This can be done as follows:

• to prepare a container of water (temperature
  36 – 37 ° C), oil cloth, cloth, rubber glove,
  terry mitten, 2 bath towels, pus­
  thuja container, shampoo, pitcher;
• remove the pillow;
• rubber gloves;
• put in the headboard chair, it is an empty water container;
• put a container of water on the bedside tum­barrel;
• podstelit under the head and shoulders of the patient adhesive­enku;
• lower end of the oilcloth in the empty container, one hundred­
  yaschuyu on a chair;
• put around the head, on the edge of the oilcloth, Sverre­towel-mentioned roll;
• put on the patient’s eye terry cloths
• stand in chairs with the container with water;
• Fill the jug and moisten the hair of the patient;
• apply a little shampoo and both hands you­wash your hair, gently massaging the scalp;
• Pour into a pitcher of water and rinse the shampoo;
• deploy a clean towel, gently lift the patient’s head and wipe dry with a hair;
• remove the tank, oil cloth, wet towel;
• Change (if necessary) soaked in the BPE­mja shampooing the lower sheet;
• comb the hair of the patient;
• Remove gloves and wash your hands.

As pollution bed or after the patient in bed washing and soaking the bottom simply no need to change it. Sheets and pillowcases on the bed seriously ill should not have c-singular seams, hems, the buckles on the side, drawn to Noah to the patient.

Change bed linens we can seriously ill­but in two ways. Better to do it together. The first method is used in the event that the PA­cient can turn in bed:

• roll clean sheet in length up to half;
• lift the patient’s head and remove the pillow;
• change the pillowcase on the pillow;
• move the patient to the edge of the bed, turning his face to one side to myself (it is desirable to help Nick was holding the patient);
• roll dirty sheet over the entire length in the direction of the patient;
• Spread a clean sheet in the liberated­Xia part of the bed;
• Turn the patient on his back, then on the other side so that he was on a clean sheet;
• remove the dirty sheet and fold the net, tuck the edges of the sheets under the mattress;
• raise the head and shoulders of the patient, and put a pillow.

The second way to change the bed linen Prima­nyaetsya with complete immobility of the patient:

• roll a clean sheet in the transverse direction­lenii;
• gently lift the upper torso portion of the patient, remove the pad (it is desirable that­to assistant I was holding the patient);
• roll dirty sheet from izgolo­Vias bed to the patient’s waist, put on a clean sheet of the vacant bed;
• Put a pillow on a clean sheet and opus­Titus at her patient’s head;
• Ask the patient to bend your knees, operators­retsya feet on the bed and lift the pelvis (if the patient make it difficult to enclose the assistant left hand under the sacrum of the patient and help him lift the pelvis);
• Slide the dirty sheet, proceed as follows to spread the net;
• Ask the patient to lower the pelvis;
• lift and hold the legs of the patient in the area of ​​the lower leg, continuing to move the dirty sheets and spread the net;
• Lower the patient’s leg;
• tuck the edges under the mattress sheet.

Disguised as the patient can read Obra­way:

• Prepare a clean nightgown;
• Ask the patient to bend your knees to lift the pelvis;
• roll up the shirt to the waist;
• Ask the patient to lower pelvis and flatten: the legs;
• lift the upper half of the body pas tsientki;
• Carefully roll up the dirty shirt to zatyl­ka and lift it over his head;
• free from the hands of the patient’s shirt.

Pure nightgown put in reverse by­row.

For seriously ill to care easier if the floor­Nost exposed as bad smoothed clothes on the patient, tight armhole style nightgown, folds in bedding, humidity Postelno­of laundry when sweating, incontinence is the cause of skin chafing and pressure sores.

Signs of diaper rash: Skin redness, thereof:­Nost, pain in the axillary WPA­Din, women – under the breasts, in the domain­STI inguinal folds.

Patients with urinary incontinence better use­vatsya diapers. Diapers are selected on the time­measure based on the patient’s weight. They put so:

• Prepare diaper;
• convince the patient of the need Utilized­
  Nia diapers;
• Turn the patient on one side (back to him);
  • expand the diaper;
• Determine where .oblast buttocks, Ms.­Vaught (there are Velcro in the abdomen);
• Put a diaper under the buttocks of the lumbar region;
• turn the patient on his back, then – over,
  straightening diaper;
• Return to the starting position of the patient – on
  back;
• Ask the patient to bend your knees slightly and dissolve them;
• Lay the diaper in the crotch area, and Daw­Vaught, flatten and spread in the hips;
• tuck diapers lower portion under the upper;
• fasten diapers velcro (left

on right).

Between shifts diapers patient must handle the genitals and buttocks.

If the damage and deformation of the skin tissues under the action of direct pressure or biasing force is used, the term “bed sores”. The degree of such tissue damage can range from persistent erythema to necrosis covering the skin, muscles, tendons and even bone. Place bedsores depends on the position in which the patient (Fig. 37). If he le­lies on the back – is the sacrum, heels, shoulder blades, zaty­Lock and elbows. If sitting – ischial tuberosity, a hundred­nN leg, shoulder blade. When lying on his stomach, suffering from bedsores ribs, knees, toes with tyl­Noah side, the iliac crest.

