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Higher nurse education




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BUKOVINIAN STATE Medical university

DEPARTMENT OF PATIENTS CARE AND

HIGHER NURSE EDUCATION

“APPROVED”


on the methodical conference of department

of patients’ care and higher

nurse education

“ ” ________ 200_ protocol N __

Chief of department, associate professor I.A. Plesh


METHODICAL INSTRUCTION

FOR SELF-PREPARATION OF STUDENTS

TO PRACTICAL CLASS №3


NURSE’S FUNCTION DURING OPERATION.

NURSE’S FUNCTION IN POSTOPERATIVE PERIOD


Discipline:

nursing in surgery

for 3nd year students

of medical faculty №4,

specialty "nurse business''


Methodical instruction was prepared by:

Assistant Riabyi S.I.


Chernivtsi - 2010

^ 1. Topic: NURSE’S FUNCTION DURING OPERATION. NURSE’S FUNCTION IN POSTOPERATIVE PERIOD.

(Nurse’s function during operation. Assistance in operative block. General notion about operation nurse’s function. Nurse’s function in postoperative period. A concept of postoperative period, its phases and variants of current. The changes in organism due to surgical damage: disturbances of protein, carbohydrate, water-salt exchange, changes of blood composition. Reparation of patient’s condition after operation. Recovering of local changes in organism. Peculiarities of patient’s feeding. Postoperative complications. Nurse’s diagnostic of postoperative complications. Nurse’s tactics in cases of early and late postoperative complication).


^ 2. Duration of the class: 2 academic hour.

3. Study aim:

3.1. The student should know:

  • nurse’s function during operation.

  • assistance in operative block.

  • general notion about operation nurse’s function.

  • nurse’s function in postoperative period.

  • a concept of postoperative period, its phases and variants of current.

  • the changes in organism due to surgical damage: disturbances of protein, carbohydrate, water-salt exchange, changes of blood composition.

  • reparation of patient’s condition after operation.

  • recovering of local changes in organism.

  • peculiarities of patient’s feeding.

  • postoperative complications.

  • nurse’s diagnostic of postoperative complications.

  • nurse’s tactics in cases of early and late postoperative complication.


^ 3.2. The student should be able:

  • to use modern methods of examination of surgical patients;

  • to analyze results of additional methods of surgical patients’ examination;

  • to take care of surgical patients after operation;

  • to make out of nurse’s documentation.


^ 3.3. The student should master practical skills:

  • to collect complaints of patients;

  • to do observation of skin;

  • to do palpation;

  • to do percussion;

  • to do auscultation;

  • to collect patterns of blood, urine, stomach juice, bile etc;

  • to do enemas;

  • to do preparation of skin;

  • to do premedication;

  • to make out of nurse’s documentation.

·

^ 4. Advice for students:

Postoperative period – it is a period from the moment of ending of operation to convalescence of patient or translation of him on disability.

In postoperative period 3 periods are distinguished: early (from the moment of ending of operation of a to 4-5 day after her), late (from a 6-7 day after the operation to the extract of patient from a hospital), remote (since the extract from a hospital to renewal of capacity).

Normal motion of postoperative period is distinguished, when heavy violations of functions of organs and systems are absent, and complicated, when the reaction on an operative trauma is sharply expressed and considerable functional violations develop.

The surgical operation and anesthesia cause patphysiological changes of patient in an organism, which carry a general character and are an answer for an operating trauma. An organism will mobilize the system of protective factors and compensate reactions directed on the removal of consequences of operating trauma and renewal of homeostasis. After the operation there is a no new type of exchange of matters, and intensity of separate processes changes – accordance of catabolism and anabolism is violated.

In a postoperative period three phases are distinguished: katabolic, reverse development, anabolic.

