Major medical procedures. What is manipulation and everything connected with it
To the question "What is manipulation?" most often you can get an answer about the psychological impact in order to achieve a certain personal benefit. However, this influence is often hidden.
What is manipulation
Manipulation is a kind of purpose which is to force a person to certain actions against his will. In this case, the influence is carried out not explicitly, but hidden. The essence of manipulation is that the person who is under pressure must want to take certain actions herself, even if it is unprofitable for her.
They resort to when they are afraid of failure or are obviously sure of the negative outcome of a particular enterprise. Perhaps even those individuals who do not fully understand what manipulation is, without realizing it themselves, quite often use this psychological technique to achieve their goals. Even children's whims can to some extent be attributed to manipulation.
Why do people resort to this
In order to perform a certain manipulation, there must be a reason, which can be both conscious and subconscious. So, people are forced to such methods by the following:
- the danger of being in a difficult or (in this case, the person begins to use others in order to get around uncomfortable moments);
- self-doubt often leads to the fact that a person subconsciously tries to influence others;
- social pressure, as well as stereotypes associated with a particular situation, often induce manipulation, the purpose of which is to conceal or justify certain actions;
- a negative attitude towards a certain person, as well as the desire for revenge, often becomes the cause of psychological impact;
- manipulation often becomes an unscrupulous method of achieving selfish goals.
How to neutralize manipulation
Having understood what manipulation is, it is important to familiarize yourself with the methods of neutralizing it. So, to avoid psychological impact, it is recommended to use the following techniques:
- having recognized the manipulation, it is worth immediately and openly declaring the inadmissibility of such an impact on you (if it is caused by self-doubt, then such a sharp answer will immediately discourage the opponent);
- revealing the intentions of the manipulator and exposing it to others (disclosure of inconvenient facts will make the impact ineffective and inappropriate);
- if you feel pressure from the opponent, call him for a frank conversation in order to clarify the situation and determine the motives for behavior (a compromise can be found during the conversation);
- a fairly effective method of dealing with manipulation is to criticize the person who is trying to put pressure on you;
- if you understand that diplomatic methods did not help you get rid of pressure from outside, resist your opponent by entering into an open confrontation with him (confrontation will unsettle him);
- try to respond with manipulation for manipulation.
How to understand that you are being manipulated?
Manipulation (influencing) can have a variety of manifestations, and in order to effectively resist it, it is important to be able to recognize it. So, it is accompanied by the following situations:
- feeling of psychological discomfort and lack of logic in the sequence of events;
- contradiction between the verbal and non-verbal messages of the opponent;
- tension in the conversation;
- mood swings in the manipulator, depending on whether he manages to achieve what he wants;
- atmosphere of distrust between interlocutors.
Simple tricks
The following simple manipulations are distinguished:
- an attempt to achieve one's own goal, relying on a feeling of resentment or guilt (in this case, the opponent begins to feel obliged to please the "victim");
- the psychological impact of silence is aimed at demonstrating a mental disorder and drawing attention to one's experiences;
- manipulation of anger and other negative feelings is based on the fact that the blackmailer demonstrates his unbalanced psychological state, trying to get certain actions or concessions from you;
- pressure on the feeling of love is designed for loved ones (often such situations arise in families or couples, when one of the parties speculates on a good relationship, trying to achieve selfish goals);
- promising and instilling a certain hope in the interlocutor is a fairly common method that is used to provoke a person to specific actions or concessions;
- vanity manipulation involves exerting pressure by demonstrating high status;
- sarcasm and ridicule can unsettle a person, which makes him more malleable in terms of management.
Complex manipulations
Complex manipulation methods can be described as follows:
- such a technique as a shift in emphasis is quite common in (the same news can be presented in completely different ways if you focus on certain facts);
- certain words or situations can cause a storm of emotions in a person, which facilitates the process of manipulating him;
- in order to give a person an attitude to certain actions, it is not necessary to speak about it directly (for this it is more reasonable to use interrogative intonation or the form of a sentence);
- as well as playing on strong emotions in order to make their illegal actions less significant against their background;
- if the manipulator does not have a clear argument for his behavior and requirements, he begins to aggressively demonstrate resentment, trying to get away from a constructive conversation;
- the dispute displacement technique lies in the fact that, without having sufficiently convincing arguments in defense of the argument, a person begins to actively criticize it;
- in order to confuse the opponent, the manipulator can bombard him with a whole stream of questions in order to later accuse him of misunderstanding and unwillingness to give a detailed answer.
How does this happen
The algorithm for manipulating public consciousness involves the passage of several successive stages:
- drawing up a psychological portrait of a group or a specific person in order to determine the main beliefs and values;
- bringing the planned situation in line with the current climate in society by influencing through the media and other methods;
- the introduction of certain mechanisms that will facilitate the transition to a new state;
- follow-up control of the situation in order to prevent deviation from the set course of development.
Types of manipulations
Trying to achieve certain goals, a person can use various kinds of methods of psychological influence. In this regard, it is important to understand what manipulations are usually distinguished:
- conscious manipulation is purposeful and planned (a person is clearly aware of the algorithm of his actions to achieve the desired effect);
- unconscious manipulation does not have a specific goal, and the individual has not developed a clear plan and ideas about the methods of influencing the opponent (often the scenario develops chaotically, under the influence of strong emotions);
- linguistic (or communicative) manipulation is based on the oratorical abilities of the individual, through which he seeks to provoke the interlocutor to certain actions;
- behavioral manipulations are based on the performance of a certain kind of actions and actions that do not require additional verbal techniques.
Means of manipulation
In order to perform manipulation, an individual can use the following means:
- in order to convince the opponent that he is right and call for specific actions;
- the emotional component, which is aimed at demonstrating one's own feelings or challenging those of the interlocutor;
- appeal to urgency, which knocks the opponent off balance and requires quick rash decisions;
- constant repetition of the same statement in order to put pressure on the interlocutor;
- highlighting a specific fragment from the general context of events in order to present the situation from the most favorable side;
- talking about the problem without mentioning the context and a number of important circumstances that can clarify the real state of affairs;
- suppression of the opposite opinion by speculation;
- use to convince others that they are right;
- presenting one's own opinion as objective and confirmed information from reliable sources;
- pressure on the interlocutor with the help of his authority or high social position.
Vulnerability
The following individuals are most often manipulated:
- those who want to please others in everything and receive constant approval;
- people who are afraid of quarrels and unfriendly attitude;
- dependent and indecisive personalities (only depending on others they feel emotional comfort);
- gullible people, confident in the honesty and rightness of others;
- altruists who consider it their duty to help everyone and in everything;
- impulsive individuals who make important decisions under the influence of momentary emotions;
- young people who do not yet have their own formed life position and are in search of authority;
- single persons who are looking for communication and friendly relations;
- insecure individuals who consider the opinion of others more correct and rational than their own.
Conclusion
Manipulation of people is the strongest mechanism of psychological influence (often hidden), which involves forcing the interlocutor to do something (while the latter must be sure that he himself wants it). Such phenomena can occur both consciously and unconsciously. At the same time, the success of manipulation depends both on the person himself and on the psychological characteristics of the individual on whom the impact is directed.
The reasons for manipulation may lie in the nature of the individual or in external circumstances. So, most often it is resorted to by people who are terribly afraid of crisis situations and are trying in every possible way to avoid them. Also, this kind of techniques are used by insecure individuals who simply do not see for themselves another way to achieve their goals. Manipulation can cause strained relations between people, and is also an unscrupulous method of obtaining benefits.
In order to resist manipulation, you need to find the strength to give a tough answer and issue a warning about the inadmissibility of such actions. A person must understand that his intentions are revealed. It is better if this fact is widely publicized in order to block the manipulator from further paths to action.
There is a whole trend in psychology called the psychology of influence. And there is also the concept of manipulation. Manipulation- this is a hidden influence on a person, the purpose of which is to force him to do what the manipulator needs against the interests of this person. The essence of manipulation comes down to making sure that the person himself wants to fulfill your will.
What is manipulation
Manipulation is referred to as hidden psychological techniques. Psychologists consider manipulation to be unethical and dishonest. in the case of manipulating other people, a person exploits them for his own purposes. According to Wikipedia, manipulation is classified as passive-aggressive behavior.
How exactly do manipulators influence their victims? It can be positive or negative reinforcement. Manipulation methods can be punishment or even traumatic one-time experience, such as an outburst of anger, an insult, or any other behavior that may be intimidating. Even one unpleasant experience can discourage the victim from resisting the manipulators. All these methods of manipulation are given by the scientist Harriet Breaker(Harriet B. Braiker).
At the same time Simon revealed much more methods of manipulative control. In particular lies or omission of the truth. The silence of the truth occurs, for example, in the business world, when the bank is silent about all the terms of the loan agreement in the hope that the client will not see or pay attention to the fine print.
Also Simon says there are also the following manipulation types: rationalization of one's behavior, minimization of harm done, selective attention or inattention, distraction from the topic, subterfuge, veiled threats, assigning false blame to the victim, shaming, judging the victim, pretending to be the injured party, playing the role of a servant, seduction, blaming others, feigning innocence , pretending to be a fool. Simon also says that an outburst of aggression and anger can become a manipulative means.
Manipulators often have personality disorders. As Robert Hare and Paul Babiak write, psychopaths are especially manipulative.
Often, manipulation involves poor moral character manipulators who are not afraid of their lies, aggression or other hidden tactics to damage their victim. Often the manipulator studies his victim and their weaknesses in order to understand what feelings or psychological characteristics can be played on?
Often, manipulation techniques are used by bosses in relation to their subordinates, business partners, and even women in relation to their young people. In some cases, manipulation can benefit everyone. For example, when a doctor tries to manipulate a patient so that he reconsiders his lifestyle (for a complete cure).
Techniques and methods of manipulation
Manipulations are widely used, including in the business world, as we wrote about above. Knowing how to manipulate will allow you to successfully resist such manipulations. For example, when you work at least a little as a sales manager and learn some tricks to manipulate customers, then later, as a consumer, it will be almost impossible to hook you with such hooks.
First of all, you need to understand that an experienced manipulator seeks to establish contact with his victim - he is looking for common interests, studying the psychological characteristics of a person, interests, beliefs and even habits. In addition, the manipulator takes into account the psychological state of the victim at the moment in order to pick up manipulation technique which will work most effectively.
- False question. The manipulator, in order to somehow clarify this or that aspect of the dialogue, asks again the thoughts voiced before, but places the accents in a different way in such a way that the general meaning changes in favor of the manipulating person. To resist this method of manipulation, you need to carefully listen to what they say to you, and if you heard a substitution of concepts, immediately correct the interlocutor.
