Tuesday, July 28, 2020

NURSING COURSE : CARE OF THE PATIENT

CARE OF THE PATIENT 

POSTURAL CHANGES: 

It is a measure that the nursing group builds up as per the arrangement of care of every patient. It is fitting the investment of a few colleagues, expanding this relying upon the prerequisites and seriousness of the patient. 

It is done in those patients who briefly or forever have lost their self-sufficiency and versatility and are incapacitated. 

Body arrangement will consistently be regarded and indexed parts will be shielded from progressively touchy or defenseless to injury. 

The mood and qualities of the progressions are characterized by the consideration plan of every patient 

CARE OF THE PATIENT 

POSITIONS: 

The essential positions are every one of those positions or places that the patient can receive in the bed, cot, surgical table, which are of enthusiasm for the administration of the patient by the helper nursing staff and in an exceptional manner by the parental figure. 

Patients can receive various positions and, with this, few destinations are sought after: 

Team up in clinical investigation. 

Permitting a careful intercession, contingent upon the employable territory, the patient will be in some position. 

Help in the treatment of an ailment. 

Get the solace of the patient. 

1.- Position of recumbent or dorsal decubitus: 

- In the anatomical position, the patient stays with the hands on each side of the body, broadened arms, adduction thumbs and pronation hands. 

- The head stays erect and the feet are coordinated forward. 

- The knees and fingers in slight flexion. 

- The patient is lying on his back with the furthest points in augmentation, the upper ones connected to the body and the lower ones together. 

- Indications: 

Chest, mid-region, upper and lower appendage test. 

Postoperative. 

Remain in bed. 

Changes of position. 

Palpation of the bosoms. 

- Contraindications: 

Old. 

Aspiratory patients. 

Long haul patients 

- Pillows can be set in various territories of the patient's body to support arrangement: 

Under the neck and shoulders, to keep away from hyperextension of the neck. 

Under the lower back (a little pad), to keep up the anatomical bend. 

A towel moved along the side under the hips and thighs, keeping away from outside pivot of the femur. 

Under the lower third of the thigh, to raise the popliteal hole. 

Under the lower some portion of the legs, to raise the heels. 

Inclined or ventral decubitus position: 

- In this position the patient lays on his midsection and chest, with his head inclined aside. 

- The help measures for the patient in this position are little pads or moves in the midsection at the degree of the stomach, to offer pay to the lumbar ebb and flow and in the event that it is a lady, to diminish the heaviness of her body on the bosoms. 

- A little cushion under each shoulder assists with supporting the anatomical arrangement. 

- When the patient is in the prono-ventral position, pressure is offered on the knees, to diminish it a little pad can be utilized under the thighs. On the off chance that the patient needs a pad for the head and there is no contraindication, you can put a little, which can even support the waste of the aviation routes, ought to be cautious in any capacity that the pad doesn't sprain the patient's head. 

- This position is utilized in tests of the back and backside. 

- Indications: 

Back investigations (in spite of the fact that for checks are utilized pretty much nothing). 

Insensible or oblivious patients. 

Patients anesthetized with general sedation to forestall regurgitating. 

Worked from section. 

Remain in bed. 

Postural changes 

- Pillows can be utilized: 

Under the head 

A little pad under the stomach, to stay away from hyperextension of lumbar bend, extreme weight on the bosoms and encourage relaxing. 

Under the lower third of the legs, to diminish the contact on the toes. 

2.- Position of parallel decubitus: 

- The patient stays bolstered on one side, right or left, with the limits broadened. 

- The upper part relating to the side on which the patient is lying, is before the body. 

- Indications: 

*To make the bed involved. 

*To place a suppository. 

*Administration of intramuscular injectables. 

*To forestall ulcers by decubitus. 

*Administration of bowel purges. 

*Stay in bed and to roll out postural improvements. 

*Hygiene and back rubs. 

*It is fitting to put pads in: 

*Under the head, to support arrangement. 

*Under the upper arm, to raise the arm and shoulder. 

*Behind the back, to keep up a decent arrangement. 

3.- Semiprona Position: 

- It is like the parallel situation where the patient is lying on his side; yet in this position, the patient's weight is stacked on the front piece of the ilium, the humerus and the clavicle, as opposed to on the horizontal piece of the ilium and scapula. 

- The weight purposes of the body are unique in relation to the weight purposes of the parallel situations, of Fowler, dorsal lean back and inclined position. 

