Organization of the dressing
dressings nurse responsible for aseptically in dressing.
Depending on the profile of separation in a pure dressing produce procaine blockade, diagnostic and therapeutic puncture of the chest and abdominal cavity, blood transfusions and medicines.The net dressings are often carried out small tasks: the imposition of skeletal traction, the removal of tumors of the skin and subcutaneous tissue, primary treatment of small wounds.
in purulent wound dressings make treatment of purulent wounds, puncture and penetration of ulcers and other manipulation of patients with purulent infection, including blood transfusions.
Staff working in the dressing room, which are produced as pure and purulent dressing should be particularly careful and attentive, so as not to confuse the tools that were used for the dressing clean and septic patients.
the responsibility of dressing nurse training includes nurses working in the dressing room, the rules of aseptic and antiseptic.
rules of behavior in the dressing
1. Set strict order of dressing: first clean, for example, after plastic surgery, then conditionally clean, for example, after operations on the abdominal organs, and in the last instance - festering bandaging.
2. Patients remove outer clothing (pajamas, bathrobe), stockings, socks in front of the dressing, in a specially designated room adjacent to the dressing room.
3. Medical staff working in masks, hospital clean, easily washable footwear (leather, rubber, etc.), or coats with short sleeves rolled up to the elbow, cap.At the entrance to the dressing room must be put to the mat soaked in an antiseptic solution.
4. infected dressings take only a tool, throw in a bucket with pedal cover and then destroyed.
Organization of work in the dressing
working day begins with a tour of the dressing.Dressings nurse checks whether used staff on duty at night dressing.When an emergency intervention or unscheduled dressing used and contaminated dressings in clean buckets with lids, use a tool having washed, soaked in an antiseptic solution.Sister checks whether the floors and furniture wiped with a damp cloth, puts Bix with the material sets obtained on the eve of pharmacy medicines.
dressings sister gets a list of all the dressings for the day, set their priority.The first bandage patients with a smooth postoperative course (removal of sutures), then granulating wounds.
Convinced ready dressing, sister job for hands.Previously she puts on an operating form, carefully hiding her hair under a scarf or hat, hog nails, putting on a mask.After treatment arms sister wears.She takes out slut gown without touching them slut edges.Carefully deploying it at arm's length, she puts it on, tying ribbons sleeve robe and hides the ribbon under the sleeve.Opens Bix and ties behind the ribbon dressing gown nurse.After that, a sister wears sterile gloves and covers the tool table.To this end, she pulls out slut sterile sheet and Lays it, folded in half, on the tool table.
When air sterilization process in kraft paper, the nurse should find out the date of the pre-sterilization.The articles sterilized in kraft paper can not be stored for more than three days.Tools should be spread in a certain order dressing nurse who chooses itself.Usually tools are laid out on the left side of the table, dressing on the right side, in the middle of placing special tools and drainage tubes.Here's sister puts sterile jars for novocaine, hydrogen peroxide, furatsilina.Right Angle sister leaves for the preparation of free stickers and bandages during ligation.Sheets, folded in half, sister closes the tool table.Preparatory work must be completed by 10 hours.
1. Organization of dressings.The nurse calls from patients the chambers, guided by a list drawn up by dressing as a nurse.Bedridden patients are transported on a gurney with a blanket and pillow, taken from their beds.Shifting the patient on the dressing table, trolley
together with a blanket and pillow are exported outside the dressing before the end of dressings.The dressing is much easier to work when there are two tables: the surgeon is bandaging a patient, a nurse at the other prepares the second patient - puts it on the table, removes the top bandage.If you can not arrange two tables in the dressing room should have two wheelchairs to the next patient waiting dressing lying about dressing.Use the gurney from the operating unacceptable.In the absence of the two gurneys dressings can be accelerated by alternating between walking and bedridden patients.Walking sick remove outer clothing and tested to the dressing table.Ward sister and a nurse helping a patient to lie down on the dressing table, and then close it to clear the sheet belt.When there is a dressing doctor;special responsibility procedures, as well as the first dressing, he makes himself.
Each dressing consists of five stages:
1) the removal of the old bandage and the toilet of the skin;
2) execution of manipulations in the wound;
3) protection of the skin and secretions from the wound;
4) the imposition of a new bandage;
5) fixation bandage.