- Emphasized indifference and inattention. Let's say the victim is trying to prove his case. But there is no reaction to his arguments. The calculation is that, trying to prove his case, the victim will give out the information that he was not going to say initially. In this case, you should not succumb to provocation.
- Quick jump to another topic. The manipulator moves on to another topic, not giving the victim the opportunity to properly challenge the first one or comprehend it, have time to think it over or doubt it. Such manipulation is carried out in order to fix information that is not always reliable. That is, in this way they are trying to inspire you with some kind of false message. To resist this type of manipulation, you need to be critical and attentive to everything that is said to you.
- Quoting the words of the interlocutor. The manipulator, unexpectedly for his partner, begins to quote his words. And sometimes distorting the phrase. You can protect yourself from such manipulations in a similar way - by quoting the manipulator.
- Sneaks up. When a manipulator shows his weakness, he wants to evoke pity or condescension towards himself. In such cases, the victim dulls attention and no longer perceives the interlocutor as a serious competitor. Don't underestimate partners. You should always see them as strong people. Only in this case can you protect yourself from this method of manipulating you.
- Flattery. People can confess their love to you, admire your qualities, flatter, say that they respect you. This way of communicating works much better than a simple request. At first they flatter you, and then they ask for something, and it’s already uncomfortable for you to refuse. In this case, you can only resist flattery with a cold mind and a head on your shoulders.
- Anger, rage and aggressive pressure. Showing an attack of unmotivated aggression, the manipulator expects that you will want to calm him down and make serious concessions on this or that issue. Psychologists advise ignoring the psychotic behavior of a colleague, because. it might confuse him. Another way to counter the raging genwu and furious pressure is to use the same method yourself - quickly increasing the degree of aggressiveness and pressure. And here already you will dictate your conditions to the manipulator.
- False haste and fast pace of speech. When the manipulator pretends that he does not have time and speaks at a very high pace, in the expectation that you will not have time to think over and give an answer to this or that thesis. Your silence will be taken as tacit consent. can give out a manipulator in your interlocutor. Countering this tactic is questioning. You can also take a short break for a phone call. All these tricks help to cool the pace of communication to a normal level.
- Make excuses by expressing suspicions. The manipulator acts out his suspicion in order to elicit an excuse reaction from the victim. Such a distraction allows you to weaken the so-called protective barrier of the psyche, so that later you can push your ideas. will help you counteract these manipulation tactics. You should show the manipulator that you do not care about his suspicions and that you will not tear your shirt off to prove the opposite.
- Feigned fatigue. The interlocutor lets you know that he is allegedly very tired. You shouldn't give discounts to anyone. If you want to object to him - object, because. a person is trying to make you agree to everything and do not mind.
- The pressure of authority. The manipulator uses his authority and tries to put pressure on him. However, his advice goes beyond the field in which he is an authority. Let's say I can understand a nutritionist's recommendation to adjust my diet. But you should not assume that a good car mechanic is also well versed in computers, building houses and management.
- Reverse psychology. Often we observe that we want to do exactly what we are forbidden to do. No wonder they say that the forbidden fruit is sweet. Sometimes manipulators use this feature of the psyche to their advantage. You can protect yourself from this type of manipulation only if you constantly remember your interests and will not succumb to manipulation.
- Small details. Sometimes the manipulator draws your attention to a small and not very significant detail of the object, not allowing you to consider the situation in general. Due to this, conclusions are drawn, which, of course, cannot be correct. It's like talking about a statistical pattern based on 2-3 random cases, while for reliable statistics there should be a survey of at least a hundred "measurements". Manipulators take advantage of the fact that many people judge events and phenomena without knowing the subject thoroughly and are guided by the opinions of other people. But what if the opinion of another person is the opinion of the manipulator? Try to rely on your knowledge, and not on the superficial judgments of other people.
- Irony and ridicule. Manipulators often try to shake the interlocutor to emotions with the help of irony or a grin. This is done because when a person gets emotional, his state of consciousness becomes altered and the person becomes more easily susceptible to suggestion. In negotiations, you must have a cold mind and not be swayed by emotions.
- Get out of your mind. Manipulators are constantly trying to twist the thread of the conversation in such a way as to confuse you. Do not give in - you should bend your line.
- False recognition of favorable conditions. The manipulator exaggerates the favorable conditions in which the victim is allegedly located. As a result, the victim begins to make excuses and becomes more driven. Do not make excuses, but admit your superiority - self-development sites advise.
- Imitation bias. The victim is placed in such conditions that he himself has to divert suspicions to the manipulator that he is biased. Thus, the victim gives himself the installation not to react critically to the words of the manipulator. Once in a similar situation, refute your bias, but do not praise the manipulator.
- Lies through special terms. As we wrote above, one of the favorite tactics of manipulators is lies and misrepresentation. In this case, the manipulations are carried out by the method of misleading with the help of specialized terms. As a result, the victim, hearing incomprehensible terms, does not ask again, fearing to seem stupid or incompetent. If you hear an unfamiliar word, then you need to ask again - there is nothing shameful in this.
- Imposing false stupidity. The method comes down to the humiliation of the victim, his merits below the plinth. In this case, the manipulation takes place with the help of hints. Can work on people with and temporarily confuse them.
- Imposing thoughts through repetition. As in American programs and books, the same thought is repeated in speech many times, in the end it can become your thought. That is why it is so important. Just don't pay any attention to it. Therefore, it is useful to fix the agreements on paper in the form of a signed contract.
- Three "yes" in a row. This manipulation technique is used by sales managers who call you on the phone. The conversation script is deliberately built in such a way that you say "yes" several times in a row. As a result, the psyche is tuned to constantly agree, and then they slip you an offer to which you must agree.
- false inattention. The manipulator deliberately pretends to be a fool, allegedly he didn’t see something, didn’t notice. However, he “does not notice” exactly what is beneficial for him not to notice.
- Observation and search for similar features. The manipulator seeks or invents common characteristics and qualities with his victim. Thus increasing the level of trust. This reduces psychological protection. You can protect yourself from this by telling the manipulator that you are not like him.
- Imposing your choices. The manipulator sets a condition so that you choose between two or three options proposed by the manipulator, without considering other alternatives. For example, a waiter in a restaurant asks what kind of wine you will drink red or white, or maybe you just wanted to grab a cup of coffee. Always pursue your interests, then no manipulation can work on you.
- "Pickling". The meeting is specially delayed to exhaust partners and get everything you need from them
Manipulation protection
Not everyone is easily manipulated. Smart and wise people are difficult to succumb to any tricks. If you feel that the manipulator wants to do some difficult work at your expense, ask yourself, are you Mother Teresa? For example, once a work colleague asked me to go out to hold on Saturday at 8 am, motivating this by the fact that his father had a birthday. However, I never saw a response. The question arises - why did I do it? Perhaps he wanted to please a colleague at work, or just purely humanly entered into a position. However, to no avail.
It will be nice if you study the book Roberta Childini about the psychology of influence. Understanding the mechanics of the human psyche, you will have a serious immunity to any manipulation.
The irony lies in the fact that the manipulators themselves have many weaknesses and their egocentrism and vanity can also be used for their own purposes 🙂
The first step in protecting against manipulation is that you realize that you are trying to solve goals that are alien to you. The second thing to keep in mind is to clearly understand your interests and compare everything that is offered to you in accordance with your personal interests.
Next - do not swing on emotions. It is not for nothing that in psychology there is such a method as. When making important decisions, one should try to drown out emotions and make decisions in a clear state. However, you should not rush into making a decision. Time constraints play into the hands of the manipulator. Learn to say "No" when you're not interested in something. Don't try to please. On the contrary, if you feel that you are being asked a question with subtext, you need to clarify it - for what purpose is the manipulator asking this and what does he want to achieve? Thus, you reveal his intentions and throw the ball to the other side. Now the manipulator will make excuses by losing psychological protection in front of you.
Give a signal to any manipulation about being seen. It can be a mockery or a critical assessment. This can neutralize the entire power of manipulative influence. There are also passive-aggressive ways to protect against manipulation. For example, ignoring. The highest class is when you understand the manipulation and do not show it. At the same time, in the process of negotiating, you lead everything in the direction that is beneficial for you.
Another ambiguous way to counter manipulation is to unpredictability. For example, the boss yelled at you in the hope that you would stay after the end of the working day and do all the dirty work, and you sent him in front of colleagues and threw a letter of resignation. As they say, an unpredictable person is simply invulnerable. allows people to behave relaxedly, confidently and almost completely protects against manipulation.
Read also:
Reading: Robert Childini - The Psychology of Influence
The duties of the nursing staff include the implementation of medical manipulations prescribed by the attending physician. Not only the early recovery of patients, but also the prevention of possible complications depend on how these manipulations are performed, therefore, knowledge of the technique and compliance with all the rules of medical manipulations is the main requirement for medical personnel.
The most important manipulations that all the staff of any medical institution should master are different ways of administering drugs, applying dressings, and physical methods of treatment. A feature of the surgical hospital is the ability of employees to care for wounds and traumatic injuries. Therefore, medical personnel need to know surgical instruments, modern suture material and dressings.
In pediatric surgery, an important criterion in the choice of drugs is the age of patients. The same criterion substantiates their route of administration. There are several routes of drug administration:
1) enteral route,
2) parenteral way,
3) rectal route,
4) external use of medicinal substances.
enteral route- the introduction of drugs through the mouth. There are many different forms of drugs for oral administration: tablets, pills, powders, capsules, tinctures, syrups, suspensions, solutions, aerosols, etc. In early childhood, the use of tablets, pills, capsules and other solid forms is difficult, so more preference is given to given to solutions, syrups, suspensions. Some medicinal substances intended for oral administration are destroyed by the action of hydrochloric acid of the stomach, therefore, a special shell consisting of gelatin (the so-called capsule) is used for such substances. This shell freely passes the stomach, collapsing only under the influence of enzymes in the duodenum, which ensures the safety of the medicinal substance. It is important that the optimal action of many oral forms is associated with the act of eating, so you need to strictly follow the sequence of intake - before meals, during meals or after meals. In the treatment of patients, a complex of drugs is most often used, which have a versatile effect, the routes of administration of which may differ. It must be remembered that some drugs in combination with each other can both potentiate the effect and be antagonists. Therefore, the introduction of medicinal substances and their sequence must be thought out in advance. Particular attention should be paid to the compatibility of medicinal substances in the parenteral route of administration.
parenteral route- the introduction of drugs into the bloodstream using intradermal, subcutaneous, intramuscular and intravenous injections, as well as intravenous infusions.
