Care of the bed patient

Irrespective of the location of the patient (a hospital, the house), he should frame a maximum of possible conveniences in bed and whenever possible to provide in it safety of the patient, excepting falling possibility.

In any case the bed of your patient should become for it the inanimate assistant in struggle against illness.

On a bed of the patient it is necessary to put a thick mattress without hollows and hillocks. Over a mattress to lay a wide oilcloth hanging down from its edges. To lay on an oilcloth the soft pure bedsheet which size is little bit less a than oilcloth. On the bed middle to put a small oilcloth, and over its pure dry diaper.

Put two soft pillows with the soft pillowcases excluding penetration outside of feathers.

In a blanket cover to enclose a soft, easy and warm blanket. From above it is possible to cover the patient with a plaid. The bulky and serious blanket frames feeling of gravity and discomfort for the patient.

The bed-clothes should be always pure and dry, without extraneous subjects and crumbs.

The finding of the patient in a bed will be safe if its one edge is at a wall, and along the second the grid (hammock) is tense. It is possible to fix one or two chairs on the bed middle.

About massage

The Greek word massein from which there was a word known to us "massage", means to "rumple". This medical procedure was known still in days of Gippokrat's which considered massage «curing a body and soul».

Massage is one of the most ancient medical-improving agents known in history of mankind.

The list of the illnesses which are giving in to treatment by agents of massage, is huge. It is defined also by the active referred action on the sites of an organism amazed with illness, both enormous by efficiency and force the general improving effect.

One of the important features of a modern society is that such agent as massage, uses more and more healthy people. In this case massage is an effective remedy of preventive maintenance of some diseases and maintenance of a high vitality and excellent health. And if in the conditions of the Middle Ages massage was presumed to themselves only by elite, i.e. it was elite enough agent, now it became really popular.

Indications (cases when medical massage is necessary):
Dorsodynias, to a loin, a neck.
Headaches.
Osteochondrosis.
Bruises, stretchings of muscles, tendons and ligaments.
Fractures at all stages of healing.
Functional disorders after fracture and a dislocation (a rigidity of joints, muscular changes, cicatrical adnations of tissues).
Arthritises in a subacute and chronic stage.
Neuralgia and neuritises.
Radiculites.
Paralyses.
Chronic insufficiency of a cardiac muscle.
Stenocardia.
Idiopathic hypertensia.
Arterial hypotension.
The rehabilitational period after a myocardial infarction.
Chronic gastritis.
Disturbance of motor function of a thick intestine.
Bronchitis.
Pneumonia.
Bronchial asthma.
Stomach and duodenum peptic ulcer (out of an exacerbation).

Contraindications: (are given in the generalised form)
At acute feverish statuses and a heat.
Bleedings and bent to them.
Illnesses of blood.
Purulent processes of any localisation.
Various diseases of a skin, fingernails, hair.
At any acute inflammations of vascular and lymphatic vessels, the clottages, the expressed varicose phlebectasia.
Atherosclerosis of peripheric vessels and brain vessels.
Aortic aneurysm and hearts.
Allergic diseases with epicutaneous rashes.
Diseases of organs of an abdominal cavity with bent to bleedings.
Chronic osteomyelitis.
Tumours.
Mental diseases with excessive excitation.
Circulatory unefficiency of 3rd degree.
During the period hyper-and hypotonic crises.
Acute ischemia of a myocardium.
The expressed angiosclerosis of a brain.
Acute respiratory disease.
At disorder of intestinal functions (a nausea, vomiting, a liquid chair).
Pulmonary heart of 3rd degree.
Combination of massage to other methods of treatment

The combination of massage with physical methods of treatment is expedient for preparation of tissues for a forthcoming massage session. For example, preliminary to warm an extremity at a rigidity of joints at a paralysis or a paresis when the dermal temperature is lowered. Physiotherapeutic procedure before massage reduces morbidity, activates a resorption of slag adjournment in walls, improves conductivity of nervous trunks.

Most rather a combination of massage to a thermotherapy: a water bath, paraffin or ozocerite applications, an inductothermy. On hot segment massage action, undoubtedly, more effectively. Heat and massage combination is especially shown at a rigidity of joints, okolosustavnyh the solderings, the slowed down education of an osteal callositas after fractures of bones, at neuritises and a neuralgia.

In clinical practice quite often combine medical massage with phototherapy in the form of an irradiation infra-red beams or a local light bath. In this case it is necessary to show care and to do massage not earlier than in 3-4 hours after phototherapy since there can be a rupture of fine vessels (they are strongly dilated under the influence of an irradiation by an infra-red spectrum).

Often massage is combined with a water treatment: manual massage under water, a shower-massage and other forms of underwater massage, a sponging down, a bath. Various hydrotherapeutic procedures can be applied before massage. If there are cicatrical adnations of tissues, solderings, a myosclerosis of tissues, a neuromyositis, lumbar radiculitis the thermal hydrotherapeutic procedure at first is applied, and then massage. If there is a pain expression other sequence is more effective: at first abirritating, relaxing massage, and after it - balneologic procedure.

It is incompatible in the same day, but the carbonic bath and the general massage, a diathermy and the general massage, the general solar irradiation and massage is compatible to massage in different days. In neurologic practice at presence at sick paralyses or deep paresises, massage combine with electrotreatment (impulse currents of low frequency). If the active electrical stimulation of the suffered muscles (electrogymnastics) massage needs to be spent at once after it is prescribed. At purpose of an electrophoresis of various medicinal substances in a combination with massage massage, and then an electrophoresis in the beginning becomes. The return order of these procedures can liquidate in general therapeutic effect of an electrophoresis since massage action will quickly remove the entered ions from dermal "depot".

All should be considered it, spending self-massage since some physiotherapeutic influences are possible and in house conditions: heaters, wrappings woollen scarfs, a shower, wet wipings, baths of various temperature with medicinal grasses or salts.

MASSAGE DOSAGE

Duration of one massage session has an appreciable range from 3 about 60 and more minutes. Massage daily or in day depending on age, statuses, the individual shipping, massed area becomes. The medical course of massage too is individual: from 5 to 25 procedures (in sanatoria of 10 procedures).

Breaks between courses of treatment from 10 days till 2-3 months. The number of procedures after a break can be reduced or enlarged. The general massage, as a rule, does not become every day, and at a cardiosclerosis, cardiovascular insufficiency, in advanced age in the first days it is possible to do massage not more often 2 times a week, and then (at good shipping) - in day.