1. Remove the old bandages, skin toilet.Bint orderly unwinds.Taking off the bandage, it can not twist, since the lower layers may be infected.Bandages soaked with blood or pus, not unwound, and cut with scissors to remove the dressing.To remove the plaster, strips of moistened it, and when the labels peeling off the skin are holding hands.Sticker tweezers surgeon removes producing bandage.To do this, sister sends surgical forceps tweezers him.The old label is removed along the wound from one end to another.Removing the bandage across the wound leads to its dehiscence and pain.Taking off the bandage, the skin are holding a spatula, forceps or gauze ball, preventing it from reaching for a bandage.Firmly adhering bandage peeled ball soaked with a solution of hydrogen peroxide or isotonic sodium chloride solution.With hands and feet the old dried-bandages removed after soaking better if the state allows the wounds to make manual or a foot bath of warm Qadi permanganate solution (1: 4000).Before starting the procedure tray treated with an alcohol, hot water or washing with synthetic detergents.Then poured into a bath with warm water 38- 40 ° C and a few drops of a 30% solution of potassium permanganate to yield intense pink color.The limb was immersed for 5 minutes with a bandage.After removing the bandage, limb removed from the water, dressing forceps grasp and thrown into the gas.The surgeon examines the wound and processes it.Bath wash with hot water and detergents, disinfectants washed and stored in a dry form.
If you remove the bandage caused capillary bleeding, it stopped, pressing lightly bleeding place a gauze ball.
After removing labels produce toilet skin around the joint or injury.Purify the wound with gauze or cotton balls, first dry, then soaked Technical ether.For cleaning you can use warm, soapy water, 0.5% ammonia solution.Pasta Lassara well shoot balls soaked with vaseline oil.The skin is wiped, from the wound edges to the periphery, and not vice versa.When this liquid droplets can not enter into the wound.With a significant contamination of the skin around the wound is possible to protect the wound area with sterile gauze, thoroughly wash the entire limb soap, if the wound festers, the following procedure must be carried out every dressing.After cleaning the skin, it is dried with gauze balls, and then treated with iodine and alcohol, or other coloring yodinolom antiseptics.Clean the skin around the wound - the first condition of successful treatment.In addition to cleaning treatment causes local congestion, which positively influences the trophism postoperative suture and accelerates healing.
2. Implementation of manipulation in the wound.When ligation produced the following manipulation: removal of sutures, sensing field seams, ointment tamponade, washing purulent cavities.
Removing skin joints can produce a sister in the presence of a doctor.This requires a surgical forceps, scissors and a small napkin.Tweezers sipping one of the ends of the threads, knotted side of the suture line.After the tissue depth of 2.3 mm seem subcutaneous silk thread portion white in this location under severe jaw of summing thread scissors and the thread intersect at the skin surface.Cut with a ligature knot is easily removed with tweezers.Each shot to put the seam lying next to a small napkin unfolded, which, after removal of sutures fold tweezers and thrown into a basin of dirty material.
Removing metal brackets.To remove the brackets must have skobkosnimatel and clip Michel brackets.Instead of clamping brackets can be used for curved clamp Billroth.Summing skobkosnimatelya or jaw of the clamp under the middle part of the bent brackets, bracket compression tool straighten and selecting one of the first the skin, then the other clove, remove it.When removing the brackets with two surgical pincers grab it at both ends, straightened and removed from the skin denticles.After removal of sutures or staples treated with antiseptic sutures line and make stickers.
3. Protect the skin from the secretions from the wound.Before applying wound dressings to the intestinal, biliary discharge (if any intestinal, biliary, pancreatic fistula) circumferentially wound in the skin should be protected from irritation and maceration.To this end, the skin around the wound smeared with Vaseline, toothpaste Lassara, zinc ointment.Sister with a trowel applied to the skin with a thick layer of paste or ointment on the wound edges and on for 3-4 cm and gives it to dry.
4. bandaging.For postoperative aseptic seam sufficient aseptic bandage.It is a spread-eagled in the full-length incision gauze, which is covered with another layer of gauze, which is the size of 3-4 cm longer.The gauze is glued around the periphery kleolom.Stitches on the face on the first day can be left without the stickers.The dry aseptic cotton-gauze bandage used in fresh wounds after removal of postoperative sutures.On top of the wound bandage, tampons filled with hypertonic saline or ointments.If there is a wound drainage tube, then its removal outside bandage incision, performing drainage through the incision.wool layer thickness depends on the abundance of discharge from the wound.Dimensions cotton-gauze bandage is determined from the size of the wound or postoperative suture so as to overlap the size of its seams line 3 cm. Long bandages often applied over the layer of absorbent cotton gray wool, bandages to prevent soaking.
