A bed patient had a swollen hand
For each of us, a house, this is where we arewe feel safe where we want to be constantly. The patient must not remain alone in the face of an incurable disease. In this difficult period, when he gradually loses the ability to control his body, realizing the inevitability of this process, the patient in particular needs contact with relatives, wants to stay in a familiar environment, among his favorite things. Therefore, it is preferable that the treatment process take place at home, as this gives hope for recovery and gives the strength to fight. Professional long-term or palliative therapy does not allow the patient and his family to feel that they are left with a one-on-one problem. The task for us, healthy people, is to ensure a high quality of life for the patient, since life is the greatest value for a person.
Prolonged bed restraint worsensfunctioning of many systems of the patient's organism and leads to the appearance of symptoms, defined as "hypokinesia". The most serious complications include cardiovascular diseases, pneumonia, bedsores, various joint diseases.
Daily care of hygiene is not difficult, but veryimportant occupation. For washing, liquid soap (pH 5.5), a sponge and a hard towel should be used. We put a towel under our hand, wash my hand with a sponge and wipe it, we do the same with the other hand and with both feet. For hygiene of intimate places it is necessary to use another sponge or a washcloth and another towel. There are special liquid gels for hygiene of the genitals, but they are necessary only if the skin is very sensitive. It is recommended to use special washcloths, ie. sewn independently or bought frotte mittens, which must be washed daily, so that the next day they can be reused. It is necessary to have two - for the whole body and for intimate places. After washing, the skin should be thoroughly drained, especially in those places where the folds are located and where the skin surface touches. In addition, rub the skin with alcohol (back and buttocks) or body oil. The places near the buttocks are rubbed with Sudocrem ointment, which has a positive effect on redness. Other creams are: PC 30V, Penaten and propolis ointment. Rubbing oil should be vigorous, because at the same time you can improve blood circulation in places where the patient lay all night. Do not forget that you can not simultaneously use talc and fatty cream, because when used at the same time they turn into a shell, which worsens the skin. It is necessary to pay special attention to the back, buttocks and skin in the sacrum. It is important that the massage does not damage the skin, because such wounds heal slowly or increase.
How to deal with the wiped up places?
There are bandages called "artificialskin "(Hydrofilm, Hydrofilm plus, Hartmanna, Tegaderm and many others), which protect rubbed places from infection. In no case can not put the patient on the rubbed places.
It should lie so that oxygen enters the affected areas of the skin. "Artificial skin" can be used only for light skin lesions.
To wash it is necessary delicately, paying attention toeyes. If the mucous membrane dries up, it is necessary to instill eyes with such agents as Sulfacetamid and Lacrima1. You can also use boiled water or a saline solution of NaCl. If everything is in order, enough boiled water.
Hygiene of the mouth is to clean the teeth, the palate,tongue and cheeks. Carrying out the hygiene of the mouth, you must put the patient in a straightened position, so that he does not choke. You should use a toothbrush and mouthwash or toothpaste, depending on the patient's condition. If he can not rinse his mouth by himself, do this with a syringe and suck out the liquid with special equipment. Spoon, wrapped in gauze, clean the tongue and mouth. The most popular means for this is Corsodyl, Tantum Verde, Elmex, but any liquid for oral hygiene can be used. Gum massage should be done carefully, so as not to damage the mucous membrane. Sensation of cleanliness and smell from the mouth are important for any person, but especially for a bed-patient. These actions must be performed twice a day. If there are any changes (red spots, swelling of the mucous membrane, holes in the teeth, spots on the tongue, etc.), you should immediately consult a doctor. Minor lesions in the corners of the lips can be lubricated with vitamin ointment, and lips with vaseline so that they do not dry out.
