Care of infectious patients
Jun 06, 2018
Care considers activities based on comprehensive patient care, the creation of conditions and treatment in accordance with medical appointments that will promote a favorable course of the disease, the speedy recovery of the patient and the prevention of complications. The main types of care for patients are general and special. General care - sanitary and hygienic maintenance of the room, bed of the patient, as well as the hygiene of the patient himself. Particular attention should be paid to the organization of proper nutrition of the patient, first aid in eating, physiological administration, etc. General care for the patient provides for strict and timely fulfillment of all the doctor's instructions for the implementation of medical procedures and medicinal prescriptions, as well as continuous monitoring of the patient's condition.
The term "special care" determines the specificity of a disease. Care of the patient is an integral part of the patient's treatment. At the same time, the household and psychological situation is extremely important at all stages of the patient's treatment: compliance with the sleep regime, maintaining the patient's positive emotions, confidence and optimism. Therefore, medical personnel need not only the application of professional skills, but also a compassionate attitude towards the patient. Often the patient's condition suggests increased irritability, nervousness, a feeling of dissatisfaction with himself, close and medical personnel. Therefore, caring for the patient requires, above all, the creation of a climate of sensitivity, the ability to support the patient, to protect him from negative emotions. In the clinic, nursing is carried out by medical personnel, at home - close to the patient. Particular attention is paid to the sanitary and hygienic requirements for the room where the patient is located. This room must be separated from other rooms, it should be well ventilated and be as safe as possible from the noise impact. With the specificity of the disease( eye disease, nervous system), light can be reduced through the use of lampshades and nightlights. It is important to keep the room at a constant temperature of 18-20 ° C.If there is a need to increase the humidity of the air, it is necessary to place the vessels with water in the room or put moistened cloth on the heating batteries. Reduce the humidity of the room can be enhanced ventilation. In urban conditions, it is recommended to ventilate the room at night, as the air is polluted by dust and gases in the daytime, especially in places of large traffic. Patients are covered with blankets during ventilation. In the summer, the windows can be opened around the clock, and in winter it is recommended to open the window leafs 3-5 times a day. The use of all sorts of fragrances in the room where the patients are located is considered unacceptable. Extremely important are careful wet cleaning and maintaining the cleanliness of the room. Cleaning is done at least 2 times a day. In places of accumulation of dirt( on carpets, drapes, mats) it is desirable to use a vacuum cleaner. It is also necessary to use noise protection.
When caring for a patient, it is extremely important to follow the rules of transportation: to transport the patient on a special wheelchair cautiously, without jolting. When transporting the patient on stretchers, 2 or 4 people are used. If the patient is transferred on the hands, the shifting of the patient is performed by 1, 2 or 3 people. When transporting a patient by one person it is necessary: the accompanying person to bring one hand under the shoulder blades, the other - under the thighs of the patient;while the patient holds the bearer by the neck. If the patient is seriously ill, then shifting it from the stretcher to the bed should be as follows: stretcher to put at right angles to the bed so that the end of the stretcher is closer to the head end of the bed. It is important to perform all actions clearly, not hurrying up, checking the availability of bedding and the availability of individual care products: a liner, a urinal, a rubber circle, a bedpot, which are extremely necessary for the seriously ill. When working with seriously ill patients, the medical staff dresses the patient, takes off his shoes. Particular emphasis is placed on the placement of the bed in the ward. It is placed so that medical workers have access to the patient on both sides. Do not place the patient's bed near heaters. Particular attention should be paid to the size of the bed of the patient( optimal for the patient width and length).Great importance is attached to the cleanliness and comfort of the bed. The patient's bedding includes: a mattress, an oilcloth, a sheet. In case the patient has a trauma to the spinal column or pelvic bones, a rigid shield is needed under the mattress. Special skill requires changing bed linen seriously ill. This is done in the following way: the patient should be carefully moved to the edge of the bunk, the side of the sheet that was released, roll up to the patient's body;on this place of bed to spread a new sheet, where to transfer the patient.
In case the patient is not allowed to move on the bed, the sheet is folded, guiding the movements from the lower extremities to the head end.
