patients who are unable to do self care.
  • Patients with incontinence of urine and stool.
  • Patients with indwelling catheters.
  • Post partum patients.
  • Patients after surgery on the genito-urinary system.
  • Patients with injury, ulcer or surgery on the perineal area or rectum.

Every person should clean the perineum after each urination and defecation.

Remember!

The perineal care — the procedure is intimate.

Very often patients are too embarrassed to ask the help of others. So the procedure requires intimate environment and the delicate treatment with the patient.

Pressure ulcers

  • Pressure ulcer is impaired skin integrity resulting from pressure
  • Pressure ulcers, also known as  pressure sores, bedsores  and decubitus ulcers.

Mechanism (etiology) of formation of pressure ulcers:

  • Pressure
  • Friction
  • Shearing force (shear tissues)

PRESSURE

  • Pressure is considered to be primary cause of the pressure ulcer. In a sick person, the areas of tissue resting against the mattress are vulnerable areas. The pressure in these areas causes depletion of blood supply with the failure of circulation (tissue ischemia). Tissue ischemia, decreased blood flow to tissue resulting in tissue death, occurs when capillary blood flow is obstructed, as in the case of pressure.
  • If this status lasts for more than 2 hours, there is ischemia, and then necrosis of the soft tissues.

The pressure over these areas are increased in the following conditions:

  • When there is lumps and creases on the bed.
  • Incorrect positioning of the body.
  • Infrequent change of position.

That’s why it is necessary to remember that a long lying or sitting still is dangerous!

SHEARING FORCE

  • Shear. The force exerted against the skin while the skin remains stationary and the bony structures move is called shear. For example, the head of the bed is elevated, gravity causes the bony skeleton to pull toward the foot of the bed, while the skin remains the sheets.

The underlying tissue blood vessels are stretched and angulated, and blood flow is impeded to the deep tissue. Ulcers occur with large areas of undermined damage at the skin surface


FRICTION

  • Friction – an injury top layer of the skin caused by rubbing from two surfaces against one another.
  • In result appears abrasion.
  • The body surfaces most at risk for friction are the elbows and heels because abrasion of these surfaces occurs when they are rubbed against the sheets during repositioning.
  • A similar situation arises in those cases, when the patient rests on elbows and heels at the surface of the bed and tries to move. He slides, rubbing elbows and heels on bed sheets, there is a BURN from FRICTION. A similar situation occurs when a motionless patient on the bed pulling – is the friction skin on the sheet.

Places of formation of pressure ulcer

  • If the patient lies on his back – bedsore formed on the sacrum (8), heels (9), elbows (7), scapula (6), back of the head (5), spinous process of chest vertebras (10).
  • If the patient lies on his abdomen – bedsore formed on zygoma, tuber ischadicum (2), costal arch (1), knees (3), crus (4), and pubis.
  • If the patient lies on one side – bedsore formed on the side of the thigh, on the sides of the malleolus and knees.

Factors contributing to the formation of pressure ulcer:

1.Age.

2.Cachexia (severe acute malnutrition)

3.Deficiency of protein and vitamins.

4.Chronic heart and lung failure.

5.Violation motor activity (diseases of the brain and spine)/

6.Diabetes.

7.Reduced blood flow in the lower and upper extremities.

8.Bad the care of critically ill: the presence in the bed of moisture, crumbs, wrinkles, stitches on the sheets.

9.Improperly moving a patient in bed (rude movements leads to injury to soft tissue).

Moisture

  • Moisture on the skin increases the risk for ulcer formation. Moisture reduces the skin’s resistance to other physical factors such as pressure or shear. Moisture originates from wound drainage, perspiration (sweating), and\or fecal and urinary incontinence. Skin moisture and wetness from incontinence can cause skin breakdown.

Nutrition

  • Poor nutrition, specifically severe protein deficiency, causes soft tissue to become susceptible to breakdown. Low protein levels cause edema or swelling, which contributes to problems with oxygen transport and transport of nutrients.
  • Poor nutrition alters fluid and electrolyte balance. In patients with severe protein loss, hypoalbuminemia leads to a shift of fluid from the extracellular fluid volume to the tissues, resulting in edema.
  • Edema increases the affected tissue’s risk for pressure ulcer formation. The blood supply to the edematous tissue is decreased, and waste products remain because of the changing pressure in the capillary circulation and capillary bed.

Cachexia

  • Cachexia is generalized ill health and malnutrition, market by weakness and emaciation, or extreme thinness. Basically the cachectic patient has lost the adipose tissue necessary to protect bony prominence from pressure and suffers from poor nutrition.

Age

  • Skin structure changes with age, causing a loss of dermal thickness and an increase in the risk for skin tears (break). Older adults are at highest risk for development of pressure ulcers; 60% to 90% of all pressure ulcers occur in patients over 65 years of age.

PRINCIPLES OF PREVENTION OF BEDSORES

ü Identification of patients at risk of developing bedsores:

  • Water low scale
  • Norton scale)

ü Daily skin care in the typical places of formation of bedsores:

  • daily inspection of the skin
  • cleansing of the skin
  • protect of the skin (if the skin is damp – to dry, if the skin is dry – to moisten)
  • percussion massage (the intensification of local blood circulation in problem areas)

ü Reducing causes of formation of pressure ulcers (pressure, friction or shear forces):

  • to use special device (anti-bedsore mattress, special pillows)
  • change position every 2 hours

ü Ensuring personal hygiene:

  • regular change of underwear and bed linen
  • hygiene of the perineum
  • the use of diapers, if necessary

ü Rational nutrition:

  • not less than 1.5 liters of fluid per day
  • fruits, vegetables, dairy products, fish, chicken

IDENTIFICATION OF PATIENTS AT RISK OF DIVELOPING BEDSORES

  • To select methods of prevention of bedsores, it is necessary to determine the risk of developing this complication. For this purpose, developed a variety of scales. The most famous of the Waterlow scale and the Norton scale.

THE REDUCTION OF PRESSURE

1.The reduction of pressure on the skin in areas of bone protuberances is achieved by putting the patient on a soft but resilient surface. The mattress takes the body shape, increases the contact area and reduces pressure on protruding body parts. By taking low risk you can use a foam mattress. With a high degree of risk, and if the sores use special anti-bedsore mattress. When placing the patient in the wheelchair under the buttocks and behind your back place a foam cushion under the foot and enclose the foam pad.

2.It is necessary every 2 hours to change the body position of the patient, including at night. Remember! The main rule of moving the patient: the patient must be implemented carefully, eliminating shear and friction to tissues RAISING HIS ABOVE THE  BED, or using the backing sheet.

The most common position: on her back; on her right side; on the left side, the sitting position; the position of the Fowler; the half-turn to right; turn left. In the last two positions of the body fixed with the use of pillows placed under the head, an arm and a leg (the Sims position).

ACTIVATION OF BLOOD CIRCULATION

To activate local blood circulation use: three times daily massage of the skin with the use of special tools (oil for skin toning liquid, etc.);

Special exercises with change of active and passive movements;

Remember! Reddened skin never massage, useful only regular massage around these places.

СLEANSING AND SKIN PROTECTION

Wash skin to use PH neutral Soaps.

Carefully dry the skin absorbent movements.

To avoid excessive moisture or dryness of the skin: with dry – moisten with cream; moisture – use a powder without talc.

Incontinence of urine and feces is to use diapers.

BALANCED DIET

The diet should contain at least 120 grams of protein and 500-100 mg of ascorbic acid. Use dairy products, greens, vegetables, fruits. Should drink at least 1.5 liters of liquid, if there are no contraindications.

On prolonged disruption the skin cells suffer from lack of nutrition and die a slow death. In terminally ill patients it is very difficult to heal bed sores because it is rarely possible to move them around. However, in general bed sores are treatable if detected early.

SIMPLE PHYSIOTHERAPEUTIC PROCEDURES IN THE ORGANIZATION OF CARING PATIENTS

  • Physiotherapy is a branch of medicine that studies the effect on the human body natural or artificially received physical factors and using them for the purpose of saving, recovery and promotion of health
  • Local Application of heat and cold to the body can be therapeutic, but before using these therapies, the nurse must understand normal body responses to application of heat and cold and how and when to use.

HOT APPLICATION

  • Hot application is the application of a hot agent, warmer than skin either in a moist or dry from on the surface of the body.