^ A katabolic phase proceeds 3-7 days. She is more expressed at patients with the heavy diseases which carried heavy operative interferences. A katabolic phase is substantially prolonged by postoperative complications. In lengthening of duration of katabolic phase the proceeding bleeding, joining of festering-inflammatory complications, gipovolemy act part, changes of water-electrolyte and albuminous balances, violations of conduct of postoperative period (not with sleeping compartments pain, inferior and unbalanced parenteral feed, gipoventilyatsiya lights).

The clinical displays of katabolicheskoy phase from the side of the nervous system are: zatormogennost, somnolence. Since the second days after the operation, as far as stopping of action of narcotic facilities and appearance of pain, the signs of excitation or oppression, unsteady psychical activity are possible. Violations of psychical activity can be conditioned by joining of complications which strengthen gipoksiyu, violation of water-electrolyte balance. From the side of the serdechno-sosudistoy system – pallor of skin, acceleration of pulse, moderate rise of arterial pressure. From the side of the respiratory system – increase of frequency of breathing, reduction of depth of breathing. The shallow breathing can be conditioned by pain, high standing of diaphragm, by development of paresis of intestine. From the side of liver and buds – growth of disproteinemii, decline of synthesis of enzymes, reduction of diureza.

^ The phase of reverse development proceeds 4-6 days. She comes at the uncomplicated flow of posleoperatsionnogo period. It is characterized by normalization of albuminous exchange, increased synthesis of albumens, glikogena, fats, by the decline of conclusion of ions of potassium with urine, renewal of water-electrolyte exchange, by predomination of the parasimpaticheskoy nervous system.

The clinical displays of this phase are: to reduction of pain, normalization of temperature of body, appearance of appetite, rise of activity of patient, normalization of color of skin, deepening of breathing, reduction of frequency of breathing, normalization of frequency of cardiac abbreviations, renewal of function of geludochno-kishechnogo highway – renewal of peristalsis, departure of gases.

The Anabolicheskaya phase is characterized by the increased synthesis of albumen, glikogena, fats which were lost during the operation and katabolicheskoy phase of posleoperatsionnogo period. In this phase there is the subsequent activating of the parasimpaticheskoy nervous system and rise of activity of anabolicheskih processes. She proceeds 2-5 weeks.

Clinical signs characterize an anabolicheskuyu phase as period of convalescence, renewals of functions of the serdechno-sosudistoy, respiratory, secretory systems, organs of digestion, nervous system. Samochuvstvie and state of patient gets better, an appetite rises, frequency of cardiac abbreviations, arterial pressure, is normalized, activity of digestive highway recommences: arcade of food, processes of suction in an intestine, appearance of independent chair.

Duration of anabolicheskoy phase relies on weight of operation, initial state of sick, expressed and duration of katabolicheskoy phase.

After operative interference the patients go back into the surgical separation or chamber of intensive therapy, which are specially organized for the supervision after a patient, conducting of the proper intensive therapy and providing of urgent help, if in her there is a necessity. To the patient the permanent monitoring is conducted after the state of vitalnih functions, by the indexes of gomeostaza.

During the supervision after a patient it is needed to be oriented on the critical performance indicators of organs and systems which must serve by a basis for finding of reason of worsening of the state of patient and providing of the first aid out.

  • The state of the serdechno-sosudistoy system: frequency of pulse more than 120 ud/min, decline of arterial pressure to 80 mm of rt. item and below or rise to 200 mm of rt. item, violation of cardiac rhythm, decline or rise of central vein pressure.

  • The state of the respiratory system: breathing frequency more than 28 in a 1 minute, absence of respiratory noises above lights.

  • The state of skin and visible mucous membranes: the expressed pallor, akrotsianoz, sticky death-damp.

  • The state of the secretory system: reduction of mocheotdeleniya (quantity of urine less than 10 ml/chas), absence of mocheotdeleniya (anuriya).

  • The state of organs of geludochno-kishechnogo highway: sharp tension of muscles of front abdominal wall, black excrement, presence of blood in an excrement, expressed swelling of stomach, absence of gases, absence of peristalsis.

