Special exercises will help improve the core­nazh lymph prevent fibrosis, increase the effect of the contraction, to expand the range of motion swollen limbs, prevent stiffness su­pose. Requires regular systematic motionvoltage swollen limbs, as the contraction of the muscles and stimulates the flow of lymph and blood circulation. If the execution of active movements difficult, the patient should be twice a day to perform sparing exercise.

It must be remembered that too vigorous, requiring effort, exercise can sometimes be at­incur damage as cause dilation of blood vessels and increases the flow of lymph. Patsien­there with swollen feet should not sit or stand for a long time, to move heavy objects – is reducible­dit to stagnation of blood and lymph. Not recommended for­Niemann arms at an angle greater than 90 °. Such a provision reduces the space between Clue­chitsey and the first rib, circulatory disturbance­Nia and leads to increased edema. Avoid at­standing use of support bandages for hands. Use them only during walks.

Self-massage and lymph drainage

Massage is performed in order to lymph flow was starting from (irreducible) lymph vessels to the deeper muscle (abbreviated­schimsya) lymphatic vessels.

The majority of patients with lymphedema after mastektomii have swelling, extending from the fingers to the upper torso. Swelling of the lower part of the body is observed in patients with lymphedema of feet.

Massage – the only way to cope with the swelling of the body, allowing more freely lymph drained from the swollen limb. Methods wt­black: stroking straight, bowing­Suitable strokes in the direction from the hands to the armpit or groin to the foot of­domain. Massage axillary carried slow circles for one minute.

Tracheotomy (incision of the trachea) is carried out in cases where the natural airflow through the trachea is not possible – for tumors of the larynx, vocal cords.

Patients who undergo surgery, both before and after surgery, fear to choke. It is therefore very important to prepare the patient’s tracheostomy. Both the patient and his relatives must realize that after the operation he could not talk because of cough and breathing strifroznogo. The patient will need care for tracheostomy tubes­Coy, so the patient and his family members have to learn to take care of a tracheostomy.

A patient in a permanent tracheostomy The necessity­ma metal tube (Fig. 24). It consists of three parts:

  • the outer tube (cannula) having a side opening for ribbons which it is attached wok­pyr patient’s neck;
  • guide (guiding unit) from the closed end, which puts the tube in place; Apply­out only with the introduction of the tube;
  • inner tube (cannula), standing in traheo­stoma with an outer tube, can be removed for washing.

Models of the inner tube somewhat, but better use a metal tracheostomy tube having a lock-box, allowing to­reliably hold the inner cannula. Constipation-FLA­Joc must always be closed, or on coughing or even during washing, the inner tube may fall out of the outdoor. The outer tube fic­siruetsya ribbons around the neck, so you need to make sure that the ribbon untied Yai, otherwise­ruzhnaya tube may pop out of the tracheostoma when sudden movement or coughing, resulting asfik­these (suffocation) as tracheostomy immediately closed without tubes.

The outer tube can be removed or replaced only by a doctor, an inner tube – at home whisker­loviyah trained member of the family or the patient himself. For the care of a tracheostomy patient must “cook: with sterile cloth bag­mi vial with 70-degree solution of ethyl alcohol, brush, roller, bottle with sterile glycyl­Rene, a container with two percent soda sol­rum (1 teaspoon to 120 ml of water);

  • Remove the bandage covering the hole pipe­ki;
  • Wash the hands;
  • stand up in front of a mirror;
  • turn lock-box outer tracheotomy­cal tube to the “up”;
  • take the “ears” of the internal tracheal tube between thumb and forefinger and firmly secure them in his hand;
  • lock plate outer traheoto­nomic tube on both sides with the other hand (so­the thumb and forefinger)
  • extract of the “ears” in the direction of ourselves Dugo­shaped movement of the inner tracheotomy tube from the outer tube;
  • lower inner tracheal tube into the container with two percent soda solution, preheated to a temperature of 45 °;
  • treat the inner tracheotomy tubes­ku a brush in a container with two percent soda ra­the shots from the crusts and mucus (until you remove all the peel);
  • Rinse the inside tracheotomy tubes­ku under running water;
  • dry the inside tracheotomy tubes­ku sterile cloth;
  • handle doubly inner tracheotomy­ical tube cloth moistened with a solution of 70 -gradusnym ethyl alcohol;
  • Moisten a sterile gauze sterilenym glycerol and lubricate the outer surface of the inner tracheal tube;
  • Shake before you enter it into the outer tube to her left drops of glycerine \ (drops remaining on the tube, can cause coughing); j
  • lock plate outer tracheal tubes thumb and forefinger of the left hand;
  • take the “ears” of the internal tracheal tube between thumb and forefinger of his right hand and put into the hole of the outer tube;
  • fix the inner tracheotomy tube by moving the lock-box to the “down”;
  • remove the container with water, ruff and drugs;
  • Wash the hands.