Three main factors are set, leading to the formation of bedsores: pressure, biasing force, friction.

Pressure – under the action of its own weight of body tissue compression occurs relatively poverhnos­ty, which supports the people. When compression of the TCA­It vascular diameter is reduced as a result of ischaemia occurs starvation tissues. At full compression of over two hours is formed necrosis. Compression of the vulnerable tissue is enhanced under the influence of heavy linen, the bandages tight clothing.

The biasing force – and the mechanical destruction of tissue damage under indirect giving­Lenia. It is caused by the displacement of tissues to the supporting surface. Microcirculation in the underlying tissues is broken, and the fabric camber­It is from oxygen deficiency. Offset TKA­It can occur when the patient is “moving out” of the bed down or pulled up to her bedside.

Friction is a component of the biasing force. It causes detachment of stratum corneum leading to ulceration its surface. age friction­It is in skin moisture. It is the most susceptible­who exposed patients with urinary incontinence, sweating, dressed in a wet and non-absorbent underwear and Raspaud­Laga on non-absorbent surfaces (podkladnye oil cloth, plastic surface).

Signs of incipient bedsores is flushing. It warns of the need for­ratit attention to the damaged skin. which has already begun poor circulation.

Prevention of bedsores:

• change the position of the patient every two hours.
  To control the regularity of the procedure of re­mended on a sheet of paper to draw qi hour­ferblat where allocate every second hour. cover up­Pete the picture on the wall in front of the patient, andat each turning mark in Figure another hour shift position of the patient;
• Find the most convenient position for patsien­that – is that body weight is evenly distributed­flax (using conventional pillows) on each­ through each body portion has a minimal pressure;
• do not expose vulnerable areas of the patient’s body abrasion;
• wash the vulnerable areas of the body, observing personal hygiene;
• use liquid soap for washing;
• thoroughly dry the areas of the body after washing, lubricate them with cream (if the skin is dry);
• Encourage the patient to get out of bed or Cres­la and a little walk (if he can walk);
• shorten the period of sitting in the chair, if the pro­Ledge develop in the pelvis;
• Encourage seriously ill possibly take accumbency;
• change the position of the patient every 2 hours using extra pillows for support (on the left side, on the back, on the right side, on the belly permitting the patient);
• if the patient’s disease confined to a chair or wheelchair, advise him to weaken giving­Lenie buttocks every 15 minutes: lean forward, lifted, leaning on the handle Cres­la, slightly tilted to the side, raising about­oppositely half of the buttocks;
• every time you move, any deterioration or change in the patient’s condition regularly inspect the skin in the area of ​​the sacrum, heels, ankles,
  blades, neck, trochanter major braid­ti, in the axillae, perineum breast;
• Check the condition of the bed to shake crumbs, smooth wrinkles on the bed;
• eliminate the patient’s skin contact with a rigid part of the bed;
• Do not use rubber circles and pads – they lead to more squeezing wok­pyr-pressure area and contribute to the spread of bedsores;
• Check each time you change the position of­standing skin pressure areas;
• Be sure to follow the patient’s personal hygiene. Morning and evening wash with warm water and wipe dry with a dry cotton swab, SMO­chennym 10% solution of camphor spirit or 40-degree solution of ethyl alcohol, or one­percent solution of salicylic alcohol places where often formed sores;
• bedding should be clean and su­chemical;
• watch out for the regular emptying kishech­Nika;

– to prevent and treat incontinence;

– Avoid unbalanced diet patient;

– vitamins and vitamin C are necessary for tissue nutrition and protein deficiency, imbalance nitrogen, sulfur, phosphorus and calcium affect blood circulation and increase the predisposition­Nost patient to bedsores;

– low hemoglobin contributes Ishe­mission tissues, hence the patient requires regular prevention and treatment of anemia;

Treat pressure ulcers must be in with­otvetstvii with the degree of lesion:

degree I limited to epidermal and dermal­E layers. The skin is not broken. the Supervisory­etsya stable hyperemia, impassable after the pressure ceases. When bedsores 1 – 2 times a day to lubricate the skin is 5 – 10 percent solution of potassium permanganate.

degree II characterized by shallow top­nostnymi impaired skin integrity­Islands, extending to the subcutaneous fat layer. Persistent redness persists. Detachment of the epidermis occurs. Recommended re­mating with a 3 percent solution of hydrogen peroxide and the ointments “rescuer” lenkomitsino-wai ointment sintomitsinovaja ointment.

degree III reveals a complete breakdown of skin­th sheet during its whole thickness down to the muscular­th layer with the penetration into the very muscle.

degree IV – loss of soft tissue. About­transform of the cavity with the appearance of her nizhelezha­boiling tissues (tendons up to the bone).

First degree treated conservatively. re-epithelization process occurs if otmiraya­It is only epidermis. When the second power remove dead tissue layer. The third and fourth degree of pressure ulcers are treated by means of surgical dissection and removal of necrotic tissue.