  • The state of the central nervous system: loss of consciousness, delirium, hallucinations, excitation, put state on the brakes.

  • The state of posleoperatsionnoy wound: the expressed soaking of bandage by a blood, divergence of edges of wound, output of organs of abdominal region in a wound (eventratsiya), abundant soaking of bandage by a pus, intestinal content.



^

Obustroystvo of bed of patient.


As a sick man, especially after operative interference, greater part of time is found in a bed, it is very important, that she was comfortable, and bed linen clean, dry, even. Correct obustroystvo of bed and control of its state – this creation of comfort position to the patient, prophylaxis of development of oprelostey, bedsores and other complications. In the early posleoperatsionnom period of patient it is desirable to lay on a functional bed which can be transformed.

On a mattress which passed disinfection in a disinfection chamber, clean matrasnik is put on. A mattress is rested in a bed with the well strained net. A sheet the edges of which on all length are tucked in under a mattress is covered so that she was not going to the folds. On a pillow a clean pillow-case is put. On a blanket a blanket cover slip is put. A patient with two towels is provided.

For a seriously sick patient it is desirable to use a sheet or diaper with a superadsorbent, which does not get wet. In default of them it is needed on a mattress postelit an oilcloth, and over an oilcloth – diaper (to prevent contamination of mattress by the excrements of man). It is recommended to seriously sicking and to the people of declining and starcheskogo years to use podguznikami.


^ Change of bed linen of sick.

Bed linen must be cotton, and worn next to the skin – from cotton or flannel fabric. There are a few methods of change of sheet of seriously sick patient. The first method is applied in that case, when to the patient a doctor allows active motions in a bed second – when active motions in a bed are forbidden. Change of linen it follows a patient to conduct carefully, not to inflict him additional pain and suffering.

Before replacement of bed linen in the beginning it is necessary to set the sections of functional bed in horizontal position.

The first method

To displace a clean sheet by a roller on length by a right side vovnutr, to heave up a bit a head and shoulders of patient, to take away pillow. Carefully to lay the head of patient on a bed. To turn a patient on a side, by a person to the edge of bed, to hold him in such position. To displace a dirty sheet by a roller on length towards a patient. On exempt part of bed to open out a clean sheet so that its free edge som e hung down from a bed. To turn a patient on the back, and then on other side, laying him on a clean sheet. To take away a dirty sheet, to place her in a waterproof sack. To straighten a clean sheet, to turn a patient on the back. To tuck the edges of sheet in under a mattress from every quarter. To replace on a pillow a pillow-case and blanket cover slip on a blanket. To place a dirty pillow-case and blanket cover slip in a sack. To lay down a pillow in a clean pillow-case under the head of patient, to conceal a patient by a blanket.

The second method.

To displace a clean sheet by a roller on a width by a right side vovnutr. Carefully a bit to heave up a head and shoulders of patient, to take away pillow. Quickly to displace as a roller a dirty sheet in direction from a head to small of the back of patient. On exempt part of bed to open out and straighten a clean sheet. Carefully to lay the head of patient on a bed (without a pillow). To replace a dirty pillow-case to clean, to heave up a bit a head and shoulders of patient, on a clean sheet to lay a pillow in a clean pillow-case, to lay a head and shoulders of patient on her. To heave up the pelvis of patient, then feet and quickly to take away from under him a dirty sheet in direction from to small of the back to the heels. To place a dirty sheet in a sack for dirty linen. To open out and straighten a clean sheet and carefully drop a pelvis and feet of patient. To tuck the edges of sheet in under a mattress from every quarter, to replace a blanket cover slip on a blanket, to conceal a patient by a blanket.


^ Help to the patient during the change of the linen worn next to the skin.

