Before beginning the procedure make sure that the container with the material to change contained everything you need. Then you need the following:

• Prepare a clean Colostomy bags;
• Increase scissors central opening of the plate so that it accurately BME­schalo a stoma;
• Separate gently used kalopri­emnik, starting from the top (try not to thee­pull the skin);
• remove Colostomy bags used in the gas­that, in a paper or plastic bag;
• Clean the skin around the stoma using a dry gauze or paper towels;
• rinse with warm water and wipe the stoma and the skin around her blotting movements;
• get wet wipes skin around the stoma dry (do not use cotton wool – it leaves on the skin of the villi);
• apply a protective cream and massage until complete absorption;
• stick to clean the stoma Colostomy bags using manual.

Application of the adhesive (adhesive) stoma bags (single-component):

• Remove the wrapping paper;
• Position the center of the hole over the stoma, Execu­Zuya mirror to check the correct position;
• press down evenly and make sure that the plate is smooth and has no wrinkles, folds;
• check the correct positioning of drainage­of the bag opening (bottom);
• Make sure the latch is in the closed position,

Two-component Colostomy bags worn differently. Adhesive (sticky) plate can remain on the patient for several days, untilyet provides comfort. The plate has a flanged ring of different sizes. To select op­optimality size of the patient is necessary to remember, that the diameter of the flange ring should be approximately 12 mm larger than the diameter of the stoma.

Your actions should be as follows

• determine the contour of the stoma;
• draw the outline of your stoma on the included template;
• cut the corresponding hole;
• apply a pattern on a support plate;
• paint over holes and contour cut (up responsesstiein the plate should match the size of your stoma);
• remove the plate protects its boom­gu holding plate for the flange ring;
• apply it to the stoma;
• press and smooth the first plate about the flange ring, and then – at the edges;
• Make sure that the bag walls are not stuck together before you put it;
• align the lower flange portion of the plate and the bag, and, starting from the bottom, gently presses­those on the circumference of flange rings, until they snap in the right place and will not­reliably fixed;
• Pull down the bag to make sure to­Connection reliability flanges.

In the care of stoma patients admit typical­nye errors leading:

• mechanical irritation when changing stoma bags;
• skin irritation chemical substance­E;

“A rapid peeling plate holes due to rinsing under the shower plate;

• an incorrect closing of the clamp when one uses­mations drainage bag;
• When gluing the bag is loosely at­Mounting by a plate, which can cause it to sweat­re.

If a patient – an elderly man and is reusable ileostomy, you must otre­gulirovat the act of defecation, and dress him roofingto the period of defecation. Colostomy bags freeing­content of dissolved, washed, and stored in polyethylene­tion package. Between acts defecation mozh­but wearing times sew oval four-six-layer cloth to sew her waist with one hand, and on the other – buttons or hooks.

After defecation with a soft cloth should wash the skin around the stoma with warm water and we­scrap. Dry dry with a soft towel. greasethe skin around the stoma paste “Stomageziv” and on the intestinal mucosa apply Vaseline, warning drying of the mucous membrane bleeding and the appearance of cracks. Then apply to the area of ​​the stoma napkin, folded in four layers and lock her belt. From top to put on underwear.

Currently it offers a wide range of products for skin care around the stoma. Pasta “Abutseya” is designed to protect the skin and scarring of tissue around the stoma. The paste has healing properties. “Statin” – poroshkoob­misc dressing means is used for treating the skin around the stoma as ranozazhiv–governing means.

The patient and his family should be aware that the nature of power has a decisive influence on the hour­Tautou his chair.

Anyone with a stoma bowel eating­a balanced diet at regular intervals, and slowly, carefully chewing on it. Patients should be warned that by­from the point, and other indigestible food components will be visible in the stool.

People with a colostomy does not require restrictions on food, although many products may cause IU­teorizm. Most ileostomy not Propus­cabins smell and some (bicomponent) have the valves for the release of gases, in some way solve the problem of flatulence.

People with iliostoma for 4 – 6 weeks pos­le operation is necessary to avoid the rich tartan­Coy and giving in feces much indigestible hour­particles products. In the following high-fiberproducts can be added in small amounts. Beli person can not tolerate such food, after two or three attempts to exclude it from the diet.