- It is regularly utilized with patients who are oblivious, in light of the fact that it encourages the waste of the mucosa of the mouth. It is an agreeable situation for some, others remembering ladies for the last trimester of pregnancy. 

- One arm is put behind the body and the other arm is flexed by the shoulder and the elbow. 

- Both legs are additionally flexed before the patient. The one on top is more flexed at the hips and at the knees than the one underneath. A cushion laying on the mid-region of the patient, will give support in this position. 

- Its sign on a basic level might be in patients who can not swallow, it permits a decent seepage of bodily fluid and gives greatest muscle unwinding, however can likewise be applied on numerous events. 

- The patient is in the left parallel decubitus position with the correct thigh flexing the correct arm forward. The head is turned along the side. 

- The body weight lays on the chest. 

- Indications: 

Security position, which is the reason it is perfect for moving mishap casualties. 

Rectal tests 

Organization of douches and rectal prescriptions. 

Situation of rectal tests. 

In oblivious patients to encourage the disposal of emissions. 

Postoperative. 

*It encourages muscle unwinding. 

* It encourages the seepage of bodily fluid. 

* Pillows will be put: 

* Under the head 

* Under the shoulder and upper arm. 

* Under the thigh and upper leg. 

* The body lays on the shoulder and hip. 

4.- Seated position: 

- The patient is perched on the bed, with the lower limits broadened and the furthest points coordinated forward, with the hands laying on the bed. 

5.- Position of fowler: 

- It is one of the most utilized situations in incapacitated patients. 

- The patient is semi-sitting, framing a 45º point. 

- It is an agreeable situation for the patient, particularly on the off chance that they are furnished with cushions for the head, back, lumbar arch, arms, and so on. 

- In this position the central matters of help are in the heels, sacrum and part of the hip bone. 

- The situation of Fowler is shown in patients or with respiratory or heart issues, since with it the greatest thoracic extension is accomplished. 

- It is utilized for assessments of the head, eyes, neck, ears, nose, throat and chest. 

- It is a position utilized often in the investigations of ENT administrations. 

- Modified Fowler; essentially equivalent to the past one, the distinction lies in the bow of the knee joint, and this empty loaded up with a cushion or collapsing the bed if conceivable. 

- The situation of Fowler is adjusted, when the patient, when situated, inclines and lays on a bed table or a few pads. 

- This last alteration is utilized in some respiratory pathologies, it gives supplemental power to breathe out the propelled air. 

Indicaciones: 

* Position generally utilized in otorhinolaryngology investigations. 

* Patients with respiratory issues (asthma, COPD, emphysema, and so forth). 

* To loosen up the abs. 

*Patients with heart issues. 

*Explorations of head, eyes, neck, ear, nose, throat and chest. 

* Pillows can be set: 

*Behind the neck and shoulders. 

* Behind the lower back. 

*Under the lower arms and hands, to keep away from pressure in the shoulders and hold the arms and hands, if the patient doesn't utilize them. 

*Under and the sides of the upper piece of the thighs. 

*Under the lower third of the thighs. 

*Under the lower legs, to raise the heels. 

*Fowler position high, the situation of the top of the bed is raised 90º regarding the feet. What's more, the semi-Fowler position, the height is 30º. 

*Modified Fowler position, which comprises of placing the patient similarly as in the past case however altering the situation of the upper appendages (hands), which must be set, higher than the elbows. This is accomplished by supporting your hands on a feasting table, for instance. It is demonstrated in heart patients to encourage venous course or return. 

CARE OF THE PATIENT 

Understanding MOBILIZATION: 

For data on the most proficient method to support patients, we should consider their status and know whether we can work together with us or it is preposterous. 

Tolerant NOT COLLABORATOR: 

Do the preparation between 2 individuals. 

1. Spot every individual on the bed, confronting the wiped out individual. 

2. You should put your feet separated just as your knees somewhat twisted. 

3. Take off the top garments from the bed just as the patient's pad. 

4. Partners or parental figures embed one arm under the patient's shoulder and the other under the thigh. They hold the patient and tenderly lift him up to the ideal position. 

NOTE: When assembling the patient in the ideal position, it is important to keep away from dreary or sudden contact and shaking, for which stage 4 is best finished with the assistance of a passage. 

You can likewise put the two individuals on a similar side of the bed, along these lines. 

1. The primary individual spots one arm underneath the shoulders of the patient and the other arm beneath the chest. 

2. The subsequent individual slides his arms to the tallness and underneath the gluteal area; 

3. Next, you will be asked to the necessary position. 

Tolerant COLLABORATOR: 

For this situation with just a single individual is sufficient. 