The change of shirt to a seriously ill patient is made in a certain order: first they have an arm under the back of the patient, then they take off their clothes to the level of the neck, release the arm from one sleeve, then from the other. In the event that there is damage to the upper limb, first remove the sleeve from a healthy arm, and then with the patient. Next, put on a shirt: first on the injured hand, then, through the head, put it on and gently smooth the wrinkles. The list of bedding for the seriously ill should include a shirt-raspashonka. As a rule, it is used in case of finding a patient on strict bed rest. Dirty linen of the patient is treated in front of the laundry in a solution of bleach. The severity and nature of the patient's illness determine a different regimen. There are several types of treatment: strict bed rest( you can not sit), bed( you can move in bed), half-bed( you can walk around the room) and general regime, when the patient's motor activity is not significantly limited. In case the doctor recommends bed rest, the patient performs a set of physiological dispatches in bed. In this case, a special object is used - a vessel which, before and after each use, undergoes thorough washing and disinfection. This device is designed to collect feces of the patient. The delivery of the vessel is as follows: the ship is placed under the buttocks of the patient in such a way that the perineal region is above the largest hole and the tube is between the thigh area. Another hand needs to raise the patient slightly under the sacrum. At the end of this procedure, remove the stool from the vessel, then rinse well and disinfect with a 3% solution of chloramine. In working with seriously ill patients, a urine collection device is often used to collect urine. This device should be given to the patient thoroughly washed and warmed. The urinal is to be thoroughly treated with solutions of potassium permanganate and sodium hydrogen carbonate after each urination. When working with tools and inventory, you need to remember the sanitary and hygienic rules and regulations. First, the rules of storage in special cabinets. Used equipment, such as gas pipes, catheters, probes, must be treated with hot water and soap, and then boiled for 10-15 minutes. There is a separate labeled crockery for storing enema tips. The beakers, cans, cans are also boiled. If possible, disposable use of care products and tools is recommended. All items, furniture, medical equipment in hospitals are systematically disinfected.
Huge importance in the outcome of the disease belongs to the personal hygiene of patients. When entering the hospital, all patients, excluding seriously ill patients, are subject to sanitary-hygienic treatment. This measure also includes the treatment of the scalp for the purpose of disinfestation. Patients who are in serious condition are wiped with swabs soaked in soapy water. Careful handling of the nails on the hands and feet. If there are no contraindications, the patient can take a shower once a week, and if there are contraindications, the patient's body should be treated with tampons daily. Systematic hair care is required. Every day, control over the cleanliness and hygiene of the body should be carried out. Properly carrying out all hygienic procedures that require a lot of patience, tact and sensitivity, medical personnel, relatives of the patient can significantly alleviate his suffering, which will positively affect his mood and, therefore, will bring healing closer.
Special care in the care of the patient is given to the prevention of diaper rash and pressure sores. Careful care for the skin in patients who are assigned to prolonged bed rest, helps to prevent the formation of pressure sores. The irreproachable cleanliness of the patient's bed, daily skin care of the patient provide effective prophylaxis of pressure sores. It is necessary to change the position of the patient in bed as often as possible: often turning the patient. If the above measures are not carried out, the epidermophytosis of the feet may develop, manifested by the formation of horny layers. Care for the patient also provides for the care of the ears, if necessary, the formed sulfur plugs are removed. To do this, it is necessary in advance to drip into the ear 3% hydrogen peroxide. Particular importance is attached to eye care, especially if there are abundant discharges that disrupt the function of vision. When soaked in an antiseptic solution with a napkin gently soften, and then remove the formed crusts. When caring for the mouth, you need to brush your teeth in the morning and at bedtime, and after eating. Care for the teeth of patients who are in serious condition, produce irrigation. To do this, use a solution of furacilin or potassium permanganate. After that, wipe with a cotton swab dipped in the same fluids, teeth of a seriously ill patient. In order to prevent the above solutions from entering the trachea, the patient's head is tilted forward. The nasal cavity also needs careful care. Formed crusts eliminate, beforehand having greased them with any softening agent( vaseline or glycerin).