Washing the head of a bed patient
Washing the patient's head at home cancause some difficulties. This requires a large number of towels and a plastic bag. The length of hair is also important - it is easier to take care of short hair. Under the head and shoulders, you must put a packet, a towel and the next package. You can use a basin with low sides or a photo tray. They allow you to lay the patient so that the head is on the edge of the mattress. You can use ordinary shampoos, but you need to watch to constantly keep the patient's head, so it's better if two people do it. The frequency of washing the head depends on the patient's condition, but it is necessary to do this, at least once a week. Rinse your hair several times, making sure that water does not get on your face and eyes. After rinsing, you need to wrap your head around with a dry towel.
The most important thing for a lying patient is hisbed and an anti-decubitus mattress. The ideal bed should allow you to change your position, but as we know, there are no ideals. Most often it happens that the anti-bedsore mattress decomposes simply on the sofa bed and this is the most convenient way at home. Given the long life of the patient, it is necessary to create comfortable living conditions for him and his guardians. The main disadvantage of an ordinary bed is its height. All the actions that we do with the patient require that we lean towards it, which is very damaging to our spine, and for a long time it becomes burdensome. As far as possible, we must use a multifunctional rehabilitation bed, access to which is available on three sides. This bed consists of four planes, forming a certain shape. In addition, they are equipped with a control panel for all four planes. Regulation is smooth and can be carried out at any time, without the presence and help of others. On the bed we put an anti-decubitus cellular or tubular mattress, depending on the weight of the patient, but it must necessarily be a mattress with a compressor. It allows you to change the pressure on different parts of the body, i.e. The next places of the mattress are pumped alternately, which reduces pressure on the muscles. This improves blood circulation and reduces the risk of bedsores, and those bedsores that have occurred earlier, heal faster. Each such mattress should have a cover that reduces sweating and ensures proper ventilation of the skin. It should be remembered that it must be made of a waterproof material that allows evaporation to escape. It is also important that it can be easily washed and disinfected. Bed linen must be cotton, always dry (moisture contributes to the development of pressure sores), ironed and clean (without food residues, which can damage the patient's skin). The patient's underwear should be free, cotton, without gum (complicate blood circulation), should be easily removed and dressed. It is necessary to change it daily, immediately after washing, and always when it is required. The same applies to socks - you should wear only those that do not have elastic bands or just cut them.
Often compressed areas (on the one hand bone, withanother - a bed) become insensitive, and the patient can not say that he has something hurts, since he does not feel it at all. It is enough to lie for 30 minutes on a solid object, so that the first stage sore (Iº) appears. The first degree is the reddened skin, which turns white when pressed with a finger. This means that the epidermis and blood circulation in the capillaries are disrupted. Change of position, and the release of this place from pressure will prevent further changes. The next degree of damage is IIº - when the reddened skin does not turn white, after pressing the finger and when there are swelling, pain or blisters. In this case, you can use Sudokrem, move pressure from the damaged area, provide access to fresh air or use special bandages if the wound does not heal. You can make a bandage from Tielle, which is superimposed on the wound lubricated with Nu-gell, and remains on the body for up to 7 days. Another remedy that has a beneficial effect on the healing of wounds is the Hydrocoll, the shape of which is specially designed to take care of the sacrum, heels and elbows. It is especially important to use a dressing in easily polluted places, i.e. on the lower back.
Referring to Torrenca, pressure sores IIIº - this is alreadyinjuries that cover the subcutaneous tissue. They are limited, have a black or brown color and, in case of infection, they emit a characteristic smell. With bedsores of the third degree, you also need to use special bandages, but this should be done by specialists. In the event that the necrosis of the wound is too large, surgical intervention and administration of antibiotics are necessary.