Ø Intradermal injections are used for local anesthesia, determination of general and local sensitivity to a medicinal substance, and vaccination. Procedure: the injection site is treated with 70% alcohol, the skin is pulled at the injection site with a hand, then the needle is inserted at an angle of 30 ° (needle cut up) to a depth of 1-2 mm, and then the medicinal substance is injected. If a tubercle forms in the form of a “lemon peel” (Figure No. 9), then the injection was performed correctly. If the rules of asepsis and antisepsis are not observed, purulent complications may occur - infiltrate, abscess, phlegmon.
Rice. 9. Formation of "lemon peel" during intradermal injection.
Ø Subcutaneous administration medicinal substances are produced in the area of the outer surface of the middle third of the shoulder or thigh, the subscapular region and the lateral surfaces of the abdomen. As a result of the injection, a drug depot is created in the subcutaneous fat, which is absorbed very slowly and thereby ensures its prolonged action. Method of implementation: the injection site is treated with 70% alcohol, then the skin is collected into a fold with one hand, and the needle is inserted into the base of the fold at an angle of 30-45 ° with the other hand to a depth of 1.5-2 cm and the medicinal substance is injected (Figure No. 10). A dry sterile cotton swab is applied to the puncture site for 1-2 minutes. Complications after subcutaneous injection can also be associated with a violation of asepsis and antisepsis (the development of a purulent infection in the subcutaneous fat), as well as the injection technique (accidental administration of the drug intravenously).
Rice. 10. Places and technique of subcutaneous injections.
Ø Intramuscular administration drugs are produced in the outer upper quadrant of the buttocks or the outer surface of the upper third of the thigh. A drug depot is created in muscle tissue, which is slowly absorbed, but slightly faster than with subcutaneous injections. When injecting into the area of the outer upper quadrant of the buttocks, the position of the patient should be strictly lying on his stomach. Method: the injection site is treated with 70% alcohol, then with one hand we stretch the skin, with the other hand we insert the needle 2/3 of its length at an angle of 90 ° to the skin, before injecting the medicinal substance, it is necessary to pull the piston up to make sure that it does not enter the syringe blood, and then slowly inject the drug.
Rice. 11. Places and technique of intramuscular injections.
After insertion, a cotton swab is pressed against the needle and the needle is removed with a sharp movement (Figure No. 11). Possible complications are associated with a violation of aseptic and antiseptic measures (purulent infection), as well as the technique of manipulation (a foreign body may remain in the soft tissues - part of the needle; or a drug may be injected into the vessel, which is fraught with an overdose of the drug, embolism).
Ø Intravenous administration medicinal substances. Most often, puncture of the veins is performed in the area of the elbow bend (cubital vein), however, in young children, due to the well-developed subcutaneous fat, the veins of the elbow bend are not visualized, therefore, the veins of the forearm, hand, rear of the foot, head are used, where the thickness of the subcutaneous less fatty tissue. With the introduction of a medicinal substance intravenously, the effect often develops "at the tip of the needle." Method of carrying out: the position of the patient is sitting or lying down, a tourniquet is applied to the middle third of the shoulder, after which the patient squeezes and unclenches his fist several times so that the veins of the elbow bend are filled with blood. The elbow area is treated with 70% alcohol, then the skin is pulled with one hand and the vein is fixed, with the other hand the needle is inserted with the cut up, almost parallel to the skin until it feels like falling through and move along the vein by 1/3 of the needle length. We check the presence of a needle in a vein by pulling the piston towards ourselves - blood should appear in the syringe. The tourniquet is dissolved and the medicinal substance is slowly injected (Fig. No. 12).
Rice. 12. Intravenous injections.
At the end of the injection, the needle is quickly removed from the vein by pressing the injection site with a sterile swab. Complications with intravenous injections are associated with a violation of asepsis and antisepsis (the development of sepsis), a violation of the technique of manipulation (embolism, thrombophlebitis, hematoma, aseptic necrosis). In newborns of the first days of life, the umbilical vein is sometimes used for intravenous infusions, however, the duration of its use is limited to several days due to a possible complication - thrombosis, therefore, the continuation of further infusions requires catheterization of peripheral veins, if it is impossible, venesection is performed (Figure No. 13).
Rice. 13. Places of punctures and venesections in children.
For longer infusions of solutions and blood products in children, central veins are used. Most often, the subclavian vein is catheterized. Subclavian vein catheterization is a medical procedure that is performed in children under anesthesia. Like venesection, subclavian vein catheterization is considered a minor operation.
rectal route the introduction of medicinal substances has a number of advantages over oral administration, especially in early childhood - low invasiveness, ease of use, rapid absorption, the drug bypasses the liver, i.e. does not break down in it. Dosage form for rectal administration are suppositories (candles), which are based on either oils, paraffin and natural fats, or gelatin-glycerin gels. Also, medicinal substances can be administered using enemas. There are several types of enemas: cleansing, hypertonic, siphon, medicinal, nutritional and others.
Ø Cleansing enema it is best to carry out in a specially designated place - usually in a manipulation room, where there should be a separate cabinet in which accessories are stored - Esmarch's mug, pears (rubber balloons) for newborns and young children, tips, oilcloth, vessel (Figure No. 14). Before the enema, the child is offered to urinate, then he is laid on his left side with his knees brought to his stomach; it is possible to carry out this enema in the knee-elbow position. Before the enema, an oilcloth is placed on the couch, the end of which should hang down into the pelvis (in case the child does not retain water in the intestines). Esmarch's mug or rubber pear is filled with boiled water at room temperature, the system is filled, the tip is generously lubricated with vaseline oil, the system is hung on a rack at a height of one meter above the couch. The buttocks are pushed apart with the left hand, and the tip is carefully inserted into the anus with the right hand, moving it into the rectum towards the navel first by 2-3 cm, and then parallel to the spine by 4-5 cm. The tip should be advanced freely and without violence. After the tip is installed, the fluid flow is opened. For a good effect of a cleansing enema, it is desirable to hold water for at least 15-20 minutes, after which the child is planted on a potty. It is necessary to monitor the action of the enema, examine the feces for the presence of pathological impurities (mucus, blood, greenery). Possible complications may be associated with a violation of technology - wounding the wall of the rectum.
Rice. 14. Rubber pears and Esmarch's mug.
Ø Hypertonic enema indicated for intestinal atony or ineffective cleansing enema. The action of an enema is based on an irritating effect - it stimulates intestinal motility by osmotic pressure created by a 10% sodium chloride solution, as a result of which interstitial fluid enters the intestinal lumen, which liquefies the contents of the intestine. Hypertonic solution is prepared at the rate of 10 g of table salt per 100 ml of boiled water. The manipulation technique is similar to a cleansing enema, it is performed with a rubber pear, because. the volume of fluid administered with this enema is less. The amount of fluid administered depends on the age of the patient. The effect of hypertonic enema occurs after 15-20 minutes. Hypertonic enema is contraindicated in inflammatory or ulcerative bowel disease.
Table 5
The volume of fluid administered depending on age during cleansing
and hypertensive enema.
Sometimes, with chronic constipation in children, an enema according to Ognev is used. This enema has a pronounced stimulating peristalsis effect, it consists of: 200 ml of a 3% hydrogen peroxide solution, 200 ml of pure (anhydrous) glycerin and 200 ml of a soap solution.
Ø Siphon enema is performed with significant stagnation of intestinal contents, as well as to prepare for surgery on the intestines, this procedure is performed in the presence of a doctor. Equipment - a long and fairly hard probe with a diameter of at least 1 cm and several side holes at the end, a funnel with a capacity of 500-600 ml, a basin and a bucket. Manipulation technique: the child is laid on his back with the legs brought to the stomach and the pelvis slightly raised. The funnel is connected to the probe, the system is filled. The free end of the tube is thickly treated with vaseline oil and inserted to a depth of 4-5 cm. Following the tube, the index finger of the left hand is inserted into the intestine and, under its control, the end of the tube is advanced into the sigmoid colon. The procedure is started with full confidence in the correct position of the tube. At the same time, the funnel is first lowered to about the level of the buttocks, then it is filled with water and lifted up, then the funnel is lowered again. The contents of the colon are removed through the funnel into the pelvis. This procedure is performed several times until clean water drains, the volume of liquid during the procedure can reach up to 15-18 liters. When performing a siphon enema, it is very important to monitor the amount of fluid in and out. The amount of injected fluid should not be greater than the output, otherwise complications associated with water intoxication may occur, which usually manifests itself 20-30 minutes after the procedure, and sometimes during it. The child has repeated vomiting, frequent pulse, shortness of breath, pale skin, sunken eyeballs and disturbed consciousness. Water intoxication is associated with the simultaneous absorption of a large amount of fluid and toxins, as a result of which the volume of circulating fluid (BCC) increases significantly, which leads to sharp electrolyte disturbances, a change in the acid-base state (ACS), and swelling of the brain and parenchymal organs occurs. Prevention of water intoxication consists in strict observance of the basic rule for performing a siphon enema - matching the amount of input and output fluid. For a siphon enema, it is better to use an isotonic sodium chloride solution. At the same time, the danger of water intoxication, although not completely excluded, is significantly reduced.
Ø Nutrient enema can be performed when it is impossible to take food through the mouth. An hour before performing a nutrient enema, a cleansing enema is performed. The nutrient fluid should be warm and have a hypotonic or isotonic concentration. To carry out a nutrient enema, a drip system is collected that allows you to regulate the flow of liquid, the speed of 6-10 drops per minute is considered optimal. The child is placed in a comfortable position, because. drip enema is carried out for a long time, it is better to use a rubber tip or a thin catheter, which is inserted to a great depth (up to 10-15 cm or more). Let us make a reservation right away that in recent years, in connection with the introduction of balanced parenteral nutrition, the need for the use of nutritional enemas has practically been reduced to 0.
Ø Therapeutic enemas - microclysters (10-30 ml.), Used to introduce solutions of medicinal substances (decoctions of herbs, solutions of drugs, suspensions of biological preparations) into the rectum and sigmoid colon, intended to keep them in the rectum for at least 30 minutes before absorption or with subsequent bowel movement. They are prescribed for the treatment of inflammation of the mucous membrane of the rectum (proctitis) and sigmoid colon (sigmoiditis), as well as for the treatment of intestinal dysbacteriosis. The negative side of using an enema as a medical procedure is a violation of the intestinal microflora with frequent use.