At an asthenia, hypotensions, mental and physical overfatigue at first mass in day, and then (at good shipping) - daily. Partial massage (on anatomic zones, on segments) do daily. It is shown in connection with traumas (fractures), illnesses of joints (an arthritis, an arthrosis). At consequences of paralyses, deep paresises, an intestine atony, edemas, at lymphostasises, gastritises with the lowered secretory function daily massage is effective, and at possibility - two-single (in the first and second half of day).

All course of medical massage can be parted for 3 periods.

I - introduction (2-3 procedures) it is necessary for specification of response of an organism (reduction or intensifying of pains, change of arterial pressure, occurrence of drowsiness or vivacity, ease and freedom of movements, simplification of breath). In this period shipping of concrete massage receptions, influence on an organism as a whole is specified.

II - the basic - 3, 4, 20, 23 procedures. In this period massage receptions are strictly differentiated taking into account complaints, climatic symptoms, features of an accompanying pathology. With each session under indications intensity of influence is enlarged.

III - final are two last procedures. Massed at this time it is possible to train in self-massage, to show sequence of receptions on concrete anatomic zones, to train in the reference with mechanical masseurs.

As to massage in the cosmetic purposes it saves a face skin healthy, elastic, warns premature education of folds, flabbiness. Under the influence of massage the skin is released from the collected died off cells of a cornual layer, blood vessels extend, the diaphoresis is enlarged, activity of sebaceous glands is normalised, tissues become more elastic and elastic. At young age at a normal skin it is quite enough to massage the face 1-2 times a month. If a skin dry, rigid and rasping it is useful to mass it in day. Usually radical improvement comes through 5-7 sessions. After 35 years when the person already covers a network of fine folds, massage it is necessary to spend 1-2 times a week under the full scheme. Duration makes it 15-20 minutes.

Massage helps at:

The strengthened activity of sebaceous glands, to a delay of dermal fat in ducts of sebaceous glands;
To dry shelled skin;
To flabby, rugosity skin;
Presence of a double chin;
Predilections to developments of stagnation, a redness of the person, cicatrical changes of a skin.

Contraindications: the inflammatory phenomena, pustulous lesions of a skin, serious pathologies of the cardiovascular system, some diseases of nervous system, superfluous growth of hair on the person, a hypertonia.

Own safety

Looking after the sick person, it is especially important to secure itself against physical overloads, traumas, from an infectious disease of which our ward is sick. For this purpose, what to save long working capacity, looking after the seriously ill patient the person, it is necessary for you:

* to Have the good physical form.
* the Nobility and to be able to use rules of a raising and moving of gravities.
* to Care of the health.
* to Observe sanitation and hygiene rules.
* to Spend bacterination at care of the infectious patient.

Maintenance of the good physical form

* As the nosotrophy demands physical strength and flexibility application, it is necessary for you not less than 4 times a week to do physical charging. Proceeding from personal features, pick up to itself a complex of exercises by duration 20 - 40 minutes Important that in the chosen complex, besides others, there were exercises on a stretching of joints, exercises for back and neck muscles.
* it is rather desirable to make daily 40-minute walks on fresh air fast step. If you have hobbies, skating type, skis, run, swimming it is good that they were regular. The nobility and to be able to use rules of a raising and moving of gravities
* the Clothes should be free
* the Footwear should fit densely a foot, the sole - minimum to slip on a floor. The footwear from a skin or dense h/b tissues is preferable, with a wide heel in height no more than 4 - 5 see
* do not lift gravity and do not work in position of an inclination of a trunk forward. The load (pressure upon intervertebral disks) with augmentation of an angle of an inclination increases in 10 - 20 times. It means, that at a raising or transferring of a subject in weight to 10 kg in position of an inclination of a trunk forward you are exposed to a load in 100 - 200 kg.
* At a raising of a serious load have it as it is possible more close to a breast and only on the arms incurvated and as much as possible pressed to a breast. The further you discharge a subject of yourselves, the more load lays down on your backbone.
* Distribute a load on arms in regular intervals and a back always hold directly.
* If it is necessary to lift a subject from low position, for example, from a floor, sit down near to a subject, saving direct position of a back, take a subject in arms and press it to a trunk, and then rise, saving a direct back.
* If it is necessary to help the patient laying in a bed, for example, to move of it or to help to accept a sitting position, it is admissible not to be declined over it and not to reach for it to deep edge of a bed, and to rise on bed edge on one knee and, strong resting on it, to help the patient.
* Feet put on width of shoulders, and stops - in parallel each other.
* If it is necessary to displace the load lifted by you aside - do not turn only the top part of a body (shoulders and arms, saving feet in former position), and turn all case.
* Always search for possibility to facilitate a load: use the help of the patient (its possibility to be tightened, make a start, lean, etc.) and associates. Do not hesitate and be not lazy to ask to help to lift or transfer the patient.
* Use special adaptations for simplification of the job: legs, transport boards, rotary circles, elevators for patients, etc.
* to Care of the health
* Care of serious patients, especially long, care of the dying, mental patients sick with the expressed painful syndrome etc. is the serious work which is taking away many of physical and sincere forces. To hope only for an impulse, on the call of duty, the emotions - it is impossible! It is necessary to raise a sincere and corporal fortress of the organism, what you could adequately, long time without harm for itself to serve the patient.
* Our health and working capacity in many respects depend on night rest. Take care of a high-grade dream! The convenient bed, pure cool air and silence is for this purpose necessary. The ideal surface for rest is an orthopedic mattress. At its absence it is possible to use moderately rigid bed or a couch with an equal, smooth surface. The blanket is better for using easy and warm, well passing air. The deep relaxation of a body during a dream allows to restore completely a circulation, including in a backbone.
* do not forget to pass preventive prophylactic medical examination once a year.
* Monotonous serious work is very unhealthy! Therefore long high-grade annual rest is important, it is desirable on the nature. At care of the serious oncologic or mental patient rest can be demanded more often. It is impossible to neglect it as both the subsequent physical and nervous breakdowns will bring your overfatigue to you and your ward of more harm, than periodic (we will tell, for a week in a quarter) parting with the patient for rest and the health amendment.
* In the course of job if it proceeds some hours, it is necessary to provide possibility of high-grade short-term rest (during 15-20 mines each 2 hours).
* a Food should correspond to an exercise stress. If you work much at bed of the patient, you should enlarge caloric content of the diet, as the person who is engaged in serious physical work. Avoid reception of exciting preparations on purpose to enlarge the period of wakefulness at bed of the patient (the period of excitation after reception, for example, coffee, always comes to an end with the inhibition period), alcohol, fat and fried nutrition.
* to Observe sanitation and hygiene rules
* Resist to external influence of an infection the pure both healthy skin and a mucosa can only.
* the Infection gets to an organism immediately through a mouth of the patient or from leaving subjects, through a touch or through air.
* 99 % of originators of infectious diseases can be removed from a surface of a skin by means of washing of arms with usual soap.
* Daily take after the termination of job with the patient of souls with soap.
* As it is possible wash arms with soap is more often. For this purpose, that the skin on arms would dry up less, it is necessary to use soap with Glycerinum both nutritious and wetting creams for arms.
* Even on a skin of arms (a scratch, a graze, the lifted up agnails) it is necessary to process insignificant damages by diamond greens and to stick with a water-proof adhesive tape.
* Antibacterial soap is better be not to using, as in due course there is an appreciable depression of protective properties of a skin.
* Helping the patient at physiological departures, at contacts to blood, at a dressing of wounds it is necessary to use medical gloves. Better the disposable. If such possibility is not present, reusable gloves should be strictly individual (they cannot be used at job with other sick or healthy person).
* premise Cleaning where there is a patient, it is necessary to spend in rubber gloves.
* Looking after the patient it is necessary to put on special clothes: a dressing gown and a kerchief. The special clothes are necessary for erasing separately from other linen.
* Handles of washrooms of cocks, handles of doors, as most often used subjects in the house it is necessary to wash and wipe switches and phone tube daily a disinfectant solution.
* Before to close the cock after washing of arms, it is necessary to wash up it the same as also arms.
* At a nosotrophy have an individual towel.
* For washing of arms it is better to use not lumpy, but liquid soap and a batcher.
* If the patient has an infectious disease passed air by, it is necessary to work with it in a mask. For a mask it is possible to use a bandage on the person from a four-layer gauze.
* In one mask it is impossible to work more than 4 hours if you observe a regimen of silence and more than 1 hour if you speak in a mask.
* For protection of a mucosa of a nose during a flu it is possible to use 0,25 % Oxolinum ointment.
* leaving Subjects are necessary for processing according to the accepted rules. Leaving Components / the infectious control see.
* At beds filling it is not necessary to shake up pillows and to stir up bedsheets and a blanket in a room of the patient. It promotes a raising and dust moving, and together with it - microbes and viruses.
* Daily spend cleaning of a room of the patient, it is better after change bed and underwear.
* Accept nutrition out of a room of the patient and necessarily take out thus a working dressing gown.
* to Spend bacterination at care of the infectious patient
* At a nosotrophy with an infectious disease, for example, a tuberculosis, a poliomyelitis, a diphtheria, etc. to you it is necessary to make preventive inoculations.