IVEP bedsore covers the subcutaneous tissues and vessels. They also require the intervention of the doctor, as well as in the case of Vº - when the muscles are injured (this is a very serious complication). Treatment of decubitus is very difficult and takes a lot of time, so it is so important to prevent their occurrence. To reduce the risk, it is necessary to shorten the action of the pressure force, by changing the position of the body. If the patient has an anti-bedsore mattress it is enough to do this every 4 to 6 hours, otherwise you have to turn the patient every 2 hours. If the patient is lying on his back, he must first turn on one side, then again on his back, or the other side, paying attention to the limbs, since it is important that the feet do not fall off. It is necessary to form a platen from the blanket and put it under the foot so as to preserve their natural position. To avoid contractures, you need to put in the palm of the small rollers - this can be ordinary kitchen rags or special rehabilitation balls. Particular attention should be paid to personal hygiene - The vessel needs to be fed carefully, so as not to disturb the epidermis. Use disposable diapers or bedding nappies for adults. Do not allow the patient to remain in dirty laundry for a long time. Sometimes it is better not to wear diapers, it is more useful to leave the patient at night on something absorbing, because all sorts of disposable diapers do not let in air. Care should be taken to ensure that the patient always has access to fresh air.
The main actions facilitating the state ofpatient, are: proper body placement and a change in the position of the body on the bed, the application of a functional position and a mattress reducing pressure on the body, as well as measures of stabilizing position, so as not to bring to too high a muscle strain. The position of the patient in bed can have an anesthetic effect, relax the muscles and prevent the onset of edema. Torso placement at an angle of 30º is used for feeding or cardiovascular failure. Limbs, at an angle of 30º, are lifted in the prevention of cardiovascular diseases and prevention of edema. To facilitate the process of secretion of the secretion from the bronchi and trachea, it is necessary to use positional drainage and patch of the thorax. The latter should be done as follows: palm, folded in the shape of a boat, vigorously pat the back of the patient lying on the side, from the bottom up a few minutes. You can do this also when the patient is sitting in a wheelchair. This method is used both for patients who are able to breathe independently, and for those who need special equipment for this. The actions that improve the performance of the respiratory system and prevent complications (they should be used in turn) include: improving the effectiveness of cough, dynamic and static breathing exercises, the use of moisturizing a special respiratory mixture. One way to isolate mucus from the respiratory tract is positional passive drainage, i.e. placing the patient in different positions to facilitate outflow and expectoration of secretions. Contraindications for the application of the above method are respiratory insufficiency and suffocation, i.e. all these methods can be used only when the patient's breathing system is working correctly (high respiratory performance, cough reflex). When positioning the drain, the following items are recommended:
- horizontal on the back,
- horizontal on the side,
- on the side with the rotation forward,
- on the side with a backward rotation.
In all the listed positions, theTrendelenburg's position, i. The inclination of the bed at an angle of 15-20%, so that the head was below the feet. If the bed does not have the function necessary for this, under the patient's legs we put wooden bars that lift the lower part of the body upwards. When using bars, the patient should be placed in a horizontal position on the side, protecting it with rollers from the blanket or cushions. Positional drainage is done 2-3 times a day - in the morning on an empty stomach, two hours after lunch and two hours after dinner. How long the patient remains in the drainage position depends on his condition and state of health at the moment. Start it from 10-15 minutes and gradually increase the procedure to one hour. Bearing in mind that such a position is inconvenient and tiresome, it is necessary to stabilize the position of the patient with the help of pillows. During drainage, the patient's chest should be patted (as described above) to speed up the expectoration process. Before positional drainage, inhalation should be done by means of moisturizing mucus or oral medications - before using them, consult with your doctor. The most popular remedy is Mucosolvan, however, it should be remembered that such remedies can not be taken after 4 pm.
