Proper care for a bedridden patient at home. Caring for bedridden patients at home - rules you need to know. Position on healthy side

Many chronic diseases forcing patients long time observe bed rest. Also, severe illnesses can disable a person, permanently confining him to bed. The quality of life of a bedridden patient and his chances of recovery largely depend on the care he receives.

For example, a hip fracture, which often occurs in older people, requires the patient to remain in bed for a long time. However, if successful surgical treatment and restoration of joint function, the victim can return to active life several months after the injury. But almost every fifth elderly patient with a hip fracture dies due to hypostatic pneumonia, which can be avoided with proper care.

Therefore, the prevention of congestion in the lungs is one of the main tasks of caring for bedridden patients. In addition, caring for a bedridden patient prevents the occurrence of bedsores, muscle atrophy and joint contractures, and ensures compliance with sanitary and hygienic standards.

Proper care creates a positive emotional background for the patient and his environment, which is the most important factor in recovery.

In this article you will find practical recommendations on organizing care for patients forced to remain in bed. In particular, you will learn about the basics of hygiene for bedridden patients, ways to prevent bedsores, muscle atrophy, joint contractures and congestion in the lungs.

Skin care, washing a bedridden patient

Bedridden patients are usually deprived of the opportunity to wash themselves, brush their teeth, or take a shower or bath. Therefore, caregivers must take care of the cleanliness of the patient's body.

Hygiene procedures should be carried out daily. If the patient is in control and can sit up, encourage him to wash his face and brush his teeth without getting out of bed. Use any suitable container that can be placed on a stand or on the patient's lap.

If the patient does not sit down, use a towel soaked in warm water to wash. And for oral hygiene, instead of brushing and toothpaste, use gauze soaked in soda solution. If the patient can rinse his mouth on his own, use herbal decoctions, soda solution, and cosmetic rinses for rinsing.

Weekly bathing and daily showers are the ideal way to care for the skin of a bedridden patient. However, in some cases such procedures are contraindicated or cannot be performed. In such situations, use a towel soaked in warm water to clean the patient's skin of sweat, secretions sebaceous glands and other contaminants.

Wash the hair of a bedridden patient at least once a week. To do this, use a special inflatable bath. With its help, you can easily wash the hair of even a patient with long hair without causing him any inconvenience.

Wash a bedridden patient at least twice a day. Do this more often if necessary. To do this, lay an oilcloth on the bed and place the patient on the bedpan. To wash, use warm water or a 0.5% soda solution.

Prevention of bedsores

Bedsores are necrosis of the skin and soft tissues that develop due to circulatory problems in areas of the body of a bedridden patient that are constantly in contact with the bed. Bedsores significantly complicate patient care, cause suffering, and also pose a threat to the patient’s life due to the risk of infection.

Remember, bedsores are easier to prevent than to cure. Keeping your skin clean is a must effective prevention their appearance. And the following recommendations will help you reduce the risk of bedsores in a bedridden patient to zero:

Change regularly bed sheets on the patient's bed. Do this at least once a week.
Make sure that the sheet on which the patient lies does not have seams or folds. Use fitted sheets that fit over the mattress.
Regularly (every 2-3 hours) change the position of the patient's body in bed. The patient should alternately lie on his side, on his back and on his stomach. If the patient is uncomfortable lying on his stomach, turn him only on his sides and back. Also, the prone position is not suitable for patients in unconscious.
Use anti-bedsore circles when the patient is lying on his back.
Rub the patient camphor alcohol several times a day. Rubbing improves blood circulation, and camphor alcohol disinfects the skin, preventing it from becoming infected. Also this remedy has a deodorizing effect.
Make sure the patient's skin is always dry. Use diapers if the patient does not control urination and bowel movements. Change them regularly.
If possible, purchase an anti-decubitus mattress with a compressor. Its use significantly reduces the likelihood of circulatory problems in the skin.

If bedsores cannot be prevented, consult a doctor immediately. This must be done already at the first stage of development of the disease, which is characterized by constant redness at the site of the lesion, which does not go away after rubbing.

Prevention of congestion in the lungs, muscle atrophy and joint contractures

Limiting a person's mobility reduces ventilation of the lungs, as a result of which blood circulation in them worsens. IN respiratory tract accumulates sticky sputum, which becomes a breeding ground for microorganisms. This is how hypostatic pneumonia develops, threatening the patient’s life. Physical inactivity also leads to muscle atrophy and contractures (limited joint mobility).