Ligation education bedsores:

• cook: a bottle of 3 percent sol­rum hydrogen peroxide, sterile wipes (na­kw), tweezers, a tube of ointment or vial odnopropercentage iodonata solution or 0.5 percent chlorhexidine bigluconate, scissors, a rubber sheet;
• put the patient;
• free space formation of bedsores;
• enclose oilcloth;
• wear gloves;
• sterile scissors to open a package;
• take tweezers sterile towel;
• drench 3-percent solution of re­KazISS hydrogen;
• treat the wound blotting movements;
• throw the tissue in the garbage bag;
• take a second tissue forceps;
• wound dry blotting movements;
• throw the tissue in the trash bag
• take tweezers sterile towel;
• drench one percent solution iodonata or 0.5 percent solution hlorgek sidina bigluconate;
• treat the skin around the wound;
• take tweezers sterile towel;
• shift in the brush, holding a Pal­ CEM;
• Ointment applied to it from a tube or vial;
• intercept of the tips of the napkin;
• impose on the wound surface lubricated;
• take tweezers dry sterile towel;
• impose top gauze;
• fix on all four sides sticky plas­ tyrem;
• clean oilcloth;
• put the patient in a comfortable position for him;
• clear solutions, a garbage bag;
• off the gloves;
• Wash the hands.

Note: bandaging done regularly once a day. If the wound is in the area of ​​the heel or elbow­Vågå joint – apply bandage.

Caring for the seriously ill, must be able to give the patient a comfortable position in bed with extra pillows (pillows under your back 2 at the position of “reclining” at the back 3 pillows with “half-sitting up in bed” position of the patient). Patient’s legs should be slightly bent at the knees. To do this, enclose a folded blanket­lo. The foot of the patient should be in the palm, under the lock­minute patient enclose a small pillow.

When you move the patient in bed The necessity­mo remember the biasing force, which is at­cause of the formation of pressure ulcers. To do this, re­displacements of the patient should be moved. The patient is involved in the movement in the bed (it is desirable to move together).

Moving the patient in bed:

• turn the patient on his back;
• remove the pillow and blanket;
• put a pillow cushion that will prevent the patient’s head hit the headboard;
• offer the patient to cover their elbows wrists;
• one person to stand in the upper part of the body­schA patient, take the hand that is closer to the patient’s bedside, brought under the upper neck
  part of the patient’s shoulder;
• promote hand further to the opposite shoulder;
• with the other hand grasp the hand of the nearest and Tribes­cho patient (hug);
• second mate, standing at the bottom part of the body­schA patient brings his hands under the waist and hip of the patient;
• offer the patient to bend your knees, keeping feet on the bed;
• bend the patient’s neck, chin pressed to the chest (and thus decreases the resistance and increases patient mobility);
• ask the patient at the expense of “three” push heels on the bed and to promote the assistants, lift your torso and move outcasts­
  lovyu bed;
• one of the assistants, located in izgolo­Vias, raises his head and chest of the patient, the other puts a pillow;
• help the patient to take a comfortable position in bed;
• cover with a blanket;
• make sure that the patient comfortable;
• Wash the hands.

To prevent the formation of pressure ulcers is necessary every 2 hours change the position patsien­that: from the “supine” to translate in at­Proposition “lying on its side.” To do this:

• bend the left leg at the knee of the patient Soest­ve (if you want to turn the patient on his right side), palming off the left foot to the right popliteal
  depression;
• put one hand on the patient’s thigh, the other on his shoulder;
• rotate the patient onto his side, the (thus “lever” effect on hip facilitates Powo­rachivanie);
• pillow beneath the head and body of the patient (thereby reducing the lateral bending of the neck and the neck muscles voltage);
• to give both the patient’s arms slightly flexed position, with the hand, located on top, le­It lies on the level of the shoulder and head; arm located
  from below, lying on the pillow next to his head;
• placed under the patient’s back folded on­Dushku, slightly podsunuv it under the back straight edge (so you can “hold” the patient on­the decomposition “on the side”);
• put a pillow (from the groin area to the hundred­nN) under slightly bent “upper” leg of the patient (thus carried prophylaxis pro­
  Ledge in the knee and ankle, and prevents hyperextension of the feet);
• provide abutment at 90 ° to the bottom of the foot (thus providing a fold back of the foot and prevents its “sagging”).

From the position of the patient “lying on its side” (fig. 39) can easily translate it to “prone” (Fig. 40). To do this:

• remove the pillow from under the patient’s head;
• straighten the patient’s arm at the elbow;
• pressed his hand to the body along the entire length;

• placing the patient’s thigh under the brush, “Perevi­pouring “of the patient through his hand on his stomach;
• move the patient’s body in the middle of the bed;
• rotate the patient’s head to the side and be placed under its lower cushion (thus decreasing flexion or hyperextension of the cervical vertebrae);
• enclose a small pillow under the abdomen just below the level of the aperture (thus reducing­etsya hyperextension of the lumbar vertebrae and the tension in the back, in addition, the women reduced the pressure on the chest);
• bend the patient’s arm in the elbow;
• hands up so that the brush LAYOUT­galis next to his head;
• placed under the lower leg and ankle joints pillow to prevent sagging and­gate outside of the foot.