Classification of Hot Applications

Classification of Hot application

HOT APPLICATION

  • Peripheral Vasodilatation
  • Increased capillary permeability
  • Increased oxygen consumption
  • Increased local metabolism
  • Decreased blood viscosity
  • Decreased muscle tone
  • Increased blood flow
  • Increased lymph flow

COLD APPLICATION

  • Peripheral Vasoconstriction
  • Decreased capillary permeability
  • Decreased oxygen consumption
  • Decreased local metabolism
  • Increased blood viscosity
  • Increased muscle tone
  • Decreased blood flow
  • Decreased lymph flow

THERAPEUTIC USES OF LOCAL HOT APPLICATIONS. INDICATION:

  • Spastic pain (in the stomach, gallbladder, intestines);
  • Spasm muscle tone;
  • Hypothermia (Provide warmth);
  • Accelerates regeneration processes (by increasing blood flow);
  • Inflammatory process (Resolving action).

CONTRAINDICATIONS for HOT APPLICATIONS

  • Malignancies
  • Impaired kidney, heart & lung functions
  • Acutely inflammed areas
  • On clients with paralysis
  • Open wounds
  • Edema associated with venous or lymphatic diseases
  • Headache
  • Very young & very old client
  • Client with very high temperature

COMPLICATIONS OF HOT APPLICATIONS :

  • Burns
  • Maceration (with moist heat)
  • Redness of the skin
  • Edema
  • Hyperthermia

COLD APPLICATION

  • Cold application is the application of a cold agent cooler than skin either in a moist or dry form, on the surface of the skin;

Classification of cold Applications

Classification of cold Applications

  • PHYSIOLOGICAL EFFECTS

HOT APPLICATION

  • Peripheral Vasodilatation
  • Increased capillary permeability
  • Increased oxygen consumption
  • Increased local metabolism
  • Decreased blood viscosity
  • Decreased muscle tone
  • Increased blood flow
  • Increased lymph flow

COLD APPLICATION

  • Peripheral Vasoconstriction
  • Decreased capillary permeability
  • Decreased oxygen consumption
  • Decreased local metabolism
  • Increased blood viscosity
  • Increased muscle tone
  • Decreased blood flow
  • Decreased lymph flow

THERAPEUTIC USES OF  LOCAL  COLD  APPLICATIONS.  INDICATION:

  • Acute injury (in the first day)
  • Relieves pain (anaesthetize an area)
  • Reduce edema
  • Reduce inflammation
  • Control the growth of bacteria
  • Control hemorrhage
  • Reduces the body temperature

Contraindications for cold applications:

  • Cold allergy/hypersensitivit
  • Uncovered open wounds
  • Compromised circulation
  • Cardiac disorder
  • Anesthetic skin
  • Advanced diabetes

COMPLICATIONS OF COLD APPLICATIONS

  • Pain
  • Blisters and skin breakdown
  • Maceration (with moist cold)
  • Grey or bluish discoloration
  • Thrombus formation
  • Hypothermia

FACTORS AFFECTING HEAT AND COLD TOLERANCE

  • Body part: Certain areas of the skin have a sensitivity to temperature variations. The inner aspect of the wrist and forearm, the neck, and the perineal area are temperature-sensitive, while the back of the hand and the foot are not as sensitive.
  • Duration of application: Therapeutic benefits of heat and cold applications are achieved with short periods of exposure to temperature variations. Tolerance increases as the length of exposure increases.
  • Area of body exposed: The larger the area exposed to heat and cold, the lower the tolerance to temperature changes. — Damage to body surface area: Injured skin areas are more sensitive than intact areas to temperature variations.
  • Individual tolerance: Tolerance to temperature variations is affected by age and physical condition. The young and the aged are especially susceptible to heat and cold. Neurosensory impairments may interfere with the reception and perception of stimuli, increasing the risk of injury.
  • Age: Thinner skin layers in children and elderly people increase the risk for burns from the heat and cold applications.
  • Scientific principles involved in hot and cold applications: Water is a good conductor of heat. Air is a poor conductor of heat. The flow of heat is from the hotter are to the less hot area. Prolonged exposure to moisture increases the skin’s susceptibility to maceration and skin breakdown, reducing the protection of the intact skin. Moisture left on the skin causes rapid cooling due to evaporation of the moisture — Presence of steam increases the temperature of the hot application. Oil acts as insulator and delays the transmission of heat. Woolen absorb moisture slowly, but hold moisture longer and cool off less quickly than the cotton materials.

HEALHT ASSESSMENT

There are three groups of methods of examination:

1.Subjective method of examination

2.Objective method of  examination

3.Additional method of examination (laboratory-instrumental)

  1. Subjective method of examination
  • COLLECTION of INFORMATION (questioning)
  • GENERAL INSPECTION
  • ASSESSMENT OF THE VITAL FUNCTIONS

Questioning

The Questioning  consists of four parts:
1.Passport data (biographic)
2. Patient’s complaints
3.  Anamnesis (history) of present illness
4. Anamnesis of life (past medical history)

            2.Objective methods of examination (The Physical Examination)

The components of a physical examination include:

  • Inspection (general outer inspection)
  • Palpation
  • Percussion
  • Auscultation

GENERAL (OUTER) INSPECTION

  • 1. General condition
    2. Mental status (consciousness)
    3. Position of patient on bed
    4. Body shape
    5. Posture, gait
    6. Body temperature
    7. Examination of the skin, skin appendages (nails, hair and visible mucous membranes
    8. Inspection of subcutaneous fatty tissue

         1. General condition
Evaluating the general condition (severity status) makes after a complete examination of the patient

It is customary to distinguish between the following gradation of the General condition:

  • satisfactory,
  • moderate,
  • severe,
  • extremely severe,
  • terminal condition (agonal, clinical death).

The severity of the condition is characterized by:

  • 1. The degree of violation of the vital functions
  • 2.The degree of threat directly the life of the patient
  • 3.Possibility of serious complications in the nearest future life

A satisfactory condition  (Good)

A person  active, freely walks, communicates  with other patients Vital signs are stable and within normal limits. Patient is conscious and comfortable.

The condition of moderate severity (Fair)

Vital signs are stable and within normal limits. Patient is conscious, but may be uncomfortable. Indicators are favorable.

Severe condition. (Serious) The patient is in an untenable situation often lies in bed, consciousness may be clear, but often violated (stupor, a sopor)

Vital signs may be unstable and not within normal limits. Patient is acutely ill. There is danger to life.

Extremely severe condition (Critical)

The patient’s position on bed is passive

Patient may be unconscious

Vital signs are unstable

Without emergency medical care the patient will die

Terminal condition (agonal condition, clinical death)

  • 2. Mental status (Consciousness)

    In the evaluation of consciousness you need to determine how adequately the patient perceives the environment, responds to the medical staff that understands the questions he was asked how quickly responds

If the patient does not respond to the questions, you can use to the following methods:

  • Call him loudly
  • Shake him slightly as you wake a sleeping person
  • If the patient does not respond, you should determine the degree of oppression consciousness (level of consciousness)

Not disturbed consciousness is called «Сlear»

The patient is completely oriented in the environment, clearly answers the questions

Not disturbed consciousness is called «Сlear»

The patient is completely oriented in the environment, clearly answers the questions

Violation of consciousness can be quantitative and qualitative

Qualitative violations of consciousness (mental disorders)
When Qualitative impairment of consciousness may experience delirium, hallucinations

  • Quantitative violations consciousness

Types of oppression consciousness with increasing of severity:

  • Stupor 
  • Sopor
  • Coma
  • Stupor (stun) – a state of stunned. The patient comes in contact. But the patient is disorientated, bewilderment, and difficulty following commands, answers the questions slowly, with a short delay.
  • The sopor (hibernation) is a condition of abnormally deep sleep. Person can still react to stimuli but falls back in the pathological sleep.
  • The patient does not respond to others, although sensitivity, including painful saved. On questions does not respond or responds with one word (Yes – No), responds to the physical examination.
  • Coma is a state of deep oppression of the Central nervous system and disorders of the regulation of the vital functions of the organism.
  • The patient is unconscious. Respiratory and cardiac activity saved. There is a decrease in or disappearance of basic reflexes.
  1. The patient’s positions on bed
    Types of the patient’s positions on bed
  • active
  • passive
  • forced
  • The active position is the possibility of self, the active movements.
  • Be aware that for different age categories activity may be different.
  • Passive position is the absence of the patient’s ability to self-service (coma, severe weakness, paralysis).
  • Forced position

Patient takes the forced position often unconsciously, to ease  suffering. Sometimes forced position of patient is very characteristic for some disease or syndrome.

