The fear of the overwhelming majority of people in front of oncological disease is associated not so much with the widely held view of the inevitability of death, but with the thought of Nepeya­tolerability excruciating pain that is accompanied­is a disease. Persistent pain syndrome vstre­chaetsya almost 90% of cases, but only 10% of the harvest­It is from severe pain requiring application of drug­cal anesthetics.

The use of modern analgesics for the treatment or reduction of pain intensity at the onco­logical patients significantly seizing­sew their quality of life.

What is pain?

Pain is a protective mechanism, the witness­ing the presence of the presence of effects on the body ka­someone Factor. Pain makes us consciously or reflexively take action direction­lennye at eliminating or weakening vozdeystvuyu-

present the stimulus. Pain occurs when irritated­SRI sensory nerve endings, embedded in the skin, muscles, blood vessels, internal organs. Excitation of them along nerve fibers before­etsya in the back, and then – to the brain.

Thus, the constant readiness of the body to perceive pain is one of the factors that determine the self-preservation. appearing­of pain should be seen as a signal for the analysis of its causes, and taking ac­tive and conscious measures to address it.

Pain during sprouting cancer arises from the stretching or compression of tissues, their destruction. Moreover, the growing tumor might cause compression (compression) or occlusion (for­kuporku) blood vessels.

If it affects the arteries violation occurs Power tissues (ischemia), which is followed by their death – necrosis. These changes are perceived as pain.

If the veins are compressed, the pain are less intense, as trophic disorders; in the tissues are less pronounced. At the same time, venous outflow violation causes congestion, edema, and tissue forms a pain impulse.

With the defeat of cancer or its metastatic bone pain caused by strong again­Drazhenom sensory endings in Supraspinous­tse. Accompanying this long muscle spasm it is also perceived as a painful sensation.

Visceral pain occurs when spasm of hollow organs (esophagus, stomach, intestines) or they are at their hyperextension associated with an increase in zloka­tive tumors.

Pain in lesions of parenchymal organs (Liver, kidney, spleen) due to irritation­I eat pain receptors within their capsule during its germination or hyperextension. In addition, the visceral pain can be associated with concomitant diseases, violation of the outflow of biological fluids during compression of the body or tumor invasion podzheludoch ducts­hydrochloric gland, liver, urinary tract.

Pain intensity at different lesion serous membranes lining the pleural and abdominal cavities, to amplify at­accumulation of fluid in these cavities.

The most pronounced painful reaction at evil­quality of malignancy associated with the compressed-Niemi or germination of various nervous wreath product­plants, is roots, nerve trunks and spinal cord. Thus, when a malignant tumor of the pancreas severe pain associated with compression of adjacent solar plexus.

When brain lesion pain may be associated with sprouting or compression, as well as with increased intracranial pressure.

But the pain in malignant tumors may be associated with a general weakening of the patient you­Needing position in bed, causing a violation of integrity of the skin, there was­yuschee due to eating disorders tissues.

Without special events can not hope for the disappearance of pain in malignant tumors, and the sooner they are started, the better is the result. The best analgesic effect – this surgical vmesha­ments. Removal of tumor-bearing bodiesor tissue results in cure of the disease and Tro­neniyu its accompanying pain response. Russ­syvanie tumor under the influence of ongoing lu­chevoy antitumor drug or tera­FDI leads to a weakening effect on tumor sensitive nerve endings in tissues and ability­creases or stop the pain.

In patients with advanced forms of zlokache­governmental tumor pain becomes chronic. Constant feeling of a man in pain on the background of tumor progression and growth of fi­phe- ailment leads to depression, Naru­sheniyu sleep, rise of feelings of fear, helplessness and despair. If a patient does not see at­power and participation on the part of relatives and health care workers, it may become aggressive or even attempt suicide (suicide).

Formulations for analgesia chosen strictly individually preferred to use tablet formulations. Painful sensation inthe patient is always determined and evaluated according to his own subjective assessment of pain.