From the “prone” set the pa­Sims patient’s position – an intermediate position between the “prone” and “lying on its side”:

• remove the pillow from under the patient’s abdomen;
• bend “upper” leg at the knee joint;
• pillow bent under “upper” leg so that the lower shin leg was lying on the lower thigh level (thus preventing rotation of the hips inward prevented ne­rerazgibanie limbs and carried profilak­teak bedsores in the knee joint);
• pillow under “upper”, sognutuyuv elbow, arm angle of 90 °;
• straighten the elbow “lower” and put her hand on the bed without bending (thus with­stored biomechanics of the patient’s body);
• provide a stop for the network 90 ° (thus ensuring correct folding rear­of the stop and are prevented from sagging).

After placing the patient in the position of the Sims, ne­revesti it to “supine”, it is necessary:

• remove the pillow from under the hand and knee Soest­Islands of the patient;
• straighten the arm and put your sides;
• put the “upper” foot on the “bottom”;
• straighten and put his hand to his hip “bottom” of the patient’s hand;
• lift the torso away from you and put the patient in the position “on the side”;
• help straighten the “bottom” hand out from under the patient’s torso;
• move the patient on his back;
• help the patient to lie down comfortably on the bed, one man placed under the patient’s neck and shouldersleft forearm and hand, his other hand clasping­a patient; another helper stands at the bottom of the patient’s body and put his hands under the small of the back and the hip of the patient;
• offer the patient to bend your knees, keeping feet on the bed, bend the neck, pinningchin to your chest;
• offer the patient at the expense of “three” push­Xia heels on the bed and give possible assistance­nicks torso lift and move to the head of the bed;
• fix and enclose additional perfume­ki;
• improve the sheet;
• hide patient.

After putting the patient at any of these polo­zheny, make sure he feels comfortable.

40% of cancer patients occasionally suffer from nausea, regurgitation (leaking of stomach contents into the mouth), vomiting.

nausea cause may be:

• delay the evacuation of food from the stomach, accompanied­nied by heartburn, hiccups, feeling perepol­nennosti;
• stomach and intestinal tumor or indirect pressure adjacent the tumor;
• medications that provoke gastrointestinal irritation (nonsteroidal protivovos­-inflammatory agents, such as diclofenac, The cylinder
  totoksicheskie, antibiotics – at length­Tel’nykh their use);
• fear, anxiety;

vomiting cause may be:

• increased intracranial pressure after­Corollary cerebral tumor;
• gastric compartment syndrome; stimulation of vagal pathways
  nerve resulting pharyngeal irritation (kandidos, sputum);
• ileus (delayed stool, neoplasms, creating direct or indirect pressure on the intestines and cause vomiting with a small amount of fecal fluid);
• the body’s response during chemotherapy.
  regurgitation reason may be:
• obstruction of the esophagus as a result of swelling­Whether esophageal tumor or indirect pressure in the lungs and bronchi. The patient regurgitates enough
  copious amounts of viscous substance.

First of all, it is necessary to conduct a thorough analysis of the situation, think and plan dei­Corollary to eliminate symptoms.

There are a number of drugs on­significant physician individually to facilitate the symptoms of nausea and vomiting.

But it is known and a number of non-pharmacological measures to combat nausea and vomiting.

1. Create patient calm and tranquil Obst­posing the, reduce the influence of factors that mayprovoke unpleasant symptoms.
2. Release the patient from all household duties (cooking, cleaning premises­scheniya etc.).
3. Avoid exposing a patient to him sharp and unpleasant odors (food, cosmetics, my­means boiling).
4. Assure the patient of the need to eat and drink little and often.
5. Eliminate foods from the menu, the use of which increases the nausea and vomiting.
6. Prevents the appearance of retching, prepare a special container for the collection of vomiting­GOVERNMENTAL wt.
7. Allow the patient to take antiemetic pre-­Paraty prescribed by your doctor, check up the efficiency of their actions.

If vomiting in a patient who is put in­SRI lying, you must:

• turn the patient’s head to one side, remove the pillow;
• enclose oilcloth and capacity for gathering vomiting­GOVERNMENTAL mass;
• hold the patient’s head during vomiting;
• prepare a glass of water to rinse polo­STI mouth after emesis napkin wiping mouth;
• reassure the patient and create the maximumcomfort;
• Change soiled bedding and underwear.

If vomiting in a patient who is put in­SRI sitting, you must:

• put the container for collecting vomit between­Do aching legs;
• tie patient tissue covering the chest;
• become the left of the patient, clutching his head with his right hand back and holding his head with his left hand on the forehead;
• to give a glass of water for rinsing the mouth and vomiting after napkin;
• reassure the patient, to create him a relaxed environment.

By vomiting in patients undergoing in bessozna­tion status, you must:

• as far as possible, in order to avoid aspiration
  (Vomitus inhalation) of­return the patient to one side, or turn it on its side of­catching;
• remove the pillow;
• remove dentures (if any);
• put a rubber sheet and bring the mouth emkostdlya collecting vomit;
• to support the patient’s head during vomiting;
• carry oral care after each act of vomiting;
• wrap the index finger of the right hand of fats­fetkoy;
• hold open the mouth by means of the index finger and thumb of his left hand;
• try to remove remnants of vomit from the oral cavity;
• right index finger rinse the mouth with the help of the pear-shaped balloon with the patient lying on her side, holding races­
  covered the mouth;
• monitor the patient’s condition constantly;
• to inform the physician about the amount and frequency of retching patient.