  • Types of forced position:

1) Forced position Orthopnea – sitting or lying in bed with a raised head end and lowered his legs.

Disease: heart failure.

A mechanism to ease the condition. The decrease of shortness of breath at the expense of Deposit of the blood in the lower limbs.

2) Forced position Orthopnea a sitting Position, leaning his hands on the edge of the bed
Disease:
bronchial asthma
A mechanism to ease the condition. Mobilization of accessory respiratory muscles, which allows to make exhale active

3) Forced position the standing – symptom “shop window”. Because stenokardicheskie pain in the sternum, created by walking, the patient is forced to stop.

4) Forced position Pose “praying  position ” – the patient is sitting on the bed, bent over, resting on the pillow

Disease: Pericardial effusion

A mechanism to ease the condition. In this position, the liquid collects in the bottom part of the fibrous-serous membranes of the heart (the pericardium), and therefore less pressure on the heart and large vessels. “Floating” heart over liquid makes it work.

5) Forced position Position “a la vache(from French “cow”) – is a four standing position.

Disease: tumor of pancreas, stomach or another organ of the abdominal cavity.

Mechanism of relief. In this position the tumor puts less pressure on solar plexus and pain decreases.

6) Forced position Lying on a sick side
Disease
: Dry pleurisy, Rib fracture
Mechanism of relief. Limiting of pleural layers friction of the affected side.

7) Forced position to sit or lie bended with hands pressed against epigastric region

Disease: gastric Ulcer (localized on a posterior wall)

Mechanism of relief. Acidic gastric juice ebbs away from the ulcer, warm hands reduces paroxysm of unstriated muscles.

8) Forced position Pointing dog position – the patient lies on the side, with legs bent and pressed against the stomach, the head is thrown back

Disease: Meningitis

Mechanism of relief. This position is caused by lower extremities muscles contracture (Kernig`s symptom) and occipitals contracture (neck stiffness)

4. Body build (Habitus)

  • The Body build is a collective term that includes constitutional type, anthropometric data (height, weight).
  • Body type is a set of functional and morphological characteristics of a body, based on the hereditary and acquired characteristics.

Body build:

  • Normosthenic
  • Hypersthenic
  • Asthenic
  • Normosthenic type is characterized by regular build and body balance, well-developed skeletal muscles, and regular form of the chest. Epigastric angle is 90 degrees.
  • Asthenic type – is often characterized by its length development. Muscles are weak, neck is long. Chest is narrow and contracted. Its lateral dimension is much bigger than anterioposterior dimension. Epigastric angle narrow (less than 90 degrees). Ribs are oblique, intercostal spaces are increased. The blade bones doesn`t bear against the chest.
  • Hypersthenic type is characterized by width development. Height is average, supernutrition, muscles are well-developed. Shoulders are wide and a neck is short. An abdomen is increased in volume. Chest is wide, its anterioposterior size is increased. Epigastric angle is blunt(more than 90 degrees), intercostal spaces are narrow.
  • Height. Normal adult height varies from 1.5 m to 2 m
    There are some deviations from the norm:
    Gigantism
    Dwarfism
  1. Body temperature
    In a healthy person body temperature varies to a small degree from 36,4 C to 36,9°C

In hospital thermometry is made twice a day – in the morning in the fasted state (at 7-8 a.m. and at 5-6 p.m. before the last meal).

The temperature may be taken every 3 hours for specific indications.

  • Thermometry

Armpits
• Oral cavity (the thermometer is placed under the tongue)

  • Inguinal folds (in children)
    • Rectum (the temperature of the rectum is usually 0.5-1 degree Celsius higher than of the armpit)
  • In addition to thermometry, it is necessary to check the temperature of any hyperemic skin area. In case of inflammatory there is localized temperature rise.

7. Skin and visible mucous membrane, hair, and nails examination

  • skin color
    • moisture
    • turgor
    • lesions (abnormal skin elements) “skin cleanliness”
    • condition of nails and hair
  • Skin color
  • Skin color varies by body part and person.
  • Despite individual variations, skin color is usually uniform over the body.
  • Normal skin pigmentation ranges from light pink to ruddy pink in light skin
  • and from light to deep brown or olive in dark skin.

A practitioner often faces several types of skin color change:
•Pallor

  • Cyanosis
  • Hyperemia
  • Jaundice
  • Bronze skin color

Pallor  (unusual paleness) may exist due to:
1) anemia of any origin

2) peripheral arterial spasm in some diseases

  • Cyanosis is a bluish discoloration of skin and mucous membranes.

Types of cyanosis depending on origin:

  • Local cyanosis
  • General cyanosis (Central, Peripheral and Mixed)
  • Local cyanosis may develop as a result of accumulation of blood in peripheral veins (thrombophlebitis, compression by a tumor or enlarged lymph nodes).
  • General cyanosis develops in case of respiratory and cardiovascular diseases
  • Cyanosis occurs if the absolute amount of reduced hemoglobin in the blood exceeds 40-50 g/l
  • (the total amount of hemoglobin-120 -150 g/l)

Central (pulmonary) cyanosis

  • Central cyanosis appears in case of blood oxygenation disorder in the lungs in case of acute and chronic diseases of lungs and heart. Skin is of ash-gray tint. The skin is warm.

2. Peripheral cyanosis (acrocyanosis) appears in case of chronic heart failure.

When myocardial contractility decreases the blood flow on the periphery slows down.

Oxygen consumption increases, that is why content of reduced hemoglobin increases, especially in the distal ends.

There may be cyanosis lips, fingertips and tiptoes cyanosis, nasal tip cyanosis, earlobes cyanosis. Limbs are cold.

  • Mixed cyanosis appears in case of severe heart and lungs diseases.
  • It is more difficult to note changes such as pallor or cyanosis in patients with dark skin tones.

Skin hyperemia can be caused by:
• fever
• local inflammatory reaction
• hemoglobin high level
• response to some drugs (e.g., nicotinic acid, nitrates)

  • Jaundice is Yellowish skin color is caused by skin and mucous membrane saturation with bilirubin and by its content increase.
  • Jaundice develops in case of liver and gall bladder diseases
  • Initial signs of jaundice are best identified during sclera examination. However, the skin colour may be normal.
  • Bronze (brown) skin colour occurs in case of depression of adrenal glands function.
  • Brownish pigmentation usually occurs in the form of spots on the different parts of the body (face, neck, hands). And on the places exposed to friction – armpits, the lumbar region, inner thighs, genitals.

MOISTURE

  • The hydration of skin and mucous membranes helps to reveal body fluid imbalances
  • Skin moisture is determined visually and with the help of palpation.
  • There are the following degrees of skin moisture: normal, dry and moist.
  • The skin is normally smooth and dry (skin folds such as the axillae are normally moist)

Turgor is the skin’s elasticity. To assess skin turgor, grasp a fold of skin on the back of the forearm with the fingertips and release.

  • Normally the skin lifts easily and snaps back immediately to its resting position.

Decrease of skin elasticity

  • The skin stays pinched or tented when turgor is poor.

Decrease of skin elasticity is possible:

  • in patients of elderly and senile age;
  • in case of dehydration (vomiting, diarrhea, and so on).
  • Increase of skin turgor (it is impossible to pull up the skinfold) often indicates a water retention, often accompanied by skin puffiness (invisible edema).

Studying subcutaneous fat you should pay attention to:

  • the degree of subcutaneous fat development,
  • the place of primary fat storage
  • edema
  • subcutaneous blood vessels changes.

While evaluating the degree of subcutaneous fat you should consider:

  • Inspection data
  • Palpation data
  • Body weight

Assessment of the subcutaneous fat by palpation

  • skin fold on the abdomen near the navel (the norm is 1-2 cm);
  • skin fold under the collarbone, and shoulder blade (the norm is 1-2 cm);

The degree of subcutaneous fat development may be:

  • normal,
  • high,
  • excessive (obesity),
  • decreased (underweight )
  • undernutrition (cachexia).
  • Extreme weight loss is cachexia. It is observed in case of long-term, severe intoxication, chronic infections, malignant tumors, thyroid gland and pancreas dysfunctions, some mental diseases and so on

Еdema is an excessive water retention in body tissues and serous cavities.

