TRADITIONAL METHODS
The best methodology of examination of sufferers is anthropometry. That is an examination of the bodily improvement of an individual. Top, weight, circumference of the chest, respiratory perform (spirometry), muscular forces (dynamometry) are decided. This manipulation is carried out whereas affected person admission to the medical institution, sanatorium, or relaxation house. It’s compulsory in sanitary institutions not like to medical hospitals.
Top is measured with an auxanometer. Whereas measuring the peak, the affected person stands together with his again to the submit, touching it together with his heels, buttocks, shoulder and again of the top. The pinnacle is in such place in order that the corners of the eyes and the highest fringe of the exterior acoustical duct are on one and the identical line. The peak is decided after reducing the board onto the top with its backside edge. In some circumstances top is measured sitting.
Weighing is carried out on medical scales. The affected person is weighed at admission to the medical institution and additional a minimum of as soon as per week, beneath the identical circumstances: on an empty abdomen, in underwear, after emptying the urinary bladder and intestines. Severely ailing sufferers are weighed sitting.
Circumference of the chest is measured with a centimeter tape, placing it within the entrance on the ninth rib beneath the nipples in males, and within the again beneath the decrease corners of the scapula. Fingers are lowered; respiratory is voluntary with none deep inhalations and exhalations. Measurements are carried out on the top of inhalation and exhalation.
Spirometry is carried out with the assistance of a spirometer. The affected person takes a deep breath, holds the nostril and slowly exhales deeply right into a glass tip within the mouth. The tip is sterilized by boiling.
Mattress sores prevention. Extra typically mattress sores seem on the again of the top, shoulder, spinous means of the vertebra, sacrum, heels, iliac bone, pubis, sternum, and so forth. The pores and skin on these areas is wiped with a disinfectant answer (camphor spirit, liquid ammonia, cologne, and so forth.), and a rubber circle lined with an oilcloth is laid beneath the areas the place mattress sores are possible. The rubber circle is laid in order that the sacrum is inside it and the mattress doesn’t contact it.
Washing the affected person. Gear: jug, dressing forceps, sterile cotton tampons, water or disinfectant answer (КМnО4, furacillin 1:5,000 and so forth.). The temperature of the answer needs to be 35–38°С. Whereas washing beneath the buttocks, a vessel is laid. The affected person lays on his again, legs are bent on the knees, hips are separated. They take the jug within the left hand, and pour the exterior genitals. A cotton tampon is used to wipe within the route in the direction of the anus. After that, the floor is dried with dry tampons. In ladies, syringing is utilized with the assistance of a tip which is entered into the vagina with the depth of 6–7 cm.
Processing the mouth. The mouth of significantly ailing sufferers is processed with the assistance of a spatula, tweezers and platens damped with a 2% answer of soda or a 5% answer of boric acid, potassium permanganate or heat water.
Processing the eyes. The eyes are washed with the assistance of sterile gauze tampons moistened in a 3% answer of boric acid. Instillation is carried out by a particular pipette, the decrease eyelid is pulled down by the left hand and a drop is launched nearer to the nostril. After just a little ready, the second drop is launched, and the affected person is recommended to shut his eyes. The remainder of the drugs is soaked up with a cotton swab. Ointments are put beneath the eyelid with a particular spatula.
Processing the ears. Whereas forming wax plug in significantly ailing sufferers, drops of peroxide of hydrogen are put within the ear, after which the plug is taken out with the assistance of a gauze turunda. It’s doable to clean away the wax plug with a Furacillin answer. The Janet’s syringe for 150 ml is utilized. The affected person is seated sideways to the physician and together with his palms he holds a a barrel-like wash-basin beneath the ear lobe. The auricle is pushed again and upwards. The cannula of the syringe is entered into the exterior acoustical duct and slowly the piston of the syringe is pressed. When the drug-solution is introduced into the ear, the nurse strikes the auricle again and upwards, the affected person bends his head in the wrong way, and the drugs is dropped into it, counting the quantity of drops; after that the exterior acoustical duct is closed with a cotton swab.
Take care of the nostril. For eradicating scabs from the nostril turundas are entered into the nasal entrance, moistened with vaseline oil or glycerin and in some minutes, whereas rotating them, take them out with the scabs.
Take care of the hair. The best methodology is combing, however, as a rule, it’s not utilized in medical institutions.
Physique temperature. The measuring of the temperature is a every day responsibility of the nurse. The medical thermometer is calibrated from 34 as much as 42°С. The mercury column doesn’t fall down by itself, it must be shaken down. Thermometers are stored in cups with disinfectant options (3% answer of hydrogen peroxide, 0.5% answer of chloramine). Earlier than use the thermometer must be wiped with a towel, convey the mercury mark to 35°С and place it beneath the affected person’s armpit, preliminary wiping it with a towel for sweat. The vessel with mercury needs to be densely touched by the affected person’s physique. The affected person ought to maintain the thermometer for 10 min. For significantly ailing sufferers, it’s doable to measure temperature within the rectum, however it’s needed to recollect, that the temperature is 0.5–1°С larger there. Earlier than coming into the thermometer into the rectum, it’s essential to grease with vaseline. Youngsters’s temperature could be taken within the inguinal wrinkle. The kid bends his leg within the hip, in order that the wrinkle within the groin will seem. Time of measurement of temperature: 6–7 am and 4–5 pm. Whereas measuring temperature the affected person ought to sit or lie down. With the presence of household the temperature might enhance by 1.5–2°С. The temperature is written down within the temperature sheet. Within the morning the physique temperature is all the time decrease than within the night.
