General care for a sick child
A sick child is even more than healthy, needs fresh air. It is necessary to systematically well ventilate the room in winter, warmly covering the child;In summer it is possible to keep windows open all the time. It is often necessary to rearrange the bed to the child, shake out the blanket and sheets, especially if the child takes food in bed, make sure that the mattress is lying flat without forming bumps and folds. It is important to change the laundry as it gets dirty, but at least once a week. If the child suffers from involuntary urination, then regardless of the age of the child, his mattress should be covered with an oilcloth on which the sheet is laid. The child should be washed daily, before each meal, wash his hands, while sweating, carefully wipe the skin with a dry towel and change the laundry. A sick child often has dry, "caked" or cracked lips. Several times a day, lubricate them with butter or petroleum jelly.
Oral health care
The medical staff of a child care institution should ensure that children of preschool and school age, with a moderate and satisfactory general condition, observe their mouth hygiene every day. In the morning, teeth should be cleaned with toothpaste or powder, and in the evening - only with a soft brush. After this procedure, the child should rinse the mouth well. The oral cavity should also be rinsed after each meal. The brushes washed after cleaning teeth should be stored in cups with the handle downwards.
Severely ill children with oral care need help. After each meal, the nurse must wipe the child's teeth, tongue, and rinse out the mouth. To do this, use a tweezers or a cochlear to clamp a cotton ball, moisten it with a solution of soda( 0.5%), borax( 5%) or saline and wipe the teeth. Then, with a sterile napkin, grab the tip of the tongue and, slightly pulling the tongue out of the mouth, with another moistened swab to remove the plaque from its back. The mouth should be rinsed with a syringe or a rubber bottle. For washing, a weak solution of soda( 0.5-1%), borax( 2- 3%), hydrogen peroxide( 0.6%), potassium permanganate solution( 1:10 000) or sodium chloride(0.9%).During the washing of the mouth, the patient should be given a semi-sitting position and tilt his head forward. Breast and neck close diaper or oilcloth apron. At the bottom it is necessary to substitute the basin and, pulling the corner of the mouth with a spatula, rinse the gums first and then the mouth with a soft stream from the can or syringe. Rinse mouth in patients with young children produce with an assistant. The child should be placed on the knee of the assistant, who should hold the child's arms with his left hand, and with his right hand, laying his palm on the forehead, pressing his head. The legs of the child must be fixed by the knees of the assistant. Having typed 1% soda solution or weak solution( 1:10 000) potassium permanganate into the boiled rubber canister, holding the spatula in the left hand, you need to open the baby's mouth and direct the light stream to the hard palate. During the procedure, the child's head should be tilted down and sideways in one and the other direction. In this case, the water from the mouth should drain into the inserted tray or basin.
Rinsing of throat and pharynx is allowed only after 3-4 years. For rinsing, solutions of furacilin( 1: 5000), rivanol( 1: 2000), potassium permanganate( 1: 5000), alkaline solutions of soda and other mixtures, herbal infusions or decoctions( chamomile, sage, marigold, eucalyptus, etc.) are used. Pre-school children for rinsing the throat should not be given irritating solutions. It is important to teach the child during the rinse to hold the liquid so that it partially hits the back of the pharynx. With angina it is desirable to gargle 5-6 times a day, with pharyngitis - 2-3 times. In case of diarrhea, the child should often be washed away.
Sick children are often irritable and capricious. Conducting hygienic and medical procedures, feeding a child are difficult because of the resistance of the child, so the nurse must be patient and affectionate in communicating with children, try to minimize trauma to the patient.
Nutrition of a sick child
The patient's food should be fully-fledged, with the exception of certain diseases in which certain restrictions are imposed. In all cases, food should contain enough vitamins. Particular attention should be paid to the feeding of children with poor appetite. You can not overfeed. Feed the sick child should be leisurely, with interruptions.
In case of vomiting in a sick child, it should be planted and supported by his head. When vomiting in the child of the first months of life, it should be turned to the side;to a little one - to put a diaper on, and to the elder - to substitute a basin. After the end of vomiting, rinse your mouth and give one or two drinks of cold water. After vomiting the child must be laid in bed and covered with a blanket. If required, put a heating pad at the feet.
Pot or bedpan
The pot or bedpan that the child uses should be thoroughly washed after each use. With an infectious disease or with diarrhea of any etiology, it is necessary to disinfect the pot and isolate the patient.
Body temperature measurement
The patient needs to measure the temperature twice a day: in the morning when the child wakes up and at 16-17 h( after a day's sleep).If necessary( with fever) thermometry is performed more often. Raising or lowering the temperature of the child's body can roughly be determined by touching the palm to the forehead or back. When determining the temperature of the skin to the touch, it is important that the hand is warm and dry. Normally, the body temperature is maintained in the range of 36.5-36.8 ° C.If there are suspicions of significant temperature deviations from the norm, it must be measured with a thermometer. The body temperature in children is usually measured by a mercury maximum thermometer. To establish the mercury column at the minimum mark, the thermometer must be shaken off. In older children, the temperature is measured in the armpit or in the oral cavity, in young children - in the inguinal fold or rectum, where the temperature is 0.2-0.4 ° C higher than in the armpit. Before measuring the temperature from the skin, moisture must be removed. If the thermometer is properly installed, its cone-shaped balloon with mercury should be completely covered by the skin fold, and the child's arm or leg should be fixed. The duration of the temperature measurement is up to 10 minutes. In the oral cavity, the thermometer should be fixed between the cheek and the gum or under the tongue with closed lips for 3 minutes. The measured temperature of the child's body should be recorded. In children's hospitals, temperature records are recorded in the medical history, and a temperature chart is drawn. For the detection of a pathological process, it is important not only a one-time measurement of temperature. It is necessary to observe its dynamics, and this can be seen only when maintaining the temperature sheet. Often the temperature rises only a certain time of the day or is of a regular nature. In such cases, measurements should be performed within a day every 3 hours. The temperature of the skin in different parts of the body is not the same even in the normal state of the child's body. In the upper parts of the trunk, it is usually higher than in the lower parts, above the distal parts of the limbs lower than above the proximal ones. To measure the temperature of the skin in different parts of the body use an electrothermometer TEMP-60( an electric medical semiconductor thermometer).
General situation
In a room where a sick child is lying, it is necessary to create a quiet environment. Very important is a sufficient sleep during the night and daytime. All observations of the nurse should be recorded. In hospitals and other children's institutions for this purpose, a special nursery sheet is set up for each child. In this sheet, the body temperature of the child, its appetite, stools, nausea or vomiting, frequency and nature of urination should be recorded daily.
When a sick child enters a hospital, it is important to create a calm, affectionate environment. In the reception room of the children's hospital there should be toys that can attract the attention of the child. If the toys are not in the waiting room, it is permissible to take a clean and safe( without cutting edges) toys from the mother. The child is hospitalized with his mother or another person close to him. For seriously ill and very excitable children, you need to ensure peace and quiet. If a mother is allowed to take care of a child, one must scrupulously demand that she follow the instructions of the doctor accurately, but at the same time treat her calmly, in a friendly manner. The nurse must be present at the doctor's round, tell him in detail about the results of his observations and personally get acquainted with the appointments.
Injections and other in-patient procedures often frighten a child. The child needs to be invited to the treatment room when everything is prepared for an injection or procedure.
In wards of convalescent children, it is necessary to take care of their leisure. If possible, children are provided with toys, books, quiet games and classes are allowed.