  • There are Local and General edema

Local edema appear most often due to:

– local dysfunction  of venous or lymphoid outflow (varicose vein disease, thrombophlebitis, elephant-leg).

Remember

Edema  appeared because of venous outflow dysfunction are usually accompanied by severe skin cyanosis

  • In other cases, most often skin is pale

General (Subcutaneous) edema appear in case of heart, kidneys diseases or diseases of other internal organs and they are caused by the mechanisms dysfunction involved in water-electrolyte balance regulation.

  • More often there are edema of heart and kidney origin

Renal edema are localized on the face, especially in the area of eyelids.

Face edema is more pronounced in the morning.

Heart edema develop gradually, and are often accompanied by shortness of breath.

  • The first edema in patients with heart diseases appear on the feet. Edema appear in the evening, especially after long-time walking and disappear after a night’s rest.
  • In advanced cases of heart and kidney failure fluid (transudate) may accumulate in serous cavities.
  • It is cavity edema.
  • The fluid that accumulates in the serous cavities is called transudate.

Type cavity edema:

  • Hydrothorax
  • Hydropericardium
  • Ascites

Hydrothorax – accumulation of fluid in the pleural cavity.

  • Hydropericardium – accumulation of fluid in the pericardial cavity.

Ascites – accumulation of fluid in the abdominal cavity.

  • Anasarca – a generalized infiltration of edema fluid into subcutaneous connective tissue

Methods of peripheral edema determination
Palpation method

1)Press the skin and subcutaneous fat of ankles, shins, sacrum or sternum with a thumb. In case of edema there will be pits remained;

2) observation of body weight dynamics

3) measuring amount of fluid you drink and amount of urine (diuresis)

Monitoring and care for patients with diseases of the circulatory system.

Cardiology

is a section of internal medicine, studying the etiology, pathogenesis, clinical manifestations, diagnosis, prevention and treatment of diseases of the cardiovascular system.

For these patients they use

  1. General care – common activities conducted in many diseases of other organs and body systems.
  2. Special care – care for patients with cardiological  diseases, it involves realization of a number of special actions associated with the presence of certain symptoms.

The main complaints

  1. heart pain
  2. dyspnea
  3. abnormal heart rhythm
  4. increase in blood pressure
  5. lowering blood pressure
  6. edema

The pain in the heart area is  an important and informative sign.

The pain in the heart region may be a manifestation of insufficient blood supply to the heart muscle due. In this case, the myocardium is in a state of ischaemia (oxygen starvation).

In these conditions, myocardial cells change biochemical processes. This leads to the accumulation of non-completely oxidized products of metabolism that annoy sensitive receptors, resulting pain.

Characteristic of Heart  pain

  1. Reasons and conditions of pain occurrence. The pain is usually associated with exercise, emotional stress.
  2. Pain is localized behind the sternum (breastbone) or slightly to the left of the sternum.
  3. Nature of pain: retro sternal pressure, constricting character.
  4. Pain commonly irradiates to the region under the left scapula, the neck, and the left arm.
  5. The pain is usually the pain is removed by nitroglycerin.
  6. This pain syndrome is called stenocardia or angina pectoris

Edema

Edema in cardiac patients appears in case of development of heart failure.

Heart failure – a reduction of myocardial contractility, resulting in the development stagnation of blood in the systemic circulation and fluid retention in the body.

Signs of cardiac edema:

  1. Edema are localized in legs
  2. Edema can spreads upwards (foot, shin, thigh, down to the groin).
  3. Edema appears in the evening, in the morning edema disappears in the beginning
  4. Edema consistency is dense like a dough (there is a fossa after pressing)

Signs of edema

In advanced cases of heart failure fluid (transudate) may accumulate in serous cavities.

It is  cavity edema. The fluid that accumulates in the serous cavities is called transudate.

Type cavity edema:

  1. Hydrothorax
  2. Hydropericardium
  3. Ascites
  4. Anasarca

Hydrothorax – accumulation of fluid in the pleural cavity.

Hydropericardium – accumulation of fluid in the pericardial cavity.

Ascites – accumulation of fluid in the abdominal cavity.

Anasarcaa generalized infiltration of edema fluid into subcutaneous connective tissue

Dyspnea

is one of the signs of acute or chronic heart failure.

The patient has a painful feeling of shortness of breath during physical exertion and excitement, and as the disease progresses and at rest.

Dyspnea cardiac origin is inspiratory (difficulty while inhale).

Blood Pressure

  • Blood pressure is the forсe exerted by the blood against the walls of the blood vessels as it flows through them.
  • Systolic pressure is the highest degree of pressure exerted by the blood against the walls of the blood vessels during the ventricular systole when the left ventricle is forcing the blood into the aorta.
  • Diastolic pressure is the lowest pressure that occurs when the heart is in its resting period just before the contraction of the left ventricle.
  • Pulse pressure is the difference between the systolic and diastolic pressure and represents the volume output of the left ventricle.
  1. The average blood pressure for the healthy adult is usually about 120/80 mm Hg.
  2. A  systolic pressure above 140 or below 90 mm Hg is regarded as abnormal.
  3. Hypertension is a condition of abnormally high blood pressure (above 140/90 mm Hg)
  4. Hypotension is a condition of abnormally low blood pressure (below 100/60 mm Hg) .

Abnormal heart rhythm

  • Right heart rhythm – the regular contractions of the heart with the same frequency.
  • The normal heart rate is 60 to 100 per minute.
  • Tachycardia is a  heart rate more then100 per minute.
  • Bradycardia is a  heart rate less then 60 per minute.
  • Deviations from normal heart rhythm are called  arrhythmia.

Standard of nursing Care:

1.Physical Examination (Regular measurement of the basic hemodynamic parameters – blood pressure and pulse)

2.Diagnostic Studies (preparation for instrumental laboratory and studies)

3.Psychological support (Creation of psychological comfort by the hospital staff  in the medical ward; Creation of psychological comfort for relatives of the patient.)

4.Control of physical activity in accordance with its tolerance (Check the position of the patient’s body in bed; Therapeutic exercises).

5.Nursing care for edema (Determination of water balance; Weighing the patient; Total care for skin on the feet).

6.Pharmacological therapy (Control of the regular intake of medicines).

7.Nutrition (diet № 10).

8.Advice to patient (Education).

9.First Aid & Emergencies (predoctor care).

Psychological support:

  • Creation of psychological comfort by the hospital staff  in the medical ward.
  • Patients with heart diseases are special patients. In psycho-emotional terms they require special attention, as stress is one of the factors of the development and exacerbation of heart diseases. Cardiac patients often have fear of death. Therefore, the medical staff must reassure the patient. You could say – you are in the hospital, everything will be fine. Compose chambers in such a way that patients requiring rest (heart attack) were not close to heavy dying patients.

Physical Examination –  Regular measurement of the basic hemodynamic parameters

Regular measurement of the basic hemodynamic parameters – blood pressure and pulse. It is important to explain to the patient that the measurement of blood pressure should be done regularly, even in good health. Since the increase in blood pressure may not always be accompanied by complaints.

Сontrol of physical activity in accordance with its tolerance.

1)Limitation of physical activity. Patients can not carry out  the load in the same volume, it leads to attack of angina (heart attack) or shortness of breath. In severe chronic heart failure patient may be tired after a little physical activity (washing, eating). In acute myocardial infarction a strict bed rest is prescribed in the first days.

1)Check the position of the patient’s body in bed. If the patient stays in bed, you need to raise the head end.

2)Therapeutic exercises. But this does not mean that a patient with heart disease should stop moving. Movement is life. Walks in the fresh air are often recommended, walking at least for 40 minutes.

Nursing care for edema

(Water balans, Total care for skin on the feet, weighing the patient)

1. It should be remembered that the edema at the early stages of the disease may be hidden. Hidden edema can be controlled by weighing the patient. The rapid increase in body weight indicates fluid retention.

2.Total care for skin on the feet. While edema skin becomes stretched, thin and vulnerable to infection. It’s necessary to wear comfortable shoes, to avoid damage to the skin, to conduct skin preparation, to put cream onto the skin.