During the day, should be separate from the solid food use of at least 1500-2000 ml liquid and 6 – 9 g of salt. The patient should know that ileostomy results in a shutdown function of the colon. The small intestine is only partially compensated capable­Rowan opportunity colon to absorb water and mineral salts to produce some wi­Tamino. Ability to accumulate and regularthe contents of the allocation is lost completely. But by the end of the second month after the surgery the small intestine is adapted so that the majority of patients can restore the old regime and ha­rakter power. Food is better to take regular­but in small portions. Fasting or restricting food intake leads to throughdimensional formation gases and diarrhea. dining beam­Chez early and eat a small Included Quantity­, an initiative which will lead to fewer vyde­tions through the stoma in the night.

At the same time, patients should know how way certain foods affect oporozh­nenie intestine.

Products that accelerate intestinal emptying­ka: sweeteners (sugar, honey, fruit); god­Tide table salt – pickles, smoked­obtained; spicy food; rich plant checkered­Coy – black bread, some raw vegetables and­you, fat (including vegetable oil), green F­salt, spinach; milk, fresh yogurt, fruit-flavored water, juices, cold dishes and drinks, ice cream,beer. Spicy food should be consumed carefully, in small amounts, combine them with rice, Ma­Karon or potatoes.

Accelerate gastric emptying excitement, then­roplivaya food and lifting weights.

Thickener content coming from the small intestine, it is possible to make rice, blueberries, ter­Tide apples, jelly.

Products that delay emptying ki­shechnika,They include astringents and legkousvai­Vai dishes, including white crackers, cereals, cheese, mucous soups, corn, pureed oatmeal, raisins, dried fruit, rice, warm pureed soups, jelly, strong tea, coffee, cacao, natural coloring­Noah wine (nekreplenoe).

Constipation also leads a sedentary lifestyle, a limited amount of fluid (less than 1.5 liters per day) as well as some medicinal fluids­CTBA (analgesics, antidepressants and others.).

Products that do not affect gastric emptying:Steam and chopped meat, fish, eggs,­grinding the fruits and vegetables without skin and bones­check, wheat bread.

Peel tomatoes, apples and corn, Ore­chi, cucumber or citrus pulp cause SIS­we bowel, leading to abdominal pain.

However, be aware that the response to the received­May of individual foods, Conse-­quently, each picks up a diet self parking­tion.

Calm and lax lifestyle with length­tion exposure to fresh air and mind­rennymi physical activity as a way to­exists a satisfactory function thin quiche­ki. ”

For choosing the right diet Paci­entu with iliostoma, upon returning home after the operation, you need to keep a diary, where he will be employed to record their food, their number and the reception, as well as the time of bowel movements, the consistency of secretions, odor, and if­honors flatus (subjective oschu­scheniyam) through the stoma. Be sure We mention­chat appearance of pain and the amount of urine. Maintaining such a diary during the first 4 – 6 no­del after surgery the patient will accurately yc­thanes, what foods and how much more acceptable to him. Form diary could be next.

When it is clear the effect of different foods on the activities of the stoma, on the future conduct of the diary can be dispensed with.

Due to the fact that the same products can have different effects on the composition and volume of discharge ileostomy, strict instructions on diet can not be given. You can give the patient a recommendation that the best return to the pro­ucts that are more likely to use them to the opera­tion figuring when administered diary those to­torye bad influence on the activities of the stoma, and­gradually abandon them.

Below is a list of foods developed in the State Research Center of Coloproctology MZRF, which can serve as a shout­entirom in formulating the diet with ileostomy.

The drinks: tea, herbal tea, broth from rosehips, cocoa, coffee weak, mine­tral gas without water, fruit juice (after meal), beer, wine.

Grain mill products: wheat bread white or gray yesterday’s batch, buns and Pec­Nya, white croutons of bread, sponge cakes.

snacks: mild cheese, low-fat herring, caviar payusnaya or grain, meat pate homemade.

fats: butter, ghee, vegetable.

eggs and dishes from them: boiled egg, boiled (not more than one egg per day), scrambled eggs as part of other dishes.

Milk and milk products: milk in Natu­eral form is strictly individual, because most people cause bloating and­nose. To maintain the correct composition of micro­the intestinal flora is recommended every morning to drink kefir. Suitable cottage cheese and processed cheese.

soups: Different loosely on meat, fish or chicken broth with different cereals, pasta, noodles, mucous broths; vegetables, pureed soups.

Meat and fish dishes: various products of low-fat beef, veal, lean Petit­tzu and fish (roasting when not rolled in su­haryah not to form a rough crust).