Excessive salivation in patients with ALS -an ordinary phenomenon. At an early stage, it is possible to achieve an improvement in the condition with a specific head arrangement, using an orthopedic collar. Drugs that reduce salivation - anticholinergic drugs, can be taken only after consulting a doctor. They also apply a chemical effect on the salivary glands with botulinum toxin (this method is not very popular in the treatment of ALS), you can also use the In-Exufflator device to pump out saliva. Most often, suction is used to eliminate the excess saliva. When using it, you must ensure that the patient does not choke. Therefore, during this procedure, you need to put the patient on its side and protect places near the mouth with absorbent tissue or a disposable diaper. It should be remembered about the lubrication of the skin around the lips and chin cream with vitamin A or ordinary cosmetic vaseline, so that the dripping saliva does not damage the epidermis, and about delicately rubbing these places to avoid irritation
Its essence lies in the elimination (suction)accumulating secretion from the oral cavity, tracheostomy tube by means of electric suction. This allows you to keep airway patency and proper breathing. It is important to follow the rules of asepsis in this procedure (disposable rubber gloves, sterilized catheters and liquid for liquefaction). The most important is the choice of the right catheter. More convenient will be a thin catheter, only if the discharge is not too thick and viscous. Since the patients with ALS are, first of all, saliva removed, we can use the thinnest catheters, given that the throat is very susceptible to any mechanical irritation. Make the procedure for saliva suctioning quickly, remembering that you first need to bend the catheter and open it only after insertion into the right place. If the patient has a tracheostomy tube, two catheters should be used - one for her and the other for the oral cavity. It is worth remembering that before inserting the catheter into the airway, one should not be allowed to touch anything, neither the bed, nor the patient's face, because it is contaminated and can cause infection. In patients who can breathe on their own after suction, you need to relax the lungs with the Ambu bag (a few breaths and breaths), because, sucking the discharge, we suck out all the air that is in the lung patient. In this way, we prevent the occurrence of atelectasis and reduce the volume of the lungs.
The vertical position in which we plantpatient, and physical exercises are conducted to avoid embolism. This disease most often occurs in bedridden patients, and it is the most serious complication. The risk of embolism appears within 24 hours, spent in a supine position. In the cardiovascular system, due to the cessation of contraction of the venous valves and deterioration of the vein, the blood begins to flow much more slowly, which contributes to the development of thrombi. Factors affecting this are: changes in vascular tissue, age, smoking, chronic vascular insufficiency, and, first of all, reduction of blood pressure as a result of constant stay in a lying position. In the prevention of this disease, heparins, such as Fraxiparyna or Clexan, are used. The dosage depends on the weight of the patient. These drugs should be administered subcutaneously once or twice a day - depending on the prescription of the doctor. This is very easy to do, since they are sold as disposable syringes with a needle and medicine inside. As part of prevention, passive exercises should be performed to stimulate the muscular system of the lower extremities - i.e. rotate feet, raise and lower the feet, massage the shins (always in the direction of the heart). It is also necessary to stroke the entire surface of the patient's body. The force of pressing should be the same for all places. This kind of massage is always done in the direction of "to the heart" - i.e. according to the direction of blood in the veins. The method of rubbing is a circular movement of the pads of the fingers or the bent part of the interphalangeal joints. Do this slowly, to achieve elasticity of ligaments. In addition, massage helps to get rid of swelling in the tissues and joints, as well as reduce muscle tension. Patting is another type of massage that can be done quite often. It is better if it is a "spoonful" pat, ie. when an air cushion occurs between the palm and the back. Cotton should be energetic, short and light, so as not to cause pain and changes on the skin. Patches improve muscle tone and blood circulation in tissues.