For a patient experiencing nausea and vomiting, it is of great importance of oral hygiene. Ezhed­watch-today the state of the mouth, tongue, inte­resuytes whether the patient’s mouth discomfort. In the presence of mucosal dryness language need daily, 2 – 3 times a day, at Pomo­cabbage soft toothbrush and a 4-percent solution of sodium hydrogencarbonate to conduct purification language. When dry mouth is recommended drink hour­then, in small sips, 1/3 cup, sucking small pieces of ice, candy, eat a slice of fresh pineapple, which contains special enzymes that help clean the mouth. Smearing Vaseline lip weakens the feeling­of dry mouth.

An important part of palliative care is to educate the patient and his family keeping a diary, where fixed the cause of the pain, nausea and vomiting, and their duration. This blog will help to plan for medical­power, to make recommendations.

To reduce symptoms of nausea, vomiting, when decreased appetite, you must go to the health food for preventing constipation. Meals patients in the later stages of Cancer­bolevaniya has a number of features. there CNI­voltage patient’s need for food, water. In some cases, food intake is poorly tolerated, PA­cient is suffering from lack of appetite (anorexia). Persistent nausea and vomiting, forcing the patient to abandon the eating and drinking. If WHO­Nicla problem of choosing between water and food before­deference is given to fluid intake. It is necessary to pv­kovodstvovatsya the following principles:

• not force the patient to take by force
  food;
• feed only when the patient who searches­Vaeth hunger, give food in small portions;
• offering the patient his favorite dishes;
• eliminate painful force-feeding­of provoking strengthening of nausea, vomiting and pain.

The patient can change the taste sensing­Nia. Familiar foods can seem gor­Kimi, sour, sweet. In this case, you need to give up eating meat, acidic juices, tomatoes, coffee, tea, chocolate. including The recommended­chit eating poultry, fish, dairy produk­you eggs. If the food is the patient seems too sweet, cloying in the diet include acidic juices. When you prepare food using lemon­ny juice, vinegar, spices, mint, marinated or pickled vegetables. If the food does not seem sick­delicious, as a snack (in the absence protivopokazany) can advise salted and pickled vegetables, salted fish, herring. 

Feeding critically ill patients

• Help the patient to take Half-upright, comfortable position in bed, placing additional­hydrochloric pillow. Wash the hands. prepare a cover up­cotton nightstand. Give the patient time for prepara­Preparations for eating.
• Neck and chest of the patient to cover salfetkoy.Blyuda with hot food should be checked cap­IBA currently on the wrist a few drops.
• Feeding the seriously ill, often stradayusche­of lack of appetite, it is not easy. Wanted in on­Daubney cases skill and patience.
• For liquid meal are spe­cial feeding cup (you can use a small amount of the teapot).
• Semi-solid food given to a patient with a spoon.
• Since the patient is necessary before the feeding of­judge, in what order it will be at­Nima food. Ask the patient not to talkduring the meal, as when talking food
  can get into the respiratory tract.
• We should not insist that the patient has eaten the entire volume of vegan food. After a short break, heating the food to continue feeding.

Feeding critically ill patients with a spoon and with the help of a feeder cup.

• Caution patient within 15 minutes of priemepischi, to obtain his consent.
• Ventilate the area. prepare a cover up­cotton table.
• Raise the head end of the bed (to put under his head and back an extra pillow)
• Help the patient to wash his hands.
• Cover the patient’s breast tissue.
• Wash the hands. Bring the food to a patient (especially­perature hot dishes – 50 ° C).
• Feed slowly called each dish offered to the patient; fill spoon 2/3 soft food; spoon to touch the lower lip, the patient to open his mouth; touch lodges­Coy to the language, leaving food in the mouth; of­involve an empty spoon; give time to chew and
  swallow food; offer a drink after a few spoonfuls of soft food; attach “but­sik “feeder cup to the lower lip; pouring a drink
  small portions.

• Wipe (if necessary) the lips of the patient tissue.
• Offer the patient to rinse the mouth with water from the feeder cup postprandial.
• Remove food from the room after the patient’s dishes and food remnants.
• Remove extra pillow and give pa­cient comfortable position.

For the patient, it is desirable to allocate individual utensils that after feeding purified from food residues and washed with a degreasing agent, and then disinfect (see. The following table for disinfection).

Constipation is a condition when the evacuation of hard stools less frequently than necessary. The rate for each particular Paci­cient individual, since, even in healthy people defecating are not always carried DAILY­but, allowing the chair to a delay of three days.

Constipation can cause secondary symptoms, urinary retention, ileus. When intestinal obstruction feces filled straight, thick and sometimes cecum. As long as the stool are in contact with the mucous membraneintestinal membrane, liquid obsorbiruetsya of them, with the result that they become hard. By­power of the mass of feces builds up so much that it removed becomes physically impossible. Time­zhizhenie upper faeces as a result of bacteria can cause diarrhea and leakage fe­potassium, when a patient complains of the appearance of a liquid­th chair in small amounts after defecation absence for a long time. This may be accompanied by spasmodic rectal pain, tenesmus (prolonged false urge to defecate), abdominal distention, nausea, vomiting. Inelderly patients with advanced stage­s disease may develop urinary retention.