1. We remain close to the patient's bed, before him and at the stature of his hip. 

2. Tell the patient that he is at the top of the bed and flexing his knees, place the bottoms of the feet on the outside of the bed. 

3. At that point we place our arms underneath the patient's hips. 

4. The patient will be approached to reinforce their feet and arms. 

5. That is the point at which the associate or the guardian - with his/her arms-must assistance the patient to go up to the bedside. 

6. On the off chance that the patient is very coordinated, this preparation must be finished. 

Preparation of the patient aided by a sheet 

It is done between two individuals, one on each side of the bed. 

1. For this strategy we take an "entrance" that is a sheet collapsed in its length into equal parts. 

2. Where you are, for instance, from the shape that has arrived at the shoulders to the thighs. 

3. To do this, place the side of the parallel decubitus on the bed and the meter of the "entremetida" on the contrary side to what in particular is turned, at that point we will show it on the opposite side and we will expel the piece of "entremetida" that is missing from setting. 

4. Once the "entremetida" was put, it was twisted around the sides of every individual, in this way having the option to move the patient to any side of the bed, staying away from grinding. 

Activation of the patient towards the side of the bed 

The Nursing Assistant or Citizen is put on the bed to which the debilitated individual will be moved: 

1. Spot one arm under the patient's shoulder, hang on the contrary axilla. 

2. Spot the other arm beneath the hip, moving it to the next hip. 

3. On the off chance that the patient is husky he should be between two individuals. 

4. Assemble it cautiously to the ideal position. 

Turn of the patient laid up of Supine Decubitus to Lateral Decubitus 

The Helper or City must be set on the bed to which the patient is going to turn: 

1. To start with, move the patient to the side of the bed inverse the ideal position, so you can turn the patient in the focal point of the bed. 

2. The patient is approached to demonstrate the arm to the side that will turn the body and to flex the other arm on the chest. 

3. You are solicited to flex the knee from the appendage that will be above. 

4. Next, on the lower some portion of the hip. 

5. Turn the patient to the side where the aide or parental figure is, who was put in the sidelong decubitus position. 

6. NOTE: In the Lateral Decubitus position, precautionary measures ought to be taken with ears, shoulders, elbows, iliac peak, trochanter and malleus so pressure ulcers don't happen. 

The most effective method to send or fuse the patient in bed 

_ For data about how you can get data about the subject. 

_ For the lifting of the shoulders, the Helper or the City. Swinging the body back, bringing down the hips vertically with the goal that the weight passes the leg before the back. 

Approach to send the patient on the edge of the bed 

1. The Auxiliary or Caregiver progresses an arm, the nearest to the head, and encompasses the shoulders of the patient, and different spots it on the farthest hip of the patient. 

2. With this hand makes the hips and legs turn so they are dangling from the edge of the bed; 

3. With the other arm assists with raising the storage compartment. 

4. The second you have plunked down, you should gauge your heartbeat and afterward put on your robe and shoes. 

Pass the patient from the bed to the cot 

WITH TWO PEOPLE 

1. One plays out the preparation of the patient and different makes a point to fix the cot so it doesn't move and help the first. 

2. The cot is set corresponding to the bed and very much joined to it. 

3. Beforehand they will have evacuated the variety and the elastic (salvacamas) in the wake of having expelled the sheet ledge and covers to the feet. 

4. One of the two individuals is set on the external side of the cot, in the inside, and pulls the entremetida towards himself, while the other is set in the headboard holding the patient by the shoulders, lifting them and moving toward him to the cot . 

5. When the patient is put on the cot, he is secured with sheets and covers and the elastic and the interferes are fixed. 

WITH THREE PEOPLE 

1. In the event that the patient can not move at all three individuals will be important. 

2. The cot is put opposite to the bed, with the top of the cot contacting the foot of the bed. 

3. The three individuals remain before the bed, propelling one foot towards it. 

4. Curve the knees as one and spot your arms under the patient: the initial, one underneath the neck and bears and the other in the lower back; the second, one under the lower back and another beneath the hips, and the third, one underneath the hips and the other beneath the legs. 

5. At that point they return the patient towards them, making him slide tenderly on his arms. These are held near the body to keep away from futile endeavors; 

6. They get up, turn their feet and move towards the cot, at that point twist their knees and bolster their arms in it. The developments must be smooth and concurrent to offer security to the patient and keep him from getting terrified. 