Safety of the patient

For maintenance of safe medium of the patient it is necessary to adhere to following rules:

* the Bed of the patient, a toilet, a bathroom should be supplied by calls for an emergency call;
* For the prevention of falling in a room of the elderly person there should not be high thresholds, wires and other subjects underfoot, cords on carpets;
* During movement of badly seeing person of a ladder and corridors should be well shined;
* After hit on a floor of its liquid it is necessary to wipe immediately that the patient has not slipped on a wet place; It is necessary to interfere with fast circulation and run of wards;

The footwear of the elderly and weakened patients should be convenient, not crushed, with not slipping sole. Check as the sole on a floor slips is better! On different coverings different soles slip variously!

* Accustom the weakened patients and patients with coordination disturbances to use a handrail, hand-rail, basic handles, crutches ;
* Periodically check durability of fastening of a handrail and hand-rail;
* Periodically check quality of points (a status of glasses) and their conformity to requirements of the ward (consultation of the oculist);
* Periodically check quality of job of a hearing aid;
* the Weakened patients, aged should use a bathroom and a toilet, not closing a door on a latch;
* In a room sick the night lamp allowing the woken up person to orient in a situation at the night should burn;
* In a room of the patient in a prominent place there should be hours for orientation of the patient in time;
* At threat of falling of the patient from a bed use the beds having lateral sides;
* If there is a threat of falling of the patient from a bed, and to establish at a bed sides it is not obviously possible, lay near to a bed a mattress for the most safe falling of the patient;
* it is necessary for Patient to avoid a sharp rising from bed or from an armchair in order to avoid giddiness, a loss of consciousness and falling of the patient;
* At a rising in a bathroom it is impossible to use as a hand-rail cocks or waterpipe pipes. In cases of failure of the cock or an abruption of a pipe the elderly person can burn;
* In connection with bad sensitivity of a skin of the elderly person to temperature in a bathroom it needs to measure water temperature not by an arm, and by means of the water thermometer, differently it can sit down in excessively hot water;
* In order to avoid a skin traumatising it is impossible to suffice older persons raspingly;
* do not submit to elderly patients nutrition too hot, burning;
* In order to avoid combustions it is impossible to use an electric heater to the people, a suffering incontience of urine and a feces;
* Looking after the seriously ill patient, hold the fingernails shortly cut, take out from ornament arms;
* to Drink and eat people with swallowing disturbances should only in the presence of the second person.

Fire safety:

On kitchen where there lives the elderly person compelled independently to cook to food, in the presence of a gas cooker of a ring of a back row should be disconnected, and the elderly person should know, that they do not work. It is necessary to do it to prevent fire of sleeves of clothes when, trying to light a back ring, the elderly person lasts through the lighted ring of a forward number and the clothes light up. We will remind, that reaction to such situation at older persons happens often inadequate and instead of bringing down a flame, the elderly person starts to run with burning sleeves on apartment therefore gets very strong combustions;

* Near to a cooker there should not be inflammable subjects: curtains, towels, washing-up liquids, etc.;
* the Smoking patients who are on a confinement to bed, should smoke only in the presence of other persons;
* Hide matches from the patients, suffering an aphrenia;
* It is impossible to smoke near to the patient using an oxygen cushion.