Active and passive gymnastics, vibration massage of the lungs and breathing exercises prevent the development of hypostatic pneumonia, muscle atrophy and joint contractures. The following recommendations These techniques will help you:

Active gymnastics is recommended for almost everyone bedridden patients conscious. Invite the patient to perform feasible exercises, roll independently on the bed, stand up, and sit down.
If the patient is unable to do the exercises on his own, perform passive gymnastics with him. To do this, bend and straighten the patient’s limbs yourself, working on all his joints in turn. Make sure that passive gymnastics does not injure the patient or cause him pain.
Vibromassage of the lungs avoids the accumulation of mucus in the respiratory tract and also reduces congestion. To perform it, place the patient on either side and rub the skin of the back well with camphor alcohol. Then tap open palm By chest the patient through the palm of his other hand. Avoid tapping on the spine and kidneys.
Breathing exercises for bedridden patients are another effective way to prevent hypostatic pneumonia. Encourage the patient to blow balloons, blow bubbles, sing songs, or simply breathe deeply from time to time.

Thus, performing hygienic procedures, preventing bedsores, muscle atrophy, joint contractures and hypostatic pneumonia are among the main areas of care for bedridden patients. Remember, care improves the patient’s mood and well-being and allows him to maintain his self-esteem. The quality of care largely depends on the relationship of the caregiver to the patient. Therefore, be patient and show the patient only positive emotions.

11.08.2016

Caring for patients who have to stay in bed for a long time is one of the problems. This is due to hygiene procedures that must be carried out without fail. Let's consider questions that will make life easier for the bedridden patient and the caregiver.

Why is hygiene important?

If the patient is forced to constantly stay in bed, then the issue of hygiene is one of the most important. There are many reasons for this:

Use the tips and forget about your problems.

Fighting stagnation in tissues

A caregiver for a bedridden patient needs to know that the basis of life is movement. Regardless of the patient’s condition and well-being, teach him to do basic physical exercises every day. If paralysis occurs, the hospital will definitely send a physical therapy specialist who will show you a special complex. In any case, you need to learn it and repeat it constantly with the patient.

At first, some may resist because it is difficult and difficult. You may need to have a conversation about the benefits of such actions. In any case, every 4 hours the patient should be forced to roll over from one position to another, and taught to do this independently without the help of others. Horizontal position leads to stagnation not only in the tissues of the whole body, including in the bronchopulmonary system. The patient should be taught basic rules breathing exercises. This procedure will avoid pneumonia. You can use balloons, inflate and deflate them.

An excellent tool is a cocktail straw, which is lowered into a glass and inhaled air is released through it. Through exercise, the lungs will begin to work more actively.

Don't let your skin dry out!

Enhanced keratization and epithelization of the skin is one of physiological mechanisms in bedridden patients. You can avoid it by following these steps:

If you cannot take a full bath or shower, you can do the following:

This is a dry bathing option that will replace a full bath. After the procedures, be sure to smear the entire body with lotion, focusing Special attention back and legs. Massage movements will help increase blood flow, and the skin will breathe easier, and hypoxia will disappear.

Lifehack for the toilet

The process of urination and defecation is something that causes both aesthetic and psychological discomfort. You can often encounter resistance from the patient and refusal to care, especially if everything happens deliberately. There are diapers on sale that alleviate the condition, but they do not always maintain the amount of fluid or the results of bowel movements, as manufacturers claim. Therefore, it is necessary to teach the bedridden person to cope with the difficulty that has arisen. To make the procedure less unpleasant, you can greatly facilitate the entire process of defecation. To do this you need:

Immediately before defecation, a garbage bag is pulled over the vessel. The patient can defecate without worrying about the result; everything will remain in the bag, which is then simply thrown away. The consequences of the procedure are removed wet wipes. The boat will remain clean and the result will be in the trash bag. Men find it easier to urinate into a dairy bottle. It's much more difficult for women. You can also use a trash bag and a bedpan.

To do this you need: This procedure is suitable for those who can control the process. For those who are not able to do this on their own, only a diaper is suitable. When putting it on, don't forget to protect your skin. Being in hygiene product, the skin is influenced by a certain “greenhouse effect”. It is imperative to use a cream with protective functions, which will create a barrier and prevent bedsores from developing. After each toilet, all excess must be removed. One of the hygienic options that has proven itself as a means of combating diaper rash and bedsores is depilation. The less hair there is, the easier it is to care for your skin.

So simple and available tools do not require large material costs. Constant care is important, and if problems arise, timely treatment is started. In any case, the doctor will always prompt and give advice on how best to care for a bedridden patient.