3.Water balance – is the ratio of the drunk fluid and the parenteral fluid and the amount of urine per day.

Normally 80% of all consumed liquid per day must be evolved.

* If the urine per day is evolved less than 70-80% of the volume consumed per day, negative  diuresis is diagnosed. I.e. a portion of liquid retains in the body.

* If the amount of urine exceeds the amount of liquid you drink per day, fluid diuresis is positive. Positive diuresis can be at the period of disappearing of  edema while intake of diuretics.

Nutrition

If developing heart failure the patient should receive a diet  № 10.

Limit intake of:

  • animal fats
  • water
  • salt

First Aid & Emergencies in cardiology practice

  • Heart  pain
  • Cardiac asthma attack
  • Hypertensive crisis – increase the blood pressure
  • Collapse –toxic ,
  • Syncope –healthy person not requires Ambulance

Heart  pain.

This pain syndrome is called stenocardia or angina pectoris.
Angina pectoris is one of the forms of the Ischemic heart disease.( Not enough blood & Oxygen Supply )

The cause for its development is the coronary atherosclerosis (arteries supplying blood to the heart).

There are two types of angina pectoris depending on the circumstances by which it occurs – angina pectoris at stress and angina pectoris at rest. The angina at stress occurs in connection with physical or emotional exertion. The angina at rest is not connected with physical exertion. It occurs at night and often involves an increased shortness of breath. Angina pectoris always occurs with spasms.

Clinic of  stenocardia:

  1. Pain is localized behind the sternum (breastbone) or slightly to the left of the sternum.
  2.  Nature of pain: retro sternal pressure, constricting character.
  3.  Pain commonly irradiates to the region under the left scapula, the neck, and the left arm.
  4.  Tachycardia
  5.  Weakness
  6.  Whiteness

Stenocardia. First aid:

  1. Call a physician.
  2. To ensure the patient is at rest.
  3. To ensure a flow of fresh air, unbutton constraining clothes.
  4. To measure pulse rate and blood pressure.
  5. If systolic BP is not less than 100 mm Hg to give 1 tablet of nitroglycerin under the tongue.
  6. If the pain is not relieved, nitroglycerin should be repeated (3 tablets at an interval of 5 minutes). Under the control of blood pressure.

With the continued attack of pain and the ineffectiveness of re-admission of nitroglycerin urgent hospitalization is shown , because the possibility that pain attack is caused by developing acute myocardial infarction decreases

MYOCARDIAL INFARCTION
The basis of this disease is the necrosis of the heart muscle.

The most common, the so-called typical (pain, anginal) variant of the myocardial infarction, characterized by:

  1. pain in the chest  it is extremely strong,
  2. pain doesn’t stop because of rest or by taking nitroglycerin,
  3. pain lasting for more than 30 minutes,
  4. fear of death,
  5. severe weakness,
  6. cyanosis.

Such patients in the first hours of the disease need urgent hospitalization in the intensive care unit, equipped with all necessary equipment for monitoring their condition and for possible resuscitation.

Cardiac asthma attack

Cardiac asthma is a severe attack of dyspnea (breathlessness) which appeared suddenly, often at night

Cardiac asthma is a condition where there is either an acute left ventricular failure (left heart failure) or congestive (left and right) cardiac failure.

  • In this condition, the hearts left side has become damaged leading to reduced capacity to pump the blood out of the heart. Thus, blood backtracks into the pulmonary veins, and the capillary baskets around the alveoli of the lungs. The hydrostatic pressure finally gives way to the transudation of fluids into the alveoli reducing the effective surface are for the diffusion of gases. This will lead to a feeling of drowning, where the patient complains of dyspnoea.

Clinic of cardiac asthma attack

  1. The patient usually sits in bed.
  2.  Patient is restless.
  3. Noisy bubbling breath
  4. Inspiratory dyspnea .
  5.  Respiration is rapid, accessory muscles are moving.
  6.  Pulse is rapid and has pulses alternans characters.
  7.  Cough  with frothy pink sputum.
  8. Fear of death

Cardiac asthma. First aid:

  1. Call for a physician.
  2. Help to take the forced position – orthopnea. Orthopnea – sitting position with bowed legs. In this case, the blood is partially deposited in the lower limbs and blood flow to the heart is reduced.
  3. Oxygen supply should be given

1.Give the patient nitroglycerin if systolic blood pressure of a patient is not less than 100 mm Hg.

2.Apply tourniquet or elastic bandage on a limb. This will reduce the blood flow to lung. We must check that only veins are pinched , i.e. arterial pulse below the tourniquet should be maintained, and limb must become cyanotic, but not white.

3.After 15-20 minutes, we should loosen the tourniquet. Removal of tourniquets should be carried out sequentially in slow mode (first from one limb, after a while from the other, etc.).

Hypertensive crisis – a sharp rise of blood pressure

Symptoms of Hypertensive crisis

  1. severe headache in the occipital region
  2. dizziness
  3. visual disturbances
  4. tremors all over the body, as in a fever
  5. nausea
  6. pain can be in the heart
  7. hyperemia of the face due to a blood flow

Hypertensive crisis. First aid:

1.Call for a doctor immediately!

2.Give the patient a comfortable position in bed. The head should be raised (put an extra pillow under his/her head), legs  are down.

3.Warmth to feet (blanket or hot water bottle, you can put mustard on the calf muscles).

4.Give to patient an extraordinary dose of his medication under the tongue (absorbs faster).

Syncope is the medical term for fainting or passing out.

  • Syncope – a brief loss of consciousness.
  • It is caused by a temporary drop in the amount of blood that flows to the brain.

Triggers/Causes:

Syncope can be a healthy person:

  1. fright
  2. hunger
  3. a stuffy room
  4. orthostatic hypotension (abrupt change of position)

Syncope may be a manifestation of the disease.

Clinic:

  1.  Before loss of consciousness – lightheadedness, nausea.
  2. Then patient settles slowly.
  3. Pale skin.
  4. Shallow breathing
  5. A slow, weak pulse
  6. Blood pressure is reduced

No consciousness (from several seconds to several minutes).

First Aid:

1.Lay, the head is turned to one side (it provides a flow of blood to the head);

2.fresh air (open a window if the person is in a stuffy room);

3.unbutton constraining clothes (collar, belt);

4.spray the face with cool water

5.Pat  on the cheeks;

6.Give  the person breathe in the fumes of ammonia. You need to slightly moisten the cotton wool with ammonia, and hold it at a distance of 1-2 cm from the nose of the person).

7.After consciousness is back, give the person strong tea with sugar.

 Collapse

Differs from syncope by longer duration and severity of events.

During collapse the tonus of all blood vessels is greatly reduced, it leads to a fall of blood pressure and cardiac abnormalities.

Clinic of collapse:

  1. Consciousness is clouded
  2.  Pointed facial features, sunken eyes
  3. Sallow skin
  4. Cold hands and feet
  5. Shallow breathing
  6. A slow, weak pulse
  7. Reduced blood pressure

First Aid:

1.Give the patient a horizontal position with lowered head end, legs are raised

2.Cover the patient

3.Monitor the pulse, blood pressure, respiratory rate and temperature.

4.Observation of the water balance.

 

Systemic Circulation

  • Systemic circulation carries highly oxygenated blood from the left side of the heart to all of the tissues of the body (with the exception of the heart and lungs).
  • Systemic circulation removes wastes from body tissues and returns deoxygenated blood to the right side of the heart.
  • The left atrium and left ventricle of the heart are the pumping chambers for the systemic circulation loop.

Pulmonary Circulation

  • Pulmonary circulation transports deoxygenated blood from the right side of the heart to the lungs, where the blood picks up oxygen and returns to the left side of the heart. The pumping chambers of the heart that support the pulmonary circulation loop are the right atrium and right ventricle.

Coronary Circulation

  • The heart has its own set of blood vessels that provide the myocardium with the oxygen and nutrients necessary to pump blood throughout the body. The left and right coronary arteries branch off from the aorta and provide blood to the left and right sides of the heart. The coronary sinus is a vein on the posterior side of the heart that returns deoxygenated blood from the myocardium to the vena cava.

Аrterial pulse

Arterial Pulse is an alternate expansion (rise) and recoil (fall) of an artery as artery as the wave of blood is forced through it during the contraction of the left ventricle.