Note:boil in a special emkos­ti 2 ruff (one – substitutes) within 30 minutes of boiling water. Drain after boil­Niya, ruffs dry and wrap in a clean cloth, where it is stored until the next use.

Patient while walking in the winter period is necessary to impose on the tube hole bilayer gauze bandage and bandage should moisturize the water (Fig. 25) in the summer.

 

Eating the patient should be in a calm state, not talking, no laughing. It is recommended to wear a scarf, scarf or kerchief around the neck. When is it addictive Paci­cient to the tube and appear confident, you can pore­recommended active cover tube collar, tie. In some cases, put an inner tube with a valve that allows you to talk. This tube can be worn during the day as long as there is a need to communicate. On her night­necessity to change an ordinary handset. patient mo­Jet learn to talk, covering the opening of the tracheal cannula finger, wrapped with a sterile cloth. We can use this technique­but short conversation.

To prevent drying of the mucous about­span of the trachea into the trachea poured into 2 – 3 drops of sterile vaseline oil or glycerol. Thinning mucus poured by pipette 0.9 ml of 1-pro­percentage of sodium chloride solution or 1 ml fer­mentha-trypsin.

When intestinal tumors when allocation of IP­EXERCISE through the rectum is not possible, in the or other intestine make an artificial opening. Ileostomy – an opening in the area under­vzdoshnoy intestine. During surgery – ileostomy- the end of a healthy ileum is displayed on the surface of the abdomen and fixed there with forms­tion of new holes for removal’s contents­direct intestine. Usually, it is placed in the right lower abdomen.

Colostomy – a hole in the ascendant about­zling or sigmoid colon. gut hemming­added to the opening in the abdominal wall and form a height­Tupa mucosa in the form of “roses”. On this artificially created back proho­du, and depart stool. Thus pischevari­tion path as well as dri ileostomy, continues to operate normally.

It is important to properly care for the skin around the ka­lovogo fistula to prevent maceration. when the correct­Mr. avoiding the patient does not have an unpleasant smell, ca.­Rouge fistula skin is not irritated.

Discharge from the intestine is most convenient to collect in spe­cially disposable colostomy bags and mnogora­zovogo use. It is important to define the mode of the GRO­bowel rozhneniya since isolation masses are periodically come about in large chunks, usually – postprandial.

Well selected Colostomy bags protects the skin, it placed a bowel movement, it corresponds to the curves of the body, allowing interference-free to bend, do not miss the smell.

The frequency shift is dependent on the type of stoma bags, used by the patient. For example, one component adizivny Colostomy bags should be changed, coh­but the content level reaches half or when the patient begins to feel discomfort from the pouch. Colostomy bags should not be changed without a real ‘need, as this can cause irritation and damage to the skin.

When using the two-component system ,; Clay plate allowed to stand for 3 – 4 days. Kalopriemnik easier to change in the bathroom. one­to learn to change Colostomy bags in toilet Paci­entu is also necessary, as it is most welcome­lemoe place outside the home. All necessary for the care of stoma items should be stored together in a container with a lid and ready for use. To replace the stoma bags should:

  • Net Colostomy bags of the appropriate typeand size;
  • measurement (stencil) to check – whether the stoma size has changed (Merck gives sister at discharge Hospital);
  • Additional materials, which benefit­etsya patient: pasta “Stomageziv ‘, deodorant, etc .;
  • paper towels, napkins, soft sponge, soap, scissors, adhesive tape;
  • paper bag, plastic bag or newspaper for used stoma bags;
  • Cooper scissors (one end is rounded, the other sharp);
  • a small mirror.

It is desirable to have a second set of the same, but in a smaller volume and number of components, koto­ing can take with you and wear a small sum­ke (leaving home).

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.