• When mild pain good results can be achieved when using dipyrone: 1 – 2 tablets­yrs 2-3 times a day in combination with suprastin or diphenhydramine.
• As required analginum replace complex analgesics, which include analgin: baralgin, pentalgin, sedalgin, tempalgin.
• analgesic effect also possess the known non-specific antiinflammatory agents such as aspirin, indomethacin, Diklo-fenac, ibuprofen and other prescribed 1 – 2 tablets­yrs 3 – 4 times a day. With increasing pain may be used and injectable formulations of these drugs.
• At moderate pain assigned stronger analgesic – Tramal, 1 – 2 capsules 2 – 3, 4 – 5 times per day. Tramal may be used as drops, injections. By the treatment at this stage of pain added sedative (uspokai­vayuschie) means – Corvalol, valerian, wasteland­nick or tranquilizers: Phenazepamum, seduksen, Relanium, 1 – 2 tablets 2 times a day.
• When a patient is prescribed strong pain drugs­cal means.

To achieve adequate analgesia using the optimum doses of drugs follows­blowing respect the fundamental principles leche­Nia chronic pain in cancer patients.

Acceptance by the hour rather than on demand. complied­of this principle makes it possible to achieve the maximum analgesic effect with a minimal daily dose of painkiller. Reception “on demand” drug ultimately entails the use of much larger doses as analgesic concentration in the blood plasma falls for its recovery and achieve a satisfactory level requires additional analgesia The amount of drug.

ascending treatment. Treatment begins with a non-opioid analgesics, when not moving­first necessity for the weak, and then – to the strong­nym opiates. Drugs are better at­Nima through the mouth as long as possible, as it is – the most convenient way to receive medication at home.

Getting rid of the pain of cancer patients – the most important thing in their treatment. This can be achieved only when the patient’s joint action, his family members and health care workers.

In critically ill patients in the mucosa of the mouth, plaque appears on the teeth, which with­worth of mucus thickened epithelial cells, pour­gayuschihsya and decaying food debris, bacteria. This contributes to oral Sun­and putrefaction-inflammatory, accompanied­yuschihsya unpleasant odor. Associated with this discomfort leads to a decrease in appetite, ability­sheniyu amount of fluid intake, deterio­general health sheniyu.

When the patient helplessness oral care is:

• a mouth rinse after each meal, after each bout of vomiting;
• cleaning of the teeth (dentures) in the morning and the Chamber­rum;
• in cleansing between the teeth 1 time
  day (preferably in the evening).

Dentifrice is better to use a soft toothbrush without injuring the gums. Concluding oral care, be sure to clean the brush tongue, removing his plaque.

If the patient is unconscious consisting­SRI, he is not only unable to brush your teeth, but swallow the saliva, open and close the mouth. In these patients, oral care must be impl­stvlyat every 2 hours during the day and at night.

Cleaning the teeth of the patient (the patient is conscious) (Figure 31.):

• prepare: rubber gloves, glass in­Doi, toothpaste, soft toothbrush, petrolatum, towel, container for collection of wash water, IU­shock garbage;
• explain to the patient the course of the upcoming Strain­ry;
• help the patient to turn the head to one side;
• Put a towel on the patient’s chest;
• wash hands, wear gloves;
• put on a towel under his chin Paci­cient, container for collecting the washing water;
• ask the patient to hold the container ru­Coy, dial a mouthful of water and rinse your mouth;
• moisten the toothbrush with water and apply it
  toothpaste;
• clean the upper teeth of the patient, conventionally times­Dividing all the teeth on the upper and lower jaws to 4 segments (better to start brushing teeth with the upper jaw);
• place the toothbrush on the buccal surface­STI row of teeth, at an angle of approximately 45 °;
• «sweeps» movement downward sag­ti for each segment at least 10 times;
• clean the chewing surfaces of the upper
  teeth;
• position the brush perpendicular to the top teeth, clean them palatal surface cautious­GOVERNMENTAL, “sweeps” movements downwards (all 4 segments);
• clean similarly lower teeth (buccal muscle and chewing surface), and then – The patient’s tongue;
• help the patient to rinse the mouth with water;
  • lubricate the lips with Vaseline patient;
  • keep the capacity at the chin of the patient, if necessary wipe chin; • remove container, towel; • Remove the rubber gloves; •Wash the hands.