Therapeutic food is a significant stage in the therapy of patients. Systematic monitoring of adherence to diet and the help of seriously ill people to eat is an important part of patient care. Patients who are on strict bed rest, should provide a comfortable posture during feeding. Basically, seriously ill patients are maximally comfortable elevated body position. To prevent contamination of clothing and bedding, the chest and neck area of the patient are covered with oilcloth. Patients with significant weakness and high fever need to take food at the stage of stifling symptoms of the disease. The food of these patients should be carefully wiped, and served in small portions. The patients' drinking is carried out with the help of a special device - a drinker. Patients who have difficulty swallowing are provided with a probe.
Patient care involves systematic monitoring of the functioning of vital vital systems, which will ensure a favorable outcome of the disease. The medical personnel who produce these measures should immediately report to the doctor about any changes in the patient's health condition. For this, it is necessary to observe the color of the skin, the patient's posture, mood, the presence of a rash on the skin, the frequency of respiratory movements, the change in cough. Particular attention is given to the coloration of urine, feces. The tasks of paramedical personnel also include measuring body temperature, calculating diuresis and water balance, weighing the patient, etc. Continuous monitoring of the correct and systematic administration of medications should be made. For the purpose of oral administration of medicines, the nurse must provide for a pot of drinking water and a set of special clean dishes. In the treatment of the pathology of the cardiovascular system, special attention is attached to compliance with the prescribed regimen. This element of treatment should be clearly performed in order to reduce the work of the heart muscle, which can be provided only in the absence of active movements. Many patients prefer a position with an elevated headboard.
In the pathology of the cardiovascular system, one of the leading problems of the patient is the fear of death. In this case, you need to seek psychological help from relatives and friends of the patient, thanks to which this problem is eliminated. In the practice of cardiac units, cases of sudden cardiac arrest are frequent. In these cases, emergency medical care is required, which is sometimes carried out by medium-sized medical personnel. If the patient has a pathology of the respiratory system, the patient is provided with a systematic change in the position of the body. Also, great importance is given to a comfortable posture, in which the symptoms of dyspnoea are reduced. To do this, for example, use an additional pillow, which is placed under the upper part of the trunk.
Care for a patient with a pathology of the respiratory system requires special breathing exercises. There is a special drainage posture, which is provided to patients for the best emptying of the bronchi from mucous sputum. To collect biomaterial of bronchi there is a personal spittoon, which is filled with a small amount of chloramine in advance. Care for patients with the pathology of the digestive system also has its own characteristics and provides for an individual approach according to the complaints of patients. The average medical staff is obliged to provide appropriate assistance in vomiting( to bring and present a special tray), to support the patient's head. The duties of paramedical personnel include the preparation of tools, solutions for cleaning enemas, gastric lavage, etc. Particular importance is given to the examination of vomit, which provides early diagnosis of many diseases. For example, emetic masses of coffee grounds indicate gastric bleeding. It is necessary to constantly monitor the vigor of the patient's actions, the size of the abdominal cavity, the symptom of Schetkin-Blumberg, and the coloration of the skin. The whole complex of measures for caring for a patient with an infectious pathology is aimed at the prevention of nosocomial infections. Great attention is paid to the sanitary and hygienic regime, the implementation of disinfection measures in the hospital. In a department or hospitals of a phthisiatric profile, the average medical staff provides training to patients on the correct use of the spittoon, the processing of dishes. Particular emphasis should be placed on the features of sputum collection for analysis. A set of clothes for medical workers should include an extra suit. Medical personnel should perform all types of treatments in gloves. Then used gloves are to be disinfected. An obligatory measure in the blocks of airborne infections is the use of a gauze mask, which should be changed three times per shift. One of the important measures in caring for a febrile patient is the change of underwear, which is especially necessary for patients during a critical temperature drop. Care for infectious patients also involves monitoring the medical staff for the mental state of a patient with a high temperature, excluding the possibility of developing a delirious syndrome.
Infectious hospital is a medical and preventive institution that isolates and treats infectious patients. It consists of three departments for various types of infectious diseases. In addition, in each department there is a ward for patients with an unclear diagnosis. The structure of the infectious disease hospital must include bacteriological and clinical laboratories. A separate unit is a morgue. It is necessary to strictly control the state of sewage from the infectious hospital, which must be disinfected before being discharged into the city's sewerage system.