Brokers influencing blood circulation. In reference to the truth that mustard plasters, jars, leeches, compresses, baths can entail heavy issues in affected person, the nurse ought to know effectively the indications and competently technically performs them.
Mustard plaster. Validity of mustard plasters is decided by their particular odor of mustard oil, and they need to not flake off. The sizes of mustard plasters are 12×18 cm. Mustard is placed on dense hygroscopic paper in a particular method. It’s doable to use mustard plasters on all areas of the physique aside from the underside of toes and palms. Earlier than making use of mustard plaster, moisten with water (water temperature not more than 45°С) and put with the mustard beneath for 10–15 min. It’s higher to place a layer of gauze or skinny paper beneath the mustard plaster, and a towel above. It’s essential to do not forget that with long-term expositions burns, even of ІІ diploma, are doable. After mustard plasters eradicating, the pores and skin must be washed with heat water, wiped dry, and the affected person needs to be wrapped in a heat blanket.
Mustard baths. For a mustard bathtub the water temperature needs to be 50°С. 50 g of dry mustard needs to be used for a bucket of water. Time of exposition is 20–30 min. After a mustard bathtub the toes are washed by heat water and wiped dry. After a mustard bathtub the toes are higher to placed on heat socks.
Cups. There are completely different sorts of cups: common — Bier’s cups and moist cups. The quantity for one affected person can vary from 10 to twenty. When making use of cups, the affected person lays on the stomach or on the facet. A steel core with a cotton swab on the top is moistened with spirit or ether. The pointless liquid is pressed out in order to not burn the affected person. If the pores and skin may be very furry, it needs to be shaved or densely greased with vaseline. The cup is held within the left hand near the affected person’s physique, with the precise hand enter an infected tampon into the cup and as quickly because it goes out, rapidly put the cup on the physique. The infected tampon cannot be held within the cup for a very long time, as a result of it makes a cup too scorching. The affected person’s hair needs to be lined throughout this process with a towel. The cups are stored on normally 15–20 min. Take away them cautiously: incline to at least one facet, urgent on the pores and skin with a finger. Haemorrhages and oedema are on the pores and skin after cups eradicating. The pores and skin on the location of exposition is cautiously wiped from vaseline. After use the cups are wiped with spirit and are saved in a particular field.
Bloodletting. Throughout bloodletting the affected person ought to lay in order to not see the blood, as a result of it might course fainting. A pillow is put beneath the ulnar bend in order that the higher extremity is straightened on the elbow; they cowl the pillow with a towel and oilcloth. The pores and skin is disinfected. Gear for bloodletting: syringe, needle with a thick tube via which blood goes in graduated utensils. 300– 500 ml of blood is taken from the affected person. A tourniquet is placed on the affected person’s shoulder so that there’s a pulse on a.radialis. The affected person ought to gripe and undo his fist a number of instances. The index finger of the left hand fixes the vein, and the precise one needles into the pores and skin (the incision of a needle needs to be directed upwards), then the vein. Whereas piercing the wall of the vein, a typical push is felt. After piercing the partitions of the vein, the needle is moved upwards by 2–3 cm. If blood is just not drawn from the needle, it’s needed to drag it in the direction of your self and take a look at once more to pierce the vein. Throughout bloodletting it’s needed to look at the affected person intently. After bloodletting the ulnar bend is disinfected and bandaged.
Leeches. Particular medical leeches are utilized. One leech sucks from 6 as much as 10 ml of the blood. Often 6 to 12 leeches are used. It’s inconceivable to place leeches on areas the place arteries and veins are near the pores and skin, as a result of erosive bleeding can happen. The pores and skin, the place leeches are utilized, is moistened with candy water. They place the leech in a take a look at tube with its head in the direction of the opening. They put the take a look at tube on the needed place. They wait till the leech sticks to. The leech sticks to the pores and skin for 30–60 min, after which falls off by itself. Whether it is essential to take away it earlier, it’s moistened with salt water. It’s inconceivable to tear them off. Aseptic bandages are positioned on bleeding websites. Leeches are used one time, after which they’re distroyed.
Warming compress. It consists of a chunk of dense hygroscopic tissue moistened and pressed, oilcloths or wax papers, cotton and bandage. The warming compress promotes blood movement and resorption of the inflammatory infiltration; it may be placed on any a part of the physique. Every following layer of the compress needs to be 2 cm wider than the earlier one. Firstly the compress is ready, after which placed on any web site, fastened with a woolen scarf. Length of a compress exposition is 10 h. The compress is modified within the morning and within the night. Options for compress: heat water, gentle answer of vinegar (one teaspoon for 0.5 l of water), vodka, cologne, and so forth.