People caring for seriously ill people face certain difficulties every day, but this task can be made a little easier if everything is organized correctly. Caring for a bedridden patient is not an easy task. Relatives and friends are dear to us, even if their illness does not allow them to move independently and take care of themselves. In such a situation, you can invite a nurse, but often relatives take on all the responsibilities of caring for their sick relatives.

It is important for them to know how to correctly perform all procedures for caring for a bedridden patient.

Medical care for bedridden patients in medical institutions carried out by staff. When patients are discharged home, care responsibilities are transferred to the patient's relatives. Creating a comfortable environment for such patients can improve their quality of life. Caring for bedridden patients at home is difficult work that requires organization, patience and a lot of time. First, let's talk about what requirements a room for bedridden patients must meet.

What should a bedridden patient's room be like?

For a bedridden patient at home, it is advisable to allocate a separate room. It should be quite spacious and bright. If it is south facing, then in summer on hot days it needs to be shaded. It's good if there are blinds on the windows. They protect from the sun when necessary and are easy to clean.

It’s good if the room is protected from strangers loud sounds, but the patient should not feel isolated from society.

The room in which the patient is located should not be cluttered, but everything necessary must be placed at hand. The room should contain the following furniture: a table, a closet or chest of drawers with linen, a chair, and, if necessary, a TV or portable radio (the patient should be aware of all the latest events and not feel like an outcast). Unnecessary items must be removed from the room, as they make cleaning difficult.

Means for caring for bedridden patients should be right there, nearby.

The bed mat should not slide. You can use a bathroom rug; they are usually made with a rubberized bottom, which prevents them from sliding on the floor.

The room should be ventilated in any weather at least twice a day for 15-20 minutes. Wet cleaning is done daily. Bedridden patients are very sensitive to dust and various infections, because they usually have reduced immunity.

Bed for a bedridden patient

If a patient spends a lot of time in bed, it is advisable that his bed be special and functional. Its height is easy to adjust; the head and foot parts can be raised and lowered if necessary. This bed has special side posts that prevent the patient from falling out of it. A functional bed will make caring for bedridden patients easier. Bedsores are best prevented, but they are difficult to treat. The possibility of bedsores forming with such a bed is much less.

But if it is not possible to purchase such a bed, then the usual one can be somewhat transformed. The desired height can be achieved by placing several mattresses on top of each other. Chairs inserted into the bed frame will prevent the patient from accidentally falling.

The bed should be wide enough, since bedridden patients spend most of their time in it. They should be comfortable. The approach must be ensured from all sides. It is so easy to change bedding and underwear and turn the patient into a different position.

Items needed by the patient

Items for caring for bedridden patients should be nearby. There should always be fresh food on the bedside table drinking water and a glass (mug or sippy cup), TV remote control, the patient’s glasses (if he reads with them), a table lamp (floor lamp or wall sconce). It is convenient if the patient has a bell on his table or bedside table, with which, if necessary, he can call a nurse or relative caring for a bedridden patient to him. All these items must be placed in such a way that the patient can easily reach them on his own.

The drawer of the nightstand should contain a blood pressure monitor, a thermometer, cotton pads and swabs, as well as special cosmetical tools, talc, cream and remedies for bedsores and necessary medications. The lower drawer can accommodate disposable nappies, nappies and trash bags. Items for caring for bedridden patients must be arranged in such a way that, if necessary, the patient himself can reach them. The toilet chair, if used by the patient, should also be located next to the bed.

Basic rules of care

A bedridden patient requires a lot of attention and time. The rules for caring for it are as follows:

patients who have had a heart attack or stroke need to measure their arterial pressure, write it down, and show these records to the attending physician;
body temperature is measured daily;
it is necessary to monitor the nature and quantity of bowel movements, and if they become pathological (loose stools, streaks of blood, little urine, dark or red urine, etc.), inform the doctor;
the condition of the skin should be assessed daily (the appearance of bedsores, rashes or redness);
All necessary medications must be given to the patient on a schedule or make sure that he does not forget to take them himself.

If it is difficult for a patient to drink from a regular cup, you need to purchase a sippy cup for him.

If a patient is incontinent of urine or feces, it is necessary to stock up on disposable diapers and diapers.

Underwear for a patient should be soft and only made of natural fabric; preferably, it should be seamless, but if it has fasteners or ties, they should only be on the front.

It is always necessary to ask the patient what he wants and, if possible, fulfill his requests. There is no point in arguing; the patient understands better what exactly he needs at the moment.