The pulse can be felt by the fingers on a point where an artery crosses a bone close to the surface of the skin.

  • Sites for taking pulse. The pulse may be felt at:

The radial artery in front of the wrist.

  1. Temporal artery over the temporal bone.
  2. Carotid artery at the sides of the neck.
  3. The brachial artery above the elbow and in the antecubital fossa (inner part of the elbow).
  4. Femoral artery in the groin.
  5. Poplitial artery in the poplitial fossa (back of the knee).
  6. The dorsalis pedis artery on the foot.
  7. The posterior tibial artery behind the medial malleolus.

Palpation of pulse

  • Palpation of the pulse is a simple and quick method study of cardiac activity, does not require special equipment.

Characteristics of the Pulse

Before assessing the pulse, nurse must determine the normal characteristics of a pulse:

  • the symmetry of the pulse
  • rhythm,
  • the rate,
  • volume
  • tension.

Symmetry of the pulse

Pulse can be symmetric and asymmetric.

In norm pulse wave should be the symmetric (same) on symmetrical arteries.

In pathology of the pulse may be asymmetrical (different) on symmetrical arteries.

In this case we are talking about only about the weakening of the pulse on one of the arteries.

The asymmetry of the pulse. Reasons: poor circulation as a result of atherosclerosis of this artery or compression from the outside.

Rhythm

  • Rhythm refers to the regularity of beats. May be regular and irregular Rhythm of the pulse.
  • Normally the heart beats are spaced at equal intervals and they are said to be regular.
  • Regular rhythm – interval between heartbeats same.
  • Irregular rhythm – interval between heartbeats different.
  • If an irregularity is present, the pulse should be counted for one full minute.

Rate

  • Rate is the number of pulse beats in a minute. The normal rate in the resting adult is 60 to 100 per minute «normocardia».
  • A pulse rate over 100 per minute is referred to be “tachycardia“.
  • A pulse rate below 60 per minute in an adult is referred to be “bradycardia“.

The factors causing variations in pulse rate are:

  • Age: The very young have a rapid pulse rate. The adults have a normal range of 70 to 80 per minute. The very old have relatively slow pulse rate.
  • Before birth – 140 to 150 per minute, 130 to 150 per minute.
  • At birth (Newborn) – 115 to 130 per minute.
  • First year – 100 to 115 per minute.
  • Second year – 90 to 100 per minute.
  • Third year – 86 to 90 per minute.
  • 4 to 8 years – 80 to 86 per minute.
  • 8 to 15 years – 70 to 80 per minute.
  • Old age – 60 to 70 per minute.
  • Sex: The female has a slightly more rapid pulse than the male.
  • Physique: The short person with small body build has a slightly more rapid pulse than the tall heavy individual.
  • Exercise: Increased muscular activity will increase the pulse rate.
  • Food: Indigestion of food causes a slight increase in the pulse rate for several hours.
  • Posture: The pulse rate is higher when the body is in standing position than when in sitting or reclining position.
  • Emotions: Mental or emotional disturbances will increase pulse rate temporarily.
  • Application of heat: Application of heat can increase the pulse rate.
  • Pain: A client in the agony of pain will have increased pulse rate.
  • Increased body temperature: When the body temperature is elevated the pulse rate tends to rise.
  • Disease conditions: Loss of blood, injury to the viscera, shock etc., increase the pulse rate. Heart diseases, typhoid, infection etc., have a marked effect on the pulse rate. In heart diseases the pulse rate may be either rapid or slow according to of cardiac lesions. In typhoid fever, the pulse rate tends to be slow.
  • Drugs: Stimulant drugs e.g., caffeine, atropine, thyroid adrenaline etc., will raise the pulse rate. Administration of sedative drugs can reduce the pulse rate.
  • Cold applications: The cold applications can reduce the pulse rate. Hypothermia can reduce the pulse rate to a very lower rate.

Volume

  • Volume refers to the fullness of the artery. It is the force of the blood felt at each beat. Volume depends upon the amount of blood in the arteries.
  • If the arteries contain a norm volume of blood, the pulse is said to be satisfactory in volume.
  • If the arteries contain a large volume of blood, the pulse is said to be full in volume.
  • If the volume of the blood is decreased (as by haemorrhage, shock, or loss of fluid from the body, e.g., diarrhoea and vomiting) the pulse will be weak thereby small weak pulse (thready at very low BP).

Tension

  • Tension pulse is formed by pressure of blood on an artery wall.
  • Tension is the degree of compressibility.
  • If pulse disappears at a moderate compression of a radial artery, such pulse characterize as pulse of a satisfactory tension.
  • When the artery is difficult to compress – pulse of high tension
  • When the artery is easy to compress low pulse of low tension.

In typical cases (in the healthy person)  pulse rate 60-90 per minute, regular, satisfactory tension,  full in volume.

  • Blood pressure is the pressure exerted by the blood against the walls of the blood vessels as it flows through them.
  • Systolic pressure is the highest degree of pressure exerted by the blood against the walls of the blood vessels during the ventricular systole when the left ventricle is forcing the blood into the aorta.
  • Diastolic pressure is the lowest pressure that occurs when the heart is in its resting period just before the contraction of the left ventricle.
  • Pulse pressure is the difference between the systolic and diastolic pressure and represents the volume output of the left ventricle.
  • The average blood pressure for the healthy adult is usually about 120/80 mm Hg.
  • A systolic pressure above 140 or below 90 mm Hg is regarded as abnormal.
  • Hypertension is a condition of abnormally high blood pressure (above 140/90 mm Hg ).
  • Hypotension is a condition of abnormally low blood pressure (below 100/60 mm Hg .

Measurement BP – an important control method behind a condition of a hemodynamic at healthy and at sick people.

Measurement of a BP can be carried out direct and indirect methods. The direct method assumes introduction of the sensor immediately in a blood channel. This method apply for the purpose of determination of pressure in large vessels or heart cavities.

In daily practice of a BP is measured by the indirect auscultation method offered in 1905 by the Russian surgeon Nikolay Sergeyevich Korotkov.

Steps of procedure – MEASUREMENT OF water balance  

Purpose: diagnostics of the hidden edemas

  1. At 6 a.m. the patient urinates into the toilet. After that the patient urinates in bedpan.
  2. Nurse сounts the amount of liquid arriving in an organism per day. Water, tea, juice plus amount of fluid, which the nurse entered into a vein.
  3. Nurse сounts the amount of excreted urine per day.
  4. Determine OF water balance. Calculation of the water balance is determined by a formula:

The amount of urine*100

Total amount of fluid

  1. To consider water balance is negative if less liquid is emitted, than it is calculated in norm (+ or – 5 – 10% may be)
  2. To consider water balance is positive if more liquid is emitted, than it is calculated.
  3. To make records in a leaf of the accounting of water balance.

Algorithm determining of water balance (daily diuresis):

1.at 6 a.m. the patient urinates into the toilet.

2.after that the patient urinates in bedpan.

3.nurse measures the volume of urine.

4.nurse calculates (nurse counts), the amount of fluid which the patient drank for 24 hours (water, tea, juice). Plus amount of fluid, which the nurse entered into a vein.

5.Determine of water balance.

ACCOUNT SHEET

Patient – Ivanov I.

Ward № 15

Count amount of liquid arriving in an organism per day.

  • Breakfast – 300 ml
  • 10.00 – 200 ml
  • 11.00 – 150 ml
  • Lunch – 600 ml
  • Dinner – 180 ml
  • 21.00 – 200 ml
  • 22.00 – 200 ml

In  total 1830 ml

Count amount of excreted urine per day:

  • 300 ml
  • 220 ml
  • 250 ml
  • 350 ml
  • 280 ml

In  total 1400 ml

Calculation of the water balance is determined by a formula:

1830 * 0,8 = 1464 ml

Gastrointestinal (GIT)

Main symptoms of gastroenterological patients:

  • Appetite changes
  • Changes in taste
  • impaired swallowing (dysphagia)
  • Gastric dyspepsia
  • Intestinal dyspepsia

Hunger is a reflex that occurs in the absence of timely intake of food.

The amount of glucose decreases in the body. It is perceived by hunger centers in the brain. Feeling of hunger appears. Sign of hunger is the increase of saliva production, acute sense of smell, pulling, sucking sensations in the stomach.