Vertical position of the body and gradualmobilization of the patient is very important because of the danger of embolism and for the proper functioning of the cardiovascular system. Verticalization is a gradual transition from a horizontal position to a vertical one. Verticalization is possible thanks to an orthopedic bed or a vertical table. But most often, because of the price and size of the device, this is done only in rehabilitation centers. Since the patient is not in a position to change his position, there are problems with equalizing blood pressure, which can lead to: disorders of thinking, sight, hearing, and even loss of consciousness. If the patient pale or sweats, you must stop verticalization. The home way to put a patient in a vertical position is a gradual transition from a lying position to a sitting position, so that he can sit on the wheelchair and move. First you need to raise your head above the body, and watch the patient feel well. It is necessary to raise the upper part of the patient's body daily higher and leave him in such position longer every day. The next step is a semi-sitting position on the pillows or raising the head of the bed. In doing so, you need to ensure that the position is stable. The process should be time-allocated, i.e. if the patient has sat down for the first time, do not immediately put him in the stroller. The next step is to sit on the bed with your legs straight. For this, the head is stabilized by an orthopedic collar, and the trunk is cushioned. The hands should also be laid properly, so that there is no undesirable muscle tension. If the patient's pulse rate increases and it begins to turn pale, you must immediately return it to the horizontal position. A gorgeous device that helps to control the correct conduct of verticalization is a manometer. Pressure is measured before the beginning of the procedure and when the patient is already sitting - if it has decreased, this means that the patient's body can not cope and must be put. External signs also allow you to determine whether the patient is coping or not: if he pale or sweat, this means that he is tired and must be put. It is necessary to gradually increase the patient's time in a sitting position, so that the circulatory system gets used to changing positions.
The next stage is sitting with legs down. From personal observations it can be said that this is the most difficult. It is necessary to put the patient with a bed or other people. You can not leave the sick one, because he can suddenly feel worse. Be sure to protect his pillows from falling forward. After several samples, we begin to gradually increase the time spent in this position. If the patient feels well, you can try putting him in a stroller. First for 5 minutes, and then for a longer time. If there is such an opportunity, it is advisable to put the patient in the stroller while eating. Thus, he has the opportunity to participate in family life. If the patient feels well, a daily walk is recommended as an excellent rehabilitation supplement.
Static breathing exercises arerhythmic breaths and exhalations, produced in a certain way. The position of the body during these exercises is of great importance. Straightened - eases breathing and complicates the exhalation, inclined - facilitates exhalation, complicating inhaling. Breathe in with your nose, exhale with your mouth. The duration of inspiration and expiration should be related to each other in a proportion of 2: 3. One-time exercise should last several minutes, so that there is no hyperventilation, which causes oxygen starvation of brain tissue and increases the excitability of muscles and the nervous system. To facilitate cough and avoid the occurrence of atelectasis it is recommended to do exercises that complicate exhalation. This, for example, inflating a balloon or blowing air through a tube into a bottle of water.
How the patient eats, directly affectson the duration of his life. Damage to the muscles of the nasopharynx and the associated dysfunction of the lips and tongue, as well as a defect in the palate and throat, affect the difficulty of swallowing. Because of this, the patient often begins to choke on food that gets into the respiratory tract. Such complications cause fast fatigue, and refusal to eat, which leads to weight loss, exhaustion and a lack of protein (it is fraught with bedsores!). Most of these patients need to change the diet to semi-liquid, but the food should remain thick (food can be thickened by adding thickeners). It is important that the food is high-calorie (Nutridrinki), as patients need more calories each day. The main daily full-fledged diet (crushed, ground, crushed food) is often not enough for the patient, so it is recommended to replenish it with proteins that are contained in the protein mixes available in the market (Protifar). The patient should take food more often (6-7 times a day), but in small portions, while observing the correct way of feeding with a respite between the next pieces. In the event that the head when eating is tilted forward it is necessary to put on the orthopedic collar. Feeding a patient who has a tracheostomy tube looks the same, but first, before feeding the first piece, it is necessary to check how much air is in the ball, on the patient's neck. If it is empty, you can not feed the patient, because he suffocates. The ball should be soft, but not too much. After feeding, you can decompress it again (if we know how to do this, because a too tight tracheotomy tube can injure the patient's throat, causing excessive salivation). You can also serve some of the food in your mouth, and when the patient is tired, the rest of the food is fed through the gastrostomy. If the patient is not able to swallow enough to feed a little food in his mouth - to increase the allocation of digestive juices, and the rest to apply to the gastrostomy. Thus, we facilitate the process of digestion and improve the state of health of the patient, who can feel the taste of food. Due to a few drops of soup the patient will not choke, but the taste will remain. Gastrostomy can be a supplement to the usual feeding, if the patient can swallow, but these possibilities are limited (he simply gets tired of it quickly, and interest in food disappears). Gastric probes should be made of silicone or polyurethane to reduce the inflammatory response of tissues and avoid the occurrence of pressure ulcers.