Chilly compresses are utilized on the wound. A cotton tissue is moistened with chilly water and placed on the injured space for 10– 15 min.
Poultices. Utilized as an anti-inflammatory agent. Heated up linen seed, chaff, salt or sand are used for this function.
Scorching-water luggage could be rubber and electrical. The rubber hot-water bag is a 1.5–2 l reservoir with a screwed high. Scorching water is poured into the bag solely to three/4 of the amount, let loose the free air and screw on the highest. After that, verify for tightness by turning the hot-water bottle the wrong way up, wrap in a towel and placed on the sore place. It’s essential to periodically observe the pores and skin beneath the bottle. The bottle is indicated very rigorously in circumstances of stomach ache (the bag is categorically contraindicated for acute appendicitis).
Ice blister. It’s prescribed in bleeding. Often the spherical rubber reservoirs with a large gap and high are used. Crushed ice is put into the reservoir, screw on the highest, cowl with a towel and placed on the physique. It isn’t really helpful to make use of a blister for greater than 30 min. After a 2-hour break the exposition could be repeated.
Baths could be sedentary, normal, handbook, mild, and medical and so forth.. If the temperature of a shower is decrease than 20°С it’s a chilly bathtub, 20–34°С — cool, 34–35°С — detached, 36–40°С — heat, 40°С and better — scorching. The nurse ought to observe for the process always.
Wiping (sponging). It’s utilized for therapy of itching and as a tempering. They take 2 mattress sheets, wrap up the affected person, wipe him with one in every of them moistened in heat water, then the identical affected person is repeatedly wrapped up with a cooler mattress sheet. After wiping, the pores and skin needs to be dried with a dry towel.
Within the division, the senior nurse writes out the medicines in accordance with to purposes of the ward nurses who every day write out the medical assignments from medical histories to particular writing-books or sheets, that are particular person for every affected person, and submit the checklist of medicine appointed to every affected person to the senior nurse.
Medication which belong to the A and B checklist are saved individually in particular safes. A listing of preparations which belongs to the A and B checklist (soporifics, codeine, platyphyllin, and so forth.) with directions of the best single and every day doses, needs to be positioned on the within of the door of the protected. Shares of narcotics shouldn’t exceed a 5-day requirement. Shares of robust medicine shouldn’t exceed a 10-day requirement. Medicines which comprise narcotics are topic to an object-quantitative account in a particular journal, numbered and stamped. Within the log-book of narcotic preparations, every analgesic is given a particular sheet, the place the identify of the medicines, quantity, date of utility, surname, identify of the affected person, variety of his case document, quantity of used ampoules and any the rest are specified.
There are completely different strategies of giving medicine:
— exterior — via the pores and skin, mucous membrane, respiratory tracts;
— enteral — via the mouth, beneath the tongue, via the rectum;
— parenteral — administration of medication into an organism exterior the digestive tract.
Exterior Utilization of Medication
Solely fat-soluble medicine are absorbed via the excretory ductules of the lacrimal gland and hair follicles of the pores and skin; due to this fact the exterior use of medicines is directed, to begin with, at their native motion on the pores and skin, mucous membrane or wounded space.
Rubbing — administration of medicine via the pores and skin like liquids or ointments. Rubbing is carried out on the next components of the pores and skin: the bending floor of the forearm, the again floor of the hips, lateral surfaces of the thorax, stomach that’s such areas the place the pores and skin is thinner and never lined with hair. If the hair could be shaven there, it’s needed. The pores and skin needs to be clear on the rubbed space. The mandatory quantity of ointment or liquid is placed on the pores and skin and rubbed in round actions till the pores and skin turns into dry. Contra-indications to such a process: inflammatory modifications of the pores and skin (eczema, dermatites, and so forth.).
Greasing as a technique of various medicine administration is extensively utilized primarily in pores and skin ailments. Cotton or gauze tampons are moistened within the answer and utilized to the pores and skin of the affected person with simple longitudinal actions. With the presence of hair, greasing is carried out within the route of its progress. With purulent ailments, the pores and skin is greased across the focus of harm from periphery to the middle.
Plaster is a sticky ointment base of dense consistence lined with impenetrable gauze. The ointment base comprises lively medicine. Contra-indications to the applying of plaster are following: eczema, allergic dermatitis. Earlier than making use of a plaster the pores and skin is diligently degreased with medical spirit, and the hair is shaven. They take away the plaster steadily; beginning with one edge, which is moistened with spirit.
Powdering or sprinkling with powdery medicine (talc or rice powder) is utilized for drying the pores and skin for intertrigo and hyperhidrosis. A powder is utilized to the pores and skin on the hyperhidrosis web site with a clear cotton tampon.
Aerosol inhalation is appointed to a affected person for the advance of bronchial permeability: dicreasing of sputum viscosity, struggle towards an infection, safety of the respiratory methods mucosa from dangerous motion of irritating brokers. The benefits for administering medicine by the use of inhalation are following:
Direct motion to the pathological course of within the lungs.