Cereal and pasta: cereal, pudin­Ki-baked patties from cereals without gross shorter­ki, boiled pasta, vermicelli. Cereals before­respectful rice and semolina.

Vegetables and herbs: Puree a variety of vegetables, ny­Ding, vegetable patties, baked without a crust, cauliflower boiled with butter, early kabach­ki and pumpkin stew. Finely chopped, early, raw herbs (dill, parsley) can be added to various dishes.

Fruits and berries: puree, jelly, jellies, mousses of different fruits and berries, dry and fresh. Jam in a limited number.

Sweet dishes: sugar, sweets and biscuits in a limited number.

Sauces and spices: in a very small amount of meat and fish sauces, tomato sauce, mayonnaise, a bay leaf, onions in moderation.

Salt: 6 – 9 grams per day.

Food is recommended to take four times a day at the same hours.

Not recommended:

products from fancy and warm dough, fatty meats, poultry and fish, smoked, marinades, meat, fish and other oils and concentrates, sausage, cold drinks, ice cream, vegetables and­you’re kind, fried eggs (fried), sharp cheeses, overheated fats, fat dessert, drinks, mustard, vinegar, saffron.

Sample menu for a person with iliostoma:

8.00 – 9.00 – Steam fish cutlets with maps­felnym puree sauce. Vermicelli with oil. Butter, tea, white bread.

13.00 – 14.00 – soup of carrots and POTATO­A meat broth with croutons. Meatballs meat with bechamel sauce and noodles. Apple mousse. Bread gray.

19.00 – 20.00 – semolina pudding, baked with grated cheese, and sour cream. Carrot Cutlets­nye, fried without flour and breadcrumbs. Tea, white bread.

22.00 – jelly, biscuit yesterday.

The patient should know that no closing apparatus in colostomy does not allow to hold the intestine gases. However, gassing can try to adjust. Their abundance and expectoration observed in colitis and gastritis with reduced­Noah acidity before the imposition of colostomy. In these cases it is advisable to consult a doctor and treat these diseases.

Excessive flatulence is also observed in the use of milk, especially boiled, potatoes, cabbage, cucumber, radish, beer, peas, beans, nuts and other products. The use of activated carbon significantly reduces to­amounts of gas in the intestines.

Part ostomy patients Decrease the mark­shenie gases in the formation decreases ratsio­not bow.

Some products give excessive feces­but the putrid smell. This is – cheese, eggs, fish, F­salt, onion (different), cabbage (any), as well as the neko­torye vitamins and medicines.

Reduce the unpleasant odor of feces: cluck­Gov. juice, cranberry juice (after a meal in the afternoon), yogurt, kefir (in the morning).

When the malodor accompanied­guide gassing, it is recommended to use a special, odor absorbing pads. In Colostomy bags can add a special pore­shock, neutralizing odor, tablets, activated­bathrooms coal or aspirin. Deodorant will not design­nyaet smell but only mixed with it, giving it a sharpness that can attract the attention of okra­zhayuschih.

As with an ileostomy, it can be argued that the spe­Hoc diet for a patient with a colostomy is not su­exists. The ideal is to return after the operation to the usual diet and regime pita­Nia in steady regular emptying.

The possible development of constipation is topical­theme in an in patients with colostomy. Preference should be given such products: pshenich­Nome and rye bread, wholemeal Pomo­la, dough; soups with meat is saturated­Mr. broth with plenty of coarsely chopped vegetables (beets, cabbage, beans); dishes lean meat, fish, poultry; dishes and garni­frames made of flour, cereals, legumes and pasta; mushrooms; fresh fruits and vegetables in natural form or slaboprovarennom; milk (at endure­Bridge) and various milk products; not­strong tea or coffee with milk (cocoa excluded­chit); juices and mineral water cooled. Meals may be prepared in any form, salt is added to taste. The volume of consumption of the Jew­bone – at least 1.5 liters per day. It is recommended for­Nima eat at least 3 – 5 times a day, at one and the same time.

It must be remembered that the right food in the presence of an ostomy although not completely solve all problems, however, it is a prerequisite for conducting a full zhiz­no.

In addition to the diet for the regulation of the chair by a doctor can use some drugs that affect the function of the intestine. If constipation is possible with­Menen laxatives, but it is also necessary to coordinate with your doctor as to the pain­shinstvu of them comes highly addictive.