At equipment use:

* Attentively study all instructions or instructions for use that either other medical equipment or stock;
* Be convinced, that you have correctly understood a principle of action of the equipment;
* Try equipment action at first on itself;
* Periodically check serviceability of the equipment;
* At use crutches, canes periodically check their durability, durability of joints, integrity of handpieces;
* Periodically check durability of a lateral handrail on a bed;

All means of transportation of the patient having wheels: the trolley, a wheel-chair, a functional bed, etc. - should have functioning brakes. Before use of these agents be convinced, that you know, how brakes work and that they are serviceable. During replacing or a rearrangement of a sick brake should be fixed. If you are compelled to leave for the period of the person who is on wheel means of transportation before to depart from the patient, you should fix brakes.

Dialogue with mentally sick person:

* In cases when the patient independently switches on gas on kitchen, it is necessary to supply a pipe resulting gas in apartment, the gate with taken out head. Leaving kitchen, the gate head should be carried away with itself;
* In the presence of the expressed excitation of the patient or the statement it of suicidal thoughts cannot be left the patient of one indoors, during excitation the way to a window should be covered looking after;
* All medicines should be hidden from the patient in a reliable place;
* All agents of household chemical goods should be under the latch;
* the Drug intake should be carried out in the presence of the second person. After a drug intake it is necessary to check an oral cavity of the patient, whether it has hidden in angles of a mouth of a tablet for this purpose, what further, having saved up them in enough to accept single-step;
* to Watch how the patient eats. In default from meal to solve a question with the attending physician about ways of feeding of the patient;
* to Clean in apartment in all internal premises latches from doors;
* to Speak with the patient it is necessary an equal, quiet voice, to abstain from objections;
* Acute, pricking, cutting subjects should be removed;
* with memory disturbance it is necessary for patient Leaving on street to put in pockets a note with the indicating of a surname, a name, a patronymic, the address, a home telephone number and phone of close people.

Features of care of patients with cardiovascular diseases

1. Regular measurement of the basic hemodynamic indicators of arterial pressure and pulse.

2. The control over regular reception of cardiovascular preparations, their dosage in strict conformity with doctor's instructions (since many elderly patients have got used to be guided by own state of health: if disturbs nothing - autocratically cancel preparations, reduce a dose, ' spare ' tablets, share with neighbours. Patients of old age with the phenomena of a senile dementia simply can refuse medicines). In the relation to cardiovascular preparations such relation is not admissible.

3. It is necessary to pay attention on unusual ' atypical ' of the complaint, changes from cardiovascular system since at persons of advanced age in most cases even acute statuses, for example, a myocardial infarction, lifting of arterial pressure, rhythm disturbance, begin atypically, ' it is erased ', develop gradually, frequently imitating diseases of other organs and systems (for example, an osteochondrosis).

4. One of terrible complications of a long confinement to bed are clottages and thromboembolisms. A motionless status of extremities compressed by own gravity or pressing subjects, even a pillow enclosed under knees, lead to stagnation of venous blood. It is useful to apply with a view of preventive maintenance physical exercises on a flexion, an extension in joints, superficial massage of feet, their periodic raising by means of a pillow, frequent change of position of a body.

5. It is necessary to own skills of the urgent pre-medical help.

6. In a food it is necessary: salt restriction - proceeding from real conditions of a life of the patient to recommend to patients with diseases of cardiovascular system a diet:

* - with depression of quantity of table salt (to prepare without it, only slightly to add some salt before giving on a table);
* - reduction of quantity of a consumed liquid;
* - depression of the use of Adepses of an animal parentage;
* - augmentation of the use of the products rich with a potassium.

Features of leaving at various acute infectious diseases

Tifoparatifozes diseases - it is paid special attention on strict observance of sanitary-and-hygienic rules and regular carrying out of current disinfection.

Care serious sick of a typhoid and paratyphoids is provided the same as and for all other highly in a fever infectious patients. From among features it is necessary to note possibility of development of an acute infectious psychosis, an intestinal bleeding and punching of the intestine, demanding special leaving and rendering of the emergency help.

The infectious psychosis develops in height of disease. One of psychosis precursory symptoms is the feeling of alarm, a sleeplessness, impellent excitation.

The delirium (delirium) proceeds with bright hallucinations of frightening character. The patient thus jumps up from a bed, aspires to escape from chamber, disappearing from imaginary persecutors, can jump out of a window. At the slightest suspicion on development of a psychosis in bed of the patient the individual post with round-the-clock watch of the personnel is established. At strong excitation to the patient enter 2 ml 2,5 %-s' amitazin's solutions, Dimedrol (1 ml 2 %-s') and magnesium Zinci sulfas (10 ml 25 %-s' solutions).

Intestine punching is one of the most serious complications of a typhoid and paratyphoids, occurs more often on 3-4 week of illness. Early diagnostics of punching plays the big role. If its signs operation the life of the patient appears in most cases out of danger is found out in due time and urgently made. In that case when from the moment of punching passes more than 6 hours, the diffuse peritonitis and the forecast develops becomes the extremely serious.

The intestinal bleeding arises in the same terms, as punching - appears blood in excrements, arterial pressure falls, pulse becomes frequent, there come sharp delicacy, temperature drop. At detection of an intestinal bleeding to the patient forbid to move, accept nutrition and to drink water. Over the bottom part of a stomach the bubble with ice is suspended, to it transfuse blood, intravenously enter 10 %-s' solution of Calcium chloratum subcutaneously and intravenously. During the first 12 ch after a bleeding of the patient do not feed and give only a small amount of the acidified water, warm sweet tea or fruit juice. Then, if the bleeding does not repeat, it is authorised to eat soft-boiled egg, jelly, kissel. Gradually a diet dilate and in 4-5 days pass to a usual food. For sick of a typhoid and paratyphoids it is necessary to watch, that they observed a bed and dietary regimen. The patient is authorised to have a seat only from 9-10th day of a normal body temperature, to get up and gradually to start to go from 14-15th day if there are no adverse symptoms. Especially attentive it is necessary to be concerning persons of advanced age, suffering chronic cardiovascular disorders. For them stay term on a confinement to bed should be enlarged. At a usual current tifoparatifoz diseases patients receive a diet № 2; 5-7 days prior to an extract them translate to a table d'hote. At intestine dysfunction in height of disease the table № 4 is given to the patient within several days.