Pass the patient from the bed to the wheelchair 

1. The primary activity is fix the wheels. On the off chance that there is still threat of the seat moving, it will take two individuals, one of whom will hold the seat by the backrest to forestall development. 

2. On the off chance that the bed is excessively high, a stage will be set that is firm and that has an adequate surface so the patient can move without falling. 

3. The patient will sit on the edge of the bed and, with the assistance of the Assistant, put on the outfit and shoes (so they don't fall off without any problem). 

4. On the off chance that the patient can not make just the developments important to sit on the edge of the bed, he will be helped in the way showed in Seating the patient on the edge of the bed. 

5. The seat is set with the backrest on the foot of the bed and corresponding to it. 

6. The Helper or Guardian is set before the patient with the foot that is nearest to the seat before the other. 

7. The patient places his hands on the shoulders of the colleague or guard while the last holds him by the abdomen. 

8. The patient puts his feet on the floor and the Helper or Keeper holds with his knee further developed the comparing knee of the patient so it doesn't twist automatically. 

9. The Helper or Helper turns with the patient and, when put before the seat, flexes the knees so the patient can get down and sit on the seat. At the point when the seat isn't wheeled, the method is the equivalent, however the threat of the seat moving is lower.

CARE OF THE PATIENT 

Loaning OF BED: 

Bed course of action with patients 

It is the technique to put or change the bedding, and for this situation as a rule, the patient must stay in it constantly, in any event, when it does the medical caretaker does. It is significant that she figure out how to transform it delicately and rapidly while the patient is resting. The confined to bed are frequently wiped out and this movement is contraindicated. 

Gear Needed 

Two huge sheets 

A cross over sheet (discretionary) 

A cover 

A blanket 

Travesera to waterproof sheet (discretionary) 

Spread (s) for pad (s) 

Versatile crate for filthy clothing, on the off chance that one is accessible. 

Method of the strategy of bed course of action with quiet 

Take off the garments from above. 

- Remove all things that are connected to the bedding, for example, the ringing chime. 

- Loosen the garments above, at the tallness of the foot of the bed, and expel the comforter and cover. 

- Leave the sheet on head of the patient (this can stay on the patient in the event that it will change and on the off chance that it gives enough asylum), or supplant it with a shower sheet, as follows: 

a) Spread the shower sheet over the top sheet. 

b) Ask the customer to hold the head of the shower sheet. 

c) Reaching under the towel from the side, hold the top finish of the sheet and evacuate it towards the foot of the bed, leaving the shower sheet set up. 

d) Remove the sheet from the bed and spot it in the clothing pack. 

Approaches to make the bed 

Open bed: Assigned to a patient, it very well may be emptied if the patient is up and involved if the patient is inside the bed (it is finished with him inside). 

Steps: 

1. Wash hands and put on gloves. 

2. Spot the bed on a level plane and brake the wheels. 

3. Situation of the material to be utilized in a seat at the foot of the bed. 

4. Expulsion of blanket and cover. 

5. Expulsion of ledge and entremetida. 

6. Expulsion of soaker and base. 

7. In the event that the sleeping pad spread is grimy, it is changed. 

8. Expand the base sheet on the bed, fold the headboard, at that point the feet,make miter corner in feet and head lastly take care of laterals. 

9. Situation of the soaker at the degree of the pelvis. 

10. Do likewise with the intruding. 

11. Spot ledge with the goal that the wide sew is on the top edge of the sleeping cushion and fold your feet. 

12. The cover that is at the tallness of the shoulders. 

13. The blanket like the cover yet above. 

Shut bed 

At the point when the patient leaves the unit and the bed isn't doled out to another patient. 

There are various kinds of bed, as indicated by the requirements of the patient: 

Explained bed: 

The metal bed outline is shaped by versatile fragments that can be inclined with the assistance of a wrench. 

Orthopedic beds: 

They are utilized for patients with orthopedic issues. In the explained bed, an edge is adjusted, which has bars put over the bed, where pulleys are set through which they pass ropes. 

One of the closures of the rope has a secured tie that is fixed to the patient's furthest point, finishing the opposite end in a grasp inside the scope of the patient, who pulls up the limit. 

The round of various ropes and pulleys, permits to guarantee the re-teaching and assembly of the patient. 

Electrocircular bed: 

That permits to change intermittently the situation of the patient. It is utilized in Burned Units. 

Beds for unique administrations: 

There are exceptionally mind boggling beds available intended for uncommon administrations. 