We must remember that life with a stoma – is not a disease. But the operated people in the first year after surgery as a young child must learn to live with a stoma, adapt to it. And it’s not just a problem for ostomy care, but also psycho­adaptation logic.

In most cases, patients with a stoma WHO­rotate to a normal life and go to work that was performed prior to surgery. However, to engage in heavy lifting, digging or heavy manual labor is not recommended. If ahis work involves heavy physical LOAD­Kami, it may be necessary to change it.

A person with a stoma can travel with the following items necessary items for the care of one hundred­and my colostomy bags.

With careful planning, training and ReA­bilitatsii people with a stoma can be engaged in de­Lamy that I did before the operation.

The patient is not contraindicated: swimming in the water­emah, exercise – limiting, of course, the load on the abdominal muscles. Colostomy is not an obstacle to the sexual life of the patient, polo­Wai potency when it is not reduced. possible on­Rushen, wearing a purely psychogenic. There are many instances when young patients have a family and children. Man is not dollars­wives “to go into the disease”, avoid everything that makes life a varied and interesting.

Сare of the patient with a gastrostomy

When obstruction of the esophagus associated with not­resectable tumor is superimposed on the stomach fistula, gastrostomy, which is introduced through pipe­ke made patient nutrition. Much less, if you can not supply through the stomach, similar to the fistula-eyunostoma superimposed on the jejunum. In both cases, the hollow body (the­ludok, jejunum), hemmed on the front bryush­hydrochloric wall rubber tube is introduced, so that­It is attached to the anterior abdominal wall suture or adhesive tape strips a length of 15 – 16 cm Tube.­ka introduced near laparotomic wounds sewn up tight.

The patient is administered high calorie easily assimilated food semiliquid consistency. Often­she feeds – 4 – used once a day. after eachFeeding should be carried out in the toilet area of ​​the stoma.

Relatives should participate in the core­straightening of the patient through a gastrostomy, since this process requires a lot of patience and tact in connection

the fact that quite often patients suffer from lack of appetite, aversion to food. should teach­Tyva tastes of the patient, his preference for this or that dish. Throughout the procedure, feed­Nia food should be warm and look APME­titno not to deprive the patient of taste Feeling­Nij. For wet food and saliva secretion of digestive glands excitation patient before­Laga chew food and then depositing­Vat its mouth (spitting) to the funnel, from wheretogether with the liquid mixture is injected through the tube into the stomach food.

For feeding the patient should:

• prepare: a glass of water, the capacity for pro­myvnyh water glass or plastic crows­Ku, sterile pack of napkins clamp polyethylene­new bag to dump waste fats­fetok, liquid and solid food consistency
• remove the rubber tube napkin close­and a conductive input terminal, reset a garbage bag;
• inserted into the end of the rubber tube a glass or plastic funnel;
• pick up the funnel, slightly bent in a hundred­Ron patient;
• give the patient a plate of food for chewing;
• offer the patient shift (spit) chewed food from the mouth into the funnel;
• pour chewed food warm liquid pi­schevoy mixture;
• Rinse the funnel and a rubber tube after core­straightening warm tea, rose hips extract (to avoid putrefaction of food residues in the rubber tube);
• remove the funnel;
• imposed on the end of the rubber tube is sterile­hydrochloric napkin and pinch clip;
• fix clamp loop length of bandage, wound up the patient’s neck;
• give the patient a glass of water and put a number capacity for washing water;
• help the patient to rinse the mouth of the food;
• clean washing water tank;
• give the patient chewing gum (for pre-­warnings related stomatitis formation in the oral cavity).

Note: remove the plastic trash bag. Wash and boil funnel dvuhpro­percentage soda solution for 15 minutes with a mo­ment boiling. Dry the funnel and put on the bedside table, covered with a cloth.

The skin around the stoma treatment is carried out on a daily basis, since the gastric juice, falling on the skin, causing irritation.

Actions in this should be the following:

• prepare 0.5-percent solution of chlorhexidine bigluconate or 0.5 percent solution of potassium permanganate, scissors, a spatula, a paste or Lassara zinc ointment, an adhesive plaster, a package with a sterile dressing, polyethylene­new bag, a container with warm water;
• explore the strip adhesive tape, which is wrapped and attached to the patient’s skin glands,­A new tube;

Note: otkleevanii with adhesive tape must be replaced: preparing strip adhesive tape length of at least 15 – 16 cm rubber tube is folded and fixed to the skin of the patient.