A patient who is near death, in need of care, whose purpose – to eliminate symptoms when­repairing inconvenience or suffering. active le­chenie may include changing the diet of the patient’s power: the consumption of large amounts of fluid, fibrous food (fruits, Zele­GOVERNMENTAL vegetables), laxatives.

Laxatives are divided into stimulating­Suitable (increasing motility), stool softeners and osmotic. By means of that increase peristalsis, are:

• bisacodyl (tablets, suppositories or orally);
• sodium picosulphate, Senade.

By means softening the chair include:

• sodium dozukat (norgalaks).

By osmotic agents include:

• lactulose;
• magnesium hydroxide (Milk magnesia);
• magnesium sulfate.

Exercising care of a patient suffering from constipation, you should immediately respond to requests for assistance in the act of defecation:

• to seat the patient on a special boat-chair (or put a vessel under the patient) to posture it was the most convenient and contributed to tension of the abdominal muscles;
• ensure patient privacy and full time
  to perform the act of defecation.

If these measures do not help the patient, you must enter into the rectum with bisacodyl candle or put a cleansing enema, or oil, preferably overnight.

The sequence of manipulations suppository when administered to a patient (candle) with the laxative effect:

• Take from the fridge pack with suppozi­thorium, read the name of the drug carefully;
• help the patient to lie on his left side and bend
  knees;
• Wear rubber gloves;
• Open the envelope, which is packed suppo­zitory without removing the suppositories from the shell;
• Ask the patient to relax;
• Dilute patient fingers of his left buttock hand, right hand, type, squeezing suppozito­ry of the shell into the anus (sheath dol­zhna remain in your hand);
• ask the patient to take a comfortable position for him lying;
• remove gloves;
• Monitor the act of defecation.
  Staging a cleansing enema.

If the patient is bleeding from pischevari­Tel’nykh tract, malignancies of the rectum, he recommended that in the absence of chair for three days to deliver a cleansing enema (Fig. 43).

To put a cleansing enema req­Dimo:

• cook: mug douches, oilcloth, salfet­Ku, container with water in an amount of 1.5 – 2 liters,
  ship, water thermometer, Vaseline, with ste package­-sterile gauze;
• pour into a mug Esmarch 1.5 – 2 liters of water (the­perature water 20-25 ° C, if the patient suffers atonic constipation – water temperature 12 – 14 ° C,
  spasticconstipation Water temperature 37 – 40 ° C);
• hang on a nail mug douches or shta­TIV to a height of 1.5 meters;
• enema tip Vaseline grease coated on sterile cloth;
• fill system: open the valve on the system, let the air out, close the valve;
• put the patient on the left side: the legs bent at the knees and slightly reduced to the stomach;

Note: if the patient lay on his side can not be put in the position of an enema patient “lying on his back.”

• placed under the patient’s buttocks oilcloth covered with a large cloth;
• push the buttocks first and second fingers of his left hand;
• right hand to gently introduce the tip into the anus, first toward the navel­ku (3 – 4 cm), then – parallel to the spine,
  to a depth of 8 – 10 cm;
• open the valve on the system;
• ask the patient to breathe stomach;
• system to close the valve after the introduction of water into the intestine (all the water can not enter, or ass­air children in the intestines of the patient);
• carefully remove the tip of the rectum; ask the patient for 10 minutes at­lying on the back, holding the water in the intestine;
• ask the patient to lift the pelvis, remove fats­fetku, substitute the vessel;
• disconnect napkin enema tip from the system;
• wash with soap under running water;
• dry cloth;
• reset wipes in a plastic bag.
  The procedure for setting an oil enema:
• Prepare: pear-shaped rubber balloon
  capacity of 200 ml, petrolatum, vegetable or vase­Linova oil (200 ml), a spatula;
• heat the oil in a water bath until evap­ry 37 – 38 ° C;
• type in the pear-shaped balloon preheated oil;
• pear-shaped balloon tip lubricate vaseline;
• Wear rubber gloves;
• sheet under the patient and napkin oilcloth;
• help the patient to lie on the left side and pull up the knees to the abdomen;
• Extend the patient’s buttocks and enter Naco­nechnik pyriform cylinder toward the navel to 3 – 4 cm and more along the spine to the depth 10 – 12 cm;
• slowly squeeze the pear-shaped balloon and enter­those of its contents into the rectum;
• extract compressed pear-shaped cylinder;
• treat anal region of the sanitary napkin patient port;
• oilcloth and remove the diaper;
• help the patient to take a comfortable position lying down;
• Treat tip pyriform ballo­on;
• remove gloves;
• explain the patient need to be in, the bed after setting an oil enema in those­chenie 3 – 4 hours to prevent leakage of oil introduced into the intestine.

The patient should be advised this morning NATO­schak drinking glass of cold water, adjust­Vat menu, including foods containing high­Niemi fibers (boiled meat and fish, wholemeal grinding, friable porridge: buckwheat, barley, fruits and vegetables in large quantities), there are often small portions.