In recover patients quite often have sharply raised appetite, therefore they are necessary for constraining from a hyperalimentation as it can lead to dysfunction of an intestine and provoke a palindromia.

Features of care of the child born before term

Fever of bones

First of all in house conditions it is necessary for not full-term child to frame an optimum temperature regimen. Air temperature in a room should be 22-25 0 S.Prichem in each 3 hours it is necessary to air a premise for 15-20 minutes. Immediately near the child (under a blanket) it is necessary to maintain temperature 28-32 degrees that allows to provide a body temperature remains of 36,5-37 degrees. Therefore often there is a necessity for additional heating of the newborn. For these purposes it is convenient to use rubber heaters. The water temperature in heaters should make 60-65 degrees. Electric heaters and blankets to heating of newborns to apply it is impossible. Depending on degree of a prematurity and temperature conditions in a room it is possible to use from one to three heaters. Wrapped in diapers, or special saccules, heaters place towels in feet (under a blanket) and on each side (over a blanket). Put them on distance of a palm from the child. For the constant control over temperature under a blanket near to the kid it is possible to put the thermometer. In no event (in order to avoid combustions) it is impossible to enclose a heater under the child or to put it from above (it complicates breath). To change heaters follows in one and a half-two hour serially that even on short term not to leave the kid without heat source. And here the person of the newborn necessarily should be left opened (not covering its blanket). To the extremity of the first month the child starts to "keep" independently a body temperature and it will be gradually possible to refuse artificial heating. It is necessary to measure a body temperature of not full-term child in the morning and in the evening. Under references of the doctor - more often, sometimes at each clothing. To do it it is necessary, not undressing the kid.


The big swimming

Kids with body mass at a birth less than 1500 g in the first 2-3 weeks of the house should not be bathed. Other newborns with low mass of a body should wait with acceptance of a bath of 7-10 days. In the first 3 months of a life of not full-term children bathe in boiled water. The water temperature in a tray should be 38 degrees, and in a room where there is a bathing, - 25 degrees.

I will leave on street

With walks it is necessary to be very cautious: sharp change of temperature can adversely affect health of the kid. Not full-term children who were born with mass of a body more 1500 g, it is possible to take out on walks since 2-week age (in a warm season at temperature of air of 25-26 degrees). The first walk is short - only 10-15 minutes. Then stay time for fresh air gradually (adding for 20 minutes) lead up till 1-1,5 o'clock. In the autumn and in the spring (at temperature of air to 10 degrees) it is possible to walk only with babies at the age of 1-1,5 months with mass of a body not less 2500 At temperature of air below 8-10 degrees to walk with not full-term children it is possible only at achievement of age of 2 months by them and masses of a body of 2800-3000

Inoculations are cancelled?

The vaccinating calendar at not full-term children is strictly individual. If the child is healthy and has body mass at a birth more than 2000 g its vaccinating calendar will not differ from full-term children.

To the kids who were born with mass of a body less 2000 g, inoculation BTSZH in maternity home is not spent. It do at achievement by newborn of mass of a body of 2500

Children who were born with mass of a body less 1500 g, are inoculated only in the end of the first year of a life and that taking into account a state of health.

Small heart

The structure and job of heart of a foetus of the pre-natal period differs from that which already is at the newborn child. Imagine, that at a foetus heart three-chambered, special apertures - «an oval window» and «botallov a duct» through which blood is admixed are opened. Fetally the child receives only the "admixed" blood that allows it to be steady enough against a possible disadvantage of oxygen. After a birth there is a reorganisation of a circulation and heart becomes four-chamber and the child starts to receive purely arterial, not admixed blood. Certainly, "apertures" are closed not at once, but blood "mixing" through them does not occur from first minutes of a life. At not full-term child such reorganisation of job of heart occurs much more slowly - is long can not only be saved, but also function additional apertures and vessels. Intensive methods of treatment - artificial ventilation of the lungs, intravenous injection of a liquid, allow to salvage a life to not full-term children, but strengthen a load on not strong heart. Gradually these changes can disappear, but behind a status of cardiovascular system the careful control, allowing to dose out an exercise stress of the child is necessary. Within first two years not full-term child should be under observation of the cardiologist. Numerous carrying out elektrokadiografii (electrocardiogram) is necessary, allowing to estimate correct job of a cardiac muscle in 2, 4, 6, 12 months of a life. Ultrasonic research of heart (an echocardiography - the KG ECHO) allows to tap defects and other anatomic defects of heart. It is desirable for spending in 2, 6, 12, 24 month of a life of the child.

Fiber is guilty?

The researches spent at University of Newcastle, have shown, that fiber G alpha S on which the tonus of muscles of a uterus depends can be the reason of premature birth. In pregnancy level of the maintenance of this fiber is very high, and during sorts is sharply reduced. If the fiber maintenance decreases before term - before the foetus completely will develop - there is premature birth.

Scientists hope to solve a problem thanks to the grant of the British medical welfare fund «Action Reseach».

The clinic of the Queen of Victoria of Njukaslsky university has received from fund of 93 000 pounds sterling on realisation of the two-year-old program of researches.

Of them observe

For children who were born not full-term, on a residence the dispensary observation till 7 years of a life is established. Periodic consultations of experts, first of all the neuropathologist are obligatory. At the age of 1-2 weeks and further rachitis preventive maintenance is spent: (an ultra-violet irradiation-kvartsevanie, addition in nutrition on doctor's orders vitamin D, massage).

Among not full-term there are no narcomaniacs

The group of physicians of Clevelend university under the guidance of Maurin's Hek's has studied indicators physical and intellectual development of 242 adults, whose weight at a birth was below 1,5 kgs, and has compared them to corresponding indicators of the control group including 233 persons, whose weight at a birth was somewhere about three kgs. It was found out: people from the first group had cases of blindness, deafness and a cerebral paralysis is more often, at them lower factor of intellectual development became perceptible, among them it has appeared less graduates of colleges. But thus research has shown, that among born not full-term their sex activity essentially more low, than at born with normal weight is less than narcomaniacs and alcoholics, and. Researchers managed to tap and gender differences in group of the people born not full-term: In particular, men with higher education among them it has appeared it is insignificant a little whereas among women this indicator almost has closely come nearer to an indicator of control group.