Ask who he would like to see and invite only these people, but the visits should not be boring.

If the patient gets worse, he should not be left alone, especially at night. Keep the lights dim in the room. If you cannot constantly be present in the room with the patient if his health worsens, then you can hire a caregiver or a nurse. Caring for bedridden patients with nurses medical education perform better. You can hire them through an agency or look for them in medical institutions.

Hygienic care for bedridden patients

For seriously ill patients, hygiene is especially important. The immunity of such people is weakened, so any infection can worsen the condition or provoke concomitant disease, for example, congestive pneumonia.

Hygienic care consists of daily washing, hand washing, brushing teeth and hygiene intimate places. To do this, it is better to use neutral liquid shampoos and detergents for the care of bedridden patients with a pH of 5.5. The body also needs regular washing. Special treatment should be carried out where there are skin folds - these are the back and buttocks (places where bedsores most often form).

To wash the body, you need to use a sponge and a hard towel, which is used to rub and massage the patient’s skin after washing. After the hygiene procedure, the body must be thoroughly dried. Growth occurs on a moist body bacterial infection, which can lead to inflammatory processes. After hygiene procedures, skin folds and places of contact with the bed (where bedsores can form) must be treated with talcum powder or baby cream.

After changing the diaper, the genital area must be washed using gentle detergents, wiped dry and treated with a protective cream (there are special creams for diapers).

When changing bed linen and diapers, they should not be pulled from under the patient, as this can damage the skin and cause the formation of bedsores.

Caring for bedridden patients. Bedsores and their prevention

Bedsores are areas of necrosis (death) of the soft tissues of the body. They can form in bedridden patients as a result of compression of the tissue of protruding areas, these are places above bone protrusions. Typically, bedsores appear in immobilized patients. Typical places of their manifestation are the buttocks, heels, back of the head, elbows, and less often the back and hips. Skin care for bedridden patients, in addition to normal hygiene procedures, includes the prevention of bedsores.

It is needed by both bedridden patients and patients who use a wheelchair to move, those who are partially immobilized (for example, an arm or leg cannot function after a stroke), as well as those who are obese, diabetes mellitus severe form or urinary or fecal incontinence.

Caring for a bedridden patient involves preventing bedsores. It would be a good idea to lightly massage your back area after each body wash. This will increase blood circulation and thereby help improve tissue trophism, which will serve as the prevention of bedsores.

To prevent the formation of bedsores, you must:

eliminate risk factors for the formation of bedsores;
use the necessary devices for the prevention of bedsores (rollers, soft pillows, rubber circle);
careful hygiene of the patient’s skin;
performance physical exercise if the patient is immobilized, but these should be passive exercises (i.e., the person caring for the patient independently flexes and straightens his limbs);
massage, it can be done on your own, it can be a non-professional massage, the main task is to increase blood flow to the places that experience the greatest compression (perform the most common movements - stroking, light patting);
complete nutrition.

How to eliminate risk factors for the formation of bedsores?

Carefully examine the patient's body every day for redness and changes. skin, pay special attention to the areas of bony protrusions.
Every 2 hours it is necessary to change the position of the patient's body. So, for example, to turn him onto his left side, you need to cross the patient's arms over his chest and put his right leg on his left. Then approach him on the right and put your one hand under his thigh and put the other on his shoulder, and then turn the lying patient in one motion. Patients should be turned from side to side as carefully as possible to avoid excessive tension or friction of the skin. You can put a soft pillow between your legs, especially for emaciated patients (for obese patients this measure will be unnecessary).
The temperature in the room must be maintained optimal (19-20 degrees) so as not to provoke excessive sweating of the patient and the formation of diaper rash.
Bed linen should always be clean and changed promptly. Use soft underwear and only made from natural fabrics. It is best to place a disposable absorbent diaper on top of it; this will prevent the formation of diaper rash and make it easier to care for a bedridden patient.

Nutrition for bedridden patients

Since a bedridden person moves little, his diet should be moderate, because such an organism does not experience large energy costs. The calorie content of the food is reduced, but the diet is well balanced. Amount of protein and minerals should be sufficient. Protein is a building material for cells; if it is lacking, tissue restoration and wound healing will be poor.

The diet must include meat, fish, dairy products (cheese, cottage cheese), fruits, and nuts. The daily calorie content of foods for bedridden patients should be around 1500 kcal.