The brokers get to the main focus of harm past the liver unchanged, which predetermines a excessive focus of the drug.
Disadvantages:
Inaccuracy of dosage.
Dangerous penetration of aerosol into the pathological focus duringacute insufficiency of bronchial permeability.
A doable aerosol causes irritation of the mucous membranes.Steam, thermal and oil inhalations are utilized in medical follow. For steam inhalation a easy steam inhaler is used. Whereas heating water, the steam that’s fashioned, sucks within the drug and disperses it, creating an aerosol which a glass tube places into the respiratory tract of the affected person. For inhalation, options of menthol, eucalyptus, antibiotics are utilized. Temperature of the aerosol is 57–60°С. Whereas conducting thermal inhalation, a compressor, which carries out dispersion by the compressed air, is used. The aerosol has the temperature of 39–40°С. For inhalation a 2% answer of house-hold soda in a combination with alkaline mineral waters and options of antibiotics are utilized. With oil inhalation, the oil, masking with a skinny layer the mucous membrane of respiratory tract, protects it from mechanical and chemical brokers and prevents the absorption of poisonous substances.
Instillation of drops into the ear. Earlier than instillation into the ear, the drops are warmed as much as the physique temperature as a result of the chilly drops irritate the labyrinth and might trigger dizziness. A pipette is used for instillation into the ear.
Enteral administration of medicine (via the mouth, beneath the tongue and into the rectum) is the preferred means of therapy as a result of it’s the easiest and most handy methodology of taking completely different medical types (dragee, tablets, capsules, powders). Disadvantages of this manner are incomplete absorption of preparations within the digestive tract, partial or full destruction of the medical types by the digestive enzymes, inactivation within the liver, impossibility to offer a sure focus of medicines within the blood.
Tablets, dragee or capsules are placed on the basis of the tongue and washed down with a drink of water. Taking a powder, the affected person unwraps the wrapper, types it right into a groove and pours out the contents onto the basis of the tongue, washing it down with water. It’s doable to dissolve the powder first in water after which drink it after.
Water options, infusions, mixtures, broths are given to sufferers in graduated beakers.
Spirit infusions, extracts and a few medical options are appointed in capsules. The mandatory quantity of drops is measured with the assistance of a pipette right into a beaker, add water, and given to the affected person to drink.
Some medicine (validol, nitroglycerine, intercourse hormones, and so forth.) are taken beneath the tongue. The great blood circulation within the mucous membrane of the mouth offers full and quick absorption of medicines. With such administration, a drugs is just not destroyed by digestive enzymes and enters the final movement of blood circulation, exterior the liver.
Administration of medicines into the rectum is given to sufferers with intestinal impassability, dysfunction of the act of swallowing and psychological sufferers who refuse to take medicines.
Typically administration of medicines is taken place by the use of electrophoresis.
Parenteral Administration of Medication
Injection is the administration of medicine intracutaneously, subcutaneouly, intramuscularly, intravenously, intraarterially, intracostally and into the spinocerebral channel, and in several cavities of an individual. The nurse ought to grasp the methods of injections. For medicine, not too long ago, disposable plastic syringes of various quantity are used — from 1 as much as 20 ml; “Luer” and “File” syringes had been used earlier. In some circumstances a syringe-tubes (principally in battle time) is used. For intravenous injections needles with the size of 5–6 cm and the opening of 0.3–0.5 mm are used. Needles with the size of three–4 cm and a gap of 0.5–1 mm are used for subcutaneous injections, needles with the size of 8–10 cm and the opening of 0.8– 1.5 mm are used for intramuscular injections. Syringes are saved in particular circumstances, a brass mandrin needs to be on the tip of the needle. It’s essential to verify the passability of needles earlier than the injection. Syringes are assembled with the assistance of tweezers. The left hand takes the cylinder, the precise one inserts the piston into the cylinder. The little finger of the left hand holds the piston, the precise one with the assistance of tweezers places the highest on the needle. Medicines are collected from an ampoule which is maintain with the two–3 fingers of the left hand right into a syringe. Earlier than filling the syringe with the drugs, it’s essential to learn the identify of medication on the ampoule (!). It’s essential to have two needles all the time: one for a set of medicines, the opposite one — for the injection. Medicines are collected into the syringe by suction, pulling the piston.
Intracutaneous administration of medicine. For this function it’s higher to make use of the anterior floor of the forearm. The needle enters solely to the corneal layer of the pores and skin. It’s doable to manage intracutaneously solely 0.1 ml of answer. After administering, a knoll like lemon peel types on the pores and skin.
Subcutaneous introduction is utilized for quick motion medicine. Essentially the most handy for hypodermic introduction are the next areas: exterior floor of the shoulder or radial fringe of the forearm, infrascapular space, anterior exterior floor of the hip, lateral floor of the stomach wall and the underside a part of the inguinal areas.