• prepare: towels, rubber gloves, the capacity to collect wash water for a cup of about­tezov, toothpaste, toothbrush, lip cream, gauze, a glass of water;
• explain to the patient the course of the upcoming Strain­ry;
• ask the patient to turn the head to one side;
• deploy a towel covering their breasts Paci­cient to the chin;
• wash hands, wear gloves;
• put the tank for collecting washing water under the patient’s chin on a detailed paintings­tse;
• ask the patient to hold the container by hand, with the other hand to take a glass of water, to collect a mouthful of water and rinse;
• Ask the patient to remove the dentures and­to lay down them in a special cup.

If the patient can not remove their own dentures, then:

• grab the thumb and forefinger of the right hand using the denture napkins;
• Remove denture oscillatory movements;
• Put them in a bowl for dental prostheses;
• ask the patient to rinse the mouth with water;
• Place a cup with the dentures in Rako­guilt;
• the tap, to adjust the water temperature;
• brush and toothpaste all the denture surface;
• rinse dentures and cup under cold running water;
• put the dentures in a cup for storing­Nia at night or help the patient back on­put them;
• Remove the gloves, throw them in a plastic package;
• Wash the hands.

Note: unless the patient wears dentures, prosthesis can be left in a cup and pour water into it, so that the water covered the prosthesis.

Care cavity, an unconscious patient’s mouth :

• prepare: rubber gloves, a glass with a solution for rinsing the gauze, soft toothbrush, petroleum jelly, 2 towels, a tank for collecting washing water, a plastic bag, adhesive tape, scissors, wooden spatula, a cup, a laundry bag, a bottle of 0.02 -percent­furatsilina a saline solution;
• Wash the hands;
• wound on wooden spatula and a napkin fix it with a plaster;
• a pour cup antiseptic solution for the oral;
• place the patient on his side so that his face It was on the edge of the cushion;
• expand the towel;
• spread a towel under the head of the patient, baa­-bank holding his head;
• deploy a second towel and cover their patient’s chest;
• put the tank for collecting washing water under the patient’s chin;
• rubber gloves;
• Open the patient’s mouth, gently, without applying * ‘ forces enter between the upper and lower teeth 1, 2, 3 fingers of one hand and gently push these fingers on the upper and lower teeth;
• put between the teeth prepared dere­vyanny spatula to mouth remained open;
• wound on the index finger and wipe, holding his thumb, moisten 0.02-propercentage furatsilina solution or 2 percent pa­alignment of sodium hydrogencarbonate;
• handle: the sky, the inner surface of the cheeks, teeth, gums, tongue, lips.

Note: change the towels as pollution­Nia slime, sticky saliva. The sequence of actions is as follows:

–  throw used tissues in polyethylen­Lenovo package;

• clean the teeth without toothpaste using a soft brush;
• smear Vaseline lip (do not let the appearance of cracks on the lips due to severe dryness);

–  clean towel, taking off the gloves;

–  turn the patient on his back;

–          Wash the hands.

If there is discharge from the eye, gluing eyelashes and eyelids, the degree during the morning toilet­-sterile swab soaked in antiseptic ra­the shots (0.02 percent solution furatsilina or 2 percent sodium hydrogen carbonate solution), about­Tirana eyelashes and eyelids;

• cook: rubber gloves with ste package­-sterile gauze, a plastic bag to dump the waste material,
  container for an antiseptic solution;
• wash hands, wear gloves;
• Opening of the packages with sterile towels;
• pour antiseptic solution prepared­hydrochloric container (cup);
• moisten the cloth and wring out;
• wipe the eyelashes, eyelids in the direction from on­ruzhnogo angle to the inside;
• throw the tissue in a plastic bag for waste material;
• repeat the processing (4 – 5 times), changing pads;
• wet remains of a solution with a dry cloth;
• remove the plastic bag from the waste material container with an antiseptic solution;
• Remove gloves, wash your hands.

Care nasal cavity

In seriously ill on the nasal mucosa accumulate mucus and dust, making it difficult to respiratory­of and aggravates the patient’s condition. Seriously ill patients can not independently release the nasal passages. During the morning the toilet in the presence of apportionment­Nij of the nose or the formation of crusts their wake­is removed with a cotton turundy:

• prepare: rubber gloves, a bottle of wa­zelinovym oil, cotton, plastic bag for dropping waste material;
• Made of wool turundy (4-6 pieces);
• Wash and dry hands;
• wear gloves;
• moisten turunda vial with vaseline weight­scrap, gently squeeze the edge of the bottle neck;
• turunda take in the right hand, left hand at­raise the tip of the patient’s nose and enter turunda physicians­Carefully movements in one of the nasal passages;
• turunda leave for 1 – 3 minutes;
• Remove the rotary movements of turunda nasal passage;
• handle the other nostril in the same od­bong;
• remove waste material in polyethylene­vy package;
• Remove gloves, wash your hands dry.