There is a certain order of taking infectious patients. The admissions department of the hospital directs patients with different types of infection to the corresponding branch disease profile: half-box for patients with severe intestinal diseases, boxing for patients with respiratory infections, diagnostic boxes for patients with an unclear diagnosis. When hospitalized, patients enter the boxes directly from the street. Patients enter the semi-boxes through a specially arranged entrance in order to prevent contact with other patients. In infectious diseases, the principle is adhered to: to fill in the wards at once and also to write patients out. At the same time, reliable prevention of reinfection is ensured. But this is not always possible. The complex of medical measures is carried out in the relevant departments( boxed and semi-proximated type).In medical institutions of an infectious profile, items such as a ship, a hot water bottle, are purely personal. The attending physician is obliged to prescribe the patient only after the required isolation time and on the basis of the negative result of the bacteriological tests. In the infectious diseases hospital, there must be an external outlet through which patients leave the hospital. The accessories( sheet, blankets, mattress, outer clothing, etc.) that the patient used are handed over to a specialized disinfection unit, where they are washed and disinfected. In anticipation of the following patients, beds are not refueled and disinfection measures are mandatory.
When caring for infectious patients, special attention is paid to sanitary and anti-epidemic measures. The personal belongings of patients are in special nightstands that are located far from the clothing of medical personnel. When moving from an infectious disease ward to another department of the hospital, medical workers need to change their clothes( robe), shoes and a mask. Mandatoryly in the box office must hang gowns, hats and masks for doctors and nurses, as well as should be a vessel with a disinfectant. Medical and maintenance personnel must strictly observe all sanitary and anti-epidemic measures in the care of patients. After working with the patient, the staff changes their accessories and handles with the help of antiseptic drugs. Particular attention should be given to the order of using the door in the box: when entering the box, you should close the outer door and only then open the inner door of the box. Required is the use of a foot mat impregnated with an antiseptic solution. In communication with a patient with an infectious disease, one can not sit down on his bed. Through a special window opening in the pre-box, the patient receives food. Obligatory examination of medical personnel, which works with patients in the diphtheria department, is mandatory. After completion of the shift, workers are subjected to sanitary and hygienic treatment. In the care of the patient mandatory processing of dry lime all its secretions are susceptible. The patient's accessories intended for the collection of feces are first treated with water and then disinfected during disinfection, soaking them in disinfectants: chloramine, lysol, etc. After feeding the patient, the cutlery should be boiled( 25 minutes) in soda or soapy water. Dishes of patients with chickenpox and viral liver damage( hepatitis) are disinfected for 30 minutes. Table accessories made of metal are placed in a 1% solution of chlorine-benataftol, then they are pelletized with boiling water and processed in dry-fire cabinets. In cases of impossibility of boiling, the cutlery is soaked in a 1% solution of bleach, then it is pelletized with chloramine.
Anti-epidemic measures in the focus of infection should be strictly followed. The activities of average medical workers include a number of activities.
Isolation of patients with infection is an important link in preventing the spread of infectious diseases. In terms of duration, this event should fully cover the period in which it is possible to transmit the infection to others. Certain types of isolation of patients are used: being in a hospital, at home and in a specialized isolator. Some types of infectious diseases require an indispensable isolation of the patient in the hospital, while the rest of the hospitalization is carried out according to the recommendations of the epidemiologist. The question of this or that type of isolation is decided by a doctor of a polyclinic institution or emergency specialists. They also fill the direction sheet, which notes the data on contacts with patients who have an infectious pathology;about trips to other countries. If the infectious patient is a child, then in the direction necessarily indicate the conduct of immunization. Transportation of patients is carried out by a specialized motor vehicle. In the case of conditions requiring urgent care, the patient is sent by emergency transport, which, following his hospitalization, undergoes a sanitary and hygienic treatment. Currently, there are specialized treatment facilities, in which patients who are infected with the infection are sent, who require quarantine measures. The separation of chambers and departments in an infectious hospital is carried out depending on the type of microorganism that caused the disease. Finding an infectious patient at home requires him to have an individual room, utensils, personal items. In order to prevent the spread of infection, it is necessary to carry out sanitary-hygienic measures and careful ventilation of the room.