FEATURES OF CARE OF UROLOGICAL PATIENTS AT VARIOUS DISEASES

In what features of a nosotrophy consist at a nephritis?

In the acute period patients are subject to hospitalisation with confinement to bed observance. The diet with restriction of a liquid to 700-800 ml a day, salts is prescribed. At development of signs of renal insufficiency fiber consumption is limited.

In the acute period of illness the nurse should watch a daily urine of the patient. After the termination of the acute period of illness the nurse watches that the patient avoided a frigorism and exercise stresses.

Categorically the use of spirits is forbidden.


In what feature of a nosotrophy consists at uremia occurrence?

At an uremia which is characterised by a nausea, vomiting, a smell of ammonia from a mouth, dryness and the skin itch, sick demand careful observation of the nurse which supervises a daily urine, arterial pressure, carries out the general leaving. For excision from an organism of nitric slags sister on doctor's orders puts to the patient high cleansing enemas, spends a gastric lavage. The patient categorically forbids spirits.

Technics of a gastric lavage

Gastric lavage at an uremia - procedure of excision from a stomach of its contents for the purpose of intoxication reduction by nitric slags.

For a gastric lavage use a thick gastric tube and a funnel. Before a gastric lavage the patient put on an oil-cloth apron; if it has demountable tooth prostheses, they are taken out. A probe before introduction grease vegetative or a liquid paraffin. The patient has a seat on a chair, densely having leant to its backrest, slightly having inclined forward a head and having moved apart knees that between feet it was possible to put a bucket or a basin.

Probe enter to a root of tongue and ask the patient to make some swallowing movements therefore the probe easily gets to an esophagus and a stomach. In some cases probe advancement calls a vomitive reflex; to the patient suggest to breathe deeply and often, and a probe in the meantime quickly enter. The funnel is lifted upwards on height by of 1-1,5 m, pour in it water, a solution of baking soda or other washing liquid. Then, when a funnel lower more low, in it stomach contents arrive. A gastric lavage make until the water arriving from a stomach, does not become pure. Procedure is carried out medics.

To wash out a stomach it is possible and in another way. The patient drinks 5-6 glasses of warm water (a weak solution of baking soda) then, irritating with a finger the tongue root, calls vomiting. This procedure repeats also until the water following from a stomach, does not become pure. Contraindications for this simplified way is the unconsciousness of the patient.


What treatment and leaving prescribe at a renal colic?

Prescribe Promedolum with atropine, a warm bath. At obvious signs of moving of a renal stone more plentiful warm drink is desirable. At the tightened attack caused by infringement of a stone, the catheterization of ureters, and sometimes an operative measure is shown. At a renal colic the nurse does not depart from the patient before putting off of pains.

At urological patients edemas more often are observed.


What basic mechanisms of development of edemas?

Edemas - a liquid clump in cavities and tissues owing to disturbance of a water exchange. In an edematization a leading role play intensifying of diffusion of a liquid from blood vessels in a tissue and a delay of a liquid a tissue.

The hydropic liquid is characterised by low relative density and the insignificant maintenance of fiber.


How the latent period of a delay of a liquid is shown?

Occurrence of obvious edemas is preceded by the latent period of a delay of a liquid which is shown by reduction of quantity of allocated urine and increase of mass of a body (it is defined at daily weighing).


How it is possible to distinguish occurrence of edemas in the patient?

At pressing on a skin in places of edemas there is longly not disappearing fossa. On a skin linen cords are printed.


What obvious implications of edemas?

The hydropic liquid accumulates usually in most low located parts of a body. At vertical position of a body edemas appear standing and are enlarged by the evening. At bed patients edemas first of all appear in the field of a loin. Renal edemas arise on the person under eyes owing to friability of a hypodermic fat.

In serious cases there are massive edemas of feet and a trunk. The skin becomes dry, smooth, acyanotic, shelled, insensitive to heat. Therefore, giving to the patient of a heater, it is necessary to watch, that there were no combustions.


What features of care of patients with edemas?

At patients with edemas predilection to education of decubituses becomes perceptible, therefore they should change is more often position in bed, is better to give to the patient a semi-sitting position. On a bedsheet there should not be cords and crumbs. Under breeches and a sacrum enclose the inflatable rubber circle covered with a diaper. Adjoining surfaces of a skin (under mammary glands at women, in inguinal cords) powder Talcum or lay between them a gauze. A skin of the patient wipe an alcohol aqueous solution, cologne or other disinfectants.

Protective properties of a skin at an edema go down. Therefore, if after an injection in a skin there is an aperture from which the hydropic liquid filters, it is necessary to grease with its iodine and to put a sterile gauze napkin for infection and pyesis preventive maintenance.


How the control over deducing of a liquid from an organism of the patient is carried out?

The patient with edemas it is necessary to weigh and measure daily its daily water balance, i.e. a parity between the liquid drunk for days and quantity of the allocated urine. The drunk liquid switches on also liquid dishes (soup, kissel). Daily urine collect in separate ware which is in a water-closet (more often it is a three-litre large bottle). Measure quantity of urine by a measured flask. In the morning night sister sums up and brings it in a case history. The daily account of these data and daily weighing of patients allow to judge dynamics of edemas - their reduction or augmentation.

All patients with edemas should be under observation of the doctor which prescribes a diet with table salt and liquid restriction.

What features of care of the patients receiving radial treatment?

At radial treatment of patients (its external application) there are skin damages. There can come reddening (erythema) / which corresponds to a combustion of I degree. In case of reception of very big exposure dose there comes amotio of external layers of a skin and, at last, its necrosis corresponding to combustion SH of degree.

At care of these patients preventive maintenance of a becoming infected of a radial ulcer has great value. To liquidation of local reactions apply various ointments, emulsions and creams into which structure enter an aloe or Thesanum emulsion, Linolum, tsigerol, gekserol, butter of berries of sea-buckthorn berries, vitamins A, E, high-quality Adepses. At reaction of a mucosa of a rectum or a vagina the specified preparations enter in the form of microclysters and wads. In some weeks the inflammation completely disappears, though pigmentation of the given site of a skin is for a long time saved.

Features of a nosotrophy the child

THE GENERAL REFERENCES

The ill child is not recommended to be conducted to (carry) in an out-patient department - call the doctor and before its arrival any medicines do not give.