The external auditory canal is allocated des­tovato-brown mass – sulfur, which can form a cluster of cerumen and cause tinnitus, hearing loss. these to­additionally symptoms may seriously disturb­patient.

Caring for healthy ears require regular cleaning of the ear and ear about the­running warm water and soap. In no event should not clean the outer ear canal acute­E items that can damage the drum­hydrochloric membrane or wall of the auditory meatus. If the plug of earwax has accumulated, it is removed under observation­deniem doctor.

nail clippers

the patient’s nails require careful ezhenedel­Foot care. Since the nails become stiffer with age, it is necessary before shearing them dipped in a container of warm water and liquid soap.

For this manipulation necessary to prepare: a container of warm water (temperature 36-37 ° C), liquid soaps, scissors, plastic bag for waste material, hand towels, and foot napkin for hands and feet for the napkin, a nail file, oil cloth, pi­tatelny cream, nail clippers. First – nail clippers on hand: • Put an to the patient’s bedside chair; • to put all the items necessary to ma­nipulyatsii;

• sit comfortably patient (if the patient mo­Jet sit);
• lay on his lap oilcloth;
• put on an oilcloth container of water (if PA­cient can not sit, lay down the oilcloth under the right hand, next to put a bowl of water);
• pour into water soap;
• Lower the tank, first the right hand 3 – 4 minutes;
• Remove the brush over time;
• dry brush cloth;
• cut the nails gently carefully from the 1st to 5th finger over the towel, leaving protruding 1 – 2 ml of the nail;
• lower in the capacity of the patient left hand for 3-4 minutes and cut the nails in the same follower­obtained;
• Treat the patient nail file nails on both hands;
• Apply a nourishing cream rubbing motion­zheniyami of nail phalanges to the forearm.

Mowing toenails:

• Seat the patient on the bed, tucked under sleep­
  Well, extra pillows;
• Lower the foot of the bed;
• put the feet in a bowl of warm water (if the patient can not sit – bend his legs in the stake­nyah, by laying a rubber sheet stack, to place her pelvis with warm water, temperature – 36-37 ° C);
• pour into water soap and lower foot of the patient in a container for 5 minutes;
• remove the patient from the foot of water;
• dry with her napkin;
• Place on a towel for the feet;
• Place the other foot in a bowl of water;
• shorten the nail clippers;
• Treat your nails nail file;
• Treat your nails on the second leg, repeating dei­Corollary defined above;
• Apply rubbing movement nourishing cream for the feet of the nail phalanxes to golenos­topnogo joint;
• pour water;
• rinse the container;
• Place the napkin and towel in polyethylene­vy package;
• Wash with soap and scissors, nail file, schipchi­ki;
• Wash and dry your hands.

Unshaven patient looks pretty messy and feels uncomfortable at the same time. It affects not only men but also women, who in old age begins active growth of hair in the area of ​​the upper lip and chin.

This problem is easily solved with an electric razor or shaving learn the technique of safe Brit­howl.

Prepare: a water tank; napkin for com­press; towel; safety razor; for brie cream­tya; shaving brush; oilcloth; cloth; lotion. Note: check the patient’s face – there are no moles on his face, because their damage is very dangerous for the life of the patient.

Aftershave lotion is better to use, contains­zhaschy alcohol, an antiseptic, warning is­rezhdayuschy fester in violation of skin integrity. Shaving comprises the following steps:

• help the patient to take the position of “semi­sitting “(back sheet under additional perfume­s);
• Cover the patient’s chest and a napkin oilcloth;
• Prepare a container of water (40 – 45 ° C);
• Wet a large cloth in water;
• press cloth and put it on the face Paci­cient (cheeks and chin) for 5 – 10 minutes;

Note: in preparing women for brie­Tew, a napkin put on the face is not necessary.