To heave up a bit a head and shoulders of patient which is found abed in position “lying on back”. To take the edge of dirty shirt and by easy motions to pull up her behind to the back of head, and at the front – to the breast. To take off a dirty shirt through a head. Carefully to lay a head and shoulders of patient on a pillow, to help a patient to heave up both hands and work hands free from a shirt. To place a dirty shirt in a sack for dirty linen. To conduct partial sanitary treatment to the patient. To dress a patient in a reverse order: at first – sleeves of shirt, and then shirt through a head. By careful motions to draw on a shirt on the back and breast, carefully to straighten the folds of shirt. To help a patient to acquire comfortable position in a bed, to conceal a patient by a blanket.


^ Observance of the sanitarno-protivoepidemicheskogo mode at the change of linen.

In permanent establishment, changing the bed and worn next to the skin beds is necessary not rarer once in 7-10 days. At contamination of linen it follows to change by the biological liquids of him. Dirty bed and worn next to the skin linen is placed in a waterproof sack (linen muddy by biological liquids displace by contamination vovnutr). In a chamber categorically it is banned to give dirty linen up on the floor or in a capacity which is not closed by a lid. String a sack and take in the special separate room intended for sorting of linen. After the extract or death of patient mattress, blanket, a pillow is handed over in a disinfection chamber for conducting of disinfection. The hygienical cleaning up of chamber is conducted with the use of disinfectant solution. In a room for sorting – rassortirovat dirty linen, to lay down him in waterproof sacks. To string sacks and send in laundry on katalke. To conduct the hygienical cleaning up of apartment of sorting room with the use of dezrastvora.


^ Care of skin and hairs of patient.

Weak seriously sick patients in the flow great of while are deprived to possibility to adopt hygienically water procedures. At the same time the cleanness of skin is the obligatory condition of convalescence of patient, because a skin executes respiratory, protective functions, takes part in termoregulyatsii, in the exchange of matters, and also is an important sense-organ – by a skin analyzer. The care of skin of seriously sick patients has not only deontological aspect, but also improves the common state of patient, warns the abscess and fungus defeats, oprelosti, bedsores.

Daily in the morning and in the evening help a seriously sick patient to wash. If the state of patient allows, he is laid, in position polusidya. A pelvis is put on a dinner-wagon or on a chair the bedside. On the hands of patient warm water is poured from a mug, at washing a head is supported. Give a clean towel to the patient.

In the case when a patient is motionlessly in bed – person, a neck and hands is wiped by a double glove or soft sponge moistened in warm water. Wipe a skin by a soft towel by the method of “soaking”.

With the purpose of prophylaxis of oprelostey the close-up of the following areas of body is daily conducted: under milk glands at women, in the arm-pits and inguinal folds of women and men. Help to adhere to the cleanness of body. The adopted parts of body are washed by a 2% solution of potassium of permanganate, osushivayut skin by the method of “soaking”, child's powder or talc, cleared butter is applied (linen, olive, almond, cod-liver oil). From time to time these areas can be oiled by a 1% spirit solution of diamond green.

A seriously sick patient is undermined 2-3 times per days, especially after urination or defecation. Feet to the patients wash one time in 2-3 days.

Nails on hands and feet sostrigayut one time in a week, it is better after hygienical bath, if she is not contra-indicated. Twice in a day it is necessary to help a patient to be combed, if he is unable to do it independently.

One time in 7-10 days it is shampooed to the seriously sick patient. Under a head and shoulders the special support is underlaid. For washing of hairs liquid shampoo or warm water is applied from a mug. After washing hairs wipe by a towel and comb by a comb or comb, tie around a head by a shawl (out supercooling).

One time in 7-10 days to the seriously sick patient, washing of skin is carried out in the following sequence: person, after ears, neck, forehand of thorax, stomach, hands, back, buttocks, thighs, shins, feet. For this purpose a double glove is moistened by warm water, wring out, wiping a skin – periodically rinse a glove in clean warm water. After washing a skin is wiped by a clean dry towel, that a patient did not get cold. If necessary it is possible to use soap.