Treatment of bedsores

If, nevertheless, preventive measures were not enough or they did not help and bedsores appeared, then their treatment should be started immediately. It consists of three main areas:

Improve blood supply to the places where bedsores form (do not lie on the wound, use a rubber circle, anti-bedsore mattress, turn the patient often).
Clean the wound of pus, dirt and necrotic tissue and treat it with chlorhexidine. Do not touch the wound with your hands, carry out all manipulations with gloves and use auxiliary means (sterile wipes, tweezers), apply the medicine directly from the bottle (do not use hydrogen peroxide, iodine, brilliant green - they dry the skin and interfere with healing).
Take measures to heal the wound as quickly as possible (completely clean the wound of necrotic tissue, since they are a breeding ground for the development of infection), change the dressing once a day.

Features of patient care after a stroke

Often, after a stroke, the patient is cared for by his relatives. Regardless of the severity of the disease, the patient should remain in bed for the first time. An ischemic stroke often leads to partial immobilization of a person. Care for a bedridden patient after discharge from the hospital is carried out by his relatives. In such patients, the right or left-hand side bodies, and when caring for them you should follow some rules.

Such patients need to change body position every 2 hours, carry out a complex physical therapy and get a massage. These measures are necessary to restore nerve impulses and restore mobility of paralyzed limbs. The more often exercise therapy and massage are performed, the better the dynamics of recovery will be. Ideally, these complexes should be repeated every 3-4 hours. Patients can perform some basic exercises on their own.

When caring for such a patient, it is very important to ensure that the paralyzed limbs are not suspended. To do this, you should place bolsters, pillows or use garters, and mobility in shoulder joint must be maintained and some distance must be maintained between the hand and the body.

If the patient is turned on his paralyzed side, then the affected arm is placed 90 degrees relative to the body, placing a small pillow under it, and the healthy arm is pulled back.

Sometimes the recovery period lasts a long time, during this time you need to be patient and consistently follow all the doctor’s recommendations. The patient will have to learn to hold objects and move independently again.

When walking, such a patient should always be supported from the affected limbs.

In the generally accepted interpretation, care is a set of activities that provide comprehensive care for a person, including the creation of optimal conditions and environment for him, the implementation of procedures prescribed by the doctor, which, in turn, contributes to a more comfortable state of health for the patient and a faster recovery.

Nursing and its basic principles

Care is divided into special and general - subtypes, which, in turn, have their own characteristics.

Let's look at each subtype separately:

General care. This subtype includes responsibilities for maintaining the hygienic condition of the patient, as well as maintaining the ideal cleanliness of the room in which he is located, organizing meals for the patient and properly performing all procedures prescribed by the doctor. Also, general care involves providing assistance to the patient with physical activities, eating, and toileting. In addition, this also includes monitoring the dynamics of the patient’s condition and his well-being.
Special care is usually associated with the specifics of a particular diagnosis.

It is worth noting that care is not an alternative to treatment: it is part of a complex therapeutic measures. One of the main purposes of caring for a sick person is to maintain a comfortable psychological and domestic environment at each stage of treatment.

How is proper care built?

The basis of proper care for patients can be called a protective regime, which is designed to protect and spare the patient’s psyche:
- elimination of excessive irritants,
- ensuring peace/quiet,
- creating comfort.
When all these components are completed, the patient feels comfortable, has an optimistic attitude and confidence in the successful outcome of the disease.
It is especially worth noting that the effectiveness of caring for a sick person requires not only certain skills, but also a compassionate attitude. After all, physical suffering and illness create feelings of anxiety in a person, often hopelessness, irritability towards medical staff and even relatives. Tact, the ability to support a person during this difficult period for him, a sensitive and attentive attitude towards him, will allow the patient to escape from his painful situation and tune in to an optimistic mood. That is why care is one of the mandatory sections of the activities of medical personnel. If the patient is treated at home, care is provided by his relatives or medical staff, after consultation with your doctor.

Basic principles of care

1. Room. It should be bright, spacious, and, if possible, insulated and protected from noise. For any disease, plenty of light, Fresh air and a comfortable temperature in the room where the patient is located will have a beneficial effect on the person. Separately, it is worth mentioning about the light: its strength should be reduced if there is a patient with an ophthalmological disease or a disease in the room nervous system. During the day, electric lamps should be covered with a frosted lampshade, and at night only nightlights or other low-heat devices can be turned on.