Intramuscular injections are accomplished on the next areas: exterior high quadrant of the gluteal area (keep in mind the gluteal nerve which passes within the inner quadrant of the gluteus), muscular hips (its exterior floor), stomach direct muscle groups, and so forth.
Intravenous introduction of medicine. The methods is much like that of bloodletting. Extra typically, for intravenous introduction the ulnar veins, much less typically — veins on the hand or subclavian veins are used. For administering a considerable amount of liquid disposable programs are utilized. It’s doable a jet introduction of liquid into the vein.
Venesection isn’t utilized now. It’s already a small operation, and it’s carried out by surgeons beneath operational circumstances.
Pleural tapping is carried out with diagnostic and medical functions. For diagnostic tapping a 20-g syringe and a needle of seven– 10 cm in size with the tip of 1–1.2 mm and abruptly indirect finish are utilized. Prepation for the tapping is similar as for an operation. The affected person sits on a chair together with his face in the direction of the chair again, palms being in entrance on the chest. The tapping is carried out within the space between the seventh–ninth ribs behind the center common axillary line to the precise or left, different intercostal areas are doable relying on the aim.
Puncture of the stomach cavity is a vital diagnostic and medical methodology. The needle is similar as in pleural tapping, and the identical diligent aseptics are utilized. The puncture is completed, as a rule, just a little under the navel alongside the center line.
Paracentesis is a extra sophisticated puncture of the stomach cavity with the assistance of a particular system — a trocar. The trocar consists of the cylinder with the diameter of 0.3–0.5 cm, in its center on the deal with — a pointy steel tip, which stands out by 2–3 mm. After disinfecting the pores and skin with subcutaneous fats is anesthetized, with the scalpel solely the pores and skin is incision and the trocar is entered the stomach cavity with rotatory actions. The trocar is held like a spear. After coming into the stomach cavity, the spear is taken out. Via the trocar it’s doable to manage a catheter or liquid into the stomach cavity.
Arthrocentesis — a easy manipulation, nevertheless it requires the strictest aseptics. The joint is punctured on the web site the place there are not any primary vessels and nerves. The puncture is carried out for prognosis and administering medicinal substances into the joint.
Paracentesis of the urinary bladder is carried out with acute retention of the urine. It’s an emergency or pressing manipulation, and each physician ought to grasp it, irrespectively of his speciality. A thick needle punctures the bladder behind the medium line above the pubis; the pores and skin is moved to the facet. The observance of aseptics and anaesthesia is compulsory.
Pulse examination. Elementary medical manipulation. Pulse is examined in a sitting or laying affected person by 2–4 fingers. It’s inconceivable to measure the heart beat by one finger (and likewise really feel your pulse). Look at the frequency, rhythm, pressure and filling of the heart beat. Calculation is carried out for 30 s to 1 min.
Measurements of arterial strain. Korotkov’s methodology with the assistance of the Riva—Rocci gadgets is fashionable. Just lately, actually, a majority of medical doctors measure arterial strain with the assistance of a sphygmomanometer. There may be an arrow which specifies the arterial strain. It’s handy, moveable. Methods of measurement: the affected person sits or lays, a cuff put by 5 cm above the elbow bend. With a stethoscope or phonendoscope, the beating of the heart beat on the above the ulnar artery are auscultated. With its disappearance, begin releasing slowly air from the cuff. When the beating of the heart beat is heard once more, that is the systolic strain, additional proceed releasing the air till the tones disappearance, that is the diastolic strain.
Measurement of venous strain is carried out with the assistance of the Valdman’s system. The ulnar or clavicular vein is punctured and linked to the system. Venous strain is measured in millimeters of water column. Usually the VP ranges from 50 to 100 mm of water column. The affected person throughout inspection ought to lie.
Throat swab. The affected person opens his mouth extensively. With a spatula they squeeze the basis of the tongue, wipe the tonsils with a sterile tampon, then the posterior wall of the throat and arches. The sting of the take a look at tube, the place the tampon was positioned, is burnt.
Gastric intubation is utilized to look at gastric juice, synthetic feeding and gastric lavage. For this function thick and skinny gastric probes are used. If the thick probe is utilized — the contents of the abdomen flows out itself, throughout washing with a skinny probe, it’s essential to extract with the assistance of a Janet’s or “File” syringe. The thick probe is entered via the mouth, the skinny one can be doable to enter via the mouth, however it’s entered via the nostril then it irritates the throat much less with out retching. The gear for gastric lavage: a watering can for 1–1.5 l, thick gastric probe (size as much as 1.5 m), a jug with water or a Janet’s syringe, options (water, 2% answer of soda, 0.1% answer of КМnO4 (gentle pink)), oilcloth apron, bucket for water, abdomen contents. Methods of process: the affected person is sitting, leaning on the again of the chair, the top is inclined ahead, knees are separated. Earlier than gastric lavage it’s essential to dispose the affected person psychologically and diligently clarify him the which means of the taking place, what the affected person and physician ought to do. The depth for coming into the gastric probe is the space from the entrance tooth to the navel plus the width of the palm of the affected person’s hand.