^ Care of eyes of patient.

At presence of festering excretions which glue together eyelids, to take a sterile gauze serviette, to moisten her to one of antiseptic solutions (furatsilin 1:5000) and impose on an eye crack. In 1-2 minutes, after softening influence of crust, by other sterile moist serviette to wipe eyelids in direction from an external to the internal corner eye. To warn the transfer of infection from one eye in other, for every eye separate sterile gauze serviettes are used. Sponging down is repeated 4-5 times (by different serviettes). Tailings of solution get wet a dry serviette.

For washing eyes use sterile undinu. Solution of antiseptika is poured in her, suggest to the patient to take undinu for a leg, to lean over her so that eyelids took place in undine to pin her against a skin, to heave up a head, holding undinu a hand. A patient must pomorgat in the flow of minute, then to lean forward and put undinu on table. Procedure if necessary is repeated. In default of undini of eye it is possible to wash by a sterile pipette in direction from the external corner of eye to the internal corner, putting a pochkoobrazniy tray.

After washing it is desirable in eyes to begin to drip solution of sulfatsila sodium.


^ Care of ears of patient.

At a seriously sick patient it is necessary to clean an outward auditory passage-way by the sterile cotton wool winded on a hygienical plastic probe. For this purpose by one hand the auricle of patient is drawn off a bit backwards and upwards, and by other hand a probe is carefully brought into an outward auditory passage-way. By easy rotatory motions an ear is cleared. In default of probe for cleaning of auditory passage-way it is possible to use a gauze turundu, for making of which to take the strip of gauze shirinoy 3 and long 10 sm, to wrap up the edges of strip on length and tightly twist up her. Then to fold in two and once again twist up. By the created plait by rotatory motions an auditory passage-way is cleared.


^ Underlaying of ship to the seriously sick patient.

From a sanitary room a prodezinfitsirovannoe dry and warm podkladnoe ship is brought. In a ship the two-bit of water is poured. A patient is laid in horizontal position, turn to one side, or trick into one hand under his buttocks and levitate a pelvis a bit. Under buttocks an oilcloth is laid, on her – diaper. Turn a patient on the back or drop a pelvis. Help a patient to bend feet in knees and a bit divorce them in sides. A ship is put so that above his large opening a crotch found oneself, and the tube of ship was between the thighs of patient towards knees. Give a toilet paper to the patient. Cover a patient by a blanket and abandon him on some time of one. After an act the defecations levitate the pelvis of patient, take ship for a tube and carefully take out him. A ship is covered by a lid, release from content in a rest room, rinse him by water and immerse solution in disinfectant. Above a clean ship a patient is undermined, a crotch is dried out. Taking away ship, oilcloth, diaper, their disinfection is conducted. A chamber is ventilated.

^ Underlaying to the mochepriemnika seriously sick patient.

Bring from a sanitary room prodezinfitsirovanniy dry and warm mochepriemnik. A patient is translated in horizontal position. Stelyat under the buttocks of patient oilcloth, on her – diaper. Bending the feet of patient in knees, a bit conduct them in sides. Give to the mochepriemnik patient in a bed, if he can not retain mochepriemnik, help him to enter cock in opening of mochepriemnika and hold mochepriemnik. After urination take away mochepriemnik, urine is outpoured in a toilet. Rinse mochepriemnik in a sanitary room by warm water, immerse him in disinfectant solution. An oilcloth is taken away, diaper from under a patient, logat them in the accordingly marked capacities for conducting of subsequent disinfection.

For the removal of strong ammoniac smell of urine it is necessary periodically to rinse by mochepriemnik 2-3% solution of hydrochloric acid or washing pastes or powders which dissolve salts of urinary acid.


^ Disinfection of ship and mochepriemnika.