2. Temperature. The optimal microclimate in the patient's room should be as follows: temperature within 18-20°, air humidity no more than 30-60%. It is very important that the room does not cool down in the morning. If the air is too dry, you can put a moistened rag on the radiator to increase the humidity, or place a vessel with water next to it. To reduce the humidity in the room, it is necessary to ventilate it. In city conditions, it is better to ventilate at night, since during the day the city air is much more polluted with dust and gases. In other conditions, in the summer, you can ventilate the room around the clock, but in the winter, ventilation should be done no more than 3-5 times a day. To protect the patient from the cold air flow during ventilation, it is necessary to cover him with a blanket and his head with a towel or scarf (the face is open). Instead of ventilation, it is unacceptable to fumigate the room with aromatizing agents!

3. Purity. The room in which the patient is located must be kept clean. So, cleaning must be done at least twice a day. Furniture, window frames and doors should be wiped with damp cloths, the floor should be washed or wiped with a brush wrapped in a damp cloth. Items on which dust can accumulate (drapes, carpets) are best removed or frequently shaken out/vacuumed. The patient's room must be isolated from street, traffic and industrial noise. It is also recommended to reduce the volume on radios, televisions, etc. You should talk in a low voice.

4. Transportation. A very important point. If a person is seriously ill, he must be transported carefully, on a special chair, stretcher or gurney, while avoiding jolts. The patient is carried on a stretcher by two or four people. It is important that they walk out of step, in short steps. Shifting and carrying the patient by hand can be carried out by one, two or three people. If the carrying is carried out by one person, then it is necessary to act in the following order: one hand is placed under the patient’s shoulder blades, the other under the hips, while the patient must hold the carrier by the neck. In order to move a seriously ill patient from a stretcher to a bed, you must proceed as follows: place the stretcher at a right angle to the bed, so that its foot end is closer to the head of the bed. Before transferring a seriously ill patient to a bed, it is necessary to first check its readiness, as well as the availability of individual care items and bedside accessories.
A seriously ill person, among other things, will need:

Lining oilcloth,
- rubber circle,
- urinal,
- bedpan.

The patient's bed should be neat, comfortable, of sufficient length and width. For a patient's bed, it is best to use a multi-sectional mattress, over which a sheet is laid. If necessary, put oilcloth under the sheet. IN special cases, for example, in case of lesions of the spine, a hard shield is placed under the mattress. It is worth remembering that the patient’s bed should not be located next to heating sources. The best location would be one in which the patient can be approached comfortably from both sides.

A seriously ill patient must be helped to undress, take off his shoes, and in special cases, the clothes are carefully cut.

5. Change of bed linen. During this procedure, the patient must not be placed in uncomfortable positions, forced muscle tension, do not cause pain. The patient should be moved to the edge of the bed, and the freed part of the sheet should be rolled up to the patient's body. Next, spread a clean sheet on this part of the bed and shift the patient. With strict bed rest, the sheet rolls down in the direction from the legs to the head - first to the lower back, then to the upper part of the body. The edges of the sheet are attached to the mattress with safety pins. Every time you change your linen, you should also shake out your blanket.

6. Change of underwear. When changing a shirt for a seriously ill person,
You should first place your hand under his back, then lift the shirt to the back of his head, remove one sleeve, then the other (in cases where one arm is injured, you should start with the healthy one). After this, the patient should put on a shirt (starting with the sore arm), then lower it over the head to the sacrum and straighten out all the folds. If a patient is prescribed strict bed rest by a doctor, he should wear a vest. If the patient's underwear has been contaminated with blood or secretions, it should first be soaked in a bleach solution, then dried, and only then sent to the laundry.

7. Mode. The doctor prescribes different regimens for the patient, depending
on the severity of the disease:
Strict bed rest, in which it is forbidden to even sit.
Bed rest, in which you can move in bed, but you are prohibited from leaving it.
Semi-bed, in which you can walk around the room.
A general regimen in which, as a rule, the patient’s motor activity is not significantly limited.

Features of caring for a patient with bed rest

1. The patient carries out physiological functions in bed. The person is given a disinfected, cleanly washed bedpan (a specialized device for defecation), into which a little water is poured to absorb odors. The vessel is placed under the buttocks so that the patient’s perineum is above the large hole, and the tube is between the thighs. In this case, you need to place your free hand under the sacrum and lift the patient. After freeing the vessel, it must be thoroughly washed hot water, and then disinfect with a 3% chloramine or Lysol solution. The container for collecting urine - a urine bag - must also be served well washed and warm. After each patient urinates, the urinal is washed with solutions of sodium bicarbonate and potassium permanganate, or a weak solution of hydrochloric acid.