The bedpan is utilized for emptying the bladder and intestines for bedridden sufferers. There are enameled and rubber bedpans. Earlier than giving the affected person the bedpan it’s rinsed with scorching water. The nurse, with one hand beneath the sacrum, helps the affected person rise just a little, and with the precise hand between the separated legs brings the bedpan beneath the gluteus. Cautiously she takes away the bedpan to not spill its contents on the mattress, without delay the bedpan is roofed with an oilcloth or newspaper and is taken out to the bathroom room. After defecation the affected person must be washed.
Flatus tube is utilized in meteorism, delay in emptying the intestines and gases, which occurs incessantly in sufferers after operative interventions. The gentle rubber thick-walled tube with the size of 30–50 cm and a diameter of three–4 cm is utilized for this function. On the half which is able to enter the rectum it’s essential to make some punched holes. The tubes are boiled, greased with sterile vaseline or different fats; the affected person separates his gluteus and with cautious actions the tube is entered into the anus in order that 5–6 cm are left externally. The exterior finish of the tube is wrapped in cotton wool or gauze. It may be lowered right into a bedpan with water. Maintain the tube within the rectum not more than 2 h (avoidance of bedsores).
Enema. In wholesome individuals intestines are emptied as soon as a day. After an operation sufferers incessantly have constipation, in these circumstances if there are not any contraindications, laxatives or enema are used. Additionally the bowel needs to be opened earlier than radiographic examination, earlier than operations and abortions. Enema is coming into of a liquid into the decrease a part of the thick intestines. There could be cleansing, siphon, nutrient, medical and drip enemas.
Cleaning enemas are made with Esmarch’s mug (enameled capability of 1–2 l) with a rubber hose with the diameter of 1 cm and the size of 1.5 m. There’s a valve and tip on the top (glass, ebonite or plastic) with the size of 8–10 cm. Method: the affected person lays on the left facet with legs bent and dropped at the abdomen, much less typically on his again (postoperative sufferers). The capability and rubber tube are stuffed with water, the tip is greased with vaseline, the buttocks are separated, and the tip is entered with the depth of 5–6 cm. The tip is entered, first, upwards and ahead, after which rotating in the direction of the sacrum. The tip must be entered precisely so to not injure any haemorrhoidal nodes, if there are any, and the mucous membrane. The Esmarch’s mug after opening the valve is lifted as much as 1 m, in some circumstances it’s needed so as to add 1–2 l of water, always watching in order that air doesn’t enter the intestines.
After coming into water, the affected person ought to maintain it for 10 min, mendacity on his again, and solely after that the intestines are emptied into the bedpan or bathroom. In some circumstances it’s needed to make use of a finger to get feces from the ampoule of the rectum that was stopped up. For growing the impact of enema just a little bit of youngsters’s cleaning soap, 2–3 spoons of oil or glycerin, 1–2 spoons of kitchen salt, 30–40 ml of three% of hydrogen peroxide, chamomile extract with valeriana root, and so forth. could be added to the water. The temperature of water needs to be close to 20°С.
Siphon enema. When a cleaning enema doesn’t assist, a siphon one is utilized. It really works acccording to the precept of the linked vessels. Construction: a watering can, rubber tube 1.5–3 m in size and 1.5–2 cm of diameter with a management glass and not using a tip. It’s higher to make use of a thick gastric probe for this function. The temperature of water is 38°С (heat). Place of the affected person is similar as for cleaning enemas. The tip of the probe is moved in the direction of the sigmoid gut so far as doable, supervising its place within the rectum with the index finger. The watering can discended, stuffed with water and slowly rised as much as 1–1.5 m. Because the can gots empty, extra water is added. As quickly because the affected person turns into disturbed, the can is lowered and inclined into the bucket the place the liquid goes out. That is repeated a number of instances, the quantity of water utilized in a siphon enema is as much as 10 l.
Medical enemas are normal and native. Microenema — 50–100 ml of answer, the temperature is a minimum of 40°С. Earlier than making use of the medical enema, the cleaning one is completed. The microenema comprises nonpathogenic, soothing, anticonvulsive, somnolent substances. With the long-term use of medicinal substances, the drip methodology is utilized and the enema known as drip. The velocity of introduction is 60–80 drops a min. It’s doable to surrender to three l of liquid a day.
Nutrient enemas are utilized when sufferers can’t be fed by common strategies. Nutritious options are entered into the rectum by the drip methodology (water, amino acids, spirit, glucose, fibers). Quantity of nutrient enemas is 250 g, the temperature — 38–40°С, 1–2 instances a day.