5. Fixing bandages bandaging is made by gluing or using reticulate-tubular bandage.Sister with a cotton swab dipped in kleole, lubricates the skin along the edges of the bandage superimposed on the width of 3-4 cm. The skin around the wound must be clean-shaven and degreased with alcohol.After drying kleola impose top, stretching the corners, a piece of gauze, which is 4 cm wider and longer bandaging.The gauze tightly pressed against the skin.Her unglued edges are cut with scissors.When fixing plaster surgeon brings his hands the wound edges and holds them in position, and sister separates from the adhesive tape roll band of the desired length without touching hands patch area, which lies on the wound.Usually 1-3 pasting strips.To the wound is not sold, it is necessary to make strips of sufficient length, capturing at least 10 cm of healthy skin.Thus, the total length of the strip is 20-22 cm. Two longitudinal stripes parallel to the top of the transverse strips wound impose, departing from the edge of the wound by 3-5 cm.
correct bandaging usually gives the patient relief.Even if ligation is accompanied by painful procedures and manipulations that caused them pain subside quickly.
is necessary to pay attention to the complaints of the patient, to enhance pain after ligation.Most often they are associated with tight bandaging, sometimes skin burns by careless use of iodine, but there may be more serious causes, such as secondary bleeding to form bursting hematoma.After ligation is necessary to ensure the strength of stickers.When moving and dressing the patient to help ward sisters and nurse dressing.The nurse should ensure that patients were only on call and did not stay after ligation.
After each ligation oilcloth, located on top of the sheets, wiped with a disinfectant solution.In case of accidental contact with pus on the floor, a nurse immediately wipes the floor mop soaked in a disinfectant solution.
Dressings patients with purulent wounds.Purulent dressings begin only after dressing nurse will check whether all clean dressings are finished and whether neperevyazannyh septic patients left.During operation, the patients with purulent staff puts on a specially selected gowns, gloves and aprons.A nurse gives a patient in the dressing room, to spread under the Pego oilcloth, given the possibility of spreading of pus, sticks to the wound or reniform basin puts several layers of lignin or sterile cotton wool to prevent the ingress of pus and wash fluids from the wound onto the table.Before opening the abscess nurse shaves the hair in the area of the surgical field and the direction of the doctor puts the patient in a comfortable position.Dressings festering wounds of both primary and secondary (if any festering operational and traumatic wounds) of the same type.Treatment of purulent wounds and dressings, in particular, are based on an understanding of the general laws governing the flow of purulent process, having three phases:
• inflammation phase, which includes two periods - vascular changes (redness, swelling), and wound cleansing;
• repair phase (the formation and maturation of the granulation tissue);
• phase of epithelization and reorganization of scar.
After removing the bandage and the skin around the wound toilet sister takes one after another few dry gauze balls.Pus does not wash, and slightly press the balls to the surface of the wound, as a blotter.Used balls soaked in pus, throwing into the basin.At the direction of the doctor's sister takes some balls soaked with hydrogen peroxide, and then re-dried pellets to dry the resulting mass of foam.Then, like a sister takes the surgeon balls soaked in furatsilina solution and then dried balls to complete drainage of the wound.
If necessary, prepare a gauze dressing sister turunda.Turundy length 20-30 cm dressing sister takes the edge of the forceps, wound around his jaw with tweezers and puts it in a jar with a 10% solution of sodium chloride, where it is easy to unwind and remove after soaking.When removing the excess solution turundy sister press in the bank with the help of tweezers.After that, she fixes the free end of the forceps and tweezers turundy delivers the doctor who takes turunda your tweezers.For turundy laying and filling the cavity it is necessary to have a doctor bellied probe.Edge turundy sister keeps on using the weight of his forceps.The surgeon progressively introduces turunda with the probe in the purulent cavity, and a sister at this time continues to support it, grabbing forceps in the right place.Above turundas with hypertonic solution is applied several napkins, also wetted in this solution.
Currently actively apply ointment on the basis of a water-soluble - Levosin, levomekol, sorbileks etc.Tampons with such ointments do not adhere to the bottom of the wound, it is easily melted at a temperature of 37 ° C.Apply the ointment in the first phase of purulent process, helping to cleanse the wounds of non-viable tissue, suppression of microflora.Used as a tampon impregnated with the ointment and is administered in an amount of 10-15 ml syringe via a catheter or mikroirrigator.If there is scant purulent discharge and the appearance of granulation, t. E. The second phase of purulent process, it is necessary to apply medicines reliably protected from superinfection granulation tissue and to ensure conditions for epithelialization of wounds.