To prevent re-lock, you should continue taking laxatives.

Diarrhea – increased frequency of defecation or dilution of feces. If this process Institute­tensiven, it can be described as feces­Noah incontinence. It is necessary to carry out observation­denie chair for the state: whether there is deviation from the rules (presence of blood, pus, mucus, undigested food); also important to monitor the nutritional Paci­cient. Exclude products that contribute to the efforts of­NIJ diarrhea: fresh and dried fruit, nuts, CBE­Giez vegetables, beans, lentils, onions, salads with Majorana nezom, spicy dishes with condiments, alcohol, coffee, fresh fruit juice.

care of the patient suffering from diarrhea, has its own characteristics and demands of attending, care, participation and patience. It is important to carefully slaughtering­titsya of patient health:

• put a vessel under the patient;
• wash the anal area with warm water using a soft cloth;
• wipe dry with a soft cloth;
• lubricate the skin in the anal area with a protective cream or Vaseline;
• put on the patient’s soft cotton underwear.

Not recommended:

• use toilet paper after defecation;
• podmyvanii use with soap (it su­shield the skin).

When caring for patients is very important to do everything possible so that the patient does not feel fear and anxiety, I felt relaxed and comfortable. It is necessary to regularly monitor the condition of the patient, to persuade him to accept more liquid diet number 4, eat 5 – 6 times a day, to familiarize with an assortment of basic products for its food. The patient re diet­mended include: crackers of white bread, soups with fat-free broth, decoctions of cereals (semolina or rice), boiled or steam meat and fish, juice of blueberries, broth hips, tea, jelly, boiled egg (no more than two pieces day), butter (40 – 50 g daily).

Exercises to restore the upper hand movements­her limbs on the operated side pain­nym need to start doing more in the hospital.

At home, they continue to class, to restore full mobility of his hands. Here are the exercises taken from the prospectus published by the Association­s on problems and breast cancer mastekto­Mia (USA).

Exercises for shoulder and arm

• Hair Bicombing.

Place the elbow on the edge of the bedside tumboch­ki. Keep your head straight. Start with brushing­Niya one half of the head, then gradually ne­Passing to another. Do not overload, but be persistent.

• Clenching and unclamping hands Use a rubber ball or other object (Fig. 9).
• Swing and rotate the hand.

Put a good hand on the back of a chair and OPU­Stith on her head (forehead). Let other hand freedoms­but hangs down, shake it from side to side and forward and backward, make small circles of rotation. As soon as the voltage in the hand Decrease the­erably, increase range of motion and dia­meter circles. Do the exercises before gaining full mobility.

• «To lock the bra.” really­wee hand in hand, then dip the brush and predple­whose leaving the shoulders at the same level, then slowly crank arms behind his back to the level of the bust­galtera.

“Sliding on the wall.

Stand with feet shoulder-width apart, so as not to sweat­ryat balance. Stand close to the wall and they believed­nites to face her. Start with a situation in which hands are at shoulder level, and gradually re­burghers hands up the wall. Again lower your arms to shoulder height, sliding along the wall. Exercise several times a day, every day notes­those achieved level and “jobs” for the next day.

• Exercise with a cosmetic bag.

For a small purse or other likeness­ny thing. The right arm – near the right shoulder, left – behind. Slung handbag (kos­metichku) from his right hand to the left. Repeat pack­razhnenie 5 times, then change hands.

With the help of a towel or other like before­meta make light movements simulating wiping back. Repeat the exercise with the other hand.

Within a few days or weeks it may be some post-operative discomfort, but all the same and it will pass. For example, marked tingling, sensation of constriction in the rumen or a mouse, may increase sensitivity.

If redness appears in the area of ​​the scar or burning sensation, it is necessary to notify the doctor. There are discomfort and stiffness in the shoulder­Vågå joint, especially if removed axillary lymph nodes. Common operations, such ascombing the hair with this hand every day,­Mogan overcome such feelings. The patient should try to use the hand as usual­but, but avoid heavy housework and raised­ment weights of at least the first 6 weeks after surgery.

Pain, dysuria (frequent or painful urination), incontinence or urinary retention, bladder spasm, and similar symptoms in patients with advanced forms of cancer can be Obus­catching both primary tumor process so and metastatic lesions. The reasons for the similarity­GOVERNMENTAL violations are also malignant OPU­Cholewa growth, causing pain, mechanical time­Drazhenom or spasms of the bladder, spinal cord compression, plexopathy, hypercalcemia, and more. As a result of cancer treatment are developing post-radiation or drug cis­Titus, post-radiation fibrosis, asthenia (infectious complications, inability to self­mu bowel). It also includes­Xia side effects of diuretics, as well as comorbidities: prostate adenoma, urolithiasis, hemorrhagic di­Ames, diseases of the central nervous system.

Urological complications can be prevented by the following measures:

• provide the patient with an opportunity at an optionally­go to retire;

conduct a thorough hygiene of the skin in the area

genitals;

• using regular diaper pin­rolirovat their purity (every 2 chasa kruglosutoch­but);
• monitor the regularity patients bladder emptying (every 2 – 3 hours);
• ensure as far as possible, the process mocheis­blowing in women in a sitting position, and men – standing (it promotes complete emptying of the mo­chevogo bladder);
• control the reception of a sufficient quantity of liquid.