Catheterization of the bladder. It’s utilized in urinary retention. It’s doable to hold out after reflex empting of the bladder is tried (we’ve already talked about it above). Catheterization is the administering of a catheter into the cavity of the bladder. It’s a harmful manipulation, and every physician ought to know its approach. There are various kinds of catheters: gentle — rubber and agency — steel, feminine and male. Earlier than utilizing a catheter it’s essentially to disinfect it. Steel catheters encompass a deal with, core and beak with two apertures. A male catheter has the size of 30 cm, feminine — 12–15 cm and the beak is much less curved. The strategy of catheter introduction within the lady: the lady is irrigated, with the left hand they separate the labia majora pudendi, and with the precise one they enter the catheter via the exterior aperture of the urethra into the bladder. The steel catheter is held with the hand, the rubber — tweezers. Catheterization in ladies is comparatively simple, in males — tough. The size of the urethra in males is 20–25 cm and it has two physiologic constrictions. Strategy of efficiency: the affected person lies on his again; between the legs there’s a urinal. They take the top of the penis within the left hand between the 2nd and third fingers, disinfect it with sublimate or spirit. With the precise hand and with the assistance of tweezers they enter the rubber catheter, disinfected and greased with liquid vaseline. The catheter is held with the assistance of the fifth finger. Strategy of catheterization with a steel catheter: with the left hand take the top of the penis, the straight a part of the catheter is directed in the direction of the navel, and the beak downwards. They pull the penis onto the catheter in order that the beak covers it utterly. After that, the catheter elevates upwards vertically, guided by the flaps on the deal with. It’s inconceivable to spare a lot effort, as a result of the bleeding is feasible.
MODERN WAYS OF DIAGNOSIS AND TREATMENT IN SURGERY
Laparoscopy
The strategy of laparoscopic examination (whether or not peritoneoscopy, pelvioscopy, and so forth.) was advised in 1901 by a Russian physician D. Ott. Nevertheless, at first it didn’t obtain a large spreading and recognition as a consequence of a lot of causes, the principle of which was the absence of particular gear. Lovers of this methodology of examination used a thoracoscope, cystoscope for a very long time. Just lately, laparoscopes with high-wave optics and a conductor of a chilly jet of sunshine to look at the organs have appeared. They’ve utterly changed fashions of optical tubes present earlier than. These laparoscopes seemed to be efficient sufficient not solely in elective but in addition in emergency surgical procedure, gynaecology, in detection and differential prognosis of traumas of the stomach cavity, pelvis minor and retroperitoneal cavities. Fashionable laparoscopy works out not solely the duties of visible prognosis of ailments of the organs of the stomach cavity, pelvis minor and retroperitoneal cavity. In a mix with instrumental palpation of the stomach organs, radiographic distinction examine of the hepatobiliar and pancreaticoduodenal zones, cholecystostomy and biopsy of most cancers suspicious formations and different operations beneath laparoscopic management (equivalent to cholecystectomy, appendectomy, ovariectomy and even resection of the abdomen and removing of the entire massive intestines and much more) are carried out.
Rules and Strategy of Advanced Laparoscopy
Laparoscopic examination consists of the next phases: preparation of the affected person, utility of pneumoperitoneum, introduction of trocar and an optical tube, examination of the stomach cavity, instrumental palpation, goal biopsy, photolaparoscopy and the top of the examination. Psychological preparation of the affected person: the affected person ought to know what sort of examination will happen and perceive its necessity. It’s essential to cleanse the gastrointestinal tract, perform premedication by administering 1 ml of two% promedol and 0.5 ml of 0.1% answer of atropine.
Utility of pneumoperitoneum: piercing needs to be accomplished at a distance from the enlarged organs, vascular prexuses and from the doable websites of adhessions. The place of making use of pneumoperitoneum needs to be the place for making use of the trocar and optical tube. The perfect one for this function is the purpose situated on the center line 2–4 cm decrease than the navel. There are not any vascular formations there, it’s handy for making use of imposing pneumoperitoneum, making use of the optical system and analyzing all of the organs of the stomach cavity and pelvis. The pathological formations are seldom noticed there, which excludes their wounding.
Introduction of trocar. In the intervening time of trocar utility the affected person ought to tense the stomach wall in order that the physician can really feel the resistance of the aponeurosis of the white line of the stomach. It’s undesirable to chop the aponeurosis, due to hernia formation at this place. It’s doable to repair the anterior stomach wall, which helps in making use of the trocar. The trocar needs to be directed on the angle of 45–60° in relation to the axis of the affected person’s physique. There isn’t any have to enter the trocar greater than 0.5 cm into the depth of the stomach cavity.
Overview of the organs of the stomach cavity is carried out constantly. Beginning with the precise hypochondria, then the left, the pelvic cavity and end with the precise hypochondria once more. If the aim is native or goal examination, to begin with the world beneath curiosity is surveyed.
After the top of the examination and different manipulations within the stomach cavity, the optical tube is eliminated, after which via the trocar’s crane fuel is let loose from the stomach cavity; one suture is utilized on the wound.
Endoscopic Examinations
The event of fibrous optics and the creation on its base of the endoscopic fiberscope within the 60s of XX century is the perfect achievement of science and expertise. The introduction of endoscopic strategies of examination in medical follow decided the progress in lots of sections of medication: gastroenterology, pulmonology, obstetrics, gynaecology, urology, pediatrics. The event of particular gear and the applying of radiological methods, electrical present, ultrasound, laser and different bodily, chemical and organic elements throughout endoscopic interventions have remodeled endoscopy into an unbiased subject of medication with alternatives of finding out the pathogenesis, pathophysiology of ailments, fixing diagnostic, tactic and medical duties. Endoscopy turned the property not solely of enormous medical facilities but in addition the achievement of sensible public well being companies even in regional hospitals. It’s needed to understand that now the certified work of medical doctors of many specialties is inconceivable with out endoscopic examinations.