After the use the ship or release mochepriemnik from content in a toilet room, wash by warm water. A ship is immersed in a 0,5% solution of chloric lime in the capacity marked “For disinfection of ships”, like immerse mochepriemnik in a capacity “For disinfection of mochepriemnikov”. In 60 minutes a ship (or mochepriemnik)is taken out, rinse under running water. Save ship and mochepriemniki in a sanitary room on the special shelves. At seriously sick patients clean ship or mochepriemnik can constantly be found under a bed in the special deepening for a ship or on the wooden chair, covered by an oilcloth which twice in a day wipe dezrastvorom.


^ Undermining of seriously sick patient.

A patient is laid in horizontal position, feet bend in knees and conduct. On a sheet under lower part of body stelyat oilcloth, over her – diaper. Under buttocks a dry warm ship is put. The mug filled by warm solution (solution of potassium of permanganate of pinky color, boiled water, solution of furatsilina and etc.) of antiseptika is taken in the left hand, and in right – korntsang with a serviette. Solution is poured on the region of outward privy parts. By a right hand by korntsanga and clutched in him gauze serviette produce motions from privy parts to the anus, I.e. from top to bottom, lobok, sexual lips is washed consistently, inguinal region on the right and on the left, region of the anal opening. So it follows to do in order to add not an infection to the mochepolovie organs. Each time it is needed to take a clean gauze serviette. The used serviette is thrown out in a tray for the used material. The Osushivayut area of crotch by the dry gauze serviette clutched in korntsang, in the same direction and in the same sequence. A ship is taken away, release him from content, solution is immersed in disinfectant, an oilcloth, diaper, is taken away, logat them in the accordingly promarked capacities for subsequent disinfection. The used gauze serviettes, place korntsang in disinfectant solution.

^ Complex prophylaxis of bedsores.

At the loosened, immobile patients, especially at occupying passive position abed, the feed of soft fabrics is violated, bedsores can appear as a result. Appearance of bedsores testifies to the insufficient care of patient.

Elements of prophylaxis of bedsores:

  • To teach patient to care of itself as far as it is possible.

  • To teach relatives to the receptions of care of seriously sicking with the purpose of prophylaxis of bedsores.

  • Comfort to place a patient in a bed. To recommend to use one of mattresses: porolonoviy, inflatable, aquatic or the mattress filled by the seeds of millet.

  • To change position of patient abed every 2 hours, to stimulate a patient to change position abed by cross-beams, rails and other adaptations.

  • To use adaptation for the removal of pressure of body on the damaged soft fabrics (porolonovie gaskets in cuffs, the sacs filled by the seeds of millet or flax).

  • To check up the state of bed during the change of position of patient (every 2 hours). Bed linen must be clean, dry, without folds, scars, buttons.

  • After every eating to shake a sheet, that in a bed there were no crumbs.

  • To do an easy massage during the change of position of sick, it is impossible to do a massage in the places of ledges of bones.

  • One time in days the areas, where bedsores can appear, to wash by warm water, to wipe by a soft towel by the method of “soaking”, and then wipe by a 10% solution of kamfornogo alcohol, 40% ethyl alcohol, or weak solution of vinegar.

  • To control the regular emptying of intestine.

  • To recommend to the patients of declining and starcheskogo years, and also to the patients with incontinence of urine to use podguznikami. Podguzniki change every 4 hours, undermining a patient here. At incontinence of excrement podguzniki is changed after the act of defecation, necessarily undermining a patient.


Care of patient with bedsore.

  • To execute measures on the prophylaxis of bedsores.

  • At removing of epidermis and formation of bubbles of them a layer by a layer it follows to process by a 1% solution of diamond green and impose an aseptic bandage.

  • Since bubbles burst, the area of bedsore is washed by solution of antiseptika, podsushivayut by a sterile serviette, around process a skin by a 1% solution of diamond green and lay on an aseptic bandage.

  • At presence of the negative emotional reactions related to the protracted medical treatment of bedsores, to render psychological support to the patient and his near


^ Feed of seriously sicking.