• put a bottle of ointment in a container of warm water;
• wash your hands twice with soap and treat them with alcohol;
• to treat the skin around the stoma tissue, SMOchennoy 0.5 percent solution of potassium permanganate (blotting movements;
• throw in the towel made of polyethylen­Lenovo bag;
• dry skin around stoma dry sterile cloth;
• throw the tissue in a plastic bag;
• cause spatula sufficiently thick layer (at least 0.5 cm) heated paste Lassara or zinc ointment sterile towel, cut type “pants” (first napkin is placed down cut, the second – the cut up, the third – on the left, the fourth – right);
• fold gauze in four layers;
• make it a cut in the center;
• Lay napkin with a large opening on the top of sterile napkins and output the rubber tube through a hole in a napkin;
• glue strips of plaster cloth big four sides.

Note:

1. After feeding through a gastrostomy leave the patient in the “reclined” position for 30 minutes.
2. When caring for a patient having a gastrostomy tube should be positioned so patsientav bed, so he was not lying on the probe.
3. Through feeding a patient through the gastrostomy and watching her in the intervals between the armature­straightening, make sure that the probe is well fixed in the stoma and the content does not appear either
   through the stoma, or through a tube.

In case of violation of the natural flow of urine associated with a tumor of the prostate, it is the high section of the bladder. In epitsistoma can be created during this operation (view urostomy) – suprapubic urocystic fistula (up responses­stie in the bladder to drain urine).

If epitsistoma left for extended periods or permanently, urine drainage is carried out through the catheter capitate Petstsera Malek, who at sformi­Rowan fistula do not require fixing. replace kata­tera produces a doctor at least once a month, as there may be blockage of the urinary catheter salts.

The distal end of the catheter through the tube conn­nyaetsya a urinal. If the patient walks,drainage bag attached to his legs, or troubles­ru, if the patient is lying in bed, the bag is suspended from the frame of the bed.

Patients with long-term epitsistomoy can locat­be under outpatient observation.

With sufficient bladder capacity Paci­UNT is in the daytime do not containe­Conner urine collection, and closing the outer end of emptying the bladder, as usual, with The appearance­lenii urge to urinate.

If the condition and age of the patient to allow the deal with the case familiar to him, for it­nd there are no contraindications. To by Paci­Enta no unpleasant smell of urine is required­mo more frequent hygienic measures in the genital area and epitsistomy. Processing Epicyte stoma-the same as the processing gastrostomy (see. “Processing gastrostomy”).

The use of the urinal with urine incontinence in men

Incontinence patient applied the bag, which helps keep the patient clean underwear and does not exude unpleasant odors.

To do this:

• prepare: urinal, urine container, the connecting tube, gloves, wipes, antiseptic solution, oil cloth, most napkin;
• ask the patient to lift the bowl and lay it under the buttocks and napkin oilcloth;
• ask the patient to bend your knees slightly and push them;
• wash hands and treat them twice with 70-gras­dusnym alcoholic solution;
• between the patient’s thighs to put the container with warm water and soap;
• and move the foreskin to expose the glans penis;
• the treated area of ​​the outer opening urine­emissivity channel;
• dry with a dry cloth;
• open the packaging with a urinal (it Napo­Mina on the form and type of condom);
• grab the penis with his left hand;
• take right hand over the bag zhestkuyuchast;
• lift the penis and put on his head the bag;
• Roll out the bag to the base of the penis;
• secure the bag at the base of the penis special adhesive tape;
• inserted into the bag the connecting pipes­ku; attach the bag to a container to collect the urine.
• fix the container on the bed (if PA­cient does not go as well as at night) or on the patient’s thigh during the day, if he goes;
• remove the container with water, oil cloth, napkins by­Place in a plastic bag;
• wash your hands twofold.

Note: a container for collecting urine q.s.­Dimo rinse thoroughly and pour onto bottom few crystals of potassium permanganate to prevent malodor.

Patients recovering from surgery can improve your immunity by using the people advice­Noah medicine.

onerecipe.

Take 300 grams of dried apricots; 300 grams of raisins; 3 with lemon peel.

Mince and add 1 table­honey-hand.

Take: on the first spoonful – adults at first a teaspoon – children, 1 times a day, preferably in the morning on an empty stomach or before dinner, one hour before meals. It can be taken at night.