• whisk brush shaving cream;
• Apply it evenly on the face of slit­Cams and chin (woman moisten your face with warm water in the areas of hair growth without using cream);
• shave the patient by pulling the skin in the direction­SRI opposite to the movement of the machine in the following­boiling sequence cheek beneath the lower lip, the neck region under the chin;
• wipe the face after shaving with a damp cloth;
• dry with a clean cloth, soft promo­tive movements;
• Wipe the patient’s face lotion (woman after lotion, apply on the skin nourishing cream);
• remove the razor, towel, a bowl of water;
• Wash and dry your hands.

Malignant neoplasms often Global Developing­It is against a background of already existing pathology – the most chronic diseases. Some of them are called precancerous. Currently precancer to rank a number of diseases, among which the most famous are:

• stomach cancer – polynosis, hypoacid (downgraded­naya acidity), gastritis, peptic ulcer disease;
• cancer of the colon and rectum – chronic ulcerative colitis or proctitis, polyposis;
• breast cancer – breast;
• cancer of the thyroid gland – nodular goiter;
• liver cancer – chronic viral hepatitis B or C;
• bladder cancer – villous polyps;
• Cervical cancer – erosion and dysplasia, etc…

The main feature of the transition of the disease in cancer – a change in the nature of sensations, already known to the patient earlier. The patient, pay attention tochanges should see a doctor. The following symptoms are observed in the presence of a malignant tumor:

general weakness – symptom of advanced malignancies. There is a fatigue in the performance of daily work, in the workplace and at home. General weakness caused

tumor intoxication – permanent poisoning­Niemi organism vital activity products pa­postglacial cells: the larger the tumor, the greater the toxicity.

. Loss of appetite in cancer is also associated with the Institute­intoxication. First, the patient loses interest when­gotovlennoy food, the pleasure of food intake, then a careful selection dishes – most patient refuses protein. In severe cases, patients refuse any proposed food they eat through force, little by little.

Weight loss – this symptom is associated not only with intoxication, loss of appetite, but also to disrupt the­Niemi protein, carbohydrate and water-salt obme­on. It takes place in the hormonal disorder Articles­Behold the body. When tumors of the gastrointestinal tract and digestive system weight loss comes from the violation of food receipt­preliminarily enzymes suction food masses. The most powerful weight loss observed in pancreatic cancer, liver, esophagus and acorns­ka. At least – for intestinal tumor. from zlokache­governmental tumors, non pischevari­tion system, these symptoms most character­us to lung cancer. When a malignant tumorbreast, larynx, thyroid, uterus, tumors of skin – no weakness, no sweat­When appetite or weight loss in patients was observed.

Increased body temperature – one of proyav­tions tumor intoxication. temperature ofWitzlaus evenings and is 37.2 – 37.4 ° C. Increase in body temperature to 38 ° C and above indicate a strong intoxication in process of disintegration of the tumor and concomitant inflammatory process.

depression – depression, in which the pre­is patient. He loses interest in everything, and I will­vitsya withdrawn and irritable.

Against the background of the following symptoms are noted “* Local symptoms of cancer. The occurrence of any symptoms tend­lo, due to a violation or a change in organ function and may exhibit the same behavior at times­individual diseases, including onkologiche­Sgiach. Only in advanced cases of cancer slaughtering­Levan are so pronounced and characteristic symptoms, the diagnosis is not in doubt. That’s why you need to know the basics of cancer symptoms­GOVERNMENTAL locations and with the appearance of any sim­ptomu promptly seek medical attention for­power.

The symptoms of lung cancer

• Cough, initially rare and dry, as pokash­Lebanon, then begins to disturb the afternoon, evening and even at night. Cough worse, getting over­sore, later it appears mucous expectoration, to­Thoraya becomes purulent.
• Shortness of breath is growing slowly. If the tumor or block the lumen of the bronchus in the pleural cavity accumulate associated with tumor growth liquid, dyspnea may sharply increase.
• Hemoptysis – one of the most disturbing Symposium­volumes. Once marked hemoptysis, even if it’s just streaks of blood in the sputum, requires examination.
• Chest pains are intense and not related to the act of breathing. these pains are often taken for “heart.” Pain in the front, back or sides of the increasingly stronger, enhancing­are deep breathing, coughing, and are associated with tumor invasion of the pleura.
• Pains appear in the lower leg, thicken phalanges of the upper limbs are violated­etsya mobility in large joints. sometimes by­cients suffer inflammation of the veins, growing hoarse­smallness of voice, swollen lymph nodes in the supraclavicular area.