Feeding of lying patient from a spoon, poilnika in permanent establishment – it is the direct duty of chamber medical sister. Enteralnie introductions of food products (by probes, fistulas, enemas), parenteralnoe (passing a digestive highway) introduction to the organism of nutritives – more difficult manipulations, at implementation of which take part chamber medical sister, senior medical sister and doctor.


^ Feeding of seriously sicking by a spoon and poilnika.

To put a patient in position polusidya, to cover the breast of patient with a towel. I ride, intended for a patient, to lay on a dinner-wagon the bedside. By one hand a bit to heave up the head of patient together with a pillow, by other hand to bring to the mouth a spoon with a meal. A meal in a liquid or semi-fluid kind (the wiped porridges, soups, clear soups, kissels and etc.) can be given to the patient from poilnika or ordinary small tea-pot. To feed a patient with small portions, slowly, with sufficient pauses, that he was in a position well to chew a meal. To offer a drink after a few spoons of hard food. For the drink of juice, fruit compote, expecting to recommend to use polihlorvinilovie tubes long 20-25 sm and ordinary cup or glass. After eating to suggest to the patient to rinse an oral cavity by water, to wipe the lips of patient by a serviette, to shake off from the sheet of crumb, to straighten folds on her, to help a patient to occupy comfortable position abed.


^ Feeding of patient through a nazogastralniy probe by the Gane syringe.

To put a patient in one of positions: sitting, polusidya, at surplus exhaustion – loafing. To cover the breast of patient with a serviette. To mix the got food from pishebloka up in one capacity and do a liquid nourishing mixture.

To check up the locations of probe – it is impossible to begin feeding of patient, not making sure, that a probe is found in a stomach.

To collect the Gane warm nourishing mixture in a syringe. At the level of stomach to put together the cone of syringe with a probe. Slowly to heave up a syringe higher than level of stomach of patient approximately on 40-50 sm so that the handle of piston was directed up. Slowly pressing on the piston of syringe, to provide the gradual passing of nourishing mixture. After liberation of syringe – peregat a probe by a clamp, to disconnect a syringe from a probe. Thus to repeat procedure until all mixture will not be entered. To disconnect a syringe, peregat a probe by a clamp. In a hour to take off clamp and close the outward opening of probe by a choke.

^ Rules of appeal with a dead body.

Establishment of death is conducted by the doctor of permanent establishment. A doctor fixs time of death in permanent establishment in a hospital chart.

A dead body is undressed, lay on the back. Feet, hands, are unbended, eyelids are closed, a jaw is tied up, cover by a sheet on 2 hours (before appearance of of a corpse spots). Clothes and valuable things are given to the relatives under a receipt.

On the thigh of dead body a medical sister writes the last name and initials, number of hospital chart. A dead body is transported ahead by feet to the patologoanatomicheskomu separation. In an accompanying message the last name, name and patronymic, number of hospital chart, separation, which a dead body, date of death, clinical diagnosis, was delivered from, is indicated.


^ 5. Study questions:

  1. Nurse’s function during operation.

  2. Assistance in operative block.

  3. General notion about operation nurse’s function.

  4. Nurse’s function in postoperative period.

  5. A concept of postoperative period, its phases and variants of current.

  6. The changes in organism due to surgical damage: disturbances of protein, carbohydrate, water-salt exchange, changes of blood composition.

  7. Reparation of patient’s condition after operation.

  8. Recovering of local changes in organism.

  9. Peculiarities of patient’s feeding.

  10. Postoperative complications.

  11. Nurse’s diagnostic of postoperative complications.

  12. Nurse’s tactics in cases of early and late postoperative complication.


^ 6. The literature:


6.1. Basic :

  1. Textbook of basic nursing / Caroline Bunker Rosdahl. – J. B.Lippincott Company. Philadelphia. - 6th ed. –1995.– 1518 p.