Appetite is a sample (emotional) manifestation of hunger, the preference for certain foods. Appetite depends on the time of day, emotional state, religious, national habits.

Appetite changes (types):

  • loss of appetite,
  • lack of appetite,
  • increased appetite,
  • aversion to food,
  • perversion of appetite.

Loss (decreased) appetite is a partial or complete refusal from the meal.

The main reason – diseases of the stomach and intestines. But another pathology may be the reason: fever, mental illness, heart disease and kidney disease, etc.

Lack of appetite is a complete rejection of the meal.

  • The main reason – the disease of the gastrointestinal tract.
  • It often occurs in cancer. The second reason is mental disorder (anorexia nervosa).

Anorexia nervosa is eating disorder characterized by deliberate artificial weight loss caused by the patient himself. More common among girls. Pathological desire of weight loss, intense fear of obesity are observed in anorexia. The patient has deformed perception of his physical form.

Increased appetite. There are a lot of reasons: stress, heavy exercise, endocrine diseases, mental diseases (Bulimia nervosa).

Bulimia nervosa – eating disorder, paroxysmal sharp increased appetite. Literal translation – ravenous hunger. Bulimia nervosa is accompanied by a feeling of painful hunger, general weakness, pain in the epigastric region.

People can have eating disorders on one of the schemes:

  • Paroxysmal absorption of huge amount of food (appetite appears suddenly);
  • Constant eating (the person is eating constantly, without breaks);
  • Night eating (hunger attack happens at night).

Aversion to food. Most often there is an aversion to certain foods, mainly meat. This symptom occurs in cancer of the stomach and intestines.

Perverted appetite (Dysgeusia) – a perversion of appetite, insatiable need to eat inedible substances. Substances: dirt, paper, glue, chalk, clay, coal and others. Such behavior shows one in three children aged 1 to 6 years old, pregnant women.

  • The reason of dysgeusia – lack of nutrients in the body. After the elimination of nutrient deficiency, the need for eating inedible substances disappears.

Changes in taste:

  • reducing taste sensations,
  • bad taste in the mouth.

Changes in taste:

  • Reducing taste sensations (Blunting of taste sensations) – the disappearance of the taste of the foods.

First of all, salty and sweet taste is lost.

Reasons: dry mouth, smoking, impaired sense of smell, impaired autonomic nervous system, mucosal atrophy tongue, tumors of the head, facial paralysis and others.

  • Tongue can detect only sweet, salty, sour and bitter taste. These mouth-feel are due to taste receptors located on the surface of the tongue, pharynx and larynx in a small amount. Taste – a combination of taste and smell. Much of what is perceived as “taste” is actually smell.

Bad taste in the mouth.

Reasons:

  • Most often, this symptom occurs when dental disease appeares (caries, gingivitis, inflammation of the salivary glands and the other, the presence of dentures).
  • Ear-nose-throat -pathology (ENT-pathology) (acute or chronic tonsillitis, rhinitis).
  • Pathology of the gastrointestinal tract (pathology of the esophagus, stomach, gallbladder).

IMPAIRED SWALLOWING

  • it is a disorder of the act of swallowing caused by organic or functional obstacles that do not allow the food to move through the esophagus

GASTRIC DYSPEPSIA is a set of symptoms:

  • heartburn
  • belching
  • nausea
  • vomiting
  • Pain in stomach

Heartburn – a burning sensation in the epigastrium or behind the breastbone.

  • Reasons: opening of esophageal sphincter. As a result, reflux of acidic gastric content into the esophagus

Belching – sudden sonorous output of air through the mouth, sometimes with small amounts of stomach contents.

Types of  belching:

  • Belching with air.
  • Sour belching.
  • Belching with bitterness.
  • Belching with the smell of rotten eggs.
  • Nausea – unpleasant sensation in the epigastrium. Occurs at the vagus nerve stimulation. Accompanied by weakness, increased salivation, dizziness. Often ends up with vomiting.
  • Vomiting – antiperistaltic reflex contraction of the muscles of the stomach, esophagus, pharynx, and sometimes bowel.

Character of vomit. Vomit can contain (vomited material):

  • Feedings
  • Bile
  • Rotten content
  • Intestinal contents
  • Coffee ground vomiting
  • Blood

In some cases the nature of vomiting can help to determine the cause.

  • Belching with air. Reason – aerophagia. Aerophagia – swallowing of excess air.

 

Aerophagy is observed in violation of meals intake (fast food, conversation during meals), due to respiratory diseases (for nasal obstruction).

Sour belching. Occurs at high acidity in the stomach.

  • Belching with bitterness. Occurs in diseases of the gallbladder.
  • Belching with the smell of rotten eggs (hydrogen sulfide). Happens in violation of the passage of food from the stomach into the intestine. As a result, the food rots in the stomach and a lot of gases are produced.
  • Nausea – unpleasant sensation in the epigastrium. Occurs at the vagus nerve stimulation. Accompanied by weakness, increased salivation, dizziness. Often ends up with vomiting.
  • Vomiting – antiperistaltic reflex contraction of the muscles of the stomach, esophagus, pharynx, and sometimes bowel.

Character of vomit. Vomit can contain (vomited material):

  • Feedings
  • Bile
  • Rotten content
  • Intestinal contents
  • Coffee ground vomiting
  • Blood

In some cases the nature of vomiting can help to determine the cause.

  • Vomiting with blood may be a sign of gastric bleeding.
  • Vomiting with undigested food can be a sign of pyloric stenosis of stomach.
  • Vomiting bile can be diseases of the gallbladder

Vomiting classification according to appearance mechanism:

  • Of gastric origin. The reason is a disease of the stomach. After vomiting, the patient always feels easier.
  • Of central origin. The reason may be the brain damage (concussion). Relief doesn’t come after vomiting.
  • Of toxic origin. The reason may be severe intoxication. Relief doesn’t come after vomiting.
  • Of reflex origin. The reason may be acute surgical pathology the organs of abdominal cavity. Relief doesn’t come after vomiting.

Epigastric pain

The mechanism of pain:

  • The direct impact of food on the inflamed mucosa of the stomach and duodenum
  • Spasm of smooth muscles of the stomach and duodenum
  • Increased pressure in the stomach

Pain signs of gastric origin:

  • location – epigastric pain
  • Often pain is cramping
  • Pain may spread into the heart, spine.
  • Seasonality of pain
  • Connection between pain and food intake (Early and Later pains)

Pain signs of gastric origin:

  • location of the pain. Localized epigastric pain.

If the ulcer is in the upper part of the stomach – the pain is located under the xiphoid appendix. If an ulcer is in the duodenum – the pain is located closer to the navel. If all the gastric mucosa is inflamed – the pain extends to the entire epigastric area.

  • The nature of the pain. Pain may be different: minor severity in epigastrium, pressing pains, cramping, cutting pains.
  • Distribution (irradiation) of pain. Pain may not spread. Pains may spread into the heart. There fore, patients sometimes come into the heart department. In case of ulcer on the posterior wall of the stomach pain may spread to the spine.

Seasonality of pain. Exacerbation of pain happens in spring and autumn.

Connection between pain and food intake.

There are:

  • Early pains. Pains appear or intensify after eating. Such patients are afraid to eat, since after food intake they feel worse. During disease patients lose weight. Early pains arise in the localization of the pathological process in the stomach.
  • Later (hungry) pains. Pains come or increase when a stomach is empty. Patients feel better after food intake.
  • These patients always carry food with them. During the disease patients may gain weight. Sometimes they get up at night to have meal.

Intestinal dyspepsia:

  • abdominal distention
  • diarrhea
  • constipation
  • fecal incontinence

Abdominal distention  – excessive accumulation of gases in the intestines. This symptom is called flatulence.

  • Mechanism: pathological gas production due to increased processes of gas production and decomposition of gases in the intestines.
  • Abdominal distention is accompanied by the following symptoms: arching abdominal pain, gas from the intestines do not depart.

Defecation is the process by which the solid waste products of digestion, know as faeces or stool, are eliminated from the bowel.

  • Defecation should be daily normal.
  • Regular defecation is one of the indicators of good health.
  • The normal defecation pattern might change according to age and dietary habits.
  • Changes in defecation pattern may cause some problems for patient.

Diarrhea – frequent, loose, watery stools, three or more times a day.

  • Diarrhea can be a manifestation of bowel disease or other organs or systems.