GCO critically ill patients, if necessary­goad intestines enjoys in the bed vessel, and when urinating – urinal. The vessel can be used for metal, enamel­Covered, plastic or rubber. Rubber boat used for extremely weak Paci­ENTOV, as well as in the presence of pressure ulcers. For on­Duvanov rubber foot on the vessel used­SOS. It should not be too tight to inflate the vessel Ina­Th is will have a significant pressure sacrum.

In the event of the patient’s urge to DEF­katsiyu, you must:

• wear gloves;
• prepare the ship: warm, dry, on the bottom pour a little water;
• Ask the patient to bend your knees and lift the pelvis (if the patient is weakened, help him to lift the buttocks);
• enclose oilcloth under the buttocks;
• put the ship on the oilcloth;
• help the patient down to the ship, so that­to his crotch I was over the opening court­on;
• allow time for the implementation of the act of defecation;
• Ask the patient to bend your knees, with­lift the pelvis;
• remove the ship from under the patient;
• wipe the anus toilet boom­Gentile;
• thoroughly wash the vessel;
• pour the vessel with hot water supply under the na­patient’s;
• undercut patient downward from the genitals to the anus;
• dry with a clean cloth;
• remove the ship, oilcloth;
• help the patient to lie down comfortably.

If the patient is in serious condition, weakened, it is best to use a rubber boat:

• wear gloves;
• prepare the ship (dry heat), at the bottom of the pour a little water;
• help the patient to bend your knees and­to return to the side with his back to you;
• right hand to bring the ship under the buttocks Paci­cient, and the left, holding the patient’s side, helping him to turn back, the boat tightly to the patient’s buttocks;
• lay the patient so that the crotch of an eye­out to be over the opening of the vessel;
• put under further back on perfume­ku, the patient can be in the “on­Lucid “;
• allow time for the implementation of the act of defecation;
• Turn the patient on one side at the end of the act of defecation, holding his left hand, the ship – the right hand;
• remove the ship from under the patient;
• wipe the anal area toilet­hydrochloric paper;
• wash vessel, pour hot water;
• put a vessel under the patient;
• undercut patient downward from the genitals to the anus;
• dry with a clean cloth;
• remove the ship, oilcloth;
• Remove gloves;
• help the patient to lie down comfortably.

After the vessel is washed, it is necessary to rinse with hot water and put about fasting­Does the patient.

After using the urine collection bag contents poured, the container is rinsed with lukewarm water. “Cleaning” To remove sharp ammoniacal odor of urine can rinse the bag with a weak solution of potassium permagnata or detergent.

The skin should be clean to function properly­tsionirovat. To do this, hold it ut­renny and evening dress. Human skin zagryaz­nyaetsya secretions of the sebaceous and sweat glands, horny scales, dust, especially in the armpits and folds of skin under the Milk Jelly­Zami in women. perineal skin further contaminated secretions from the genito-urinary organs and intestines.

The patient should be washed in the bath or shower at least once a week. If the patient is weak­flax, it is recommended to wash in the shower in the bathroom, seated on a chair. The necessity daily patient­mo washing, cleaning the washing of hands before meals.

Help the patient during a hygienic shower and washing of the head:

• establish a special bath seat or high chair;
• adjust the water temperature to 35 – 37 ° C;
• help the patient to remove clothing;
• warn the patient of the need to inform­Niya about a possible deterioration of his state of health (Ser­dtsebienie, shortness of breath, etc.);
• help the patient become in a bath, then arrange­camping on a seat, supporting its rear by the elbows;
• rubber gloves;
• folded cloth in several layers, ask the patient to cover her eyes;
• Moisten the patient’s hair, spraying water from soul;
• Apply shampoo and wash the hair with both hand­E, gently massaging the head until the hair will not be completely lathered;
• lather rinse water;
• remove the diaper, close my eyes, wipe the hair;
• help the patient consistently wash Tulo­vische, upper limbs, neck, chest, back, LO­of limbs, groin, perineum, using a soft terry washcloth or mitten;
• wipe dry the patient’s body (preferably soft­Kim towel), paying attention to Pal­tsam lower extremities help to get out of the bath (if necessary, provide assistance together);
• help comb your hair, put on clothes and shoes.