Bed of the ill kid put in well shined place but so that it did not lay faced to light. Daily re-make it, wipe an oilcloth, air linen. A room some times in day air. In the winter after an aeration take out from the child warm things only after air in a room will be warmed.

For the prevention of a heat rash do not muffle up the child when it is sick. The wrapped up child quickly will overheat, and fever will amplify. The clothes should correspond to an ambient temperature. If the heat rash nevertheless has appeared, process inguinal cords and axillary hollows, dermal cords on a neck, a body and extremities a weak solution of potassium permanganate (potassium permanganate) or make a tray of a train. At first well dissolve crystals, filter a solution through a trizonal gauze, then add it in a bath, leading up colour of water before occurrence of pink colouring. Duration of reception of such bath of 5-7 minutes

The intertrigoes arising at kids in the form of reddenings, preliminary having washed up these sites of a skin with soap and dry having wiped, prisypajut a powder containing oksid of zinc, or a children's dusting powder. It is possible to grease a skin with sterile vegetable oil or a children's cream. The liquid paraffin in these cases is better be not to applying - it contains many impurity and can irritate a skin. Watch, that the dusting powder has not got on genitals, especially at girls. It is impossible to use simultaneously a cream (or butter) and a dusting powder, otherwise skins formed pleated lumps can aggravate inflammatory process only.
• If the intertrigo is called by funguses, address to the doctor. For children who had pustulous diseases, there should be especially careful leaving. Natelnoe and bed-clothes boil and iron a hot iron.

If the child is disturbed strongly by an itch, it is necessary to protect a skin from raschesov. Put on to it varezhki from a flannel, sew up sleeves. It is possible to use medical baths - the general or local.
• prepare baths with infusion from train or camomile grasses More often. For infusion preparation dry tsvetki make boiled water in the enameled ware (from calculation 1 item a spoon on 1 glass of boiled water) and insist 10 minutes
• It is possible to prepare a starched bath: 100 g potato flour to dissolve in cold water and to add in the water prepared for a bath.
• the Soda bath is prepared from calculation by 1 items a spoon of baking soda on 1 bucket of water.

Show consideration for complaints of the child to abdominal pains. It is dangerous to put thus a heater and to give laxative.

If the child had diarrhoeia, vomiting, before arrival of the doctor do not feed him, give to drink only boiled water and tea. A diaper or a pot with excrements save before arrival of the doctor.

At diseases of a gastroenteric tract by symptoms there can be a nausea, vomiting, an eructation, diarrhoeia, abdominal pains, a meteorism (abdominal distention). The nausea precedes often vomiting, is accompanied by a blanching, salivation. Allow to the child to drink acidified by a lemon or a water cranberry. At vomiting set the child conveniently, to a mouth bring a bowl or put on a floor tazik, and a head support a palm for a forehead. If the child lays, turn his head on one side that it was below a trunk. After vomiting allow to rinse a mouth warm water then let will drink the boiled water acidified by a lemon.

If at the child diarrhoeia (usually it is bound to an intestinal infection), it is necessary to give to drink to him often as the organism loses a lot of liquid, salts and trace substances. If the child refuses meal, do not force it is, but if the child asks something, do not refuse. At diarrhoea the mashed potatoes, baked apples are better to stop on crackers, porridge. Do not give some fruit juice - they can call diarrhoeia.

To wash away the child it is necessary after each excrement.

Meteorism can call and such foodstuff as black bread, milk, bean, etc. Give to the child a tablet of the activated coal (0,5-1 tablet 2 times a day). Newborns and grudnichkam can enter a colonic tube.

At constipations children should move more. It is very important to develop a reflex on oporozhnenie an intestine. To laxatives resort only as a last resort and if nevertheless decide to give only phytogenesis laxative (a buckthorn cortex, a rhubarb).

At an inflammation of a mucosa of eyes, at vydelenijah from eyes put the child sideways (on the party of a sick eye), and on a pillow enclose the diaper combined several times. If it is necessary to instill drops or to apply ointment a pipette or a glass rake for ointment before it necessarily will boil. Before zakapyvaniem a thaw a lower eyelid delay and instill one drop (more close to a nose). Ask the child that it has thus taken away a view in other party (or distract its view in this party). The Oculentum pawn as, having delayed a lower eyelid. After that the child should close eyes and then cautious movement of an arm triturate ointment on a century.

Plentiful allocation from a nose wipe a gauze slice. A nose clean and grease with the wadded flagella moistened with a liquid paraffin, Glycerinum or other Solutio oleosa.
• If the kid has caught a cold, and slime from a nose flows much more, than earlier, and it of other colour, consult to the doctor: dense yellow or green slime can be a symptom of an inflammation of adnexal sinuses of a nose (sinusitis) which treat antibiotics.

Temperature to the sick child measure correctly. At the baby is better to take temperature in the rectal way. Grease a handpiece of the thermometer with ointment, insert to the child into an anus not more deeply than on 4 sm and take at least 3 minutes Doing it, put the kid on a table or to itself on knees how you put it when change diapers or pampers, and lift its legs; or put it on a tummy and move apart breeches.

At temperature measurement consider time of days. Usually it above all in the evening, and more low - in the morning. It is influenced also by hot meal or a motor performance. To receive the most exact digit, take temperature through 30 mines after plentiful meal or active movement. What to consider as norm? Though 37 °s it is considered normal temperature at oral measurement, at some people it constantly happens hardly above. It is possible to consider temperature raised if the thermometer shows more than 38 °s at rectal measurement, 37,2 °s - under the arm or 37 °s - at measurement in a mouth.

LEAVING AT THE BRONCHITIS, THE CHICKEN POX, EPIDEMIC PAROTITIS, THE MEASLES, THE OTITIS

At a bronchitis try to give to the child of more liquid - it fluidifies slime, facilitates tussis, softens a mucosa of the throat which have been tired out by tussis. The eight-year child should drink at least 4 glasses of a liquid in day - 1 l.

Raise humidity in a room of the child who has ill with a bronchitis - it softens angry membranes of bronchuses. Close a door of a bedroom of the kid, switch on the special evaporator (steam generator) for half an hour before the child will lay down in a bed, and leave the evaporator to work on all night long is will lift level of humidity to 70 %. If the evaporator is not present, hang up on heating batteries wet towels.