Outdoor use medicinal substances is widely used in modern medicine and attracts with its non-invasiveness and ease of use. For external use, the following dosage forms are used: ointments, gels, solutions, drops, aerosols, powders, powders, etc. These forms are applied locally, such as applied to the skin or injected into the eyes, ears, and nose. For the introduction of eye drops use a sterile pipette. The patient is asked to look up, the lower eyelid is pulled down and 1-2 drops of the drug are instilled behind the eyelid. Oil solutions heated to body temperature are injected into the ear. The auricle is pulled back and up to straighten the ear canal. After the introduction of 3-4 drops, press the tragus several times to push the solution into the ear canal. Drops in the nose should be instilled, after clearing the nasal passages. To do this, you can use hypertonic, isotonic sprays, as well as nasal aspirators or rubber pears are used to cleanse the nasal passages. Nasal aspirators are used as suction (Figure #15). In children from the age of 5, the following technique can be used: one nostril is closed, and liquid is introduced into the nasal cavity with a rubber bulb into the second, at the same time the child exhales air through it, then this procedure is carried out on the other side. After the nasal passages are cleared, the child is seated with his head slightly thrown back, the tip of the nose is turned in the opposite direction to the nasal passage into which the drops are injected. 2-3 drops are instilled, after which the patient tilts his head in the opposite direction. After 2 minutes, repeat the manipulation on the other side. In addition, for the external administration of medicinal substances, an electromagnetic field (electrophoresis) and ultrasonic waves (phonophoresis) are often used, which ensures a deeper penetration of the drug into local tissues.
Rice. 15. Nasal aspirators.
One of the components of therapy for children in a surgical hospital is the use of physical methods- heating pads, compresses, therapeutic baths. Local exposure to heat and cold has an analgesic, absorbable and soothing effect. In different phases of the same disease, it is possible to use both heat and cold, so this procedure should be regulated by a doctor. It must be remembered that a hot or cold heating pad must not be used on a naked body in order to avoid burns and frostbite. The heating pad is filled with hot or cold water to ½ volume, the air is removed and closed with a cork. Before applying a heating pad, it should be wrapped in a diaper or towel. Compresses have a similar local effect. Compresses warm and cold, wet and dry. Compresses are applied to clean, dry skin. For warming compresses, use warm water (37 ° C) or 70 ° ethyl alcohol diluted in half with water (semi-alcohol compress). Gauze, folded in several layers, is abundantly moistened with a solution, then moderately squeezed and laid. A layer of cotton wool is applied on top and the compress is strengthened with a bandage. Exposure time 30-60 min. With cold compresses, gauze is moistened in ice water, squeezed and applied, changing every 3-5 minutes. After removing the compress, the skin is dried and wiped with alcohol. Mustard plasters were prescribed earlier for the prevention and treatment of pulmonary complications in the postoperative period, congestion in the lungs, pleurisy, pneumonia, bronchitis. Method of carrying out - mustard plasters are moistened in warm water and applied with a working surface to the skin. Compress paper is applied on top and a towel or diaper is placed on it. The exposure time is 5-10 minutes, after which the mustard plasters are removed, the skin is gently wiped with warm water and lubricated with vaseline oil. A contraindication to the use of mustard plasters are inflammatory skin diseases. At the present stage, due to the low efficiency, mustard plasters are not used. Temperature, mechanical factors, as well as chemicals dissolved in water, are widely used in medicine in the form therapeutic baths . All baths according to the degree of fullness are divided into general and local. Among the latter, there are: semi-baths (lower part of the body to the waist), sitz baths (pelvis, lower abdomen and upper thighs without immersing the legs), foot baths (from feet to knees, depending on the purpose), baths for hands. Baths also differ in water temperature: cold (up to 20º C), cool (up to 30º C), indifferent (34-36º C), warm (up to 38º C), hot (above 39º C). You can also say that baths are divided into simple ones (that is, without any additives - salt, herbs, needles and others) and with the addition of any preparations. Bath fillers can be: herbal collection, potassium permanganate, sea salt and seaweed, a wide variety of minerals, table salt, pine needles and much more. Contraindications to taking baths are acute cardiovascular diseases (myocardial infarction, stroke, hypertensive crisis), bleeding, exacerbation of chronic diseases (peptic ulcer, glomerulonephritis, pyelonephritis and others), fever, acute infectious diseases, postoperative period.
A feature of the surgical hospital is the presence of patients with various types of wounds and injuries, and, therefore, caring for them requires a good knowledge of the rules of desmurgy, surgical instruments and suture material by the medical staff.
Desmurgy(Greek desmos - leash, connection, bandage and ergon - business, performance) - the science of bandages. The process of applying a bandage to a wound and the therapeutic manipulations preceding it are referred to by the term "bandaging". Any person should master the technique of applying bandages.
There are the following types of bandages:
o soft,
ó adhesive,
ó tough.
Soft dressings, especially bandages, are more widely used in medicine. By appointment, soft bandages are divided into
MANIPULATION ALGORITHMS ON THE BASICS OF NURSING
BASIC MANIPULATIONS ON OSD
HEIGHT MEASUREMENT No. 1/18
Target: Measure the patient's height and record on the temperature sheet.
Indications:
Contraindications: Severe condition of the patient.
Equipment:
temperature sheet.
Possible patient problems:
The patient is agitated.
The patient has a serious condition or is physically damaged (blind, missing a limb), etc.
Disinfect the oilcloth in accordance with current orders and place on the stadiometer.
Place the patient with his back to the counter so that he touches it with the back of his head, shoulder blades, buttocks and heels.
Tilt your head so that the outer corner of the eye is at the level of the upper edge of the ear tragus.
Lower the bar on your head and mark your height according to the divisions on the height meter stand.
Record the growth data on the temperature sheet.
Growth data were obtained, the results were recorded in the temperature sheet.
DETERMINATION OF BODY WEIGHT No. 2/19
Target: Measure the patient's weight and record it on the temperature sheet.
Indications: The need for a study of physical development and as prescribed by a doctor.
Contraindications: Severe condition of the patient.
Possible patient problems:
The patient is agitated.
Reluctant to intervene.
Severe condition.
The sequence of actions of a nurse with ensuring the safety of the environment:
Inform the patient about the upcoming manipulation and its progress.
Check that the scales are correct.
Lay a clean oilcloth on the scale platform.
Open the shutter of the balance and balance it with a large and small weight.
Close shutter.
Help the patient to stand in the middle of the scale platform (without shoes).
Open the shutter.
Balance the patient's weight with weights.
Close shutter.
Help the patient get off the scale.
Record the results in the medical history.
Process the oilcloth in accordance with the requirements of the sanitary and epidemiological regime.
Evaluation of achieved results: Weight data are obtained and the results are recorded in the temperature sheet.
Education of the patient or his relatives: Advisory type of intervention in accordance with the above sequence of actions of the nurse.
RESPIRATORY RATE COUNTING No. 3/20
Indications:
Assessment of the patient's physical condition.
Respiratory diseases.
doctor's appointment, etc.
Contraindications: No.
Equipment.
temperature sheet.
Clock with second hand or stopwatch.
Possible patient problems: Psycho-emotional (excitement, etc.)
The sequence of actions of a nurse with ensuring the safety of the environment:
Prepare a clock with a stopwatch or a stopwatch.
Wash your hands.
Ask the patient to lie down comfortably so that you can see the top of the anterior chest.
Take the patient's hand as you would for a radial pulse, so that the patient thinks you are examining his pulse.
Look at the chest: you will see how it rises and falls.
If you cannot see the movement of the chest, place your hand on the patient's chest and you will feel the movement.
Count the frequency in 1 minute (number of breaths only).
At the end of the procedure, help the patient sit comfortably, remove all unnecessary.
Wash your hands.
Record the measurement data on the patient's temperature sheet.
Evaluation of achieved results: NPV calculated, registered in the temperature sheet.
Notes:
Normally, respiratory movements are rhythmic (i.e., repeat at regular intervals). The frequency of respiratory movements in an adult at rest is 16-20 per minute, and in women it is 2-4 breaths more often than in men. During sleep, breathing usually becomes less frequent (up to 14 - 16 beats per minute), breathing becomes more frequent during physical exertion, emotional arousal.
An increase in respiratory rate is called tachypnea; decrease in respiratory rate - bradypnea; apnea is the absence of breathing.
Types of breathing: chest - in women, abdominal - in men, mixed - in children.
When counting the respiratory rate, pay attention to the depth and rhythm of breathing, as well as the duration of inhalation and exhalation, note the type of breathing.
PULSE STUDY No. 4/21
Target: Examine the patient's pulse and record the readings in the temperature sheet.
Indication:
Assessment of the state of the cardiovascular system.
Doctor's appointment.
Contraindications: No.
Equipment.
temperature sheet.
Possible patient problems:
Negative attitude towards intervention.
The presence of physical damage.
The sequence of actions of a nurse with ensuring the safety of the environment:
Inform the patient about the study of his pulse, explain the meaning of the intervention.
Grasp the left forearm of the patient with the fingers of the right hand, the right forearm of the patient in the area of the wrist joints with the fingers of the left hand.
Place the 1st finger on the back of the forearm; 2nd, 3rd, 4th sequentially from the base of the thumb on the radial artery.
Press the artery against the radius and feel for a pulse
Determine the symmetry of the pulse. If the pulse is symmetrical, further examination can be carried out on one arm. If the pulse is not symmetrical, carry out further research on each arm separately.
Determine the rhythm, frequency, filling and tension of the pulse.
Count pulse beats for at least 30 seconds. Multiply the resulting figure by 2. If there is an arrhythmic pulse, count for at least 1 minute.
The pulse was examined. The data is entered in the temperature sheet.
Education of the patient or his relatives: Advisory type of intervention in accordance with the above sequence of nurse actions.
Notes:
Places for examining the pulse:
radial artery
femoral artery
temporal artery
popliteal artery
carotid artery
artery of the dorsal foot.
More often, the pulse is examined on the radial artery.
At rest, in an adult healthy person, the pulse rate is 60-80 beats per 1 minute.
Increased heart rate (more than 90 beats per minute) - tachycardia.
A decrease in heart rate (less than 60 beats per minute) - bradycardia.
The level of independence in the implementation of the intervention is 3.
BLOOD PRESSURE MEASUREMENT No. 5/22
Target: Measure blood pressure with a tonometer on the brachial artery.
Indications: All sick and healthy patients to assess the state of the cardiovascular system (at preventive examinations, with pathologies of the cardiovascular and urinary systems; with loss of consciousness of the patient, with complaints, headache, weakness, dizziness).
Contraindications: Congenital deformities, paresis, fracture of the arm, on the side of the removed breast.
Equipment: Tonometer, phonendoscope, pen, temperature sheet.
Possible patient problems:
Psychological (does not want to know the value of blood pressure, afraid, etc.).
Emotional (negativity towards everything), etc.
The sequence of actions of a nurse with ensuring the safety of the environment:
Inform the patient about the upcoming manipulation and its progress.
Place the patient's arm correctly: in an extended position, palm up, the muscles are relaxed. If the patient is in a sitting position, then for better extension of the limb, ask him to place a clenched fist of his free hand under his elbow.