The nursing staff should provide detailed information to the caregiver about how to prevent infection with this infection.
This involves first of all the use of a mask when communicating with a patient, as well as careful handling of hands. The isolation room is necessary for the patient's unstable separation from contact, where the patient is waiting for transfer to a hospital or home for isolation. These rooms are necessarily organized in kindergartens and clinics.
1. Deratization, disinfestation, sanitary and hygienic measures for the area and people in the outbreak.
2. When identifying the symptoms of the disease, the patient is immediately isolated from other people.
3. Systematic control of the well-being of people who are in communication with infectious patients after the end of the incubation period.
4. Implementation of methods of immunization of residents.
5. Inspection of the nasopharynx, nose and throat for diphtheria;analysis of feces for E. coli.
The essence of infectious diseases lies in the relationship between macro- and microorganisms. Getting into the body, the infectious agent forms its own - so there is a pathological process. A large number of microorganisms are constantly found in the organs and tissues of a person. Under certain conditions - such as a lowering of the body's immunity, the effect of provoking factors of the environment - their unfavorable effects and the development of the infectious process are possible. Sometimes a certain symptomatology of an infectious disease is caused by the action of special substances - exo- and endogenous toxins, which produce pathogens. A special form of infectious disease is concealed carriage. It is due to the characteristics of the microorganism, the ways of transmission, etc. With this form of the disease, immunity is organized in the immune system, i.e.there are no corresponding signs of the disease. Similarly, there are diseases of viral and bacterial etiology.
There is the concept of "mixed infection", meaning that the patient has several infections at once. Autoinfection presupposes the presence of an infection associated with the pathogenic action of microorganisms constantly on the skin and mucous membranes. Activation of the microflora of the human body is caused by a sharp decrease in immunity. At present, the basic principles of care for patients with infectious pathology have been developed. Great importance is attached to the patient regimen. According to the peculiarities of the disease, its stage, intensity of manifestations, potential complications, the mode 1, 2, and 3 species are distinguished. The first type implies a bed rest, in which the patient can not actively move. The nurse must inform the patient about the need to comply with this prescription of the doctor and systematically monitor its implementation. The complex of measures for the care of the patient is made in bed. The second type presupposes a ward mode, in which the patient can go to the toilet and the manipulation room independently of the nurse, although the patient should mainly be in bed. The third type provides a general regimen that is recommended to patients without threatening conditions. In this case, the patient can eat in the dining room, independently carry out hygiene procedures.
Medical personnel are responsible for ensuring proper treatment. An important element in the successful outcome of the disease is compliance with the protective regime in the ward. It implies the exclusion of noise effects on patients, especially at night. Great attention in the care of infectious patients is given to therapeutic nutrition. Food should be optimally balanced for proteins, fats and carbohydrates, contain enough vitamins. Eating should be done after 4 hours and be carried out at exactly the prescribed time. Each patient is made an individual diet. The average medical staff is obliged to monitor its implementation. To do this, a portioning is formed, in which the information on the recommended dietary nutrition recommended by the doctor is clearly recorded. It is the responsibility of the nurse to regularly check the products that are passed on to the sick. If the products brought in are absent from the portion, then the sister must give them back.
It is also the responsibility of nursing staff to regularly check the conditions of the products in the patient cabinets and department refrigerators. Currently, infectious hospitals use diets № 2, 4, 5, 13, 15. Dietary table № 2 is recommended for patients in the stage of recovery after a previous intestinal infection. The food should be high-grade, but as much as possible sparing for exception of mechanical and temperature damage of a mucous digestive tube. Dietary table No. 4 is recommended for patients with diarrhea in the case, for example, of dysentery. Food should contain physiological protein norms and a limited amount of fats and carbohydrates. Dietary table number 5 is assigned to patients with hepatitis in the recovery stage. The diet should be high-grade in the content of protein, carbohydrates, fats are limited. Also, food should be enriched with lipotropic substances, fiber and liquid. Dietary table number 13 is recommended by a febrile patient. Diet consists of liquid dishes with fiber restriction. Dietary table № 15 is recommended, if there is no restriction in the products, which is established by the attending physician. This diet involves food with the optimal and sufficient content of proteins, fats, carbohydrates and vitamins.