2. Tools and equipment necessary for maintenance must be stored in a strictly designated place. Everything necessary for the patient should be ready for use. Heating pads, bedpans, urine bags, rubber rings, ice packs must be washed with hot water, then rinsed with a 3% chloramine solution and stored in specialized cabinets. Probes, catheters, vent pipes, enema tips are washed in hot water with soap and then boil for 15 minutes. Enema tips must be stored in designated, labeled containers. Beakers and sippy cups are ordered to be boiled. If possible, you should use care products designed for one-time use. Chairs, gurneys, cabinets, beds, stretchers and other medical equipment must be periodically disinfected with a 3% solution of chloramine or Lysol, and must be wiped daily wet rag or wash with soap.

3. The patient’s personal hygiene is great value during the rehabilitation period. Primary patients (with the exception of patients in extreme in serious condition) should be subjected to sanitary treatment, which includes a bath, shower or wet wiping, and, if necessary, a short haircut followed by disinsection treatment of the scalp. If the patient needs outside help during hygiene procedures, he should be lowered into the bath on a sheet, or placed on a special stool placed in the bath and washed with a hand shower. If a person is seriously ill, taking a bath is replaced by wiping the body with a swab dipped in warm water and soap. Upon completion of the procedure, it is necessary to wipe the patient’s body with a swab dipped in warm water without soap and wipe dry. Unless otherwise prescribed, the patient should take a shower or bath at least once a week. The patient's toenails and fingernails must be cut short.

4. Secondary or dispensary patients are recommended to wash their hair with warm water and soap (after the procedure, the hair is carefully combed). If a person is seriously ill, then it is recommended to wash your hair in bed. As for the frequency of these hygienic procedures, it is as follows: the patient’s hands should be washed before each meal, feet - every day before going to bed. The upper body, as well as the face and neck should be washed daily. The genitals and anus should also be washed daily. In cases where a person is seriously ill, washing the genitals should be carried out at least twice a day. The procedure is as follows: a bedpan is placed under the patient’s buttocks (at this time the patient lies on his back, legs bent at the knees). For the washing procedure, it is also convenient to use an Esmarch mug, which is equipped with a special rubber tube with a tip, which, in turn, has a clamp or tap. A stream of water or a weak solution of potassium permanganate is directed into the perineum. At the same time, a cotton swab is passed in the direction from the genitals to anus. Then, using another cotton swab, the skin of the perineum is dried. This procedure can also be performed using a jug into which a warm disinfectant solution is poured. Inguinal folds, axillary areas, as well as folds of skin under the mammary glands, especially if the patient is obese or prone to excessive sweating,
It is necessary to wash frequently to avoid diaper rash.

5. Exhausted patients, as well as those patients for whom bed rest lasts a large number of time, require especially careful care of the body and skin to avoid the appearance of bedsores. As a preventative measure, in addition to skin care, it is necessary to keep the bed in perfect order: regularly smooth out the folds of the sheets and eliminate unevenness. The skin of patients at risk of developing bedsores should be wiped once or twice a day with camphor alcohol, and also powdered with talcum powder. In addition, it is necessary to use rubber circles wrapped in a pillowcase, placing them under the places that are most subject to pressure (for example, the sacrum). Necessary preventive measure is also a frequent change in the patient's position on the bed. Caring for the patient’s feet is no less important - with insufficient care, thick horny layers can form on the soles, which is a manifestation of epidermophytosis in a scaly form. In these cases, removal of keratinized skin followed by treatment of the skin of the legs with antifungal agents is indicated.

6. Feeding seriously ill patients is extremely important point in care. Must be strictly observed prescribed by a doctor nutrition and diet. When eating, bedridden patients must be placed in a position that will avoid fatigue. As a rule, this is a slightly elevated or semi-sitting position. The patient's neck and chest must be covered with a napkin. Feverish and weakened patients should be fed while the temperature decreases/improves. Such patients are fed with a spoon; pureed or crushed food is given in small portions. For the purpose of feeding, you should not interrupt daytime sleep in cases where the patient suffers from insomnia. Seriously ill patients are given a drink from a sippy cup. If a person cannot swallow food, he is shown artificial nutrition: probe.

7. Another necessary condition successful treatment- monitoring the patient's condition. Thus, caregivers must regularly inform the doctor about every change that occurs in the patient’s condition. It is necessary to take into account the patient’s mental state, changes in the position of his body, skin color, facial expression, the presence of a cough, breathing rate, changes in the nature and color of urine, feces, and sputum. In addition, on the instructions of the doctor, it is necessary to measure body temperature, weigh, measure the ratio of the fluid excreted and drunk by the patient, and make other prescribed observations. It is important to monitor the patient's intake of prescribed medications. For the medication administration procedure, clean beakers and a carafe of boiled water.