Place the cuff on the patient's bare shoulder 2-3 cm above the elbow; clothing should not squeeze the shoulder above the cuff; fasten the cuff so tightly that only one finger passes between it and the shoulder.
Connect the pressure gauge to the cuff. Check the position of the pressure gauge pointer relative to the zero mark on the scale.
Feel the pulse in the cubital fossa and place a phonendoscope in this place.
Close the valve on the pear and pump air into the cuff: pump air until the pressure in the cuff, according to the pressure gauge, exceeds by 25-30 mm Hg the level at which the arterial pulsation has ceased to be determined.
Open the vent and slowly deflate the cuff. At the same time, listen to the tones with a phonendoscope and follow the readings on the pressure gauge scale.
Note the systolic pressure when the first distinct sounds appear above the brachial artery,
Note the value of diastolic pressure, which corresponds to the moment of complete disappearance of tones.
Record your blood pressure measurement as a fraction (the numerator is systolic pressure and the denominator is diastolic), for example, 120/75 mmHg. Art.
Help the patient lie down or sit comfortably.
Remove all unnecessary.
Wash your hands.
Record the obtained data in the temperature sheet.
Remember! Blood pressure should be measured 2-3 times on both hands at intervals of 1-2 minutes for a reliable take the smallest result. The cuff must be completely deflated each time.
Evaluation of achieved results: Blood pressure was measured, the data was entered into the temperature sheet.
Note. Normally, in healthy people, blood pressure figures depend on age. Indications of systolic pressure fluctuates normally from 90 mm Hg. up to 149 mm Hg, diastolic pressure - from 60 mm Hg. up to 90 mm Hg An increase in blood pressure is called arterial hypertension. A decrease in blood pressure is called hypotension.
Education of the patient or his relatives: Advisory type of intervention in accordance with the nurse's sequence of actions described above.
HAND TREATMENT BEFORE AND AFTER ANY MANIPULATION No. 7/33
Target: Ensure infectious safety of the patient and medical staff, prevention of nosocomial infection.
Indications:
Before and after manipulation.
Before and after examining the patient.
Before eating.
After going to the toilet.
After donning and after removing gloves.
Contraindications: Not
Equipment:
Soap disposable.
Individual dry towel.
Gloves
Disinfectant: ethyl alcohol 70 degrees or another, proposed by the institution in accordance with regulatory documents (AHD - 2000, AHD - specialist, etc.).
The sequence of actions of a nurse with ensuring the safety of the environment:
Open the faucet and adjust the water hood,
Wash the faucet knobs.
Lather your hands with soap, starting from the wrist.
Wash the right hand with the left and then the left with the right.
Wash the interdigital spaces of the back of the left hand with the right hand and vice versa.
Make a lock with the fingers on the palm side and rub them while washing the nail beds.
Rub each finger in a circular motion on your left hand, then on your right.
Rinse your hands with warm running water, starting at the wrist.
Close the faucet.
Dry your hands with an individual or disposable towel, starting at the fingertips.
Throw away the used disposable towels.
Put on clean gloves if manipulation requires it.
Evaluation of achieved results: Hands are washed and ready for manipulation.
Notes.
Hands are washed with soap twice.
If it is necessary to carry out invasive procedures, then immediately after washing, the hands are treated with one of the disinfectants (70% ethyl alcohol, AHD 2000, AHD 2000 special) and put on gloves.
Education of the patient or his relatives: Advisory type of intervention in accordance with the above sequence of nurse actions.
PREPARATION OF DETERGENT AND DISINFECTANT SOLUTIONS OF DIFFERENT CONCENTRATION No. 8/35
Target: Prepare a 10% bleach solution.
Indications. For disinfection.
Contraindications: Allergic reaction to chlorine-containing drugs.
Equipment:
Rubber gloves.
Scales or measuring container.
Dry bleach 1 kg.
Enameled container with lid.
Dark glass bottle with ground stopper.
Wooden spatula.
Label.
Cold water -10 liters.
Gauze cloth or sieve.
Long surgical gown.
Rubber apron.
Respirator (or 8-layer mask).
The sequence of actions of a nurse with ensuring the safety of the environment:
Put on a second coat, an oilcloth apron, rubber gloves, a respirator or an eight-layer mask.
Take 1 kilogram of dry bleach
Pour it carefully into an enameled container, grind it with a wooden spatula.
Mix everything and carefully pour cold water up to the 10 liter mark.
Close the lid and leave for 24 hours (during this time stir several times) to release active chlorine, you will get a mother liquor.
After 24 hours, pour the resulting solution through 4 layers of bandage (gauze) into a dark glass bottle labeled "10% bleach solution."
Stopper.
Put on the label the date of preparation of the solution, its concentration, your position and last name.
Remove protective clothing.
Wash your hands with soap.
Evaluation of the achieved results. Prepared 10% bleach solution (clarified).
Note:
10% solution can be stored for 5-7 days in a dark place.
The solution must be stored out of the reach of the patient.
Preparation of working solutions of bleach:
0.5% - 500 ml of 10% bleach solution per 9.5 liters of water;
1% - 1 liter of 10% bleach solution per 9 liters of water;
2% - 2 liters of 10% bleach solution per 8 liters of water;
The formula for making bleach is:
Y = (% number of liters). Y is the amount of clarified bleach solution.
Working solution of chloramine (prepared before use)
1% -10 g of chloramine per 990 ml of water;
2% - 20 g of chloramine per 980 ml of water;
3% - 30 g of chloramine per 970 ml of water;
5% - 50 g of chloramine per 950 ml of water.
CARRYING OUT WET CLEANING OF HCI PREMISES USING DISINFECTANT SOLUTIONS No. 10/37
Target: Conduct a general cleaning of the treatment room.
Indications: According to the schedule (once a week).
Contraindications: No.
Equipment:
Cleaning equipment (bucket, mop, rag, rags) with appropriate markings.
Disinfectant and cleaning solution (prepared in accordance with the current regulatory documents for SEP).
Bathrobe marked "for cleaning".
Gloves.
Sequencing:
Put on a gown, gloves, a mask and wear comfortable shoes.
Prepare 10 liters of 0.5% detergent (50g CMC per 10 liters of water).
Prepare 10 liters of 1% chloramine and add 40 ml of ammonia (to activate the chlorine).
Free the room as much as possible from the equipment.
Wash the walls and floor with a cleaning solution.
Wash the walls, floors, baseboards with a 1% solution of activated chloramine.
After an hour, wipe the walls and floor with a clean, dry rag.
Apply UV light for 2 hours.
Soak cleaning utensils in 1% chloramine solution for 60 minutes (in the same bucket used for cleaning), rinse and dry.
Remove gown, gloves, mask.
Wash your hands.
Result evaluation: General cleaning was carried out in accordance with Order No. 408, 720. OST 42-21-2-85.
Notes:
Rooms are cleaned at least 2 times using a 0.5% solution, detergent.
Cleaning of the pantry and dining rooms is carried out after each distribution of food.
INSPECTION AND IMPLEMENTATION OF SANITATION IN THE DETECTION OF PEDICULOSIS No. 15/43
Target: Examine the hairy parts of the patient's body and, if pediculosis is detected, carry out sanitization.
Indications: Prevention of nosocomial infection.
Contraindications:
Patient arousal.
Extremely serious condition of the patient.
Equipment: 3 styling.
Hair clipper.
Machine for shaving.
Alcohol lamp.
Basin or baking sheet.
Table vinegar 6% -9%.
2 bags (cotton and oilcloth).
For the nurse: gown, gloves, scarf.
For the patient: cape, 2 kerchiefs (cotton, polyester), oilcloth.
For treatment: karbofos 0.15% solution (1 ml of a 50% solution per 200 ml of H20) or other insecticides.
Toilet soap or shampoo.
Possible patient problems: Reluctant to intervene.
The sequence of actions of a nurse with ensuring the safety of the environment:
Inform the patient about the upcoming manipulation and its progress.
Examine the patient's hairy parts.
Put on a second gown, scarf, gloves when detecting pediculosis in a patient.
Have the patient sit on a chair or couch covered with oilcloth,
Put the cape on the patient.
Treat the patient's hair with one of the disinfectants.
Cover the patient's hair with a plastic kerchief and then with a kerchief for 20 minutes.
Rinse the patient's hair with warm water.
Rinse the patient's hair with a 6%-9% vinegar solution.
Comb the patient's hair with a fine-tooth comb (over a basin or baking sheet).
Rinse your hair with warm water and dry it.
Examine the hair for the presence of nits (if single ones are found, then remove them mechanically, if there are a lot of them, then treat the hair with a 9% solution of vinegar and cover the hair with a scarf for 20 minutes), then repeat from point 6.
Collect the patient's underwear in one bag, the nurse's gown in another and send it to the pest control chamber.
Remove gloves and process them in accordance with the requirements of the sanitary and epidemiological regime.
Wash your hands.
Make a note on the title page of the case history about the detected pediculosis, (P (+)) and write down the epidemiological situation. room.
Evaluation of achieved results: When examining the patient, pediculosis was detected, sanitization was carried out.
Education of the patient or his relatives: Advisory type of intervention in accordance with the above sequence of nurse actions.
IMPLEMENTATION OF FULL OR PARTIAL SANITATION OF THE PATIENT No. 16/44
Target: Carry out full or partial sanitization of the patient.
Indications: By doctor's prescription.
Contraindications: Severe condition of the patient, etc.
Equipment:
Labeled containers for clean and dirty washcloths.
Clean linen for the patient.
Towel.
Water thermometer.
Soap or shampoo.
CMC, 1% chloramine solution.
Bags - 2 (cotton, oilcloth).
foot rest,
temperature sheet.
Oilcloth apron.
Gloves - 2 pairs.
Possible patient problems: Impossibility of self-service.
The sequence of actions of a nurse with ensuring environmental safety in preparing and conducting a hygienic bath for a patient:
Inform the patient about the upcoming manipulation and its progress.
Determine the air temperature in the bathroom (it must be at least 25 degrees Celsius).
Put on gloves and an apron.
Scrub the tub with any cleaning solution, then scrub with 1% chloramine solution. Rinse the tub with hot water.
Take off your gloves.
Fill the bath first with cold water, and then with hot water up to 1/2 of the volume of the bath. The water temperature should not be lower than 36-37 degrees Celsius.
Help the patient to sit comfortably in the bath so that the patient does not slip, place a footrest,
Put on gloves.
Wash the patient: first the head, then the trunk, upper and lower limbs, groin and perineum.
Help the patient get out of the bath.
Dry the patient and dress.
Wash your hands.
Take the patient to the room.
Make a note in the medical history, temperature sheet.
The sequence of actions in the preparation and conduct of a hygienic shower.
Inform the patient about the upcoming manipulation and its progress.