. Feeding is of great importance in the care of the patient. In this paper, the patience and perseverance of medical workers is necessary. The amount of food is gradually reduced, but food intake in this case is carried out up to 7 times a day. Served dishes should be optimally heated. For the nursing procedure, the nurse wears special clothes and hand treatment. First, it is necessary to treat the patient's hands, then ensure the patient's position with a raised headboard. The nurse has a special napkin on the chest and neck of the patient. Then, without haste, they make direct feeding with the help of a drinker or spoon. After the end of the procedure, it is necessary to irrigate the oral cavity. If the patient is in a very serious condition or has difficulty with food intake, it is probed. The introduction of the probe is provided by the doctor. The amount of nutrients injected is 150-200 ml at the probe feed. Parenteral nutrition is also allocated in which the patient's body is saturated with the necessary amino acids, salts, vitamins, etc. for the physiological processes. Most patients with infection, especially those having a high temperature, require a large amount of liquid, which is ensured by the introduction per os( through the mouth) of various types of fruit juices, tea, etc. In the care of patients with infectious pathology communication should be built moderately, calmly, but at the same time one must resort to perseverance in convincing the conduct of a procedure. Medical personnel working with infectious patients should be aware that the patient's psyche is changing. They become irritable and coarse under the action of the pathogen in the body. In care, you must remember the rules of medical deontology. Particular attention is paid to the patient's personal hygiene, which complies with the generally accepted principles of caring for a patient with various pathologies. The tasks of the nurse include preventing the formation of decubitus, changing bed linen, feeding the vessel to the patient, and the toilet of the external genitalia. One of the main measures in the care of an infectious patient is the control of his condition. For this, the nurse systematically measures temperature, blood pressure, heart rate, etc. The above mentioned parameters are fixed in a temperature sheet.
The most important measure in the care of an infectious patient is a high temperature care in the patient, which involves putting the patient in bed, warm wrapping, ensuring warming of the lower extremities, giving a warm drink. In the second period, when a persistent high body temperature is observed, it is necessary to provide the patient with regimen No. 2, systematically monitor his condition, give abundant drink, apply cold on the forehead of the patient. In the stage of falling temperatures, one should adhere to bed rest, ensure warming of the body, plenty of drink, change the bedding and clothing of the patient. Medical staff should always be aware of the complications of the third period of fever, when there may be a rapid drop in body temperature and thereby cause collapse. In this case, it is necessary to give an elevated position to the lower limbs, call the doctor through a third person, warm the patient's body and perform a systematic control of blood pressure, heart rate. Also, the nurse must prepare for the arrival of a doctor caffeine-benzoate sodium or cordiamine. These drugs are administered only on the advice of a doctor.
Some infectious diseases are accompanied by a change in the rhythm, frequency and depth of respiratory movements. In this case, it is the nurse's responsibility to know how to determine the state of the respiratory system, to recognize the type of disorder, and also to help with this. Respiration is normal with a respiratory rate of 16-20.Dyspnoea is the most common sign of a disturbance of the respiratory system that accompanies an infectious disease. This condition is treated as a subjective feeling of lack of air. Activities carried out by the nurse in this case, suggest providing a pose with an elevated head end with additional pillows, oxygen supply. The heart rate is measured on the arteries( ray, carotid) of both upper limbs. The frequency of the normal pulse is considered to be 60-80 beats per minute. The states of shock, sudden drop are accompanied by almost not palpable pulse. Pressure in the arteries is examined using a tonometer on the arteries of the shoulder. The responsibility of the nurse is to count the amount of urine that the patient allocated within a day. Normal diuresis is 1100-1750 ml. The sister also measures the water balance - this is the ratio between the injected and the extracted liquid( normal 300 ml.).The results of all studies the nurse puts on an individual temperature sheet. One of the most important activities carried out by the average medical personnel is the control of the patient's chair, which is carried out daily. This measure allows you to suspect the complication of the infectious process that has occurred, which will provide emergency measures in this regard and prevent the deplorable outcome of the disease. The result of the observation of the chair is also fixed in the temperature sheet.