2recipe.

Mark: 100 grams of treated ground nuts; 100 grams of pureed peeled apples; 2 limo­on (juice); 1 tablespoon honey.

The whole mass of mix. Accept composition according to the first tablespoon (1st teaspoon) 2 – 3 times a day before meals.

3recipe.

Lemon grind with garlic (1 lemon zest 1 head and garlic). Can all be chopped. Behind-

casting the cooked weight of 0.5 liters of boiled water cooled. Close the container with the prepared mixture and place in refrigerator for 3 – 5 days.

Take the first spoonful in the morning on the­empty stomach. Taken continuously until you come on­are positive changes in the body.

All the mixtures should be stored in the refrigerator.

During radiation and chemotherapy Paci­ENTOV decreased blood hemoglobin. To increase the hemoglobin level is recommended for­ratit attention to well-known plant – edge­beer burning, or rather, on the juice of this plant. Kra­Beer has unique medicinal their­properties. Fresh nettle juice squeezed from May to September. Fresh nettle shoots are cut and about­passed through a meat grinder or a juicer.

Take: for the first 1/2 teaspoon in a glass of water 20 minutes before eating.

nettle juice is good mixed with birch – except in­Denia 1: 5, in a mixture with carrot – a dilution of 1: 2.

When receiving the juice not only increases blood hemoglobin, but in general strengthens the body by enhancing immunity. folk Celite­Whether called nettle vitamin piggy bank. It contains vitamins C, A, K, B2, E. Moreover, vita­With the mine in the leaves of the nettle twice more than in the berries of black currant, and vitamin A, no less than in carrots and sea buckthorn fruits. A lot of it, and the green pigment chlorophyll, protein. The nettle contains a significant set of mic­element deficiencies of iron, nickel, copper, promoting

formation of red blood cells and improve gemoglo­Bina.

Attention! We should not get involved in regular cooking nettle people suffer­conductive hypertension, since nettle accelerates blood clotting and may contribute to thrombosis.

Palliative care begins when all other treatments are no longer effectiveness­tive, when a person starts talking about Smer­minute, when they begin to deny the vital organs. The aim of this treatment is to create opportunities for the patient a better quality zhiz­no. It should be aimed not only satisfies­letvorenie physical needs of the patient, but also to meet the equally important – Psychologists­iCal, social and spiritual.

In the palliative treatment of primary purpose is not to prolong life and make the rest as comfortable and meaningful as possible.

Palliative treatment will be effective:

• if it is possible to create and maintain for PA­patient’s comfort and safety conditions;
• if the patient will feel the most their independence;
• if the patient does not feel pain;
• If, despite the impending loss of life, providing patient support system for­he may live as actively and creatively as much as possible for him.

Relatives should actively participate in the palliative treatment of their loved ones. In order to provide support to the patient, should give him the opportunity to express their feelings, even if it will be feelings of anger, grief. Not to let the manifestation of negative emotions. Tact, resists­ka, attention, sensitivity to help families in dealing with the patient.

Communicating with the patient, try to set aside time for him to see that you do not rush­Tes. You should always keep in mind that if your near­cue the person is terminally ill, he sometimes does not feel fear and despair, until he sees the fear and despair in the eyes of others. About the diagnosis of PA­cient can guess by your eyes, Mimi­ke, gestures, ie body language. You should not pretend to be cheerful, to lie, to avoid direct and honest conversation. False optimism is the destroyer of hope. It is absolutely not taken into account, that the orientation only on the positive­tion in life brings a person relaxes and cheating, making it unstable in the mountain. He can not cope with the dropped its share of misfortune­eat.

The patient can follow the most insignificant­GOVERNMENTAL changes and interpret them as if­signs of improvement or deterioration of their consisting­Nia. In any case, knowing that he was doomed, trail­a fight for the quality of life, not its duration. It should agree with that­Kimi patient decisions as refusal to eat, and by visitors, or vice versa – the desire to see them. It is necessary to continue the basic nursing care, aiming to perform gigieniches­FIR procedures to ensure the purity of the skin and

prevention of pressure ulcers. It is recommended to apply and relaxing treatments such as deep breathing, rubbing and massage, to­extremities.

Currently, the organization created, obe­Dinh efforts of medical staff, the priesthood­nicks and psychologists to assist the hopeless­nym patients.

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.