Put on gloves and an apron.
Treat the bath with disinfectants.
Take off your gloves.
Place a bench in the bath and seat the patient on it.
Put on gloves.
Help the patient wash in the following sequence: head, torso, upper and lower limbs, perineum.
Remove gloves and process in accordance with the requirements of the sanitary and epidemiological regime.
Wash your hands.
Help the patient towel dry and dress.
Make a note on the medical history sheet, temperature sheet.
The sequence of actions when wiping the patient (partial sanitization)
Inform the patient about the upcoming manipulation and its progress.
Shield the patient with a screen, put on gloves.
Place a sheet under the patient.
With a "mitten" or a sponge dipped in water, wipe the patient's neck, chest, arms.
Dry these parts of the body with a towel and cover it with a blanket.
Wipe then the stomach, then the back and lower limbs and wipe them dry and cover them with a blanket.
Remove oilcloth, screen, remove gloves.
Treat the sponge, gloves, oilcloth in accordance with the requirements of the sanitary and epidemiological regime.
Evaluation of the achieved results. Partial or complete sanitization of the patient is given.
Education of the patient or his relatives: Advisory type of intervention in accordance with the above sequence of nurse actions.
Notes:
The method of sanitization is determined by the doctor.
The presence of a nurse during the sanitization of the patient is mandatory.
Provide first aid if the condition worsens and inform the doctor.
Control the temperature of the water with your hand while pointing it at the patient.
REGISTRATION OF THE TITLE SHEET OF THE "MEDICAL CARD" OF THE IN-SITE PATIENT No. 17/45
Target: Collect information about the patient and issue a title page for educational and inpatient medical records.
Indications: To register a newly admitted patient to the hospital.
Equipment: Educational medical history, hospital medical history.
Possible patient problems: If it is impossible to collect information from a patient (deaf-mute, in a coma, and so on), collect information from the patient's documentation, accompanying persons and others are asked for a medical card from the clinic.
The sequence of actions of a nurse with ensuring the safety of the environment:
Inform the patient of the need to keep a medical history.
Date and time of admission (up to the minute for emergency patients), case history number,
Full Name.
Year of birth.
Home address and phone number.
Who lives with or the address and phone number of relatives.
Profession and place of work, work phone.
From where and by whom it was delivered, the phone of the health facility.
Diagnosis of the referring institution.
Where the patient is sent from the emergency department.
Does he have allergic reactions and to what.
Contacts with other patients at home or elsewhere.
State Autonomous Educational Institution "Volsk Medical College"
them. Z.I. Mareseva"
Algorithms for performing obstetric and gynecological procedures
Educational and medical allowance
Volsk 2014
Algorithm for performing obstetric and gynecological procedures. Methodological guide.
This manual is recommended for use in self-preparation of students of medical colleges and schools for intermediate certifications in the II-III courses for all specialties in the disciplines "Obstetrics" and "Gynecology" and preparation for the final state certification, as well as students of the college and advanced training departments of paramedical workers .
Compiled by: teacher of the Volsky Medical College Kochetova Vera Vasilievna.
GAOU SPO "VMK 2014"
Obstetrics
Collection of anamnesis in a pregnant woman………………………………………………………………4
Measurement of the external dimensions of the pelvis………………………………………………………4
Methods for determining the truth of a conjugate………………………………………………6
Measuring the circumference of the abdomen and the height of the fundus of the uterus………………………..6
Leopold's techniques…………………………………………………………………………8
Listening to the fetal heartbeat…………………………………………………..10
Determining the gestational age, the expected date of birth…………………..11
Determination of the estimated weight of the fetus in the later stages……………………..12
Technique for measuring blood pressure, counting PS and contractions in a woman in labor……………………………12
Sanitation of a woman in labor…………………………………………………………………..13
Cleansing enema technique…………………………………………….13
Signs of separation of the placenta……………………………………………………………………14
Ways of external allocation of placenta…………………………………………………16
Manual separation of the placenta and separation of the placenta……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
Determination of the integrity of the afterbirth and the amount of blood loss………………………..20
The fight against bleeding in the subsequent period……………………………………..20
The fight against bleeding in the early postpartum period………………………….…21
Definition of edema………………………………………………………………………..22
Determination of protein in urine…………………………………………………………………22
Emergency care for eclampsia……………………………………………………..23
Caring for crotch sutures…………………………………………………..23
Gynecology
1. Examination and assessment of the condition of the external genital organs……………………………..25
2. Research using mirrors………………………………………………………………………………………………………………………26
3. Methodology of bimanual research…………………………………………………..28
1. Stand to the right of the woman face to face.
2. Put the palms of both hands on the bottom of the uterus.
3. Determine the height of the uterine fundus, the large part of the fetus located in it, and the gestational age.
4. Move both hands to the lateral surfaces of the uterus to the level of the navel and palpate them one by one.
5. Determine the position, position and type of fetus.
6. Position the right hand in the suprapubic part so that the thumb clasps the presenting part on one side, and all the rest on the other side
7. Determine the presenting part of the fetus, its mobility and relation to the entrance to the small pelvis
8. Turn to face the woman's feet.
9. Place the palms of both hands in the region of the lower segment of the uterus on the presenting part of the fetus.
10. Grasp the presenting part of the fetus with the ends of the fingers.
11. Determine the ratio of the presenting part to the entrance to the small pelvis.
Listening to the fetal heartbeat.
1. The pregnant woman lies on her back on the couch.
2.Install the obstetric stethoscope at one of the eight points. Note: manipulation is performed after Leopold's maneuvers.
3. Attach your ear to the stethoscope and remove your hands.
4. Listen to the fetal heartbeat for 60 seconds.
5. Evaluate the number of beats, clarity, rhythm of the heartbeat.
6. Fix the result.
7. Determining the duration of pregnancy, the expected date of birth.
Indications:
fix the gestational age at the first appearance;
promote social protection of pregnant women;
identify critical periods in the pathology of pregnancy;
timely issue prenatal maternity leave;
diagnose relapse.
Implemented:
by the date of the last menstruation - identify the first day of the last menstruation, add two weeks for conception and from this date according to the calendar, count by weeks until the deadline for attending the antenatal clinic;
according to the date of the first fetal movement - the first-pregnant woman feels the first movement at a period of 20 weeks, the second-pregnant woman - at 18 weeks;
according to objective data:
howling appearance in the women's clinic;
b) measurement of the height of the fundus of the uterus and the circumference of the abdomen in late pregnancy;
c) according to the size of the head and the length of the fetus. An additional method is ultrasound.
Determining the estimated due date
Find out the first day of the last menstruation. From this day, count back three months and add 7 days. Prenatal maternity leave is issued for a period of 30 weeks.
8. Determination of the estimated weight of the fetus in the later stages.
Indications:
Determine the gestational age;
Detect fetal growth retardation (exclude fetal malnutrition);
Determine the correspondence between the sizes of the pelvis and the head of the fetus.
Action algorithm:
1) lay the pregnant woman on the couch in a horizontal position. Legs slightly bent at the knee and hip joints;
2) measure the circumference of the abdomen and the height of the fundus of the uterus with a centimeter tape;
According to the formulas:
a) (circumference of the abdomen) x (height of the fundus of the uterus);
b) (circumference of the abdomen) + (height of the bottom of the uterus) / 4 x 100;
According to the results of the ultrasound.
9. Technique for measuring blood pressure, counting PS and contractions in a woman in labor.
Technique for measuring blood pressure
Indications:
determination of the value of systolic and diastolic pressure;
fixing the initial blood pressure;
determination of the difference in blood pressure on the left and right hand;
detection of elevated blood pressure during childbirth;
determination of pulse pressure.
measurement is carried out on both hands;
apply a cuff to the upper third of the upper arm and use a pressure gauge to determine blood pressure.
Pulse count
Indications:
determine the state of the cardiac activity of the woman in labor;
identify complications of cardiac activity during childbirth.
put three fingers of the right hand on the inner surface of the forearm in the area of the wrist joint;
press the left radial artery and determine the frequency, rhythm, clarity and strength of heart contractions.
Determination of the duration of the contraction and pause
Indications:
exercise control over labor activity;
timely detect anomalies of labor activity.
the midwife to sit next to the woman in labor;
put your hand on the bottom of the uterus;
feel the beginning of an increase in the tone of the uterus and fix the beginning of the contraction with a stopwatch;
feel the time of relaxation of the uterine tone and fix the end of the contraction and the beginning of the pause.
10. Sanitation of a woman in labor.
1) Trim nails
2) Shave pubic and armpit hair
3) Give a cleansing enema
4) Take a shower using bar soap (after having a bowel movement in
within 30-40 min.)
5) Put on sterile underwear
6) Treat the nails of the hands, feet with iodine, nipples with a solution of brilliant green.
11. Technique for conducting a cleansing enema.
Indication:
First stage of childbirth.
Enema is contraindicated:
in the period of exile;
with bleeding from the genital tract;
in severe condition of the mother.
Action algorithm:
fill the mug with water and hang it at a height from the level of the pelvis of the woman in labor
fill the rubber tube and the tip with water, close the clamp, grease the tip with vaseline oil;
lay the woman in labor on her left side, bend her legs;
spread the gluteal folds with the left hand;
insert the tip through the anus into the rectum, first towards the navel, then parallel to the spine;
open the clamp, pour in water, and ask for deep breathing movements;
after pouring water, close the clamp;
remove the tip, rinse in a separate container and put in a basin with disinfectant. solution;
12. Signs of separation of the placenta.
13. Ways of external allocation of placenta.
Indication:
Infringement of the placenta;
Bleeding in the aftermath.
Abuladze's reception
Action algorithm:
2) bring the uterus through the anterior abdominal wall of the abdomen to the middle and conduct an external massage;
3) grab the anterior abdominal wall with both hands in a longitudinal fold so that both rectus abdominis muscles are tightly grasped by the fingers, and ask the woman in labor to push. The separated placenta is easily born.
Genscher's reception
Action algorithm:
bring the uterus through the anterior abdominal wall of the abdomen to the middle and conduct an external massage;
stand on the side of the woman in labor facing her legs;
put the hands of both hands, clenched into fists, on the bottom of the uterus in the area of the tubal corners;
put pressure on the bottom of the uterus from top to bottom. In this case, the placenta can be born;
with negative results of these techniques, perform the obstetric operation "Manual removal of the placenta".
Action algorithm:
1) perform bladder catheterization;
2) bring the uterus through the anterior abdominal wall of the abdomen to the middle and conduct an external massage;
3) grasp the bottom of the uterus with the hand in such a way that the thumb is located on the front wall, the palm is on the bottom, and four fingers are on the back wall of the uterus;
4) simultaneously press on the bottom of the uterus in the anteroposterior direction and down to the pubis. At the same time, the afterbirth is born.