Fashionable endoscopes are created on the premise of fibrous optics. Flexibility made them protected and efficient, offering extensive sensible utility. Essentially the most fast interval of latest endoscopes introduction fell on 60–70-s of the XX century, their quantity elevated. Essentially the most widespread are endoscopes from the businesses “Olympus” (Japan) and “ASM” (USA).
Ultrasound Prognosis in Surgical procedure
In medical medication ultrasound prognosis started to be utilized originally of the 50s of the XX century. That point the gear meant for revealing cracks in steel objects. For the following 4 many years there was a fast improvement of ultrasound prognosis, technical enhancements, which allowed to increase diagnostic alternatives of ultrasound gadgets. As we speak one can say with certainty that ultrasound researches have occupied one in every of main locations in fashionable medical medication.
Cryosurgery
The applying of chilly along with medicinal herbs and bloodletting is the oldest within the historical past of mankind methodology of therapy. Within the works of the “Father of Medication” — Hyppocrates — the medical results of native utility of chilly to cease bleedings in wounds and traumatic oedema are described in particulars. Chilly is the oldest anesthetizing agent. Within the Center Ages army surgeons used it as anaesthesia throughout surgical operations.
Even though cryosurgical therapy of various damages to the pores and skin started a very long time in the past, the fast improvement of cryosurgery within the fashionable which means of this time period turned doable solely because of technical progress and the chance to create sophisticated fashionable gadgets for cryogenic destruction within the depth of tissues and organs of a affected person. Cryosurgery is extensively utilized in neurosurgery, ophthalmology, othorhinolaryngology, gynaecology, and urology. The primary cryosurgical operation within the former USSR was carried out in 1962 by I. Kooper, and A. Li in 1961 provided the system like a steel probe via which liquid nitrogen is ready to enter straight the pathologically modified organs — their components, mucous membranes, pores and skin. In 1971, Laberopulos proposed a cryoscalpel.
E. E. Sandomirsky and coauthors (1979), А. І. Paches and coauthors (1978), V. M. Zaporozhan (1982) and plenty of different authors, who studied the peculiarities of affect of low temperatures onto the organs and tissue with completely different sorts of pathology, confirmed that cryosurgery is a physiologic and sparing methodology of therapy, which is exsanguinate, painless, much less traumatic, has excessive technical alternatives, absence of issues, which permits to make use of it in medical follow.
Utility of Laser Beams in Surgical procedure
Initially of 60-s of the XX century, because of the researches of the Nobel Prize winners N. G. Basov and A. M. Prokhorov and their American colleagues C. Tauns and A. Shavlov, the brand new precept of accelerating radiowaves with the assistance of a bundle of “lively” molecules was investigated. The optical quantum generator, which operates on a crystal of synthetic ruby was created.
The essence of the laser motion consists within the following: through the exercise of a strong gentle flash created by a pumping gentle, the lively substance turns to the excited situation. In a sure time interval (105–106 s) part of the excited atoms comes again to the preliminary situation, thus releasing gentle quantum. Attributable to quite a few reflection from resonator’s mirrors the quantity of collisions of photons with lively substance will increase, due to this fact an avalanche of sunshine quantum, which after reaching a sure capability escapes as a vivid gentle impulse with a really excessive focus of power, types.
The primary working laser plant was designed within the USA in 1960. Because the finding out of the organic interplay of laser radiation with organic objects has began. Researches concluded that the laser beam could be manipulated with excessive accuracy, influencing areas of tissues of any dimension, teams of cells, endocellular buildings, for instance, the nucleus of a cell, and so forth.
First, the laser was utilized primarily in oncology, ophthalmology and another fields of surgical procedure and subsequently obtained extensive recognition in medication.
Ultraviolet Irradiation of Blood
The primary constructive outcomes from medical utility of irradiation by ultra-violet rays turned doable after the invention of the primary system for irradiation of blood (E. Ok. Knott). In 1928 for the primary time on the planet, the reinfusion of irradiated blood was carried out in a affected person after a septic abortion, which was handled earlier with out success. After this remedy the affected person recovered. Because the 80s, ultra-violet irradiation of blood (UVIB) has been extensively utilized in medical institutions. For irradiating blood, lamps, which radiate ultra-violet rays each of the brief and combined sort, are used. The reinfusion of irradiated blood promotes the ache disappearance, wounds therapeutic, the final state of well being improves, working means will increase, sleep and the physique temperature normalizes. The strategy has no issues and contraindications and has the next motion:
— bactericidal, antibacterial;
— anti-inflammatory;
— desintoxication;
— stimulates oxidation-reduction reactions, reduces hypoxia in tissue;
— raises the resistance of an organism to infections; — stimulates phagocytosis, and so forth.