Features of caring for senile and elderly patients

Care for such patients must be carried out taking into account the characteristics of the aging organism and, as a consequence, a decrease in adaptive capabilities. It is also necessary to take into account factors such as age-related changes psyche, as well as the uniqueness of the course of diseases in older people. Among these features the following can be distinguished:

Atypical sluggish course of the disease in the absence of a pronounced temperature reaction.
- relatively rapid onset of severe complications.

Elderly people are susceptible to various types of infectious diseases and the emergence inflammatory processes, and this feature requires increased care of hygienic care.

In addition, older people often exhibit increased sensitivity to changes in diet and routine, to changes in microclimate, and to the appearance of noise. Among the characteristics of the behavior and psyche of an elderly person, one can highlight slight vulnerability, emotional instability, and, if there is vascular diseases – a sharp decline memory, criticism, intelligence, helplessness, and, often, untidiness. Features of this kind require increased attention from service personnel, as well as a patient and compassionate attitude.

Strict bed rest for older people is recommended to be reduced as early as possible. And it is recommended to prescribe treatment as early as possible physical culture and massage for the fastest return to motor mode. This will avoid hypokinesia. Also, in elderly patients it is recommended to prescribe breathing exercises With
for the purpose of preventing congestive pneumonia.

Features of care for resuscitated patients

The peculiarity of care for resuscitated patients, as well as for patients who are in conditions intensive care, is that here care includes both general and special elements, in relation to traumatological, surgical, neurological, as well as unconscious patients.

Great attention must be paid to monitoring the patient’s condition, including monitoring, monitoring physiological functions patient, including breathing, urination, blood circulation. In addition, it is necessary to monitor the condition of perfusion tubes, catheters and conductors from systems and devices connected to a person.
Special care is required for patients who are on mechanical ventilation through a tracheostomy or through an endotracheal tube. In such cases, a thorough toilet of the tracheobronchial tree is required (in some cases, every 15-20 minutes).
Without this procedure, bronchial obstruction may be impaired and, as a result, asphyxia may develop. Removal of secretions from the bronchi and trachea must be carried out wearing sterile gloves, or after the hands have been treated with a disinfectant solution. To perform the procedure, a specialized angled catheter is used, which is connected to a vacuum pump through a tee. One elbow of the tee must be left open. The patient's head must be turned, then, while inhaling, in one movement, insert the catheter into the tracheostomy or endotracheal tube and push it through the bronchi and trachea into the lung until it stops. After this, the tee hole is closed with a finger to ensure the action of vacuum suction; the catheter must then be removed by gently rotating it with your fingers. After this, the catheter is washed with isotonic sodium chloride solution or replaced and the procedure is repeated the required number of times. The effectiveness of the procedure will be doubled if you simultaneously perform a vibration massage of the chest.
In order to prevent the development of congestion in the lungs and the appearance of bedsores, the patient’s position must be changed every 2 hours. In addition, it is necessary to place ring gauze pads under the bone protrusions and wipe the patient’s skin with antiseptic solutions.
It is better if the patient lies on an anti-decubitus mattress.
It is also necessary to pay great attention to feeding patients, since eating on their own is often impossible for them. The feeding process is carried out using a sippy cup, to the outlet of which a rubber tube 20 to 25 cm long is attached. The end of the tube is inserted into the posterior parts of the oral cavity. Food is introduced through a tube, portions are regulated by squeezing it. Solid food must be brought to a creamy consistency by first subjecting it to heat treatment, then grinding it and diluting it with liquid. Do not give the patient spicy or hot food. During feeding, the patient must be placed in a sitting position (in severe cases, the head should be raised), covered with an oilcloth apron so as not to stain the bed linen, clothes, and bandages. The feeding procedure should be repeated an average of 4 times. If it is impossible to feed the patient through a sippy cup, feeding is carried out using a nasogastric tube.

If the patient is unconscious, it is necessary to provide parenteral feeding, as well as parenteral administration liquids. Before introducing the solution into the oral cavity or vascular bed, it is necessary to warm it up to the patient’s body temperature. Upon completion
feeding, oral cavity the patient is washed with a solution of sodium bicarbonate, and after that with a solution of potassium permanganate in a ratio of 1: 5000, or with another disinfectant solution.