14. Manual separation of the placenta and the allocation of the placenta.
Target: violation of the independent separation of the placenta.
Action algorithm:
empty the bladder
treat the external genitalia with an antiseptic solution;
give anesthesia inhalation or intravenous;
open the genital slit with your left hand;
insert the conically folded right hand into the vagina, and then into the uterus. At the time of the introduction of the right hand into the uterus, move the left hand to the bottom of the uterus. In order not to mistakenly take the edematous edge of the pharynx for the edge of the placenta, hold the hand while adhering to the umbilical cord;
then insert a hand between the placenta and the wall of the uterus and gradually separate the entire placenta with sawtooth movements; at this time, the outer hand helps the inner, gently pressing on the fundus of the uterus.
after separation of the placenta, bring it to the lower segment of the uterus and remove it with the left hand by pulling on the umbilical cord;
with the right hand remaining in the uterus, once again carefully check the inner surface of the uterus to completely exclude the possibility of retaining parts of the placenta. After complete removal of the placenta, the walls of the uterus are smooth, with the exception of the placental area, which is slightly rough, fragments of the decidua may remain on it;
after a control examination of the walls, remove the hand from the uterine cavity. The puerperal should introduce pituitrin or oxytocin, put a cold on the lower abdomen.
15. Determination of the integrity of the afterbirth and the amount of blood loss.
Action algorithm:
after the separation of the newborn from the mother, put the end of the umbilical cord in a tray to collect placental blood;
monitor the condition of the woman in labor (measure blood pressure, pulse), secretions from the genital tract;
monitor signs of placental separation (sign of Schroeder, Alfeld, Chukalov-Kyustner);
with positive signs of placental separation, ask the woman in labor to push and slightly pull on the umbilical cord. When eruption of the placenta, take it with both hands and release it with a careful rotational movement and remove the entire placenta with membranes;
carefully examine the born placenta: place the placenta on a smooth tray or on the palms of the midwife with the maternal surface up. Examine all the lobules, the edges of the placenta and membranes: to do this, turn the placenta with the maternal side down, and the fruit side up, straighten all the membranes and restore the cavity where the fetus was located along with the waters;
Drain the blood accumulated in the tray into a special graduated flask. Calculate blood loss during childbirth. Physiological blood loss is a maximum of 300 ml, that is, there is no reaction from the body of the puerperal to this blood loss;
permissible blood loss is the amount of blood loss when a short-term reaction occurs from the body of the puerperal (weakness, dizziness, lowering blood pressure, tachycardia, blanching of the skin, etc.). The compensatory mechanisms of the body quickly connect and the condition returns to normal. Calculation of allowable blood loss:
0.5% of the mass of a healthy puerperal;
0.2-0.3% of the mass of the puerperal in diseases of the cardiovascular system, preeclampsia, anemia, etc.
16. The fight against bleeding in the afterbirth period.
Causes of bleeding:
violation of the separation of the placenta;
infringement of the placenta.
perform bladder catheterization;
examine the soft tissues of the birth canal - the cervix, the walls of the vagina, the tissues of the vulva and the perineum with the help of mirrors and cotton balls in order to exclude ruptures;
if soft tissue injuries of the birth canal are detected, accelerate the course of the afterbirth period and suture;
with the integrity of the tissues of the birth canal, check for signs of separation of the placenta to determine the separation of the placenta from the walls of the uterus;
if there are positive signs of placental separation, apply external methods of placental separation (methods of Abuladze, Krede-Lazarevich, Genter), and in the absence of results, perform the operation “Manual removal of the placenta”;
in the absence of signs of separation of the placenta, perform the obstetric operation "Manual separation of the placenta and separation of the placenta."
17. The fight against bleeding in the early postpartum period.
Causes of bleeding:
injuries of soft tissues of the birth canal;
retention of elements of the fetal egg in the uterine cavity;
hypotension-atony of the uterus;
coagulopathy.
Action algorithm:
perform bladder catheterization;
examine the soft tissues of the birth canal - the cervix, the walls of the vagina, the tissues of the vulva and perineum (using mirrors and cotton balls);
if injuries of the soft tissues of the genital organs are detected, suture them.
Action algorithm:
with the integrity of the tissues of the birth canal, carefully examine the afterbirth for the integrity of the placental tissue and membranes;
in case of a defect in the placental tissue and doubts about the integrity of the placenta, perform a "Manual examination of the uterine cavity" in order to remove parts of the placenta from the uterine cavity.
Action algorithm:
perform an external massage of the uterus;
put cold on the lower abdomen,
inject intravenous reducing drugs (methylergometrine, oxytocin);
in the absence of effect, conduct a "Manual examination of the uterine cavity and combined external-internal massage";
insert a swab with ether into the posterior fornix of the vagina;
in the absence of effect, deploy the operating room and prepare the puerperal for the operation "Laparotomy";
in parallel to carry out conservative methods of combating bleeding:
put clamps on the lateral fornix of the vagina,
put clamps on the side walls of the body of the uterus in the lower segment,
put stitches on the cervix according to Lositskaya,
use an electrical stimulator
press the aorta against the spine with a fist for 10-15 minutes,
carry out infusion therapy.
ligation of the main vessels of the uterus,
Extirpation of the uterus (with significant hypotension of the cervical tissues, the left neck can become a source of further bleeding).
coagulopathy
Action algorithm:
1) transfuse intravenously:
fresh frozen plasma at least 1 liter;
6% solution of hydroxyethylated starch-infucol;
fibrinogen (or cryogfecipitant);
platelet-erythrocyte mass;
10% calcium chloride solution;
1% vikasol solution;
18. Determination of edema.
a) on the legs
Seating or laying down a pregnant woman.
Press with two fingers in the area of the middle third of the tibia (while the legs should be bare).
Rate the result.
"Seat or lay down the pregnant woman.
Measure the circumference of the ankle joint with a centimeter tape.
Fix the result.
19. Determination of protein in urine.
The study is necessarily carried out in the antenatal clinic before each appearance of the pregnant woman for an appointment, as well as when she enters the maternity ward.
Indication: detect the presence of protein in the urine.
Methods:
Sample with sulfosalicylic acid. 3-5 ml of urine is poured into a test tube and 5-8 drops of sulfosalicylic acid are added. In the presence of protein, a white precipitate appears.
Boiling urine. In the presence of protein, white flakes appear.
Express method. An indicator strip is used - biofan. The strip is immersed in warm urine for 30 seconds and compared with a color scale.
20. Emergency care for eclampsia.
Target: prevention of recurrence of an attack.
Action algorithm:
1) lay the patient on a flat surface, turn his head to the side, hold it during convulsions;
clear the airways by carefully opening the mouth using a spatula or spoon handle;
aspirate the contents of the oral cavity and upper respiratory tract;
when breathing is restored, give oxygen. When holding your breath, immediately start assisted ventilation (using the Ambu apparatus, mask) or intubate and switch to artificial ventilation;
in case of cardiac arrest, in parallel with mechanical ventilation, conduct a closed heart massage and carry out all methods of cardiovascular resuscitation;
to stop convulsions intravenously simultaneously inject 2 ml of a 0.5% solution of seduxen, 5 ml of a 25% solution of magnesium sulfate;
start infusion therapy (plasma, albumin, reopoluglykin);
expand the operating room and prepare the patient for the operation "Caesarean section".
21. Caring for the seams in the crotch area.
Target:
exclusion of infection of the seams;
promoting better healing of sutures.
Action algorithm:
lay the puerperal on the couch, bend the legs at the knee and hip joints and spread;
wash the external genital organs and perineal tissues from top to bottom with an antiseptic solution;
dry with sterile gauze wipes;
treat the seams with a 5% solution of potassium permanganate.
22. Caring for a puerperal after a caesarean section.
Target: timely detection of postoperative complications.
Action algorithm:
monitor the restoration of respiratory function after exiting the state of anesthesia, tk. when exiting anesthesia, vomiting, aspiration of vomit and, as a result, suffocation may occur;
watch for signs of internal bleeding. possible slipping of the ligature from the vessels in the depth of the surgical wound;
monitor the temperature reaction (with an uncomplicated course, the temperature should return to normal on the 5th day);
bed rest: after 12 hours, turn on its side. A day later, you can walk. Apply to the breast of a newborn - individually (for 2-3 days);
track:
on the 1st day - only drinking;
2 days - broth;
3 days - porridge, cottage cheese;
4 days - broth, porridge, cottage cheese, crackers;
5-6 days - a common table;
for bladder function
for bowel function:
for 3-4 days to put a hypertonic enema;
on the 5th-6th day - a cleansing enema;
control dressing on the 3rd day,
on the 7th day - removed through the seam,
Gynecology
Inspection and assessment of the condition of the external genital organs.
Indications:
assessment of the condition of the external genital organs;
identification of existing pathology.
put the patient on a gynecological chair after the release of the bladder;
put on sterile gloves;
examine the external genitalia, while taking into account:
the degree and nature of the development of the hairline (according to the female or male type);
development of small and large labia;
state of the perineum (high, low, trough-shaped);
the presence of pathological processes (inflammation, tumors, ulceration, warts, fistulas, scars in the perineum after ruptures). Pay attention to the gaping of the genital slit, inviting the woman to push, to determine if there is any prolapse or prolapse of the walls of the vagina and uterus.
examine the anus in order to identify possible pathological processes (varicose nodes, fissures, condylomas, discharge of blood, pus or mucus from the rectum).
spreading the labia minora with your fingers, examine the vulva and the entrance to the vagina, taking into account:
b) the nature of the secret,
c) the state of the external opening of the urethra and the excretory ducts of the Bartholin glands,
d) the shape of the hymen or its remnants.
Study with mirrors.
The procedure for examining a woman using the Cuzco mirror
Indications:
examination of the cervix and vaginal walls;
taking swabs.
lay a lining oilcloth;
lay the woman on a chair;
put on gloves;
with the right hand, insert the folding mirror closed in a straight size to the middle of the vagina;
turn the mirror into a transverse dimension and move it to the vaults;
open the valves and examine the cervix;
removing the mirror to examine the walls of the vagina;
put the mirror in a container with a disinfectant solution.
The procedure for examining a woman with spoon-shaped mirrors
Indications:
examination of the cervix;
taking smears;
removal, insertion of the IUD;
surgical interventions.
Equipment: spoon-shaped mirrors; lift.
Action algorithm
put on gloves;
push the labia minora with the left hand;
with the right hand, gently insert the mirror with an edge along the back wall of the vagina, and then turn it across, pushing the perineum backwards to the posterior fornix;
insert the elevator with your left hand and lift the anterior wall of the vagina;
expose the cervix;
removing the mirror, examine the walls of the vagina;
place the mirror and the lift in a container with a disinfectant solution.