Food should be served directly in a probe or gastrostomy in a volume of 300-500 milliliters 5-6 times a day.
When enteral nutrition should be controlledsusceptibility of the organism to drugs, as well as the rate and mode of delivery. Essential is the correct selection of a diet - in accordance with the clinical picture and the level of supply of the body with nutrients. The most commonly used are balanced concentrates, which are characterized by:
- a certain amount of nutrients and calories (recalculated for 1 ml)
- simple way of cooking,
- liquid consistency, necessary for the proper functioning of the digestive system,
- the correct osmolarity: 250 - 400 mosm / l,
- chemical safety of content,
- volume, adapted for convenient use.
The most popular drug is Nutrison Standard(a diet with a normal calorie content of 1 kcal / ml with a neutral taste for admission through the digestive tract). The main source of protein is casein, the drug contains only LTC fats, the source of carbohydrates is, slowly absorbed, maltodextrin. This wasteless and stick-free diet, from 1500 to 2000 milliliters of Nutrison, supplies the body with all the necessary nutrients that it needs during the day, the osmolality of the drug is 265 osmol / l. Another drug used for feeding by the gastric tube is Fresubin Orginal Fiber. It is rich in fiber, which does not contain gluten and lactose, is intended for patients with an identified depletion of the body or the risk of its appearance. A protein-rich, non-waste product, whose osmolarity 270 osmol / l - Reconvan - increases the performance of the intestine. Probiotic nutrition is associated with many dangers: improperly (qualitatively and quantitatively) a selected diet, improperly fed food (too fast rate), mechanical complications associated with the installation of the tube, a metabolic disorder, a violation of the water-electrolyte balance, vitamin disorders, fluctuations in blood sugar levels , as well as infections of the digestive tract and aspiration pneumonitis. Complications that have arisen due to this method of feeding can be avoided as follows:
- Each time before feeding, check the position of the gastric tube,
- at least twice a day to check the volume of substances in the stomach, if their volume of more than 300 milliliters to remove the contents and reduce the next dose,
- bring the patient to a semi-sitting position for half an hour after feeding the food by the dosing method and constantly while feeding the peristaltic pump,
- check the temperature, consistency, composition, odor, and the amount of food served,
- if the gastric tube is installed through the nose, special attention should be given to the places in which pressure sores may appear,
- as far as possible, use silicone tubing,
- every 4-6 hours to conduct oral hygiene,
- it is recommended that chewing gum without sugar or sucking candy to avoid parotid inflammation,
- if the patient is not able to chew on his own or is unconscious, 3 times a day to do massaging of the chewing muscles,
- the bandage on the gastrostomy should be changed daily according to the rules of hygiene,
- 2 times a day to check whether the stomach tube, passing through the nose, is correctly placed,
- that the catheter is not clogged up after each ingestion of food it is necessary to rinse it with distilled water or physiological solution of NaCl,
- medicines should be given well crushed and dissolved, taking a break in feeding and rinsing the catheter before and after medication.
When caring for a patient with gastrostomy, you can meet with the following problems
- ingestion of gastric contentsway caused by too fast food or by the fact that the portions are too large. It should be borne in mind that the patient for a long time, because of unwillingness or fatigue, took small portions of food. Therefore, you need to gradually increase the amount of food served. Important is also the position in which the patient is when eating, he must sit or "sit down". If the patient has choked, you need to push the diaphragm. To do this, you need to stand behind the back of the patient, grab him below the ribs, one hand to clench his fist and clasp her with the other hand, and then quickly pull him to him, squeezing his shoulders. The action is repeated several times - until the moment when breathing is restored. In such cases it is recommended to have a suction with which it is easy to remove food from the mouth and throat. If the patient has a probe or gastrostomy and is sick, you need to open them immediately to ensure a free food outlet. This will help avoid choking.
