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Peculiarity care
of patients in surgical practice
Lector:
Assistant of General Surgery Department
of medical faculty
c.d.m. Barinov V.E. 1
General Surgery Department of Russian State Medical University
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General Surgery Department of Russian State Medical University
Care is art.
Professional care of patent is at the first
maximal
quality care.
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General Surgery Department of Russian State Medical University
Participants of care:
Doctor
Nurse
Hospital attendant
Kins
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General Surgery Department of Russian State Medical University
Respect of patient’s
Confidentiality senses and dignity
Infection safety
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General Surgery Department of Russian State Medical University
Patient needs:
1. Normal breathing
2. To use enough for food and liquid
3. To excrete by-product of life
4. To move and keep active position of body
5. To sleep
6. To dress and undress, choose the clothing by himself.
7. To keep the normal temperature
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General Surgery Department of Russian State Medical University
Patient needs:
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General Surgery Department of Russian State Medical University
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General Surgery Department of Russian State Medical University
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General Surgery Department of Russian State Medical University
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General Surgery Department of Russian State Medical University
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General Surgery Department of Russian State Medical University
Complication:
Standstill pneumonia
Athelectasis in the lungs
Lung’s edema
To keep of adequate lung’s ventilation :
well-time anesthetization
To remove a phlegm from bronchial tree
Breezing practice
Early activation of patient
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General Surgery Department of Russian State Medical University
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General Surgery Department of Russian State Medical University
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General Surgery Department of Russian State Medical University
Nutrition of patient
Artificial
Natural
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General Surgery Department of Russian State Medical University
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General Surgery Department of Russian State Medical University
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General Surgery Department of Russian State Medical University
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General Surgery Department of Russian State Medical University
Cardio-vascular complications:
Cardio-vascular deficit;
Cardio-vascular accident;
Thrombosis and embolia.
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General Surgery Department of Russian State Medical University
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General Surgery Department of Russian State Medical University
Causes of thrombosis
Triad of R.Virchov
damage of vessel wall
decrease speed of blood flow
hypercoagulation
Rudolf
Virchow
(1821–1902)
Morphological and functional damage of vessel
Change characteristic of blood flow
Increase the coagulation property of bloods
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General Surgery Department of Russian State Medical University
Patient without
fail must know
how to apply to
elastic bandage
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General Surgery Department of Russian State Medical University
Law of Laplas
P = T/ R
Pressure = tension force of bandage / radius
of extremity
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General Surgery Department of Russian State Medical University
high
compression
low
compression
5 = incorrect 4 = correct
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General Surgery Department of Russian State Medical University
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General Surgery Department of Russian State Medical University
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General Surgery Department of Russian State Medical University
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General Surgery Department of Russian State Medical University
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General Surgery Department of Russian State Medical University
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General Surgery Department of Russian State Medical University
Critical result of
incorrect elastic
compression
This is a way to
amputation of
lower extremity
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General Surgery Department of Russian State Medical University
Necessity study of patient or participation of Physician make the selection of type of elastic stoking
physician in form elastic bandage and compression volume. Patient may use this type of
compression himself.
Difficult chose of compression and fixing on hip Effective compression on hip, have special
accessories for fixing on skin
Bandage shell unusable after few wash, and need Keeping elastic characteristic during half of year.
replaceable. Don’t lose function after wash in hot water.
Low compliance. Consent of patient to use this type of compression
Low accommodation and esthetical characteristics. High esthetical characteristics and comfort in use.
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General Surgery Department of Russian State Medical University
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General Surgery Department of Russian State Medical University
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General Surgery Department of Russian State Medical University
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General Surgery Department of Russian State Medical University
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General Surgery Department of Russian State Medical University
Decubates
( lat.- decubare is laying)
Decubates is ulcer due to the pressure on the
skin in place where bones locate superficial
Decubates appear in consequence of local
deficit of microcirculation (ischemia) and as
result death of tissue cells (necrosis).
To take for grating, that pressure on tissue
more than 70 mm. Hg. during 2 hours appear
irreversible process in tissue.
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General Surgery Department of Russian State Medical University
1 stage 3 stage
2 stage 4 stage
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General Surgery Department of Russian State Medical University
Decubates
Auriculars
Occiput
Scapulas
Shoulder joint
Elbows
Elbow joint
Kreuz
Femoral joint
Ichiadicus hillock
Genus joint
Heel
Ancle-bone 38
Contact places
General Surgery Department of Russian State Medical University
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General Surgery Department of Russian State Medical University
and pelvis
Use a cytostatic treatment
Violation transported rules of patient
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General Surgery Department of Russian State Medical University
Norton’s scale
Most important in decubates prevention is detection risk
of this complication. There are many valuation scale in
this aim.
For example:
scale Norton (1962);
• scale Waterlow (1985);
• scale Braden (1987);
• scale Medley (1991) and others.
Nortons’s scale is so easy for use because they is more
popularly among nursing personal
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General Surgery Department of Russian State Medical University
Norton’s scale
Read to intercourse Full – 4 Short – 3 Particle - 2 Absence - 1
Inspection of skin
Examine and feel the skin
Theoretical substantiation
Ageing of skin has influent of defense barrier’s state, decrease of
perception of pain and property of immune system. Heal of wound is
slow down.
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General Surgery Department of Russian State Medical University
Single-use hygienic
devices and prophylactic cosmetic is
recommend for care of patient.
Who is recommend?
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General Surgery Department of Russian State Medical University
Cleaning of skin
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General Surgery Department of Russian State Medical University
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General Surgery Department of Russian State Medical University
Cleaning of skin
MENALIND®
Application:
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General Surgery Department of Russian State Medical University
Application:
- drift 15-20 ml liquid on pure skin.
- Event drift from skin surface
- Time of procedure 5-7 minutes
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General Surgery Department of Russian State Medical University
Skin protect
MENALIND®
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General Surgery Department of Russian State Medical University
Easy state
Less than 100 ml of urine during 4 hours
Medium state
100-200 ml of urine during 4 hours
Hard state
200-300 ml of urine during 4 hours
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General Surgery Department of Russian State Medical University
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