Bed plan. 

Alerts: 

- Respect the security of the patient all through the procedure, never leaving it completely revealed. 

- Avoid automatic separations of tests, catheters, serums and so forth. By assembling it. 

- Taking the safeguard of moving it as meager as could be expected under the circumstances. 

- Avoid wrinkles of sheet material. The weight and uneasiness endured by the patient are negligible if the lower sheets are tight, keeping them from bothering the skin and preferring the presence of wrinkles. 

- The upper sheet, ought to be free and not apply pressure on the patient's appendages, so as not to constrain their developments. 

- The grimy clothing that is evacuated, must be brought legitimately into a sack. This attire jam microorganisms that can be moved by direct contact. To keep away from sullying, the Nursing Assistant will work on washing the hands before making the bed and will put on the dispensable gloves. He will take off the filthy garments keeping away from contact with the uniform and once the administration is done, he will wash his hands once more 

- The clothing truck will consistently be cleaned before filling it and ought not go into the room. It will be jettisoned. 

- In the controls of garments, you ought to abstain from blending clean dresses in with messy ones. 

Bed improvement methods: 

- The bed must be changed totally consistently, subsequent to washing or cleaning the patient. 

- If you are a confined to bed tolerant or conveying channels, tests, serums, and so on., the crosspiece or sheets will be changed, the occasions vital for your solace and along these lines dodge skin sores because of abrading. 

- Before beginning, it will be watched that all material is readied, both for bed and individual use, night robe or robe, towels and packs for gathering filthy garments, which will consistently be recognized in red or dark as indicated by the patient's sickness . 

Void bed 

- Place the bed in a level position and evacuate the pad. 

- Make sure that the sleeping pad is in acceptable condition. 

- Place the base sheet on head of the bedding in the lower half, coordinating the longitudinal overlap of the sheet with the focal point of the sleeping pad, the free edge hanging by the feet of the sleeping cushion. At that point unfurl up the other portion of the sheet. 

- The edges relating to the head and feet are put under the sleeping pad and for the four corners, there is a strategy that leaves the sheet totally fitted. 

- The parallel edge of the sheet is lifted and the overabundance is put under the sleeping pad. 

- The sidelong edge is collapsed under the sleeping cushion. 

- The overabundance sheet point covers the abovementioned, leaving a right corner. 

- It is known as a corner looking like a miter. 

- Place the crosspiece with the goal that its focal overlay is in the bed, its side edges fit cozily under the sleeping pad. 

- Place the ledge sheet, which likewise its focal overlap is in the bed, its upper edge will coordinate the relating edge of the bedding. The lower part is fixed under the bedding. The embozo of around 25 cm is made. 

- If covers or quilt is required, the lower edges ought to be set after a similar strategy as the ledge and the upper edge underneath the embozo. 

- The sheet, cover and spread, will drape the equivalent from each side and won't be tucked sidelong 

- The exact opposite thing to put is the cushion. 

Occupied BED: 

Prior to beginning the administration, the patient's circumstance is evaluated to shape the vital nursing group. 

*You are educated regarding what you will do to get your most extreme cooperation. 

*The pad is expelled and the spread is changed. 

*To cause the bed, to continue: 

*By longitudinal parts. 

*The quiet is lateralized to the furthest limit of the bed, holding a right hand for his wellbeing. 

*The other assistant, will expel the messy sheets in its free part and will put in a fan towards the middle the bed the base sheet and the crosspiece. 

*By methods for a solitary development the patient is turned towards the spotless part. The messy garments are evacuated, the spotless sheet and the crosspiece are extended, which must stay without wrinkles and the corners are put making the miter edges. 

*The sheet or towel that secured the patient is evacuated. 

*The ledge sheet is set leaving the blueprint on the top and staying free on the feet, for an all the more free versatility. The corners are fixed and the cover and spread is set if vital. 

*The pad is put. 

* On a plate If the patient is totally immobilized, (polytraumatized, neurological, and so in.) a group of four individuals is required, put two by two on the two sides of the bed with the goal that they can be lifted on a plate and the garments set on the bed. 

Cleaning the bed: 

- The bed will be cleaned once per week or at whatever point it is free with cleanser and water, drying it later with a dry fabric. 

- The sleeping pad will be cleaned every day with a material and if the patient can get up we will turn it over. 

- When the patient is high, the sleeping cushion will be cleaned with heated water, cleanser and a 0.1% blanch arrangement.

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