Mechanisms of diarrhea:

  1. This is accelerated motion of contents along the intestines
  2. Delayed absorption of fluid from the lumen intestine.

Characteristics of stool.

To clarify the causes of diarrhea it’s necessary to find out:

  • Frequency of feces. Liquid feces can be allocated once. Liquid feces can be allocated ten times.
  • Colour. Malformed feces can be allocated. Water coloured with feces may be allocated. Green liquid stool may happen.
  • Consistency and form.
  • Odour/The smell of feces. Normally, a stool has a peculiar smell. In the pathology fetid smell may appear.

Constipation – long delay of feces in the intestine, more than 48 hours), sometimes painful passage of hard, dry stool.

Causes of constipation:

  • Malnutrition
  • Insufficient water intake (less than 2.5 L)
  • Improper combination of products
  • Failure to supply natural physiological cycles (rare food intake)
  • Psychoemotional factors
  • Diseases of the gastrointestinal tract
  • Diseases of other organs

Constipation classification depending on the mechanism:

  • Spastic constipation. Occurs due to spasm of the muscles of the intestine. Spasm promotes retention of passage of feces.
  • Atonic constipation. Occurs due to the lack of physical activity. As a result, intestinal motility is reduced. Feces moves slowly through the intestines. Much water is absorbed back into the blood. Feces becomes dry.
  • Alimentary constipation. Arises because of the lack of fiber in the diet.
  • Mechanical constipation. Occurs due to mechanical obstruction in the intestine (colon scarring, tumor, etc.).
  • Reflex constipation. Occurs in case of artificial delay of defecation.

Main symptoms of gastroenterological patients:

  • Appetite changes (loss of appetite, lack of appetite, increased appetite, aversion to food, perversion of appetite).
  • Changes in taste (reducing taste sensations, bad taste in the mouth).
  • impaired swallowing (dysphagia)
  • Gastric dyspepsia (Heartburn, belching, Nausea, Vomiting, Stomach pain)
  • Intestinal dyspepsia (abdominal distention, diarrhea, constipation, fecal incontinence)

Nutrition
Rational nutrition. Food intake 5-6 times a day in small portions. Limitation of fatty, spicy, fried)

  • After food intake no laying down 1-2 hour (in a horizontal position food can flow into the esophagus).
  • In acute diseases of the stomach – diet № 1.
  • Flatulence (abdominal distention) – diet № 2
  • Constipation diet № 3.
  • Diarrhea – diet № 4.

Nursing care in Constipation

. Health Teaching

  • Any person suffering from constipation must understand the physiology of defecation and the factors affecting the defecation.
  1. Adequate Intake of Diet
  • If the dietary intake is too little, it may not stimulate the peristalsis.
  1. Adequate Intake of Roughage in Duet
  • Foods containing high fibrous content should be included in the diet such as raw and cooked vegetables, raw and cooked fruits, whole grain cereals etc. The quantity and quality of breakfast is more important to prevent constipation. One purpose of the breakfast is to produce a vigorous gastrocolic reflex and expulsion of the faecal matter.

. Establishing a Habit Pattern

  • Usually the defecation reflex is found immediately after a full breakfast. So the person should find time to sit on the toilet immediately after the breakfast.
  1. Relaxation
  • Have an environment conducive to relaxation because tension, anger, worry, hurry, fear etc., interfere with the defecation reflex. Reassure the nervous client.
  1. Privacy
  • All persons need privacy for the defecation. Leaving the client alone and providing him privacy with curtains etc. help him to have bowel movement.
  1. Posture
  • A squatting position is most effective posture during defecation because the individual can increase intraabdominal pressure, necessary for expelling the faeces. Unless contraindicated a sitting position with the feet flat on the floor should be used for all persons.
  1. Exercise
  • Any activity that improves the muscle tone of the abdominal and perineal muscles should be encouraged.
  1. Adequate Amount of Fluid Intake
  • Normally, an individual should take 2000 to 3000 ml of fluid in 24 hours.

Nursing Care in Diarrhoea

1.Replacement of fluid and electrolytes: The fluid lost from the body should be replaced immediately to prevent shock and collapse of the patient. When oral fluids are tolerated by the patient, the fluids may be given in plenty orally. If there is marked dehydration, the fluids are given by the IV. route. Potassium losses may be great with diarrhoea and therefore food and fluids containing potassium should be encouraged.

2.Small frequent feedings of blend food may be helpful to meet the nutritional requirements of the patient. Avoid foods containing chillies, spices, excessively hot and cold foods etc., because they stimulate peristalsis.

3.Make arrangement for the use of bedpan or commode which is placed in a convenient and accessible place.

4.Care of the skin: skin excortation around the anal region can be prevented by proper cleaning and drying of the area after each defecation.

5.Adequate rest: Reducing the physical activity is helpful in lessening the bowel activity.

6.Psychological support: If the cause of diarrhoea is sustained anxiety, the patient should be reassured.

7.Medications: The usual medication which are administered to the patients with diarrhoea are antidiarrhetics, demulcents, astringents, intestinal antiseptics, sedative and antispasmodics.

Acute abdominal pain acute abdomen» ):

The term «acute abdomen» refers to a sudden, severe abdominal pain of unclear etiology that is less than 24 hours in duration.

Symptoms:

  • Severe abdominal pain
  • Nausea and vomiting
  • «Hard» and painful abdomen
  • Temperature increas

Severe abdominal pain. First aid:

  • Call for a doctor
  • Help to take a forced position. Side position, legs bent at the knees, pull up to the abdomen, lead hands to stomach.
  • You Must Not feed, water, warm the patient, give painkillers.

a forced position

  • Side position, legs bent at the knees, pull up to the abdomen, lead hands to stomach.

Gastrointestinal bleeding

  • Gastrointestinal (GI) bleeding is bleeding from any part of the gastrointestinal tract (esophagus, stomach, small intestine, large intestine (colon), rectum, and anus).
  • GI bleeding is not a disease, but a symptom of any number of conditions.
  • The causes of gastrointestinal (GI) bleeding are classified into upper or lower, depending on their location in the GI tract.

Causes of upper GI bleeding include

The most common causes of lower GI bleeding include

Symptoms of GI bleeding:

  • Vomit looks like “coffee grounds“. The gastric acid digests the hemoglobin to brown color.
  • Fresh blood in the vomit (if gastric big bleeding)
  • Impurity of blood colors vomit of pink color.
  • blood in the stool, or black, tarry stools (melena).

Symptoms associated with the blood loss include

  • fatigue,
  • weakness,
  • pale skin, and
  • shortness of breath.

Gastrointestinal bleeding. First aid:

  • Call for a doctor
  • The patient should be placed in bed (middle Fowler‘s position), head to one side
  • Ice bag is applied to the epigastrium.
  • Collect the blood in dry clean glass to check its amount.
  • Do not drink , do not eat, do not take oral medication.

 

  • Stool /Feces – the final product which is formed as a result of complex biochemical processes and absorption of fission products in the gut.

Fecal research should be carried out in patients suffering from diseases of the digestive system. Fecal analysis has important diagnostic value.

Fecal analysis allows you to:

  • set a diagnosis
  • monitor the development of the disease
  • monitor the results of treatment.

Classic laboratory Methods of feces research:

  • coprology,
  • feces analysis on helminthes,
  • stool for occult blood

Feces for examination of occult blood (algorithm)

  • Three days before the date of this analysis you should exclude meat, liver, blood sausage and other products.
  • As well as drugs containing iron (apples, bell peppers, spinach, white beans, green onions, cucumbers, etc.) from the diet.

General rules for Collection of Stool Specimen:

  • Do not use a laxative before collecting specimen.
  • Only fresh feces is collected for research.
  • Empty the bladder before collecting of feces.
  • Collect feces in a bedpan.
  • Central portion of feces is placed in a disposable container with a special spoon.
  • Put the required amount of feces in the container.
  • While using a container, put on gloves.

Research on enterobiasis (algorithm)

The procedure is performed in the morning after getting up from bed.

  • Before hygienic procedures, urination and defecation.
  • The man leans forward, move apart buttocks hands.
  • Material is taken from perianal folds with cotton swabs in a circular motion.
  • A cotton swab is placed in a special tube.
  • Unused end of a cotton swab must be removed.
  • Material is delivered to the laboratory within 3 hours after collection.

 

The end 

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