Note: in the same way the patient is carried out washing in the bathroom.

If the bath or shower contraindicated req­Dimo conduct sponging the patient in bed:

• prepare a container of water (temperature 36 – 37 ° C), oil cloth, cloth, rubber glove, mitten terry, terry towels 2;
• rubber gloves;
• Rinse terry mitten (without soap) forever one eye of the patient from the inner corner to the outdoor temp­Nome;
• wipe the eyelids dry with a towel;
• Rinse the other party gloves forever WTO­cerned eyes;
• wipe the eyelids dry with a towel;
• Wash terry mitten forehead, nose, cheeks;
• Wipe dry with a towel;
• Wash with neck and ears soap (we­scrap use sparingly);
• rinse and wipe dry;
• , recline on a sheet with a patient’s arm­to lay down a towel under the arm;
• terry mitt wash, rinse;
• Wipe dry using a towel lying
  hand, the patient’s forearm, shoulder and podmyshech­hydrochloric cavity supporting arm in the region of the joints;
• wash your hands a brush in the container, pre-bed oilcloth on the bed next to the patient and putting her capacity;
• remove the container and oil cloth with the patient’s bed;
• Wipe dry with a brush and cover with a sheet;
• fold the sheet with the other arm of the patient and
  the same sequence wash it and dry it;
• fold the sheet into a roll, releasing the chest and abdomen;
• Wash the patient’s chest and abdomen;
  • rinse and wipe dry (women osmot­Ret skin under the breast);
• hide the chest and abdomen sheets, rolling to the lower extremities;
• put a towel under one of the lower finite­obtained;
• terry wash mitt hip, knee, th­laziness;
• rinse and wipe dry with a towel;
• remove the towel from under his feet, his leg bent in to­county, lay the oilcloth, and put in a container with­Doi;
• lower the stack in a container with water;
• Wash, rinse and dry the foot, paying attention to the skin between the toes;
• remove the container with water and rubber sheet;
• Wash the other leg in the same posledovatelnos­ty;
• cover the patient’s feet to help the patient pover­nutsya side, back to you;
• Put a towel on top of the sheets along the sleep­us and the patient’s buttocks;
• Wash, rinse and dry with a neck, the back, the buttocks of the patient, carefully examining the skin for detection of pressure ulcers;
• spread out under the buttocks of the patient oilcloth, put the ship and turn the patient on his back;
• Change the water in the tank.

If the patient can wash about­region of the perineum, ask him to do it sa­Momo, leaving him alone. Otherwise, about­Enter the procedure themselves.

• help the patient with­bend your knees and place them;
• oilcloth lay on the bed, on top – salfet­ku;
• wear terry ru­kavichku, lather it;
• soap pubis;
• rinse the pubis;
• rinse mitten;
• push the labia and wash one of lovuyu lip, then the other party about the gloves­second wash sexual lip (gloves movement in the direction from the pubis to the anus;
• rinse mitten in the water tank;
• push the labia and wash the area between the labia, perineum, in the direction­apart from the pubis to the anus;
• rinse the pubis, labia, perineum

patient;

• Wipe dry pubis, labia, Intermedia­NOSTA patient in the same sequence;
• Wash, rinse and dry anal area­The leg openings in the direction away from the genitals to the anus;
• remove the oil cloth and napkins;
• washed terry mitten, pour the water;
• rinse the container, remove the rubber gloves, wash your hands.

Care crotch men

Preparations for the care is the same as in women: • to take with one hand the penis, pull the foreskin, wash the glans penis in a circular motion in soapy mitten-I on board from the urethra to the peri-­ferii;

• rinse soap with gloves, rinse it; • rinse and dry with a wet towel to individual head of the penis in the samesequence;
• return the foreskin in natural position; • Wash, rinse and dry the restareas of the penis toward the pubis;
• help the patient to bend your knees and times­
  move them;
• Wash, rinse and blot dry skin
  scrotum;
• help the patient to turn to one side, his back to you;
• Wash, rinse and wiped dry oblastanalnogo holes;
• remove the oil cloth and napkins;
• wash terry mitten;
  pour water and rinsing tank;
• remove gloves, wash your hands.