With extensive local spread swelling­Whether bladder catheterization. Some patients even temporary catheterization­tion of the bladder may become intractable psychological problem. Therefore, you must patiently and clearly explain that the purpose of proce­fools – provide maximum comfort patsien­the. When atony of the bladder, its constant obstruction or incontinence, bedsores, wounds perineal shows prolonged bladder catheterization.

The patient should follow the recommendations for the catheter and drainage bag care, connect­yuschimsya catheter. In order to reduce the riskof infection should be used twice a day and after each act of urination process catheter and the surrounding genital area:

• Prepare a container of warm water, wipes, liquid soap;
• Wash your hands and treat them doubly anti-­septic solution (70-degree alcohol solution, 0.5-percent solution of chlorhexidine
  bigluconate);
• napkin soak in warm water with a liquid soap;
• treat the tissue by the catheter into the urethral opening direction (to prevent ascending infection);
• change the cloth and handle the catheter adjacent to the genital area;
• wash your hands;
• observe and promptly report to your doctor about the appearance of secretions around the catheter.

A similar sanitization is performed and as filling the drain bag, which is attached to the patient’s femur or tibia or on the fixed bed frame seriously ill Paci­cient. The catheter and the drainage bag may be with­Uniform for 5 – 7 days. To ensure a good flow of urine, the receiver should be crucifiedfalse below the bladder. This is especially important at night. We can not allow the tube twist, for which the outflow, as this could lead to disruption of the flow of urine through the catheter.

Emptying of the urinary drainage bag:

• wash hands, wear gloves;
• put the container for collecting the urine at the discharge pipe of the drainage bag;
• free outlet tube from the holder;
• open the tube clamp, drain urine into the container (branch tube does not touch the wall of the container for collecting urine);
• close the clamp;
• wipe the end of the outlet tube swab dipped 70-degree alcohol (twice);
• consolidate the branch pipe in the holder;
• off the gloves;
• make sure that the tube connecting the catheter and drainage bag is not kinked (see. fig.).

Remember!

• The patient should drink more often to the urine was less concentrated. Recommended juices, preferably cranberry helps to prevent infection.
• Exercise regularly care for the perineum, from front to back, followed by drying of the skin.
• Observe the condition of the skin of the perineum, for the amount of urine, its color, about­transparency, scent
• Inform your doctor about any pain in catheter site, about changes in the urine.

Intermittent catheterisation is performed for regular and effective voiding­of the bubble in disorders caused by attenuation­eating or lack of muscle tone, as well as in the case of obstruction of urine outflow. frequency catheter­tion depends on the function of the urinary pu­Zira and 6-12 times per day for 1 – 2 times a week. Patients can learn to performmanipulation for the catheter itself­-sustaining (self-catheterization). The procedure is performed aseptically. periodic ka­teterizatsiya Nelatona performed using the catheter, which is a cylindrical tube with drainage holes (Fig. 46). Women self-catheterization, “wash your hands, to retire;

• undercut front to back in the direction of the anus, to avoid the risk of infection;
• wet genital area dry with a clean cloth;
• sit on the edge of the hard bed or on a chair;
• put in front of the bed or chair mirror so that you can see the opening of the urethra and surrounding area (you can determine the presence Ureta­ ry to the touch);
• placed between the legs of the capacity for the collection of urine;
• handle hands twice with 70-degree Speer­Tom;
• open the package the catheter by atRonchi;
• take the catheter in the area of ​​the funnel and put on He gel (if the catheter has no lubricant on­covered), without touching the catheter;
• with his left hand to breed big lips in the genital area, right – enter slowly into the urethra kata­ter to a depth of 4 – 5 cm;
• lower end of the catheter into the vessel for collecting urine;
• after reducing the outflow of urine slow start­but withdraw the catheter from the urethra;
• Wash and dry your hands, get dressed.

Men self-catheterization:

• wash your hands, to retire;
• wash the glans penis, slightly pulling the foreskin of the urethra down;
• wet penis dry with a clean cloth;
• sit on the edge of the hard bed or a chair (WMS­but to carry out the manipulation of standing);
• placed between the legs of the capacity for the collection of urine;

handle hands twice with 70 gradusnymspirtom;

• open the package the catheter by at­Ronchi;
• take the catheter in the area of ​​the funnel and put on He gel (if the catheter has no lubricant oncovered), without touching the catheter;
• with his left hand to take the penis, right – a catheter;
• gently, slowly introduce a catheter through the urethra into the bladder;
• forward end of the catheter into the vessel for collecting urine;
• slowly withdraw the catheter when the urine flow is reduced, stopping the renewal of urine – ensuring complete emptying of the bladder;
• tightly close the funnel opening pointer­nym right thumb until complete removal of the catheter from the urethra (urine to prevent falling
  on clothes);
• without removing your finger from the funnel to the container to bring the catheter for urine collection and release the funnel to collect urine in the catheter completely you­flowed;
• Wash and dry your hands, get dressed.

If it is impossible transurethral catheter­tion bladder patient superimposed epitsistostoma.