  2. Fundamentals of nursing /Taylor Mary Carol, Mary Carol, Lillis Carol– J. B.Lippincott Company. Philadelphia. - 1989.– 1356 p.


6.2. Аdditional:

  1. Gostishev V.K. "Guidance to practical employments on general surgery". M., "Medicine" - 1987.

  2. P. of Brown. Operating block. Operating brigade. – Kharkov, 1997. – with. 1-32.



Methodical instruction was prepared by

Assistant Riabyi S.I.


A review is positive, associate professor Chomko O.J.

Postoperative period this:

а) Period from the moment of ending of operation to convalescence of sick (+)

б) Period from the moment of hospitalization of patient to his extract from the separation

в) Period from the moment of operation to the extract of patient from the separation

г) Period from the moment of operation to transition of patient on ambulatory medical treatment

д) Period from the moment of ending of operation to translation of patient on disability (+)


Divide a postoperative period on:

а) Middle

б) Early (+)

в) Small

г) Remote (+)

д) Urgent


Divide a postoperative period on:

а) Remote (+)

б) Planned

в) Middle

г) Urgent

д) Late (+)


Motion of postoperative period can be:

а) Balanced

б) Functional

в) Normal (uncomplicated) (+)

г) Physiological

д) Complicated (+)


In a postoperative period the following phases are distinguished:

а) Anabolic (+)

б) Reverse development (+)

в) Pathological

г) Physiological

д) Decompensate


In a postoperative period the following phases are distinguished:

а) Pathological

б) Physiological

в) Katabolic (+)

г) Compensations

д) Reverse development (+)


To the measures it is possible to take on the prophylaxis of bedsores:

а) Shaking of sheet after every eating, that in a bed there were no crumbs (+)

б) Laying of patient on a “hard bed”

в) Laying of oilcloth to the patient

г) Change of position of patient abed every 2 hours (+)

д) Change of position of patient abed every 6 hours


To the measures it is possible to take on the prophylaxis of bedsores:

а) Wiping of “dangerous areas” of body of patient with a 5% spirit solution of iodine

б) Application of the sacs filled by the seeds of millet or flax (+)

в) Wiping of “dangerous areas” of body of patient with a 10% solution of camphor alcohol (+)

г) Appendix to the places of possible defeat of spirit compress

д) Permanent position of patient on the back


To the measures it is possible to take on the prophylaxis of bedsores:

а) Wiping of region of coccyx by a 5% solution of glucose

б) Change of position of patient abed every 4 hours

в) Appendix of ice-bag on a lumbar-sacrum region

г) To change stimulation of patient position abed (+)

д) Wiping of “dangerous areas” of body of patient with a 40% solution of ethyl alcohol (+)


In relation to development of bedsores the following regions of body are dangerous:

а) Front abdominal wall

б) Region of sacrum (+)

в) Heels (+)

г) Back surface of thighs

д) Regions of humeral joints


Seriously sick it is possible to feed with the help:

а) Mugs

б) Forks

в) Spoons (+)

г) Bottles

д) Drinker (+)


In relation to development of bedsores the following areas of body are dangerous:

а) Areas of bone ledges of shoulder-blade (+)

б) The back of head (+)

в) Back surface of thorax

г) Front surface of thorax

д) Lateral surface of thighs


The feed of patient after the operation can be:

а) Interstitial

б) Enthrall (+)

в) Internal

г) Parenteral (+)

д) Parenhimatic


The change of bed linen is conducted:

а) At once after contamination by biological liquids (+)

б) In 2 hours after contamination by biological liquids

в) One time in a day

г) One time in 15 days

д) One time in 7-10 days (+)


The used bed linen is needed:

а) To collect in the special waterproof sacks (+)

б) To be dabble in a capacity with a synthetic cleanser on 2 hours

в) To collect in the special waterproof sacks and take in a trash tank

г) To send linen after sorting in laundry (+)

д) To wash in the sanitary room of separation

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