Methodology of bimanual research.
Preventive examinations;
Diagnosis and determination of the duration of pregnancy in the early stages;
Examination of gynecological patients.
Contraindications: menstruation, virginity.
Execution algorithm:
ask the woman to empty her bladder;
lay a lining oilcloth;
lay the woman on a chair or on a couch (at the same time, place a roller under the sacrum so that the pelvic end is raised);
treat the external genitalia only if they are significantly contaminated with blood or secretions;
put on sterile gloves;
With the index and thumb of the left hand, spread the large and small labia;
examine the vulva, the mucous membrane of the external entrance to the vagina the opening of the urethra, the excretory ducts of the Bartholin glands and the perineum;
insert the index and middle fingers of the right hand into the vagina, rest against the perineum with the back of the ring finger and little finger,
examine with fingers inserted into the vagina: the condition of the muscles of the pelvic floor, the walls and arches of the vagina, the shape and consistency of the cervix, the condition of the external pharynx (closed, open);
then transfer the fingers of the right hand to the anterior fornix of the vagina;
fingers of the left hand through the abdominal wall of the abdomen to palpate the body of the uterus. Bringing together the fingers of both hands to determine the position, shape, size,
12) then move the fingers of the investigating hands from the corners of the uterus alternately to the lateral fornix of the vagina and examine the condition of the appendages on both sides;
13) at the end of the study, feel the inner surface of the pelvic bones and measure the diagonal conjugate;
14) remove the fingers of the right hand from the vagina and pay attention to the color, smell of the discharge.
The method of taking a smear for the degree of purity.
Indications:
examination before vaginal operations;
inflammatory diseases of the genital organs;
examination of pregnant women.
Action algorithm:
lay a lining oilcloth;
lay the woman on a chair;
put on gloves;
push the labia minora with the left hand;
insert a mirror into the vagina;
take material from the posterior fornix of the vagina with a Volkmann spoon, apply a smear on a glass slide;
place the instruments in a container with a disinfectant solution.
The method of taking a smear to detect gn (gonorrhea)
diagnostics of inflammatory processes and venereal diseases;
examination of pregnant and gynecological patients.
slide.
Action algorithm:
lay the processed lining oilcloth;
put a woman on a gynecological chair;
put on gloves;
with the right hand, insert the fold mirror, closed in direct size to the middle of the vagina, then turn the mirror into a transverse size and advance to the arches, opening the valves, as a result of which the cervix is exposed and becomes available for inspection;
take the material from the cervical canal with one end of the Volkmann spoon and apply a smear on a glass slide in the form of the Latin letter C;
remove the mirror;
with the index finger of the right hand, massage the urethra through the anterior wall of the vagina;
Wipe the first drop of discharge from the urethra with a cotton ball, then take a smear from the urethra with the second end of the Volkmann spoon and apply a smear in the form of the Latin letter “U” on a glass slide;
the third smear with the second spoon of Volkmann is taken from the rectum and applied to a glass slide in the form of the Latin letter "R";
the fourth smear is taken from the lateral fornix of the vagina and applied to a glass slide in the form of the Latin letter "V";
put the instruments in a basin with a disinfectant solution.
The method of taking a smear for oncocytology.
diagnostics of precancerous and malignant processes of female genital organs;
preventive checkups.
slide.
Action algorithm:
lay a lining oilcloth;
lay the woman on a chair;
put on gloves;
with the index and thumb of the left hand, push the large and small labia;
with the right hand, insert a folding mirror, closed in a straight size, to the middle of the vagina. Next, turn the mirror into a transverse dimension and move it to the vaults, opening the valves, as a result of which the cervix is exposed and becomes available for inspection;
With one end of the Volkmann spoon, take the material by scraping from the outer surface of the cervix and apply a smear in the form of a horizontal line on a glass slide;
with the other end of the spoon, take the material from the inner wall of the cervical canal and apply a smear on a glass slide in the form of a vertical smear;
write out a referral to the laboratory, where it is necessary to note: full name, age, address, clinical preliminary diagnosis;
put the instruments in a basin with a disinfectant solution.
Instrument preparation and probing technique.
determination of the relief of the inner surface of the uterus;
measuring the length of the uterus;
determining the position of the uterus;
suspicion of a tumor in the uterine cavity;
suspicion of anomalies in the structure of the uterus;
determination of the patency of the cervical canal, atresia, stenosis;
before the expansion of the cervical canal during curettage of the uterine cavity.
acute and subacute inflammatory diseases of the uterus and appendages;
established and suspected pregnancy.
Action algorithm:
lay a sterile diaper;
put the patient on a chair;
treat the external genitalia with an antiseptic solution;
put on sterile gloves;
with the left hand, spread the labia minora;
insert spoon-shaped mirrors into the vagina;
seize the neck with bullet forceps;
gently insert the probe into the cervical canal and into the uterine cavity.
Instrument preparation and puncture technique.
Indications:
diagnosis of intra-abdominal bleeding;
suspected accumulation of inflammatory fluid in the pouch of Douglas.
spoon mirrors,
forceps,
bullet tongs,
long needle syringe
70% alcohol,
5% alcohol solution of iodine,
cotton balls, gloves.
put a sterile diaper under the buttocks;
put on gloves;
using a forceps with a solution of alcohol and iodine, treat the cervix and posterior fornix of the vagina;
fix the cervix by the back lip with bullet forceps and lift it up;
strictly along the midline 1.5-2 cm below the neck, puncture with a needle through the posterior fornix and suck out the contents;
in the presence of non-clotting blood in the syringe, the suspicion of intra-abdominal bleeding is confirmed, in the presence of an inflammatory fluid - pelvioperitonitis;
place the instruments in a basin with a disinfectant solution.
Tool kit and diagnostic technique
Indications:
diagnosis of a malignant tumor of the body of the uterus;
delay of elements of the fetal egg;
endometrial tuberculosis;
ectopic pregnancy;
menopausal bleeding;
bleeding of unknown etiology.
acute infection in the body;
temperature rise.
Action algorithm:
put the patient on a gynecological chair;
carefully treat the pubis, external genitalia, inner thighs with an antiseptic solution;
put on gloves;
apply general anesthesia: inhalation anesthesia (nitrous oxide + oxygen), intravenous anesthesia (calypsol, sombrevin);
open the vagina with spoon-shaped mirrors. First, insert the rear mirror, place it on the back wall of the vagina, lightly press on the perineum. Then, parallel to it, insert the anterior speculum (elevator) that raises the anterior wall of the vagina;
seize the cervix with bullet forceps;
probing the uterus;
to expand the cervical canal by sequentially introducing Gegar dilators up to No. 10;
curettage of the uterine cavity with a curette;
remove bullet tongs;
treat the cervix with a 5% alcohol solution of iodine;
place the resulting tissue in a glass container, pour 70% ethyl alcohol and write a referral to the histological laboratory, where it is necessary to note the full name. patient, age, address, date, presumptive clinical diagnosis;
A set of tools and techniques for cervical biopsy.
pathological processes (ulceration, tumors, etc.);
suspicious for malignancy and localized in the cervix.
spoon-shaped mirrors;
forceps;
bullet forceps;
scalpel;
needle holder;
needles;
scissors;
70% alcohol;
5% alcohol solution of iodine;
suture material (special scissors - conchotomy);
gloves.
lay the patient on a gynecological chair;
carefully treat the external genitalia, inner thighs with an antiseptic solution;
lay a sterile diaper under the buttocks;
put on gloves;
insert a spoon-shaped mirror into the vagina and place it on the back wall, slightly press on the perineum;
parallel to it, introduce a lift that raises the anterior wall of the vagina;
treat the cervix and vaginal walls with 70% ethyl alcohol and 5% alcohol solution of iodine;
put two bullet forceps on the lip of the cervix so that the area to be biopsied is located between them. Cut out a wedge-shaped piece from the suspicious area, sharpening deep into the tissue. This piece should contain not only the affected, but also part of healthy tissue (tissue for research can be obtained using special forceps-nippers - conchotomes);
put knotted sutures on the resulting tissue defect;
place the cut piece of tissue in a jar with 10% formalin solution or 70% alcohol solution; in the direction indicate full name patient, age, address, date, presumptive clinical diagnosis; send the material for histological examination;
Immerse the instruments in a basin with a disinfectant solution.
Vaginal douching technique.
Indications:
colpitis;
pathology of the cervix;
inflammatory processes of the uterus, uterine appendages and parauterine tissue.
infected wounds of the perineum, vulva, vagina;
acute inflammation of the uterus and uterine appendages.
Action algorithm:
lay a lining oilcloth;
lay the patient down, put a vessel under the pelvis;
fill Esmarch's mug with a sterile solution of a medicinal product (antiseptic, etc.) in an amount of 1-1.5 liters;
hang the mug on a tripod at a height of 1 m from the level of the couch;
put on gloves;
first, wash the external genital organs with a solution, then insert the tip along the back wall of the vagina to a depth of up to the middle of the vagina and open the faucet-clamp and douche with a stream of a solution of medicinal substances;
after the procedure, the tip is immersed in a disinfectant solution.
Technique of vaginal baths and tampons.
diseases of the vagina;
diseases of the cervix.
acute colpitis;
menstruation.
Action algorithm:
lay a lining oilcloth;
lay the woman on a gynecological chair or on a couch (at the same time, place a roller under the sacrum so that the pelvic end is raised);
put on sterile gloves;
With the index and thumb of the left hand, spread the large and small labia;
with the right hand, insert the Cusco speculum to the vaults of the vagina in a closed form, then open its flaps, pull out the neck and fix the speculum with a lock;
first remove the mucus from the cervical canal with a cotton swab moistened with a solution of sodium bicarbonate;
pour a small portion of the medicinal solution (collargol, protargol, furacillin, etc.) into the vagina and drain it. Pour the second portion in such an amount that the neck is completely immersed;
drain the solution after 10-20 minutes and insert a swab with ointment (synthomycin emulsion, prednisolone ointment, fish oil, sea buckthorn oil, etc.) until contact with the neck. The tampon is removed by the woman herself after 10-12 hours;
Immerse the instruments in a container with a disinfectant solution.
First aid for a patient with bleeding from
The reasons:
retention of elements of the fetal egg after spontaneous or induced abortion;
ovarian dysfunction;
termination of uterine pregnancy;
termination of an ectopic pregnancy;
cystic skid;
genital trauma;
breakdown of the malignant neoplasm.
put the patient to rest;
call a doctor;
lower the head end;
put cold, load on the lower abdomen;
introduce hemostatic agents;
introduce reduction funds;
prepare instruments for examining the genital organs and scraping the uterine cavity.