- Diarrhea can also be a consequence of too fastfeeding or improper cooking (bacteria) or possible intolerance to milk or drugs. In any case, you need to consult a doctor to prevent dehydration.
- constipation occurring in bedridden patients, caused byslowing of peristalsis and lack of movement. In this case, you usually need to change the diet, by adding yogurt, fiber - about 40 grams daily (you can add oatmeal fiber), crushed fruits and vegetables. If this is not enough, then light laxatives are needed. It should be remembered that an increase in the amount of liquids helps to relieve the intestines, softening the feces. You can take plum jam, chopped boiled beet. It is necessary to avoid the use of chocolate, rice broths and other food that causes constipation. Lactulosa is a mild laxative, but before using it, consult a doctor.
- on the skin, around the gastrostomy tube canchanges due to irritation with food or infection. For prophylaxis, we must monitor the skin, daily washing the patient with soapy water, and immediately near the drainage apply an antiseptic drug (Polodine-R, Octanisept). Do not use alcohol-containing products to avoid drying the skin. After treatment, ointment Argosulfan, Alantan, Linomag or another is applied to the skin near the drainage tube with a sterile wipe. If irritation or red spots appear on the skin, consult a doctor. The drainage pipe should be glued to the skin with an anti-allergic adhesive plaster so that it does not move. The dressing should be changed daily or more often - if necessary.
- bedsores around the tube are caused by too much pressure of the plate on the skin. The correct distance is 2 millimeters, it allows caring for this place.
- Gastrostomy gastrectomy can be causedfeeding poorly chopped food or medicines. Sometimes you can rinse it with boiled water, but if there is no such possibility, it is necessary to install a new drainage tube in hospital conditions. You should always make sure that the food is not too thick, as it can clog the tube. It should be remembered that after feeding or taking medications, always rinse the gastrostomy with clean boiled or mineral water (50 milliliters).
- if the patient has a normal gastrica probe passing through the nose or mouth, remember to check it and change - those that are made from PCV, should be changed every 7-10 days, polyurethane - every 6 weeks. On the nose or cheek, it is necessary to cover the probe with anti-allergic patch, changing the bandage daily and observing the skin condition.
- in the evenings, about three hours afterthe last meal, you need to check the level of contents in the patient's stomach, remove the food residue with a syringe, or connect the gastrostomy with a sterile bag hung below the lying patient (you can use ordinary sterile bags for urine). Depending on the results of the inspection (the amount of remaining substances), the volume of food delivered should be reduced.
Always take care of the appropriatetemperature in the patient's room and change the soaked underwear. Nails on the hands of the patient need to be trimmed in a semicircle, on the legs - straight (without the removal of the okolonogte skin). If this is required, the keratinizations on the heels are removed, after preliminary soaking and softening.
Quite often, inconvenience brings a crackingskin on arms and legs. To do this, apply moisturizing balms and vitamin ointments, and even the usual olive oil. Especially important is the elasticity of the skin during edema, when every crack in the skin oozes, and infection can get into it. When treating such wounds, the most effective is the anesthetic ointment, which the doctor should prescribe.
The patient's room must be light, it must beoften ventilate. It is important to put the patient's bed in such a way that he can see the light and enter the room. If this is not done, the patient will experience stress. It should be borne in mind that often the patient is unable to turn his head to find out who has come. The optimal temperature in the room: 20-22 degrees, humidity: 40-60%. In winter, when the temperature outside the window is very low, it is necessary to ventilate the room indirectly, i.e. Open the window in the next room and only then the door to the patient's room.