Encourage tussis (slime in bronchuses calls it). Help the kid who to cough is not able, slightly patting it on a backrest. Give it an additional pillow that it became easier to breathe. Expectorants available in your house first-aid set, will help to weaken slizeobrazovanie, but attentively read references on their use and give to the child a dose corresponding to age.

If the kid coughs so, that cannot have a rest even at night, give it Suprastinum or Tavegilum (the tablet part according to age) is will help it to be abirritated and fall asleep.

Do not allow anybody to smoke in the house. If you smoke - leave outside. The smoke irritates bronchuses!

The chicken broth really helps to cope with some occlusion of a throat. Scientific researches have shown, that it clears a throat from mucous vydeleny better, than all other liquids.

At a chicken pox if fever or an itch very much annoy the child, it is possible to give it paracetamol (Panadolum). Only attentively read indicatings on a dosage. In the event that the child transfers the raised temperature easy, do not try to lower it - so the organism is protected from an infection.
• One more way to lower temperature - to rub off the child a wet rag (vodka) or to bathe him in hardly to cool water. However watch, that the child has not frozen.

The bath with a baking soda solution will help to soften an itch. Stir soda half-cups in a fine bath or the whole cup in deep and moisten with a sponge all pruritic sites of a body of the child. If on a body of the kid is especially pruritic one-two site, dip a rag into cold water and take it on these sites of 5 mines is will for a short while stop an itch (the rag should be soft).

Do not muffle up the kid at a chicken pox. Put on the child easy cottonous linen - the clap almost does not irritate a skin. Also do not send the child to sleep in the same pyjamas or a shirt in which it has spent all the day. Linen change will reduce risk of a becoming infected ranok.

Try to supervise combing. If the child already enough big, explain, that it is better not to comb blisters on a skin as from it it is possible to be ill even more strongly. But most likely it will not be kept. Give it a wet cold rag for body wiping is will prevent combing to blood.

Ostrigite to the child fingernails as soon as there will be first symptoms of a chicken pox. At combing by acute fingernails in ranki the bacteriemic infection that leads to constant scabs gets.

Antihistamine preparations (Suprastinum, Tavegilum) usually reduce an itch but even if it will not occur, the child who has accepted them, becomes somnolent so, will have a rest and will be abirritated.

At all do not give to the child aspirin to lower fever or to suppress a pain, accompanying a chicken pox. It is better to give other febrifuge.

At epidemic parotitis it is possible to give to the child paracetamol for dropping of temperature and delicacy putting off. However attentively read indicatings on packing and pick up the necessary dose. If to the child of less than two years, consult to the doctor.

Cook to the child liquid food. Parotid glands produce a saliva, but during epidemic parotitis they work noneffectively, therefore it is necessary to feed sick children with liquid or semifluid nutrition.

Do not give to the child of citron juice or fresh citruses, and also all acidic. The acidic meal stimulates saliva allocation that is painful enough for glands at epidemic parotitis.

It is necessary to the child to try during epidemic parotitis something peppered or salty as he will feel a pain. Spices call narrowing of sialadens, aggravate the troubles bound to epidemic parotitis.

At measles reduce temperature medicines. Give any not containing aspirin soothing to bring down fever and to lower irritability. Attentively read the instruction on packing and pick up the necessary dose according to age and weight of the child. If the kid still does not have two years, consult to the doctor.

Do not stint drink - give liquids so much, how much the child can drink. At a heat and strong potovydelenii the organism is much fast dehydrated.

At tussis it is recommended to give calmatives of moderate action.

National ways of treatment of tussis at children:
1. To admix on 100 g honey and fresh butter with 0,2 g vanillin and to accept 3 times a day on 1 ch. To a spoon.
2. To cook in 1 l of water 1 potato, 1 head of onions and 1 apple while water will not evaporate half. To give broth to the child 3 times a day on 1 ch. To a spoon.

Try to raise humidity of air in a room that it became easier to child to breathe. Use for this purpose wet bedsheets, having hanged out them on a room, place vessels with water.

At eye measles are very sensitive to light, therefore light in a room of the patient should be soft, it is possible even to put on to it sun glasses. The lavage of eyes a normal saline solution (it is in any drugstore) can appear rather salutary. By means of a pipette instill some drops in corners of eyes. If a boring very strong, get wet their wadded globules moistened with boiled water. For each such procedure take a new globule and soak through movement from an eye corner outside.

The otitis delivers to the child the big sufferings. Antibiotics weaken a pain for the term from 12 to 24 ch. In expectation of offensive of their action it is possible to give to the kid atsetaminofen (children's tajlenol). Pick up a suitable dose. If the child does not have two years, consult to the pediatrist.

Try warmly - it at times brings the big simplification. Experts recommend to instill sometimes in acoustical passage of 2-3 drops of a medical product (which - the doctor let will advise), but necessarily warm - is hot or cold can call giddiness. Take a blister with drops (butter) of 15 mines in an arm before to drip, or warm up it in capacity with hot water within 5 minutes Check up temperature, having dripped to itself on an arm. Attention! Never resort to zakapyvaniju if from an ear pus flows!

It is possible to take some time at a sick ear the blister turned in a towel with warm, but not hot water.

If the doctor advises to do a compress, put it not on an auricle, and round it. For this purpose in the gauze napkin combined some times do a cut for an auricle, a napkin moisten with vodka, wring out and obkladyvajut it a sick ear. From above impose, as usually, a wax paper and a thick layer of cotton wool and bandage. The compress is changed by everyone 3 ch, alternating a vodka compress with a dry warm bandage.

If the baby was ill, nurse it to raise immunity of the child. Thoracal milk contains antibodies to originators of infectious diseases.

If you wish to prevent an otitis, nurse the baby exclusively at least six months.

At feeding of the kid by a breast hold the child correctly, watch, that its body has been raised at least on 45 °, especially if it belches.

In very rare cases of a pain in ears can be an allergy consequence on milk. If at the kid about one year the otitis became chronic, try to take it without milk products of week four and look, whether there will be all still. But never change a ration of the kid, not having consulted to the doctor not to undermine health of the child.

At a heat allow to the child to drink so much, how much will sustain its stomach. Only drink should be warm, instead of hot. Let's to it drink more often, small doses. Do not use as drink Coca-Cola, sprajt and other sparkling drinks, and also strong tea and coffee. Is better grassy teas, a cranberry or currant berry juice, kissels, compotes approach.

Do not smoke at the sick child!